Transitory evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) outcomes from a three-stage newborn hearing screening protocol.

OBJECTIVE: Comparison of the efficacy of Transitory Evoked Otoacoustic Emissions (TEOAEs) and Distortion Product Otoacoustic Emissions (DPOAEs) in a neonatal hearing screening protocol, based on a three-stage strategy. METHODS: In the first stage, a hearing screening using both evoked emissions was conducted in 3,480 neonates from March 2006 through January 2012. Both TEOAEs and DPOAEs were recorded. Neonates, who did not undergo the test before being discharged, were examined within 30 days at a scheduled appointment. Follow-up of the referred newborns (second-stage screening) was performed as an outpatient re-screening, within a month. The third-stage evaluation, i.e., the diagnostic testing, included a clinical otolaryngological examination, high-frequency tympanometry at 1,000 Hz and Auditory Brainstem Response (ABR) measurements. RESULTS: A total of 3,480 (97%) newborns (n =1,765 males) out of 3,595 infants were enrolled in the study. In the first-stage evaluation, 8.9 % of the infants were referred according to TEOAEs, while the percentage of the referred infants for DPΟΑΕs was 25.7 %. At this initial assessment stage, the specificity of TEOAES and DPOAEs were determined as 92% and 75%, while positive predictive values (PPV) were 3.8 % and 1.3 %, respectively. In the second stage of evaluation, the specificity of TEOAES and DPOAEs were 86 % and 76 %, while the PPV increased to 18 % and 15 %, respectively. CONCLUSIONS: With a lower follow-up rate, TEOAEs testing was significantly easier to perform and more reliable compared to the DPOAEs test. Hippokratia 2016, 20(2): 104-109.

A Chryseobacterium meningosepticum colonization outbreak in a neonatal intensive care unit.

PURPOSE: To report the epidemiologic, bacteriologic, and clinical features of a Chryseobacterium meningosepticum outbreak in a neonatal intensive care unit (NICU) of a referral teaching hospital. PATIENTS AND METHODS: From April to October 2002, a strain of C. meningosepticum was isolated from four neonates in the NICU. All neonates were colonized in the endotracheal tubes and respiratory secretions, but none of them progressed to clinical infection. Multiple samples were obtained for cultures. RESULTS: Pulsed-field gel electrophoresis (PFGE) of isolates showed them to be representatives of a single strain. Environmental surveillance did not reveal the C. meningosepticum source. None of the neonates received specific treatment. The outbreak was only controlled by reinforcement of the usual measures and no additional colonization/infection was confirmed for more than a year after the last case. CONCLUSION: This study suggests that C. meningosepticum colonization in neonates does not necessarily lead to infection and that such colonization outbreaks may be controlled with emphasis on the standard precautions.

Parental reports of emotional and behavioural difficulties on the SDQ for school-age children with vertically acquired HIV infection living in London.

This study uses a screening questionnaire (the Strengths and Difficulties Questionnaire, SDQ) to indicate levels of parental or carer concern about behavioural or emotional difficulties in a representative group of school-age children with vertically acquired HIV attending London clinics. Fourteen per cent of the total 107 children screened were reported to have behavioural and emotional difficulties scoring in the "abnormal" range. Older children tended to have higher scores. Overall, levels of reported difficulties were found to be similar to those reported for other chronic childhood illnesses and slightly higher than in the general child population.

Spontaneous intestinal perforation in a full-term infant: association with infection.

The term spontaneous intestinal perforation suggests a perforation in the gastrointestinal tract of a newborn of no demonstrable cause. Only a few cases have been described in full-term newborns. The aetiology and pathogenesis of the disease are unknown although multiple theories have been proposed. Some authors suggest ischemia as the most likely cause. Conditions associated with fetal or neonatal hypoxia are important antecedents for this emerging distinct entity. We present a case of a spontaneous, intestinal perforation in a full-term neonate with urinary tract infection. There was no clinical evidence of necrotizing enterocolitis or bowel obstruction. Radiological images revealed a pneumoperitoneum. An emergency explorative laparotomy was performed. A localized linear perforation was identified in the transverse colon. Pathological examination of the resected specimens failed to reveal any etiology for the perforation. The neonate recovered rapidly, with no gastrointestinal complications. In our case none of the factors which have previously been associated with intestinal perforation could be implicated. We suggest that focal intestinal perforation is possibly the result of infection. Further studies, including careful recording of cases and close histopathological examination of resected specimens, are required in order to provide more information and improve our understanding of the aetiology of this rare occurance.

