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Objective:Apnea of prematurity is a common complication in premature newborns and caffeine is a widespread medication used to treat this complication. Caffeine may have adverse effects on the cardiovascular and central nervous system, yet its effects on the autonomic nervous system modulation of heart rate have not been studied in premature newborns, which was the objective of our study.Study Design:We prospectively studied 21 premature newborns who were treated with caffeine. We analyzed heart rate variability by power spectral density and by dynamic nonlinear analyses methods.Result:There were no changes in heart rate, blood pressure or the autonomic nervous system tone following administration of caffeine, nor were the nonlinear dynamical properties of the system altered by caffeine.Conclusion:Caffeine does not have detrimental effects on heart rate variablility, heart rate or blood pressure in conventional doses given to premature newborns. [ABSTRACT FROM AUTHOR]

Objective: To study the long term neurodevelopmental outcome of children who participated in a randomised, double blind, placebo controlled study of early postnatal dexamethasone treatment for prevention of chronic lung disease.Methods: The original study compared a three day course of dexamethasone (n = 132) with a saline placebo (n = 116) administered from before 12 hours of age in preterm infants, who were ventilated for respiratory distress syndrome and had received surfactant treatment. Dexamethasone treatment was associated with an increased incidence of hypertension, hyperglycaemia, and gastrointestinal haemorrhage and no reduction in either the incidence or severity of chronic lung disease or mortality. A total of 195 infants survived to discharge and five died later. Follow up data were obtained on 159 of 190 survivors at a mean (SD) age of 53 (18) months.Results: No differences were found between the groups in terms of perinatal or neonatal course, antenatal steroid administration, severity of initial disease, or major neonatal morbidity. Dexamethasone treated children had a significantly higher incidence of cerebral palsy than those receiving placebo (39/80 (49%) v. 12/79 (15%) respectively; odds ratio (OR) 4.62, 95% confidence interval (95% CI) 2.38 to 8.98). The most common form of cerebral palsy was spastic diplegia (incidence 22/80 (28%) v. 5/79 (6%) in dexamethasone and placebo treated infants respectively; OR 4.45, 95% CI 1.95 to 10.15). Developmental delay was significantly more common in the dexamethasone treated group (44/80 (55%)) than in the placebo treated group (23/79 (29%); OR 2. 87, 95% CI 1.53 to 5.38). Dexamethasone treated infants had more periventricular leucomalacia and less intraventricular haemorrhage in the neonatal period than those in the placebo group, although these differences were not statistically significant. Eleven children with cerebral palsy had normal ultrasound scans in the neonatal period; all 11 had received dexamethasone. Logistic regression analysis showed both periventricular leucomalacia and drug assignment to dexamethasone to be highly significant predictors of abnormal neurological outcome.Conclusions: A three day course of dexamethasone administered shortly after birth in preterm infants with respiratory distress syndrome is associated with a significantly increased incidence of cerebral palsy and developmental delay. [ABSTRACT FROM AUTHOR]

Acute infantile spinal muscular atrophy (SMA type I, Werdnig-Hoffmann disease) has generally been accepted as an autosomal recessive disorder. However, several investigators have noted a slightly increased male to female ratio. We describe here a family with two affected male sibs who had a form of acute infantile SMA with congenital bone fractures, whose parents were first cousins. Pedigree analysis strongly suggested autosomal recessive inheritance, but X linked recessive inheritance could not be ruled out. In view of the heterogeneity of the SMAs, and the distinct clinical features found in our patients, we suggest that their infantile SMA might well be a distinct entity. We suggest that SMA I with congenital contractures and bone fractures appears to be a recognisable disorder that can be distinguished from the more common classic form of SMA I. [ABSTRACT FROM PUBLISHER]

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Objective: To study the effect of early postnatal dexamethasone (days 1-3) on the incidence and severity of chronic lung disease in preterm infants with respiratory distress syndrome.Methods: A multicentre, randomised, placebo controlled, blinded study was carried out in 18 neonatal intensive care units in Israel. The primary outcome measure was survival to discharge without requirement for supplemental oxygen therapy beyond 28 days of life. The secondary outcome measures were requirement for mechanical ventilation at 3 and 7 days, duration of ventilation or oxygen therapy, need for subsequent steroids for established chronic lung disease and incidence of major morbidities.Results: The study consisted of 248 infants (dexamethasone n = 132; placebo n = 116). No differences were found in the outcome variables except for a reduction in requirement for mechanical ventilation at age 3 days in treated infants (dexamethasone 44%, placebo 67%; P = 0.001). Gastrointestinal haemorrhage, hypertension, and hyperglycaemia were more common in treated infants, but no life threatening complications, such as gastrointestinal perforation, were encountered.Conclusions: These data do no support the routine use of early postnatal steroids, but may justify further study in a selected, high risk group of infants. [ABSTRACT FROM AUTHOR]

