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The issues of vertical viral transmission from mother to fetus and the potential complications caused by SARS-CoV-2 coagulopathy are still unclear. There are few literature data about the vertical transmission of SARS-CoV-2 and health outcomes in neonates born to mothers with symptomatic or asymptomatic coronavirus disease, with the existing data based on small sample sizes. This case series study consists of two newborn children (one pre-term and one term) who were born to SARS-CoV-2-positive mothers and admitted to the neonatal intensive care unit a few hours after birth. One child had cyanotic changes that affected the entire left leg and the left forearm, with multiple livid changes on the front of the chest and abdomen, the right upper arm, right thigh, neck, and face, and one child had an altered umbilical cord. The first child was treated conservatively, and the second child was treated surgically. [ABSTRACT FROM AUTHOR]

The radiograph is a cost-effective and minimally invasive testing mechanism used to assist clinicians in the diagnosis of many diseases that affect the newborn. However, radiographic interpretations can differ between radiologists and clinicians. The interpretation of findings is most accurate when considered in the context of the patient's clinical presentation, symptoms, and test results. This column presents readers with a basic approach to reading a radiograph as well as a guide to interpreting both chest and abdominal x-rays. [ABSTRACT FROM AUTHOR]

Background: The effect of different probes and operator experience on the reliability of lung ultrasound (LU) interpretation has not been investigated. We studied the effect of probes and operator experience on the interpretation reliability of LU in critically ill neonates.Methods: This was a prospective, blind, cohort study enrolling patients with basic patterns ("B," "severe B," consolidation). Patients were scanned with microlinear (15 MHz; L15), phased-array sectorial (6-12 MHz; S7), and microconvex (8 MHz; C8) probes, in random order. Static images were acquired in high resolution, anonymized, and included in a pictorial database in random sequences. Seventeen clinicians with different LU experience were asked to blindly assess the pictorial database. Interrater agreement and interpretation reliability were analyzed. Subanalyses according to expertise and probe, and multivariate linear regression (including an "expertise × probe" interaction factor), were also performed.Results: The agreement tends to be lower and more heterogeneous for residents (intraclass correlation coefficient [ICC], 0.82 [95% CI, 0.74-0.9], P < .001; I2, 67%, P = .04) and for fellows (ICC, 0.93 [95% CI, 0.9-0.97], P < .001; I2, 69%, P = .04), especially when using nonlinear probes, compared with senior physicians (ICC, 0.95 [95% CI, 0.93-0.96], P < .001; I2, 0%, P = .433). Area under the curve (AUC) values were high for all probes (L15, 0.96 [95% CI, 0.93-0.99]; C8, 0.91 [95% CI, 0.85-0.98]; S7, 0.86 [95% CI, 0.82-0.91]) and physicians (senior physicians, 0.95 [95% CI, 0.83-0.99]; fellows, 0.95 [95% CI, 0.75-0.99]; residents, 0.86 [95% CI, 0.5-0.99]). Worse reliability and higher heterogeneity were found when the evaluation was performed by residents (AUC, 0.9 [95% CI, 0.85-0.94], P < .01; I2, 93.6%, P < .001) than by fellows (AUC, 0.99 [95% CI, 0.9-0.999], P < .001; I2, 34.3%, P = .09) and/or by senior physicians (AUC, 0.99 [95% CI, 0.9-0.999], P < .001; I2, 18%, P = .236). The "expertise × probe" interaction factor was associated with lower ICC (standardized regression coefficient β, -0.69; P < .0001; adjusted R2, 0.99) and AUC (standardized regression coefficient β, -0.76; P < .0001; adjusted R2, 0.98).Conclusions: LU interpretation in neonates shows good interrater agreement and reliability, irrespective of the probe and rater expertise. The use of nonlinear probes by novice operators is associated with the lowest agreement and reliability. [ABSTRACT FROM AUTHOR]

Purpose: The effects of therapeutic hypothermia (TH) on hemodynamics in newborns with hypoxic-ischemic encephalopathy (HIE) were evaluated.Materials and Methods: Thirty-two neonates (gestational age, 39.4 ± 1.3 weeks) who had TH for HIE and echocardiographic hemodynamic assessments during TH and post-TH period were studied. Gestational-age-matched 34 healthy neonates were enrolled for comparison.Results: During TH, patients had significantly decreased left ventricular cardiac output (LVCO), descending aorta blood flow (DABF), and DABF/LVCO ratio, and increased resistive index of DA compared to controls. Upper body blood flow (UBBF) remained unchanged but UBBF/LVCO ratio significantly increased during TH. Urine output decreased significantly during TH and increased after rewarming, and showed significant positive correlation with DABF/LVCO ratio. Sixteen patients (50%) showed hypoxic-ischemic (HI) lesions on brain magnetic resonance imaging (MRI) and had significantly increased UBBF/LVCO ratio during TH compared to patients without HI lesions. Patients with UBBF/LVCO ratio >55% had significantly higher risk of having HI lesions on brain MRI (odds ratio 13.0; 95% CI, 2.4-70.2).Conclusions: Decrease in cardiac output and descending aorta blood flow, and preferential cerebral redistribution of cardiac output along with an increase in systemic peripheral vascular resistance may affect systemic organ perfusion and cerebral metabolism. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical features and early neurological outcomes in neonatal Chikungunya.Methods: Clinical, pathological and radiological details of neonates with acute encephalitic features and typical rash, later diagnosed as Chikungunya, are presented. Neurodevelopmental evaluation and imaging was done at discharge/three months.Results: Abnormal neurological examination with fever was typical presentation in all 13 babies with/without seizures/peri-oral rashes; 12 had persistent neurological abnormalities at discharge. A follow-up at three months revealed continued neurodevelopmental deficits. Neuroimaging abnormalities were seen in eight out of ten cases.Conclusions: Perinatal Chikungunya should be considered in neonates presenting within first week with fever, encephalopathy and perioral rashes with/without seizures with history of maternal Chikungunya within last week before delivery. [ABSTRACT FROM AUTHOR]

