Hydrops foetalis caused by hepatic haemangioma.

The authors report a moderately premature baby with Down's syndrome and hydrops, the latter probably caused by a large hepatic haemangioma which was diagnosed only after birth. At birth the baby was affected by massive right hydrothorax, ascites, hypoalbuminaemia and severe respiratory distress. With the use of modern neonatal intensive care, the baby survived. Corticosteroid treatment (prednisolone 2 mg kg(-1) d(-1) i.v. in divided doses) was associated with a very rapid resolution of the haemangioma and the baby was healthy at follow-up. Although hepatic angiomas are not uncommon in the neonatal period, the association with hydrops is a rare finding.

[Sepsis caused by Streptococcus pneumonia in newborn infants. 2 case reports]. / Sepsi da Streptococcus pneumoniae in epoca neonatale. Descrizione di due casi clinici.

Streptococcus pneumoniae is responsible for 2% of all neonatal sepsis. The results of epidemiological studies suggest that newborns acquire infection by the ascending route or during the passage through the birth canal. It has been hypothesized that colonization of the maternal genital tract with S. pneumoniae might be caused by contamination of obstetric instruments with the microorganism or by sexual practices, particularly oro-genital contact. From our NICU's database, two cases of newborn sepsis due to Streptococcus pneumoniae, occurred between 1988 and 1996 have been found; the first case presented a fatal disseminated intravascular coagulation (DIC), the second a severe respiratory failure. Antibiotic treatment of women carrying S. pneumoniae in the genital tract and their infants should be strongly recommended, on the basis of the potentially serious consequences for the infants.

[Perinatal outcomes of newborn infants of mothers over 40 years old. A case-control study]. / Esiti perinatali di neonati da madre ultraquarantenne. Uno studio caso-controllo.

The changing life patterns for women in current society are accompanied by a postponement of pregnancy in advanced reproductive age. The aim of our study was to compare perinatal outcome among 314 newborns from women > or = 40 years old with 6.683 controls from mothers 20-29-year-old who delivered at our Division between 1983 and 1993. For each analyzed variable (birth weight, gestational age, congenital malformations, still-births, neonatal mortality and morbidity) the odds ratio (OR) and 95% confidence intervals (95% CI) were calculated for the group of women > or = 40 years old. The incidence of nulliparas in the older age group was 13.5%. The cesarean section rate was higher in the mature mothers than in their younger controls (52.1% vs 34.7%). The more frequent prenatal genetic management in women past the age of 35 years may be the reason for the reduced overall frequency of still-births and malformations in the group > or = 40 years. Preterm delivery was observed more frequently in the older mothers compared with controls (18.5% vs 11.7%). The frequency of LBW and VLBW was higher, but not significant, in the cases than in the controls. Newborns from older mothers had a significant increase of macrosomia (8% vs 4.8%) and a twice increase of mortality (3.2% vs 1.6%) and morbidity (20.4% vs 11.4%). These data suggest to improve the perinatal care of women > or = 40 years old.

[The validity of the certification of natimortality: the experience of a local study]. / Validità della certificazione di natimortalità: l'esperienza di uno studio locale.

Although several study confirmed the inaccuracy of information in death certificates, very few investigations were performed to assess the validity of stillbirth certificate reporting. The aim of the present study was to evaluate the extent to which the clinical diagnosis of stillbirth cause reported in certificates can be considered sensitive and specific. Eighty-five consecutive stillbirths were independently classified by two neonatologists with certificate information, using the new Wigglesworth classification, and the reliability of the classification process was evaluated. Afterwards we compared the classes made with certificate causes and the ones made with clinical-autoptic data (the "gold standard") and we estimated sensitivity and specificity of certificate cause of stillbirth. The reliability of the classification process was very high. Values of sensitivity were considered unacceptable, mainly in the field of congenital malformations, intra-partum asphyxia and other specific causes. By contrast, specificity was found to be satisfactory. The accuracy of clinical stillbirth diagnosis is not sufficient and good description needs the contribute of post-mortem necropsy.