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AbstractPurpose: To measure grating visual acuity in premature infants and compare it with that in full-term infants. Methods: The visual acuity of 73 premature and 73 full-term infants was tested at 6 months of age by the Teller Acuity Card procedure. All premature infants had undergone indirect funduscopy for the detection of retinopathy of prematurity (ROP). Seven infants had developed ROP. The mean gestational age of the premature infants was 33 ± 1.4 weeks as compared with 39.9 ± 0.9 weeks in the full-term infants. The mean birth weights of the 2 groups were 1,906 ± 412 and 3,244 ± 420 g, respectively. Results: Impaired binocular visual acuity was found in 53.4% of the premature infants, but in only 11% of the full-term infants (p < 0.0001). Impaired monocular visual acuity was found in 13.7% of the premature infants as compared with 2.7% of the full-term infants. Within the premature infant group, monocular visual acuity was impaired in 42.9% of those with ROP and in 10.6% of those without ROP (p = 0.0497). Pathological refraction was found in 33.3% of the prematures without ROP and in 14.3% of the prematures with ROP. This difference was not statistically significant. Visual acuity of preterm infants was not different from full-term infants when examined at 6 months of postconceptual age. Conclusions: Both monocular and binocular visual acuities as measured by the Teller Acuity Cards are worse in premature infants than in full-term infants at the same chronological age. Poor visual acuity in premature infants can be attributed mainly to immaturity of the visual system.Copyright © 2004 S. Karger AG, Basel

This study was conducted to investigate maturation of the medial olivocochlear efferent system (MOCS) in pre- and full-term neonates using Quickscreen (Otodynamics Ltd) and to confirm previous findings on transient otoacoustic emission (TEOAE) suppression in neonates. MOCS maturation was investigated in 46 neonates born at the Chaim Sheba Medical Center, Tel Hashomer, Israel, using Quickscreen. All neonates were normal with no family history of general or auditory disease and no risk factors for hearing impairment. MOCS function appears gradually in human pre-term neonates and is considered to reach maturity shortly after term birth. The clinical value of MOCS testing in specific populations of newborns at risk for hearing and/or brainstem function can be legitimately raised as activation of the MOCS clearly alters cochlear output. The present results can be interpreted to support the testing of infants at risk of developing abnormal MOCS function using a commercially available rapid TEOAE measurement system.

Abbiamo studiato con spettroscopia a risonanza magnetica tre neonati a termine affetti da encefalopatia perinatale ipossico-ischemica con più selettivo interessamento dei nuclei della base e buona prognosi a 6 mesi. Abbiamo verificato la presenza di un valore molto basso del rapporto NAA/Cr ed un elevato valore del rapporto mI/Cr a livello dei nuclei della base, mentre a carico della sostanza bianca questi valori sono risultati quasi normali. I dati sono concordi con quelli riportati in letteratura, ovvero l'abbassamento del rapporto NAA/Cr sarebbe da correlare alla perdita neuronale susseguente al danno ipossico-ischemico, corrispondente alla sede ove tale danno è evidente all'esame di risonanza magnetica, mentre l'innalzamento del rapporto mI/Cr è probabilmente spiegabile con la gliosi reattiva al danno ipossico-ischemico stesso.

Two-dimensional color-coded Doppler examination revealed a cranial arteriovenous (AV) malformation in a critically ill newborn with intractable congestive heart failure. This case emphasizes the value of color-coded Doppler in the diagnosis of this rare malformation.

The antibody titers of 41 premature infants receiving inactivated poliovirus vaccine at 2 months of age (control group) were compared with titers of 39 infants receiving an additional dose at 5 to 10 days of age (study group). At 1 month of age 97.4% of the study group but only 70.8% of the control group had protective antibodies against poliovirus 3 (p <0.001). (J PEDIATR 1995;127:128-30)

We describe three infants in whom hypertrophy of the tongue developed while they were receiving beclomethasone inhalation therapy. The condition resolved after cessation of treatment, an outcome suggesting that tongue hypertrophy is a possible side effect of this therapy. (J PEDIATR 1995;127:651-3)

Summary Pefloxacin was applied to a newborn suffering from ventriculitis caused byKlebsiella pneumoniae after failure of routine antibiotics. Treatment was successful. Blood and CSF levels were high, thus documenting good CSF penetration. In addition to this case report, a review of the literature regarding seven neonates with CNS infection treated with fluoroquinolones and from whom CSF levels were obtained, is presented. In conclusion, due to their excellent activity against gram-negative microorganisms, fluoroquinolones may be considered in the treatment of neonatal CNS infections if the pathogen is resistant to routinely used antibiotics. Only limited experience is available with fluoroquinolones in pediatric patients given their potential for cartilage toxicity in young animals.

Objectives: C-CMV infection affects 0.4-2% of newborn infants in Israel, most of whom are asymptomatic. Of these, 10-20% will subsequently develop hearing impairment and might have benefitted from early detection by universal neonatal screening.Methods: We retrospectively analyzed the results of a universal screening C-CMV program using RT-PCR from umbilical cord blood, carried out at the Sheba Medical Center, Israel over a 1-year period. C-CMV was confirmed by urine CMV culture (Shell-vial assay). All confirmed cases were further investigated for C-CMV manifestations by means of head ultrasound, complete blood count, liver enzyme measurement, ophthalmology examination and thorough hearing investigation and follow up.Results: From June 1, 2009 to May 31, 2010, 11,022 infants were born at the Sheba Medical Center, 8,105 of whom (74%) were screened. Twenty three (0.28%) samples were positive for CMV and all except one were confirmed by urine culture. Two more infants, who had not been screened, were found positive after clinical suspicion. All 24 infants were further investigated, and three (12.5%) were found positive for central nervous system involvement (including hearing impairment) and offered intravenous ganciclovir for six weeks. Of these 24 infants, 18 (82%) infants would not otherwise have been diagnosed.Conclusion: The relatively low incidence of C-CMV detected in our screening program probably reflects the low sensitivity of cord blood screening. Other screening methods using urine or saliva should be further investigated. Nevertheless, this screening program detected a non-negligible number of infants that could benefit from early detection.

