Lower limb standards in newborns

To define standards for lower limb measurements in the newborn, 198 full-term and preterm infants (range, 27 to 41 gestational weeks) were examined. The gestational age was determined chronologically and clinically, and the total length of the lower limb and the leg and foot lengths were measured by two observers with the use of standard measurement techniques. Normal values were determined by plotting the mean +/- 2 SDs for each gestational week v gestational age.     

Neonatal polycythemia: I. Early diagnosis and incidence relating to time of sampling

The dynamic changes occurring in hematocrit and blood viscosity within the first 18 hours of life were studied in 50 full-term infants who were vaginally delivered and had weight appropriate for gestational age. In all cases, the cord was clamped within 30 seconds and cord blood was collected from the vein and artery. Subsequently, samples were taken from a peripheral vein at ages 15 minutes, and 2, 4, 6, and between 12 to 18 hours. Both the Hct and blood viscosity reach their peak at age 2 hours. The incidence of neonatal polycythemia varied greatly with age. Thus at the age of 2 hours, ten infants (20%) were polycythemic, whereas by age 6 hours only six (12%) of these infants were still polycythemic and by age 12 to 18 hours only one infant (2%) was polycythemic. A linear correlation was found between cord Hct levels and peripheral venous Hct levels by age 2 hours. None of the infants with cord blood Hct levels less than or equal to 56% had developed polycythemia, whereas ten of the 12 infants with cord Hct levels greater than 56% developed polycythemia. In this particular group of infants, cord blood Hct levels may be used for the screening of neonatal polycythemia.     

Failure of left ventricular hypertrophy to regress after surgery for aortic valve stenosis

BACKGROUND: Regression of left ventricular (LV) hypertrophy usually follows surgery for aortic stenosis (AS); however, a significant number of ventricles remain hypertrophied. The extent of this phenomenon, the reasons for failure to regress, and its significance are unclear. METHODS: We investigated 43 patients before and after aortic valve surgery and divided them into two groups: 30 patients with regression of LV hypertrophy (Group A) and 13 patients without regression (Group B). Preoperative echocardiographic measurements, clinical status, and operative factors were compared between the two groups. The patients were followed up for 42 +/- 22 months for the occurrence of hospitalization for congestive heart failure (CHF) or death. RESULTS: Preoperatively, the two groups were similar except for an excess of patients in New York Heart Association (NYHA) functional Class IV and a greater incidence of old myocardial infarcts in Group B. Postoperatively, Group B patients had larger LVs with decreased systolic function. This was associated with a poor prognosis (23% mortality and 38% CHF vs 0% and 4% for Group A patients, P = 0.0002). Cox regression analysis showed previous myocardial infarction (P < 0.001) and percent mass reduction (P = 0.019) to be independent predictors of CHF or death. CONCLUSIONS: Successful regression of LV mass is difficult to predict before surgery; however, its absence is related strongly to a poor long-term prognosis.