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Objective: To compare the maternal and perinatal outcome of triplet pregnancies delivered by cesarean section with those delivered vaginally and to assess whether a vaginal delivery of triplets is still acceptable among women who are interested in further births., Study Design: A retrospective analysis of 73 triplet pregnancies delivered at ≥28 week between 1997 and 2005 in a single tertiary center. Twenty-six triplets planned for a trial of labor were compared with 47 sets of women with triplet gestations who delivered by scheduled cesarean section., Results: Mean gestational age was 33.1 ± 2.9 and 33.4 ± 2.6 weeks for the vaginal and cesarean groups, respectively (NS). 88.4% of the vaginally-intended group had a successful vaginal delivery of all three newborns. There were four cases of mortality among the triplets that underwent a vaginal trial of labor (50/1000) but none in the planned cesarean delivery group. Neonatal and maternal complication rates were not different between the groups., Conclusion: According to the relatively small number of patients included in this study, the safety of vaginal delivery should be considered uncertain. Vaginal delivery for triplets might be possible just in particular cases, >28 weeks, with future risks for further pregnancies, after thorough consult with the couple and under strict protocol.

Postpartum negative mood interferes with maternal-infant bonding and carries long-term negative consequences for infant growth. We examined the effects of birth-related risks on mother's postpartum anxiety and depression. A community cohort of 1,844 low-risk women who delivered a singleton term baby completed measures assessing delivery, emotions during labor, attitudes toward pregnancy and infant, mood regulation, and postpartum anxiety and depression. Under conditions of low risk, 20.5% of parturient women reported high levels of depressive symptoms. Following Cesarean Section Delivery (CSD), 23% reported high depressive symptoms, compared to 19% following Vaginal Delivery (VGD), and 21% after Assisted Vaginal Delivery (AVGD). State anxiety was highest in CSD and lowest in VGD. Mothers undergoing CSD experienced labor as most negative, reported highest somatic symptoms during the last trimester, and were least efficient in regulating negative mood. Postpartum depression was independently associated with higher maternal age, CSD, labor pain, lower negative and higher positive emotions during labor, inefficient mood regulation, somatic symptoms, and more negative and less positive perception of fetus during last trimester. Results demonstrate that elevated depressive symptoms are prevalent in the postpartum even under optimal socioeconomic and health conditions and increase following CSD. Interventions to increase positive infant-related perceptions and emotions may be especially important for promoting bond formation following CSD.

Objectives: To measure 3 intervals of time-induction of regional anesthesia to delivery (I-D), initial skin incision to delivery (S-D), and uterine incision to delivery (U-D)-in elective cesareans and to evaluate the impact of the duration of these 3 components on short-term neonatal outcome., Methods: We reviewed retrospective data on the duration of the components from the computerized database of the obstetrics operation room at the Sheba Medical Center, Tel Aviv, Israel, and from the medical records of term neonates., Results: Sufficient data were available in 933 cases. The parameters associated with longer time to delivery at any stage were epidural rather than spinal anesthesia, maternal diabetes, previous cesarean delivery, antihypertensive treatment, higher birth weight (3456 g and 3285 g for U-D interval longer than 2 minutes and U-D interval up to 2 minutes, respectively; P=0.02), and male fetus. The duration of the I-D, S-D, and U-D intervals had no significant impact on any of the measured neonatal parameters., Conclusion: With regard to neonatal wellbeing, obstetricians have a relatively large safety margin in the time taken for inducing regional anesthesia and making the first and uterine incisions., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background: Although maternal thrombocytopenia during pregnancy is common, its effect on neonatal platelets has not yet been fully evaluated., Methods: We retrospectively evaluated the rate of thrombocytopenia among 767 healthy term neonates (gestational age 37-42 weeks) born to 723 mothers with pregnancy-induced thrombocytopenia to define risk factors predicting thrombocytopenia in this group., Results: Thrombocytopenia was diagnosed in 2.2% of the infants. Multivariate analysis showed that infants with thrombocytopenia were more likely to be male, to be born at lower gestational age and to have lower birth weight associated with lower maternal platelets counts. Maternal platelet counts of 100-149 x 10(9)/L, 50-99 x 10(9)/L, and <50 x 10(9)/L corresponded respectively to 1.7%, 4.3%, and 12.5% of neonatal thrombocytopenia (P = 0.031)., Conclusions: Routine blood counts are recommended, in particular for male infants with low birth weight born to mothers with moderate-to-severe thrombocytopenia.

In a longitudinal study conducted in Israel, the authors compared mothers of preterm twins (n=64) with mothers of full-term single babies (n=75) and twins (n=72). The authors examined the contributions of internal resources (mother's attachment style, mental health, sociodemographic characteristics), external resources (perceived maternal grandmother's support, mother's marital adaptation), and features of the event itself (infant temperament, additional stressful life events, mother's feelings toward her baby or babies) in proximity to the birth, to personal growth 1 year following the birth. Although mothers of preterm twins reported the highest level of negative feelings toward their infants and the lowest level of mental health, they also experienced the greatest personal growth. Younger age and lower level of education, along with higher perceived support from maternal grandmothers contributed to higher personal growth. It seems that in the wake of stress, even mothers who display lower personal resources can rely on their environmental resources and experience personal growth.

Aim: To demonstrate the differences in treatment of isolated rectal bleeding (IRB) by comparing two study time period groups and to evaluate whether decreased treatment intensity increased complications during the follow-up period., Methods: Retrospective recording of medical charts of 307 neonates with IRB during two time periods., Results: The rate of IRB in both period groups was similar among term and near-term infants, but significantly lower among preterm infants in the later period study group. The rate of breast milk feeding among preterm infants increased significantly in the later compared with the early group. Duration of antibiotic treatments and feeding cessation was significantly shortened in the late period study as compared with the early period. The rates of recurrent episodes of IRB among preterm infants were similar in the early and late period groups. No infant developed necrotizing enterocolitis within the episode of isolated rectal bleeding., Conclusions: Decreased treatment duration to 1 day of nil per os and 2 days of antibiotics was not associated with increased rates of deterioration to severe clinical conditions, nor to recurrent episodes of isolated rectal bleeding.

