Level of in utero cocaine exposure and neonatal ultrasound findings.

OBJECTIVE: To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables. STUDY DESIGN: In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group. RESULTS: Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weight z scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35). CONCLUSIONS: This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.

Imaging of musculoskeletal disorders in children.

A review of the year's literature on musculoskeletal disorders in infants and children includes many advances in imaging principles, especially MR imaging pulse sequences. We have not attempted to review these advances because the principles are essentially the same in children as in adults. We have confined this review to several topics including the importance of differentiating the findings in osteogenesis imperfecta from those in the abused child, limb-lengthening procedures in infants and children, the treatment of slipped upper femoral capital epiphysis, spinal anomalies, and skeletal abnormalities associated with cloacal exstrophy. A brief comment on cervical spine films in pediatric trauma patients is also included.

Radiographic manifestations of congenital anomalies of the spine.

Although the foregoing review of embryologic development and congenital anomalies of the spine in infants and children is necessarily brief, the most commonly encountered abnormalities have been reviewed, and when possible, an attempt has been made to cite the stage of embryologic development at which the various abnormalities originate. As noted, congenital abnormalities of the spine are relatively uncommon but may be of profound clinical significance. During the past decade, the most significant developments in the diagnosis and treatment of these abnormalities have been ultrasonography, CT scanning, and MR imaging. In the neonate, the spinal cord and neural outflow can be evaluated by ultrasonography until the osseous elements begin to fuse. Thereafter, MR imaging is the procedure of choice because it permits evaluation of the spine and spinal cord in all planes of imaging and provides detailed evaluation of the effect of osseous abnormalities on neural structures. Finally, plain radiographs of the spine for evaluation of neonates who have any of a spectrum of sacral dimples are rarely helpful, and in the presence of significant cutaneous or subcutaneous abnormalities, ultrasonography is the preferred modality for evaluation.

Delayed appearance of right diaphragmatic hernia associated with group B streptococcal infection in newborns.

Right diaphragmatic hernia should be considered when an infant with Group B streptococcal infection shows deterioration. Although the diaphragm appears normal at first, increased density is seen in the right lower lobe shortly thereafter, indicating pneumonia and/or irregular aeration. Pleural effusion may develop over the next few days. Characteristically, the bowel gas on the right and the liver shadow gradually become elevated and the heart and mediastinal structures shift into the left hemithorax; loops of bowel may be seen in the right hemithorax as well. Static plain views should confirm hernia or eventration, necessitating immediate surgery.

The area and volume of the sella turcica in childhood primary hypothyroidism.

Sellar area and volume are compared to chronological age, stature, and osseous maturation (bone age) in a series of control children of short stature and in those with primary hypothyroidism and idoiopathic pituitary deficiencies. Sellar area is increased most significantly in relation to bone age in primary hypothyroidism; volume is less useful than area in the diagnosis of this disease.