Neonatal screening for developmental dysplasia of the hip on the maternity wards in Crete, Greece. correlation to risk factors.

OBJECTIVE: To evaluate the effects of ultrasound examination of newborns in early detection and management of developmental dysplasia of the hip (DDH), and its correlation to known risk factors. The incidence of DDH in newborns throughout the general population of Crete has also been investigated. METHODS: From 1996 to 2000, 6,140 full-term newborns were examined in the Maternity Department of the University Hospital. All received standard assessments, with their medical history recorded, and a physical examination performed on the first and the fifth postpartum days. Ultrasonography of both hips using the Graf technique was performed on the 15th day after birth on both high-risk newborns and those with any clinical suspicion of DDH. Treatment was initiated according to the Graf classification. RESULTS: Ultrasound examination was performed on 220 newborns (3.58%). Ultrasound findings were positive in 65 neonates (10.83 per 1,000). Twenty-one neonates whose clinical examination was normal, but who underwent ultrasound because of the presence of risk factors had pathological findings on the hip sonography (32.30%) CONCLUSION: The incidence of DDH in Crete is estimated to be 10.83 per 1,000; higher than in the rest of Greece. Medical and family histories and clinical examination play an important role in the diagnosis of hip instability. Selective ultrasonography for all infants with risk factors, and those with clinical abnormality of the hip, is an adjunctive tool which aids early diagnosis and offers higher control in the results of treatment.

Infantile myofibromatosis with visceral involvement and complete spontaneous regression.

Infantile myofibromatosis is an unusual mesenchymal disorder characterized by the proliferation of tumors in the skin, muscle, bone, and viscera. Two types can be distinguished; the solitary type, defined by the presence of one nodule in the skin, muscle, bone or subcutaneous tissue; and the multicentric type which can be divided into two sub-types. In the first sub-type the lesions are multicentric but without visceral involvement, while in the second, visceral involvement is present. The prognosis of the disease depends on whether visceral involvement is present. Solitary and multicentric nodules without visceral involvement usually have excellent prognosis with spontaneous regression of lesions within 1 to 2 years of diagnosis. On the other hand, visceral lesions are associated with a significant morbidity and mortality, resulting from vital organ obstruction, failure to thrive, or infection. Death in these cases often occurs at birth, or soon after, and is usually due to cardio-pulmonary or gastrointestinal complications. The case being reported here, is that of a female newborn who had multiple skin, subcutaneous tissue, skeletal muscle, bone, and lung lesions immediately after bith. At the age of three years, the child is in good health, her psychomotor development is in accordance with her age group, and the lesions have completely regressed. This is a case of the multicentic type of infantile myofibromatosis with visceral involvement, where all lesions have spontaneously regressed. This is a rarity since the prognosis in the majority of such cases is poor.

Association between duration of neonatal hospital stay and morbidity in the first month of life.

The morbidity of 506 healthy full-term newborns was studied in the first month of life in relation to the time they stayed in the hospital. The average time for the newborns who were born by vaginal delivery was 73.3+/-11.7 hours, while for those who were born by cesarean section it was 135+31.5 hours. Thirty-seven newborns presented health problems during the neonatal period (7.3%) and only 2% needed hospital readmission. The commonest problem in the newborns we studied was jaundice which appeared from the fourth to sixth day of life. During the second fortnight the commonest problems were infections of the respiratory tract. From the results of our study it is obvious that only a small percentage of readmissions could have been avoided if the original stay in hospital had been prolonged.

Breast feeding--when nature fails to satisfy.

Human milk is the ideal source of nutrition for the healthy neonate. Milk from the mother whose diet is sufficient will supply the necessary nutrients. It is a considerable problem to discern if the milk supply is the adequate quantity for the infant. If the infant's water and caloric needs are not met for several days, signs and symptoms of hypernatremic dehydration >10% may develop. This report presents a case of a 15-day-old, breast-fed infant who developed significant hypernatremic dehydration.

