[Persistent hyperbilirubinemia after intrauterine intraperitoneal transfusions in 4 newborn infants. Role of intraperitoneal red cells present at birth]

Four neonates who had undergone intra-uterine peritoneal blood transfusions for Rhesus disease and hydrops fetalis presented, during the first days of life, with intractable hyperbilirubinemia in spite of multiple exchange transfusions. The hyperbilirubinemia was due to delayed absorption and hemolysis of peritoneal red cells. This unusual complication can be successfully managed with peritoneal lavage which should be performed when the antenatal history is contributive for low absorption of transfused blood.

[Chickenpox and pregnancy. Perinatal aspects and prevention]

Five neonates born to women who had had varicella late in pregnancy or in the post-partum were admitted to our unit during the last year. In utero transmission of varicella-zoster virus occurred in 2 cases. One of them had no clinical eruption but specific IgM at a titer of 1/200. The mother presented with varicella 15 days before delivery. The other developed severe neonatal congenital varicella (with disseminated eruption, pneumonia and seizures). She was treated by Aciclovir (15 mg/kg/8 h). The mother presented with chickenpox 24 hours after birth. Varicella occurring in a pregnant woman from 4 days before to 2 days after delivery is dangerous because the baby will lack maternal antibodies. It may develop severe neonatal varicella (mortality: 20-30%). A neonate in critical condition was successfully given a prophylactic treatment by Aciclovir IV (15 mg/kg/8 h for 5 days) and varicella-zona immunoglobulins (2 ml on days 1, 2, 3). This approach may be the best treatment for babies at risk for severe neonatal varicella.

Evaluation of single sensor transcutaneous measurement of PO2 and PCO2 in the neonate

A single combined transcutaneous sensor for PO2 and PCO2 was evaluated in a neonatal intensive care unit. The values obtained with the combined sensor were compared with the values obtained with two separate electrodes monitoring respectively PO2 and PCO2. Adequate correlations were found. The combined sensor represents an improvement on individual electrodes as it spares available skin surface and needs less handling.

Role of prenatal genetic counseling before amniocentesis. A survey of genetics centers

Although prenatal genetic amniocentesis is an accepted procedure for certain high-risk pregnancies, there is no standard approach to prenatal counseling, timing of counseling, materials used and location of the procedure. This survey of 126 genetics centers offering prenatal genetic amniocentesis reviewed aspects of 48,502 counseling events and a total of 61,174 samples processed in 1982. Eighty-three percent of the samples were obtained after counseling at the centers. Of the patients counseled, 88.5% chose amniocentesis, but the utilization rates varied widely between the centers. The choice of amniocentesis varied measurably with the educational materials used but not with the center size. Educational materials, written or audiovisual, were used by genetics centers in counseling 82% of the patients. There was a wide variation in center size, counseling methods used, the timing and use of counseling, and patient responses in the survey population.

Evolution of the visual prognosis of prematures in the last 20 years

Ophthalmoscopic examinations were performed on 5678 prematures, born between 1964 and 1984, by the same investigator in the same neonatal care unit. Three periods can be differentiated. In the first period (1964-1970) retinal disorders were frequent (20%), a quarter of them severe (stages 3-5). The inspiratory fraction of oxygen was the only oxymetric factor that was monitored. In the second period (1970-1977), less severe forms were observed, but still 4.5% of stage 1 and 8.7% of stage 2 (mild forms) were assessed. During this period, oxygen partial pressure was measured every 6 h in arterial blood whenever the inspiratory fraction of oxygen exceeded 0.3. In the last period (1977-1984), no severe forms were observed and mild forms amounted to only 0.9%. In this period, oxygen partial pressure was continuously monitored transcutaneously, whenever the inspiratory fraction of oxygen exceeded 0.21. Such data show that there is an association between better oxygen monitoring and the dramatically reduced incidence of retinopathy in prematures (RP).

[Aortic valve stenosis. Prenatal diagnosis. A case]

Closed aortic valvotomy through the left ventricular apex could be performed in a 3-day old child thanks to an echocardiographic diagnosis in utero, at 32 weeks, of aortic stenosis, confirmed immediately after birth. The functional and echocardiographic results 5 months after the operation are excellent. This case shows that the prenatal diagnosis of cardiac malformation is feasible and facilitates an early treatment in the post-natal period.