More than 27,000 human genes have been sequenced and described. Only a few of these genes are relevant for common human diseases with regard to diagnostic or therapeutic purposes. This review describes the genetics of common traits and diseases with a particular focus on perspectives for drug discovery and drug therapy in neonates. [ABSTRACT FROM AUTHOR]

Aim: Evaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used and (iii) variation between clinicians' assessments.Methods: Parent and staff questionnaires addressed difficulty in assessing pain/comfort in neonates and strategies used in making assessments.Results: A total of 47 of 50 (94%) parents and 83 of 91 (91%) staff participated; 50% of staff reported it was moderately/very difficult to assess persistent pain, and 13% very easy; 75% of parents found it moderately/very easy and 23% difficult to assess their baby's comfort; 15% of parents thought staff found pain assessment difficult. Staff described 94 different factors indicative of comfort and 139 factors of persistent pain. Terminology differed widely and was often nonspecific; 67% of staff described forming a 'general impression'.Conclusion: Pain assessment is challenging for staff. Most parents feel confident in assessing their babies' comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers. [ABSTRACT FROM AUTHOR]

Background: Despite the advancements in antenatal diagnostic and postnatal management in neonates with esophageal atresia (EA)/tracheoesophageal fistula (TEF) resulting in better survival rates in the developed world, the outcome still remains poor in developing countries. Materials and Methods: Retrospective analysis of medical records of neonates who were operated for EA/TEF from 1991 to 2015 at our center was done. Results: A total of 693 neonates were operated during the study period with male-to-female ratio 1.9:1. Mean birth weight was 2300 ± 840 g and mean gestational age was 36 ± 4 weeks. Prenatal diagnosis with ultrasonography screening was done in only 9% cases. Mean age of neonates at referral was 4.3 ± 1.5 days. Frothing from mouth and tachypnea were the most common presenting features seen in 94% and 78% neonates, respectively. Type III EA was the most common variety seen. Incidence of associated anomalies was 52% with congenital heart disease being most common. Overall postoperative survival rate of 57% was observed. In the past 10 years of study, survival improved to 64% in comparison to 48% during initial 15 years. Poor prenatal supervision, aspiration pneumonia, prematurity, low birth weight, delayed referral and inadequate transport facilities, associated congenital anomalies, and lack of advanced Neonatal Intensive Care Units (NICUs) facilities were the important contributing factors for high mortality. Conclusion: In developing countries, only improving the NICUs and surgical techniques will not deliver a better outcome in neonates with EA/TEF. Emphasis should be on the strengthening of peripheral health services and transport facilities to achieve good survival rates. [ABSTRACT FROM AUTHOR]

Introduction: Wolf-Hirschhorn syndrome (WHS) is a contiguous gene syndrome involving deletions of the chromosome 4p16 region associated with growth failure, characteristic craniofacial abnormalities, cardiac defects, and seizures. Case Report: This report describes a six-month-old girl with WHS with growth failure and typical craniofacial features who died of complex congenital heart disease. Genetic studies revealed a 9.8 Mb chromosome 4p-terminal deletion. At autopsy, the liver was grossly unremarkable. Routine sampling and histologic examination revealed two hepatocellular nodular lesions with expanded cell plates and mild cytologic atypia. Immunohistochemical staining revealed these nodules were positive for glutamine synthetase and glypican 3, with increased Ki-67 signaling and diffuse CD34 expression in sinusoidal endothelium. These findings are consistent with hepatoblastoma or hepatocellular carcinoma. Conclusions: A possible association betweenWHSand hepaticmalignancymay be an important consideration in the care and management of WHS patients. [ABSTRACT FROM AUTHOR]

Background: Ralstonia genus are gram negative bacillus and includes four bacteria namely Ralstonia picketti, Ralstonia Solanacearum, Ralstonia insidiosa and Ralstonia mannitolilytica. These are opportunistic pathogens and cause infections in immunocompromised host. The sources of infection are usually contaminated solutions and water. The majority of the reported cases are caused by R. picketti. It is very rare cause of neonatal sepsis with less than twenty cases reported in literature till date. Case presentation: A late preterm male infant, Indian race was admitted to the neonatal intensive care unit for respiratory distress developing soon after birth. The infant was managed with respiratory support and gradually infant improved and diagnosis of transient tachypnea of newborn was made. At age of 84 h of postnatal life, the infant developed features of neonatal sepsis and investigations were suggestive of sepsis. The infant was started on intravenous antibiotic, multiple vasopressors and steroids. The blood culture showed growth of multi-drug resistant R. picketti. The antibiotics were changed as per sensitivity pattern and infant was discharged in good condition and was accepting breast feeding at the time of discharge. There was also no other case of R. picketti in the nursery during the same time period. Conclusion: Ralstonia picketti is an uncommon cause of neonatal sepsis and usually source of infection are contaminated solutions and medical products. The management involves early detection, treatment with appropriate antibiotics and doing surveillance culture to identify the possible source of infection. [ABSTRACT FROM AUTHOR]

Unlabelled: Primary care providers commonly obtain spine ultrasounds for neonates with simple sacral dimples due to perceived concerns about underlying spinal dysraphism, despite a lack of scientific evidence. Nine papers addressing routine spine ultrasounds for children with sacral dimples showed that 3.4% of the 5166 patients had abnormal spine ultrasounds, compared with the 4.8% reported by another study for children without sacral dimples. Most of the abnormal findings in patients with sacral dimples were of no clinical significance.Conclusion: Sacral dimples do not predict underlying spinal cord malformations, and spine ultrasounds should not be performed for neonates with simple sacral dimples. [ABSTRACT FROM AUTHOR]

