Pearls of Neonatal Intertrigo in Ancient Greek and Byzantine Medicine.

OBJECTIVE: Confirmation of knowledge of neonatal intertrigo in ancient Greek and Byzantine medicine. METHOD: A search of Thesaurus Linguae Graecae was conducted with the following terms as key words, "syggama", "xyggauma", "paratrimma" and "ektrimma". RESULTS: Ancient Greek medico-philosophers introduced therapeutic measures based upon herbs and minerals, while a similar therapeutic approach was also used by the Byzantines. Hippocrates of Kos (460-377) was among the first to introduce written instructions, also proposing preventive treatment with palliative and aromatic herbs. Cataplasms, thalassotherapy, and fumigation were used, combined with hygienic measures in the affected area. Chalk powder was also prescribed to absorb moisture. CONCLUSION: The main principles in the treatment of intertrigo remain the same, celebrating the ancient Greeks' methodology and rationalism.

Bacterial Infections in Neonates, Madagascar, 2012-2014.

Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Low-income countries should prioritize interventions to decrease neonatal infections; however, data are scarce, specifically from the community. To assess incidence, etiologies, and antimicrobial drug-resistance patterns of neonatal infections, during 2012-2014, we conducted a community-based prospective investigation of 981 newborns in rural and urban areas of Madagascar. The incidence of culture-confirmed severe neonatal infections was high: 17.7 cases/1,000 live births. Most (75%) occurred during the first week of life. The most common (81%) bacteria isolated were gram-negative. The incidence rate for multidrug-resistant neonatal infection was 7.7 cases/1,000 live births. In Madagascar, interventions to improve prevention, early diagnosis, and management of bacterial infections in neonates should be prioritized.

A Historical Perspective on the Transport of Premature Infants.

A premature newborn was first transported via helicopter from place of birth to a specialty nursery 50 years ago. Since that time, the care of high-risk and premature newborns has evolved, but specialized services are not always available at the birth site. As a result, the demand for newborn transfer continues to grow. Today, neonates are transported to tertiary centers via ground ambulances, helicopters, and airplanes by highly trained personnel using sophisticated incubators and equipment.

Necrotizing: A historical perspective.

Necrotizing enterocolitis is a devastating disease afflicting premature infants, though after 50 years of investigation, the pathophysiology remains elusive. This report describes the possible etiologic factors from a historical perspective, and outlines the importance of human milk, intestinal blood flow, and intestinal blood flow changes from a developmental perspective over the last 40-50 years.

[The Changing Value of Mother's Milk. Feeding Premature and Sick Newborns Since the Late 19th Century]. / Wie wertvoll ist Muttermilch? Die Ernährung Früh- und Neugeborener seit dem ausgehenden 19. Jahrhundert.

In the 1960s/early 70s there was a widespread conviction in West Germany that mother's milk was no longer essential even for premature infants given the availability of improved industrial milk products. But today the superiority of human milk is again undisputed, and progress in neonatology has created a growing target group of extremely premature infants who show clear benefits from being fed with human milk, particularly regarding improved outcomes. Currently there is a revival of donor milk banks (FMB). Globally there are around 500, 15 in Germany. Until the 1960s, mother's milk was the preferred means of German pediatricians to counter infant mortality. During the German Empire and the Weimar Republic doctors widely recommended nursing and engaged wet nurses to meet the demand for human milk and the first donor milk banks were set up; during the Nazi regime there were dozens. The GDR continued using donor milk, while FRG milk banks were shut down in the 70s. The history of milk banks has been shaped not only by science, but also by culture, politics and economics. In the German Empire and the Weimar Republic, social, national and eugenic considerations became intertwined in the struggle against infant mortality. In Nazi Germany human milk was used to strengthen the "German Volksgemeinschaft" ("community of the German people"), particularly individuals who were considered as "erbgesund" ("hereditarily healthy"). Massive advertising of the baby food industry in the West and public debate about pollutants and HIV/AIDS increased doubts about the advantages of natural feeding. In East Germany the planned economy, state health system and censored media significantly contributed to the survival of milk banks.

Newborn screening: a review of history, recent advancements, and future perspectives in the era of next generation sequencing.

PURPOSE OF REVIEW: The purpose of this review is to summarize the development and recent advancements of newborn screening. RECENT FINDINGS: Early initiation of medical care has modified the outcome for many disorders that were previously associated with high morbidity (such as cystic fibrosis, primary immune deficiencies, and inborn errors of metabolism) or with significant neurodevelopmental disabilities (such as phenylketonuria and congenital hypothyroidism). The new era of mass spectrometry and next generation sequencing enables the expansion of the newborn screen panel, and will help to address technical issues such as turnaround time, and decreasing false-positive and false-negative rates for the testing. SUMMARY: The newborn screening program is a successful public health initiative that facilitates early diagnosis of treatable disorders to reduce long-term morbidity and mortality.

Innocent blood: a history of hemorrhagic disease of the newborn.

