Search

The article presents a case study of a 38-week term newborn born via vaginal delivery to a previously healthy 24-year-old mother. It discusses the treatment with ceftriaxone and vancomycin without resolution of her fever. It mentions another case of a newborn at 39 weeks gestational age delivered via urgent caesarian section secondary to non-reassuring fetal heart tones to a 21-year old primigravid mother.

The article describes the case of a four-year old female neonate presented to the emergency department with lethargy, irritability, decreased urine output, poor feeding, and sepsis. Data presented show the results of the patient's complete blood count, urinalysis, complete metabolic panel, blood and urine cultures. An analysis of the association of group D streptococcus, S gallolyticus subsp. gallolyticus infection with infective endocartitis and with colorectal cancer is presented.

In this prospective study, we examined the usefulness of C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cells (s-TREM-1), and procalcitonin (PCT), in identifying serious bacterial infection (SBI) among neonates. Infants younger than 3 months with suspected SBI were included and serum concentrations of CRP, PCT, and s-TREM-1 were determined. Results. A total of 112 patients (19 with SBI and 93 with negative cultures) were evaluated. There were no statistical differences between the 2 groups regarding age, presence of fever, and serum concentrations of the different biomarkers. Performance of the different biomarkers were as follows: The sensitivities were 45%, 55%, and 82% for CRP, PCT, and s-TREM-1, respectively, whereas the specificities we 82%, 75%, and 48% for CRP, PCT, and s-TREM-1, respectively. The areas under the receiver operating characteristic curve were 0.6, 0.63, and 0.61, for CRP, PCT, and s-TREM-1, respectively. Conclusions. In real-life pediatric practice, none of the tested biomarkers was sufficiently accurate to serve as a reliable indicator for the identification of SBI in neonates. [ABSTRACT FROM PUBLISHER]

How naming a medical malady can be both horrifying for new parents and a key to unlocking resources and care. [ABSTRACT FROM AUTHOR]

This case control study, aimed at identifying complications of macrosomia, was conducted in two major hospitals of Yaoundé, Cameroon over a 6-month period from 1 October 2012. Maternity records were compared of births weighing ≥4000 g with those weighing between 3000 g and 3500 g. The main outcome variables were mode of delivery, low genital lacerations, Apgar score, birth injuries, postpartum haemorrhage and early neonatal death. Data were analysed using SPSS 18.0. Chi-square test or Fisher’s exact test and t-test were used for comparison. P < 0.05 was considered statistically significant. Maternal complications observed were poor uterine contractions during labour, second-degree perineal tears, Caesarean section, instrumental delivery and postpartum haemorrhage. Neonatal complications were birth injuries, poor 5-minute Apgar score and early neonatal death. In our setting, macrosomia is associated with increased maternal and neonatal complications. [ABSTRACT FROM AUTHOR]

The article presents a case study of a one-day-old girl who noted to have an absolute neutrophil count (ANC) on complete blood count (CBC) obtained after delivery. Topics discussed include the patient having a family history of neutropenia with her sister also being a neutropenia's patient; admission of the patient to neonatal intensive care unit (NICU) and granulocyte-colony stimulating factor (G-CSF) injections; and further tests confirming the diagnosis of neonatal alloimmune neutropenia.

Objective. To study the frequency of congenital hypothyroidism (CH)/thyroid disorders at a major, urban medical center. Methods. We conducted a retrospective review of a preexisting database for 2007 to 2011. Infants were classified as having CH, secondary/tertiary hypothyroidism, thyroid-binding globulin deficiency, and other types of newborn thyroid dysfunctions. Results. A total of 353 (50%) abnormal newborn screens were found to be normal and 42% were abnormal on repeat. Of the latter, 14% had true CH, 1% had thyroid-binding globulin deficiency, and 27% had other causes of thyroid dysfunction. The 5-year incidence of CH at NYP Morgan Stanley Children’s Hospital was significantly greater than in New York City, New York State, and Upstate New York. Conclusion. The incidence of CH and other thyroid dysfunctions were greater in our population for 2007 to 2010, after which there was an unexplained decline. The study underlines the importance of continued newborn screening for thyroid dysfunction. [ABSTRACT FROM PUBLISHER]

