Factors affecting outcome in hypoxic-ischemic encephalopathy in term infants

Forty-nine term infants were prospectively shown to have hypoxic-ischemic encephalopathy (HIE). All infants survived the neonatal period, and all but two infants (seen at 12 months) were followed up to at least 27 months of age. Factors that significantly correlated with outcome included the Sarnat encephalopathy stage and the occurrence of intractable seizures not controlled by phenobarbital sodium alone. There was no association between the one- or five-minute Apgar score, the need for early ventilation, the EEG, the occurrence of seizures, and the subsequent outcome. There was no significant difference in outcome for those infants who received dexamethasone sodium phosphate (n = 29) v those who did not receive the drug (n = 20). A review of 97 term infants with HIE from a regional perinatal program during a one-year period (1979), including 35 of the 49 infants in the present study, did show a significant increase in morbidity and mortality for transported infants.     

Hypoxic-ischemic encephalopathy of the full term newborn. Contribution of the electroencephalogram and trans-fontanelle echography to the prognostic evaluation. Report of 29 cases

This study was aimed at assessing by EEG recording and cranial imaging the cerebral function of 29 full term newborns presenting with hypoxic-ischemic encephalopathy and at establishing a correlation between the results and the neurological outcome. A correlation between the Sarnar's classification and the neurological outcome was observed, except for the intermediate grade. In this case, impairment of the EEG was variable and neurological prognosis was sometimes evidenced by cranial imaging. Unfavorable neurological outcome occurred when thalamic lesions were present, independently of clinical signs and EEG abnormalities.     

Immuno-prevention in newborn infants and infants

The author describes two cases of ambulatory iliac phlebitis occurring in young women, one pregnant, the other taking synthetic oestrogen-progestogen drugs. Anti-coagulants were contraindicated because of the pregnancy in the first case, and because of practical obstacles to their correct use in the second. In consequence both cases were treated as outpatients by physical compression (Nard's method), without any anticoagulant medication : the results were striking and lasting.     

Eosinophilia in newborn infants

To evaluate the clinical significance of eosinophilia in newborn infants, 261 admissions to the neonatal unit over a 12-month period were studied retrospectively; 33 babies with eosinophilia (> 1.0 x 10(9)/l) were studied. Clinical and laboratory data for the first month of life were compared, where available, between gestational age-matched pairs with and without eosinophilia. Of the 33 babies with eosinophilia, 23 were > 26 weeks' gestation and all had age-matched controls; 10 were < or = 26 weeks' gestation but had no appropriate gestational age-matched controls. Babies > 26 weeks' gestation with eosinophilia had a significantly higher number of septic episodes than controls: 20 of 23 versus 4 of 23. All 10 babies < or = 26 weeks' gestation with eosinophilia developed sepsis. Infections with gram-negative organisms and necrotizing enterocolitis occurred only in babies who developed eosinophilia. In 5 babies no cause for the eosinophilia was found. In conclusion, eosinophilia in the newborn is usually explainable and is most often associated with infection.     

Oropharyngeal control of hand-mouth coordination in newborn infants.

This research identifies a coordinative structure of action that integrates hand and mouth activities within hours after birth. Infants in the supine position received 7 presentations of 12% sucrose solution. Differences in hand–mouth coordination relative to preceding and succeeding epochs of nonsucrose presentation were striking: 32% of the sucrose period was spent by infants with hands inside the mouth or in contact with it, and 18%, for the same measures during periods of nonsucrose delivery. In addition the hand was brought to the mouth 50% more often during the sucrose period. These data provide evidence for oropharyngeal control over intergration of gross motor patterns of hand movement as they relate to the mouth. A possible functional significance of these findings is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Kernicterus. Anatomo clinical correlation in 64 newborn infants

The case histories and autopsy reports of 64 neonates who died from kernicterus were reviewed. The most outstanding findings were: high incidence of kernicterus with serum indirect bilirubin less than 15 mg.; different clinical picture of the premature in comparison with term neonate; predisposing factors such as respiratory distress and intrauterine malnutrition were often associated in the premature. Preventive, educational and therapeutic measures were discussed at the end.     

Pigmented lesions in newborn infants

1058 newborn infants were examined. Forty-one (3-9%) had clinically discernible pigmented lesions compatible with melanocytic naevi. Biopsy was performed on thirty-four of the forty-one and of these; eleven, representing 1-01% of the infants, proved to be melanocytic naevi. No giant (garment) naevi were seen in this series. Two of the eleven naevi pathologically examined showed histological changes similar to those that have been reported in some giant naevi, but the remaining nine were not only different from criteria usually assigned to giant naevi, but they also differed from the usual adult naevi, in that most were predominantly junctional. None of the melanocytic naevi in this series showed any suggestion of malignant change. In newborn infants it is often impossible clinically to distinguish naevi from other types of pigmented lesions, as only eleven out of the thirty-four pigmented lesions were melanocytic naevi. Seven of the eleven melanocytic naevi were under 1-5 cm in diameter. No pigmented lesions were found on the palms, soles or genitalia.     

Lymphocyte markers in newborn infants

Purified peripheral blood lymphocytes from 20 newborn infants and 12 adults have been studied for the presence of surface markers. Adults and infants did not differ in the percentage of sheep RBC-binding cells (means 58-65%) or in Ig-bearing cells measured by the mixed antiglobulin reaction (means 7.2-11.6%). However, newborn infants had a significantly lower percentage of lymphocytes binding Fc of IgG (mean 10.4%) as compared to adults (mean 17.2%). No overall correlation between plasma Ig levels and Ig-bearing lymphocytes was found but a single infant with increased plasma IgA also showed the highest level of Ig-bearing lymphocytes among all infants.     

