Intrapartum fever and unexplained seizures in term infants

OBJECTIVE

Early-onset neonatal seizures are a strong predictor of later morbidity and mortality in term infants. Although an association of noninfectious intrapartum fever with neonatal seizures in term infants has been reported, it was based on only a small number of neonates with seizures. We therefore conducted a case control study to investigate this association further.

METHODS

All term infants with neonatal seizures born at Brigham and Women's Hospital between 1989 and 1996 were identified. For this study, cases consisted of all term neonates with a confirmed diagnosis of seizure born after a trial of labor for whom no proximal cause of seizure could be identified. Infants with sepsis or meningitis were excluded. Four controls matched by parity and date of birth were identified for each case. The rate of intrapartum maternal temperature >100.4 degrees F was compared for case infants and controls. Potential confounding was controlled in logistic regression analysis.

RESULTS

Cases comprised 38 term infants with unexplained seizures after a trial of labor. We identified 152 controls. Infants with seizures were more likely to be born to mothers who were febrile during labor (31.6% vs 9.2%). In almost all cases, the fever developed during labor (94.7% cases, 97.4% controls). At admission, mothers of infants with seizures were not significantly more likely to have factors associated with concern about infection such as a white blood cell count >15 000/mm(3) (28. 9% vs 19.1%) and premature rupture of the membranes (15.8% vs 17.8%). In a logistic regression analysis controlling for confounding factors, intrapartum fever was associated with a 3.4-fold increase in the risk of unexplained neonatal seizures (odds ratio = 3.4, 95% confidence interval = 1.03-10.9).

CONCLUSION

Our data indicate that intrapartum fever, even when unlikely to be caused by infection, is associated with a fourfold increase in the risk of unexplained, early-onset seizures in term infants.

Permanent pacemaker implantation via the femoral vein: an alternative in cases with contraindications to the pectoral approach

BACKGROUND

This paper presents a consecutive series of permanent pacemakers (PPM) implanted via the femoral vein in patients with contraindications to pacing systems via the superior vena cava (SCV). The femoral vein approach is a less invasive and feasible alternative to epicardial lead placement.

METHODS

Twenty-seven patients had femoral pacemakers inserted. Indications for femoral vein pacemaker insertion were: SVC/subclavian obstruction (12 patients, 44.4%), previous infection in SVC leads (four patients, 14.8%), mastectomy and/or radiotherapy to chest (four patients, 14.8%), multiple leads in SVC (two patients, 7.4%), recurrent erosion (two patients, 7.4%), abnormal anatomy (one patient, 3.7%), painful pacemaker pocket (one patient, 3.7%) and burns (one patient, 3.7%). Fifty-one leads, 25 atrial and 26 ventricular, were inserted. The majority of leads were active fixations (96% of atrial leads and 85% ventricular leads).

RESULTS

During a mean follow-up of 36.5 months (range 0.9-116.5), six additional unplanned procedures were performed in four patients. Atrial lead displacement occurred in five leads (20%). There were no ventricular lead displacements. In two patients, box revision for pre-erosion was required. One patient had persistent pain at the site of abdominal pacemaker generator. Infection, thromboembolic events, thromophlebitis, evidence of lower limb venous occlusion and lead fracture did not occur.

CONCLUSION

Femoral vein PPM are a simple and feasible alternative in patients in whom the SVC approach is contraindicated.

Ocular perfusion pressure and choroidal thickness in eyes with polypoidal choroidal vasculopathy, wet-age-related macular degeneration, and normals

PURPOSE

To measure the choroidal thickness and ocular perfusion pressure in eyes with polypoidal choroidal vasculopathy (PCV), wet-age-related macular degeneration (AMD), and age-matched normal subjects, and look for a possible association between the two.