Aim: Postnatal hypoglycaemia increases the risk of adverse neurological outcomes in newborn infants, and adequate glucose control requires repetitive and painful blood sampling. This study evaluated a continuous glucose monitoring system (CGMS) that aims to improve glucose control and decrease the frequency of blood samples taken from neonates.Methods: CGMS sensors, which measure glucose values every five minutes and require calibration twice a day, were placed on 20 infants at risk of hypoglycaemia. The infants also underwent blood glucose sampling, and the blood glucose values were compared with CGMS values six times during the first 30 minutes after sampling.Results: We used 97/264 (37%) of the blood glucose values taken for the CGMS calibration. The highest accuracy, a mean of 0.22 (95% confidence interval 0.13-0.30 mmol/L), was found 15-19 minutes after sampling, due to the calibration process. No significant subcutaneous glucose time lag was detectable.Conclusion: The CGMS system was an accurate and feasible method for glucose control, provided earlier detection of hypoglycaemia in newborn infants and reduced their exposure to procedural pain. The delay in calibration in infants was a new finding and needs to be taken into account when comparing CGMS readings to blood glucose values. [ABSTRACT FROM AUTHOR]

Objectives: To generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns. Design: Cross-sectional study. Setting: Neonatal unit of a tertiary care teaching hospital in Kolkata. Participants: 378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities. Interventions: Measurements were recorded using a digital vernier caliper between 24-72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured. Main outcome measures: Gestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios. Results: Mean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance. Conclusions: The normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure. [ABSTRACT FROM AUTHOR]

Background: Considering the increasing rates of early hospital discharge and kernicterus in healthy full term newborns, timely identification of neonates at risk of severe hyperbilirubinemia is of great significance. The aim of this study was to investigate the predictive value of umbilical cord serum (UCS) bilirubin level for subsequent hyperbilirubinemia. Moreover, we compared the predictive value of UCS bilirubin with that of risk factor assessment and predischarge bilirubin level. Methods: In this prospective, cohort study, 450 healthy neonates born at the gestational age of ³ 35 weeks were included. UCS bilirubin concentration, direct Coombs test results, and blood group were determined in the newborns. Total serum bilirubin level was re-assessed before hospital discharge. The subjects were followed-up for 1-4 days after discharge and the total serum bilirubin level was measured in neonates with clinical jaundice. Results of the assessment of risk factors for hyperbilirubinemia were recorded. Results: In total, 319 newborns were followed-up within the study period. The mean UCS bilirubin level in non-icteric and icteric neonates was 2.35 and 2.49 mg/dl, respectively. No significant relationship was found between UCS bilirubin level and development of hyperbilirubinemia (P=0.30), whereas a significant correlation was detected between predischarge bilirubin level and development of jaundice (P=0.009). Gestational age, birth weight, history of jaundice in siblings, and mode of delivery were the clinical risk factors which showed a significant correlation with postnatal hyperbilirubinemia. Conclusion: Based on the findings, UCS bilirubin level could not predict subsequent hyperbilirubinemia. Therefore, the best predictive marker for neonatal jaundice is the assessment of clinical risk factors and predischarge bilirubin level. [ABSTRACT FROM AUTHOR]

This study aims at documenting the changes in ventricular tissue velocities, longitudinal strain and electromechanical coupling during the first month of life. During the neonatal period, when the ventricular myocardium is not yet fully maturated, the heart is subjected to significant hemodynamic changes. We studied the ventricular performance of 16 healthy neonates at three time points over the first month of life: on days 2 (IQR [2;2]), 13 [12;14] and 27 [25;29]. We found that systolic and diastolic tissue velocities increased significantly in both left and right ventricle (by 1.2-1.7 times, p < 0.001). Congruently, we found that peak systolic longitudinal strain of the right and left ventricles increased significantly. However, no significant changes in longitudinal strain rate were observed. Finally, QS-intervals shortened during the neonatal period: being measured at 12 points throughout the left ventricle, time to peak systolic velocity decreased on average to 89 % in the second and to 80 % in the fourth week of life (22.3 ± 0.2 vs. 19.8 ± 0.3 vs. 17.8 ± 0.5 ms, r = −0.564, p < 0.001). When comparing opposing walls of the left ventricle, no dyssynchrony in left ventricular contraction was found. In addition to increasing systolic and diastolic tissue velocities during the first month of life, the time to peak systolic contraction shortens in the neonatal heart, which may reflect an increasing efficiency of the excitation-contraction coupling in the maturing myocardium. While there appears to be no dyssynchrony in ventricular contraction, these findings may extend our appreciation of the immature neonatal heart and certain disease states. [ABSTRACT FROM AUTHOR]

Orbital abscess generally occurs in older children but it can rarely affect infants and neonates too. We report a case of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) neonatal orbital abscess in a 12-day-old term female neonate with no significant past medical history or risk factor for developing the infection. The case highlights the importance of consideration of CA-MRSA as a causative agent of neonatal orbital cellulitis even in a neonate without any obvious predisposing condition. Prompt initiation of appropriate medical therapy against MRSA and surgical drainage of the abscess prevents life threatening complications of orbital cellulitis which more often tend to be fatal in neonates. [ABSTRACT FROM AUTHOR]

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]

