Misshapen heads in babies: position or pathology?

A newborn's skull is highly malleable and rapidly expanding. As a result, any restrictive or constrictive forces applied to a baby's head can result in dramatic distortions. These changes can be mild, reversible deformations or severe, irreversible malformations that can result in brain injury. This paper reviews the anatomy and physiology of normal and abnormal brain and skull growth, the etiology of cranial deformation, the types of craniosynostosis most commonly seen in infants, and the importance of early diagnosis and treatment.

Aberrant retropharyngeal internal carotid artery in a child with spondyloepimetaphyseal dysplasia and cleft palate.

In a patient with spondyloepimetaphyseal dysplasia and cleft palate, the course of the internal carotid artery was aberrant. Prompt identification of this anomaly is critical, because operative fatality can occur if the defect is unrecognized. This case illustrates the occurrence of this vascular anomaly and focuses on options for radiologic identification and evaluation of the defect.

The role of the pediatrician in the promotion of cardiovascular health.

The subspecialist has been historically on the forefront of diagnosis and management of cardiovascular disease in our society. Recently, however, we have seen the focus shifting from high technology to include primary care and prevention. Cardiovascular risk evaluation has been identified as the thrust of the 1990s, and there is a reemergence of the generalist as a potential leader in cardiovascular care. It is now recognized that efforts early in life to promote cardiovascular health may have dramatic impact beyond the pediatric age. Five major areas are identified as targets for cardiovascular health promotion in childhood: obesity, cardiovascular fitness, hypertension, hypercholesterolemia, and smoking prevention. Pediatricians, as well as family physicians, must recognize their critical role in the promotion of cardiovascular health. The focus should not be limited to traditional childhood diseases but also to adult diseases that have their origins in childhood. Appreciation of the scientific findings generated by studies such as the Bogalusa Heart Study should influence the pediatrician in assuming a major role in prevention of adult heart and other chronic diseases.

Evaluation of a commercially available latex agglutination test for rapid diagnosis of group B streptococcal infection.

We studied the clinical value of Wellcogen, a latex particle agglutination test designed to diagnose rapidly Group B streptococcal infections in 620 infants. The sensitivity and specificity were 18 of 20 (90%) and 18 of 22 (81%), respectively. False negatives were documented in 2 patients and false positive tests occurred in 4. Also 10 of 620 (1.6%) infants had detectable antigen in the absence of proved infection. In addition, in 4 other infants with Group B streptococcal bacteremia, antigenemia was absent in serum obtained on the day of hospitalization but antigen was detected in specimens obtained subsequently. We also assayed the sera of 102 randomly chosen hospitalized adults; 4 (4%) contained "antigen" but none had Group B streptococcal infection. None of 50 urines obtained from other randomly chosen hospitalized adults contained "antigen." In patients with Group B streptococcal meningitis cerebrospinal fluid and unconcentrated urine uniformly contained antigen but in bacteremia without focality, assay of blood and urine were both necessary to diagnose correctly all 7 patients with the Wellcogen test. We conclude that despite acceptable sensitivity and specificity, the interpretation of the Wellcogen test must be performed with caution and knowledge of its limitations.