Placental pathology is not predictive for sudden infant death syndrome (SIDS).

A previous report has suggested an increased incidence of chorioamnionitis in the placentae of sudden infant death syndrome (SIDS) victims. To further evaluate placental pathology in SIDS, 27 cases were identified from coroner's records and matched to two control groups. Both control groups were matched for birthweight, gestational age, and season, with the second also matched for maternal race, infant sex, blood type B, and maternal parity. No significant increase in chorioamnionitis or other placental abnormalities were found in SIDS victims when controlling for prematurity, which is a factor related to chorioamnionitis. An increased incidence of vaginal bleeding (P less than 0.04) and possibly substance abuse or anemia at delivery was found in SIDS mothers. There were more premature and black infants found in the SIDS group compared with the general birth population, and also lower five-minute Apgar scores (P less than 0.02) compared to matched controls. Analysis of the second control group match, including infant Apgar scores, maternal hematocrit, maternal age, and complications of pregnancy and delivery, did not influence any of our conclusions. The data suggests that matching for prematurity may be important in identifying the strength of additional risk factors for SIDS, since the risk factors for SIDS and premature delivery are similar.

Idiosyncratic reactions to phenytoin.

We present a detailed case report of an idiosyncratic reaction to phenytoin and review the manifestations in 16 additional pediatric patients (2.5-21 years of age) described in the literature. These cases illustrate the frequency of fever (82%), rash (94%), lymphadenopathy (94%), hepatitis (94%), and eosinophilia (76%). This constellation of signs and symptoms will frequently mimic common pediatric illnesses so the pediatrician responsible for the care of the seizure patient being treated with phenytoin should be aware of the possibility of an idiosyncratic reaction. Delay in discontinuation of the drug may be life-threatening.

Sudden infant death syndrome in infants evaluated by apnea programs in California.

Home apnea/bradycardia monitoring is frequently used in the management of infants at increased risk for sudden infant death syndrome (SIDS). However, some infants have died despite evaluation by infant apnea programs, and the benefits of home monitoring remain unproven. To determine the SIDS rate and risk factors of infants evaluated by infant apnea programs, 31 apnea programs and ten home monitor vendors in California were surveyed. Eleven (35%) of the apnea programs and four (40%) of the vendors responded. Information was obtained on 26 infants who died. Thirteen (50%) deaths were due to SIDS. Abnormal sleep studies did not predict death. Fifteen infants died despite a recommendation for home monitoring. Seven deaths occurred in association with technical errors or noncompliance with monitoring. Four deaths were due to nonaccidental trauma. The apnea programs evaluated 3,406 infants during a 5-year period; 1,841 had monitoring recommended. Term infants with apnea, subsequent siblings of SIDS victims, and infants evaluated at referral centers were more likely to have monitoring recommended than premature infants with apnea or infants evaluated at nonreferral centers (P less than .0001). Infants who had monitoring recommended were at equal risk of dying of SIDS as those who did not.

A case report of lingual lymphangioma presenting as recurrent massive tongue enlargement.

Lymphangiomas are benign congenital tumors that frequently result in macroglossia. Tongue involvement may lead to airway obstruction, swallowing difficulties, mandible-dental deformities, and speech disturbances. This case report demonstrates the many difficulties in diagnosis and management. Reduction in tongue size with preservation of motor and sensory function is best accomplished by wedge resection of the tip of the tongue.