Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy.

Median nerve to biceps nerve transfer in the arm has been reported only in adults. The following paper reports on 10 cases of this transfer in obstetric brachial plexus palsy. All patients had upper palsy (ERb's or extended ERb's palsy) and presented to the author late (13-19 months of age) with poor or no recovery of elbow flexion. Following the nerve transfer, nine children recovered elbow flexion (a score of 6 in one child and a score of 7 in eight children by the Toronto scale). The remaining child did not recover elbow flexion.

Neonatal brucellosis and blood transfusion: case report and review of the literature.

Neonatal brucellosis following blood transfusion has not previously been reported. A premature male infant born at 24 weeks gestation developed low grade fever and decreased activity and showed poor weight gain at 45 weeks post-menstrual age. Blood culture grew Brucella melitensis and the brucella antibody titre was positive. He received a 6-week course of septrin and rifampicin and made a full recovery. The infant had received a blood transfusion 5 days prior to his illness. The blood donor had symptoms suggestive of brucellosis, and it was suspected that the blood transfusion was the source of infection but this could not be confirmed as the donor was not traceable. It is suggested that, in areas endemic for brucellosis, prospective blood donors should be questioned about symptoms of brucellosis, and serological tests to screen for brucellosis might be indicated.

Obstetric brachial plexus injury in subsequent deliveries.

It is well known that multiparas who had previously been delivered of newborns with obstetric brachial plexus palsy are at risk of having the same complication in subsequent deliveries. However, none of the studies in the literature have actually attempted to estimate how high is that risk. The aims of the current paper were to investigate obstetric brachial plexus injury in subsequent deliveries and to study other factors associated with birth palsy, perinatal morbidity, mortality, and motor recovery of the brachial plexus. We reviewed retrospectively the records of 28 consecutive multiparas who presented with their children to our brachial plexus clinic from 1994 to 1995. Eight of the 28 multiparas gave birth to one or more children after having a newborn with brachial plexus birth palsy. These 8 mothers were delivered of a total of 16 newborns with brachial plexus injury. Injury was associated with vaginal mode of delivery, gestational diabetes, instrumental deliveries, and fetal macrosomia. One neonatal death and significant perinatal morbidity were observed in the affected newborns. Seven newborns (44%) had total birth palsy and the remaining 9 had Erb's palsy. Excellent recovery of the limb occurred in only one-third of the patients. It was concluded that multiparas who had previously been delivered of large infants with brachial plexus injury are at high risk of having the same complication in subsequent deliveries and consideration may be given to delivery of subsequent macrosomic babies by cesarean section.

Erythropoietin therapy in neonates at risk of having bronchopulmonary dysplasia and requiring multiple transfusions.

OBJECTIVES: To determine whether treatment with recombinant human erythropoietin (r-HuEPO) reduces transfusion requirements in premature neonates at risk of having bronchopulmonary dysplasia and requiring multiple transfusions. STUDY DESIGN: A double-blind, randomized, controlled trial. SUBJECTS: Fifty-five infants appropriate in weight for gestational age (less than 1250 gm birth weight) who, at 10 days of age, were predicted to have a greater than 75% probability of having bronchopulmonary dysplasia. This criterion had previously been shown to identify infants requiring multiple transfusions. Twenty-seven infants were randomly assigned to receive r-HuEPO therapy and 28 to a control group. r-HuEPO was administered in a dosage of 20 U/kg body weight, subcutaneously, three times a week for 6 weeks. Control infants received sham treatment. RESULTS: Infants treated with r-HuEPO required significantly fewer transfusions than control infants during their entire hospital stay (mean 3.48 +/- 1.58 vs 5.68 +/- 2.30; p = 0.0001) and had a higher mean reticulocyte count (p < or = 0.0005) and a higher mean hemoglobin concentration (p < or = 0.005) during the treatment period. At follow-up, 4 months after term, there were no significant differences between the groups in mean reticulocyte count (p = 0.86) or mean hemoglobin concentration (p = 0.56). However, two infants in each group had low serum ferritin values indicative of depleted iron stores. CONCLUSIONS: Treatment with r-HuEPO effectively stimulated erythropoiesis in premature infants at high risk of having bronchopulmonary dysplasia and requiring multiple transfusions; the result was a reduction in transfusion requirements. This treatment, together with other strategies to reduce the need for transfusions, is appropriate in this population. Unrelated to r-HuEPO treatment, these infants may be at risk of having iron deficiency later in infancy.

