Torticollis in infants with neonatal abstinence syndrome.

OBJECTIVE: To report the incidence of torticollis diagnosed in infants treated for neonatal abstinence syndrome (NAS) and compare neonates with and without torticollis. STUDY DESIGN: This prospective cohort study reports on infants examined at 1-4 months of age. Numerous obstetrical/newborn factors and other drugs used during gestation were compared. RESULTS: Of 501 neonates treated for NAS, 421 (84%) were seen for follow-up. Of these, 105 (24.9%) were diagnosed with torticollis. The only significant obstetrical/newborn factor identified was a lower rate if the parents were the primary caregiver after hospital discharge. Of the 105 cases, 88 (84%) were right-sided and 17 (16%) were left-sided. CONCLUSIONS: These data demonstrate that torticollis is a common diagnosis in infants examined at 1-4 months of age after being treated for NAS with a predilection for this to be right-sided. The etiology for this is uncertain, but newborns treated for NAS need close follow-up post discharge.

Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse.

The American College of Obstetricians and Gynecologists recommends medication-assisted treatment (MAT) for pregnant women who misuse opioids rather than detoxification because of possible relapse and dropout from treatment (ACOG, 2017). In a prospective study, fifty-five pregnant women with an opioid use disorder were offered a choice of MAT or detoxification. Ethical concerns precluded random assignment. We assessed dropout, treatment outcome, relapse, other illicit drug use, infant neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Of 55 women, 13 initially chose MAT and 42 women chose detoxification. All women received behavioral support. No one dropped out of treatment prior to delivery. All women who chose MAT initially remained on MAT. Of women who chose detoxification, 23% switched to MAT, 30% tapered below initial MAT doses, and 45% fully detoxified by delivery. There was a significant difference in opioid relapse between women on MAT (26%) and those who detoxified (0%), but no differences for other illicit drug use. Infants of women on MAT were more likely to have neonatal NOWS (91%) than infants of women who tapered below initial MAT doses but did not fully detoxify (62%). Infants of mothers who tapered (62%) were more likely to have NOWS than infants of women who fully detoxified (0%). Women on MAT reported significantly lower sexual abuse severity than did women who tapered or detoxified. It is critical to replicate the current findings and to follow up with mothers and their infants postpartum to ascertain the long-term impact of tapering or detoxification during pregnancy.

Subcutaneous Extended-Release Buprenorphine Use in Pregnancy.

BACKGROUND: Opioid use disorder (OUD) in pregnancy is managed by medication-assisted treatment. Sublingual buprenorphine is one option, but subcutaneous extended-release buprenorphine (Sublocade®) is an alternate form administered in monthly injections. Through an extensive literature search, we did not find any prior publication on the use of Sublocade in pregnancy. CASE: Two patients with OUD switched from sublingual buprenorphine to Sublocade. One patient received a total of eight injections and then discovered she was pregnant. Based on ultrasound dating, the last 5 administrations occurred during her pregnancy. The second patient received 6 injections with the last occurring at the time of her last menstrual period. Both declined further injections, as well as oral buprenorphine. Serial urine drug screens remained positive for buprenorphine through delivery in both cases. Neither the mothers nor the neonates experienced withdrawal symptoms or adverse outcomes. No birth anomalies were found. Discussion. Though further research is needed regarding the use of Sublocade in pregnancy, it is likely that other pregnancies will occur during this treatment modality. If this long-acting form of buprenorphine medication is found to be safe, it might play a role in managing some pregnant patients with OUD.

Fetal Bradycardia in Response to Maternal Hypothermia.

BACKGROUND: Fetal tachycardia can occur with maternal fever (hyperthermia); therefore, a low maternal temperature (hypothermia) might produce fetal bradycardia. CASES: Five cases of fetal bradycardia are presented in gestations complicated by maternal hypothermia. The fetal heart rate (FHR) tracings demonstrated stable baselines of 88-96 beats per minute with moderate variability and accelerations. All baselines returned to normal after maternal warming measures. CONCLUSION: A possible cause for fetal bradycardia with a stable baseline and moderate variability is maternal hypothermia, a pattern not indicative of fetal hypoxia. Delivery is not indicated, and maternal warming results in FHR baseline normalization.

Clinical Utility of Weekly Laboratory Testing in the Outpatient Management of Preeclampsia and Gestational Hypertension.