Objective. Our hypothesis is that specific proinflammatory and anti-inflammatory urinary cytokines are useful in the diagnostic evaluation of risk for sepsis in term neonates. We conducted a pilot, prospective hospital-based longitudinal observational study to test the urine of term neonates with a 13 biomarker panel of cytokines. Methods. Infants were divided into 2 groups: The control group (n = 15) consisted of infants admitted to newborn nursery, and the test group (n = 15) consisted of infants admitted to the neonatal intensive care unit for presumed sepsis. Bagged urine samples were collected from 30 term neonates for testing our hypothesis. Results. Urinary interleukin (IL)-8 (P = .004*), inducible protein (IP)-10 (P = .007*), and monocyte chemoattractant protein (MCP)-1 (P = .02) were significantly increased in the test group compared with the control group. Conclusions. Urinary IL-8, IP-10, and MCP-1 are proinflammatory cytokines that are increased in the neonate during an infectious inflammatory process. These may be useful predictors as an adjunct to the current protocols to recognize neonatal sepsis. [ABSTRACT FROM PUBLISHER]

Neonatal Screening (NBS) is a mass screening, secondary prevention policy aimed at detecting one or several often congenital disorders in all neonates in a given country. The French CF NBS programme is completely functional since the middle of 2003. Drawing its inspiration from the socio-material approach, this article advances a description and analysis of the interactions between the biomedical technologies used in neonatal cystic fibrosis screening and the resulting changes in clinical practice, the bioethical debate and finally in the interstice between voluntary individual consent to screening and the management of a population’s health. The analysis grid focuses on four dimensions: institutional, techno-scientific, regulatory and socio-professional. Backed up by a field survey conducted in the specialised healthcare centres, this study explores two major aspects of the repercussions of NBS: first, the genesis and institutionalisation of this public policy and the impact of a more flexible form of Evidence Based Medicine (EBM) and the sustained controversy on the neonatal screening programme uniting the community of cystic fibrosis paediatrics. This study suggests that institutional stability remains fragile and in this respect constitutes a paradoxical form of production with incompleteness and uncertainty as constituting factors. [ABSTRACT FROM AUTHOR]

Neonatal seizures can be difficult to recognize given the variation in their presentation. Hence, diagnosis and appropriate treatment may be delayed. Morphology of seizures in this age group is discussed, followed by common etiological entities. Special emphasis is laid on treatable disease states such as vitamin responsive seizure disorders and benign conditions that may not warrant aggressive treatment. Conditions that may have devastating neurological consequences are discussed in some detail so that the treating pediatrician can provide realistic information to the parents of such newborns. Imaging and laboratory workup is outlined, followed by guidelines for ordering and interpreting an electroencephalogram in this age group. Finally, treatment options in the form of antiepileptics are discussed with mention of new avenues for diagnosis and treatment that may become commonly employed in the future. [ABSTRACT FROM PUBLISHER]

Within a single-center prospective cohort study of neonatal encephalopathy involving 315 subjects, 15 neonates were found to have a focal stroke on magnetic resonance imaging. These 15 patients were matched on the basis of gender and degree of encephalopathy to 30 neonates without stroke from the same cohort. On Bayley Scales of Infant Development, the stroke group had Mental Development Index scores that were 1.7 standard deviations lower compared with controls (P = .007). This association was no longer seen after adjustment for the presence of neonatal seizures (P = .11). Of the 15 patients with stroke, 5 had been treated with hypothermia. None of these 5 had seizures in the neonatal period, compared with 7 of the untreated 10. This is the first human study to demonstrate a potential treatment effect of therapeutic hypothermia on perinatal stroke. It was also shown that seizures are associated with worse cognitive outcomes for stroke that presents with encephalopathy. [ABSTRACT FROM AUTHOR]