[Value of prealbumin in the 1st and after the 12th day of life]

From a series of 129 neonates, well defined with regard to weight and gestational age, the authors established that serum concentration of prealbumin (PA) in an aseptic neonate depends on its gestational age on the first day of extrauterine life (p less than 0.001). Serum concentrations of PA are significantly different in appropriate for gestational age (AGA) and small for gestational age (SGA) neonates; this may be the consequence of insufficient materno-foetal transfers in the majority of SGA children. The study of the ratio maternal PA/neonatal PA at the time of delivery helps to establish the cause of SGA. On and after the 12th day of life, serum concentrations of PA are closely correlated with the usual data of anthropometry (weight, height, skull circumference) (p less than 0.001), when correlation is less close with gestational age at the time of sample taking: it may be used as a marker of the appropriateness of gestational age rather than of maturity. However, the ratio PA/weight varies from one child to another and from one week to another for a same child, giving PA a value different from ordinary anthropometry for the evaluation of the appropriateness of gestational size in neonates.

[Neonatal bacterial infections. Kinetic study of C-reactive protein and orosomucoid]

Changes in serum concentrations versus time of C reactive protein and orosomucoid were investigated in 134 neonates with either materno-foetal infection (group A, n = 111) or nosocomial infection (group B, n = 23). Both proteins were significantly elevated in group A neonates, with mean +/- S.E.M. values of 0.029 +/- 0,003 g/l for C reactive protein (n = 111) and 0.56 +/- 0.003 g/l for orosomucoid (n = 37). In cases with superinfection serum levels of both proteins rose before clinical symptoms developed. Changes in orosomucoid concentrations occurred a few hours after changes in C reactive protein concentrations. Monitoring C reactive protein and orosomucoid levels, in an excellent means of assessing the effectiveness of treatment and of deciding on its withdrawal when both proteins return to normal values.

C-reactive protein measurement: a reliable method of diagnosing and monitoring the infected newborn for the assessment of a mezlocillin therapeutic trial

Clinical and bacteriological efficacy of mezlocillin was evaluated in 41 neonates (including 12 premature babies) with clinical and laboratory evidence of bacterial infection, as shown by elevated C-reactive protein serum concentrations. They received intravenous mezlocillin (80 to 100 mg/kg/dose) every 8 h for 10.4 days. The mean serum concentration (+/- S.E.M.) of mezlocillin in full-term neonates was 214 +/- 19.8 mg/l 1 h after the infusion and 52.0 +/- 9.3 mg/l prior to the next infusion. In premature neonates these mean concentrations were respectively 167 +/- 23.4 mg/l and 40.7 +/- 6.7 mg/l. The efficacy of mezlocillin was documented by the decrease in C-reactive protein serum concentrations and by improvement in clinical condition. Therapy with mezlocillin alone proved to be safe and effective when used for non-nosocomial infections during the neonatal period.

[Prevention of iatrogenic effects of artificial ventilation with transcutaneous monitoring of PO2 and PCO2 in the newborn infant]

The authors have monitored Tc PCO2, Tc PO2 and mean airway pressure in 25 ventilated newborns, during 68 days. They show that the best blood gases values are not even obtained with the most aggressive artificial ventilation (A.V.). Tc PCO2 and Tc PO2 transcutaneous monitoring and mean airway pressure measurement allow an "à la carte" adaptation of the A.V. to bring in each case the most efficient and the least aggressive A.V. This method may decrease the iatrogenic complications of the A.V.

[Exfoliatin in neonatal staphylococcal infections]

An outbreak of staphylococcal skin infection in neonates was investigated clinically, bacteriologically and epidemiologically with the following findings: (1) In 8 out of 13 cases, exfoliatin-producing staphylococci were present in the bullae, which is unusual with bullous lesions occurring at other ages; (2) exfoliatin producing staphylococci were present in all children with bullous lesions, as well as in carriers; (3) 39% of the phage II group staphylococci studied produced exfoliatin; (4) purulent lesions due to phage II staphylococci which did not produce exfoliatin were observed. The contaminating agent could be identified in most cases.

[Value of C-reactive protein in neonatal bacterial infections]

C reactive protein (CRP) levels were measured in the serum of 2 groups of neonates before and after the 12th hour of life. One group consisted of controls, the other of children with neonatal sepsis. The means (+/- standard error) for CRP serum level were 6 +/- 0.7 mg/l and 7.7 +/- 0.8 mg/l respectively before and after 12 hours of life in controls (n = 100); they were 19.7 +/- 3.4 mg/l and 67.5 +/- 6.6 mg/l in the group of infected neonates (n = 54). For both times of sampling, levels were significantly higher (p less than 0.001) in infected neonates. The low percentage of false-positives and false-negatives suggests that this dosage is almost specific for neonatal sepsis.

[Etiology and prevention of severe mental handicaps]

In a group of 124 children with mental retardation, a study showed 21% of chromosomal abnormalities, 26% of perinatal causes and 33% of undetermined causes. Current preventive measures are well adapted. They might be usefully completed by mandatory ultrasonographic examinations during pregnancy and promotion of birth of at-risk children in well-equipped centers for perinatal medicine. In cases when in utero transfer is not possible, transfer by specialized pediatric emergency care services should be generalized. A better supervision of families where retarded children are living would be advisable. The detection of bacterial meningitis should be improved. Finally, an active research should be undertaken in order to better dissociate and understand the as yet unknown causes of mental retardation.

