Neonatal myocardial infarction due to thrombotic occlusion

Neonatal myocardial infarction is rare and its prognosis is poor. We describe the clinical course and autopsy findings of a newborn female with myocardial infarction. Her clinical course was rapidly progressive, becoming fatal before we could detect the cause. Autopsy demonstrated significant occlusion of the left coronary artery as well as evidence of new infarction, suggesting that the event occurred at birth. This case illustrates myocardial infarction as a possible cause of early neonatal death.     

Neonatal myocardial infarction due to thrombotic occlusion.

Neonatal myocardial infarction is rare and its prognosis is poor. We describe the clinical course and autopsy findings of a newborn female with myocardial infarction. Her clinical course was rapidly progressive, becoming fatal before we could detect the cause. Autopsy demonstrated significant occlusion of the left coronary artery as well as evidence of new infarction, suggesting that the event occurred at birth. This case illustrates myocardial infarction as a possible cause of early neonatal death.     

Hemolytic disease of the newborn from anti-E. A case report

Anti-E is rarely acknowledged as a cause of severe hemolytic disease of the newborn. A patient presented with a low titer (32) that increased following repeated amniocentesis, used to evaluate the fetal condition. The infant developed severe disease requiring multiple exchange transfusions but did well and was discharged in good condition.     

Intravenous Immunoglobulin therapy for anti-E hemolytic disease in the newborn

Anti-E alloimmunisation is a less common cause of haemolytic disease in the newborn (HDN) and is usually associated with mild to moderate clinical manifestations, that are often less severe than anti-D immunisation. Conventional treatments for HDN are phototherapy and exchange transfusion, the latter still representing a high-risk procedure. Currently, intravenous immunoglobulin has been used as alternative treatment for HDN to reduce the need for exchange transfusion, as well as the length of phototherapy and hospitalisation. We report a case of anti-E HDN treated successfully with intravenous immunoglobulin, as adjuvant treatment to phototherapy.     

Clinical Implications of Perinatal Depression

The evaluation of the depressed newborn as a possible role in intrapartum asphyxia must be based on the objective findings of the fetal heart rate tracing, umbilical cord blood gas, and newborn neurologic function. Using these points as a basis for long-term followup, the following principles have been elucidated: Intrapartum asphyxia is an uncommon cause of childhood neurologic disfunction, the intrapartum insult necessary to cause long-term neurologic dysfunction is profound, and the child who does not manifest encephalopathy in the newborn period will not suffer long-term neurologic dysfunction that can be attributed to intrapartum asphyxia.     

Use of lactoferrin in the newborn: where do we stand?

Sepsis and necrotizing enterocolitis (NEC) cause significant morbidity and mortality in the newborn. Their ill effects persist in spite of appropriate and effective antibiotic therapy. Lactoferrin as an adjunct to antibiotics in the treatment of sepsis or NEC in the newborn may improve the clinical outcomes by enhancing the host defense and modulating the inflammatory response. This review focuses on the various aspects of lactoferrin use in the newborn.     

Chlamydia,Group B Streptococcus,and Herpes in Pregnancy

ABSTRACT: This is a review of three sexually transmitted diseases which can affect pregnancy and the newborn. Maternal chlamydia may cause neonatal conjunctivitis and pneumonia. More severe is group B streptococcus, which can cause fatal infection in the newborn and severe perinatal infections in the mother. Primary herpes infections may result in fetal malformations, abortions, and premature labor, while neonatal herpes may cause death or severe neurologic and ocular sequelae.     

宫内窒息后新生鼠的状态与脑损伤关系的研究

目的 探讨宫内窒息后的新生鼠脑病理变化。并与生后的状况相联系。方法 制备宫内不同程度缺血缺氧（15，30，45及60min)及再灌注（缺血缺氧15min后再灌注1，4，8，15及24h)模型。观察剖宫产后新生鼠的一般状况并进行光，电镜下的脑病理观察。结果 轻度的宫内缺血缺氧可引起神经元的变化，但生后的一般状态无明显改变；严重的宫内缺血缺氧当时即可引起胎死宫内，此时神经元表现为坏死，宫内轻度窒息的新生鼠，出生时一般状态尚可，但再灌注后状态越来越差，与神经元再灌注后呈现的进行性凋亡过程相平行。结论 急性宫内缺血缺氧可以引起胎死宫内，神经元表现为坏死，在坏死之前再灌注将引起凋亡。再灌注后进行性凋亡过程是某些宫内窒息新生儿在出生后状态越来越差的主要原因。新生儿缺氧缺血性脑病的病理变化可能在宫内已经开始发生。     