Evaluation of clot formation in neonates is troublesome. Our aim was to investigate cord blood clot formation of pre-term versus full-term infants and adults, using rotating thromboelastogram (ROTEM), Pentafarm, Munich, Germany). ROTEM was investigated in cord blood of 184 full-term and 47 pre-term infants. Measurements of the clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) were obtained in order to asses reference values for this age group, and compare between full-term and pre-term neonates and compared to adult controls. For each infant demographic information and data regarding pregnancy and delivery were gathered. Infants were prospectively followed until discharge. CT and CFT were significantly shorter among pre-term and term infants as compared to adults [median CT: 185, 194, 293 seconds respectively, p pound0.001, CFT: 80, 76, 103 seconds respectively, p pound0.001). MCF was lower in pre-term and term as compared to adults (p pound0.001) with significantly lower values in pre-term as compared to full-term neonates (p=0.004). Clotting time and MCF correlated with gestational age (R=0.132, p=0.045, R= 0.259, p<0.001, respectively). No association was found between any ROTEM values and the occurrence of post-natal complications in infants of our study group. This is the first study assessing clot formation by ROTEM in pre-term infants. Clot formation parameters of term and premature infants correlated with gestational age. The predictive value of clot formation tests in neonates deserves further attention.

Objective: To investigate the extent and risk factors for hypotension among women undergoing elective cesarean section, and whether maternal hypotension has any impact on perinatal infant outcome., Study Design: Retrospective analysis of data on 919 mother-infant pairs after elective cesarean section that involved the use of regional anesthetic. Data collection included information on maternal blood pressure during the cesarean section procedure and any infant perinatal complications., Results: Nearly one-half of the mothers underwent a decrease in their mean arterial blood pressure by > or =30%. The risk factors for hypotension included preoperative hypertension, older age, type of spinal anesthesia, and a higher infant birthweight. A drop in the maternal mean arterial blood pressure exceeding 30% or even 50% compared with the preoperative value was not found to predict any perinatal complications., Conclusion: Despite a very high prevalence of maternal hypotension during cesarean sections, term infants tend to tolerate this placental blood perfusion challenge without any major sequel., (2010 Mosby, Inc.)

Although feeding problems are common during infancy and are typically accompanied by relational difficulties, little research observed the mother-infant feeding relationship across the first year as an antecedent to the development of feeding difficulties. We followed 76 low-risk premature infants and their mothers from the transition to oral feeding in the neonatal period to the end of the first year. Prior to hospital discharge, microlevel patterns of maternal touch and gaze were coded during feeding and nonfeeding interactions, global patterns of maternal adaptation were assessed, and infants' neurobehavioral status was tested. Psychomotor development was evaluated at 4 months. At 1 year, feeding difficulties were determined on the basis of maternal interview and direct observations of feeding interactions. Mothers of infants who exhibited feeding difficulties at 1 year showed less affectionate touch and gaze during nonfeeding interactions and more gaze aversion and lower adaptability during feeding interactions already in the neonatal period. Infants with feeding difficulties demonstrated poorer psychomotor performance at 4 months. Feeding interactions of infants with feeding difficulties at 1 year were characterized by higher maternal intrusiveness, lower infant involvement, and greater infant withdrawal. Less maternal affectionate touch and lower maternal adaptation in the neonatal period, poor infant psychomotor skills, and higher maternal intrusiveness and lower infant involvement at 1 year predicted feeding difficulties. The findings underscore the role of the relational components across the first year in the development of feeding difficulties., (2009 International Society on Infant Studies.)

Objective: To examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome., Method: Using an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother-infant interaction, emotion regulation was microcoded from a fear paradigm, and mother's and infant's cortisol were sampled at baseline, reactivity, and recovery., Results: The infants of depressed mothers scored the poorest on all three outcomes at 9 months-lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity-with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity., Conclusions: Pathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.

Background: Circulating endothelial cells may serve as novel markers of angiogenesis. These include a subset of hem-endothelial progenitor cells that play a vital role in vascular growth and repair. The presence and clinical implications of circulating RNA levels as an expression for hematopoietic and endothelial-specific markers have not been previously evaluated in preterm infants. This study aims to determine circulating RNA levels of hem-endothelial marker genes in peripheral blood of preterm infants and begin to correlate these findings with prenatal complications., Methods: Peripheral blood samples from seventeen preterm neonates were analyzed at three consecutive post-delivery time points (day 3-5, 10-15 and 30). Using quantitative reverse transcription-polymerase chain reaction we studied the expression patterns of previously established hem-endothelial-specific progenitor-associated genes (AC133, Tie-2, Flk-1 (VEGFR2) and Scl/Tal1) in association with characteristics of prematurity and preterm morbidity., Results: Circulating Tie-2 and SCL/Tal1 RNA levels displayed an inverse correlation to gestational age (GA). We observed significantly elevated Tie-2 levels in preterm infants born to mothers with amnionitis, and in infants with sustained brain echogenicity on brain sonography. Other markers showed similar expression patterns yet we could not demonstrate statistically significant correlations., Conclusion: These preliminary findings suggest that circulating RNA levels especially Tie2 and SCL decline with maturation and might relate to some preterm complication. Further prospective follow up of larger cohorts are required to establish this association.

Background: Early-onset neonatal sepsis is a major cause of morbidity and mortality among newborn infants., Objectives: To determine the incidence, type of pathogens and resistance to antibiotics among newborns with early-onset neonatal sepsis, and to identify the risk factors predisposing infants to resistant pathogens in order to reevaluate antibiotic regimens appropriate for resistant bacteria in these high risk neonates., Methods: We retrospectively studied maternal and neonatal variables of 73 term and near-term infants and 30 preterm infants, born over a period of 10.5 years and exhibiting early-onset neonatal sepsis (positive blood cultures in the first 72 hours of life)., Results: Predominant pathogens in term and near-term infants were gram-positive compared with gram-negative organisms (mostly Escherichia coli) in preterm infants. Mothers of infants with antibiotic-resistant organisms weremore likely to have prolonged rupture of membranes and prolonged hospitalization before delivery and to be treated with antibiotics. No trends towards more resistant strains of pathogens were recorded over the 10.5 years of the study period., Conclusions: Early-onset neonatal sepsis in term infants differs in bacterial species from that in preterm infants, with predominantly gram-positive organisms in term and near-term infants and gram-negative organisms in preterms. Rates of bacterial resistance to the combination of ampicillin and gentamicin, though higher among infants born to mothers with prolonged hospitalization who had been treated with antibiotics, still remained very low in our department. Thus, it seems that our classic antibiotic regimen is still appropriate for both term and preterm newborns.

