Congenital aglossia and situs inversus.

Lingual agenesis is a rare anomaly caused by failed embryogenesis of the lateral lingual swellings during the fourth and fifth gestational weeks. Most reported cases have been part of oromandibular limb hypogenesis syndromes. A review of the literature reveals two previously reported cases of congenital aglossia and situs inversus. A case of lingual agenesis associated with micrognathia and situs inversus is reported in a newborn presenting with upper airway obstruction at birth.

Group B streptococcal meningitis associated with otitis media.

A full-term infant of an appropriate size for gestational age was found to have meningitis due to Lancefield group B beta-hemolytic streptococci at 8 weeks of age. On admission, the baby had bulging tympanic membranes Lancefield group B beta-hemolytic streptococci were isolated from aspirate of the middle ear, supporting the importance of otitis media in the pathogenesis of late-onset Lancefield group B beta-hemolytic streptococcal meningitis.

Physiologic changes associated with endotracheal intubation in preterm infants.

Physiologic changes associated with endotracheal intubation were examined in 10 preterm infants. Laryngoscopy was associated with apnea and minor abnormalities in cardiac rhythm in 2 infants. Three infants had nasal airflow recordings which demonstrated obstructed breaths during laryngoscopy. Systolic blood pressure (BP) increased 47% when the trachea was intubated, whereas heart rate and transcutaneous oxygen tension (PtcO2) decreased. Because endotracheal intubation is a physiologically stressful procedure, personnel who intubate preterm infants must be skilled and experienced to minimize the duration of laryngoscopy and the number of intubation attempts.

Gentamicin vs cefotaxime for therapy of neonatal sepsis. Relationship to drug resistance.

An outbreak of serious infections due to gentamicin-resistant Klebsiella pneumoniae occurred in a neonatal intensive care unit in which the combination of gentamicin sulfate and ampicillin sodium had been used for standard initial therapy for suspected sepsis for nearly 11 years. After institution of control measures that included the substitution of cefotaxime sodium for gentamicin in the standard regimen, the outbreak promptly subsided. Nevertheless, a second outbreak of serious infections due to cefotaxime-resistant Enterobacter cloacae began ten weeks later. Sequential stool cultures from patients in the unit confirmed the disappearance of gentamicin-resistant K pneumoniae and the emergence of cefotaxime-resistant E cloacae after the change in antibiotic policy. These observations suggest that routine use of newer cephalosporins for therapy of suspected sepsis may lead to the emergence of drug-resistant microorganisms more rapidly than has occurred with the aminoglycosides.

Neonatal bladder injury occurring after umbilical artery catheterization by cutdown.

Umbilical artery catheterization is a widely used technique for monitoring sick neonates. When it is performed by cutdown, the proximity of peritoneum, urachus, and bladder makes these structures vulnerable to injury. Three neonates experienced bladder perforation that resulted from umbilical artery catheterization by cutdown. The diagnosis was aided by measuring electrolyte levels in the umbilical fluid and was confirmed by cystography. Conservative treatment was successful in one neonate, but two required operative repair of the bladder laceration.

The prognostic value of a risk score for necrotising enterocolitis.

Necrotising enterocolitis is the most common severe acquired gastrointestinal disorder in the neonate yet there remains disagreement on predictive and prognostic factors. A previously published risk score purports to predict infants at greater risk of the disease. Fifty-nine cases and 59 matched controls were evaluated using data from the first 24 h after birth to determine the predictive and prognostic value of the score for necrotising enterocolitis. In simple models the risk score was significantly, but inversely, associated with necrotising enterocolitis, primarily due to greater respiratory problems among controls. This finding contrary to the premise is clarified by a significant interaction of the risk score with feeding variables. Odds ratios for the risk score varied at different levels of daily feeding increments. However, the risk score was not statistically significant in any models which controlled for feeding increment and the interaction. The risk score was significantly associated with mortality among necrotising enterocolitis cases. Though the score was not statistically significant when the outcome was disease stage or surgery, trends were in the expected direction. The data suggest that the risk score itself may not be an independent predictor of necrotising enterocolitis, but may indicate infants more vulnerable to other potential risk factors and, in addition, may be related to prognosis for those who do develop necrotising enterocolitis.

Extracorporeal membrane oxygenation in the neonate.

ECMO is a modified heart-lung bypass system for treatment of moribund neonates. The techniques are described. Our experience with 19 patients reveals a survival rate of 79 percent. In the future, with advances in technology, ECMO may become less invisible and extended to a larger population of newborns.