Tissue iron storage patterns in fetal hydrops associated with congestive heart failure

To learn whether fetal congestive heart failure causes a characteristic tissue iron storage pattern, we selected 15 neonatal autopsy cases of hydrops fetalis in which both the clinical and gross autopsy findings suggested intrauterine congestive heart failure. The latter appeared to be due to functional causes in 10 (3 nonhemolytic anemia, 4 cardiac dysrhythmia, 3 dilated cardiomyopathy) and was associated with cardiac malformation in 5. We graded the amount of hepatocellular siderosis, reticuloendothelial siderosis, and renal tubular siderosis in Perls-stained microscopic sections of liver, spleen, and kidney and compared the iron storage pattern with that in 15 normally developed neonatal autopsy controls (4 preterm, 11 term) and a further 7 with hemolytic anemia (5 alpha-thalassemia, 2 parvovirus B19 infection). Liver cell siderosis was absent in the three cases with nonhemolytic anemia. It was increased in 11 of the remaining 12 cases, as in hemolytic anemia controls. Among the five cardiac malformation cases, three had proximal renal tubular siderosis (as in hemolytic anemia controls) attributed to turbulent blood flow through the heart. Among the five, hydrops appeared to be due to prenatal closure of the foramen ovale in one and to prenatal constriction of the ductus arteriosus in another. In one of the five, and despite complex malformation of the heart, hydrops appeared to be due to complete heart block. We concluded that, although clinical information and morphologic assessment of the heart were basic to identifying a cardiac cause of fetal hydrops, histologic assessment of the pattern of iron storage helped confirm the pathologic diagnosis. Analysis of the pathologic findings led to a scheme for categorizing cardiogenic fetal hydrops.     

Fetal supraventricular tachycardia complicated by hydrops fetalis: a role for direct fetal intramuscular therapy

Maternally administered digoxin for the treatment of fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis may be ineffective secondary to poor transplacental drug transfer. We present our experience with eight pregnancies treated with transplacental therapy or combined maternal and direct fetal intramuscular therapy. Response to treatment following maternal intravenous administration (MIV) of digoxin or a combination of fetal intramuscular (FIM) digoxin and MIV is described for eight hydropic fetuses during nine successful pharmacologic conversions. The MIV digoxin was administered using standard loading and maintenance protocols. FIM was administered at a dose of 88 micrograms/kg q 12-24 hours, to a maximum of three injections in the fetal buttock. Time to onset of the first two hours of sinus rhythm (TO2 degrees), time to onset > 90% sinus rhythm (TO > 90%), and time to resolution of hydrops fetalis (HF) were noted. The mean heart rate was 257 +/- 36 beats/minute and the mean gestational age was 29 +/- 4.8 weeks. Fetal SVT was due to a reentrant mechanism in all cases. For the three fetuses that underwent successful cardioversion following MIV digoxin (all required additional maternal antiarrhythmic drugs), TO2 degrees was 145 +/- 114 hours, TO > 90% was 176 +/- 55 hours, and HF resolved in 41 +/- 37 days. Initial combined FIM and MIV therapy in four fetuses resulted in a TO2 degrees of 5.5 +/- 4 hours, TO > 90% of 22 +/- 14 hours, and resolution of HF in 25 +/- 21 days. For the two failed cardioversions with transplacental treatment alone (one fetus had recurrent SVT with hydrops after initial successful cardioversion with MIV), TO2 degrees was 203 +/- 180 hours and TO > 90% was 313 +/- 270 hours. Once FIM was begun in these fetuses, TO2 degrees was 17 +/- 7 hours and TO > 90% was 60 +/- 13 hours; HF resolved in 45 days in one fetus, whereas the other fetus never had resolution of hydrops despite 100 days of antiarrhythmic therapy. Direct fetal intramuscular injection of digoxin combined with transplacental therapy appears to shorten the time to initial conversion of SVT and to sustain sinus rhythm in the fetus with SVT complicated by hydrops fetalis.     