Background: The achievement of oral feeding is a critical task for the premature infant-mother dyad, yet neurobehavioral and relational factors associated with feeding difficulties of low-risk premature infants during hospitalization are not well understood., Aim: To examine the relations between infant neurobehavioral functioning, the transition to oral feeding, and the emerging mother-infant feeding relationship in premature infants., Study Design and Subjects: Ninety-seven low-risk premature infants (birth weight>1000 g; gestational age>30 weeks) and their mothers were followed at the NICU. Neurobehavioral functioning was assessed with the Rapid Neonatal Neurobehavioral Assessment Procedure., Outcome Measures: The duration of the transition to oral feeding and specific feeding difficulties during the transition were assessed. Infant feeding robustness, suck and milk transfer rates, and maternal adaptability, affect, intrusiveness and distractibility were coded from videotaped mother-infant feeding interactions prior to discharge from the NICU., Results: Thirty percent of the infants presented feeding difficulties during the transition to oral feedings. Infants with abnormal neurobehavioral functioning (37% of the cohort) showed more feeding difficulties, slower suck rates, and lower feeding robustness, and their mothers displayed less adaptive and more intrusive behavior. Maternal intrusiveness was related to lower feeding robustness and to lower suck and milk transfer rates. Neurobehavioral functioning and maternal feeding behavior predicted feeding robustness., Conclusions: Less intact neurobehavioral functioning in the neonatal period is related to difficulties during the transition to oral feeding and to less optimal early mother-infant feeding interactions. Low-risk premature infants with poor neurobehavioral functioning should receive special attention and care.

Background: Early hypotension is a common problem among preterm infants. Studies have shown conflicting data regarding the definition of hypotension, the way to treat it and the correlation to outcome., Objectives: To investigate the risk factors for developing hypotension and its relations to short- and long-term outcomes., Methods: Medical charts of all surviving very low birth weight infants were retrospectively reviewed during a 4-year period. The data of infants suffering from early hypotension and needed treatment were compared with those of a control group with 'normal' blood pressure. In addition, medical charts were reviewed for neurodevelopment outcome., Results: The study and control groups comprised 109 infants each. The mean blood pressures were 24.1 +/- 3.2 and 30.3 +/- 4.3 mm Hg in the study and control groups (p < 0.0001). No significant perinatal variables were found to predict hypotension. Bronchopulmonary dysplasia and retinopathy of prematurity were related to treated hypotension. Logistic regression analysis found that neonatal treated hypotension was related to periventricular leukomalacia, with an odds ratio of 2.61 (95% CI 1.0-7.12), p = 0.049. Intraventricular hemorrhages grades 2-4 were found to be related to lower mean blood pressure, with an odds ratio of 1.3 (95% CI 1.12-1.51), p < 0.01. Major long-term neurological disability was found by regression analysis to be related to periventricular leukomalacia and treated hypotension, with odds ratios of 63.1 (95% CI 13.3-299, p < 0.001) and 5.4 (95% CI 1.29-22.7, p = 0.01)., Conclusions: This study supports the hypothesis that early provision of antihypotensive therapy is related to intraventricular hemorrhage, periventricular leukomalacia and major neurodevelopment impairment., ((c) 2008 S. Karger AG, Basel.)

Objectives: To discover the risk factors for developing hypoglycemia in newborns born to diabetic mothers and to characterize the rates of glucose concentrations in the first two days of life., Methods: Retrospective recordings of medical charts of 576 healthy term infants of diabetic mothers during an 18-month period. We determined the following pre-feeding glucose concentrations: 'normoglycemia' (> or =47 mg/dl = 2.6 mmol/l), 'mild hypoglycemia' (40-46 mg/dl = 2.2- 2.5 mmol/l), 'moderate hypoglycemia' (30-39 mg/dl = 1.7-2.1 mmol/l) and 'severe hypoglycemia' (<30 mg/dl = 1.7 mmol/l)., Results: Glucose concentrations below 'normoglycemia' and 'severe hypoglycemia' were observed in 280 (48.6%) and 23 (4%) of the infants, respectively. The main risk factors for developing glucose concentrations below 'normoglycemia' in the first day of life were large size for gestational age and maternal insulin-dependent diabetes mellitus. 'Severe hypoglycemia' was more common among infants born to mothers who needed insulin (either type A2 or insulin-dependent diabetes mellitus). Infants born to mothers with insulin-dependent diabetes mellitus were less mature, heavier, large for their gestational age and exhibited more 'severe and moderate hypoglycemia' in the first day of life as compared to infants born to diabetes type A1 and A2 mothers. In addition, infants who were large for gestational age tended to have more 'moderate hypoglycemia' when born to diabetes type A1 mothers compared to small and appropriate-for-gestational-age infants. Thirty infants (5%) still had hypoglycemia on the second day of life. This subgroup of infants did not differ with regard to maternal-type diabetes., Conclusions: Infants born to diabetic mothers tend to have a high rate of hypoglycemia on the first day of life when a relatively high cut-off point (> or =47 mg/dl = 2.6 mmol/l) is used. Infants born large for gestational age as well as those born to mothers with juvenile diabetes mellitus are at higher risk and should be closely monitored., (Copyright 2009 S. Karger AG, Basel.)

Background: Over the last two decades, the epidemiology, treatment strategy and mortality rate for congenital diaphragmatic hernia have changed., Objectives: To retrospectively analyze our experience with CDH of the last 22 years., Methods: We reviewed the charts of all infants suffering from CDH between 1985 and 2007. Prenatal and maternal as well as perinatal and neonatal data were collected, including outcome parameters. The 71 infants that we identified were divided into two historical groups: from 1985 to 1995 (group 1, 23 patients) and from 1996 to 2007 (group 2, 45 patients)., Results: There was an increase in the incidence of prenatal diagnosis and a subsequent significant decrease in gestational age at diagnosis in group 2 (25 weeks gestation, compared with 30 weeks gestation in group 1, P = 0.018). In addition, we noted a trend toward a reduced number of infants with right-sided hernia and associated cardiac anomalies. The timing to post-delivery surgery was significantly longer in group 2 (20 hours in group 1 vs. 53 hours in group 2, P < 0.001). A significant reduction in postoperative mortality was demonstrated in group 2 compared with group 1 (13.5% vs. 38.7% respectively, P = 0.04),, Conclusion: Our data suggest a higher survival rate for operated infants in group 2 during the last decade, probably due to changes in preoperative methods of treatment as well as later surgery timing compared to group 1. We speculate that today's cases of congenital diaphragmatic hernia are probably milder than in the past due to earlier and more detailed prenatal diagnosis and subsequent termination of pregnancies for the more severe forms of the disorder.