Background: Biliary atresia is a rapidly progressive liver disease necessitating prompt diagnosis and surgical intervention, so it must be promptly distinguished from other neonatal/infantile liver diseases. Objective: To determine whether US shear wave elastography (SWE) can differentiate biliary atresia from other neonatal/infantile liver diseases based on liver hardness. Materials and methods: Eleven children younger than 1 year who had suspected liver disease underwent anatomically and temporally-related hepatic shear wave elastography and clinically indicated percutaneous core needle biopsy. Shear wave elastography was performed immediately prior to liver biopsy at the targeted biopsy site using an Acuson S3000 US system/9L4 transducer (Siemens Medical Solutions USA, Malvern, PA). Shear wave elastography was performed using Virtual Touch Quantification (VTQ) and Virtual Touch IQ (VTIQ) modes, and six shear wave speed measurements were acquired from each subject for each mode. Children were placed in two groups based on histology, biliary atresia ( n = 6) vs. non-biliary atresia (other neonatal/infantile liver diseases) ( n = 5), and mean shear wave speed measurements were compared using the unpaired student's t-test (two-tailed). A P-value <0.05 was considered significant. Results: Using the VTQ mode, mean liver shear wave speed was 2.08 ± 0.17 m/s for the biliary atresia group and 1.28 ± 0.13 m/s for the non-biliary atresia group ( P < 0.0001). Using the VTIQ mode, mean liver shear wave speed was 3.14 ± 0.73 m/s for the biliary atresia group and 1.61 ± 0.23 m/s for the non-biliary atresia group ( P = 0.003). Ishak liver fibrosis scores ranged from 3 to 6 for the biliary atresia group and from 0 to 1 for the non-biliary atresia group. Conclusion: Liver shear wave speed is abnormally increased in neonates and infants with biliary atresia. [ABSTRACT FROM AUTHOR]

We describe the clinical presentations of 118 infants admitted to the hospital in New South Wales, Australia, during an epidemic of human parechovirus type 3. Infants presented with an acute sepsis-like syndrome with a high rate of intensive care admission.Background. Infections with human parechoviruses (HPeVs) are associated with a wide range of clinical presentations in children, ranging from mild or asymptomatic infections to severe sepsis-like presentations or meningoencephalitis.Methods. We reviewed medical records of infants admitted to 5 hospitals in New South Wales, Australia, during an outbreak of HPeV-3 infection. Data were collected on clinical presentation, laboratory markers, and outcome of infants with HPeV infection confirmed by reverse transcription polymerase chain reaction.Results. We identified 118 infected infants. Most presented with an acute sepsis-like syndrome with high fever, tachycardia, poor perfusion, and severe irritability. Other common features were erythrodermic rash, abdominal distension, edema, and hepatitis. The age range of infants was 4 days to 9.5 months; 75% were <2 months old, including all but 1 of the 30 infants (25%) admitted to intensive care units (ICUs), who as a group, were significantly younger than infants not admitted to ICUs. Only 4% of evaluable cerebrospinal fluid samples had pleocytosis, but HPeV was detected in 95%. Brain magnetic resonance imaging on a small number of children demonstrated white matter changes and diffusion restriction. Sequencing of the VP1 gene confirmed HPeV-3 in all samples tested. All children recovered without ongoing complications at last follow-up.Conclusions. We report the largest series of HPeV-3 infection in infants, and the first outbreak in Australia. Infants presented with a severe sepsis-like syndrome with a high rate of ICU admissions, but all recovered from the acute infection without complications. Long-term sequelae are unknown. [ABSTRACT FROM PUBLISHER]

Congenital heart disease (CHD) is the most common congenital anomaly in the United Kingdom (UK). Despite major advances in diagnosis and management over the last decade, CHD remains a leading cause of infant morbidity and mortality. Current existing screening tools fail to identify up to 50% of children with CHD before discharge from hospital. Pulse oximetry screening has been well studied and seems a promising screening tool. Combined use of pulse oximetry with fetal anomaly screening and routine newborn examination could detect the majority of critical CHDs in asymptomatic infants. Notably pulse oximetry screening has yet to be incorporated as part of universal screening programme in the United Kingdom. Echocardiography remains the gold standard investigation but is not always available. Chest X-rays and four limb blood pressures are of limited diagnostic value while electrocardiogram helps in only few diagnoses during infancy. A detailed history and thorough clinical examination are of paramount significance in suspected CHD in infants. As the clinical presentation can mimic or overlap with other common conditions in infancy (sepsis, respiratory or metabolic condition), a high index of suspicion with a systematic approach is vital for the timely diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Classical duplications may present along any part of gastrointestinal tract (GIT) from mouth to anus. Atypical or unusual rare varieties of GIT duplications may also occur, but with different anatomical features. Materials and Methods: We reviewed our 5-year record (February 2008-January 2013) to describe clinical profile of unusual GIT duplications in neonates and small infants. Results: Three patients with atypical variety of GIT duplications were managed in our department during this tenure. Two were females and one male. Age was ranged between 11 days and 2 months. All patients presented with massive abdominal distension causing respiratory embarrassment in two of them. In all patients, the pre-operative differential diagnoses also included GIT duplication cysts. Computerized tomography (CT) scan showed single huge cyst in one and multiple cysts in two patients. In one patient the CT scan also depicted a thoracic cyst in relation to posterior mediastinum. At operation, one patient had colonic tubular duplication cyst along with another isolated duplication cyst, the second case had a tubular duplication cyst of ileum with its segmental dilatation, and in the third case two isolated duplications were found. Duplication cysts were excised along with mucosal stripping in one patient, cyst excision and intestinal resection and anastomosis in one patient, and only cysts excision in one. All patients did well post-operatively. Conclusion: We presented unusual GIT duplications. These duplications are managed on similar lines as classical duplications with good prognosis when dealt early. [ABSTRACT FROM AUTHOR]

Anorectal malformation (ARM) is a common neonatal anomaly. Gastrointestinal perforation in a neonate with this anomaly is uncommon. Much rarer, there is a perforation complicating a low ARM with anocutaneous fistula discharging meconium and gas. We present a case of colonic perforation in a neonate with low ARM and an anocutaneous fistula. [ABSTRACT FROM AUTHOR]

