Giant hemangioma of the placenta as a cause of life-threatening anemia in the newborn infant with hydrops congenitum

A premature infant (33.-34. gestational week) delivered by caesarean section suffered from congenital hydrops and severe anaemia (7,2 g/dl) with pronounced marks of erythroblastosis; its placenta contained a haemangioma of 750 gs. A gigant haemangioma is extremely rare and can lead to a characteristic symptom complex endangering the life of mother and foetus.     

Catecholamine surge and lung function after delivery.

Lung function was measured at 30 minutes and again at 2 hours after birth in 12 infants delivered vaginally, in 15 infants delivered by elective caesarean section under general anaesthesia (GA), and in 15 delivered under epidural anesthesia (EDA). Umbilical arterial blood was analysed for pH and for concentrations of catecholamines and cortisol. No important differences in gestational age, birthweight, Apgar scores, or haematocrit were found among the three groups. Tidal volume and minute ventilation measured 30 minutes after birth were lower in infants delivered by caesarean section than in those delivered vaginally and at 2 hours the tidal volume was still lower in the babies delivered by caesarean section than in those delivered vaginally. Dynamic compliance was lower at 30 minutes in the group that had a caesarean section than in the vaginal group, and this difference was significant at two hours. Tidal volume, minute ventilation, and dynamic compliance in the GA and EDA groups did not differ. The catecholamine and cortisol concentrations at birth were higher in the vaginal group than in the group delivered by caesarean section. Two hours after birth there was a significant correlation (r = 0.84) between the catecholamine concentrations of the infants born vaginally and lung compliance. The lower dynamic lung compliance in infants delivered by elective caesarean section might be explained by delayed absorption of liquid in the lung due to lack of catecholamine surge.     

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

This study was carried out to assess the feasibility of late cord clamping of 45 s in preterm infants delivered mainly by caesarean section and the effects on post-partal adaptation and anaemia of prematurity. Prior to delivery, 40 infants of <33 gestational weeks were randomised to either 20 s or 45 s of late cord clamping. After the first shoulder was delivered, oxytocin was given intravenously to the mother in order to enhance placento-fetal transfusion while the infant was held below the level of the placenta. The 20 infants in group 1 (20 s) had a mean birth weight of 1070 g and a mean gestational age of 29 + 4/7 weeks versus 1190 g and 30 weeks in group 2 (45 s). On day 42 of life there were ten infants without transfusions in group 2 versus three in group 1 (P < 0.05). Out of the 20 infants in group 1, 19 and 15/19 in group 2 were delivered by caesarean section. There were no significant differences in Apgar scores, temperature on admission, heart rate, blood pressure and requirements for artificial ventilation. Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life. Received: 10 February 2000 / Accepted: 12 April 2000     

剖宫产儿早期潮气呼吸肺功能的研究

目的：研究剖宫产儿早期潮气呼吸肺功能各项指标的特点。探讨剖宫产对新生儿早期肺功能的影响。方法：研究对象分两组:剖宫产组42例,阴道分娩组33例;采用潮气呼吸法测定两组新生儿1h内潮气呼吸肺功能的各项指标。主要参数:每分通气量(MV),呼吸频率(RR),潮气量(VT/kg),吸气时间(TI),呼气时间(TE),吸呼比(TI/TE),达峰时间(TPEF),达峰时间比(TPEF/TE),达峰容积(VPEF),达峰容积比(VPEF/VE),潮气呼吸呼气峰流速(PTEF),25%,50%,75%潮气量时呼气流速(TEF25%,TEF50%,TEF75%)。同时描绘出流速容量环(TFVcurve)。结果：剖宫产组MV为1.16±0.31L/min,VT/kg4.81±1.05mL/kg较阴道分娩组1.34±0.33L/min,5.55±1.24mL/kg明显缩小(P<0.05)。PTEF为69.40±21.96mL/s,TEF25%为62.17±20.62mL/s较阴道分娩儿59.03±15.23mL/s,51.52±13.83mL/s明显增快(P<0.05)。反映气道阻塞的指标:TPEF/TE和VPEF/VE分别为(66.08±11.51)%和(62.19±8.69)%高于经阴道分娩组(60.36±9.70)%和(55.75±7.28)%(P<0.05)。而RR,TI,TE,TI/TE,TEF50%,TEF75%两组无显著差异(P>0.05)。流速容量环:两组新生儿流速容量环呈较狭长的不规则椭圆型,呼气流速峰值延迟出现,剖宫产组的流速容量环窄于经阴道分娩儿,呼气流速峰值高于阴道分娩组。结论：剖宫产儿1h内潮气呼吸肺功能显示潮气量、每分通气量小于经阴道分娩儿,剖宫产儿较阴道分娩儿在1h内限制性通气功能障碍更明显,大气道的阻塞亦更明显。     

Factors associated with maternal choice to provide breast milk for low birthweight infants.