We describe a newborn infant with multiple congenital skull fractures and intracranial hemorrhage. He also had multiple skin folds suggesting a connective tissue abnormality. Electron microscopy of the skin biopsy showed collagen abnormalities with a "hieroglyphic appearance." The analysis of the synthesis of collagen in the cultured dermal fibroblasts demonstrated an accumulation of procollagen I. Molecular analysis found a nonsense mutation Q225X in ADAMTS2 gene, which encodes procollagen I N-terminal proteinase. All these findings confirmed the diagnosis of Ehlers-Danlos syndrome type VIIC (MIM 225410). Family studies suggested a founder effect in Ashkenazi Jews originating from Belarus. Prenatal diagnosis in the subsequent pregnancy reassured the parents that the fetus was an unaffected carrier., (Copyright (c) 2008 Wiley-Liss, Inc.)

Objectives: To determine the association between the first thyroxine blood concentration and necrotizing enterocolitis (NEC) among preterm infants., Study Design: The study group included a cohort of 34 preterm infants with NEC developed at least 48 h after thyroid function screening was obtained. The control group was consisted of 102 preterm infants (3 infants for each infant with NEC, born at the same gestational age) without NEC. Clinical data and first filter paper of total blood thyroxine concentration taken in the first 2 weeks of life were recorded retrospectively and compared between the study and control groups., Results: Mean filter paper total thyroxine concentration was slightly lower in the study group compared to the control group (86.2 nmol/L and 97.8 nmol/L, respectively) but did not reach statistical significance (p=0.14). Nine infants (26.5%) in the study group were small for gestational age (SGA) in comparison to 11 infants (10.8%) in the control group (p=0.07)., Conclusions: It seems that the first thyroxin serum concentration is not a significant predisposing risk factor for NEC in preterm infants.

Our objective was to evaluate the extent of weight loss in very low birth weight (VLBW) preterm infants and to discover how weight loss and other variables correlate with bronchopulmonary dysplasia (BPD). We conducted an observational study of 387 VLBW preterms, gestational age (GA) < 33 weeks, in a single institution over a period of 5 years. The mean weight loss of AGA infants was significantly greater than that of SGA infants. In AGA infants, GA, z-score, weight loss, and male sex were found to correlate with BPD. After adjustments were made for GA and birth weight, each 10% loss of body weight increased the risk for developing BPD by a factor of 2.7. We concluded that excessive weight loss does not prevent BPD in VLBW preterms and presumably should be prevented. Controlled fluid restriction resulting in milder weight loss is probably the right choice.

Isolated sulfite oxidase deficiency is a rare genetic neurometabolic disease. The first symptoms of this disorder (similar to symptoms of ischemic events) may lead to misdiagnosis and to subsequent birth of affected children in these families. This study characterizes the magnetic resonance (MR) imaging and (for the first time, to our knowledge) the MR spectroscopy features of isolated sulfite oxidase deficiency to provide a means for early and correct diagnosis. Three patients with isolated sulfite oxidase deficiency are studied who manifested intractable seizures and severe hypotonia in the immediate postnatal period with an unknown diagnosis, despite extensive workup. MR imaging and proton MR spectroscopy examinations were performed early in the neonatal period in 2 infants and after 5 months in the third infant. The prominent MR features were early cystic white matter damage, accompanied by profound cerebral atrophy in the third infant. Compared with hypoxic-ischemic disorder, MR findings in isolated sulfite oxidase deficiency demonstrate a more severe condition, without subsequent recovery. The MR spectroscopy studies indicate early onset of energetic and metabolic imbalance. Urine stick findings demonstrated high sulfite levels in 2 patients, and the final diagnosis was subsequently made based on molecular, biochemical, and genetic findings. Magnetic resonance imaging and MR spectroscopy measurements may help differentiate isolated sulfite oxidase deficiency from hypoxic-ischemic condition in patients in whom this diagnosis is not clinically suspected and may lead to further genetic antenatal inquiry that might prevent the birth of other infants affected with this severe and incurable congenital disease.

Hospital acquired infections including staphylococcal species are common in neonatal intensive care units. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was recently observed in our unit. The clinical and laboratory characteristics of all neonates with Staphylococcus aureus bacteremia during an 11-year period were retrospectively reviewed. Three groups of patients were compared: 1. Patients with CA-MRSA defined as MRSA-resistant only to beta-lactams, but sensitive to all other antibiotic groups and carried SCCmec IV. 2. Patients with multi-drug-resistant (MDR)-MRSA and 3. Patients with MSSA (methicillin-sensitive S. aureus). Forty-three neonates with documented S. aureus bacteremia were included. Of these 41 were preterm babies. Eleven infants had CA-MRSA, 20 had MDR-MRSA and 12 had MSSA bacteremia, the Panton-Valentine-Leukocidine gene (pvl-gene) was not present in any of these strains. Risk factors, clinical manifestations and laboratory tests were similar in all three groups studied. Although neonates infected with CA-MRSA were more premature and had more related diseases, the mortality rate was similar in all groups (9.1% in the CA-MRSA group). Skin infections, osteomyelitis or pneumatocele were not observed more frequently in the CA-MRSA group. We did not find significant differences in risk factors or outcomes in neonates in the three groups. One possible explanation for this observation is that the CA-MRSA outbreak strain did not contain the pvl-gene, which has been suggested to be a significant virulence factor.

