Extremely Preterm Neonate with a Tracheobronchial Foreign Body: A Case Report.

We report the case of an approximately 27-week gestational-age preterm infant admitted on the day of life number four for evaluation of a foreign body noted on serial chest X-rays. CT of the chest revealed a foreign body present in the trachea, extending from just above the tracheal bifurcation deep into the posterior basilar segment of the right lower lobe. Endoscopic removal of the foreign body revealed a portion of the plastic sheath of the stylet used during intubation. We also provide a brief review of the relevant literature.

Sudden Infant Death Syndrome: A Review.

Sudden infant death syndrome (SIDS) is the sudden unexpected death of an apparently healthy infant younger than age 12 months whose cause of death remains unknown despite a thorough death scene investigation, a review of the clinical history, and an autopsy. Despite the huge achievement of the Back to Sleep program, SIDS remains one of the leading causes of infant death in the United States. In recent years, the SIDS rate has remained stationary despite major public health efforts aimed at high-risk groups to improve sleep environment and strategies. This review focuses on SIDS epidemiology, pathogenesis and risk factors, the American Academy of Pediatrics recommendations on safe infant sleeping environment, and the US Centers for Disease Control and Prevention's multistate registry to improve knowledge on SIDS, evaluate trends, and analyze circumstances and events surrounding SIDS cases. [Pediatr Ann. 2018;47(3):e118-e123.].

Prolonged ileus in an infant presenting with primary congenital hypothyroidism.

Congenital hypothyroidism (CH) is the most common endocrine disorder affecting the newborn. Universal newborn screening (NBS) has virtually eliminated the static encephalopathy and devastating neurodevelopmental syndrome known as cretinism. This report describes the presentation of an infant referred by the primary pediatrician to our hospital at 12 days of age for confirmatory testing after the NBS was consistent with CH. The infant had hypoglycemia secondary to lethargy and poor feeding and required transfer to the neonatal intensive care unit for worsening abdominal distension despite normalization of serum thyroid function tests following hormone replacement. In particular, the recalcitrant ileus and secondary bowel obstruction resulted in an additional diagnostic workup and lengthened hospital day. Our report highlights the acute gastrointestinal consequences of hypothyroidism despite evidence of effective treatment. We believe that the preclinical detection and immediate therapy for CH have lessened the prevalence of this presentation in general practice, and hence practitioners are less likely to be familiar with its natural history and management.

PLAC1 Expression Decreases in Chorionic Villi in Response to Labor.

PLAC1 (Placenta-Specific 1) is a recently described, trophoblast-expressed gene essential for normal placental development. The protein localizes to the microvillus membrane surface of the syncytiotrophoblast in direct proximity to the maternal compartment. Although its role has not been defined, increased circulating levels of human PLAC1 mRNA in maternal blood are associated with preeclampsia. Furthermore, PLAC1-null mice exhibit decreased viability in the peripartum period suggesting a role in pregnancy maintenance late in gestation. We examined PLAC1 gene expression in the human placenta during normal pregnancy and pregnancies associated with maternal diabetes and preeclampsia using quantitative, real time PCR (q-RT-PCR). Although there was no apparent difference in PLAC1 gene expression among human pregnancies complicated by diabetes or preeclampsia, an unexpected effect of labor was noted at term. PLAC1 expression in placentae delivered vaginally following induced or spontaneous labor was significantly reduced compared to placentae not exposed to labor making it one of only a few placental genes influenced by labor. The significance of this finding is unknown. Viewed in the context of its importance in placental development, however, these findings are consistent with a role for PLAC1 in the maintenance of the maternal-fetal interface.