Objective To investigate the utility of obtaining weekly laboratory testing in patients managed as an outpatient for gestational hypertension and preeclampsia without severe features. Study Design A multisite retrospective cohort study was performed evaluating preterm women diagnosed with gestational hypertension/preeclampsia managed in an outpatient setting between gestational ages of 23 0/7 and 36 6/7 . Patients were divided into two groups: weekly laboratory evaluation (laboratories group) and a no laboratories group. The primary study outcome was composite maternal morbidity including more than one of the following: development of severe features, HELLP syndrome, eclampsia, placental abruption, maternal intensive care unit admission, or maternal death. Results A total of 204 patients were included in this study, laboratories group ( n = 120) and no laboratories group ( n = 84). The laboratories group was older (28.8 vs. 26.6 years, p = 0.02), had a higher rate of chronic hypertension (44 [36.7%] vs. 17 [20.2%], p = 0.01), and more often experienced the primary composite outcome (53 [44.2%] vs. 24 [28.5%], p = 0.02). No patients in our cohort were delivered for abnormal laboratory values. Conclusion This study found that weekly laboratory testing may have minimal clinical utility in the outpatient management protocol in monitoring patients with mild gestational hypertension or preeclampsia. Delivery was guided by other clinical factors.

Psychosocial Background History of Pregnant Women with Opioid Use Disorder: A Prospective Cohort Study.

OBJECTIVE: This study aimed to evaluate the psychosocial background history and confounding social factors in pregnant women with opioid use disorder (OUD). STUDY DESIGN: We performed a prospective observational cohort study of pregnant women from a dedicated obstetrical OUD clinic. Data collection came from extensive interview sessions regarding psychosocial background events and other social factors that might impact prenatal care. RESULTS: From February 1, 2017, through September 30, 2018, 411 pregnant women were evaluated and 294 (72%, 95% confidence interval [CI]: 67-76%) reported abuse of which 217 (53%, 95% CI: 48-58%) involved sexual abuse (prior to the age of 13 years in 54% of cases) and 209 (51%, 95% CI: 46-56%) involved cases of other physical abuse. Only 10% reported habitual opioid use for managing chronic pain. Only 9% had a valid driver's license with access to a car making transportation to office visits difficult. CONCLUSION: A history of abuse (mainly sexual and/or physical) appears to be the main precipitating event leading to OUD in our pregnant population. Transportation was the primary social factor limiting access to prenatal care. For primary prevention to be successful in our region, early identification of young women who have experienced abuse needs to occur followed by psychotherapy health care intervention before opioid drugs are used.

Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review.

OBJECTIVE: This study aimed to perform a systematic review of all studies reporting fetal outcomes following detoxification or tapering of opioid drugs during pregnancy. STUDY DESIGN: PubMed, Scopus, Medline, and Google Scholar were searched, and only manuscripts clearly reporting pregnancy/fetal outcomes involving tapering or detoxification from opioid drugs were included. Only pregnancies managed after 1980 were included (when antenatal fetal surveillance became more routine). Collected data included study design, location, years patients were managed, number of patients who were tapered or detoxified, method of tapering, and pregnancy outcome. RESULTS: A total of 14 publications met the criteria for review after evaluating more than 2,000 abstracts and 153 published manuscripts. In 1,097 pregnancies, based on mortality rate analyses and forest plots, no increased fetal risks due to tapering or detoxification from opioid drugs were identified. No increased risk of preterm delivery was found. CONCLUSION: Pregnant women with opioid use disorder who are stable in a medication-assisted treatment program with behavioral health can be informed that tapering or full detoxification from opioid drugs does not increase the fetal risk of poor pregnancy outcome. Future research needs to answer the questions on maternal and long-term newborn consequences of tapering or detoxification versus long-term newborn consequences of continued chronic in utero opioid exposure.

Use of naltrexone in treating opioid use disorder in pregnancy.