Anti-D antibodies in D- and Du-positive women: a cause of hemolytic disease of the newborn

Regardless of the decrease in Rh sensitization as a cause of hemolytic disease of the newborn, antenatal antibody screening must be performed in all patients to detect not only anti-D sensitization, but other less common antibodies capable of provoking hemolytic disease of the newborn. The relative incidence of hemolytic disease of the newborn due to sensitization to such irregular antibodies as Kell, Kidd, and Duffy is increasing. We report here five patients who had D- or Du-positive blood with antenatal anti-D sensitization, and whose neonates had hemolytic disease of the newborn of varying severity. Blood that is D- and Du-positive with anti-D has been classified by Tippett; such blood types lack part of the D mosaic and are considered to be "D variants" yet are typed routinely as Rh positive. Anti-D antibody produced by D- and Du-positive blood is indistinguishable from the ordinary variety of anti-D.     

Challenges in classification and assignment of causes of stillbirths in low- and lower middle-income countries

Stillbirths account for 2.6 million deaths annually. 98% occur in low- and lower middle-income countries. Accurate classification of stillbirths in low-resource settings is challenged by poor pregnancy dating and infrequent access to electronic heart rate monitoring for both the newborn and fetus. In these settings, liveborn infants may be misclassified as stillbirths, and stillbirths may be misclassified as miscarriages. Causation is available for only 3% of stillbirths globally due to the absence of registration systems. In low-resource settings where culture and autopsy are infrequently available, clinical course is used to assign cause of stillbirth. This method may miss rare or subtle causes, as well as those with non-specific clinical presentations. Verbal autopsy is another technique for assigning cause of stillbirth when objective medical data are limited. This method requires family engagement and physician attribution of cause. As interventions to reduce stillbirths in LMICs are increasingly implemented, attention to accurate classification and assignment of causes of stillbirth are critical to charting progress.     

Sialic acid in newborn and maternal lymphocytes: preterm deliveries

Sialic acid was determined in newborn and maternal lymphocytes immediately after preterm deliveries of 34 and 35 weeks of gestation. The results were compared with those found in full-term deliveries. In contrast with full-term deliveries, in preterm deliveries a significant increase in sialic acid in maternal as compared to newborn lymphocytes was found. However, the mean cumulative value of sialic acid for maternal and newborn lymphocytes was similar in both groups. In addition to this, sialic acid concentrations seem to be sex-dependent and higher mean cumulative values for maternal and newborn lymphocytes could be found for male as compared to female newborns after full- as well as after preterm deliveries.     

Viral infections in pregnancy.

The responsibility of the physician for viral infections in pregnancy has changed dramatically in the last 15 years. Genital herpes infections have become much more frequent, and the recognition of these infections in women near term is particularly important. Cytomegaloviruses have been found to be the most commom cause of congenital infection, but no satisfactory methods are available for prevention or treatment. Varicella is now recognized as a teratogen when infection occurs in the first 4 months of pregnancy. It can also cause severe generalized disease in the newborn when infection takes place in the last few days of gestation. Hepatitis B infections are becoming more frequent in many populations, and this virus can transmit to the child, particularly when maternal infection occurs in the last trimester. Venezuelan equine encephalitis virus has been found to be a teratogen. This must be considered in southern states such as Florida and Texas, as well as in Central and South America. Rubella, fortunately appears to be coming under control with the intensive use of serodiagnosis and vaccines in the United States.     

Neonatal intussusception due to a cecal duplication cyst.

Intussusception in the first month of life is rare; however, it should be considered a distinct clinical and pathologic entity. Cecal duplication as the cause of intussusception in a neonate is extremely rare. We report a case of a newborn with ileocecocolic intussusception. She presented with vomiting and bloody stools. Abdominal sonography revealed a target lesion with a cystic component. We performed a laparotomy and found an ileocecocolic-type intussusception which was caused by a cecal duplication cyst. Right hemicolectomy with ileocolostomy was performed. She remained well at one year follow-up.     

Cecal duplication cyst: a cause of intestinal obstruction in a newborn infant

Intestinal obstruction is the most common surgical emergency in newborn infants. We report a case of cecal duplication cyst (CDC) as a cause of intestinal obstruction in a newborn infant. Prenatal ultrasonography (US) had shown an intra-abdominal cyst that was confirmed by the first postnatal US. Water-soluble contrast enema and a repeat US showed an intracecal cyst, however, the diagnosis of CDC was only established at laparotomy. CDC should be considered in the differential diagnosis of intestinal obstruction in an infant with an intra-abdominal cyst on US and a palpable right iliac fossa mass.     