Honduran infant mortality (20/1000) has fallen below the Latin American newborn screening target rate (<30/1000). The authors report 2 Honduran maple syrup urine disease cases and a newborn screening pilot study. The first infant, diagnosed by plasma/urine testing in the U.S., prompted this study. Although marked clinical/radiological improvement occurred after treatment, moderate neurodevelopmental delays persist at 5 years. This 1-month, prospective study used blood spot specimens from hospitalized term Honduran neonates shipped overnight to South Carolina for routine newborn screening with electronic result submission to Honduras for follow-up. Of 88 consecutive neonates (mean age: 4.2 days, standard deviation: 4.2 days) tested, 24 (0.6%) of 3837 completed tests were positive. Another infant with maple syrup urine disease, diagnosed after study completion by blood spot testing, later died. The study findings indicate that collaborative blood spot testing aids in the diagnosis of Honduran metabolic-genetic disease. Newborn screening is now needed to diagnose and treat these diseases before morbidity/mortality develops. [ABSTRACT FROM AUTHOR]

The article presents a case of an asymmetric mandibular dysplasia in a newborn due extrinsic compression of the jaw by the infant's shoulder. Examination revealed a severe right-sided head deviation that had been present for an extended period of time in utero. Also, there was lack of subcutaneous tissue and a prominent sternocleidomastoid muscle. Findings suggest that mandibular asymmetry is usually the result of the shoulder being raised up under the mandible as a consequence of breech of prolonged vertex presentation.

The recent increase in the number of cases of syphilis in the UK, including among women of reproductive age, has stimulated the need for a review of practices concerning assessment and management of syphilis in pregnancy and the neonatal period. This paper summarizes available evidence from published guidelines, primary and secondary research. Optimal management of syphilis in pregnancy and the neonatal period relies on the early diagnosis and staging of maternal disease, prompt treatment to prevent congenital syphilis, and timely assessment of newborns. [ABSTRACT FROM AUTHOR]

Normal thyroid function is essential for brain development postnatally, in the first two to three years of life. Over 80% newborns with congenital hypothyroidism appear normal, and cannot be suspected to have CH on the basis of clinical features alone. Delayed thyroxin replacement results in permanent mental retardation. Therefore, neonatal thyroid screening programs have been set up in developed countries, so that appropriate replacement can be started in the first 2 weeks of life. These programs have been shown to be highly cost effective. Worldwide, CH occurs in 1/3,000–4,000 newborns; in India, where the incidence may be higher, screening is not being done universally. In Indraprastha Apollo Hospital, the neonatal team has been screening all newborns (inborn and outborn) almost since its inception (Jan 1997). Most countries have opted for primary TSH screening, while the US uses primary T4. For logistical reasons, we have so far done both tests in each baby, and have moved from screening in the second week of life, to just before discharge (48–72 hrs of life), to testing in the cord blood (liquid sample, not filter paper), keeping the TSH cut-off as 30 uU/ml. Our incidence appears to be much higher than the universal incidence. [Copyright &y& Elsevier]

The article describes the case of an otherwise healthy 3-week-old African American male who developed a temperature of 38.9 degrees Celsius and mild respiratory distress. He was admitted to the inpatient general pediatric wards for concern of sepsis in light of neonatal fever with lung opacities and was recommended to take meropenem and vancomycin to widen antibiotic coverage. The article discusses the clinical manifestations of chronic granulomatous disease (CGD).

Describes high-risk newborn infants with infective endocarditis (IE). Ratio of disease per 100 patients; Microorganisms responsible for the infection; Echocardiographic findings; Characteristics of post-mortem examinations.

The diagnosis of congenital syphilis (CS) in newborns can only be made through a review of the mothers' testing and treatment history and through the infants' clinical and laboratory findings. We describe difficulties in the classification of CS by physicians and the health department during a recent syphilis epidemic. The records of infants identified as potential cases of CS by laboratory testing, discharge diagnosis, or health department records were reviewed by epidemiologists. The reasons for concordance and discordance in classification between the physician and the epidemiologist were determined. Congenital syphilis was identified in 126 infants. Seventeen cases were discordant and 12 cases concordant but the physician's classification was for incorrect reasons. Misclassification occurred because physicians lacked data known to the health department (n=7), health departments lacked data known to the physician (n=1), and physicians misinterpreted the case definition for CS (n=21). Suggestions for improving the diagnosis and reporting of CS are included. [ABSTRACT FROM AUTHOR]

Examines the value of diagnostic tests identifying neonatal sepsis related to intrapartum treatment with antibiotics. Comparison between infants whose mothers received intrapartum antibiotics and those that did not received; Incidence of positive blood cultures after maternal intrapartum treatment with antibiotics.

