Mother-to-child transmission of hepatitis C virus.

This review reinforces the lack of a single maternal risk factor that is highly associated with vertical transmission (VT) of the infection with hepatitis C virus (HCV): indeed HCV RNA levels, mode of delivery, breast feeding, viral genotype or maternal IL28B status were not associated with HCV VT.

Neonatal neurological examination during the first 6h after birth.

BACKGROUND: Few neurological assessments are easily performed during the first 6h after birth. AIMS: To assess a cohort of low risk term born newborns within the first 6h and at 48h after birth using the Hammersmith Neonatal Neurological Examination. STUDY DESIGN AND SUBJECTS: A population of low risk term born newborns was examined within 3h from birth or between 3 and 6h. Each infant was re-assessed at 48h, establishing the range and frequency distribution of neonatal neurological scores at each time point. RESULTS: Of the 124 full-term born newborns, 62 were assessed at 0-3h and 62 at 3-6h. All infants were re-assessed at 48h. For 23/34 of the neurological items, the range and median scores were similar across the 3 time points. In the remaining 11 items the three groups had a similar range of scores but the median scores were different with different rates of changes. In 6 of the 11 the median scores at 3-6h were similar to those observed at 48h but they appeared to be 'less mature' at 0-3h. Only in one item the median scores were consistently different at the 3 time points. CONCLUSIONS: Our results suggest that a neurological examination can already be reliably performed soon after birth. These findings will help in the interpretation of the few items that show changes with increasing postnatal age.

Diagnostic accuracy of heart murmur in newborns with suspected congenital heart disease.

BACKGROUND: The correlation between heart murmur and congenital heart disease (CHD) is complex and varies with observed population. METHODS: Ninety consecutive newborns (41 with heart murmur and 49 controls) were routinely examined with auscultation and echocardiography. Intensity and characteristics of heart murmur, presence and type of CHD were recorded. Echocardiographic findings were considered as benchmark. RESULTS: Heart murmur was related to the presence of ostium secundum [odds ratio (OR) 4.2], patent ductus arteriosus (OR 11.9), tricuspidal regurgitation (OR 9.5), muscle ventricular septal defect (VSD) (OR 12.3), membranous VSD (OR 9.7), and any CHD (OR 26.7) (P < 0.05 in all cases). Diagnostic accuracy of clinical examination with a finding of heart murmur was 83%, lower if considering single CHD (58-69%), negative predictive value 90%, and positive predictive value 76%. Patients with any CHD, tricuspidal regurgitation and muscle VSD were characterized by a more intense heart murmur. In case of concomitant multiple CHD, intensity of heart murmur correlated with the number of congenital heart anomalies. CONCLUSION: Diagnostic accuracy of heart murmur at clinical examination (83%) declines when single CHDs are considered. Higher negative predictive value and lower positive predictive value suggest an echocardiographic second-level confirmation in the case of heart murmur at clinical examination suspected for CHD, probably unnecessary in the case of negative auscultative findings. Heart murmur intensity correlates with the number of concomitant congenital heart anomalies.

Anti-Rh(c), "little c," isoimmunization: the role of rHuEpo in preventing late anemia.

The overall prevalence of non-Rh-D isoimmunization seems to lie between 0.15% and 1.1%. Anti-Rh(c) alloimmunization, "little c," occurs in 0.07% of pregnancies and shows a quite broad clinical presentation. Late anemia is a frequent problem occurring in the setting of isoimmunization. It occurs more frequently after intrauterine blood transfusions or exsanguinotransfusion, and it can be thought as a hyporegenerative anemia. The authors describe the use of human recombinant erythropoietin in preventing late anemia in a case of anti-Rh(c) isoimmunization. The use of human recombinant erythropoietin is a valid tool for preventing late-onset anemia due to either anti-Rh-D or non-anti-Rh-D isoimmunization.

Is growth-discordance in twins a substantial risk factor in adverse neonatal outcomes?