Fetal rhabdomyoma. A case report with the diagnosis suggested by intraoperative cytology.

BACKGROUND: Fetal rhabdomyoma is a relatively rare tumor that occurs mainly in the head and neck of toddlers. A similar lesion can occasionally be found in the adult female genital tract. Increased cellularity may be seen in the fetal type and can lead to confusion with the well-differentiated types of rhabdomyosarcoma. CASE: An 8-day-old infant presented with a unilateral, right-sided, postauricular mass. Intraoperative cytology of the mass showed numerous cells with spindled nuclei in a background of myxoid material. A provisional diagnosis of fetal rhabdomyoma was made and subsequently confirmed by histopathologic examination. CONCLUSION: In neonates presenting with cervical swelling, the possibility of fetal rhabdomyoma should always be considered and confirmed by both intraoperative cytology and histopathologic examination of the resected tumor.

Obstetrical brachial plexus injury in newborn babies delivered by caesarean section.

The hand surgeon is frequently involved in the medicolegal assessment of birth palsy cases. Although brachial plexus injury has been reported in newborns delivered by Caesarean section, it is difficult to determine if these cases are due to excessive force when delivering the infant from the uterus or whether the palsy is related to other factors. We have studied our series of 16 cases of obstetrical brachial plexus palsy with special attention to the newborn baby delivered by Caesarean section. We have reviewed the English literature over the last decade and found that birth palsy in newborns delivered by Caesarean section is extremely rare (1% of all birth palsy cases). The differentiation between brachial plexus injury caused by forcible delivery and congenital upper limb palsy from other causes is discussed.

Determinants of term intrauterine growth retardation: the Saudi experience.

In a clinical study from an unselected Saudi obstetric population, the incidence of and risk factors for intrauterine growth retardation among live births were investigated. From a total study group of 4578 consecutive live births, 76 (1.7%) infants were found to be growth retarded. These infants were then compared with a randomly selected control group of 76 term newborns with appropriate birthweight for their gestational ages. Delivery at term of a growth-retarded infant was significantly associated with maternal age under 20 years, maternal body mass index less than 23, first degree consanguinity, poor housing, primiparity, and inadequate prenatal care in univariate analysis. When considered jointly in multivariate logistic regression analysis, the significant determinants were reduced to primiparity, first degree consanguinity, and poor housing. These risk factors correctly predicted 63% and 71% of the intrauterine growth-retarded infants or normal birthweight infants, respectively.

PIP: In Saudi Arabia, physicians compared data on 76 term intrauterine growth retardation (IUGR) infants with data on 76 randomly selected term newborns of appropriate birth weight to study the determinants of term IUGR. The term IUGR rate was 1.7% (76/4578 consecutive live births). The univariate analysis found significant risk factors to be a maternal age of less than 20 years (odds ratio [OR] = 4.89), a maternal body mass index of less than 23 (OR = 2.86), first degree consanguinity (OR = 3.1), living in a mud house (OR = 5.10), primiparity (OR = 3), and inadequate prenatal care (OR = 2.86). A stepwise multiple logistic regression model revealed that the significant risk factors of term IUGR included primiparity (OR = 3.3), first degree consanguinity (OR = 3.4), and living in a mud house (OR = 7.5). These three risk factors correctly predicted 63% and 71% of the IUGR and normal-birth-weight infants, respectively. These findings suggest that health care providers may be able to identify pregnancies at risk of IUGR and can thus prevent and manage IUGR births.