Determines associated risk factors that would identify babies with possible hearing loss. Relationship between neonatal illness and hearing loss; Age of the population of hearing-loss infants; Risk factors studied; Investigations on the concept of otoacoustic emissions.

The article describes the case of a four-day old female infant who had a history of fever and fussiness. After physical examination, the child was started on ampicillin and gentamicin but she remained febrile and fussy. She progressed to lethargy and poor feeding. A magnetic resonance imaging (MRI) was ordered and she was transferred to the neonatal intensive care unit. She also developed tonic-clonic movements of the upper extremities and she was later diagnosed with encephalitis.

The article presents a case of a 22-month-boy who was brought to a pediatric pulmonary division for evaluation of recurrent wheezing and coughing after being hospitalized with pneumonia. He was diagnosed with a negative newborn screen for cystic fibrosis (CF) with an immunoreactive trypsinogen (IRT) 2 days after his birth. He was also diagnosed with pancreatic insufficiency based on stool pancreatic elastase testing and 2 morphologies of Pseudomonas aeruginosa from a pharyngeal respiratory culture. It states that despite normal newborn screening, there is a need to consider diagnosis of CF and sweat testing should be performed. Nevertheless, screening is not a definitive means of diagnosis and is associated with false positives and false negatives.

Assesses the utility of screening cocaine-exposed infant (CEI) for cardiac ischemia, renal anomalies and silent cerebral infarction with electrocardiography (ECG), urinalysis and noncontrast computed tomography (CT) scan. Characteristics of screened infants; ECG and central nervous system abnormalities; Retention of maternal custody.

Editorial. Comments on the occurrence of neonatal endocarditis. Forms of the disease; Prevalence in older, premature newborns; Diagnosis; Signs and symptoms; Mortality rate.

Examines the possibility of using the umbilical arterial catheter as an alternative to the heel stick collection site in newborn screening. Subjects and methods; Test name; Possibility of errors due to preceding blood transfusion and dilution.

This article discusses whether scanning should be performed in congenital hypothyroidism or not. The goal of hypothyroid screening is early detection of low levels of thyroxine that are associated with a high frequency of mental retardation if the diagnosis is not made early, before clinical findings are obvious. In addition to detection, the system must provide for rapid reporting and bringing in of infants to start replacement therapy, as well as appropriate counseling and education of families to promote adherence to the treatment program, particularly since most children lack any signs or symptoms of hypothyroidism when seen. Any part of the evaluation that goes from optional to needed should enhance these goals. This is especially true of a procedure that might delay the start of treatment, no matter how briefly. Congenital hypothyroidism is a disease requiring lifetime therapy, but it does not necessarily follow that a diagnosis more specific than provided by the screening test and laboratory confirmation is needed. Although thyroid scanning remains the most accurate diagnostic modality to determine the anatomic cause of congenital hypothyroidism, there is no evidence to suggest that such knowledge leads to more effective treatment, better prognostication, or wiser counseling.

Anemia is a common manifestation of congenital syphilis, but rarely is the only presenting feature of the disease. A three-month- old infant is reported who had anemia of sudden onset with no other feature suggestive of congenital syphilis. This case was puzzling to all the physicians involved because the diagnosis of congenital syphilis was never considered. It was only the fortuitous hospitalization of the mother for surgery and the serologic study which led to the diagnosis in the infant. The infant had none of the typical physical findings of the disease. No reports of similar instances of congenital syphilis presenting only with anemia and no other physical sign of the disease could be found in the literature. ..