Retinal hemorrhage in newborn infants

The fundi of the 527 infants born within one week were investigated. The results showed that 54 cases (78 eyes) had retinal hemorrhage. Among them, 23 cases (28 eyes) accompanied macular hemorrhage. The retinal hemorrhage in newborn infants was higher in vaginal delivery than in cesarean section, and the incidence of the fetal distress was higher in the newborn infants with macular hemorrhage. The essential causes of the retinal hemorrhage in newborn infants, development of infant macular and the mechanism of amblyopia induced by macular hemorrhage were discussed.     

Visual outcome at 5 years of newborn infants at risk of cerebral visual impairment

Among some 7500 respondents with known place of birth who had completed a nationwide questionnaire survey for multiple sclerosis (MS) in France in 1986, there were 260 born in former French North Africa (Algeria, Morocco, Tunisia). They had migrated to France between 1923 and 1986, but 66% came between 1956 and 1964. Two-thirds were from Algeria, where virtually the entire European population had emigrated in 1962 at the end of the Algerian war for independence. The migrants were younger at prevalence day (mean 43.4 years) and at onset (29.4 years) than the French-born MS (46.6; 31.3 years). Eight migrants lacked age information. The 225 migrants with onset more than 1 year after immigration presumably acquired their MS in France. They provided an age adjusted (US 1960) MS prevalence rate 1.54 times that for all France. If the latter is taken at 50 per 100,000 population their estimated adjusted rate is 76.8 with 95% confidence interval of 67.1 to 87.5. The other 27 with presumed acquisition in North Africa gave an estimated adjusted prevalence of 16.6 per 100,000 (95% CI 10.9-24.1). For those migrants with acquisition in France there was a mean interval of 13 years between immigration or age 11 and clinical onset, with a minimum of 3 years. This series provides further support for the theses: 1) that MS is primarily an environmental disease acquired after childhood; 2) that acquisition requires prolonged or repeated exposure (here 3 years for these medium-to-high MS risk migrants) followed by a prolonged latent or incubation period between acquisition and symptom onset (here 10 years); and 3) that this disease is most likely a widespread but unknown persistent infection which results in clinical MS in only a small proportion of those affected.     

Temporal conditioning of heart rate responses in newborn infants.

Evaluated temporal heart rate conditioning in 32 newborns (16 experimental and 16 control) by examining responses to the UCS, in anticipation of the UCS, and in its absence. There was weak evidence, only in the females, of a conditioned anticipatory deceleration immediately before the UCS. Response differences between the experimental and control groups following the UCS and in its absence were also found. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determination of plasma digoxin in newborn infants. Practical applications

Measurement of plasma digoxin concentrations in infants after three increasing dosage levels shows that the optimal dose of this glycoside in 20 microgram/kg/day, i.e. a loading dose of 20 microgram/kg followed every 8 hours by a maintenance dose of 7 microgram/kg. The plateau concentration achieved is 3.0 +/- 0,5 ng/ml 8 hours after the last administration. When digoxin levels exceed 5 ng/ml (overdosage, renal failure or low body weight), toxic manifestations occur.     

Persistent pulmonary hypertension in newborn infants

On the basis of a review of the literature, a survey is presented concerning persistent pulmonary hypertension of the newborn. In this article the authors focus on the pathophysiology, diagnostic criteria and treatment, including mechanical ventilation, pharmacological vasodilation and extracorporal membrane oxygenation. Particular emphasis is placed on the treatment of the condition with inhaled nitric oxide. Nitric oxide is a selective pulmonary vasodilator and able to improve ventilation/ perfusion mismatching in cases where there is an affection of the pulmonary parenchyma. Data from randomized trials with close long-term follow-up is necessary before routine nitrogen oxide treatment can be recommended.     

Ability of newborn infants to discriminate sapid substances.

Observed taste preferences in newborn infants to determine (a) the ability of newborns to discriminate different sapid substances and different molar concentrations within those substances and (b) the role of immediate prior sucking and ingestion experience in altering subsequent oral behavior. Ss were 48 male and 48 female full-term, single birth 1-3 day old infants. Results show that the sucking rate varied with the substance (glucose, sucrose, and water) delivered through the nipple and with the order in which the substances were presented within a test session. Amount of fluid delivery was controlled automatically by the infant's own sucking behavior, a procedure which provides a taste preference report as well as evidence of the discriminability of taste substances. It remains to be demonstrated that profound taste aversions, resulting in complete inhibition of sucking, are also present at this young age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Persistent hyperinsulinemic hypoglycemia in the newborn and infants

Persistent hyperinsulinemic hypoglycaemia of infancy (PHHI) is the most frequent cause of hypoglycaemia in infancy. Clinical presentation is heterogeneous, with variable onset of hypoglycaemia and response to diazoxide, and presence of sporadic or familial forms. Underlying histopathological lesions can be focal or diffuse. Focal lesions are characterised by focal hyperplasia of pancreatic islet-like cells, whereas diffuse lesions implicate the whole pancreas. The distinction between the two forms is important because surgical treatment and genetic counselling are radically different. Focal lesions correspond to somatic defects which are totally cured by limited pancreatic resection, whereas diffuse lesions require a subtotal pancreatectomy exposing to high risk of diabetes mellitus. Diffuse lesions are due to functional abnormalities involving several genes and different transmission forms. Recessively inherited PHHI have been attributed to homozygote mutations for the beta-cell sulfonylurea receptor (SUR1) or the inward-rectifying potassium-channel (Kir6.2) genes. Dominantly inherited PHHI can implicate the glucokinase gene, particularly when PHHI is associated with diabetes, the glutamate dehydrogenase gene when hyperammonaemia is associated, or another locus.