To evaluate whether growth discordance is an independent risk factor in the neonatal outcome of the smaller twin, all medical records of twin pregnancies delivered between 26 and 41 weeks during a 5-year period (January 2004-December 2008) were reviewed. Among the 49 selected twins, weight discordance was 15-20% in 7 infants, 21-30% in 16 infants, 31-40% in 16 infants and > 40% in 10 infants. No significant differences between the four groups were found with regards to obstetric complications and neonatal disease. Occurrence of birthweight below the 10th percentile and rate of admission to the neonatal intensive care unit significantly increased as intra-pair birthweight difference increased (p = .03). The > 40% discordant group had a significantly lower gestational age (p = .03), lower birthweight (p = .007) and a significantly higher mortality rate (4/10 versus 3/39 p = .04) in comparison with the other discordant groups. Multiple logistic regression analysis showed that birthweight was the single independent and consistent factor associated with elevated risks of mortality. For every 250 g increase in birthweight, the risk for mortality decreased by about 84% [RR 0.16(CI 0.00-0.70)]. Gestational age was the most reliable predictor for major neonatal complications. For every 1-week increase in gestational age a significant decreased risk for all outcomes was found. Discordance alone should not be considered as a predictor for adverse neonatal outcome. Neonatal outcome in discordant twins appears to be related to gestational age and birthweight rather than to the degree of discordance.

Infants born to mothers under phenobarbital treatment: correlation between serum levels and clinical features of neonates.

OBJECTIVE: Phenobarbital crosses the placenta quickly, and the balance between maternal and fetal blood is achieved in a few minutes. Data on the clinical outcomes of infants born to mothers under phenobarbital treatment during pregnancy show that they are at risk of adverse events, such as sedation and abstinence syndrome. The aim of this study was to analyse the correlation between serum levels of phenobarbital and clinical features of neonates. STUDY DESIGN: Twenty-three infants born between 2001 and 2008 were studied. Maternal, neonatal and pharmacological variables were considered. RESULTS: Eleven infants displayed symptoms related to phenobarbital. Withdrawal syndrome was seen in seven infants and sedation syndrome was seen in four infants. One infant had severe cardiorespiratory depression at birth. None of the infants had severe neonatal abstinence syndrome. No statistically significant differences were found between symptomatic and asymptomatic infants. At birth, the mean serum level of phenobarbital of the 23 infants was 15.4 [standard deviation (SD) 6.2] µg/ml. A peak (16.1 µg/ml, SD 5.5) was seen on Day 3, followed by a gradual decrease to non-therapeutic levels (<10 µg/ml) by Day 8 (9.3 µg/ml, SD 1.0). Phenobarbital levels were higher in symptomatic infants than asymptomatic infants, although the difference was not statistically significant. CONCLUSIONS: Serum levels of phenobarbital remained in the therapeutic range for both mothers and infants, and reduced gradually in infants. However, some infants displayed symptoms related to phenobarbital. As such, a clinical pharmacological surveillance protocol is necessary.

Toward a bioethical issue: induced multiple pregnancies and neonatal outcomes.

Assisted reproductive technology has made great progress during the last three decades. After the initial enthusiasm, many ethical, legal and social issues related to the application of these procedures began to evolve. Multifetal pregnancy and fetal reduction, embryo cryopreservation, preimplantation genetic diagnosis, risks of birth defects and other adverse outcome associated with assisted reproductive technology are issues that have to be addressed building future collaborative studies and continuing the debate on related ethical issues.

Massive fetomaternal hemorrhage and late-onset neutropenia: description of two cases.

Massive fetomaternal hemorrhage (FMH) occurs in approximately 1:1,000 deliveries. In most cases, the cause is not identified. The clinical manifestations and the prognosis of a FMH depend on the volume of the hemorrhage and the rapidity with which it has occurred. We describe two cases of chronic massive fetomaternal hemorrhage with favorable outcome. During the follow-up, both infants showed late-onset neutropenia, which was not previously reported in healthy, growing infants with history of massive FMH.