With the escalation of terrorism worldwide in recent years, situations arise in which the perpetration of violence and the defense of human rights come into conflict, creating serious ethical problems. The Geneva Convention provides guidelines for the medical treatment of enemy wounded and sick, as well as prisoners of war. However, there are no comparable provisions for the treatment of terrorists, who can be termed unlawful combatants or unprivileged belligerents. Two cases of severely injured terrorists are presented here to illustrate the dilemmas facing the medical staff that treated them. It is suggested that international legal and bioethical guidelines are required to define the role of the physician and auxiliary medical staff vis a vis injured terrorists. There are extreme situations where the perpetration of violence and the defense of human rights come into conflict, leading to serious ethical and psychological discord. Terrorists, using violence to create fear in order to further their political objectives, might require life-saving medical care if injured during the course of their terror activities. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Absence of nasal bone in fetuses with trisomy 21 at 11-14 weeks of gestation: an observational study," by S. Cicero and colleagues published in the previous issue.

Oral insulin promotes intestinal maturation and may prevent diabetes in animal models. The aim of this study was to evaluate the concentration of insulin in human milk and in different infant formulas. Our results show that the concentration of insulin in human milk is significantly higher (60.23 +/- 41.05 microU/ml mean +/- SD) compared with cow's milk (16.32 +/- 5.98 microU/ml mean +/- SD) and that insulin is hardly detectable in infant formulas. We propose the addition of human insulin to infant formula to match its composition more closely to human milk. [ABSTRACT FROM AUTHOR]

We describe a neonate with severe bilateral diaphragmatic paralysis caused by haemorrhage in the lower brain stem. To our knowledge this association has not been previously reported in the English medical literature. [ABSTRACT FROM AUTHOR]

AbstractObjectiveTo describe the sonographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region. MethodsA detailed sonographic survey was performed in 46 244 consecutive pregnancies. Both low- and high-risk pregnancies were included. Transvaginal examinations were performed at 14–16 weeks’ gestation, while transabdominal examinations were performed after 18 weeks’ gestation. ResultsIsolated hyperechogenic foci in the thalamic region were observed in seven fetuses. All cases were diagnosed at 14–16 weeks’ gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2–4 mm. A serologic work-up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid-pregnancy in all cases, and fetuses were normal at delivery and on follow up to the age of 9 years. ConclusionsIsolated hyperechogenic foci in the thalamic region in early pregnancy are probably benign in nature. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine the incidence in an unselected population of a rod-like structure on the fetal upper lip (called a ‘mustache’) which we had previously observed as an incidental finding. A secondary aim was to determine whether this was associated with any abnormalities or abnormal outcomes. Design Prospective non-randomized study. Subjects Three thousand consecutive fetuses from an unselected population were scanned by one sonologist. Method Transvaginal ultrasound examinations were performed at 14–16 weeks' gestation. Repeat sonographic examinations were performed at 20–22 weeks' gestation in cases where a mustache was detected, and these neonates were examined by a pediatrician after delivery. Results Seven of 3000 fetuses had a mustache-like structure on the upper lip. The ‘mustache’ disappeared later in gestation. No anomaly of the upper lip was detected after birth in these fetuses. Conclusion A mustache-like structure on the fetal upper lip in early pregnancy probably represents a normal variant of lip development. It is likely to represent a delay in the normal process of lip fusion during embryonic life. [ABSTRACT FROM AUTHOR]

We present a male infant with a giant omphalocele, diaphragmatic hernia, hepatic cyst, bilateral radioulnar synostosis, absent left thumb, and triphalangeal right thumb. [ABSTRACT FROM PUBLISHER]

An abstract of the conference paper "Late onset fetal nuchal translucency: Clinical implications," by M. Bronshtein and colleagues is presented.

An abstract of the research paper "Early Transvaginal Detection of Cardiac Malformations," by M. Bronshtein and colleagues is presented.

Purpose: To assess the incidence of a non-visualized gallbladder in early pregnancy and to determine its prognostic significance. Material and methods: Transvaginal ultrasound examination was performed in 29 749 consecutive pregnant women at 14–16 weeks gestation. All women underwent a detailed fetal survey prospectively. The incidence and associated risk in cases of a non-visualized fetal gallbladder was determined. Results: The gallbladder was not visualized in early pregnancy in 34 fetuses, giving an incidence of 0.11% (1 in 875 pregnancies). Associated malformations were detected in 14 fetuses (41%), and in 20 fetuses non-visualization of the gallbladder was an isolated finding. All fetuses with an isolated finding had a normal outcome, in 13 fetuses the gallbladder was detected later on in pregnancy, in five no gallbladder was found after delivery, and two patients were lost in follow up. Of the 14 fetuses with associated anomalies, five had also an abnormal karyotype. Termination of pregnancy was performed in nine of these fetuses. Of the cases which continued pregnancy there was one case of neonatal death, two cases of developmental delay and only one normal child. Conclusion: Non-visualization of the fetal gallbladder in the early pregnancy is uncommon but is associated with a high incidence of associated anomalies. Fetuses with an isolated finding of a non-visualized gallbladder have usually a favorable outcome. [ABSTRACT FROM AUTHOR]