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Neonatal myocardial infarction (MI), in the absence of congenital heart disease or cardiac surgery involving the coronaries, is a rare condition with associated high mortality. A cluster of neonatal myocardial infarction cases was observed, leading to an investigation of causes and contributors. We performed a single-center review of neonates >37 weeks between 2011 and 2017 to identify neonates with myocardial infarction. Neonates with prior cardiac surgery, congenital anomalies of the coronaries, or sepsis were excluded. Diagnosis of MI was based on ECG changes, elevated troponin, decreased function or regional wall abnormality, and abnormal coronary angiography. There were 4,583 admissions to the NICU without interval changes in referrals or the incidence of neonatal asphyxia. There were six cases of neonatal myocardial infarction. Of 2,155 admissions in the first three years, there were no cases. The incidence in the next three years was 1.3/1,000, 2.7/1,000, and 3.3/1,000. There was a significant difference (0.03, Fishers exact) between the first and second halves of the study period. All cases underwent catheterization, revealing coronary artery thrombosis requiring thrombolytic therapy. Additionally, obstetric providers were surveyed to determine changes in umbilical cord handling practices. Of 48 obstetric providers, 57% changed their practice of cord clamping since 2014: 13% reported cord milking then clamping; 47% delayed cord clamping for a few minutes; 28% delayed cord clamping until the cord stopped pulsating; and 13% immediate clamping. Only 40% reported routine documentation of cord clamping. In conclusion, there was an increased incidence of neonatal myocardial infarction due to coronary thrombosis. Early diagnosis and initiation of therapy of neonates with myocardial infarction can improve outcomes. A larger study cohort could lead to better understanding of risk factors and outcomes of myocardial infraction in neonates.

Background The aetiology and exact incidence of infantile haemangiomas (IHs) are unknown. Prior studies have noted immunohistochemical and biological characteristics shared by IHs and placental tissue. Objectives We investigated the possible association between placental anomalies and the development of IHs, as well as the demographic characteristics and other risk factors for IHs. Patients and methods Pregnant women (n = 578) were prospectively enrolled and their offspring followed for 9 months. Placental evaluations were performed and demographic data collected on all mother-infant pairs. Results We evaluated 594 infants: 34 haemangiomas [either IH or congenital (CH)] were identified in 29 infants, yielding an incidence of 4·5% for IH (27 infants) and 0·3% for CH (two infants). Placental anomalies were noted in almost 35% of haemangioma-related pregnancies, approximately twice the incidence noted in pregnancies with unaffected infants (P = 0·025). Other risk factors for IH included prematurity (P = 0·016) and low birth weight (P = 0·028). All IHs were present by 3 months of age, and cessation of growth had occurred in all by 9 months of age. Most occurred on the trunk. Of note, 20% of identified IHs were abortive or telangiectatic in nature, small focal lesions that did not proliferate beyond 3 months of age. Only one IH required intervention. Conclusions This is the first prospective American study to document the incidence of IHs in infants followed from birth to early infancy. The association with placental anomalies was statistically significant. The overall incidence mirrors prior estimates, but the need for treatment was lower than previously reported.

Though the reported frequency of infant hydrocele has varied, the frequency of hydrocele in the fetus has not been studied. Our purpose was to determine the frequency of fetal hydrocele in the third trimester and subsequent outcome. Of the 123 fetuses studied, 19 fetuses had hydroceles. Of these, 14 babies were normal at follow-up, one baby had a persistent hydrocele, and four babies were lost to follow-up. Our study suggests that hydrocele is a relatively common finding in the third trimester in utero. Moreover, it suggests that parents can be reassured that, in the absence of other abnormalities, a hydrocele is usually a physiologic finding which resolves spontaneously.

Hepatoblastoma is the most common liver malignancy in childhood. The reported incidence is 11.2 cases per 1 million during the first year of life. Genetic predispositions include Beckwith-Wiedemann syndrome and familial polyposis. The prognosis depends on the extent of tumor spreading at the time of initial treatment, which typically includes chemotherapy and surgery. Imaging of hepatoblastoma has only rarely been reported prenatally. Here we report a recent case with a successful outcome and discuss issues of differential diagnosis and treatment.

Color Doppler and gray scale sonography can be used prenatally to identify the location of the cord insertion into the placenta. The purposes of this paper were to (1) relate sonographic identification of placental cord insertion with placental pathology; (2) evaluate the possibility that a marginal cord insertion may evolve into a velamentous cord insertion; and (3) determine the frequency and factors affecting sonographic visualization of cord insertion. Our results show that the sonographic assessment of cord insertion correlated with the pathologic outcome in 83% (106 of 128) of singleton pregnancies and at least one of the fetuses in 72% (8 of 11) of twin or triplet pregnancies. Although the sensitivity for identification of an abnormal cord insertion was low (42%), the specificity was high (95%). Our data suggest that marginal cord insertion evolved into velamentous cord insertion in one singleton and one twin. Our results showed that cord insertion was visualized in 54% of fetuses scanned in a routine clinical practice. Cord insertion visualization was possible at all gestational ages, although it was more difficult at later gestational ages. In conclusion, this study provides evidence that (1) ultrasonography (either gray scale or color Doppler) is useful in identifying normal, marginal, and velamentous cord insertion; (2) marginal cord insertion may evolve into velamentous cord insertion as pregnancy progresses; (3) in clinical practice the cord insertion site was visualized in just over half of the cases, and (4) prenatal identification of marginal and velamentous cord insertion potentially may be useful for planning obstetrical management.