Identification and genetic analysis of Schizosaccharomyces pombe cDNAs that suppress deletion of IRA1 in Saccharomyces cerevisiae

OBJECTIVE: To determine the etiology, pregnancy complications, and outcome of isolated fetal pleural effusion diagnosed antenatally and to evaluate the benefits of prenatal fetal interventions. DATA SOURCES: A literature search of MEDLINE was performed for relevant English language publications between 1985-1991. In addition, reference lists of articles were used to identify reported cases of isolated fetal pleural effusion. METHODS OF STUDY SELECTION: Our search uncovered 31 papers published in peer review journals. From these reports, 82 cases met our selection criteria: All fetuses were diagnosed antenatally with pleural effusion and had no other signs of hydrops at initial diagnosis. DATA EXTRACTION AND SYNTHESIS: The etiology of isolated fetal pleural effusion was unknown in most cases. Possible causes included congenital chylothorax, goiter, lung tumors, and infection. Cardiac defects (4.9%), Down syndrome (4.9%), and polydactyly (1.2%) may be associated with isolated fetal pleural effusion. Perinatal mortality was high (36%) and was related to the development of nonimmune hydrops, prematurity, and pulmonary hypoplasia. Early gestational age at diagnosis of isolated fetal pleural effusion (32 weeks or less) was associated with poor outcome and a neonatal death rate of 55%. In contrast, the neonatal death rate approached 31% as gestational age at diagnosis exceeded 32 weeks. Fifty-four cases were managed conservatively whereas 24 received intrauterine intervention, which included either pleuroamniotic shunt or repeated thoracenteses. Neonatal death rates were 37 and 33%, respectively. CONCLUSION: Not enough data exist to support either the conservative approach or intrauterine pleural drainage in cases of isolated fetal pleural effusion diagnosed antenatally.     

Severe fetomaternal hemorrhage: a review

The etiology, clinical presentation, obstetrical antecedents, and outcome of pregnancies complicated by large fetomaternal hemorrhage (FMH) were reviewed by doing a MEDLINE search from 1966 to the present and manual search before 1966. One hundred thirty-four infants with FMH > 50 dl were reported in the literature. The primary variables: birth weight, gestational age, presence of sinusoidal fetal heart rate pattern, decrease or absent fetal body movements (FBM) estimated the amount of fetomaternal bleeding and the pretransfusion hemoglobin. Other variables included the condition of the infants at birth, erythroblasts, and reticulocyte blood counts at birth, as well as the year of publication. Thirty-five of the 134 cases were preterm. Twenty infants born to mothers reporting decreased or absent FBM survived. FBM was absent in 17 cases for a period ranging between 24 hours and 7 days. In this group, six infants survived, five were stillborn, and five died in the neonatal period. A sinusoidal heart rate (SHR) pattern was reported in 21 cases. A SHR pattern was associated with decreased FBM in 13 cases (39.3 percent). Fifteen cases with sinusoidal fetal heart rate pattern survived (71.4 percent). Both decreased or absent FBM and SHR patterns were reported more often in 1990 or later than before 1990 (P < .0017 and P < .008, respectively). The cause of FMH was not known in 82 percent of the cases. The most common presenting symptoms of FMH were anemia at birth (35.2 percent), decreased or absent FBM (26.8 percent), and unexpected stillbirths (12.5 percent). Seventeen intrauterine transfusions were performed in nine cases (eight survived). A negative correlation was found between pretransfusion hemoglobin and FMH (r = -0.35; P = .0019). No significant difference was found between the cases with FMH of > 200 ml or < 200 ml. Thus, decreased or absent FBM, SHR pattern, or hydrops fetalis are late signs of FMH. Other means of early detection are needed. The role of intrauterine transfusion (IUT) needs to be better defined. The inadequate outcome data indicate the need to follow infants born with large FMH into childhood to document the effect on the central nervous system.     

Neutrophil (granulocyte) transfusions in the new millennium

BACKGROUND: Ebstein anomaly is a rare tricuspid valve anomaly. Some fetuses with Ebstein's anomaly have concurrent severe cardiac function impairment, which results in hydrops fetalis. Most of these fetuses are inevitably terminally ill. No reports have demonstrated the potential prenatal therapy for fetuses under such conditions. CASE: Ebstein's anomaly and hydrops fetalis were detected at 28 weeks' gestation. Tricuspid regurgitation with congestive heart failure was observed. From 28 to 34 weeks' gestation, intrauterine therapy with digoxin, 0.75 mg/d, was administered. The fetal hydrops status improved gradually, while the tricuspid valve regurgitation persisted. At 36 weeks' gestation the fetus was delivered normally. During the neonatal phase, digoxin was continued and gradually tapered off. The tricuspid valve regurgitation and cardiomegaly gradually improved. CONCLUSION: The favorable outcome in this case supports the positive effect of prenatal digoxin therapy for Ebstein's anomaly with hydrops fetalis. In such conditions, upon the appearance of hydrops and congestive cardiac failure, immediate digoxin therapy may be useful. This successful trial encouraged us to manage such fetuses more aggressively.     