BACKGROUND: The mainstay of the management of opioid use disorder in pregnancy is with methadone or buprenorphine medication-assisted treatment. Methadone and buprenorphine are opioid agonist drugs. Naltrexone, an opioid antagonist, is also a medication-assisted treatment option; however, to date, only a few retrospective studies have reported its use in pregnancy. OBJECTIVE: Our study objective was to evaluate prospectively obstetric and newborn outcomes and the maternal/fetal effects of the use of naltrexone as a medication-assisted treatment in pregnant patients with opioid use disorder. STUDY DESIGN: We performed a prospective cohort study collecting data on all pregnant women who were treated with naltrexone medication-assisted treatment compared with pregnant women who were treated with methadone or buprenorphine medication-assisted treatment. Based on a sample size calculation, it was determined that for a power of 90, a minimum of 160 study participants (80 in each group) was needed with an alpha of .01 and an expected 60% rate of newborn infants who were treated for neonatal abstinence syndrome in the methadone or buprenorphine medication-assisted treatment group compared with a 30% rate in the naltrexone medication-assisted treatment group. In a random subset of 20 maternal/newborn dyads, blood levels for naltrexone and 6-beta-naltrexol (an active metabolite) were analyzed at delivery. RESULTS: A total of 230 patients were studied: 121 patients with naltrexone medication-assisted treatment compared with 109 patients with methadone or buprenorphine medication-assisted treatment. No differences between groups were seen regarding demographics, the use of comedications/drugs, or obstetric outcomes. For newborn outcomes, the rate of neonatal abstinence syndrome in neonates >34 weeks gestation was significantly lower in the naltrexone medication-assisted treatment group (10/119 [8.4%] vs 79/105 [75.2%]; P<.0001). Multivariate analysis demonstrated that the only significant factor for the rate of neonatal abstinence syndrome was the form of medication-assisted treatment. Of 87 patients who received naltrexone up to delivery, no neonates experienced symptoms of neonatal abstinence syndrome. No maternal relapses occurred in the 7-day no-treatment window before the initiation of naltrexone therapy. No cases of spontaneous abortion or stillbirth occurred in either group. In 64 patients who started naltrexone therapy at ≥24 weeks gestation, no changes were seen in the fetal heart monitor tracing with drug initiation. The incidence of birth anomalies was no different between the groups. Umbilical cord blood and maternal levels for naltrexone and 6-beta-naltrexol matched; no levels were elevated, and values were undetected if naltrexone was discontinued >60 hours before delivery. CONCLUSION: These study data demonstrate that, in pregnant women who choose to completely detoxify off opioid drugs during gestation, naltrexone, as a continued form of medication-assisted treatment, is a viable option for some pregnant patients who experience opioid use disorder. Naltrexone crosses the placenta, and maternal and fetal levels are concordant. Because naltrexone clears quickly from the maternal circulation, this rapid clearance needs to be addressed with patients. This is important because maternal relapse could occur in a short time-period if the oral drug is discontinued without the knowledge of their healthcare providers. Nonetheless, the drug is well-tolerated by both mother and fetus, and newborn infants do not experience symptoms of neonatal abstinence syndrome if naltrexone medication-assisted treatment is maintained to delivery.

Pregnant women's history of childhood maltreatment and current opioid use: The mediating role of reflective functioning.

There is an association between the experience of childhood maltreatment and opioid misuse in adults, especially for women. However, we know little about this association in pregnancy, and less about processes that could be the target of interventions to help women better parent their infants. We examined reflective functioning as a putative process. Reflective functioning is the ability to interpret one's own and others' behavior in terms of underlying mental states, e.g., emotions, motivations, and beliefs. We sampled 55 pregnant women who misused opioids and 38 women at high risk due to medical factors, e.g., heart disease. We assessed maltreatment with the Maltreatment and Abuse Chronology of Exposure (MACE; Teicher & Parigger, 2015), and reflective functioning with the Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016). Maltreatment variables included the sum of severity across all subtypes, number of subtypes experienced, and severity of sexual, physical, and emotional abuse, and of neglect. We created a categorical opioid user group variable: women who used opioids in pregnancy vs. high-risk medical comparisons. We found that women who used opioids in pregnancy had poorer reflective functioning than did high-risk medical comparisons. We also created an opioid use severity scale (ranging from 0 to 3) from urine assays and history of prescribed opioids from medical records. Using Hayes (2012)'s bootstrapping PROCESS macro, we found that reflective functioning mediated the association between all maltreatment variables and opioid use severity. We discuss the results in terms of how best to intervene to improve women's reflective functioning, which may help their ability to parent.

Opioid use in pregnancy: Borderline features and Hepatitis C virus.