The aim of this study is to evaluate and characterize amplitude-integrated electroencephalogram tracings in preterm infants at varying gestational ages. Eighty-six amplitude-integrated electroencephalogram traces (1.5-9 hours in duration each) were recorded in 32 preterm infants (24-41 weeks of postconception age) during the study period (July 1, 2001, through August 31, 2002). A stepwise rather than gradual progression was detected, with the first step at 24 to 30 weeks, the second at 31 to 34 weeks, and the third at 35 to 41 weeks. The cyclic pattern amplitude-integrated electroencephalogram typical of healthy full-term infants was not detected in the first step, which was marked by a very low baseline and a wide continuous band width of up to 98.5 microV, with a mean of 74.2 microV (SD = 23.3). The first appearance of cycles was in the second group (31-34 weeks), with a mean intercycle band width of 38.3 microV (SD = 26.3) and a cycle band width of 51 microV (SD = 18). The third step (35-41 weeks) differed from the second, having a mean intercycle band width of 16 microV (SD = 3.5; P < or = .001), with quite a similar cycle band width of 43.8 microV (SD = 19.2). The number of cycles per hour increased from a mean of 0.44 (SD = 0.33) per hour to 0.58 (SD = 0.25) per hour in the second and third steps, respectively (P < or = .001). Amplitude-integrated electroencephalogram is a feasible and reliable brain-monitoring tool in healthy preterm infants. Its features are age dependency and stepwise progression. Its real-time clinical significance and prognostic value in healthy and sick preterm infants are yet to be determined.

Background: Necrotizing enterocolitis is a common progressive gastrointestinal disease affecting more than 5% of very low birth weight infants and associated with a high mortality rate., Objectives: To determine whether excessive weight gain in preterm infants is an early sign of NEC., Methods: Seventeen preterm infants with perforated NEC were identified and matched with 17 control subjects for birth weight and gestational age. The postnatal age (days) at diagnosis of NEC was identified, and weight changes as well as clinical and laboratory data were recorded and compared for 7 days prior through 7 days post-diagnosis., Results: A significant difference in weight gain was noticed between D-1 and D 0. The NEC and control groups gained 5.1% and 1.2%, respectively (P = 0.002). None of the sick infants lost weight on days -1 to D 0., Conclusions: Excessive weight gain was observed in premature infants who subsequently developed NEC. Daily evaluation of weight changes should be considered part of a strategy for early identification of infants at risk for developing NEC. Future studies are needed to confirm this finding in a prospective manner and to investigate its pathogenesis.

Our objective was to determine maternal risk factors for developing intrapartum fever during term labor and to evaluate perinatal outcomes for infants exposed to mothers with fever. We performed a retrospective cohort study of 330 mothers and their infants and 330 controls in a single institution. Prolonged labor, nulliparity, maternal disease, and prolonged membrane rupture were found to be the most significant predictors for developing intrapartum fever. Caesarean section and instrumental delivery were more commonly performed. Bacteriuria was present in 10 % of the mothers. Babies born to mothers with fever were more likely to have meconium-stained amniotic fluid. More babies in this group were symptomatic (mostly dyspnea) on admission. No cases of neonatal infection were recorded, and no severe morbidity or mortality was present. We concluded that in low-risk asymptomatic intrapartum fever, infection is the least common explanation. Perinatal outcomes may be influenced by medical decisions due to fever onset, such as delivery mode. Short-term outcomes are favorable.

Aim: To describe a group of neonates with congenital, non-traumatic chylothorax, one of whom developed transient hypothyroidism following treatment with somatostatin., Methods: The charts of seven infants with congenital chylothorax were reviewed in terms of their clinical presentation, the severity of their disease, the complications they presented and the duration of their hospitalization. Their pituitary-thyroid axis function was monitored in particular., Results: The seven infants, all preterm (32-34 wk), suffered from congenital chylothorax and hydrops fetalis diagnosed during the prenatal period. Four were treated by intrauterine drainage, and four had congenital malformations. Hospitalization lasted from 32 to 120 d. Three of the infants suffered from thrombocytopenia, three had chronic lung disease, and one suffered from Gram-negative sepsis. The infant treated with somatostatin initially had normal thyroid function, but later developed primary transient hypothyroidism and was treated with L-thyroxine. The thyroid screening tests for the infants who were not treated with somatostatin were all normal., Conclusions: Repeated doses of somatostatin were effective in reducing chylus production. Administering this treatment earlier should be considered in order to minimize known complications. The only potential side effect observed was primary transient hypothyroidism. Therefore, careful monitoring of the pituitary-thyroid axis is advised.

Objective: To identify the characteristics of mothers who prevent their newborn babies from receiving the hepatitis B vaccine., Methods: Women who gave birth and prevented the administration of routine hepatitis B vaccine to their newborn infants (study group) were compared to women who complied with vaccination (control group). During their hospital stay, both groups were asked to answer a questionnaire constructed to evaluate relevant demographic data, knowledge and attitudes liable to differ between the two groups., Results: The 51 women in the Prevent (study) group were more educated and had a higher income level. They expressed more knowledge about the vaccine, and held more naturalistic and less conventional medical attitudes than did the women in the Comply (control) group (153 women). Some of the reasons given by the Prevent group for vaccine rejection included the following: "The child is too young"; "vaccines are dangerous"; "Doctors vaccinate without consideration"; "Vaccines causes trauma to the baby". The Comply group's reasons for giving the vaccine were mainly "to protect the baby" and "trust in the doctors". Differences between the groups were also found with respect to their future intended behavior. The study group planned to breastfeed for a longer period than the control group. Only 16% of the study group compared to 98% of the control group stated they intended to comply with the full vaccination program offered to developing children. On the basis of the answers to the questionnaire, the Comply group was further subdivided into two groups: those with knowledge and those lacking knowledge (determined by subjective evaluation). This subdivision showed that the differences between the Prevent Group and the Comply group exist, even though knowledge was controlled for., Conclusions: Mothers prevent administration of the hepatitis B vaccine to their newly born children based upon their overall approach, and not due to ignorance. In order to overcome this harmful trend, the medical community must supply counter information that encourages vaccinations.

A neonatal intensive care unit outbreak was caused by a strain of methicillin-resistant Staphylococcus aureus previously found in the community (ST45-MRSA-IV). Fifteen infected neonates were identified, 2 of whom died. This outbreak illustrates how a rare community pathogen can rapidly spread through nosocomial transmission.