Obstetric outcome after RhD and Kell testing

The study was conducted to report on the use of molecular biology methods and pregnancy outcome in women sensitized to either Rhesus D (RhD) or Kell 1 (K1) antigens. Paternal RhD genotype was determined by DNA amplification of an RhD-specific sequence from single sperm cells. Paternal Kell phenotype was determined by serologic assays using peripheral blood samples, and the fetal RhD or Kell-type status were established by the polymerase chain reaction (PCR) with amniotic cells. Thirteen women (14 pregnancies, one with twins) sensitized to RhD and four sensitized to K1 antigens, comprised the study group. All had paternal heterozygosity to either D or K1 antigens. Nine fetuses were RhD positive and five were RhD negative. An additional woman underwent early spontaneous abortion. The nine RhD-positive fetuses underwent a total of 41 invasive procedures. One fetus with hydrops fetalis died in utero after intrauterine blood transfusion. All the remaining RhD-positive fetuses were delivered after 33 weeks gestation, and all those who were RhD negative were delivered at term. Four women were sensitized to the K1 antigen; in three, the fetus was found to be K1 negative, and in one, K1 positive, necessitating intrauterine blood transfusion. In all cases, the results of RhD or K1 genotype analyses from amniotic fluid were compatible with fetal/neonatal red blood cell RhD or Kell phenotypes. In conclusion, the use of molecular biology techniques represents a major advance in the clinical management of RhD and Kell alloimmunization.     

"Relation between mastery behavior in infancy and competence in early childhood": Correction to Messer et al.

Reports an error in "Relation between mastery behavior in infancy and competence in early childhood" by David J. Messer, Mary E. McCarthy, Susan McQuiston, Robert H. MacTurk, Leon J. Yarrow and Peter M. Vietze (Developmental Psychology, 1986[May], Vol 22[3], 366-372). In the article, an incorrect copyright note has been given. The copyright note has been corrected and is included in the erratum. (The following abstract of the original article appeared in record 1986-24138-001.) 53 infants were observed at 6 and 12 mo of age during 2 24-min play sessions. The Bayley Scales of Infant Development (BSID) were given at 6 and 12 mo and the McCarthy Scales of Children's Abilities (MSCA) at 30 mo of age. Results reveal that measures of competence in infancy (successful task completion during play and the BSID scores) were not strongly correlated with the 30-mo MSCA scores. In contrast, infant mastery behavior during play strongly predicted MSCA scores: The time spent investigating toys at 6 mo and persistence in solving tasks at 12 mo of age were behaviors significantly positively correlated with the MSCA scales. It is suggested that infant behaviors that predict later competence do not remain static but change with age and that infants' mastery behavior is a more effective predictor of later development than their competence with either toys or developmental tests. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and behavioral characteristics of physically abused children.

Compared 11 physically abused males (aged 3 yrs 11 mo to 5 yrs 8 mo) on the McCarthy Scales of Children's Abilities (MSCA) and the Wide Range Achievement Test with 10 nonabused males matched on age, family income, and maternal age and education. In addition, behavioral observations of their performance on a persistence task were coded. Significant differences were found on the Verbal and Memory Scales and the General Cognitive Index of the MSCA. No behavioral differences were noted. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between mastery behavior in infancy and competence in early childhood.

[Correction Notice: An erratum for this article was reported in Vol 22(6) of Developmental Psychology (see record 2008-10958-001). In the article, an incorrect copyright note has been given. The copyright note has been corrected and is included in the erratum.] 53 infants were observed at 6 and 12 mo of age during 2 24-min play sessions. The Bayley Scales of Infant Development (BSID) were given at 6 and 12 mo and the McCarthy Scales of Children's Abilities (MSCA) at 30 mo of age. Results reveal that measures of competence in infancy (successful task completion during play and the BSID scores) were not strongly correlated with the 30-mo MSCA scores. In contrast, infant mastery behavior during play strongly predicted MSCA scores: The time spent investigating toys at 6 mo and persistence in solving tasks at 12 mo of age were behaviors significantly positively correlated with the MSCA scales. It is suggested that infant behaviors that predict later competence do not remain static but change with age and that infants' mastery behavior is a more effective predictor of later development than their competence with either toys or developmental tests. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concurrent validity of the Minnesota Child Development Inventory in a nonclinical sample.