Objective: Neutrophil counts are used routinely as part of the sepsis evaluation in newborn infants. In this article, we review the normal blood neutrophil concentrations and the clinical approach to neutropenia and neutrophilia in the neonatal period. Methods: A literature search was performed using the databases PubMed, EMBASE, and Scopus, and the electronic archive of abstracts presented at the annual meetings of the Pediatric Academic Societies. Results: Neutropenia and neutrophilia are documented frequently in premature infants. Neutropenia can be seen in up to 8% of all infants admitted to neonatal intensive care. Neutrophilia is even more common, reported in up to 40% of all preterm infants. Conclusions: Neutrophil counts should be carefully evaluated in premature neonates. Maternal and perinatal history, physical examination, and a limited laboratory assessment is usually adequate for making a diagnosis in most infants. [ABSTRACT FROM AUTHOR]

A mesenchymal hamartoma of the chest wall is a rare benign tumor. Each case has a different clinical course as well as different radiological imaging findings, and various histopathological diagnoses. In addition, mesenchymal hamartoma is sometimes mistaken for a malignant tumor. This report presents a neonatal case of mesenchymal hamartoma of the bilateral chest wall. [ABSTRACT FROM AUTHOR]

Background: The utility of amplitude-integrated electroencephalography (aEEG) monitoring has been established for patients with neonatal hypoxic-ischemic encephalopathy. Objective: To evaluate the role of aEEG in the diagnostic process and treatment of patients with encephalopathy due to inborn errors of metabolism. Methods: Cases collected through an international registry were divided into 5 groups of metabolic disorders. Common aEEG features were sought for each group. Results: In total, 21/30 (70%) cases had abnormal aEEG background patterns, 18/30 (60%) showed seizure activity. Patients with disorders of energy metabolism, hyperammonemia, and organic/amino acidopathies often showed marked aEEG depression with seizure activity. In contrast, aEEGs of patients with peroxisomal disorders did not show major background abnormalities but seizures were present in 5/6 subjects. We report two features of interest: firstly, two tracings displayed an unusual upward shift of the lower aEEG amplitude margin. Secondly, aEEGs of infants with non-ketotic hyperglycinemia showed a pattern we refer to as 'high-frequency burst-suppression pattern'. Conclusions: aEEG in patients with inborn errors of metabolism frequently reveals abnormalities and assists clinicians in the clinical assessment, management and monitoring of these patients. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: The high cerebral morbidity of premature neonates is thought to be related to changes in tissue perfusion in vulnerable areas of the brain. Quantification of power Doppler (PD) images using the index fractional moving blood volume (FMBV) may allow measurement of regional cerebral perfusion. Objective: To evaluate the reproducibility of calculating FMBV using PD ultrasound images to estimate cerebral perfusion. Methods: Two experienced clinicians performed head ultrasounds on 24 normally-grown neonates at less than 33 weeks' gestation. Both clinicians independently acquired and stored three PD images in two different coronal planes. FMBV was calculated offline after selecting two predefined regions of interest within these planes (basal ganglia and subependymal regions). Reproducibility was evaluated by calculating the intraclass correlation coefficient (intraCC) and the interclass correlation coefficient (interCC). Results: FMBV was successfully evaluated in 24/24 neonates by both clinicians. The intraCC for repeatability for observer A was 1.00 (95% CI 1.00-1.00) for the basal ganglia and 0.99 (95% CI 0.99-1.00) for the subependymal region, and for observer B was 0.99 (95% CI 0.99-1.00) for the basal ganglia and 0.96 (95% CI 0.92-0.98) for the subependymal region. The interCC was 0.86 (95% CI 0.68-0.94) for the basal ganglia and 0.93 (95% CI 0.86-0.97) for the subependymal region. Conclusion: Using standardised settings and a well-defined region of interest, the calculation of FMBV using PD images is a reproducible method of estimating neonatal regional cerebral perfusion. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: This study examined EEG under clinical anesthesia in neonates and infants, to clarify how growth affects EEG during anesthesia. Subjects comprised 62 neonates and infants. Patients were divided into four groups according to age: Group 1 (neonates), <1 month; Group 2, 1–2 months; Group 3, 3–5 months; and Group 4, 6 months to 2 years. Anesthesia was maintained with sevoflurane and fentanyl and/or caudal block. At four points of sevoflurane concentration (0.5%, 1%, 1.5%, and 2%), 90% spectral edge frequency (SEF90), burst suppression ratio (BSR), relative beta ratio (RBR) and approximate entropy (ApEn) were analyzed. In Group 4, SEF90, BSR, RBR and ApEn changes were dependent on the concentration of anesthesia, along with changes in sevoflurane concentration from 0.5% to 2% (from 14.3 (2.7) [mean (SD)] Hz to 8.2 (3.8) Hz, from 0.0 to 0.32 (0.36), from −1.58 (0.14) to −1.10 (0.15), and from 0.56 (0.25) to 0.24 (0.25) respectively; p <0.05 each). Conversely, these processed EEG parameters in Group 1 showed little anesthesia-dependent change under sevoflurane concentrations between 0.5% and 2% (SEF90: 7.3 (1.2) Hz vs. 7.7 (2.1) Hz; BSR: 0.51 (0.20) vs. 0.62 (0.29); RBR: −1.00 (0.17) vs. −1.03 (0.27); ApEn: 0.32 (0.18) vs. 0.25 (0.14), respectively). The unique EEG features of neonates during anesthesia rapidly change to the usual anesthesia-dependent patterns seen in older children, with a boundary of 3–5 months old. In infants younger than 6 months old, neural network regulation reflected in EEG by anesthesia is weak. [Copyright &y& Elsevier]