Objective: To examine the increasing number of full-term infants at our hospital exhibiting necrotizing enterocolitis (NEC) in order to characterize these cases and to discover common risk factors., Methods: Medical charts were reviewed for all full-term infants (gestational age > 36 weeks) that were born in our institution during a 5-year period (from January 1, 1998 to December 31, 2002) and that developed definite NEC. Data regarding the rate of Cesarean section (CS) in our institution over the study period and five years prior to the study was also recorded., Results: During the 5 years of the study, 14 full-term infants were found to have NEC. The incidence of NEC in full-term infants increased from 0.16 to 0.71 per 1000 live births in the 5-year period. Mean birth weight was 2829 g. All the NEC infants except one were delivered by CS, and all of them were fed either with a mixture of breast milk and formula or entirely by formula. Seven of the infants (50%) had no major known risk factors predisposing them for NEC. Mean age of disease onset was very early (4.1 days) in most of the infants (12 infants), and the colon was the main NEC site. The short-term outcome was favorable in all but one case, which required explorative laparotomy for intestinal perforation. The number of infants born by CS has been steadily increasing, and was almost three times greater during the study period in comparison to the preceding years., Conclusions: The etiology of NEC in the full-term population seems to differ from the etiology for the preterm group in its intestinal location and in the timing of its onset. The increase in the rate of CS over the years might be related to the concurrent increase in NEC, and this relationship should be further investigated.Journal

The association between thrombophilia and neonatal complications was evaluated in a single-center prospective study. Prevalence of genetic prothrombotic markers (FVL, MTHFR, FIIG20210A) and levels of plasma homocysteine were assayed in 166 premature (mean gestational age: 30.9+/-2.3 weeks) and low birth weight (mean weight: 1327+/-319 grams) infants. The incidence of any neonatal complications was compared in infants with and without thrombophilia. A total of 38 infants were defined as "thrombophilic" due to heterozygous FVL (n=4) and/or FIIG20210A (n=8, including one case of combination with FVL) or homozygous 677T MTHFR (n=22) or homocysteine plasma levels above 15 micro mole/liter. Neonatal complications included: small for gestational age (28.8%), respiratory distress syndrome (51.8%), broncho-pulmonary dysplasia (10.2%), patent ductus arteriosus (12.7%), intraventricular hemorrhage (17%), periventricular leucomalacia (8.4%), retinopathy of prematurity (15.1%) and necrotizing enterocolitis in 1.2% of infants. No thrombosis was documented. The prevalence of perinatal complications and the severity of diseases were similar among infants with or without thrombophilia (p = 0.564). Our data suggest that preterm infants with thrombophilia are not at increased risk for developing neonatal complications.

The objective of this study is to identify the risk factors for neonatal thrombocytopenia among preterm infants. During a 4-year study period all consecutive, singleton preterm deliveries (between 27 and 35 weeks of gestation) were evaluated, and separate cohorts were compared-growth restricted (small-for-gestational-age; SGA) and appropriately grown (appropriate-for-gestational-age; AGA) infants. An initial comparison was done for the presence of thrombocytopenia (platelet count below 150,000/mL) and marked thrombocytopenia (below 100,000/mL). Following that, a comparison was made between the groups as determined by platelet count for various possible risk factors. Three hundred and five preterm infants were included in the study. Mean platelet count was significantly lower in the SGA group (p = 0.0009). Ninety-three neonates (31%) were thrombocytopenic and 212 infants with a normal platelet count served as controls. In the thrombocytopenic group, the rate of preeclampsia was significantly higher (p = 0.002). Thrombocytopenic infants had a significantly lower average gestational age at delivery (p = 0.002), lower birth weight (p = 0.0001), and low 5-minute Apgar score (p = 0.0002). They were more likely to suffer from intraventricular hemorrhage (IVH) ( p = 0.04) and sepsis (p = 0.002). Growth restriction, lower gestational age and low 5-minute Apgar score (<7) were found to be significantly independent risk factors for marked thrombocytopenia, when analyzed separately. Growth restriction, lower gestational age at delivery, and low 5-minutes Apgar score are significantly associated with neonatal thrombocytopenia in preterm infants, which may lead to significant morbidity. Screening these high-risk groups for thrombocytopenia might be beneficial in terms of early diagnosis and management.

The objective of this study was to investigate the effect of massage therapy on phase adjustment of rest-activity and melatonin secretion rhythms to the nocturnal period in full-term infants. Rest-activity cycles of infants (measurement 1, n = 16) were measured by actigraphy before and after 14 days of massage therapy (starting at age 10 [+/-4] d) and subsequently at 6 and 8 weeks of age. 6-Sulphatoxymelatonin excretion was assessed in urine samples at 6, 8, and 12 weeks of age (measurement 2, n = 21). At 8 weeks the controls revealed one peak of activity at approximately 12 midnight (11 p.m.-3 a.m.) and another one at approximately 12 noon (11 a.m.-3 p.m.), whereas in the treated group, a major peak was early in the morning (3 a.m.-7 a.m.) and a secondary peak in the late afternoon (3 p.m.-7 p.m.). At 12 weeks, nocturnal 6-sulphatoxymelatonin excretions were significantly higher in the treated infants (1346.38 +/- 209.40 microg/night vs 823.25 +/- 121.25 microg/night, respectively; <.05). It is concluded that massage therapy by mothers in the perinatal period serves as a strong time cue, enhancing coordination of the developing circadian system with environmental cues.

Objective: To suggest a new ultrasonographic approach for prenatal diagnosis of esophageal atresia (EA)., Methods: Since 1995, whenever EA is suspected, we perform a systematic multiplanar ultrasonographic scanning of the fetal upper body in order to demonstrate an esophageal pouch. This includes three image plans of the neck and upper chest: coronal, sagittal and axial views in the cephalic direction. The scan time is 20-30 min., Results: Twenty-five pregnant patients were referred during the period under study for prenatal examinations due to polyhydramnios and/or absent or small stomach. In six fetuses an esophageal pouch was demonstrated at ultrasonography in utero, thus a definitive diagnosis of EA was obtained. All six were confirmed with EA postpartum. In 19 fetuses an esophageal pouch was not demonstrated and all delivered normal neonates. During the same period two additional newborns, who were not included in the referred patients because amniotic fluid volume and stomach size were normal, were diagnosed postpartum with EA. The earliest gestational age of pouch visualization was at 23 weeks. The sagittal view was the best for visualizing a low-level pouch, and the coronal view was optimal for revealing a high pouch., Conclusions: Our three-sectional view of the neck and upper chest is useful for in utero detection of esophageal pouch that may enhance the prenatal diagnosis of EA. The positive predictive value for prenatal ultrasound for detecting EA is 100% with a sensitivity of 80%., (Copyright 2002 John Wiley & Sons, Ltd.)