This study examined the relationship between borderline personality disorder assessed as self-reported borderline features (Morey, 1991), opioid use, and Hepatitis C virus (HCV) in pregnant women. There were 55 women in the opioid use group and 38 in the comparison group who were at high risk due to medical issues that did not include drug use. Women were in their 2nd or 3rd trimester. All women received Medicaid and were racially representative of the geographic area (84% White). We assessed opioid use severity from medical records based on urine assays and prescriptions for opioids. The results revealed that women who scored in the clinical range of total borderline features, which is associated with a diagnosis of borderline personality disorder (Trull, 1995), had 2.83 greater odds of being opioid users (prescribed and nonprescribed) than had individuals below the cutoff. The borderline features of affective instability, identity disturbance, negative relationships, and self-harm/impulsivity were significantly correlated with opioid use severity. Negative relationships and self-harm/impulsivity contributed significant variance in opioid use severity over and above affective instability and identity disturbance. Women in the clinical range of borderline features were more likely to have HCV than were women below the cutoff, and the borderline feature of negative relationships specifically was associated with HCV. We discuss implications for interventions to address negative relationships and self-harm/impulsivity and interventions to help prevent opioid misuse in women before they become pregnant. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fetomaternal Bleeding and Neonatal Hematocrit following Cesarean Delivery: Routine versus Transplacental Transection.

Objective To evaluate fetomaternal bleeding following routine cesarean delivery compared with cesarean delivery involving transplacental transection. Study Design A prospective cohort study evaluating cesarean delivery in which the placenta was transected (cases) versus controls (placenta not transected) from January 2016 to April 2018. A maternal Kleihauer-Betke's (KB) test and newborn hematocrit were performed shortly after delivery. Results The rate of a positive KB test was not significantly different between cases ( n = 31) and controls ( n = 61) (19 vs. 14%; odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.46-4.49; p = 0.74). Median neonatal hematocrits were not different. However, the rate of newborn hematocrits <40% at delivery was higher in cases compared with controls (23 vs. 3%; OR: 8.90; 95% CI: 1.72-45.90; p = 0.005). Conclusion A cesarean requiring transplacental transection to accomplish delivery does not significantly increase the rate of fetomaternal bleeding but is associated with a higher likelihood of newborn hematocrit <40% at delivery.

Infant follow-up postdelivery from a hepatitis C viral load positive mother.

Objective: The primary current recommendation for infant follow-up postdelivery from a hepatitis C virus (HCV) viral load positive mother is to evaluate for the presence of antibody at or after 18 months of age. Our study objective was to analyze compliance with this recommendation for postdelivery infant HCV screening at our institution among a cohort of infants delivered from HCV viral load positive mothers. Methods: Starting 1 January, 2015, a prospective database was developed for all pregnancies that involved mothers with a positive HCV viral load during pregnancy. This short report describes the infant follow-up for deliveries through 30 June, 2016. At hospital discharge, all neonates were given follow-up pediatric appointments and mothers were supplied the date and time of the appointment along with the pediatric group name, office directions, and phone number. Statistics involved simple percentages with Poisson binomial 95% confidence intervals. Results: A total of 127 newborns were delivered of HCV viral load positive mothers during the study period and 55 (43%, 95% CI 35-52%) attended their pediatric appointments and were still in follow-up. Regarding the 72 cases (57%, 95% CI 48-65%) not in follow-up, 24 (19%, 95% CI 13-27%) never presented to care and 48 (38%, 95% CI 29-47%) came to one or two visits shortly after delivery but were absent for further follow-up. Conclusions: These data demonstrate that follow-up at 18 months postdelivery from an HCV viral load positive mother occurs in less than half of the cases and alternative screening strategies should be evaluated.

Incidence of maternal tachycardia during the second stage of labor: a prospective observational cohort study.

OBJECTIVE: To our knowledge, this is the largest prospective study reporting on maternal heart rate (MHR) levels in laboring women (30 patients), and maternal tachycardia that is a potential risk factor in fetal monitoring confusion. Our objective was to analyze a large population of contiguous laboring patients and to assess the MHR levels attained during the second stage. METHODS: We performed a prospective study that analyzed MHR levels of second-stage laboring patients evaluating numerous predisposing maternal conditions. Univariate and stepwise multivariate logistic regression analysis were performed. RESULTS: A total of 1105 contiguous patients were analyzed and 33.9% had a sustained MHR ≥100; 18.8% had an MHR ≥110; and 9.1% had an MHR ≥120. Multivariate analysis of all potential predisposing maternal conditions did not reveal any specific variable as uniformly significant for predicting maternal tachycardia across all levels of analysis. CONCLUSIONS: The incidence of maternal tachycardia in the second stage of labor is common. We recommend that if the MHR is ≥100 during labor, the simultaneous maternal and fetal heart rate (FHR) monitoring will be used to minimize the potential for fetal monitoring confusion and risking poor fetal outcome if the fetus is in distress.

