[Prenatal steroids, cesarean section, and cerebral hemorrhage in newborns with birth weight under 1500 g]. / Steroidi prenatali, parto cesareo ed emorragia cerebrale nel neonato con peso alla nascita inferiore a 1500 g.

OBJECTIVE: To identify perinatal risk and protective factors for peri-intraventricular hemorrhage (PIVH) in 214 very low birth weight (VLBW) infants. METHOD: Perinatal risk and protective factors for PIVH were examined by univariate analysis and by multivariate logistic regression analysis that adjusted simultaneously for the effects of year of birth and perinatal characteristics. Because mode of delivery and antenatal use of steroid represent the only factors, among those considered, that could in most cases be controlled by the clinician, we calculated for each of the four combinations the relative risk of PIVH. RESULTS: By univariate analysis, antenatal steroid administration, cesarean section delivery, increasing birth weight and increasing gestational age were protective perinatal factors. By using logistic regression, significant protective factors against PIVH included a complete course of antenatal steroid therapy and increasing gestational age. Intrauterine growth retardation was associated with an increased risk of PIVH. The relative risk of intraventricular hemorrhage for each of the four combination of mode of delivery and antenatal steroid exposure demonstrate that antenatal steroid exposure and cesarean section delivery are most protective with a relative risk of 14% compared with vaginal delivery and no antenatal steroid exposure. CONCLUSIONS: Association of antenatal steroid administration with cesarean section delivery has an important role in lowering the risk of PIVH in VLBW infants.

Hemimegalencephaly associated with somatic hemihypertrophy and a malformation of the feet: case report.

Hemimegalencephaly (HME) is a rare neuronal migration anomaly, rarely associated with hemihypertrophy or some other somatic malformation; it can coexist with intracranial arteriovenous shunts which cause cardiac failure. We report a rare case associated with hemihypertrophy of the face, trunk and limbs and malformation of the feet. The neuroradiological findings are underlined and the differential diagnoses discussed.

Neonatal spinal muscular atrophy with diaphragmatic paralysis is unlinked to 5q11.2-q13.

Two sibs affected by the severe neonatal form of spinal muscular atrophy (SMA) with diaphragmatic paralysis are described. The two sibs were discordant for the haplotypes determined by DNA markers flanking the SMA locus. This supports non-linkage of SMA to chromosome 5 in this family and indicates that the uncommon SMA type I variant associated with early onset respiratory failure maps outside the 5q11.2-q13.3 region.

Postnatal ultrasound screening of urinary malformations.

We performed routine neonatal ultrasound screening on 3,454 neonates in the first week of life to establish the real incidence of congenital uropathy. Pronounced anomalies were found in 36 cases (1.04%) and mild renal pelvis dilatation in 159 (4.60%). In the population study prenatal ultrasonography showed evidence of severe anomalies in only 7 fetuses (0.2%). Surgical correction was required in 14 cases. Our results indicate that neonatal ultrasound screening has sufficient sensitivity and specificity for the early detection of the vast majority of urinary tract malformations. In 2 cases mild vesicoureteral reflux was not detected until a urinary tract infection was noted. Thus, neonatal sonography appears to be of limited value in detecting mild reflux.

Supplementation of an adapted formula with bovine lactoferrin. 2. Effects on serum iron, ferritin and zinc levels.

Breast milk provides an excellent supply of most nutrients for newborn infants. Infant formulae should be nutritionally comparable to breast milk especially with regard to critical nutrients like iron and other trace elements. Infant formulae supplemented with various amounts of bovine lactoferrin were given to two groups of infants. These infants were compared with infants receiving unsupplemented formula and breast-fed infants. The effects of these diets on levels of haemoglobin, haematocrit, serum iron, ferritin and zinc were examined for a study period of 150 days. At birth, concentrations of iron, haemoglobin, haematocrit and zinc were comparable in all four feeding groups. The fact that the serum zinc level was not altered by lactoferrin supplementation appears to rule out an in-vivo effect of lactoferrin on zinc nutrition of infants. Ferritin levels of breast-fed infants were significantly higher than in non-supplemented formula-fed infants at day 30 and day 90. This difference was seen only at day 30, when comparing breast-fed infants to lactoferrin-supplemented formula-fed infants. Comparing the infants receiving formulae, the formula supplemented with the higher amount of bovine lactoferrin induced significantly higher serum ferritin levels compared to the unsupplemented formula at day 90 and day 150. These observations favour the idea that lactoferrin may be involved in iron absorption. Since this effect was pronounced only after 90 days, it has to be discussed as to whether this effect is a convincing argument for supplementing infant formulae with bovine lactoferrin.