Objective: To investigate the association between intrauterine growth restriction (IUGR) fetuses with echogenic bowel and high resistance in the umbilical artery and increased risk of developing neonatal necrotizing enterocolitis., Methods: We analyzed two groups: group 1, singleton IUGR fetuses with echogenic bowel or reversed diastolic flow in the umbilical artery, and group 2, neonates who were diagnosed as having neonatal necrotizing enterocolitis. In group 1, the pulsatility index of the superior mesenteric artery and celiac trunk were determined. In group 2, a retrospective analysis was carried out from the medical records of the neonates., Results: Fifteen fetuses with echogenic bowel and severe IUGR were evaluated by Doppler studies, and 21 neonates with neonatal necrotizing enterocolitis were reviewed. In group 1, none of the IUGR fetuses developed neonatal necrotizing enterocolitis, whereas in group 2, only one neonate was defined as IUGR. The mean gestational age at delivery did not differ statistically between the two groups (28.8 +/- 2.3 weeks versus 30.1 +/- 3.3 weeks), whereas the mean birth weight was significantly lower in the first group (700 +/- 200 g versus 1431 +/- 466 g in the second group, P <.001). The mean pulsatility index +/- standard deviation in the superior mesenteric artery and celiac trunk of the IUGR fetuses were 1.5 +/- 0.14 and 1.2 +/- 0.17, respectively, both being found significantly lower than those of normal, appropriate controls (1.9 +/- 0.15 and 1.7 +/- 0.1, respectively, P <.005)., Conclusion: Fetal echogenic bowel in IUGR fetuses is not associated with development of neonatal necrotizing enterocolitis. In these fetuses, vasodilatation in the superior mesenteric artery and celiac trunk have been demonstrated.

Background: The method of "massage therapy" has consistently shown increased weight gain in preterm infants. The weight gain was apparent during massages administered by professionals., Aims: To replicate the results of increased weight gain in the course of "massage therapy" in preterm infants, and utilize a new, cost-effective application of this method by comparing maternal to nonmaternal administration of the therapy., Study Design: Random cluster design., Subjects: The study comprised 57 healthy, preterm infants assigned to three groups: two treatment groups--one in which the mothers performed the massage, and the other in which a professional female figure unrelated to the infant administered the treatment. Both these groups were compared to a control group., Results: Over the 10-day study period, the two treatment groups gained significantly more weight compared to the control group (291.3 and 311.3 vs. 225.5 g, respectively). Calorie intake/kg did not differ between groups., Conclusions: Mothers are able to achieve the same effect size as that of trained professionals, allowing cost-effective application of the treatment within the neonatal intensive care unit.

Objective: To test the hypothesis that continuous gastric infusion (CGI) is better tolerated than intermittent gastric bolus (IGB) in small very low birth weight (VLBW) infants., Design: Two-center, prospective, randomized, unmasked clinical trial., Patients: 28 VLBW infants (birth weight <1250 g). A strict feeding protocol was followed., Intervention: Patients were randomized to IGB or CGI., Main Outcome Measures: Time to reach full feeds (160 cc/kg/d)(by design and real), daily weight, caloric intake, residual gastric volume and type of feeding (formula vs. human milk vs. both)., Results: Five infants failed to complete the study because of death (n = 4) or protocol violation (n = 1). The two groups did not differ by birth weight or gestational age; infants fed via IGB reached full feeds earlier (p = 0.03) and had less delay in reaching full feeds than infants fed via CGI., Conclusion: Contrary to our hypothesis, gravity IGB is more effective than CGI in improving feeding tolerance in small VLBW infants.

The biochemical characteristics of white matter damage (WMD) in preterm infants were assessed using magnetic resonance spectroscopy (MRS). The authors hypothesized that preterm infants with WMD at term had a persisting cerebral lactic alkalosis and reduced N-acetyl aspartate (NAA)/ creatine plus phosphocreatine (Cr), similar to that previously documented in term infants weeks after perinatal hypoxiaischemia (HI). Thirty infants (gestational age 27.9 +/- 3.1 weeks, birth weight 1,122 +/- 445 g) were studied at postnatal age of 9.8 +/- 4.1 weeks (corrected age 40.3 +/- 3.9 weeks). Infants were grouped according to the presence or absence of WMD on magnetic resonance (MR) images. The peak area ratios of lactate/Cr, NAA/Cr, myo-inositol/Cr, and choline (Cho)/Cr were measured from an 8-cm3 voxel in the posterior periventricular white matter (WM) using proton MRS. Intracellular pH (pHi) was calculated using phosphorus MRS. Eighteen infants had normal WM on MR imaging; 12 had WMD. For infants with WMD, lactate/Cr and myo-inositol/Cr were related (P < 0.01); lactate/Cr and pHi were not (P = 0.8). In the WMD group, mean lactate/Cr and myo-inositol/Cr were higher (P < 0.001, P < 0.05, respectively) than the normal WM group. There was no difference in the NAA/Cr, Cho/Cr, or pHi between the two groups, although pHi was not measured in all infants. These findings suggest that WMD in the preterm infant at term has a different biochemical profile compared with the term infant after perinatal HI.

The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.

Attachment has generally been examined from the infant's perspective. We focused on mothers' post-partum thoughts and behaviors. Guided by an ethological approach, maternal bonding was examined under conditions of proximity, separation, and potential loss. Ninety-one mothers were interviewed: mothers of full-term infants who maintained continuous proximity to the infant, mothers of healthy premature infants who were separated from the infant, and mothers of very low birthweight infants who experienced potential loss and prolonged separation. Mothers of term infants reported medium-to-high levels of preoccupations with thoughts of infant safety and well-being. Preoccupations increased with separation (Group 2) and significantly decreased with impending loss (Group 3). Attachment behaviors and representations were the highest among mothers of term infants and declined linearly with the duration of mother-infant separation. Maternal trait anxiety and depression were related respectively to higher levels of preoccupations and reduced attachment behaviors and representations, independent of the infant medical condition and mother-child separation. Discussion focused on the comparability of maternal and infant attachment in relation to the neurobiological system underlying bond formation.