Investigated the criterion-related validity of the Minnesota Child Development Inventory (MCDI) in 103 30-mo-olds. Results show that (a) MCDI scales correlated with cognitive but not motor development as measured by the McCarthy Scales of Children's Abilities and (b) the MCDI accurately identified Ss performing below normal in general cognitive development. Findings demonstrate that the MCDI is a valid and clinically useful cognitive developmental screening instrument for preschoolers in the general population. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postnatal growth and psychomotor development in small for gestational age Brazilian infants.

Early psychomotor development (PD), as measured by the Gesell Developmental Schedules, of 29 infants that were small for gestational age (SGA) was more dependent on postnatal growth than the PD of 51 infants whose birth weight was appropriate for gestational age. The significant association of postnatal growth with PD in SGA Ss at 4, 8, and 12 mo of age was not explained by birth weight or SES. Findings support the hypothesis that the factors that determine postnatal growth in SGA infants also affect neurointegrative development. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Follow-up study on physical and mental development in small-for-gestational age infants

A follow-up study on physical and mental development was carried out in 35 small-for-gestational-age (SGA) and 35 appropriated-for-gestational age (AGA) infants. Excluded for congenital abnormality, intrauterine infection, and neonatal asphyxia SGA and AGA infants were similar in maternal education level, infant sex, illness, and feeding history. The results revealed that the body weight (8.09 +/- 0.73kg), height (69.55 +/- 2.49 cm), head circumference (43.27 +/- 1.67cm), Kaup index (16.17 +/- 1.05), and development quotient (96.37 +/- 5.76, Gesell diagnostic method) level at 40 weeks of age in SGA infants was lower than that in AGA infants (P < 0.001), and the development quotient (DQ) in SGA infants was especially low in language and receptive regions. Cord serum insulin level was significantly correlated with follow-up body weight, height, and DQ level (P < 0.01). This article proposed that infants with intrauterine growth retardation have a physical development delay at 40 weeks of age, and which could be predicted by measuring cord insulin level.     

Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies

OBJECTIVE: The aim of our study was to investigate whether women with placental abruption, intrauterine fetal death or small for gestational age infants have metabolic and/or haemostatic abnormalities which are known to be risk factors for intravascular thrombosis. DESIGN: For two years blood tests were performed at > 10 weeks after delivery on all women without hypertensive disorders either before or during pregnancy, who had been consecutively admitted to our hospital with placental abruption, intrauterine fetal death and small for gestational age. SAMPLE: A total of 62 women who had placental abruption (n = 31), intrauterine fetal death (n = 18) and a small for gestational age infant (n = 13). SETTING: Obstetric outpatient clinic in a university hospital (Free University Hospital, Amsterdam). METHODS: Presence of hyperhomocysteinaemia, various coagulation abnormalities and anticardiolipins was investigated. RESULTS: Abnormalities were found in 20 women in the placental abruption group (20/31, 65%), in 10 women in the intrauterine fetal death group (10/18, 56%) and in 11 women in the small for gestational age group (11/13, 85%). Eight out of these 31 women had more than one abnormality. In the group of 62 women protein S deficiency was demonstrated in 26%, hyperhomocysteinaemia in 24%, Protein C deficiency in 6%, anticardiolipin IgG in 11%, anticardiolipin IgM in 5%, Lupus anticoagulant in 2%. An antithrombin III deficiency was not found. Thirty-three women were tested for activated protein C resistance (9% positive) and factor V Leiden mutation (6% positive). Hyperhomocysteinaemia was treated with a daily oral dose of 250 mg pyridoxine and 5 mg folic acid. After six weeks of vitamin supplementation homocysteine levels were tested again. At that time a mean reduction of fasting homocysteine value of 68% (95% CI 57-79) was found and of post-load value of 65% (95% CI 55-76). CONCLUSIONS: Based on the results of our study, it can be concluded that women whose pregnancies are complicated by either placental abruption, intrauterine fetal death or small for gestational age, even if there is no history of thrombo-embolic disorders or hypertension during pregnancy, should be advised to undergo an examination for metabolic and/or haemostatic abnormalities.     