Objective: Neonatal sepsis (NS) is a common and life-threatening disorder in infants. Previous studies showed that interleukin-6 (IL-6) may be a valid non-invasive and rapid method for diagnosis of NS. We conducted this review to assess the validity of IL-6 for predicting NS. Methods: This was a systematic review with meta-analysis. Embase, Medline and Web of Science databases were searched between January 1990 and December 2009. The search terms used were "cytokine", "neonate", "sepsis" and "interleukin-6". We used standard methods recommended for meta analyses of diagnostic test evaluations. The analysis was based on a summary ROC (SROC) curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of meta-analysis. Potential presence of publication bias was tested using funnel plots and the Egger test. Findings: Meta-analysis was performed on 13 publications including 353 infants with sepsis and 691 control infants. The pooled sensitivity and specificity of IL-6 was 0.79 and 0.84, respectively. The maximum joint sensitivity and specificity (i.e., the Q value) in SROC curve was 0.82 and the area under curve (AUC) was 0.89 (95% CI: 0.84-0.94). Meta-regression analysis showed that the diagnostic accuracy of IL-6 was not affected by confounding variables. The evaluation of publication bias showed that the Egger test was not significant (P=0.07). Conclusion: IL-6 seems to be a valid marker for predicting NS. It may be considered for early diagnosis of sepsis in neonatal care units. [ABSTRACT FROM AUTHOR]

Invasive fungal disease is a significant cause of morbidity and mortality in the neonate. The current study aims to assess the 1, 3-βD-Glucan (BG) assay in a prospective analysis in neonates with suspected fungaemia. A multicentre, prospective cohort study was conducted in Johannesburg, South Africa. The study included 72 neonates with clinically suspected late onset sepsis who were at high risk of fungaemia. A BG assay was performed on each patient and correlated with a sepsis classification based on the full blood count, C-reactive protein and blood culture results as no fungaemia, possible fungaemia, probable fungaemia or definite fungaemia. Sensitivity and specificity of the BG assay at levels of 60 pg/mL are 73.2% and 71.0% respectively and at levels of 80 pg/mL are 70.7% and 77.4% respectively. Positive and negative predictive values at 60 pg/mL are 76.9% and 66.7% respectively and at 80 pg/mL are 80.6% and 66.7% respectively. The area under the receiver operating curve is 0.753. The BG assay is a useful adjunct to the diagnosis of invasive fungal disease in neonates. It does, however, need to be considered in the context of the clinical picture and supplementary laboratory investigations. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis is a major cause of mortality and morbidity, especially in developing countries. The goal of the present study was to determine the bacterial etiology and antibiotic sensitivity patterns of neonatal sepsis. Methods: This cross sectional study was conducted on 208 neonates admitted with clinically suspected sepsis over a period of 30 months. Sepsis was divided into early onset sepsis (EOS, ≤5 days of age) and late onset sepsis (LOS, >5 days of age). The two groups were further divided into proven (culture positive ± abnormal markers) and probable (culture negative + abnormal markers) subgroups. Blood culture was performed using Bactec. Results: Of 208 cases, 90 had neonatal sepsis consisting of 38 (26 proven) presented as EOS and 52 (42 proven) as LOS. In the EOS, Escherichia coli (E. coli) was the most common organism followed by klebsiella spp, Staphylococcus aureus (S. aureus). As for LOS, Coagulase-negative staphylococci (CONS) were the most common organism followed by Enterococcus spp, S. aureus. The antibiogram on the isolated E. coli and klebsiella spp revealed a greater combined sensitivity to cefotaxime. Coagulase- negative staphylococci and S. aureus had 100% and Enterococcus spp 90% sensitivity to vancomycin. Conclusion: Escherichia coli and CONS were the most common organisms causing EOS and LOS, respectively. Since the antibiotic sensitivity patterns of these organisms are changed, it seems necessary to conduct bacterial etiology studies and to determine antibiotic sensitivity patterns periodically in order to promote the empirical therapy. [ABSTRACT FROM AUTHOR]

To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy. [ABSTRACT FROM AUTHOR]

Background: Head US, the cornerstone neuroimaging modality in neonates, is believed to be less sensitive than MRI for detecting hypoxic ischemic injury (HII). Most reports comparing these modalities are retrospective and have a long interval between the exams. Objective: To prospectively characterize the range of abnormalities found in US examinations performed within 2 h of brain MRI in encephalopathic neonates. Materials and methods: A total of 76 consecutive exams met our inclusion criteria. Diagnostic performance of the US images was prospectively compared with MRI. Results: MRI was considered positive for HII in 53 neonates. Of the remaining 23, MRI was negative for HII in 9, showed white matter abnormalities unrelated to HII in 8, and was inconclusive in 6. Of the 70 neonates with conclusive examinations, the US exam was regarded as positive in 67. Diagnostic accuracy of US was 95.7%. Conclusion: Our study demonstrates that US should still be regarded as a screening test in neonates. US is more sensitive for the detection of injury than previously reported, and more attention should be paid to proper US technique. MRI shows disease more extensively and should be accomplished as early as possible. [ABSTRACT FROM AUTHOR]

Background: Recent advances in multi-slice computed tomography (MSCT) and three-dimensional computed tomography (3D CT) provide good-resolution images and short scan time for complete diagnosis of congenital heart disease (CHD). In the present study, we found that MSCT rapidly provides clinically relevant information for diagnosing extracardiac vascular anatomy in neonates with CHD. It is less invasive, necessitating only minimum or no sedation and a relatively small amount of contrast material. These advantages are crucial, especially for critically ill neonates. Methods: Between January 2007 and December 2008, MSCT scans were conducted on 41 neonates who were admitted to our neonatal intensive care unit. All the neonates were suspected to have complex CHD after an initial echocardiography examination. The scans were focused on detecting extracardiac vascular anatomy and abnormalities. All the image data sets were sent to image processing workstations for multiplanar interactive viewing and 3D reconstruction. Results: High-resolution MSCT scan images were obtained from 41 patients. Reported indications and findings of extracardiac abnormalities and related structural anatomy pertaining to congenital heart disease from MSCT and 3D CT findings were confirmed by clinical and surgical findings by a team of multidisciplinary congenital heart disease specialists. Conclusion: Based on clinical and surgical confirmation of the MSCT scan results from a multidisciplinary congenital heart disease specialist team, we concluded that adequate information on CHD, specifically that regarding extracardiac abnormalities of the anatomy, can be obtained and MSCT can be used to replace cardiac catheterization. [ABSTRACT FROM AUTHOR]