Factors associated with maternal choice to provide milk for premature infants were investigated in 925 mother/infant pairs in five hospitals. A well educated, married, primiparous mother aged 20 or over who delivered a baby boy by caesarean section was nearly 1000 times more likely to choose to express her milk than a mother who was poorly educated, single, multiparous, and aged under 20, delivering a female infant vaginally. Evidence from the five centres suggested that hospital staff have little influence on a mother''s choice of feeding method. The major differences between the populations of babies whose mothers do or do not choose to provide milk, raise important issues concerning the interpretation of data from non-randomised clinical trials of feeding premature infants.     

Increasing ambient operating theatre temperature and wrapping in polyethylene improves admission temperature in premature infants

Aim:   To improve admission temperatures of preterm infants ≤31 weeks gestation by increasing the ambient temperature in the operating theatre and wrapping in polyethylene wrap at caesarean section.
Methods:   A review of admission temperature of infants with gestational age ≤31 weeks from January 2000 to July 2002 was performed. Between October 2002 and 2003 the ambient operating theatre temperature was increased to 26–28°C for deliveries ≤27 weeks gestation and to 25°C for deliveries ≥28 weeks gestation. From September 2004 to December 2005 the ambient theatre temperature was increased along with wrapping infants in polyethylene. A clinical audit cycle review of admission temperatures and early morbidity and mortality was undertaken.
Results:   156 premature infants were included, 42 <28 weeks and 114 28–31 weeks gestation. The mean admission temperature in <28 weeks infants prior to intervention was 35.3°C, after increasing ambient theatre temperature 35.9°C, and after increasing ambient temperature and using polyethylene wrap 37.0°C ( P  < 0.0001). For infants 28–31 weeks the mean admission temperatures in the three epochs were 36.3°C, 36.5°C and 36.6°C, respectively ( P  = 0.002). There was no statistically significant difference in: total days of ventilation or oxygen, definite necrotising enterocolitis, intraventricular haemorrhage grade 3 or 4 or survival.
Conclusions:   Increasing the ambient temperature in the operating theatre and wrapping premature infants in polyethylene wrap improves admission temperature. Further studies are required to determine whether these interventions are associated with improved outcome in the premature neonate.     

An outbreak of hepatitis A in a day-care center: Immunoprophylaxis with human immunoglobulin

Abstract Background : An outbreak of seven cases of hepatitis A (HA) occurred in a day-care center. Five of the cases were children attending the center, one was a nurse and one was the mother of a child. It is probable that the first case with HA was a male child infected by an unknown source.
Methods and Results: Human immunoglobulin (HIG) was administered to both children and staff at the center following which there were no new cases of infection among in-center contacts. However, a new case of HA among household contacts developed 3 weeks following the treatment of in-center contacts.
Conclusions : The outbreak may have been prevented if the sibling (case 2) of the source case of infection (case 1) had been given HIG as soon as infection had been confirmed. Additionally, the data suggest that HIG for prevention of HA should be given not only to children but also to their parents.     

When does mother to child transmission of hepatitis C virus occur?

OBJECTIVE: To investigate when hepatitis C virus (HCV) infection from mother to child occurs, and evaluate possible associated factors. DESIGN: Prospective cohort study. PATIENTS: Fifty four HCV infected children tested within three days of birth and their mothers. MAIN OUTCOME MEASURES: HCV RNA polymerase chain reaction (PCR) results. RESULTS: Seventeen of the children (31%, 95% confidence interval 19% to 46%) were positive in the first 3 days of life and could be assumed to have acquired infection in utero. Testing PCR positive was not associated with sex (53% v 49% boys; p=0.77) or mode of delivery (29% elective caesarean section in both groups; p=0.98). Children with evidence of intrauterine infection were significantly more likely to be of lower birth weight and infected with genotype 1 (58% v 12%, p=0.01). Although a higher proportion of infants born to HCV/HIV co-infected women were PCR positive in the first 3 days of life, this difference did not reach statistical significance; excluding infants born to co-infected women did not affect the results. Thirty seven of the children (68%) were negative in the first 3 days of life, 27 of whom were positive when tested again at 3 months, and nine were first PCR positive after 3 months (one child had no further tests). CONCLUSIONS: These results suggest that at least one third and up to a half of infected children acquired infection in utero. Although postpartum transmission cannot be excluded, these data suggest that it is rare. The role of HCV genotypes in the timing and mechanism of infection should be explored further.     

