Skull subcutaneous emphysema--a rare complication of vacuum extraction and scalp electrode.

A full-term newborn infant with severe subcutaneous emphysema of the skull as a complication of vacuum extraction and scalp electrode wound is reported. We hypothesize that detachment of subcutaneous tissue and transmission of the negative pressure associated with the vacuum extraction resulted in entry of air through the scalp electrode wound.

Anuria in a premature infant due to ureteropelvic fungal bezoars.

Systemic candidiasis with renal involvement is a well recognised complication of intensive care in premature newborns. However, the development of reversible obstructive oliguric acute renal failure has not been well documented. We report a premature infant who developed anuria associated with bilateral candidal bezoar formation in the renal collecting system. The sonographic appearance of the renal fungus balls is described. Treatment by surgical removal of the bezoars, open placement of nephrostomy tubes and intravenous antifungal therapy resulted in apparent complete recovery.

Determination of amniotic fluid microviscosity at body temperature: a predictor of fetal lung maturity.

One of the most convenient ways to determine fetal lung maturity is by measuring the fluorescence polarization (P) of the amniotic fluid at room temperature. With sensitivity fixed on 100%, specificity is relatively unsatisfactory. The present study compared the predictive power of fluorescence polarization measured at temperatures 25C (P25), 37C (P37), and 40C (P40) among 195 consecutive samples tested at both 25C and 37C, with a subgroup of 86 samples tested also at 40C. A better separation between the results for fetuses with and without hyaline membrane disease is attained at P37, demonstrated by a greater mean standardized distance (distance between P values for those patients with and the mean P value for those patients without hyaline membrane disease in unit of standard deviation of the latter; 1.597 +/- 0.528 for P25 versus 2.332 +/- 0.591 for P37). Fixing the sensitivity at 100%, the specificity of P25 and P37, were 68.9 and 94.9%, respectively; a highly significant difference (P less than .001). The specificity of P40 was 90.5%, lower than that of P37. P37 is the best predictor and adding either P25 or P40 does not improve the prediction of lung maturity. It is concluded that P37 should replace P25 as the definite index for fetal lung maturity.

Familial persistent pulmonary hypertension.

We report three siblings who presented with a clinical picture of persistent pulmonary hypertension of newborn and died between 4 and 15 days of age. Pulmonary artery pressure in all was above systemic values, with a right to left shunt via either the foramen ovale or ductus arteriosus, or both. Histology of the pulmonary vascular bed showed extension of muscle into small arteries which are normally non-muscular.

Adherence of Candida albicans to buccal epithelial cells of neonates.

Adherence of Candida albicans to buccal epithelial cells of newborn infants was studied by the visual adherence method. Forty-five samples of buccal epithelial cells were obtained from 21 normal newborns at different times following delivery. In group 1 (mean age 7.5 hr) 367 +/- 51 yeast cells adhered to 100 epithelial cells. In group 2 (mean age 2.3 days) 384 +/- 36 yeast cells adhered to 100 cells. In group 3 (mean age 6.2 days) 488 +/- 57 yeast cells adhered to 100 cells. Differences among the groups were not significant (p greater than 0.1). A significant difference was found in the percentage of epithelial cells binding 10 yeast cells between group 1 (7.25 +/- 0.9) and group 3 (14.9 +/- 2.5), and group 2 (8.0 +/- 2.0) and group 3 (p less than or equal to 0.025). In 12 infants studied twice at mean age of 2.1 and 6.3 days (included in groups 2 and 3) a significant increase was found in the number of adherent yeasts binding to 100 epithelial cells (330 +/- 87 and 485 +/- 52 respectively) (p less than or equal to 0.03), and in the percentage of epithelial cells binding greater than or equal to 10 yeast cells (5.0 +/- 3.0 and 14.7 +/- 3.5 respectively, p less than or equal to 0.004) for each infant. The age-related increased affinity of buccal epithelial cells to Candida albicans may have relevance in the development of oral thrush.

Determination of fetal lung maturity from amniotic fluid microviscosity in high-risk pregnancy.