Soluble transferrin receptor levels and soluble transferrin receptor/log ferritin index in the evaluation of erythropoietic status in childhood infections and malignancy.

UNLABELLED: Soluble transferrin receptor (sTfR) is a new diagnostic tool for determining iron status and erythropoietic activity. The increased concentrations of sTfR in patients with iron deficiency reflect the hyperplasia of erythroid precursors. The objective of this study was to evaluate sTfR and sTfR/log ferritin index (sTfR-F) values in healthy children (n = 64), full-term neonates (n = 18), children with iron deficiency (n = 16), hemolytic anemia (n = 7), beta-thalassemia traits (n = 18), respiratory infections (n = 41) and malignancies (n = 13), and to compare these parameters for the different subgroups with those of healthy children. The sTfR levels were increased in children with iron deficiency in the same way as in adults (p < 0.0001) and in cases of increased erythropoietic activity, such as during the neonatal period (p < 0.0001), and of hemolytic anemias (p = 0.006). The index was significantly increased in iron deficiency (p < 0.0001) and decreased in neonates (p = 0.011). Children carriers of beta-thalassemia were found to have increased sTfR values (p = 0.015), but not sTfR/log ferritin index (p = 0.491), a finding suggesting that use of both parameters is necessary for distinguishing between those with and those without iron deficiency. In children with upper respiratory infection, the sTfR levels were close to normal, while the index was found to be low. In order to evaluate the iron status in infections, we further subdivided the children into two groups according to the value of ferritin, with the cut-off point at 35 microg/L. Children with ferritin level above 35 microg/L experienced normal sTfR levels but very low index, a finding which could enable the use of these two parameters for distinguishing patients with infection without concomitant iron deficiency. In the group of malignancies under chemotherapy both indices were low (p = 0.005, p < 0.0001) mainly due to myelosuppression. CONCLUSION: The interpretation of both sTfR and sTfR/log ferritin index is useful in the evaluation of iron status and erythropoietic activity, especially in children with heterozygous beta-thalassemia, infection and malignancies.

Multimodal cancer chemotherapy during the first and second trimester of pregnancy: a case report.

This paper reports treatment with combined chemotherapy during pregnancy. A 39-year-old woman with breast cancer was given adjuvant chemotherapy including cyclophosphamide, methotrexate and 6-fluorouracil from the 6th to the 24th week of gestation. The possibility of teratogenic effects on the fetus was explained to the patient however she refused to terminate the pregnancy. A 30-week male infant with only a minor malformation was delivered. The authors reviewed the literature regarding chemotherapeutic agents given during the first trimester of pregnancy. Most cytotoxic drugs have teratogenic effects on experimental animal subjects. However, actual data on human fetuses are sparse because of the variety of therapeutic regimens and the rarity of administering chemotherapy during pregnancy. The long-term effects of exposure to cytotoxic drugs in utero, needs further research.

Spontaneous gastric perforation in premature twins.

Two pairs of identical and non-identical premature neonates proceeding from twin pregnancies were operated on for spontaneous gastric perforation. The newborns in our case, one girl and one boy two different pregnancies were delivered by emergency cesarean section. Their gestational ages were 30 and 32 weeks, and their birth weight 1400 and 2100 g, respectively. Both of the neonates were being treated in the Neonatal Intensive Care Unit when the perforations were diagnosed. They presented clinically abrupt symptoms of abdominal distension and pneumoperitoneum. The sites of the ruptures were located at the anterior gastric wall near the gastroesophageal junction. The sibling twins were consequently also observed very carefully and fortunately they did not develop any similar clinical symptoms. All four twins were finally discharged from the hospital in good condition.

An unusual case of lead poisoning in an infant: nursing-associated plumbism.

Lead poisoning remains a common environmental threat for children today. The majority of cases of lead poisoning are caused by oral intake of lead dust or lead-containing paint flakes and thus occur during the second and third years of life. An unusual case of severe lead poisoning in a breast-feeding infant girl is here presented; the source proved to be a nipple shield made of a lead-containing metal. Despite the severity of the intoxication, by the end of treatment and for a year afterwards the infant has been well and her psychokinetic development has been normal.

