Unexplained neonatal jaundice as an early diagnostic sign of septicemia in the newborn

This prospective study was performed to determine the frequency of unexplained unconjugated hyperbilirubinemia associated with bacterial infection during the first week of life. Of 5805 infants delivered between September 1984 and December 1986, 93 jaundiced newborns without evidence of septicemia fulfilled the following criteria to be enrolled in the study: weight greater than 2500 g, gestational age greater than 38 weeks, age less than 7 days, and unexplained unconjugated bilirubin greater than 170 mumol/L (greater than 10 mg/dL) during the first 48 hours of life and/or greater than 255 mumol/L (greater than 15 mg/dL) thereafter. Evaluation for septicemia included blood and urine cultures, and white cell and thrombocyte counts. The study disclosed three (3.2%) infants who developed septicemia before any clinical suspicion had been aroused. It is concluded that bacterial infections should be considered a possible cause of neonatal unconjugated hyperbilirubinemia during the first week of life, regardless of the clinical condition of the infant.     

Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years' Experience

IntroductionThe Israeli Defense Forces Medical Corps (IDF-MC) implemented the use of low-titer group O whole blood (LTOWB) as the first-choice resuscitation fluid in the IDF airborne Combat Search and Rescue Unit (IDF-CSAR) for aerial evacuation of both military and civilian casualties in June 2018 for injured patients with hemorrhagic shock and at least one of the following: systolic blood pressure <90 mm Hg, heart rate >130 beats/min, deterioration of consciousness without head injury or hemoglobin concentration ≤7 g/dL.MethodAll casualties treated with LTOWB by IDF-CSAR providers from June 2018 to January 2021 were included. Demographic and prehospital treatment data were collected in order to check compliance and adherence to the IDF-MC guidelines. This is a follow-up retrospective report.ResultsOverall, 1,608 LTOWB units were supplied to the IDF-CSAR during the study period. Of these, 33 were transfused to 27 casualties; 17 (69%) with blunt injury, 8 (29.6%) with penetrating injuries, and 1 (3.7%) with gastrointestinal bleeding without trauma. The leading cause of injury was motor vehicle accidents. A total of 23 casualties received 1 unit of LTOWB, 3 received 2 units and 1 patient received 4 units. Two casualties were children. The median heart rate was 120 beats/min, 8 (29.6%) casualties had heart rates >130 beats/min. Median systolic blood pressure was 95 mm Hg, 7 (26%) casualties had blood pressure <90 mm Hg. The median Glasgow Coma Score was 14. No adverse reactions were documented following the administration of LTOWB. 77.8% of patients received LTOWB in adherence to the guidelines.ConclusionAppropriate administration of LTOWB has improved over time in IDF-CSAR. Using LTOWB is feasible and simpler than administering packed red blood cells and plasma concurrently. Further efforts are needed to introduce LTOWB in other prehospital and in-hospital scenarios, with an increase in the maximum antibody titer threshold, to meet the expected increase in demand.     

Critical analysis of risk factors for shoulder dystocia

Objective  

The study was aimed to define trends, risk factors and perinatal outcome associated with shoulder dystocia (SD).     

Reduced fetal movement: factors affecting maternal perception

Objective: Evaluate physiologic factors associated with reduced maternal perception of fetal movements (RFM).

Methods: A historical cohort study of all women (years 2011–2013, n?=?399) that visited the maternal emergency room (ER) (gestational age 24?+?0–42?+?0) due to RFM (group A), that was compared to a control group consisted from women with normal perception of fetal movements (group B). Groups were compared for maternal characteristics (age, gravity, parity, BMI), gestational age, placental location, gestational age at birth and fetal outcomes (birth-weight and Apgar scores).

Results: In a multivariate regression analysis, including maternal age, height, weight, BMI, gestational age on admission to ER, gravity, parity and placental location, only two variables remained significantly associated with RFM – nulliparity (OR?=?2.28, p?=?0.001) and anterior placenta (OR?=?1.44, p?=?0.034). Group A was not associated with lower Apgar scores (1 and 5-min, p?=?0.40 and 0.57, respectively) or low birth-weight (p?=?0.76), nor was it associated with prematurity (p?=?0.41), low (<7) 5-min Apgar score, fetal death or neonatal death.

Conclusions: Reduced fetal movements are associated with anterior placenta and nulliparity.     

Factitious lymphedema of the hand: a diagnostic challenge

A case of factitious lymphedema of the hand is presented. Attention is drawn to this entity and its differential diagnosis. Delayed detection in our case resulted in prolonged and costly hospitalization with some loss of hand function. Treatment should be left to those skilled in psychotherapy.     

Mapping of the human body skin with the transcutaneous oxygen pressure method

Transcutaneous oxygen pressure (TcPO2) measurements are studied to determine whether location, side of body, sex, and age affect the values at 23 different sites. Measurements were taken on 19 healthy volunteers on one side or the other of the body. Values were similar at all sites with the exception of the forehead, cheek, medial aspect of the leg, and the scapular region. There was no difference between sides of the body or between younger and older subjects. Women had significantly higher values. The results are discussed, and it is concluded that most skin regions can serve as controls for areas under investigation.     

A simple clinical test for differentiating physiological from pathological head lag in full-term newborn infants

This prospective study was designed to assess the value of a simple clinical test, a “feeding test”, on the outcome of head lag among term neonates. Of 5718 infants who were examined before their morning meal, 67 had moderate to severe head lag in the absence of predisposing risk factors for head lag. Fifteen minutes following feeding, 62 infants (92%) showed an improvement in or disappearance of head lag with concomitant rise in serum glucose. All of these infants had normal psychomotor development on follow up. In 4 infants in whom no improvement occurred after feeding, an underlying pathological cause for head lag was subsequently diagnosed. Conclusion Use of the feeding test as a screening procedure in apparently healthy newborns with head lag may rule out pathological conditions in over 90% of the cases. Received: 18 February 1997 and in revised form: 30 September 1997 / Accepted: 2 October 1997