Region of birth, income and breastfeeding in a Swedish county

Aim:  To study the relationship between maternal region of birth, disposable income and breastfeeding initiation and duration.
Methods:  The study population consisted of 12 197 term born, singleton infants, born 1997–2001 in the county of Uppsala. Data on breastfeeding at 1 week, 6 months and 12 months were collected from the register of statistics of the Child Health Care Unit in Uppsala and socioeconomic indicators from Swedish national registers. Multivariate analysis was conducted using Cox regression.
Results:  No influence of disposable income or region of birth on breastfeeding initiation was observed. Breastfeeding rates at 6 months were lower for mothers with disposable incomes in quartile 1–3 compared with mothers with the highest incomes in quartile 4 (hazard ratios (HRs) 0.88–0.90, adjusted HRs 0.92). The breastfeeding rates at 12 months were higher for mothers born in all regions compared with mothers born in Sweden (HRs 1.25–2.45, adjusted HRs 1.20–2.14).
Conclusions:  The findings in the present study show that disposable income is a strong predictor for breastfeeding at 6 months in the Swedish context. Region of birth of the mother predicted long term breastfeeding, ≥12 months. This calls for professionals in the maternity and child health care to pay extra attention to breastfeeding in low-income mothers in all ethnic groups.     

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目的探讨亲代出生体重对子代出生体重的影响及母亲宫内发育不良的经历是否会影响子代宫内发育状况,为研究环境和遗传因素对出生体重的影响提供线索。方法首都儿科研究所采用回顾性队列研究,于1995~2001年以1948~1954年北京协和医院出生的“宫内发育与成人疾病”队列人群为基础,利用研究对象的出生记录和回顾性问卷调查资料,分析出生体重在亲代与子代之间的关联。结果在控制了母亲的产次、生育年龄以及配偶的身高体重等影响因素后,母亲的出生体重与其子代出生体重之间存在显著的正相关关系(r=0·38,P<0·001),而父亲与子代之间在出生指标尚未表现出相关性;母亲为低出生体重(出生体重<2500g),其子代中低出生体重发生的危险是对照组(亲代出生体重≥3500g)的3倍多。结论母亲与子代在出生体重上存在明显正相关,母亲低出生体重可能会增加子代发生低出生体重的危险。     

Prenatally diagnosed fetal hydrothorax

A predominantly unilateral hydrothorax in an unborn child was diagnosed by sonography during the 34th gestational week. Because of a pathologic cardiotocogram it was necessary to make a primary caesarean section one day later. The premature baby was intubated immediately and the pleural discharge was removed. Later developmental of the child was uneventful. The hydrothorax was interpreted as a partial factor of a hydrops fetalis. Controlling the fetal pleural discharge by ultrasound examination and regular cardiotocogram a caesarean section should be done between the 34th and 36th week of pregnancy.     

Is elective caesarian section really essential for prevention of mother to child transmission of HIV in the era of antiretroviral therapy and abstinence of breast feeding?

AIM: To determine whether vaginal delivery along with antiretroviral therapy and avoidance of breast feeding is safe in preventing mother to child transmission (MTCT) of HIV. SETTING: Pediatric & Perinatal HIV clinic, B.J. Wadia Hospital for children, Mumbai. STUDY DESIGN: Retrospective analysis. METHODS AND MATERIALS: 222 HIV-infected pregnant women were treated with zidovudine from 14 weeks of gestation onwards. 174 women underwent an elective caesarian section whereas 48 women delivered spontaneously vaginally. All infants were treated with zidovudine for 6 weeks and breast feeding was withheld. The HIV status of infants was determined at 18 months by ELISA test. RESULTS: Of the 174 infants delivered through LSCS delivery, two were HIV infected whereas 172 (98.9%) were HIV uninfected. Of the 48 infants delivered vaginally, 47 (97.9%) were HIV negative and one child was HIV infected. Thus, elective caesarean section was not statistically better as compared to vaginal delivery (p = 0.8696) suggesting that vaginal delivery was as effective as caesarean section for prevention of MTCT of HIV when added with antiretroviral therapy and no breast feeding. CONCLUSION: Vaginal delivery along with antiretroviral therapy in mother and baby and avoidance of breast feeding is equivalent to that of an elective LSCS delivery for prevention of mother-to-child transmission of HIV. Surgical intervention may thus not be required in these women.     