Infantile myofibromatosis: a case study and review of literature.

Infantile myofibromatosis is an unusual condition generally presenting in the newborn period. The case being reported is that of a female newborn who had multiple lesions that involved skin, subcutaneous tissue, skeletal muscles, bone, and lungs. The disease was diagnosed because of the easily palpable skin tumors and subcutaneous nodules that were obvious immediately after birth. The diagnosis was established by histopathological examination of one nodule that showed a spindle-celled mesenchymatogenic lesion demonstrating the morphological and immuno-phenotype characteristics of myofibroblastic differentiation. The histologic picture, combined with the clinical manifestations and the imaging findings, are consistent with infantile myofibromatosis. The physical condition of the newborn was excellent and remains so six months later. The tumors of the skin and the subcutaneous nodules have gradually regressed without therapy. At the age of six months, four (4) nodules are palpable; the infant is under continuous observation.

Anemia due to massive chronic foetomaternal hemorrhage.

We report a case of massive chronic foetomaternal hemorrhage. The labor course was uncomplicated. The newborn presented with pallor. tachypnea, and moderate hepatosplenomegaly. The initial hemoglobin was 6.5 g/dl. The Kleihauer-Betke stain on a maternal blood sample was 12%, which is equivalent to 540 ml of fetal blood in the maternal circulation. A clot in the umbilical vein was demonstrated sonographically. The possible association of foetomaternal hemorrhage with umbilical vein thrombosis is discussed.

Congenital infection by human parvovirus B19 ascites-anaemia.

A case of intrauterine infection by human parvovirus B19 (HPV B19) manifested as ascites during pregnancy is presented. Ascites was diagnosed by ultrasound at 27 weeks' gestation. A caesarean section was performed at 37 weeks'. owing to affected mobility of the fetus. A pale, female infant with low haemoglobin and bradycardia was delivered. Polymerace Chain Reaction (PCR) lab tests revealed that the mother and the fetus were infected by HPV B19. The neonate was born with low haemoglobin (Hb = 10 g/dl) and with ascites; it was discharged in good general condition 50 days after delivery.

Delayed interval delivery and survival of the two fetuses after second trimester loss of one triplet.

Due to the implementation of assisted reproduction techniques, the incidence of multiple pregnancies associated with fetal and neonatal complications has significantly increased. A woman in the 24th week of a triplet pregnancy came to the hospital because of premature rupture of membranes of one amniotic sack and she had a miscarriage of one of the fetuses the same day. After confirmation of the viability of the two fetuses, she was kept under observation with antibiotic therapy only. The woman gave live birth to these remaining fetuses in her 32nd week of pregnancy. The outcome of this case demonstrates that watchful expectancy may be a feasible alternative to invasive intervention. The aim of this report is to add to the currently very limited literature of an expectant (conservative) policy with regard to pregnancy outcome after the early loss of a fetus from a multiple pregnancy.

Immunologic variables in normal pregnancy and spontaneous abortion.

OBJECTIVE: The aim of the study was to establish if pregnancy belongs to pathological situations, if it changes SIL-2R, sCD4 and sCD8 levels, and to verify if these levels have a prognostic value in the evaluation of pregnancy. PATIENTS AND METHODS: Thirty pregnant women in the first trimester of pregnancy were studied. Ten of them had a normal evolution of pregnancy, ten had a threatened abortion with a bad outcome, and ten had an ectopic pregnancy. We determined SIL-2R, sCD4, and sCD8 levels in the serum and in the amniotic fluid in 10 pregnant women in their second trimester, and in 10 healthy women without pregnancy (control group). RESULTS: We found that (a) 50% of the pregnant women in their first trimester had abnormal SIL-2R values, and 90% had abnormal sCD8 values; (b) 9/10 women with threatened abortion and bad outcome had abnormal SIL-2R values; (c) SIL-2R levels were significantly higher in the amniotic fluid than in the serum (P <.001). CONCLUSION: Our results sustain the opinion that pregnancy must be included among those situations that increase SIL-2R, sCD4, and sCD8 levels. SIL-2R levels greater than 1,300 U/mL carried a bad prognosis in the evolution of pregnancy.