Application of a neonatal assessment of visual function in a population of low risk full-term newborn.

BACKGROUND: We have previously developed and described a battery of 9 items suitable for assessing different clinical aspects of visual function in newborn infants. AIM OF THE STUDY: Application of the test battery to a cohort of low risk term-born infants at 48 and 72 h after birth 1) to define the normative distribution of results for each item and 2) to document any effect of postnatal age. STUDY DESIGN AND SUBJECTS: 124 term-born low risk infants were assessed at 48 h; fifty of them were re-assessed 24 h later at 72 h. RESULTS: The visual test battery was successfully completed in 110 of the 124 infants assessed at 48 h and in all the 50 infants assessed at 72 h after birth. For 3 of the 9 items (fixation on a black/white target of concentric circles, on a coloured (red/yellow) face and horizontal tracking), the findings were very similar at both ages. For the remaining 6 items the range of findings was wider. There was a statistical difference in the responses obtained at 48 and 72 h for vertical and arc tracking (p<0.05) and the ability to discriminate stripes and attention at distance (p<0.001). CONCLUSION: Our results provide information on the visual abilities in a low risk population of term-born infants and the distribution of frequency of their visual responses to our battery of visual tests. These findings may be used as reference data when using our visual test battery in both clinical and research settings.

Neonatal outcomes in triplet pregnancies: assisted reproduction versus spontaneous conception.

AIMS: The purpose of this study is to compare neonatal outcomes of spontaneously conceived triplets with triplets conceived by assisted reproduction. METHODS: This was a retrospective cohort study of all cases from assisted triplet pregnancies and controls from spontaneous triplet pregnancies. A total of 24 triplet pregnancies were studied: six spontaneous and 18 assisted. The following variables were evaluated in all newborns: prematurity, birth-weight, small for gestational age, birth-weight discordance, Apgar scores, major neonatal morbidity and perinatal mortality. RESULTS: Gestational age (33+/-1 vs. 33+/-2 weeks) and birth-weight (1760+/-256 vs. 1907+/-452 g) were similar in spontaneous and assisted triplet pregnancies. There were no significant differences in the rates of small for gestational age, discordance, and major neonatal morbidity. In the assisted reproduction group only the following cases were recorded: 1 surgically treated patent ductus arteriosus, 1 feto-fetal transfusion syndrome, 2 grade II intraventricular hemorrhage, 1 Cri du Chat syndrome and 1 stillbirth with malformations. CONCLUSIONS: This study is unable to assess the influence of assisted reproduction on the neonatal outcomes of triplet pregnancies. However, the results suggest that the incidence of major neonatal morbidity, especially malformations, might increase due to assisted reproduction. This finding requires further confirmation.

Visual development in infants with prenatal post-haemorrhagic ventricular dilatation.

OBJECTIVE: The aim of this study was to assess visual function in 13 infants with evidence of prenatal post haemorrhagic ventricular dilatation. DESIGN: Infants were assessed at 5, 12 and 24 months using a battery of tests specifically designed to assess various aspects of visual function in infancy. Visual findings were correlated with several variables, including extent of the lesion and presence of epilepsy. RESULTS AND CONCLUSIONS: Abnormalities of visual function were frequent (over 60%) in our cohort at age 2 years, ranging from isolated abnormal ocular movements to severe abnormalities of all the aspects of visual function assessed. The most severe and persistent abnormalities of visual function were found in infants with grade IV intraventricular haemorrhage and shunted hydrocephalus who also had epilepsy in the first year.

Hydrolysed milk in preterm infants: an open problem.

AIM: To review knowledge about the role, indications and nutritional adequacy of protein hydrolysate formulas (HF) in the preterm newborn. METHODS: A review of the available literature was carried out. RESULTS: No data support the use of HF for atopy prevention. HF could have a positive role in the early feeding of very-low-birthweight infants, but several concerns exist about their nutritional adequacy. CONCLUSION: Further investigations addressing protein and mineral metabolism as well as long-term effects, including neurodevelopment, are needed.