The perinatal revolution.

The Perinatal Revolution is an exciting and rapidly developing field of medicine that aims to treat and possibly cure disease in the prenatal period, and thereby to improve health across the lifespan of the child. Here we describe an overview of the perinatal field, with specific emphasis on current therapies and interventions for specific fetal problems, such as myelomeningocele and congenital diaphragmatic hernia. Advances in perinatal medicine have resulted in increased survival rates and improvements in morbidity and mortality for premature neonates. Novel innovations in screening and genetic diagnosis, as well as future prospects in cell-based therapies, tissue engineering, gene therapy, and artificial womb are significantly expanding the field and are discussed. Ethical, regulatory and policy concerns closely linked to clinical practice and public awareness are also highlighted as the Perinatal Revolution continues to unfold through research, genetic, medical and surgical advances.

A randomized trial comparing beractant and poractant treatment in neonatal respiratory distress syndrome.

AIM: To compare the effects of beractant and poractant in neonatal respiratory distress syndrome (RDS). METHODS: Infants with RDS were randomized to receive beractant or poractant. The primary outcome measure was fraction of inspired oxygen (FiO2) requirement in the first 48 h after surfactant therapy. RESULTS: 58 infants completed the study. The mean gestational ages for the poractant and beractant groups were 29.6+/-3.6 and 29.3+/-2.9 wk, with average birthweights of 1394+/-699 and 1408+/-534 g, respectively. In the first 48 h, infants who received poractant had a lower FiO2 requirement compared to those who received beractant (p=0.018). The prevalence of patent ductus arteriosus (PDA) was lower in the group of infants that received poractant (17%) compared to the group that received beractant (45%) (p=0.02). CONCLUSIONS: Infants with RDS treated with poractant had a lower FiO2 requirement during the first 48 h compared to infants who received beractant. Infants who received poractant also had fewer PDAs than infants who received beractant. The difference in FiO2 was not associated with a difference in age of first extubation, total intubation time, or incidence of bronchopulmonary dysplasia between groups.

Hemophagocytic lymphohistiocytosis presenting with nonimmune hydrops fetalis.

Hydrops fetalis is a condition of diverse etiologies. An association between hemophagocytic lymphohistiocytosis (HLH) and hydrops fetalis has not been reported in the English literature. We describe an intrauterine case of HLH in an infant who presented with hydrops fetalis at 32 weeks gestation. We suggest that HLH should be considered in the differential diagnosis of nonimmune hydrops fetalis, especially in the presence of cytopenias.

Cefuroxime-induced immune hemolysis.

Drug-induced immune hemolytic anemia (IHA) is rare but is being reported with increasing frequency. The most commonly cited cause of drug-induced IHA has been receipt of second and third generation cephalosporin antibiotics. We report the first case of IHA associated with cefuroxime administration.