During a 3-year period, 377 samples of amniotic fluid, free of blood and meconium and obtained from a total of 471 patients, were examined by the fluorescence polarization technique to estimate fetal lung maturity. Fluorescence polarization values of 287 samples from normal and abnormal pregnancies were correlated with gestational age. A total of 272 pregnancies comprising cases complicated by toxemia, placental insufficiency, placenta previa, premature contractions, and diabetes mellitus, and including a control group of 37, were studied to discern the effect of such pathologic conditions on the usual decline of fluorescence polarization (FP) values with increasing gestational age. No complicated pregnancy had values significantly different from those of the control group, except for pregnancies complicated by diabetes mellitus. The threshold of fetal lung maturity as related to respiratory distress syndrome (RDS) was determined in correlation with the lecithin: sphingomyelin (L:S) ratio. FP values of 0.311 +/- .005 corresponded to an L:S ratio of 2.0. An FP value of 0.316 +/- .005 is recommended as a practical threshold related to the clinical outcome of the newborn as regards RDS. The technique was found reliable, simple, and accurate and has been of great value in the antenatal diagnosis of fetal lung maturity.

The prenatal ultrasonic diagnosis of urethral obstruction and diverticulum of the urinary bladder.

In a 28 year old gravida 2 para 1 an ultrasonogram at 35 weeks of gestation revealed a huge cystic abdominal tumor in fetus. Postpartum ultrasound, excretory urography and micturating cystourethrography showed a trabeculated bladder with a large diverticulum and hydronephrosis due to a posterior urethral valve. The prenatal diagnosis of this anomaly and immediate surgical intervention prevented additional severe damage in the newborn.

Pyloric channel duplication in a newborn infant.

This is the first reported case of pyloric channel duplication demonstrated preoperatively by endoscopy and contrast radiography. Endoscopically, the lesion resembled a mucosal flap overlying the pyloric orifice. On radiography the lesion presented as a polypoidal filling defect in the duodenal bulb. The infant had, in addition, postduplication stress ulcer.

Neonatal hypernatremic dehydration due to excessively concentrated prepared milk formula.

Excessively concentrated milk formula was administered accidentally to five newborn infants. Diarrhea, dehydration, hypernatremia, and hyperosmolality were present in all of them. Abnormal neurologic manifestations during the acute disease were observed in one infant. On follow-up, psychomotor development and electroencephalographic recordings were normal in four infants. One infant, in whom accelerated growth of head circumference had been noted before the episode of diarrhea, was found to have obstruction of the foramen of Monro at the age of 6 weeks. Possible errors in preparing milk formulas by medical staffing resulting in hypertonic dehydration are stressed in this report.

Hypovolemic shock at birth due to extensive fetomaternal hemorrhage.

Three cases are described in which fetomaternal hemorrhage caused hypovolemic shock at birth. The etiology was confirmed by a postpartum maternal smear which showed approximately 15% of fetal red cells in the maternal circulation. All infants had severe anemia with hematocrit values of from 11 to 15%. Initial resuscitative measures included cardiac massage and artificial ventilation. Plasma expanders were given in order to restore the effective circulatory volume. Repeated blood transfusions resulted in an increase of blood pressure to normal range in all patients. One infant survived without neurological sequelae. The other two infants died following irreversible hypoxic injuries to vital organs. Early recognition of perinatal posthemorrhagic shock is crucial for recovery, and whole blood and plasma expander transfusions should be used immediately. Early assisted ventilation, administration of type O- whole blood and the autotransfusion of fetal blood are suggested for restoring the effective circulatory volume.

Plasma testosterone and beta HCG levels in the first twenty-four hours of life in neonates with cryptorchidism.

We determined serum concentrations of beta HCG and testosterone by specific radioimmunoassays in eight cryptorchid and 13 normal newborns in the first 24 h of life. Mean serum beta HCG concentration in the cryptorchid infants (18.9 +/- 9.7 miu/ml) did not differ significantly from the control group (26.7 +/- 7.6 miu/ml). Mean serum testosterone level in the cryptorchid newborns (271 +/- 27 ng/dl) also did not differ significantly from the control group (333 +/- 30 ng/dl). These data suggest beta HCG and testosterone concentrations on the first day of life are of the same magnitude in normal and cryptorchid infants.