Effect of Enteral Zinc Supplementation on the Anthropometric Measurements of Preterm Infants at Discharge from the Neonatal Intensive Care Unit and Evaluation of Copper Deficiency.

Enteral zinc supplementation in preterm infants has been reported to improve short-term weight and height gain. This study aims to evaluate whether early enteral zinc supplementation in preterm infants admitted to the neonatal intensive care unit (NICU) affects their physical measurements at discharge, and to periodically test serum copper levels. Of the 221 patients admitted to the NICU, 102 were in the zinc group and 119 were in the no-zinc group. The zinc group was administered 3 mg/kg/day of zinc. Body weight, height, and head circumference at discharge (or on the expected delivery date) were evaluated, and the factors affecting these parameters were examined. Serum zinc and copper levels were also evaluated on admission and monthly thereafter. Multivariate analysis was performed and showed that the weeks of gestational age and small for gestational age (SGA) status affected the height and weight at discharge. SGA also affected the head circumference. Serum copper levels were within the reference range for all patients at 3 months of age. Enteral zinc supplementation of 3 mg/kg/day in preterm infants did not affect the weight, height, or head circumference at discharge, but was shown to be relatively safe.

Serum zinc and copper levels in infants admitted to the neonatal intensive care unit.

OBJECTIVES: Zinc and copper are trace elements, but their reference values during the neonatal and infant periods are not clear. We aimed to determine the trend of serum zinc levels in infants admitted to the neonatal intensive care unit and compare serum zinc and serum copper levels at admission between small-for-gestational-age (SGA) and non-SGA infants. METHODS: From 406 patients admitted to the neonatal intensive care unit from January 2009 to September 2012, 339 patients were included in this retrospective study. Blood samples were collected on admission, and serum zinc and serum copper levels were measured. Serum zinc was tested every month until discharge. RESULTS: Serum zinc levels of infants born at <30 wk of gestation decreased by 46% in the first month of life. All infants born at ≤34 wk of age became zinc deficient at 2 mo of age. The relationship between gestational age and serum zinc level at admission had a negative correlation (Spearman's rank correlation cofficients) = -0.66; P < 0.001). There was a negative correlation between serum zinc and serum copper at admission (rs = -0.49; P < 0.001). Serum copper levels of SGA infants at admission were significantly higher than those of non-SGA infants (P < 0.001). CONCLUSIONS: All of the infants admitted to the neonatal intensive care unit at ≤34 wk of gestation were zinc deficient by 2 mo of age, suggesting the need for enteral zinc administration. Serum copper was higher in SGA infants than in non-SGA infants on admission, but further studies are needed to determine whether excess copper affects development.

Delayed Birth-Related Femur Fracture after Cesarean Section: A Case Report.

Background Birth-related femur fractures are rare. They have been reported following difficult delivery and are commonly diagnosed immediately after birth or on the following day. However, some birth-related femur fractures are diagnosed several days after birth. Mechanisms underlying the development of delayed femur fracture are incompletely understood. Case We report the case of a girl diagnosed with a left spiral femur fracture with associated edema and hypoesthesia on postpartum day 9. A nondisplacement femur fracture was identified on plain radiography at birth after cesarean section; however, it was undiagnosed due to the lack of symptoms. She was treated with plaster cast fixation; the physical examination at age 1 was normal. Herein, the diagnosis of birth-related femur fracture according to plain radiography findings suggests that the symptoms related to birth trauma develop several days after birth. Conclusion Birth-related fracture should be considered in all neonatal femur fracture cases and in patients with no symptoms at birth. Neonates delivered in the breech presentation by cesarean section should be carefully monitored after birth. The findings of the present case further our understanding of the pathogenic mechanisms underlying delayed diagnosis of birth-related femur fracture.

Parainfluenza virus type 3 outbreak in a neonatal intensive care unit.

Parainfluenza virus (PIV) is a respiratory pathogen in young children and is second only to the respiratory syncytial virus (RSV) as a cause of lower respiratory tract infection. PIV type 3 (PIV3) is the most severe. Herein we describe an outbreak of PIV3 in three infants in a neonatal intensive care unit. They were diagnosed on virus culture from pharyngeal swabs. We prevented the spread of the virus using standard infection control procedures and isolation of the symptomatic infants. One infant had severe chronic lung disease and was complicated with recurrent wheezing for a long time. Because RSV and PIV have many structural, pathogenic, epidemiologic, and clinical similarities, we speculate that PIV infection causes recurrent wheezing, as observed with RSV infection. Therefore, physicians must consider recurrent wheezing at the time of treatment of PIV infection early in life.

Ex utero intrapartum treatment for an infant with cerebro-costo-mandibular syndrome.

