History of the birth certificate: from inception to the future of electronic data.

Enumerations of people were carried out long before the birth of Jesus. Data related to births were recorded in church registers in England as early as the 1500s. However, not until the 1902 Act of Congress was the Bureau of Census established as a permanent agency to develop birth registration areas and a standard registration system. Although all states had birth records by 1919, the use of the standardized version was not uniformly adopted until the 1930's. In the 1989 US Standard Birth Certificate revision, the format was finally uniformly adopted to include checkboxes to improve data quality and completeness. The evolution of the 12 federal birth certificate revisions is reflected in the growth of the number of items from 33 in 1900 to more than 60 items in the 2003 birth certificate. As birth registration has moved from paper to electronic, the birth certificate's potential utility has broadened, yet issues with updating the electronic format and maintaining quality data continue to evolve. Understanding the birth certificate within its historical context allows for better insight as to how it has been and will continue to be used as an important public-health document shaping medical and public policies.

Inhaled nitric oxide in premature infants: effect on tracheal aspirate and plasma nitric oxide metabolites.

OBJECTIVE: Inhaled nitric oxide (iNO) is a potential new therapy for prevention of bronchopulmonary dysplasia and brain injury in premature infants. This study examined dose-related effects of iNO on NO metabolites as evidence of NO delivery. STUDY DESIGN: A subset of 102 premature infants in the NO CLD trial, receiving 24 days of iNO (20 p.p.m. decreasing to 2 p.p.m.) or placebo, were analyzed. Tracheal aspirate (TA) and plasma samples collected at enrollment and at intervals during study gas were analyzed for NO metabolites. RESULT: iNO treatment increased NO metabolites in TA at 20 and 10 p.p.m. (1.7- to 2.3-fold vs control) and in plasma at 20, 10, and 5 p.p.m. (1.6- to 2.3-fold). In post hoc analysis, treated infants with lower metabolite levels at entry had an improved clinical outcome. CONCLUSION: iNO causes dose-related increases in NO metabolites in the circulation as well as lung fluid, as evidenced by TA analysis, showing NO delivery to these compartments.

[First SIBEN clinical consensus: diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns]. / Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeable en recién nacidos pretérmino.

OBJECTIVE: To report the process and results of the first neonatal clinical consensus of the Ibero-American region. DESIGN AND METHODS: Two recognized experts in the field (Clyman and Van Overmeire) and 45 neonatologists from 23 countries were invited for active participation and collaboration. We developed 46 questions of clinical-physiological relevance in all aspects of patent ductus arteriosus (PDA). Guidelines for consensus process, literature search and future preparation of educational material and authorship were developed, reviewed and agreed by all. Participants from different countries were distributed in groups, and assigned to interact and work together to answer 3-5 questions, reviewing all global literature and local factors. Answers and summaries were received, collated and reviewed by 2 coordinators and the 2 experts. Participants and experts met in Granada, Spain for 4.5 h (lectures by experts, presentations by groups, discussion, all literature available). RESULTS: 31 neonatologists from 16 countries agreed to participate. Presentations by each group and general discussion were used to develop a consensus regarding: general management, availability of drugs (indomethacin vs. ibuprofen), costs, indications for echo/surgery, etc. Many steps were learnt by all present in a collaborative forum. CONCLUSIONS: This first consensus group of Ibero-American neonatologists SIBEN led to active and collaborative participation of neonatologists of 16 countries, improved education of all participants and ended with consensus development on clinical approaches to PDA. Furthermore, it provides recommendations for clinical care reached by consensus. Additionally, it will serve as a useful foundation for future SIBEN Consensus on other topics and it could become valuable as a model to decrease disparity in care and improve outcomes in this and other regions.

Case report of Haddad syndrome in a newborn: congenital central hypoventilation syndrome and Hirschsprung's disease.

Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by failure of automatic control of breathing. Diagnosis is made by exclusion of other causes of hypoventilation. Genetic etiology is strongly suspected. Other autonomic nervous system dysfunctions, tumors of neural crest origin and Hirschsprung's disease are often found in affected children. Association with Hirschsprung's disease is known as Haddad syndrome. We present a newborn with respiratory distress since birth and Hirschprung's disease subsequently diagnosed with Haddad syndrome.

Effects of surfactant treatment on gas-exchange and clinical course in near-term newborns with RDS.

OBJECTIVE: To determine if there is a relationship between acute improvement in pulmonary gas exchange and surfactant use in near-term (35-39 weeks' gestation) infants with respiratory distress syndrome (RDS). METHODS: We examined retrospectively the records of 54 infants admitted during a 15 month period who were 35 or more weeks of gestation, and who demonstrated all the diagnostic features of RDS. Data analyzed included: birth weight; gestational age; Apgar scores; calculated alveolar to arterial oxygen gradient (AaDO2) and oxygenation index (0I); hours of life at intubation; surfactant administration; complications with surfactant administration; use of inotropic medications. RESULTS: A total of 30 of infants were treated with intubation and surfactant administration. Mean FiO2 at the time of surfactant administration was 0.96. The AaDO2 decreased from 64.0 +/- 14.8 kPa to 41.8 +/- 22.5 kPa by 6 hrs (p < 0.0001). There was no relationship between age at treatment (6-89 hr) and response to treatment as measured by changes in AaDO2, FiO2, or oxygenation index (OI). CONCLUSIONS: Near-term infants with severe RDS often respond to exogenous surfactant, suggesting a functional deficiency of endogenous surfactant at a "late" stage in their disease process. We speculate that delayed treatment may still be effective in these patients.

The use of inhaled nitric oxide in newborn medicine.

Persistent pulmonary hypertension is common in neonates with respiratory failure. It is characterized by pulmonary hypertension and extrapulmonary right-to-left shunting across the foramen ovale and ductus arteriosus. Nitric oxide has been found to be an important inter- and intracellular messenger in virtually every organ in the body. Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. The use of iNO improves oxygenation in severely hypoxemic neonates, showing both acute and sustained improvement. It decreases pulmonary arterial pressure, and improves ventilation-perfusion mismatch. This, in turn, may lessen the need for extracorporeal membrane oxygenation. This article reviews the discovery of nitric oxide, its metabolism, its use in persistent pulmonary hypertension of the newborn (PPHN), long-term follow-up, and safety issues related to NO. It has recently been approved by the FDA for the treatment of hypoxic respiratory failure associated with PPHN.

Immunodeficiency in a patient with Baller-Gerold syndrome: a reason for early demise?

We describe the case of a 37-week-old, small-for-gestational-age, white baby girl born with Baller-Gerold syndrome (BGS), with craniosynostosis and partial absence of the corpus callosum, absent radius, and syndactyly. She died at 2 months of age because of overwhelming sepsis that appeared to be due to an underlying humoral immunodeficiency. Unexpected sudden death has been reported in patients with BGS, but there has been no previous documentation of immunodeficiency. We suggest that a basic immunologic and hematologic workup should be part of the standard of care of all patients affected with BGS or related syndromes.

Non-classical 3 beta-hydroxysteroid dehydrogenase deficiency in children in central Iowa. Difficulties in differentiating this entity from cases of precocious adrenarche without an adrenal enzyme defect.

Over a three-and-a-half year period, 26 children with precocious pubarche or other forms of sexual precocity were studied. All had plasma steroid patterns analyzed, in most cases both before and after stimulation with ACTH. 17 of the children had elevation of the delta 5-steroids dehydroepiandrosterone and 17-OH-pregnenolone and their individual results are presented. Five of these children were diagnosed with probable late-onset 3 beta-HSD deficiency. The difficulties in differentiating this entity from idiopathic premature adrenarche are emphasized.