Clinical Pediatrics

Gerdes, Jeffrey S.; Abbasi, Soraya; Bhutani, Vinod K.; Bowen, Frank W.

doi: 10.1177/000992288602500801pmid: 3731666

Survival and significant chronic morbidity were determined by retrospective chart review for 107 inborn "micropremies." "Micropremies" are defined as appropriate-for-gestational age neonates of <1,001 grams and ≤28 weeks gestation. The overall survival rate for "micropremies" was 64 percent, ranging from 20 percent at 24 weeks to 83 percent at 27 weeks gestation. Race and sex are important determinants of survival in these infants. The incidence of severe, chronic morbidity in "micropremies" is relatively low. The acceptable outcome for "micropremies" supports aggressive perinatal management for fetuses as low as 24 to 25 weeks gestation. However, it is important for physicians to use current statistics from their own institutions when counseling parents and making management decisions.

Walsh, Margaret; McIntosh, Kenneth

doi: 10.1177/000992288602500802pmid: 3731667

Forty-one cases of neonatal mastitis seen at Children's Hospital, Boston since 1947 have been analyzed and the literature since 1950 reviewed. All 41, like those in the literature, occurred in full-term infants 1-5 weeks of age, with a sex ratio of 2:1 (females:males). Bilaterality was rare (3 cases in this series, one in the literature review) and systemic spread or extramammary foci even rarer. The incidence has changed little in the past 35 years except for the larger number of cases in the 1950s. In the present series, all but a few cases have been caused by Staphylococcus aureas, and gram-negative enteric bacilli have not been seen. Therapy is surgical incision and drainage when fluctuance is present, but early treatment with appropriate intravenous antibiotics has apparently obviated the need for surgery in many recent cases. The prognosis for cure of the infection is excellent.

Rhine, William D.; Arvin, Ann M.; Stevenson, David K.

doi: 10.1177/000992288602500803pmid: 3731668

Neonatal aspergillosis is a rare, usually overwhelming multisystem infection diagnosed postmortem. We present a neonate who had a brain abscess diagnosed by CT scan that was found at surgical exploration to contain aspergillus. Treatment included prolonged antifungal medication and several surgical interventions. The child has neurologic sequelae, including a seizure disorder and hemiplegia. There are no previously reported survivors of neonatal aspergillosis.

Friedman, Allan D.; Naqvi, Shehla H.; Arens, Max Q.; Eyler, Margaret A.

doi: 10.1177/000992288602500804pmid: 3524958

Respiratory syncytial virus (RSV) is a common cause of infection in infancy and early childhood. A presumptive diagnosis of RSV infection can frequently be made on clinical grounds. Confirmation can be made by viral culture, which may take 3 to 7 days. Immunofluorescent assay (IFA) is a specific and sensitive test that can provide laboratory confirmation of RSV infection the same day. Rapid diagnosis of RSV infection may have implications regarding prevention of nosocomial spread of RSV, early initiation of anti-viral therapy, use of antibiotics, and duration of hospital stay. Data are presented regarding the use of RSV-IFA and its effect on patient management.

Rubin, Bruce K.; McRobert, Elizabeth; O'Neill, Michael B.

doi: 10.1177/000992288602500805pmid: 3731669

Sick babies often have an umbilical artery catheter (UAC) inserted. To minimize risk to the baby, the catheter is inserted a distance calculated to place it either between the third and fifth lumbar vertebrae or between the sixth and 10th thoracic vertebrae when checked radiographically. The methods used to calculate this insertion distance require that length measurements of the baby be plotted on reference graphs. Directly measuring the distance from the baby's xiphoid process to his pubis and adding this to the distance from the pubis to mid-umbilicus yields an UAC insertion length that places the catheter between T6 and T10 as accurately as methods that require reference charts.

Mimouni, Francis; Porat, Shimon; Merlob, Paul; Zaizov, Rina; Reisner, Salomon H.

doi: 10.1177/000992288602500806pmid: 3731670

The differential leukocyte count was studied within the first 24 hours of life in 115 infants of diabetic mothers (IDMs) appropriate for gestational age (AGA), 16 IDMs large for gestational age (LGA), 104 infants of non-diabetic mothers (INM's) AGA, and 22 INMs-LGA. A significant "shift to the left" was found in IDM's-LGA only. The usual causes of "shift to the left" such as maternal hypertension or fever, respiratory distress syndrome, meconium aspiration, neonatal asphyxia, sepsis, convulsions, or hypoglycemia could not explain this finding. It is hypothesized that increased glucocorticoid secretion may possibly play a role.

Williamson, Paul S.; Donovan Evans, Nolan

doi: 10.1177/000992288602500807pmid: 3731671

Eleven male newborns were circumcised with a local dorsal penile nerve block, and 13 controls were circumcised without anesthetic. Matched pairs of pre- and postcircumcision cortisol levels in the two groups were compared. The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. Blood sampling and anesthetic injection of venipuncture alone did not evoke the adrenal response in uncircumcised control infants. Cortical input or secondary epinephrine elevation may be producing the cortisol elevation in infants despite regional blockage of the afferent nerve pathways.

doi: 10.1177/000992288602500808pmid: N/A

Santhanakrishnan, B.R.; Panneerselvam, S.; Ramesh, S.; Panchatcharam, M.

doi: 10.1177/000992288602500809pmid: 3731672

Pycnodysostosis is a rare bone disease. Visceral manifestations associated with anemia and/or rickets have been reported in pycnodysostosis. Five children with typical findings of pycnodysostosis with hepatosplenomegaly, anemia with rickets, one with visceromegaly and anemia, and another with rickets alone are reported here. These findings strongly suggest that extramedullary erythropoiesis does occur in pycnodysostosis.

doi: 10.1177/000992288602500810pmid: 3731673