A simple clinical test for differentiating physiological from pathological head lag in full-term newborn infants.

UNLABELLED: This prospective study was designed to assess the value of a simple clinical test, a "feeding test", on the outcome of head lag among term neonates. Of 5718 infants who were examined before their morning meal, 67 had moderate to severe head lag in the absence of predisposing risk factors for head lag. Fifteen minutes following feeding, 62 infants (92%) showed an improvement in or disappearance of head lag with concomitant rise in serum glucose. All of these infants had normal psychomotor development on follow up. In 4 infants in whom no improvement occurred after feeding, an underlying pathological cause for head lag was subsequently diagnosed. CONCLUSION: Use of the feeding test as a screening procedure in apparently healthy newborns with head lag may rule out pathological conditions in over 90% of the cases.

Echovirus type 22 outbreak associated with gastro-intestinal disease in a neonatal intensive care unit.

An echovirus type 22 outbreak involving 19 neonatal intensive care unit (NICU) patients during the months of October and November 1992 is reported. Twelve infants presented with diarrhea, 7 of whom had bloody stools and x-ray findings compatible with early stages of necrotizing enterocolitis, while one infant demonstrated characteristic pneumatosis intestinalis. Outbreaks of echovirus type 22 infection in premature infants have rarely been reported. The possibility of Echovirus 22 infection should be considered in neonatal gastrointestinal disease associated with features of necrotizing enterocolitis.

Early immunization with inactivated poliovirus vaccine in premature infants.

The antibody titers of 41 premature infants receiving inactivated poliovirus vaccine at 2 months of age (control group) were compared with titers of 39 infants receiving an additional dose at 5 to 10 days of age (study group). At 1 month of age 97.4% of the study group but only 70.8% of the control group had protective antibodies against poliovirus 3 (p < 0.001).

Adenovirus type 8 conjunctivitis outbreak in a neonatal intensive care unit.

An outbreak of adenovirus type 8 conjunctivitis occurred in seven premature infants who had undergone ophthalmological examination four to seven days previously. Three of the affected infants, treated with steroids because of bronchopulmonary dysplasia, showed systemic manifestations and deterioration of their respiratory disease. Second and third waves affected nine staff and 12 family members.

Continuation of breast-feeding in an Israeli population.

Demographic and perinatal factors were analyzed in an Israeli urban community to determine the rates of continuation of breast-feeding and the factors influencing these rates. For the purpose of this study, breast-feeding was defined as occurring if infants received at least one breast-feed during a 24-h period. Among 633 mothers initiating breast-feeding, 40.3% completed 3 months of breast-feeding. The factors significantly associated with the continuation of breast-feeding were maternal religious belief, high education level, high parity, and previous breast-feeding success. Multivariate analysis by stepwise logistic regression showed that orthodox religious belief was the most significant associated factor. A third interview undertaken after 12 months among the 165 mothers who successfully completed 3 months of breast feeding showed declines of breast-feeding at the second (31.5%), third (53.1%), and fourth (60.4%) trimesters. Only 12.7% of this population completed 12 months of breast-feeding. Again, the mothers' religious beliefs and education levels were significantly related to the continuation of breast-feeding. Each specific community must be analyzed to find those groups of mothers at risk for early weaning from breast-feeding.

Demographic factors influencing the initiation of breast-feeding in an Israeli urban population.

The influence of demographic and prenatal factors on the initiation of breast-feeding in an urban Israeli population was evaluated by interviewing 1,000 parturients prior to discharge from the hospital. The mothers were all Jewish, none were single, and none were social welfare dependents. Of these mothers, 72% were breast-feeding, 6% stated an intent to breast-feed, and 22% were formula-feeding their infants. A significantly increased rate of breast-feeding was found among mothers with the following characteristics: those of orthodox religious belief, high educational level, in the academic and paraacademic professions, nonsmokers, those who worked outside of the home during the pregnancy, those who had previous breast-feeding success, and mothers whose husbands' attitude toward breast-feeding was positive. The decision to breast-feed was made prior to delivery in 85% of mothers. Participation of the mother and/or father in antenatal preparation courses did not significantly influence the initiation of breast-feeding. Multivariant analysis with a stepwise logistic regression model delineated the four factors most significantly associated with the initiation of breast-feeding: positive spousal attitude toward breast-feeding, orthodox religious belief, nonsmoking, and work outside of the home during the pregnancy. The expected probability for initiating breast-feeding was computed for the various combinations of these four categories and ranged from .94 with all factors present to .33 in the absence of these characteristics. Pediatrics 1989; 83:519-523; breast-feeding, Israel.

Skull subcutaneous emphysema--a rare complication of vacuum extraction and scalp electrode.

A full-term newborn infant with severe subcutaneous emphysema of the skull as a complication of vacuum extraction and scalp electrode wound is reported. We hypothesize that detachment of subcutaneous tissue and transmission of the negative pressure associated with the vacuum extraction resulted in entry of air through the scalp electrode wound.

Pyloric channel duplication in a newborn infant.

This is the first reported case of pyloric channel duplication demonstrated preoperatively by endoscopy and contrast radiography. Endoscopically, the lesion resembled a mucosal flap overlying the pyloric orifice. On radiography the lesion presented as a polypoidal filling defect in the duodenal bulb. The infant had, in addition, postduplication stress ulcer.

Neonatal hypernatremic dehydration due to excessively concentrated prepared milk formula.

Excessively concentrated milk formula was administered accidentally to five newborn infants. Diarrhea, dehydration, hypernatremia, and hyperosmolality were present in all of them. Abnormal neurologic manifestations during the acute disease were observed in one infant. On follow-up, psychomotor development and electroencephalographic recordings were normal in four infants. One infant, in whom accelerated growth of head circumference had been noted before the episode of diarrhea, was found to have obstruction of the foramen of Monro at the age of 6 weeks. Possible errors in preparing milk formulas by medical staffing resulting in hypertonic dehydration are stressed in this report.

Hypovolemic shock at birth due to extensive fetomaternal hemorrhage.

Three cases are described in which fetomaternal hemorrhage caused hypovolemic shock at birth. The etiology was confirmed by a postpartum maternal smear which showed approximately 15% of fetal red cells in the maternal circulation. All infants had severe anemia with hematocrit values of from 11 to 15%. Initial resuscitative measures included cardiac massage and artificial ventilation. Plasma expanders were given in order to restore the effective circulatory volume. Repeated blood transfusions resulted in an increase of blood pressure to normal range in all patients. One infant survived without neurological sequelae. The other two infants died following irreversible hypoxic injuries to vital organs. Early recognition of perinatal posthemorrhagic shock is crucial for recovery, and whole blood and plasma expander transfusions should be used immediately. Early assisted ventilation, administration of type O- whole blood and the autotransfusion of fetal blood are suggested for restoring the effective circulatory volume.