Evidence of participation of the soluble tumor necrosis factor receptor I in the host response to intrauterine infection in preterm labor

PROBLEM: This study was conducted to determine whether: (1) the soluble tumor necrosis factor receptor I (sTNF-rI) is present in human amniotic fluid, neonatal urine, and the feto-maternal plasma; (2) there are changes in the concentration of the sTNF-rI in amniotic fluid with gestational age; and (3) microbial invasion of the amniotic cavity (in term and preterm parturition) is associated with changes in amniotic fluid sTNF-rI concentrations. METHOD: Amniotic fluid was retrieved by amniocentesis from 185 women classified into 11 groups according to gestational age (midtrimester, preterm gestation, and term), the presence or absence of labor, spontaneous rupture of membranes and microbial invasion of the amniotic cavity. sTNF-rI was assayed with a sensitive and enzyme-linked immunosorbent assay (ELISA) validated for amniotic fluid. In addition, sTNF-rI concentrations were determined in fetal blood obtained by cordocentesis in preterm gestations (N = 24) or at the time of delivery after spontaneous labor at term (N = 10). sTNF-rI concentrations were also measured in maternal venous and cord blood and neonatal urine (n = 13). RESULTS: sTNF-rI was found to be present in all amniotic fluid samples, maternal blood and fetal blood and neonatal urine samples; sTNF-rI concentrations were higher in the midtrimester than at term (mean +/- SD: 36.2 +/- 12.2 ng/ml versus mean +/- SD: 5.56 +/- 5.72 ng/ml [P < .05]); patients with preterm labor and microbial invasion of the amniotic cavity (with intact or with ruptured membranes) had significantly higher amniotic fluid concentrations of sTNF-rI than patients without microbial invasion; in the absence of microbial invasion, parturition (both term and preterm) was not associated with changes in amniotic fluid concentrations of sTNF-rI; neonatal urine contained the highest concentrations of sTNF-rI of all biological fluids assayed including maternal and neonatal/fetal blood and amniotic fluid. CONCLUSIONS: It was concluded that sTNF-rI is a physiologic constituent of amniotic fluid, as well as of the fetal and maternal plasma; that amniotic fluid sTNF-rI concentrations decrease as a function of gestional age and increases in the concentration of the sTNF-rI are part of the host response to intrauterine infection in preterm parturition.     

A critical review of intrauterine fetal transfusion

A critical review of 142 intrauterine fetal transfusions performed in 99 patients during 107 pregnancies raised doubts about the absolute benefit of the procedure. Two main problems emerged: the diagnostic criteria upon which decisions were based were inadequate and the fetal mortality associated with transfusion was high, especially when this was performed before 28 weeks. We measured amniotic fluid bilirubin concentration by a biochemical method but the results following intrauterine fetal transfusion were similar to those observed by others using spectrophotometric examination of amniotic fluid.     

Neurodevelopmental investigation of academic achievement: A report of Years 1 and 2 of a longitudinal study.

Investigated the neuropsychological and cognitive basis of early achievement among 105 kindergartners (mean age 5 yrs 6 mo) to determine the stability of this relation over a 2-yr period. Portions of the Reitan–Indiana Neuropsychological Test Battery and the McCarthy Scales of Children's Abilities were used to predict readiness skills in kindergarten (Year 1) and later achievement in 1st grade (Year 2). MANOVA revealed that (a) neuropsychological and intellectual function was related to early achievement; (b) multiple correlations were similar for the Reitan–Indiana and McCarthy variables with kindergarten readiness skills (Year 1); (c) multiple correlations were higher for the Reitan subtests than they were for the McCarthy for Spelling, Reading, Total Reading, and Total Mathematics achievement for 1st grade (Year 2); (d) the Reitan and McCarthy subtests showed similar accuracy for discriminating high, average, and low readers in 1st grade; and (e) specific predictor variables were relatively stable across 2 yrs of development. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental development: Concordance for same-sex and opposite-sex dizygotic twins.