Objective: To evaluate the distribution of peak serum bilirubin levels in very low birth weight (VLBW) infants and the performance of exchange transfusion in infants with excessively high bilirubin levels.Methods: A population based observational study using data collected by the Israel National VLBW Infant Database. The study sample comprised 13,499 infants of 24 to 33 weeks gestation. Two definitions of excessively high peak bilirubin levels which might be considered as threshold levels for performance of exchange transfusion were used. Firstly, a bilirubin level of = 15 mg/dL for all infants (PSB-15), and secondly, incremental bilirubin levels ranging from 12-17 mg/dL according to gestational age (PSB-GA). Multivariable logistic regression analyses were performed to examine the factors associated with performance of exchange transfusion.Results: Four hundreds sixty eight (3.5%) and 1035 infants (7.7%) infants in the PSB-15 and in the PSB-GA groups respectively had peak serum bilirubin levels above thresholds for exchange transfusion. Exchange transfusion's were performed in only 66 (14.1%) of these infants in the PSB-15 group and 91 (8.8%) in the PSB-GA group. In both groups performance of exchange transfusion was significantly associated with peak serum bilirubin levels, with an odds ratio of 1.38 for each mg/dL increase above the threshold level.Conclusion: Exchange transfusion was performed in only 9-14% of VLBW infants with excessively high bilirubin levels. This may be related to an absence of definitive guidelines or the possible belief that the risks of exchange transfusion outweigh the potential risk of bilirubin induced neurological injuries.

AIM: To investigate whether hepatitis B vaccination has increased the number of cases of unexplained neonatal fever. METHOD: The files of all infants born from 1 January 1991 to 31 December 1992, in whom a diagnosis of "injected antibiotic" or "disease of temperature regulation" was recorded, were reviewed. Those who had unexplained fever of 38 degrees C or higher during the first three days of life were divided into two groups: infants who did not receive the hepatitis B vaccine (1991) and infants who did (1992). RESULTS: In 1992 the incidence of unexplained fever in hepatitis B vaccinated neonates was significantly higher than in the 1991 group of pre-vaccination neonates (35 out of 5819 (0.6%) vs 14 out of 5010 neonates (0.28%) respectively, p=0.013). CONCLUSIONS: The increase in the number of cases of unexplained neonatal fever seems to be associated with the introduction of routine hepatitis B vaccination on the first day of life. The possibility that an excess number of neonates will undergo unnecessary procedures and treatment to diagnose unexplained fever justifies planning a controlled study to determine whether these preliminary findings point to a significant problem.

AIMS: To determine normal concentrations of 17alpha-hydroxyprogesterone (17OHP) for premature infants. METHODS: 17OHP was measured in 66 consecutive premature infants once a week during the first month, and once every two weeks thereafter, until the age of 3 months. The 17OHP values in 100 full term healthy neonates on the third day of life served as controls. Blood was sampled on filter paper using a neonatal radioimmunoassay kit. Findings were correlated with gestational age, birthweight, mode of delivery, Apgar scores, presence of respiratory distress syndrome and intake of maternal steroids. RESULTS: Mean 17OHP was raised at 7 days of age (138.9, 46.3, 53.3, 29.9 nmol/l, respectively, for infants whose gestational age was under 29 weeks, 29 to 30 weeks, 31 to 32 weeks, and 33 weeks and above). It fell sharply in the first two weeks after which it gradually decreased further, reaching 32.7, 23.6, 16.9, and 13.0 nmol/l, respectively, by the age of 90 days. The mean (SEM) 17OHP concentration in full term infants on day 3 of life was 17.8 (8.9) nmol/l. These values were independent of the presence and severity of respiratory distress syndrome and of prenatal maternal steroids. CONCLUSIONS: The increased 17OHP concentrations found at birth fell to those found in term infants during the first three months of life in infants over 31 weeks of gestation. Postconceptional age is the most important factor determining 17OHP concentration.

AIM: To evaluate the influence of the intravenous injection of iodine during cardiac catheterisation, and of topical iodine antiseptics during surgical procedures, on thyroid function in full term neonates. METHODS: Twenty one full term infants with major cardiac anomalies who survived for more than a month were studied. Thyroxine and thyrotropin concentrations were measured (by radioimmunoassay) before each procedure, 24 hours after the procedure, and every week thereafter until the age of 1 month or until normal. Thyroxine values less than 64.4 nmol/l were considered low, while thyrotropin values greater than 30 mU/l were considered high. RESULTS: Thyroid function tests before iodine exposure were within normal limits in all infants. Following catheterisation or surgery six infants had raised thyrotropin concentrations; three had low thyroxine concentrations. Two of those infants were treated with L-thyroxine. CONCLUSION: Iodine exposure during cardiac catheterisation or surgery may induce transient hypothyroidism in term infants.