Unlabelled: This prospective study was designed to assess the value of a simple clinical test, a "feeding test", on the outcome of head lag among term neonates. Of 5718 infants who were examined before their morning meal, 67 had moderate to severe head lag in the absence of predisposing risk factors for head lag. Fifteen minutes following feeding, 62 infants (92%) showed an improvement in or disappearance of head lag with concomitant rise in serum glucose. All of these infants had normal psychomotor development on follow up. In 4 infants in whom no improvement occurred after feeding, an underlying pathological cause for head lag was subsequently diagnosed., Conclusion: Use of the feeding test as a screening procedure in apparently healthy newborns with head lag may rule out pathological conditions in over 90% of the cases.

The authors report a rare case of congenital fistula between the distal aspect of the descending aorta and the inferior vena cava. The clinical features of this aortocaval fistula is being described as well as the preoperative diagnostic workup, the intraoperative findings, and the complicated postoperative course and treatment.

Mucormycosis is an uncommon infection caused by fungi of the order Mucorales, family Mucoraceae, and almost always occurs in individuals with predisposing factors such as diabetes mellitus, metabolic acidosis, or immunodeficiency states. Although mucormycosis is a rare infection in childhood, sporadic cases of skin infections have been described in young infants and older children; primary skin infection has been associated with multiple nosocomial outbreaks caused by contaminated elastic bandages. In all reported cases involving premature infants, the elimination of the infection involved surgical debridement. We report for the first time successful conservative treatment with intravenous amphotericin B in a premature infant with primary cutaneous infection caused by Rhizopus oryzae.

This study was designed to investigate the placental transfer of maternal poliovirus antibodies in full-term and pre-term infants. Two hundred healthy, Israeli born mothers and their infants, were enrolled immediately after birth. The study population comprised two groups: a full-term group of 150 mothers and their infants, and a pre-term group of 50 mothers and their infants (gestational age < 35 weeks). Maternal and umbilical cord blood samples were taken in all cases. Antibody titers against the three poliovirus serotypes and a polio virus type 1 strain that caused an outbreak in 1988 (epidemic strain 1) were measured by a microneutralization system. The proportion of individuals with protective titers against each of the poliovirus types tested was slightly lower in the infants compared with their mothers. When protection to all strains combined was tested, the difference between mothers and infants was significant (P < 0.05). Transplacental transfer to epidemic strain 1 was less effective--12% of the premature infants were not protected against it at birth. The geometric mean titers against poliovirus types 1, 3 and epidemic type 1 strain were significantly lower in the pre-term group than in the full-term group. In both the full-term and pre-term groups there were significant linear correlations between the maternal and neonatal antibody titers for each of the polio viruses tested. For all poliovirus types, the transfer of maternal antibodies to the full-term infant was significantly higher than the transfer of maternal antibodies to the pre-term infant (P < 0.001). Owing to diminished transfer of maternal antibodies, pre-term infants are at greater risk of poliovirus infection.

Contralateral acoustic stimulation (CAS) has the effect of reducing the amplitude of transient evoked otoacoustic emissions (TEOAE) of the opposite cochlea. This phenomenon is considered to be mediated via the efferent pathway, from the superior olivary complex through the medial olivocochlear system to the contralateral cochlea. The assessment of this suppressive effect provides an objective and noninvasive technique for exploring the function of the efferent auditory system in humans. Two previous studies investigated the suppression effect of TEOAE in newborns and revealed a significant effect in 18 full-term neonates. In this study, the effect of contralateral acoustic stimulation on TEOAE was investigated in 13 full-term neonates (gestational age, 40-42 weeks). The TEOAE were recorded alternately with and without simultaneous, contralateral white noise. The CAS effect of TEOAE was present in all subjects; a mean of 2.21 dB +/- 1.7 (21% +/- 9.3%) was found. Our study demonstrated additional support for the functional maturity of the medial olivocochlear efferent system from birth.

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.

The influence of topical iodine-containing antiseptics on thyroid function test results of premature infants was determined in two separate studies. Thyroxine and thyrotropin levels were measured on blood-spotted filter paper. Samples were obtained from 128 premature infants on their tenth day of life; the infants were treated in two neonatal intensive care units. Both units used similar treatment protocols; however, one routinely used topical iodinated antiseptic agents (n = 73), whereas the other used chlorhexidine-containing antiseptics (n = 55). There was no difference in the mean T4 levels between the two groups. The mean thyrotropin levels were elevated in preterm babies exposed to iodine (15.4 vs 7.8 mIU/L, p < 0.01). Among the iodine-exposed infants, elevated thyrotropin levels (> 30 mIU/L) were found in 13.7% of infants, compared with none in the chlorhexidine-treated group (p < 0.01). We then studied an additional 46 premature infants who were treated in one neonatal intensive care unit. Iodine-containing solutions were used in 24 infants and chlorhexidine was used in 22 infants. T4 and thyrotropin levels were measured weekly during the first 28 days, one every 2 weeks until the age of 60 days, and at the age of 90 days. Among iodine-exposed infants, 20.8% had thyrotropin values > 30 mIU/L, whereas none of the infants in the chlorhexidine group had elevated thyrotropin values (p < 0.05). The elevated thyrotropin levels correlated positively with the area of disinfection. Elevated urine iodine levels were present reflecting an abnormally high iodine absorption. This study suggests that iodine absorption from topical iodine-containing antiseptics may cause disturbances in thyroid function test results in premature infants. We recommend that caution be exercised in the use of iodine-containing antiseptics in premature infants.

An echovirus type 22 outbreak involving 19 neonatal intensive care unit (NICU) patients during the months of October and November 1992 is reported. Twelve infants presented with diarrhea, 7 of whom had bloody stools and x-ray findings compatible with early stages of necrotizing enterocolitis, while one infant demonstrated characteristic pneumatosis intestinalis. Outbreaks of echovirus type 22 infection in premature infants have rarely been reported. The possibility of Echovirus 22 infection should be considered in neonatal gastrointestinal disease associated with features of necrotizing enterocolitis.