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The incidence of syphilis among women delivering babies at the Boston City Hospital appeared to increase from 1951 to 1991. Blood samples from 647 women admitted for delivery were tested for syphilis in 1991. These results were compared with those from 1,005 women tested after delivery in 1951. In the earlier study 2.4% of the women tested positive for syphilis either before or during pregnancy. In the 1991 study, 3.9% of the women tested positive for syphilis during pregnancy or delivery. In the 1991 study women who tested positive were more likely to be infected with other sexually transmitted diseases and more likely to use illicit drugs. No cases of congenital syphilis were diagnosed in either study., Objective. To examine the incidence and epidemiologic correlates of congenital syphilis at an inner-city Boston hospital, and draw comparisons with the situation at the same hospital 40 years ago. Design. Chart review and comparison with data collected in 1951. Setting. Maternity and pediatric services at Boston City Hospital. Methods. A study conducted in 1951 on the maternity service of Boston City Hospital in which demographic data were collected on all women admitted in labor over a 5-month period was replicated. Serologic testing for syphilis was carried out on these women, and the demographic and medical correlates of positive maternal syphilis serology were examined. This study was repeated exactly 40 years later, using the cord blood screening for syphilis done routinely at delivery and a review of prenatal records. Results. From a group made up largely of married white women in 1951, the study population shifted in 1991 to a group made up mostly of minority women, with 75% unmarried. In 1951, 24 patients were diagnosed with syphilis either before or during the pregnancy, giving a prevalence rate of 2.4%. In 1991, 25 of 647 women were diagnosed with syphilis, for a prevalence rate of 3.9%. The women with positive cord blood serologies had a higher rate of other sexually transmitted diseases and substance abuse. No symptomatic cases of congenital syphilis were seen in 1951 or in 1991, although at least 11 of the 26 infants born to mothers with positive serologies in 1991 received intravenous penicillin therapy. Conclusions. The continued prevalence of diagnosed syphilis in women at delivery reflects an inner-city epidemic of congenital syphilis that is tied to substance abuse, human immunodeficiency virus, and changing social patterns, as well to older problems of serologic screening, prenatal care, treatment failures, and maternal reinfection. It is essential that screening programs be maintained and improved in this high-risk population, and that infants born to mothers with positive serologies receive full and adequate treatment if there is any doubt at all about their infection status. Pediatrics 1994;94: 24-28; syphilis, congenital; serologic tests, prenatal screening, epidemiology, history.

Low birth weight (LBW), less than 3.6 pounds (1,750 grams), is associated with a poor infant outcome. LBW infants are at risk for periventricular-intraventricular hemorrhage, bleeding in or around the small cavities of the brain. The more severe the hemorrhage, the greater the brain damage. Phenobarbital, an anticonvulsant, is often given to control seizures in infants experiencing severe periventricular-intraventricular hemorrhage. The relationship between the location of the hemorrhage and the neurological deficit sustained has not been well-studied. The neurological outcome of 228 low birth weight infants who initially required mechanical ventilation and phenobarbital therapy to prevent seizures was evaluated. The results of ultrasonographic imaging, the use of high frequency sound to visualize internal structures, were related to motor abnormalities experienced by the surviving infants 18 months later. There were 51 infants with confirmed hemorrhage. Periventricular-intraventricular hemorrhage was related to neurological abnormalities such as decreased grasp maturity, persistent closure of the fingers, decreased parachute reaction (both arms extended when the infant is turned face-down), delayed walking, spastic palsy and abnormal movements. There was an increased risk for a neurological abnormality regardless of the type and location of the hemorrhage. The deficits were similar with and without phenobarbital prophylaxis. The most common abnormalities were abnormal jerky movements, exaggerated flexing of ankle or knee, and poor muscle tone. Infants experiencing substantial enlargement of the brain's ventricles were five times more likely to develop spastic cerebral palsy and delayed walking. They were three times more likely to have poor resistance to stretch and hyperactive, exaggerated knee-ankle reflexes. There is an increased risk for motor and reflex abnormalities among infants who experienced periventricular-intraventricular hemorrhage, particularly those infants having damage to the white matter of the brain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract. The association between bronchopulmonary dysplasia and sudden infant death syndrome was studied retrospectively in low-birth-weight infants discharged from the neonatal program at Harvard Medical School. The incidence of sudden infant death syndrome was seven times greater in infants with bronchopulmonary dysplasia when compared with a group of control infants without bronchopulmonary dysplasia. Confounding factors, including birth weight, sex, multiple birth, socioeconomic status, and apnea were evaluated. The results indicate that there is an association between bronchopulmonary dysplasia and sudden infant death syndrome. [ABSTRACT FROM AUTHOR]