The effect of standardizing treatment when managing neonatal abstinence syndrome.

Objective: Standardizing treatment of neonatal abstinence syndrome (NAS) is currently recommended; however, single institution prospective studies are lacking regarding the success of this approach. The study objective was to evaluate overall newborn response and length of stay (LOS) of neonates treated for NAS following the institution of a strict standardized treatment protocol. Methods: From 1 January 2014 to 30 June 2016, a prospective cohort study was performed collecting neonatal outcomes before and after the standardization of a strict NAS morphine weaning treatment protocol. The primary outcome measure was length of stay. The standardized protocol was fully instituted in June 2015. Results: A total of 395 neonates were treated for NAS during the study. The LOS for the 17 months prior to the initiation of this protocol was 23.31 (±6.2) days (233 neonates). The LOS in the 13 months after protocol initiation was 18.17 (±5.1) days (162 neonates). This was a difference of 5.14 days (95%CI 4.0-6.3 days) less in LOS (p < .0001). Conclusions: These data demonstrate that the initiation of a standardized NAS treatment protocol can significantly improve neonatal response and decrease LOS. It is recommended that institutions with nurseries that treat infants with NAS develop standardized treatment protocols to improve care for this complicated patient population.

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome.

OBJECTIVES: To compare head circumference (HC) in neonates treated for neonatal abstinence syndrome (NAS) with control neonates without antenatal opioid exposure. METHODS: Our prospective cohort study ran from April 1, 2014, through December 31, 2016. Newborns treated for NAS delivered from well-dated pregnancies ≥34 weeks' gestation were compared with newborns who were nonopioid exposed and matched for race, parity, mode of delivery, and gestational age. All mothers underwent serial antenatal urine drug testing. A minimum of 754 study participants were needed (377 in each group) to demonstrate an increase in the proportion of newborns with HCs less than or equal to the 10th percentile from 10% in controls to a minimum of 20% in NAS newborns with 90% power. RESULTS: A total of 858 neonates were enrolled (429 NAS cases and 429 controls). Mean HC for cases was 33.04 cm (±1.9 cm) compared with 33.99 cm (±2.0 cm) for controls (P < .0001). Among the 429 NAS cases, the mothers of 372 (87%) were on opioid medication-assisted treatment. For NAS cases, 30.1% (95% confidence interval: 25.8%-34.7%) had an HC less than or equal to the 10th percentile (129 of 429 neonates), and 8.2% (95% confidence interval: 5.8%-11.2%) had an HC less than or equal to the third percentile (35 of 429 neonates). Multivariate analysis was used and determined that only chronic opioid use during gestation resulting in a neonate who was NAS treated was a significant risk factor for the observed smaller HC. CONCLUSIONS: Chronic opioid use during pregnancy sufficient to cause NAS was associated with smaller HCs at birth. Most mothers were on opioid agonist medication-assisted treatment, which is currently the recommended treatment option during pregnancy.

Empirical Studies Addressing the Opioid Epidemic: An Urgent Call for Research.

Opioid misuse has become one of the most pressing public health problems facing the country. In this article, we briefly review literature regarding the opioid epidemic in the United States and the negative consequences of opioid use disorder. We provide information regarding treatment and relapse using a variety of intervention approaches. We call for research on people with opioid use disorder that can contribute to a variety of areas: improving medication-assisted treatment, addressing chronic pain, examination of adjunctive behavioral interventions, overdose, high risk behaviors and infections, pregnancy, diverse populations, and other psychological factors. Collectively addressing these crucial areas of research will advance the field and help alleviate suffering and prevent death from opioid use disorder.

Preoperative cesarean delivery intravenous acetaminophen treatment for postoperative pain control: a randomized double-blinded placebo control trial.