Smoking during pregnancy: a significant cause of neonatal thyroid enlargement

The influence of maternal smoking during pregnancy on the function and the echographic volume of the neonatal thyroid gland was examined in an area of borderline iodine intake (median maternal urinary iodine: 315 range 79-1558 nmol/l). There was a positive correlation (P less than 0.001) between cord serum thiocyanate (SCN) concentrations used as an index of maternal smoking and the maternal smoking habits. The thyroid volume/birthweight ratio increased significantly as a function of SCN values (P less than 0.005): this increase was secondary to a decrease in birthweight as well as to an increase in thyroid volume. There was also a positive correlation between cord serum thyroglobulin (Tg) and SCN levels (P = 0.001). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) values remained within the normal range for age in all newborn infants and were not significantly correlated with SCN values. These results show that smoking during pregnancy in areas with borderline iodine intake may be a significant cause of thyroid enlargement in the newborn.     

Smoking during pregnancy: a significant cause of neonatal thyroid enlargement

Summary. The influence of maternal smoking during pregnancy on the function and the echographic volume of the neonatal thyroid gland was examined in an area of borderline iodine intake (median maternal urinary iodine: 315 range 79–1558 nmol/l). There was a positive correlation (  P<0.001  ) between cord serum thiocyanate (SCN) concentrations used as an index of maternal smoking and the maternal smoking habits. The thyroid volume/birthweight ratio increased significantly as a function of SCN values (  P<0.005  ): this increase was secondary to a decrease in birthweight as well as to an increase in thyroid volume. There was also a positive correlation between cord serum thyroglobulin (Tg) and SCN levels (  P = 0.001  ). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) values remained within the normal range for age in all newborn infants and were not significantly correlated with SCN values. These results show that smoking during pregnancy in areas with borderline iodine intake may be a significant cause of thyroid enlargement in the newborn.     

Diphenhydramine toxicity in a newborn: a case report.

Maternal drug intake before delivery may influence the clinical behavior of the newborn. The effects of anesthetic agents and narcotics may cause symptoms of depression in the infant. Infants of substance-abusing mothers may also have altered clinical states. This is a case report of a newborn, very depressed at birth, who apparently was sedated by diphenhydramine (Benadryl) ingested by the mother before delivery. The importance of complete history of drug ingestion by mother before delivery is important in evaluating the behavior of a neonate.     

The diagnosis and treatment of syphilis in women

Syphilis is a sexually transmitted diseage with a known cause and an effective cure. Unfortunately, during the past decade syphilis has resurfaced as a major public health problem. This resurgence of cases has paralleled the rise of crack cocaine abuse and the attendant risky sexual behaviors associated with drug-seeking. Syphilis, as a leading cause of genital ulcer disease, enhances human immunodeficiency virus transmissibility. Syphilis has returned to damage our most vulnerable patients, the developing fetus and newborn. The eradication of this disease awaits the solution of the stubborn social problems of ignorance, poverty, drug abuse, and prostitution.     

Serum FSH and synthetic LHRG response in pregnant women at term and in the newborn.

Serum immunoreactive FSH was undetectable in a) pregnant women past 38 weeks of gestation, b) newborn infants, and c) anencephalic infants. The intravenous administration of 100 mug of synthetic LHRH elicited no FSH release in each instance. These results seem to indicate that the absence of FSH in serum in pregnant women in the last trimester, as well as in the newborn, is due to the suppressive effect on the anterior pituitary of the increased amount of circulating sex steroids.     

Lymphocyte subpopulations in mother and newborn: correlation with sex of the newborn and number of pregnancies

T cell subsets were defined with monoclonal antibodies of the OKT series, OKT3, OKT4 and OKT8, in 23 male and 22 female newborns and in their mothers 4-10 h after delivery. The data were compared and statistically evaluated between mother and newborn, between male and female newborns as well as between parity groups. The results indicate that the distribution of OKT4 and OKT8+ cells is different in mother and newborn and a significantly increased percentage of OKT4+ cells and a significantly decreased percentage of OKT3+ cells was observed in newborns as compared to their mothers after the first and second delivery. For maternal cells from male as compared to female newborns the percentage of OKT4+ was significantly decreased after the second delivery. OKT8+ cells in the mother were significantly decreased after the second as well as after three or more deliveries of male as compared to female newborns. With increasing parity the percentage of OKT3+, OKT4+ and OKT8+ cells decreased slowly for both sexes and the difference was significant between primi- and multiparae. The present findings suggest a possible role of the newborn sex and of parity in the distribution of specific T cell subsets in mother and newborn shortly after delivery.