Intracranial hemorrhage in low-birth-weight twins during neonatal period

Since twins have a higher incidence of premature birth, fetal distress, asphyxia and other pre- and intrapartum high-risk factors, it is reasonable to expect that they may be vulnerable to intracranial hemorrhage. Forty-seven pairs of low-birth-weight twins were studied during the newborn period by serial cranial ultrasound. The comparisons of groups, based on birth order, relative size of the neonates, and the mode of delivery, showed no significant differences in the incidence of intracranial hemorrhage between first and second twins, smaller and larger twins, or vaginal and cesarean delivery. However, the comparison based on the presentation of the infant revealed a significantly higher number of intracranial hemorrhages within the first week of life in the breech group than in the cephalic presentation group. The adverse effect of breech presentation on intracranial hemorrhage did not appear to be mediated by the well recognized risk factors such as lower gestational age, lower Apgar scores, and higher incidence of respiratory distress syndrome and assisted ventilation. Since most of the twins with ICH had breech presentation and were delivered by cesarean section, this mode of delivery does not seem to protect the twins with breech presentation from intracranial hemorrhage.     

Low-density lipoprotein profile changes during the neonatal period.

OBJECTIVE: To investigate natural change of low-density lipoprotein (LDL) profile during the neonatal period and the impact of gestational age and birth weight on those changes. STUDY DESIGN: We measured lipid composition in LDL fraction, LDL particle size and apolipoprotein B (apoB) concentration at birth, 5 days of age and 1 month of age in 63 healthy neonates that had 37 to 41-week gestational age. RESULT: Low-density lipoprotein cholesterol and apoB concentrations increased from birth to 5 days of age, and the concentration persisted at 1 month in breast-fed and mixed-fed infants. However, in formula-fed infants, the concentration decreased at 1 month. At 5 days of age, neonates had larger and more triglyceride (TG)-rich LDL particles than at birth. At 1 month of age, LDL particles were smaller and more cholesterol rich than at 5 days of age. Single regression analyses showed that gestational age had influenced the LDL profile at birth and 5 days of age, while at 1 month milk determined the profile. CONCLUSION: The number of LDL particles increased rapidly during the first 5 days of life, and the composition of LDL particles is modulated by TG content throughout the neonatal period. Gestational age and milk, rather than birth weight, determine postnatal changes in LDL profile.     

The use of antiviral drugs during the neonatal period

Parenteral therapy of viral infections of the newborn and infant began with vidarabine (adenine arabinoside) for the treatment of neonatal herpes simplex virus (HSV) infections in the early 1980s. Acyclovir has become the treatment of choice for neonatal HSV infections and a variety of other herpesvirus infections. Ganciclovir is beneficial for the treatment of congenital cytomegalovirus (CMV) infections involving the central nervous system (CNS). This article reviews the use of acyclovir and ganciclovir in the treatment of neonatal HSV and congenital CMV infections. A brief summary precedes a detailed discussion of available established and alternative therapeutics.     

The use and misuse of oxygen during the neonatal period

This article describes aerobic metabolism, oxygen free radicals, antioxidant defenses, oxidative stress, inflammatory response and redox signaling, the fetal to neonatal transition, arterial oxygen saturation, oxygen administration in the delivery room, oxygen during neonatal care in the NICU, evolving oxygen needs in the first few weeks of life, and complications that can occur when infants go home from the hospital on oxygen.     

Update on the management of hepatitis B and C infections in the neonatal period

Hepatitis B virus and hepatitis C virus have received a significant amount of attention in recent years, and both viruses share a significant amount of similarities with one another beyond just that they both primarily target the liver. In recent years, cases of both infections have been fueled by a nationwide epidemic of injection drug use. Most relevant to this audience, they are both transmitted from mother to child. The increased cases in young adults combined with mother to child transmission translate into more exposed infants that will need to be managed and followed. Screening of pregnant women for hepatitis B infection coupled with appropriate treatment and prophylaxis measures are incredibly effective to preventing transmission. Prevention of hepatitis C infection is not yet possible, but advances in antiviral therapy make interruption of transmission a future possibility.     

Factors identified during the neonatal period associated with risk of cerebral palsy

OBJECTIVE: To identify factors during the neonatal period that are associated with the subsequent development of cerebral palsy (CP). DESIGN: Case-control study. SETTING: Ten hospitals in Victoria, Australia. SAMPLE: Cases were babies with moderate or severe CP identified from the Victorian Cerebral Palsy Register. Controls were matched with cases for year of birth, plurality, sex, birthweight, gestation and hospital of birth. METHODS: A range of neonatal variables was compared between cases and controls, initially in a univariate analysis and subsequently in a logistic regression. The analysis was matched where possible. Where missing data prevented a matched analysis, an adjusted unmatched analysis was performed. MAIN OUTCOME MEASURES: Those neonatal factors making an independent contribution to the risk of CP in both term and preterm infants. RESULTS: Among babies born at term, 73% of cases and 2% of controls were identified by at least one of the following factors: seizures, congenital abnormalities of the brain and elsewhere, 'other lesions', abnormal muscle tone and meconium aspiration. Among babies born preterm, 68% of cases and 26% of controls were identified by the following factors: seizures, intraventricular haemorrhage, periventricular leukomalacia, 'other lesions' and abnormal muscle tone. CONCLUSIONS: The neonatal factors which best identify neonates who will subsequently develop CP are different for term and preterm babies. Babies born at term are identified more efficiently than those born preterm. Among term babies especially, some of these factors are clearly of a long-standing nature and are not associated with delivery.     