BACKGROUND: The United States currently has an opioid use disorder epidemic and research evaluating ways to minimize the use of opioids postsurgery are needed. One of these options is intravenous acetaminophen. If the use of preoperative intravenous acetaminophen was found to be effective for cesarean delivery, this would be beneficial for both the mother and breast-feeding neonate. OBJECTIVE: The primary study objective was to see if maternal opioid use was significantly less in the postoperative period for the study group that received 1 g of intravenous acetaminophen preoperatively compared with a control group that received placebo. The secondary objectives were to evaluate maternal length of stay and pain scores postoperatively, and assess the acetaminophen level in cord blood at delivery. STUDY DESIGN: This study was a prospective double-blinded randomized placebo-controlled trial. All pregnant patients who entered labor and delivery for a scheduled cesarean from November 2015 through April 2017 were eligible. Once consented, the medication was supplied by the pharmacy department, which performed the blinded randomization. Both the study drug of 1000 mg (1 g) of acetaminophen and placebo of normal saline were distributed as unmarked 100-mL bags administered over 15 minutes just prior to incision. No study personnel from the obstetric or anesthesia departments had any access to the randomization. Based on a power analysis using the published surgical data results, the goal was to obtain a minimum of 100 patients (50 patients in each arm). Primary data collection included demographics, number of opioid doses and morphine milligram equivalents administered to the patient postoperatively, length of stay postdelivery, pain scores, and newborn cord blood acetaminophen levels. Exclusions were maternal acetaminophen allergy, receipt of acetaminophen in the prior 24 hours, opioid use disorder, and hepatitis/liver impairment. Statistics involved χ2, Fisher exact, and the Student t test where appropriate and a P value <.05 was considered significant with all tests considered against a 2-sided alternative hypothesis. RESULTS: A total of 105 patients were evaluated with 51 who received intravenous acetaminophen and 54 who received placebo. The number of postoperative opioid medication doses administered to the study group was 11.1 (±8.9) compared with the number received by the control group of 10.5 (±8.5), P = .72. The morphine milligram equivalents in the study group was 94.2 (±40.4) compared with the control group of 90.7 (±42.1), P = .67. The length of stay and pain scores were not different between the groups. All of the umbilical cord blood values for acetaminophen were subtherapeutic. CONCLUSION: These data demonstrate that for cesarean delivery, the use of a preoperative 1-g intravenous dose of acetaminophen does not decrease the number of opioid medication doses or the morphine milligram equivalents administered postoperatively, nor does it decrease length of stay postcesarean. The administration of 1-g intravenous acetaminophen preoperatively does not result in elevated newborn cord blood levels (ClinicalTrials.govNCT02694653).

Transplacental passage of vancomycin.

OBJECTIVE: To evaluate a larger number of patients receiving a vancomycin-dosing regimen of 20 mg/kg IV every 8 h for Group B streptococcus (GBS) chemoprophylaxis and analyze maternal and neonatal cord blood levels at delivery. METHODS: We prospectively enrolled every mother that entered labor with a positive GBS culture and a high-risk penicillin allergy with resistance to clindamycin or unknown sensitivity. Maternal and cord blood vancomycin levels were obtained at delivery. Time from last dose completion to delivery, number of doses administered and body mass index were assessed. RESULTS: A total of 30 patients consented and 23 (77%) maternal levels and cord blood levels were therapeutic. There were eight patients where one or both maternal and/or cord blood values were non-therapeutic, but in six of these, there was a regimen violation regarding timing of the next dose or total dosage administered. Of the 24 patients where the regimen was correctly followed, 22 (92%) had therapeutic maternal and cord blood levels. CONCLUSIONS: Using a vancomycin-dosing regimen of 20 mg/kg IV every 8 h (maximum individual dose of 2 g) produces therapeutic levels in more than 75% of mother/newborn pairs and this can exceed 90% when dosing regimens are correctly followed.

Polybrominated diphenyl ethers (flame retardants) in mother-infant pairs in the Southeastern U.S.

Polybrominated diphenyl ethers (PBDEs) are commonly used flame retardants in foams, building material, electronics, and textiles. These chemicals leach into the environment, where they persist, and are found today in virtually every population worldwide. Several studies in recent years have detected the presence of PBDEs in maternal and infant samples. However, few of these studies were conducted in the U.S., and few examined paired or matched mother blood-cord blood samples. We analyzed serum from 10 mother-infant pairs for the presence of PBDEs in a patient population in the Southeastern U.S. Out of 35 measured PBDE congeners, five (BDE-28, -47, -99, -100, and -153) were present, with detection frequencies of 65-100 %. The total PBDE concentrations in maternal and infant sera were highly correlated (r2 = 0.710, p = 0.0043). The levels of BDE-47, -99, and -100 and of total PBDEs were higher in the infant cord sera when compared with those in maternal sera (p < 0.017), suggesting that fetuses and neonates might have higher circulating concentrations of these potentially neurotoxic and endocrine disrupting chemicals compared with their mothers. The primary focus henceforward should be whether there are any deleterious effects from exposure to these chemicals on human health.