Enormous progress has been made in assessing the neonatal brain, using magnetic resonance imaging (MRI). In this review, we will describe the use of MRI and proton magnetic resonance spectroscopy in detecting different patterns of brain injury in (full-term) human neonates following hypoxic–ischaemic brain injury and indicate the relevance of these findings in predicting neurodevelopmental outcome. [ABSTRACT FROM AUTHOR]

Abstract: Hepatopulmonary fusion is a rare condition in which a dense adhesion occurs between the right lung and herniated hepatic parenchyma in patients with right-sided congenital diaphragmatic hernia. Plain radiographic and magnetic resonance imaging (MRI) findings of hepatopulmonary fusion in a neonate have been reported in a retrospective study with a small patient population and a case report. However, to our knowledge, there is no report regarding the secondary hepatopulmonary fusion (after right-sided congenital diaphragmatic hernia repair) evaluated with multidetector computed tomography (MDCT) in a neonate. We report a case of secondary hepatopulmonary fusion in a neonate, in which multiplanar and three-dimensional (3D) images were helpful in delineating the precise anatomy for preoperative evaluation. Understanding the diagnostic limitations of plain radiographs and MRI, the use of MDCT with its multiplanar and 3D imaging may emerge as a useful noninvasive imaging modality in the evaluation of possible hepatopulmonary fusion in pediatric patients with right-sided congenital diaphragmatic hernia. [Copyright &y& Elsevier]

Summary: Developmental Hemostasis refers to the age-related changes in the coagulation system that are most marked during neonatal life and childhood. An understanding of these changes is crucial to the accurate diagnosis of hemostatic abnormalities in neonates and children. This paper explains the current understanding of developmental hemostasis and describes the common pitfalls observed in clinical practice through failure to implement the principles into routine diagnostic work. Finally, there is a brief discussion as to a potential physiological rationale for developmental hemostasis and the implications of this for hemostatic interventions in neonates and children. There remains a need for further study to improve our understanding of the implications of developmental hemostasis in normal growth and development. [Copyright &y& Elsevier]

Background and purpose: Diagnosis of Hirschprung's disease is one of the most important problems of pediatric surgeons and leaving it without treatment has its own complications. Early diagnosis in younger age with special attention to clinical and radiological findings can reduce these complications. The aim of this study was to compare the findings of plain abdominal radiography and contrast enema in neonates with Hirschprung's disease. Materials and methods: Twenty seven neonates referred to Boo-Ali Sina Hospital, in Sari (2007-2009) for Hirschprung's disease underwent abdominal X-ray and barium enema, and the findings were evaluated followed by rectal biopsy was. In all cases, radiological and barium enema findings were seen by a radiologist, and in each view presence of serration in colon, distention of colon, absence of gas in colon, small intestinal distention, soap bubble and mottling in RLQ of abdomen, delay on barium transit, recto-sigmoid index, absence or present of TZ (Transitional Zone) were assessed. Data were analyzed using SPSS 16 software. Chi-Square test and descriptive statistical methods were used for comparing abdominal X-ray and barium enema effectiveness for differentiating patients with Hirschprung's disease. Results: The findings in plain abdominal radiography were: colonic distention and TZ (82.59%), absence of gas in rectum (48.15%), small bowel distention (7.41%), soap bubble pattern (3.7%) and mottling in RLQ (3.7%). In contrast the findings of enema of neonates were: distention (70.3%), delayed barium transition (59.2%), transitional zone (55.5%), barium-fecal mixing (22.2%), micro colon (7.4%) and serration (3.7%). Conclusion: A plain abdominal radiography is reliable and useful in diagnosis of the disease in patients with ENiled contrast enema. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The description and evaluation of two EEG-based algorithms for automatic and objective determination of the seizure location in the neonatal brain as it is reflected on the scalp. Methods: Each algorithm extracts the electrical potential distribution of the seizure over the scalp using the higher-order canonical decomposition or Parallel Factor Analysis (PARAFAC), also referred to as the CP model. This model decomposes a tensor in a sum of rank-1 components. The two algorithms differ in the way the tensor is constructed and in the type of activity they are able to extract. While the first method extracts oscillatory seizure activity, the second extracts spike train activity. Results: We compared the seizure localization results of 21 seizures from 6 neonates with post-asphyxial hypoxic ischemic encephalopathy, with that based on the visual analysis of the EEG by a clinical neurophysiologist. There was a good agreement between the two methods in the localization of seizure onset in all. Conclusion: The techniques presented in this paper are robust, objective methods to determine neonatal seizure localization. They can be a useful tool for neonatal EEG analysis and for continuous brain function monitoring. Significance: The proposed algorithms significantly improve neonatal seizure localization and monitoring. [Copyright &y& Elsevier]

Congenital hypothyroidism is one of the most urgent diseases of the neonate. When diagnosed and treated at an early stage, its most important complication, mental retardation, is preventable. The signs of congenital hypothyroidism are nonspecific in neonates. Only 5% of the cases have characteristic clinical findings. One of the most important and earliest signs is prolonged jaundice during the neonatal period. We report herein a case of congenital hypothyroidism, who presented with icterus accompanied with sludge formation into the gallbladder, which disappeared after treatment with L-thyroxine. [ABSTRACT FROM AUTHOR]