Fetal and neonatal varicella-zoster infections

Maternal varicella during pregnancy may have a variety of effects on the fetus and newborn infant. Infection early in pregnancy may result in fetal malformations. Zoster early in life appears to be a sequela of maternal infection at any period during pregnancy. Infants may escape disease, may have mild varicella, or fatal illness following maternal varicella just prior to delivery. The outcome appears to be related to the onset of maternal and newborn illness relative to delivery. A variety of management options are available to the physician. Choices will be dictated by weighing the risks of VZV infection in a particular situation with the risks and benefits of other proposed intervention. In many cases, recommendations must be made on the basis of very limited data. It is hoped that additional information will lead to a more rational approach to VZV infection of the fetus and newborn.     

Changing sonographic features of fetal ovarian cysts during pregnancy and the neonatal period

We present a case in which serial sonographic examinations revealed changing pattern of cystic ovarian masses from hypoechogenic to echogenic appearance. These changes were attributed to suspected torsion of ovarian cyst. Nevertheless, a healthy baby girl was born without clinical and sonographic evidence of ovarian torsion. Received: October 1998 / Accepted: 12 January 1999     

Relationship between brainstem auditory function during the neonatal period and depressed Apgar score

Objective.?To understand whether infants with depressed Apgar scores are at high risk of brainstem auditory impairment, we examined the relationship between brainstem auditory function during the neonatal period and depressed Apgar score.

Methods.?Brainstem auditory evoked responses (BAERs) were recorded from day 1 to day 30 in 145 term infants with Apgar scores?≤?6.

Results.?For 1-min Apgar score none of BAER response wave latencies and interpeak intervals during the first 15 days correlated significantly with the score. On day 30, all wave latencies but no intervals correlated negatively with the score (all p?<?0.05). For 5-min Apgar score, only on day 3 wave V latency and I–V and III–V intervals correlated negatively with the score (all p?<?0.05). For 10-min Apgar score, only III–V interval correlated negatively with the score (p?<?0.05). No correlation was found between BAER variables on any other days and 5 and 10-min Apgar scores. Wave V latency and I–V and III–V intervals on day 3 were all significantly longer in infants with 5-min Apgar scores?≤?6 than in those with scores?>?6.

Conclusions.?During the neonatal period, only on day 3 after birth a depressed 5-min Apgar score is an indicator associated with central auditory impairment. A depressed 1-min score may be associated with later peripheral auditory impairment.     

Dealing with pandemic influenza A during postpartum and early neonatal period in a busy family-centered neonatal intensive care unit

Although most infections with the current pandemic H1N1 virus have been self-limited, the risk of influenza complications is higher in some subpopulations. Pregnant women had an increased risk of influenza complications in two past epidemics (1918–1919 and 1957–1958). Since neonates do not have a well-developed immune system, they are also vulnerable to viral infections and its complications. This article reports the interventions and health care planning strategies for pandemic influenza A, and its seasonal results in a tertiary perinatal care center with annually 20,000 deliveries.     

Venous thromboembolism in the neonatal period

Thromboembolism occurs more frequently in newborns than in older infants or children. The developing hemostasis system of neonates has decreased concentrations of procoagulant proteins and the naturally occurring anticoagulants and hemostatic control proteins. Overall, neonatal hemostasis provides protection from excessive bleeding at the expense of an increased risk for thromboembolism. Intensive medical care for premature and ill infants often requires central vascular assess, and the most frequent risk factor for thromboembolism is the presence of an indwelling vascular catheter. Management of venous thromboembolism in the newborn period varies depending on the location and extent of the thrombus as well as the risk for acute embolic complications and later vascular compromise. Therapeutic decisions are guided by practitioners' past experience, published case reports and case series, several large registries, and extrapolation from results of clinical trials in adults with thromboembolic disease. Valuable consensus guidelines have been compiled by the AACP Conference on Antithrombotic and Thrombolytic Therapy. Heparin, either unfractionated or a low molecular weight preparation, is the most commonly utilized anticoagulant to treat thromboembolism in newborn infants. Thrombolytic therapy may be considered if the thrombus is life or limb threatening and there is no hemorrhagic contraindication. Multicenter, prospective, controlled clinical trials in this important patient population are needed to provide evidence-based data to better inform optimal management.     

Gastrointestinal perforations in the neonatal period

Forty-eight neonates were treated for gastrointestinal perforation during a 9-year period. In 30, perforation occurred within the first week of life. Thirty-six were preterm infants and many had a history of obstetric and postnatal complications. Perforation resulted from necrotizing enterocolitis in 26 patients, whereas in 14 neonates spontaneous perforation occurred in an apparently normal bowel, with no evident cause (idiopathic perforation). In 6 patients perforation was associated with meconium ileus. Primary closure was carried out for perforations of the duodenum and stomach. Intestinal perforations were usually treated by resection and enterostomies. The overall mortality rate in this series was 46%. The highest mortality rate was associated with necrotizing enterocolitis (62%). The mortality rate was only 14% in patients with idiopathic perforation. Despite improvement in the prognosis of neonatal gastrointestinal perforations in recent years, it is still discouraging, reflecting the difficulty in preventing and treating necrotizing enterocolitis.