Evaluation of a mini-cascade impactor for sampling exposure chamber atmospheres

Andersen 4-stage mini-cascade impactors, designed primarily for personnel dosimetry, were tested for suitability of characterizing solid-particle aerosols within inhalation exposure chambers. Performances were assessed by comparing their particle-size separating capabilities against cyclone separators and Andersen 8-stage ambient cascade impactors. Data reveal excellent agreement between respirable (ACGIH) mass fractions, and mass median aerodynamic diameters, measured with the mini-samplers and the larger laboratory cascade impactors. Cyclone data did not correlate as well. Findings indicate that where accurate particle characterization at low sampling flow rates is desired, compact mini-cascade impactors are appropriate instruments.

[Ductus arteriosus in neonatal cyanotic cardiopathies. Value of the recording of the cutaneous partial pressure of oxygen]

Adaptation to extrauterine life is always precarious in the newborn with cyanotic cardiac malformations. Limited survival is possible in cases with obstructive lesions of the right heart providing ductal closure is delayed. This was monitored in 3 cyanotic neonates with ductal dependant cardiac malformations (tricuspid atresia, transposition of the great arteries with atresia or severe stenosis of the pulmonary valve) by continuous measurement of the cutaneous pO2. The value of cutaneous pO2 monitoring has already been established. It is a reliable indicator of arterial pO2 in the neonatal period. Its major advantage, apart from the possibility of continuous monitoring, is that it is non-invasive and may be performed at the bedside. Analysis of curves recorded over several hours or days showed the cyclical nature of cutaneous pO2, probably related to slow variations in ductal diameter equilibrating effective pulmonary flow, arterial pO2 and ductal constriction. Prolonged hyperoxygenation of these desaturated children does not usually improve their condition; progressive deterioration due to the constrictive effect of oxygen on the ductus may be observed. When a clear decrease in the amplitude of oscillation is recorded ductal closure is imminent and palliative surgery should be undertaken whenever possible.

[Drug treatment of apnoea in premature infants (author's transl)]

Primary apnoea in premature infants can be treated by three categories of drugs. Drugs of the first category act on chemoreceptors and include doxapram and possibly almitrine if the latter proves non-toxic during the neonatal period. Phenobarbitone is so far the only representative of the second category of drugs which alter the pattern of sleep. As for the third category, it has the second messenger of respiratory centres for target and includes the phosphodiesterase's inhibitor (not yet tried in man) and the xanthines. At the moment, xanthines are the drugs of choice, since they are both effective and safe, provided dosage is adjusted to each patient.

[Peripheral retinal lesions in the premature infant]

The periphery of the retina was examined with the use of contact lenses at the age of 5 years in children who were born prematurely and weighed less than 1,500 g at birth. In this retrospective series 65% of the children were found to have lesions similar to the classical findings in retrolental fibroplasia although only to a minor degree. Low oxygen levels with a short duration of the exposure cannot completely prevent these sequalae. This retinopathy which is limited to the periphery, may account for the frequency and severity of myopia in children who were premature. Later in childhood and more rarely retinal detachment or tears may occur which cause severe visual impairment.

[Present status of retrolental fibroplasia in France]

A national survey showed that retrolental fibroplasia still exists in France, as it does in other countries of the world. Retrolental fibroplasia is a condition that principally affects low birth weight premature babies in whom oxygen therapy has not been adequately controlled. The premature babies who have apnaeic attacks are most risk. Strict control of all oxygen therapy, preferably using continuous monitoring techniques together with other changes in the methods of treatment should reduce the incidence of this condition.

[Aortic arch interruption and cutaneous PO2]

In three neonates with cardiac failure and coarctation the cutaneous PO2 (cPO2) has been measured during the administration of a high concentration of oxygen. One sensor was fitted to the skin just below the right clavicle (preductal) and the other on one of the legs (postductal). The difference in the cPO2 provided evidence for a large right to left shunt through the duct. This finding in conjunction with the clinical syndrome of co-arctation is characteristic, in our view, of atresia of the aortic arch. The results of the test, with clinical and echocardiographic details enable more accurate decisions to be made before catheterisation and surgery.

[Survey on retrolental fibroplasia in France]

From 1964 to 1976, 20 cases of retrolental fibroplasia were recorded in the south of France while 38 cases were recorded in the north from 1970 to 1977. The more children are immature, the more they are liable to suffer from this disease. Etiological factors are apparently not limited to oxygen, which however plays the most important part in the process.

