Fatal neonatal stroke from a prenatal cardiac thrombus.

Despite careful investigation, the etiology of many perinatal arterial strokes is unknown. We report on a 5-day-old boy with a cardiac thrombus of prenatal origin resulting in a fatal postnatal stroke. The thrombus was discovered only at autopsy, challenging the assumption of a placental source of embolus in perinatal strokes in the absence of macroscopic and microscopic examination of the heart.

Normal fetus with a twin presenting as both a complete hydatidiform mole and placenta previa.

BACKGROUND: A twin gestation comprising a complete hydatidiform mole and a coexisting normal fetus is a rare and high-risk condition. Only a few such gestations have resulted in live infants. We report a case with a very large molar component presenting as a placenta previa. CASE: A live infant was delivered by cesarean at 31 weeks of gestation. The delivery incorporated prophylactic temporary balloon occlusion of the internal iliac arteries. The patient did not develop persistent gestational trophoblastic disease. CONCLUSION: We recommend that intra-arterial balloon catheters be considered before cesarean delivery in cases of complete hydatidiform mole with a coexisting normal fetus if the molar pregnancy presents as a previa. The size of the molar gestation is not an independent risk factor for persistent or metastatic disease.

Sudden and unexpected fetal death associated with agenesis of the arcuate nucleus in the medulla oblongata.

Abnormalities have been reported in the medullary arcuate nucleus (ARCN) in unexpected late fetal death. They speculated that this developmental anomaly may underlie cardioventilatory abnormalities intrapartum and postpartum. This article describes a case of an unexpected late fetal death associated with absence of the ARCN.

A comparison of apparent life-threatening events before and after the back to sleep campaign.

OBJECTIVES: The incidence of the Sudden Infant Death Syndrome (SIDS) has decreased significantly in the United States since the 1992 recommendation that healthy term infants be placed on their backs or sides during sleep. However, little is known regarding the effect that this recommendation has had on the incidence and epidemiology of apparent life-threatening events (ALTEs) in this country. METHODS: To examine this, we completed a retrospective chart review study of all infants admitted to the Children's Hospital of Wisconsin with the diagnosis of an ALTE during two study periods before and after the back to sleep initiative: January 1, 1991 to December 31, 1992 and January 1, 1996 to December 31, 1997. RESULTS: There were 81 ALTEs in 1991-1992 vs. 102 in 1996-1997. Infants in both groups were similar with respect to gender, race, and age, with approximately 80% in each group < 4 months of age. ALTEs occurred equally throughout the year during both time periods. The majority of episodes occurred during sleep; 74% of the 1991-1992 cohort and 59% of the 1996-1997 infants did not have information in the medical record describing their position during the ALTE. Three infants (2 during 1991-1992) died during the hospitalization and were subsequently diagnosed with SIDS or probable SIDS.