Cerebro-costo-mandibular syndrome (CCMS) is a rare disorder characterized by multiple rib abnormalities, micrognathia described as Pierre-Robin sequence, and cerebral involvement. Appropriate management of respiratory distress immediately after birth is crucial to rescue these patients. A boy, having a mother with Pierre-Robin sequence and a sister with CCMS, was diagnosed prenatally with CCMS and successfully treated with ex utero intrapartum treatment (EXIT) at 36 weeks 6 days of gestation. EXIT would be an effective option for rescuing patients with prenatally diagnosed CCMS and preventing neonatal hypoxia.

Refractory neonatal epilepsy with a de novo duplication of chromosome 2q24.2q24.3.

There are only two reports on epileptic patients associated with microduplication of 2q. We found a de novo duplication of chromosome 2q24.2q24.3 in another infant with neonatal epilepsy. The patient had refractory focal seizures since the third day of life. Her seizures were refractory against phenobarbital and levetiracetam, but were controlled by valproate. Array comparative genomic hybridization revealed a 5.3-Mb duplication of 2q24.2q24.3, where at least 22 genes including a cluster of voltage-gated sodium channel genes (SCN1A, SCN2A, SCN3A, SCN7A, and SCN9A) and one noncoding RNA are located.

Trapezium fracture associated with occult fracture of the proximal pole of the scaphoid.

There has been no case of simultaneous fracture of the trapezium and the proximal pole of the scaphoid. We have treated a case with this combination. The fracture of the proximal pole of the scaphoid was only found on computed tomography imaging. We performed accurate reduction and fixation of both fractures with cannulated headless compression screws in a minimally invasive technique. We obtained rigid initial fixation and good clinical and radiographical results.

Palmar plating for AO/ASIF C3.2 fractures of the distal radius with arthroscopically assisted reduction.

We performed a retrospective study of 15 patients with AO/ASIF C3.2 fracture of the distal radius. All patients were treated with arthroscopically assisted reduction of the radiocarpal joint followed by palmar plating with autologous bone graft, with a follow-up evaluation of 24 months. According to the demerit point system of Gartland and Werley, five patients had excellent results and 10 had good results. Grade 1 arthritic changes were found in 10 patients even though with no step-off on radiographs. In the current study, this combined treatment was challenging and useful for AO/ASIF C3.2 fractures.

Palmar plating with calcium phosphate bone cement for unstable Colles' fractures.

A prospective study was done in 20 patients with unstable Colles' fractures with metaphyseal bone defects and who were treated with palmar plating combined with injectable calcium phosphate bone cement. The patients were three men and 17 women with a mean age of 69 years (range, 65-86 years) at the time of the injury. The followup after the operation ranged from 6 to 24 months (mean, 12 months). Union was gained in all the patients. The records of radiographic parameters, including the palmar tilting angle, radial inclination, radial length, and ulnar variance had been maintained since the surgery. According to the rating scale of Gartland and Werley, 16 patients had excellent results and four had good results. There were no neurovascular and tendon injuries as complications.

Measles infection in pregnancy.

OBJECTIVES: Measles during pregnancy has deleterious effects on both the perinatal outcome and the mother. However, in-depth knowledge about gestational measles is lacking. The objectives of this study were to describe the clinical course of eight cases of gestational measles and to study the effect of measles and pregnancy on each other. METHODS: From late 2000 to early 2001, we experienced a measles outbreak with eight infected pregnant women. The clinical course of each case is described in detail. RESULT: Three of the four cases before 24 weeks of gestation ended in spontaneous abortion or stillbirth. The clinical course of the three abortions and stillbirth were singular because of the sudden onset of the abortion and the spontaneous pregnancy termination. In contrast, the four pregnancies after 25 weeks of gestation ended in live-term delivery and two out of the four neonates were diagnosed with congenital measles. There was no maternal death, instead two pneumonia cases and one hemorrhagic shock case. CONCLUSIONS: Gestational measles may potentially damage the fetus and is one of the serious complications that can occur during pregnancy.

Galeazzi-equivalent lesions in adolescence.

Two cases of a Galeazzi-equivalent lesion in adolescence are described. Accurate diagnosis of the epiphyseal injury of the distal ulna, rigid fixation of the distal radius, and stabilization of the distal radioulnar joint are keys in obtaining a good result in the treatment of Galeazzi-equivalent lesion in adolescence.

Palmar plating for dorsally displaced fractures of the distal radius.

Extensor tendon rupture and irritation caused by implants or surgical intervention are serious complications in the treatment of fracture of the distal radius when a dorsal approach is used. To prevent complications, the dorsally displaced fracture of the distal radius was treated using a palmar approach. The subjects were 18 men and 15 women with a mean age of 54 years at the time of the injury (range, 23-75 years). All the patients had internal fixation with a plate and screws using the palmar approach. Union was achieved in all patients. Radiographic parameters, including the palmar tilt, radial inclination, radial length, and ulnar variance have been maintained since the operation. According to the rating scale of Gartland and Werley, there were 12 excellent, 20 good, and one fair result. There were no extensor tendon injuries that occurred during use of the palmar approach in this small series of patients. Palmar plating can be safe and effective for treatment of a dorsally displaced fracture of the distal radius.