[Neo-natal neutropenia induced by anti-NA 2 allo-immunization. Serological and clinical study of 2 cases in a family]

A severe neutropenia in a 2 day old newborn drew attention to anti-HLA and NA 2 antigranulocytic antibodies in the maternal serum. Close supervision from birth of a younger sibling demonstrated a neutropenia on the 5th day of life. Serological investigation showed the anti-NA 2 antibody to be responsible in both cases. A good result with total blood replacement of leucocyte-free blood in the second case would advocate this treatment in cases of severe immunological neutropenia.

[Retinal dysplasia with hydrocephalus (author's transl)]

A Study is described of a family in which four children of the same generation died during early childhood; three of them had an obvious hydrocephalus. Two of the latter could be examined clinically, and their eyes removed for pathology. One of them presented clinically bilateral leucocoria; histology showed a total detachment of a dysplastic retina, with absence of development of the vitreous. The other child had apparently normal eyes. Yet on microscopical examination there was a discrete retinal dysplasia without retinal detachment in both eyes, and a persistent hyaloid artery, in one. This association of hydrocephalus with retinal dysplasia is clinically and genetically different from other types of retinal dysplasia.

[Visual future of prematures]

The retinal periphery of 60 premature children now between 5 and 8 years of age and with a weight at birth equal or less than 1,500 g has been investigated. In 20% of these children, pigmentary modifications were noted which were often associated with chorioretinal atrophy. Polymorphic vascular abnormalities were seen in 14% of the cases, i.e. sinuous vessels of irregular caliber or neovascularization. Abnormalities of the vitreous body were also noted in 12% of the patients with glial bags on the periphery and sometimes potentially dangerous tractions folds (4%). All these abnormalities could cause complications such as retinal tear, retinoschisis or retinal detachment. Even if these signs are discrete, they can later on be the source of complications. Refraction studies revealed 30% of myopic children. The most important group had myopias equal or higher than 8 d. The characteristics of the myopia of premature children are its constancy (all premature children are myopic at birth); its importance (it depends on birth weight and on the severity of the retinopathy), and its evolution (the myopia of premature children does not evolve or evolves very slightly).

[Placental anomalies and neonatal development of hypotrophic infants]

The study of 181 hypotrophic children led to the following conclusions: 1. In pregnancies preceding the birth of hypotrophic children, placenta is significantly more frequently altered than in all other cases. 2. Among all the changes observed in the structure of placenta, ischemic necrosis of placental villi seems to be the worst, in terms of immediate neonatal evolution. Hypoglycemia, especially, is most often observed in such instances. Consequently, examination of the structure of placenta allows a prognosis at the time of birth of a child with intra-uterine growth retardation; its practice should become generalized.

A long term evaluation of infants who received a beta-mimetic drug while in utero

The administration of beta-mimetic drugs to pregnant women poses the problem of possible long-term repercussions in the children born to these mothers. 42 children from women who had been treated with 60-80 mg a day of ritodrine hydrochloride (Pre-par), during a period varying from 3 to 93 days, were closely matched with infants from untreated mothers. Each child, (aged from one to 3 years), was fully investigated on the basis of: a detailed questionnaire to the mother; careful clinical examination; assessment of psychomotor development; the Denver test; electrocardiography and urine analysis. There was no statistically significant difference between the two groups for any of the variables of development that were studied. One child had left ventricular hypertrophy, which was probably incidental. It is concluded that administration of ritodrine hydrochloride to pregnant women induces no harmful long-term effects in their offspring.

Aminoglutethimide in the treatment of Cushing's syndrome

The efficacy and tolerability of aminoglutethimide for the treatment of Cushing's syndrome was assessed in 66 cases three of which are described in the present paper. Aminoglutethimide provided palliation from the signs and symptoms of hypercorticism in 13 of 21 patients with metastatic adrenocortical carcinoma and four of six patients with ectopic ACTH production due to metastatic carcinomas. All six of the patients with adrenal adenomas showed clinical and biochemical improvement, while 14 of the 33 patients with bilateral adrenal hyperplasia of pituitary origin improved. Adverse reactions attributed to aminoglutethimide such as drowsiness, rash, and nausea occurred in 58 per cent of cases. These data suggest that aminoglutethimide has a place in controlling the signs and symptoms of adrenocorticoid excess in patients with Cushing's syndrome due to malignancy and is effective preoperative therapy for patients with adrenal adenomas and bilateral hyperplasia.

[Severe hyperosmolarity caused by dietary error in the newborn. A disorder of particular concern in migrants]

Hyperosmolarity as a result of dietary error is a fairly common condition. It is more grave than "thirst fever", the benign reputation of which should not be taken too lightly. The consequences may be serious: death or sequelae related to vascular thrombosis or cerebral lesions. Prevention should be possible in most instances as long as obstetricians, paediatricians, midwives and nursery nurses are aware of the danger of overconcentrated milk formula. Its treatment remains fraught with hazard.