Background: It is controversial whether thrombocytopenia is suggestive of one (or more) causative agents of neonatal sepsis: a low platelet count has been related in turn to Gram-positive, Gram-negative or fungal sepsis. Methods: A retrospective, cohort study on 514 very low-birthweight (VLBW) neonates admitted over a 9 year period to a large tertiary neonatal intensive care unit (NICU) in Italy was carried out. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Statistical analysis was performed to look for significant association between thrombocytopenia and sepsis caused by different (Gram-positive, Gram-negative or fungal) organisms. Results: Sepsis diagnosed on microbiological criteria occurred in 197 of 514 VLBW neonates (38.3%), and thrombocytopenia (at least one finding of platelet count <80 000/mm3) was detected in 34 (17.2%) of the 197 septic infants. Thrombocytopenia occurred in 10 of 51 neonates with fungal sepsis (19.6%), and in 24 of 146 with bacterial sepsis (16.4%; P = 0.37). The difference was not significant when clustering for sepsis caused by Gram-positive (nine thrombocytopenic of 51 with Gram-positive sepsis, 17.6%; P = 0.40) and Gram-negative organisms (15/95, 15.7%; P = 0.22), or when considering only coagulase-negative Staphylococcus sepsis (6/37, 16.2%; P = 0.25). Conclusions: In contrast with previous reports, thrombocytopenia might not be an organism-specific marker of sepsis. Caution should be maintained in relating a low platelet count to any infectious agent (or group of agents) in preterm VLBW neonates. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Changes in cerebral impedance in the newborn piglet are able to discriminate, within 1–2h of acute hypoxia, between animals which will have a good neurological outcome, and those who have suffered more severe hypoxia resulting in poor outcome. The aim of this study was to determine if cerebral impedance could be used to identify those human infants with an encephalopathy following acute hypoxia who subsequently have a poor neurological outcome. It is these infants who may benefit most from neural rescue treatment. Methods: Twenty-four newborn term infants with evidence of severe acute intrapartum hypoxia and encephalopathy were studied. Bioimpedance spectroscopy was commenced as soon as possible after birth and repeated every 30min until the infant was 12h old. Neurodevelopmental outcome was assessed at 12 months of age. Results: Although cerebral impedance was different to control values, there was no significant difference in cerebral impedance between hypoxic babies with normal and those with abnormal development. Conclusion: Cerebral impedance was increased in hypoxic babies, as predicted from animal data, but the method was not suitable for discrimination of outcome. Significance: Cerebral impedance is not useful for early identification of infants who subsequently have a poor outcome after acute intrapartum hypoxia and who may benefit from neural rescue treatment. [Copyright &y& Elsevier]

The article discusses about dumbbell neuroblastoma. According to the article, preoperative chemotherapy is recommended in dealing with dumbbell neuroblastomas which are considered to be unresectable tumors. It is reported that the pre-natal diagnosis of a dumbbell neuroblastoma was effectively administered through premature delivery succeeded by chemotherapy.

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]

A male infant born at 32 weeks' gestation with a birthweight of 1030 g was started on intravenous vancomycin for a femoral osteomyelitis. On day 7 of treatment, he developed an erythematous flushed rash, rapidly spreading from the head to trunk and extremities, and became markedly irritable; vancomycin infusion was promptly stopped, with subsequent skin clearance. Given the wide use of vancomycin for the treatment of neonatal infections, a good awareness of red man syndrome signs and symptoms in the neonatal population is fundamental to recognize this adverse drug reaction and manage its rare but possible life‐threatening complications. [ABSTRACT FROM AUTHOR]

We report a 2-month-old child with galactosemia and falsely high glucose readings with a glucometer using mutant variant of quinoprotein glucose dehydrogenase (MutQ-GDH) chemistry. Potentially fatal hypoglycemia could have been induced in the child if insulin infusion had been initiated as per glycemic management protocol. Even though, the product information with the glucometer carries warning regarding interference by high galactose levels, the awareness regarding this interaction is generally poor in many practice settings. Although, false readings have been reported with glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ) glucometers, to our knowledge this is the first case report of a falsely high glucose reading due to high galactose in a proven case of galactosemia with a glucometer using the MutQ-GDH chemistry (a modified GDH-PQQ chemistry). Our experience has prompted us to write this case report and we suggest avoiding these glucometers in neonates and infants when a metabolic disease is suspected. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any ages but it is rare in neonates and infants. Here, we report a case of Fournier's gangrene in a 21 day old male neonate who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gives good results and probably in our setting, to some extent, it is a preventable condition. [ABSTRACT FROM AUTHOR]

The article discusses a study by C. Kiser, U. Nawab, and K. McKenna published within the issue on the role of guidelines on the length of therapy in chorioamnionitis and neonatal sepsis. Conclusions based on this research are cited including the need for close monitoring of symptomatic neonates without risk factors for infection, the intrapartum use of antibiotics that decreases the sensitivity of postnatal blood cultures and the use of physical examination in determining sepsis.

A letter to the editor is presented which discusses a study on the prevalence of glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency among neonates in Iran from April 2007 to April 2009.

Abstract: We report a case of a non-resolving pseudo-obstruction in a 2-week old neonate presenting as an acute abdomen. The diagnosis was made by exclusion of a mechanical cause of the intestinal obstruction through a laparotomy. Pseudo-obstruction is a rare differential diagnosis for neonatal intestinal obstruction. A definitive method of diagnosing this pathology without performing a laparotomy would be useful, as surgery should be avoided if at all possible in pseudo-obstruction. [Copyright &y& Elsevier]

Abstract: Congenital pancreatic cysts are extremely rare in newborns. The case of a neonatal congenital pancreatic cyst with pancreatitis is reported. The rapid increase in cyst size concomitantly with clinical symptoms prompted surgical management. Intraoperatively, the pancreatic head showed signs of chronic pancreatitis, and in attempts to preserve most of the functional pancreatic tissue, a Roux-en-Y cystojejunostomy was performed. Histology demonstrated a true pancreatic cyst with degenerated epithelial lining. [Copyright &y& Elsevier]