Perinatal risk factors for early childhood onset type 1 diabetes in Austria – a population-based study (1989–2005)

Background:  To investigate the rapid increase in incidence of type 1 diabetes mellitus (T1DM) in children <5 yr in Austria.
Methods:  Data of children born between 1989 and 2005 (n = 444) from the T1DM children incidence registry were linked with birth certificates (n = 1 407 829).
Results:  Age of mother, level of education, birth weight, birth length, body mass index, and APGAR score at 10 min were not significant. Boys have about 25% higher risk than girls [hazard ratio = 0.75, 95% confidence interval (CI): 0.62–0.91]. The risk of developing diabetes increases over time significantly (1989–1991 vs. 2001–2005, hazard ratio = 2.86, 95% CI: 2.07–3.94). The linear effect of parity is borderline significant (p = 0.045), with lower risks for second and later born siblings. Marital status is significant [hazard ratio = 0.73, 95% CI: 0.57–0.90)]. Native-born children exhibit twice as high risk as non-native children (hazard ratio = 0.51, 95% CI: 0.37–0.71). Birth weight shows a positive but not significant effect on risk of T1DM.
Conclusions:  In this very young and rapidly increasing cohort of diabetic children <5 yr of age, no association with birth weight but with year of birth, gestational age, nationality and parity could be observed.     

Hepatitis A seroprevalence and demographics in Turkish children in Ankara

Background:  Hepatitis A virus (HAV) is the most common cause of hepatitis in childhood and an important public health problem. The objective of the present study was to determine the seroprevalence of hepatitis A and patient demographics in children between 1 and 15 years old who were admitted to a pediatric outpatient clinic in Ankara, Turkey.
Methods:  Hepatitis IgM and G antibodies were determined in the sera of children who attended the outpatient clinic. Informed consent was obtained from all subjects or their parents.
Results:  The mean age of the children ( n  = 335) was 7.9 ± 2.1 years; 47.5% of them were girls. The overall anti-HAV IgG prevalence in children aged 1–15 years was 47.2%. The positivity of hepatitis A IgM was highest in the 6–10 years age group (22.7%; P  < 0.001). HAV IgG was highest in the 11–15 years age group (69.4%; P  < 0.001). A total of 95.6% of the children had social insurance, 49.3% were living in poverty. The socioeconomic level of 82.4% of subjects was low. The history of hepatitis in their families was 6.9%.
Conclusions:  Hepatitis A is intermediate endemic in Ankara and children must be vaccinated before school age, in addition to health education and improved sanitation.     

Gestational diabetes and offspring body disproportion

Aim:  It has been demonstrated that females born large for gestational age (LGA) in weight but not length are at increased risk of being obese at childbearing age. We addressed the question whether women with gestational diabetes mellitus (GDM) are at increased risk of giving birth to such infants.
Methods:  Birth characteristics of 884 267 infants of non-diabetic mothers and 7817 of mothers with GDM were analysed. LGA was defined as birth weight or birth length >2 standard deviation scores for gestational age. Multiple logistic regression analysis was performed.
Results:  The odds ratio (OR) for a woman with GDM to give birth to an LGA infant that was heavy alone was four times increased (OR: 3.71, 95% CI: 3.41–4.04). Furthermore, in the population of mothers giving birth to LGA infants, the proportion heavy alone was 68% in the group of women with GDM compared with 64.4% in the group of non-diabetic women. The risks were independent of gender of the foetus.
Conclusion:  Women with GDM have an almost four times higher risk of delivering an LGA infant that is heavy alone. The noted disproportion between weight and length in infants of such mothers may have an impact on the risk of later obesity.     

