Vitamin E-dependent anemia in a premature infant

Reported is a case of a premature infant who developed a well documented hemolytic anemia which responded to vitamin E therapy. The infant developed the syndrome while receiving an artificial formula containing iron and vitamin E, plus iron supplementation. The infant had a feeding problem which may have complicated absorption of vitamin E. It is suggested that premature infants who are formula fed should not receive iron supplement until they have doubled their birth weight or have a hemoglobin concentration of less than 10 mg%. Premature infants should receive supplemental vitamin E if they are not breast fed.     

Citrobacter sedlakii meningitis and brain abscess in a premature infant

Citrobacter sedlakii was isolated from blood and cerebrospinal fluid cultures of a 5-day-old premature infant with sepsis, meningitis, and brain abscess. This newly described organism was difficult to identify due to discrepancies between the Vitek and API 20E identification systems. To our knowledge, this is the first report of the isolation of C. sedlakii from cerebrospinal fluid.     

Supraventricular tachycardia with left bundle branch block in a premature infant

The addition of certain amounts of the zeolite mineral klinoptilolith to freshly obtained bird feces led to the retention of nitrogen--up to 14 per cent and more--as compared with feces without zeolite in storage. The addition of the mineral produced also a deodorizing effect in neutralizing the offensive smelling accompanying the putrefaction process.     

The premature infant below 1000 g

74 premature infants with a birth weight of 1000 g or less were hospitalized in the period 1963-1975. 20 babies survived the first 4 weeks of life and 2 died during the second month of life from progressive lung disease. 77% of all patients were mechanically ventilated and 9 ventilated patients survived. The main causes of death were cerebral hemorrhage, severe asphyxia and septicemia. Prognosis was impaired by hypothermia, IRDS, gestational age below 27 weeks and premature rupture of membranes with bacterial infection. At the age of 1 year 8 out of 12 survivors followed up showed normal mental and motoric development. 3 children had minor or obvious signs of cerebral paresis and one further child has partial retrolental fibroplasia. Due to modern intensive care the survival rate of these very small premature babies has now reached 40%. The prognosis is favourably influenced by optimal obstetric and neonatal care, while special precautions should be undertaken to avoid hypothermia. Our results with mechanical ventilation justify the administration of full intensive care to these very small premature babies.     

Subclavian artery compression from a chest tube after thoracotomy in a premature infant

A premature baby underwent thoracotomy for repair of esophageal atresia and tracheoesophageal fistula, during which time a right chest tube was placed. In the immediate postoperative period, right subclavian artery occlusion was recognized and relieved by partial withdrawal of the chest tube, which had migrated high into the apex of the right hemithorax.     

Bilateral pneumonia and inappropriate secretion of antidiuretic hormone in a premature infant

A 6-week-old infant born prematurely had severe hyponatremia and other features of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This disturbance was believed to be secondary to extensive bilateral pneumonia with collapse of the right upper lobe. Although this association has been recognized in adults, this is the first report of its occurrence in an infant. SIADH must be considered in the differential diagnosis of hyponatremia in association with pneumonia in an infant.     

Congenital diabetes in an infant with trisomy 21

A newborn infant with trisomy 21 was found to have congenital diabetes which appears to be permanent. Congenital diabetes is extremely rare and differs from type I or type II diabetes. It has never been reported previously in Down's syndrome and it seems to be due to a selective beta cell defect with undetectable C-peptide but normal alpha-cell function.     

Nutrition of the fetus and premature infant

Nutrition in the fetus and the premature infant is a rapidly changing field, not solely due to the acquisition of new knowledge but also because there have been major conceptual advances that have altered our approach to nutrition during early stages of development. This special report will highlight some of these conceptual advances in this area.     

Cranial transillumination norms of the premature infant

Ninety-five infants from 26 to 42 weeks of gestational age were studied with a simple standardized cerebral transillumination technique utilizing a Chun gun fitted with a clear flexible disc to establish normal measurements and to test the hypothesis that transillumination is useful in differentiating "catch-up" growth from hydrocephalus. One group of infants were measured at birth; the other group were infants grown to similar gestational age and serially measured. Data from these groups were found to be similar. Transillumination was not found to be a useful technique for separating "catch-up" growth infants from the normal population, but was found to be potentially useful in separating the normal and "catch-up" population from children with hydrocephalus or serious anatomic abnormalities of the central nervous system.     

Coma in a premature infant associated with the transdermal absorption of propylene glycol

A case of propylene glycol intoxication in a premature infant is reported. The infant went into a state of coma after treatment for burns with antiseptic dressings. Cessation of the topical treatment resulted in complete recovery. An exceptionally high level of the dressings' solvent, propylene glycol, found in the urinary chromatogram, was believed to be the causative agent. It is suggested that topical preparations containing propylene glycol should not be used in premature infants during the first weeks of life.     

Successful treatment of liver hemorrhage in the premature infant

BACKGROUND: The efficacy of tube thoracostomies inserted at the sixth intercostal space at midaxillary line was evaluated retrospectively in children. METHODS: Ninety-seven children with pneumothorax, treated by tube thoracostomy were taken into the study. There were 67 male and 30 female patients with a mean age of 6.5 years (range 1 days to 15 years) RESULTS: Pneumothorax was located at the right side in 50 (51.5%), and at the left in 38 (39.1%) of the cases. Bilateral pneumothorax was found in 9 additional patients (9.2%). All patients were treated with tube thoracostomy placed in the pleural cavity at the sixth intercostal space at the mid-axillary line. Postoperative course was uneventful and no complication was encountered at any of the patients. CONCLUSIONS: On the basis of these data we suggest that all thoracostomy tubes should be inserted on the sixth intercostal space where both air and the accumulating fluid can be reached. The insertion of the thoracostomy tube at the second intercostal space must be avoided since it carries a high risk of subclavian vein injury in small children, and also a secondary tube is frequently required to drain the accompanying intrapleural fluid.     

Recurrent renal vein thrombosis in a premature infant. Doppler ultrasound diagnosis and follow-up

Renal vein thrombosis (RVT) is a rare disorder in neonates. Early diagnosis is mandatory since immediate thrombolytic therapy favours prognosis. Our case report describes RVT demonstrated by Duplex Doppler Ultrasound. A possibly characteristic sequence of changes in the echogenicity of the renal parenchyma and in the Duplex Doppler flow pattern of the renal arteries could be found.