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Background/purpose To test the hypothesis that clinical and radiological features of necrotizing enterocolitis vary with gestational age in all neonates with NEC and in subgroup of surgically treated patients. Methods This was a retrospective study case series. NEC cases treated in Stockholm County from 2009 to 2014 were identified in the National Quality Register. Patients were included in the study if they had a verified NEC diagnosis and they were divided into 2 groups according to the gestational age. Results A total of 89 patients were included. Of these 60 (67.4%) neonates had a gestational age < 28 and 29 (32.6%) infants ≥ 28 weeks. Surgical NEC patients were 57 (64%). Pneumatosis intestinalis at the abdominal radiographs was noted significantly more often in neonates born at ≥ 28 weeks of gestation (86.2%) compared to extremely preterm newborns (60.0%). Neonates born at ≥ 28 weeks of gestation presented more often bloody stools (58.6%) compared to extremely preterm newborns (20.0%). In surgical NEC patients gasless abdomen was detected in 35.6% of the neonates born < 28 weeks compared to 6.7% of the more mature neonates. Conclusions Extremely preterm neonates with NEC show less specific clinical and radiological signs of NEC compared to more mature neonates. This suggests that Bell's classification is not adequate for the diagnosis and staging of NEC in extremely preterm neonates. Level of evidence III. [ABSTRACT FROM AUTHOR]

Background Acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome, is an immune-mediated polyneuropathy usually triggered by infections or vaccinations. In childhood AIDP is commonly described after the first year of life. Here, we present a case of a newborn infant with AIDP manifestation directly after delivery. Case study A newborn girl with a healthy mother, without known exposure to immunomodulating factors, was admitted to the neuropediatric department due to ascending hypotonia, weakness, pain and areflexia in the lower extremities. The clinical presentation, laboratory and neurophysiological studies supported the diagnosis of AIDP. The infant showed first signs of clinical improvement following administration of intravenous immunoglobulin and her recovery was complete at one year. Conclusion AIDP should be considered as a differential diagnosis in ascending hypotonia also in the neonatal period. [ABSTRACT FROM AUTHOR]

Abstract: Objective: In spite of its known negative effects on brain development, phenobarbital is the most commonly used drug for neonatal seizures. We conducted a national survey among neonatologists and child neurologists to determine the variation in practice and attitudes. Methods: Surveys were sent to all board-certified child neurologists and neonatologists in Sweden as well as to residents in subspecialty training. In addition to questions concerning respondent demographic characteristics, the survey contained questions related to overall attitudes and practices and specific patient scenarios. Results: Responses were obtained from 170 physicians (corresponding to approximately 50% of all eligible respondents). We found a high level of agreement concerning the initiation of treatment of neonatal seizures, as well as choice of first- (phenobarbital) and second-line (midazolam) drugs. In contrast, third-line drug choice differed between specialties, with neurologists being more prone to use levetiracetam or other drugs. Neonatologists were more likely to treat premature infants differently. For continued phenobarbital treatment there was less agreement among respondents. Whereas almost 75% of neonatologists felt that phenobarbital should “seldom” or “never” be used in long term treatment following neonatal seizures, a majority of child neurologists indicated “often” or “always”. The same pattern was seen in responses to individual scenarios. Conclusion: The discrepancies between different specialties involved in treating neonatal seizures may reflect differences in training, but is also likely due to the lack of uniform guidelines. This highlights the importance of designing and carrying out clinical trials determining optimal treatment of neonatal seizures. [Copyright &y& Elsevier]

Objectives: To compare cortical hemodynamic responses to known and unknown facial stimuli between infants born extremely preterm and term-born infants, and to correlate the responses of the extremely preterm-born infants to regional cortical volumes at term-equivalent age.Study Design: We compared 27 infants born extremely preterm (<28 gestational weeks) with 26 term-born infants. Corrected age and chronological age at testing were between 6 and 10 months, respectively. Both groups were exposed to a gray background, their mother's face, and an unknown face. Cerebral regional concentrations of oxygenated and deoxygenated hemoglobin were measured with near-infrared spectroscopy. In the preterm group, we also performed structural brain magnetic resonance imaging and correlated regional cortical volumes to hemodynamic responses.Results: The preterm-born infants demonstrated different cortical face recognition processes than the term-born infants. They had a significantly smaller hemodynamic response in the right frontotemporal areas while watching their mother's face (0.13 μmol/L vs 0.63 μmol/L; P < .001). We also found a negative correlation between the magnitude of the oxygenated hemoglobin increase in the right frontotemporal cortex and regional gray matter volume in the left fusiform gyrus and amygdala (voxels, 25; r = 0.86; P < .005).Conclusion: At 6-10 months corrected age, the preterm-born infants demonstrated a different pattern in the maturation of their cortical face recognition process compared with term-born infants. [ABSTRACT FROM AUTHOR]