Administered the Bayley Scales of Infant Development, the Stanford-Binet Intelligence Scale, the McCarthy Scales of Children's Abilities, and the Wechsler Preschool and Primary Scale of Intelligence to 375 same-sex and opposite-sex dizygotic (DZ) twins from 3 mo–6 yrs of age. With 1 exception (9 mo), there was no significant difference in concordance at any age for same-sex and opposite-sex twins. In both groups, the within-pair correlations increased during early childhood to a maximum value at 3 yrs, then gradually regressed at 6 yrs. Data provide no evidence of greater discordance among opposite-sex twins for mental development in the preschool years. It is concluded that sex differences may be set aside as a nonsignificant factor in the concordance estimates for DZ twins. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of indomethacin tocolysis on fetal ductus arteriosus constriction with advancing gestational age

OBJECTIVE: Our purpose was to determine whether continuing exposure to indomethacin tocolysis is associated with an increased incidence of constriction of the human fetal ductus arteriosus with advancing gestational age. STUDY DESIGN: Fetal echocardiograms were reviewed in 61 cases in which the pregnant women were treated for preterm labor with indomethacin (25 mg orally every 6 hours). Density function analysis and regression analysis were used to assess the effect of indomethacin tocolysis on ductal constriction with advancing gestational age. RESULTS: A total of 193 fetal echocardiograms were obtained for 72 fetuses. Ductal constriction developed in 50% of the fetuses ranging from 24.7 to 35.0 weeks' gestation. Fetuses with indomethacin-induced ductal constriction demonstrated a greater increase in systolic flow velocities with advancing gestational age compared with the nonconstricted group (p < 0.05). Constriction was detected at a mean gestational age of 30.9 +/- 2.3 weeks at an average of 5.1 +/- 6.0 days after initiation of therapy. Ductal constriction occurred by 31 weeks' gestation in 70% of the affected fetuses. After discontinuation of indomethacin therapy, all follow-up echocardiograms demonstrated a return to nonconstricted ductal flow velocities. No significant adverse neonatal outcomes were attributed to indomethacin use. CONCLUSIONS: A dramatic yet reversible increase in the incidence of indomethacin-induced ductal constriction occurs at 31 weeks' gestation. However, ductal constriction can occur at any gestational age. With indomethacin tocolysis, weekly fetal echocardiography is warranted for the duration of therapy.     

In which neonates does early recombinant human erythropoietin treatment prevent anemia of prematurity? Results of a randomized, controlled study

To assess whether erythropoietin (EPO) treatment is safe and reduces the need for transfusion, we randomized 44 preterm infants to an EPO group and a comparable control (CON) group. EPO 150 U/kg was given s.c. twice weekly for 6 wk from the 1st wk of life. Hematologic parameters, transfusion requirements, and growth were followed during therapy and for 6 mo thereafter. To better assess in which neonates EPO treatment was effective, we classified retrospectively the EPO and CON groups into uncomplicated neonates (EPO A: n = 9, birth weight = 1247 +/- 126 g, gestational age = 29.8 +/- 1.5 wk; CON A: n = 7, birth weight = 1217 +/- 145 g, gestational age = 29.9 +/- 1.5 wk) and neonates requiring artificial ventilation (EPO B: n = 16, birth weight = 1169 +/- 249 g, gestational age = 28.1 +/- 2 wk; CON B: n = 12, birth weight = 1173 +/- 215 g, gestational age = 28.3 +/- 2 wk). There were significant differences in reticulocytes between both uncomplicated and ventilated neonates in the EPO group compared with respective control groups. However, the need for transfusion was significantly less in the uncomplicated EPO group (EPO A: 0.44 +/- 0.73 versus CON A: 1.28 +/- 0.75, p < 0.05) but not in the neonates on ventilation (EPO B: 8.25 +/- 5 versus CON B: 7.75 +/- 3.7). In conclusion, early EPO administration reduces the need for transfusion in uncomplicated premature neonates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thrombolytic therapy with tissue plasminogen activator for prevention of vasospasm in experimental subarachnoid hemorrhage: its efficacy and problems

Parvovirus B19 infection has been associated with fetal anaemia, hydrops, and in some cases demise. Most of the reported cases of fetal hydrops were detected in second-trimester fetuses. We report a series of three cases in which human parvovirus infection was associated with hydropic changes at an earlier gestational age. Spontaneous resolution of hydrops occurred in all fetuses. A greater understanding of the natural history of human parvovirus infection is needed prior to deciding on the mode of therapy (conservative management versus in utero fetal therapy).