Tentorial hemorrhage associated with vacuum extraction.

The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistent structural abnormalities.

Nutritional balance studies of VLBW infants fed their mothers' milk fortified with a liquid human milk fortifier.

This article reports the results of a study designed to compare human milk fortified with a liquid human milk fortifier to a preterm infant formula by analyzing the metabolic balances of certain nutrients when these milks are fed to premature infants. Ten very low birth weight (VLBW) infants were studied during 4-day equilibration periods, then 4-day metabolic balances of N, fat, Ca and P, while each consumed a 1:1 mixture of a pool of its own mother's milk and the liquid human milk fortifier (HM/LF). For comparison, another 10 VLBW infants were studied in similar fashion while consuming the preterm infant formula (PF). Percent nitrogen retentions were 77 +/- 4% (+SD) and 79 +/- 4%, and fat absorptions were 94 +/- 7% and 92 +/- 5% in the HM/LF and PF groups, respectively, and did not differ between the groups. Calcium retention was 86 +/- 21 mg/kg/day (51 +/- 12%) in the HM/LF group and 104 +/- 43 mg/kg/day (45 +/- 19%) in the PF group. The percent Ca retentions did not differ. Phosphorus retentions were 56 +/- 7 mg/kg/day (67 +/- 9%) and 77 +/- 18 mg/kg/day (61 +/- 14%) in the HM/LF and PF groups, respectively. Increases in weight, length, and occipitofrontal circumference (OFC) were similar and normal in both groups. We conclude that VLBW infants fed the HM/LF, mixed 1:1 with their mothers' milk, had rates of absorption and retention of Ca, P, N, and fat similar to rates found in the concurrent study of VLBW infants fed a commercially available PF.

Benzyl alcohol toxicity: impact on mortality and intraventricular hemorrhage among very low birth weight infants.

Benzyl alcohol preservative in intravascular flush solutions has been reported to cause neurologic deterioration and death in very low birth weight infants. Following the widespread discontinuation of the use of such solutions in newborns, scattered reports of decreased mortality and decreased incidence of intraventricular hemorrhage among small premature infants appeared in the pediatric literature. To better assess the true impact of benzyl alcohol toxicity in this group of infants, we undertook a detailed review of the medical records of all babies less than 1,250 g birth weight admitted to our neonatal intensive care unit for 13 months before and 13 months after the use of solutions containing benzyl alcohol was stopped. Significant decreases were found in both mortality rate (from 80.7% to 45.7%) and incidence of grade III/IV intraventricular hemorrhage (from 46% to 19%) among infants less than 1,000 g birth weight who did not receive the preservative compared with those who did. No significant changes were found in several other prenatal factors that could have contributed to this improvement in survival. We conclude that benzyl alcohol toxicity contributed significantly to both mortality and the occurrence of major intraventricular hemorrhage among infants weighing less than 1,000 g at birth and that solutions containing benzyl alcohol should never again be used in the care of such infants.

Benzyl alcohol toxicity: impact on neurologic handicaps among surviving very low birth weight infants.

Benzyl alcohol preservative in solutions used to flush intravascular catheters has been linked with increased mortality and incidence of intraventricular hemorrhage in small preterm infants. This study evaluated the outcome of surviving very low birth weight infants exposed to benzyl alcohol while in our neonatal intensive care unit. Surviving infants, less than 1,250 g birth weight, admitted during the 12 months prior to discontinuation of benzyl alcohol (period I), were compared with those infants admitted during the 12 months after discontinuation of benzyl alcohol (period II). Survivors were enrolled in a follow-up program. Results of the study demonstrated that infants from period II had fewer neurologic handicaps. The incidence of cerebral palsy decreased from 50% to 2.4% (P less than .001), and the presence of cerebral palsy and developmental delay combined decreased from 53.9% to 11.9% (P less than .001). Several factors other than benzyl alcohol exposure were examined for their importance on outcome but were found not to be related to it. It is concluded that the dramatic improvement in outcome could be the result of discontinuation of benzyl alcohol.