Longitudinal correlates of the persistence of irregular eating from age 5 to 14 years

Aim:  To report the stability of parent-perceived child irregular eating from 6 months to 14 years of age and to investigate a predictive model inclusive of child and parent factors.
Methods:  Of the 7223 singleton children in a birth cohort, 5122 children were re-interviewed at 5 years and 4554 for the 14-year analysis. Information was obtained from structured interviews including questions answered by parents of the child at birth, 6 months, 5 years and 14 years; and by teenagers at age 14 years and from physical measures of the child. The mother's perception that the child was an irregular eater at age 14 years was the major outcome variable of interest.
Results:  Approximately 40% of irregular eaters at age 5 will still be irregular eaters at age 14 years. This was not related to maternal education or socio-economic class. Significant at multivariate analysis were infant feeding problems and the children's ability to regulate their sleep and mood. Significant maternal factors were greater age, not feeling positive about the baby and persistent maternal anxiety during the child's early years.
Conclusion:  Irregular eating behaviour displays considerable continuity from childhood to mid-adolescence. Independent contributions to this behavioural phenotype include child biological and psychological factors and maternal anxiety during the child's early years.     

External cephalic version at term

About 3 - 4 % of all pregnancies reach term with a foetus in the breech presentation. Because of higher risk of complications for mother and foetus during the vaginal breech birth, only 50% of patients try to deliver vaginally - at the end 40 - 70% of labours are finished by caesarean section. In other cases planned caesarean sections are performed, and finally 10 - 20% of patients with breech presentation at term deliver vaginally. Prenatal mortality and serious complications after breech vaginal birth are 5% and after planned caesarean section 1.6%. This is the reason why the caesarean section is chosen as a final way of delivery with breech presentation. At present, after a period of increasing percentage of caesarean section one can observe a tendency to decrease this number. One of the procedures performed to decrease the number of complications and cost of perinatal management is external cephalic version (ECV). An indication to ECV is breech presentation at term, while there is no contraindication to ECV. Multiple pregnancy, significant third - trimester bleeding, uteroplacental insufficiency, IUGR, oligohydramnion, PROM, PIH, nonreassuring foetal monitoring patterns and all contraindications to vaginal birth are concerned to execute ECV. The real number of patients with breech presentation at term, after ECV, is according to the literature about 1 - 1.5%. The risk of serious complications during ECV, which are the indications for urgent caesarean section, is 1 - 3%. The risk of intrauterine death of foetus after ECV is about 0.0001%. According to the literature it appears that ECV at term seems to be useful and it is safe both for the mother and the foetus and helps to avoid a significant number of caesarean sections.     

Glucose metabolism soon after birth in very premature infants with small- and appropriate-for-gestational-age birth weights

The intrauterine environment affects the development of insulin resistance in adulthood. To determine the influence of foetal growth restriction on glucose metabolism, we assessed indices of insulin sensitivity soon after birth in very premature infants. Blood samples were collected at birth from 52 premature infants with a gestational age of ≤31 weeks, who were divided into a group whose birth weight was small for their gestational age (SGA group, n=19) and a group whose birth weight was appropriate for their gestational age (AGA group, n=33). Blood glucose, serum insulin and C-peptide immunoreactivity (CPR) levels were measured in both groups. Furthermore, the quantitative insulin check index (QUICKI) was also calculated. Correlations between these indices and glucose metabolism and the standard deviation (SD) score for birth weight were also determined. The levels of insulin and CPR were significantly (p<0.05) lower in the SGA group than in the AGA group. The QUICKI was significantly (p<0.05) higher in the SGA group compared with the AGA group. The SD score for birth weight was correlated with the QUICKI (p<0.01), the serum insulin level (p<0.05) and the CPR level (p<0.05) in all 52 infants. Conclusion: In very premature infants, poor foetal growth may impair foetal insulin secretion and affect the QUICKI at birth.     

Is intrauterine growth retardation a risk factor for child abuse?

A case-control study was conducted to determine whether infants with intrauterine growth retardation are at an increased risk of child abuse. Case children were those who had been born at Yale-New Haven Hospital and were reported to the hospital's child abuse committee because they had been physically abused. For each case, one control child was chosen from the hospital's log of births and matched to the case child by age, gender, race of the mother, method of payment for the hospitalization, and the provider of the child's health care at the time of birth. Infants were defined as having intrauterine growth retardation if they had either a ponderal index or a birth weight that was less than the tenth percentile for gestational age using the Kansas City or Denver growth standards. We identified 117 case-control pairs that met those criteria. The matched odds ratios for each of the four definitions of intrauterine growth retardation were less than one, indicating that infants with intrauterine growth retardation are at a decreased risk of abuse. The matched odds ratio for a low ponderal index according to the Kansas City standard was 0.4 (95% confidence interval 0.19, 0.83). This result was not affected by such possible confounding factors as the mother's age. We conclude that infants with intrauterine growth retardation are not at an increased risk and may be at a decreased risk of physical abuse.