Hemorrhages occurring in the newborn without trauma have been observed by obstetricians since the 17th century, but have been considered different diseases depending on their location. Umbilical hemorrhage associated with obstructed bile canals was described by Cheyne in 1802. Grandidier in 1871 and Townsend in 1894 grouped together various forms of neonatal bleeds and associated them with disturbed coagulation. When the clotting system became better understood in the last decade of the 19th century, effective symptomatic treatment was developed: gelatin, serum injection, and the transfusion of fresh blood. In 1935, Dam detected the function of vitamin K in the coagulation system and 4 years later, Waddell introduced vitamin K administration into therapy and prevention of neonatal hemorrhagic disease. Kernicterus occurred when high doses of synthetic water-soluble vitamin K analogues were given to preterm infants, reminding physicians that progress in neonatal therapy rests on the cornerstones of controlled trials and follow-up.

Non-operative advances: what has happened in the last 50 years in paediatric surgery?

Paediatric surgeons remain paediatric clinicians who have the unique skill set to treat children with surgical problems that may require operative intervention. Many of the advances in paediatric surgical care have occurred outside the operating theatre and have involved significant input from medical, nursing and allied health colleagues. The establishment of neonatal intensive care units, especially those focusing on the care of surgical infants, has greatly enhanced the survival rates and long-term outcomes of those infants with major congenital anomalies requiring surgical repair. Educational initiatives such as the advanced trauma life support and emergency management of severe burns courses have facilitated improved understanding and clinical care. Paediatric surgeons have led with the non-operative management of solid organ injury following blunt abdominal trauma. Nano-crystalline burn wound dressings have enabled a reduced frequency of painful dressing changes in addition to effective antimicrobial efficacy and enhanced burn wound healing. Burns care has evolved so that many children may now be treated almost exclusively in an ambulatory care setting or as day case-only patients, with novel technologies allowing accurate prediction of burn would outcome and planning of elective operative intervention to achieve burn wound closure.

The eponymous Dr James Marion Sims MD, LLD (1813-1883).

Dr James Marion Sims was born in 1813 in Lancaster County, South Carolina. It was while pioneering numerous surgical procedures in Alabama that in 1849 he achieved the outstanding landmark in medical history of successfully, and consistently, repairing vesicovaginal fistulae. Sims soon developed a reputation as a fine surgeon, with new operations and techniques, using novel surgical instruments and his innovative approaches frequently published. Moving to New York City in 1853, he further established hospitals devoted entirely to women's health. Sims was controversial, with flamboyant descriptions of self-confident success, yet they were tempered with sober reflection of failure and loss. Today we remain with the Sims speculum and Sims position, eponymous tributes to his accomplishments as the 'Father of Gynaecology'.

Early neonatal special care units and their scientific achievements.

Treatment of sick neonates originated in maternity and foundling hospitals in the 19th century. Nosocomial infections and difficult logistics of wet-nursing prevented admission of neonates in most children's hospitals well into the 20th century. In this article, 31 hospitals are described, all located in large cities, in which preterm and sick neonates were treated before the Great Depression. Even though mostly initiated by private charity, these institutions performed research right from the start. Topics included warming and feeding preterm infants, collecting and distributing human milk, developing and storing breast milk substitutes, prevention of rickets and nosocomial infections, maternal and public education regarding infection control, pathoanatomic characterisation of diseases and malformations and epidemiologic studies of infant mortality. These pioneering hospitals, their founding dates, researchers and classic publications are presented in a table.

Sixty-year anniversary of the Apgar scoring system and 100-year anniversary of the "Moro" reflex.

It is well known that the names of discoverers are commonly used in medical terminology, especially in everyday use. The advantage of an eponym is that a complex description of a certain syndrome, surgical procedure, manifestations of a particular disease, or its details, can be expressed in a single word (Holománová & Brucknerová 2003). Current official anatomical nomenclatures do not use eponyms. Some exceptions do however exist. In pediatrics, we frequently use the names of two famous persons: Virginia Apgar and Ernst Moro.

Universal antenatal group B streptococcus screening? The opinions of obstetricians and neonatologists within Australia.

Group B streptococcus (GBS) is the leading infectious cause of morbidity and mortality in Australian newborns. Although intrapartum chemoprophylaxis is recommended to reduce the risk of neonatal GBS transmission and disease, controversy exists as to the best method to select women 'at risk' for this treatment. Our study aimed to survey the opinions of obstetricians and neonatologists currently in practice in Australia on GBS screening and treatment. Of the 488 obstetricians and 68 neonatologists currently in practice who responded to the survey, 271 obstetricians (56%) and 40 neonatologists (61%) supported universal antenatal screening. Of those respondents who did not support a universal antenatal screening policy, 196 (93%) and 24 (92%) of the obstetricians and neonatologists respectively, supported antenatal screening based on risk factors. This diversity in practitioner opinion highlights the lack of certainty in the literature as to the best management strategy to prevent neonatal GBS sepsis.