Conservative management of urinary abnormalities detected in utero.

During a 5-year period, we observed 48 fetuses with urinary malformations diagnosed by antenatal sonography. Postnatal investigations confirmed the presence of a urinary tract anomaly in 44 of the 48 fetuses selected by prenatal ultrasound (91%). Accurate antenatal diagnosis was made in 35 of the 48 cases (73%). In 9 fetuses renal disease was detected, but its specific nature was not in accordance with the prenatal diagnosis. In our series the most common anomaly was hydronephrosis secondary to ureteropelvic junction obstruction. This condition was observed in 31 of the 44 patients (70.4%); 7 of the newborns who showed an obstructive pattern were submitted to early surgical repair, while the remaining 24 cases and 1 renal unit of the group undergoing early surgical repair were relegated to expectant observation, with periodic clinical and laboratory controls. A spontaneous recovery was observed in 12 cases; the dilatation remained unchanged in 10 cases, while 3 patients showed a progressive worsening of the condition which led to a surgical correction. Our findings agree with those in recent reports in providing little support for early, indiscriminate surgical repair. Moreover, our experience confirms the possibility of a spontaneous recovery in newborns with hydronephrosis and draws attention to the benefit of a conservative management in properly selected patients.

Neonatal periventricular leukomalacia: diagnosis and evolution evaluated by real-time ultrasound.

Recent advances in imaging techniques have provided the opportunity to obtain prompt diagnosis and to study the natural evolution of periventricular leukomalacia (PVL). Three premature neonates were followed up by brain sonograms from birth to six, four and three months of age, respectively. Sequential ultrasound examinations confirmed previous observations which identified four stages of PVL; 1. increased echogenicity in the periventricular white matter, 2. apparent normalization, 3. cystic cavitation, 4. resolution of cysts and development of ventriculomegaly. Decreased perfusion of the periventricular end-arterial zone is responsible for the development of PVL; this selective hypoperfusion has been documented in infants with a significant history of cardiorespiratory disturbances and group-B streptococcal sepsis. Two of our patients and other cases described in the literature, however, did not exhibit these clinical features. The present study suggests the involvement of chronic hypoxia and toxic insults in the pathogenesis of this condition and confirms the value and accuracy of sequential sonography in the diagnosis of PVL.

Criteria for discontinuing neonatal seizure therapy: a long-term appraisal.

In order to evaluate the criteria for discontinuing neonatal anticonvulsant treatment, 55 newborns with seizures have been studied. Clinical and EEG serial examinations were performed: soon after the first seizure, throughout the hospital course, and during the follow-up every 3 months until a year, and every 6 months later on. Anticonvulsant treatment with phenobarbital was discontinued (at 4 days-19 months; mean 104 days) on the basis of the following variables: type and number of seizures, time taken for their control, type and persistence of EEG abnormalities, initial neurological features, and seizure etiology. At the follow-up (12 months-8 years; mean 36 months) only 4 children had relapsed, 3 of them with a single short seizure without EEG abnormalities. The results obtained by means of the correlation between the length of anticonvulsant treatment and the clinical and EEG variables provide evidence of the value of the criteria employed. Of these, the duration of persistence of EEG abnormalities was the most important for planning the maintenance of anticonvulsant treatment and its discontinuation.

[Adrenal hemorrhage in the newborn. Diagnostic problems and presentation of a case]. / L'emorragia surrenale nel neonato. Problemi diagnostici e presentazione di un caso.

Adrenal haemorrhage is not an exceptional event in the newborn. The probable predisposing factors are difficult delivery, fetal hypoxia, trombocytopenia and coagulation defects. The recommended therapeutical approach is conservative, even if some Authors prefer surgical evacuation of the haematoma. This report was prompted by our recent experience of a case of unilateral adrenal haemorrhage in a newborn. The methods useful in the diagnosis are thoroughly evaluated and discussed with special emphasis on echography which holds an important position in the early diagnosis of this condition.

Suprarenal abscess in a newborn.

A case report of a new born with unilateral suprarenal abscess extending in to the right kidney is represented. Both the adrenal gland and the kidney had to be surgically removed. Early diagnosis is important, so the surgical intervention, the only successful therapy, can be kept as conservative as possible.