METHODS

This was a prospective study including 22 eyes with PCV, 33 eyes with wet-AMD, and 35 age-matched normal eyes. Choroidal thickness was measured using enhanced depth imaging (EDI) with spectral-domain optical coherence tomography (SD OCT). Mean ocular perfusion pressure (MOPP) was calculated using the mathematical formula 2/3[DBP+1/3{SBP × DBP}]-IOP (DBP-diastolic blood pressure, SBP-systolic blood pressure, IOP-intraocular pressure). Analyses were carried out using SPSS 14 software and comparisons of mean made using't' tests.

RESULTS

Eyes with PCV showed increased (285.9 μm; subfoveal) choroidal thickness, whereas eyes with wet-AMD (119.4 μm; subfoveal) showed reduced choroidal thickness in comparison with normal eyes (186.77 μm; subfoveal). MOPP in the PCV group was 57.85 mm Hg (P value 0.00), in the wet-AMD group was 52.1 mm Hg (P-value 0.12), and in the normal group was 49.79 mm Hg.

CONCLUSION

It is postulated that higher MOPP in eyes with PCV could have an etiologic implication in disease manifestation and progression. Larger studies with longer follow-up may help validate these findings.

The role of transthoracic echocardiography in excluding left sided infective endocarditis in Staphylococcus aureus bacteraemia

In all patients with Staphylococcus aureus bacteraemia a transoesophageal echocardiogram is recommended to exclude infective endocarditis. We determined that a finding of normal to trivial valvular regurgitation on transthoracic echocardiogram in these patients significantly reduced the probability of infective endocarditis. Furthermore, in the absence of embolic phenomena the likelihood of infective endocarditis was less than 2%. This probability could be further reduced if the echocardiogram was performed greater than 5 days after the bacteraemia. Therefore, in the assessment of patients with S. aureus bacteraemia a transoesophageal echocardiogram is not always required to exclude infective endocarditis.

The role of angiotensin II type 1 receptor blockers in the prevention and management of diabetes mellitus

Angiotensin II Receptor blockers (ARBs) are an important addition to the current range of medications available for treating a wide spectrum of diseases including cardiovascular diseases. Coronary heart disease (CHD) is the most common cause of death in the United Kingdom and worldwide. More importantly, the presence of the metabolic syndrome and the likelihood of diabetes mellitus taking on epidemic proportions in the years to come all threaten to maintain the mortality rate due to CHD. This review article focuses on the clinical studies that have helped define the trends in the usage of these agents in the prevention and treatment of diabetes mellitus and its complications and also explores possible mechanisms of action and future developments.

Biomimetic synthesis and ultrastructural characterization of a zerovalent gold–hydroxyapatite composite

This manuscript describes one-pot, in situ synthesis of organoapatite-gold nanoparticle composite and its characterization by XRD, energy dispersive X-ray analysis, atomic force, and scanning electron microscopy. This methodology offers a different approach into the synthesis of zerovalent metal-mineral-phase nanocomposites having potential application as osteointegrative ceramics.

Chemical Interaction and Phase Morphology Development of Carboxy Terminated Butadiene-co-Acrylonitrile Rubber Toughened Epoxy Blends

The nature of chemical interaction between carboxy terminated butadiene-co-acrylonitrile (CTBN), a reactive liquid rubber, and epoxy cresol novolac (ECN) resin during curing with diamino diphenyl methane (DDM) as hardener has been studied by Fourier transform infrared spectroscopy (FTIR). Blends of CTBN and ECN were withdrawn at a regular interval of 15 min for 2 h and the FTIR spectra were recorded in each case. Variations of the positions of the characteristic peaks of the oxirane group of epoxy and carboxyl group of CTBN as well as formation of several new peaks with the progress of the curing were observed. Scanning electron microscopy (SEM) was conducted in each of the above samples to study the evolution of phase morphology through growth of the rubber phase while the continuous epoxy matrix underwent curing by the hardener. The surface topography and microstructure of impact-failed toughened epoxies have also been studied with the help of atomic force microscopy (AFM).

Polyglandular autoimmune syndrome type 2 presenting for the first time during pregnancy

We report a case of polyglandular autoimmune deficiency presenting during pregnancy which was associated with a favourable outcome for both mother and fetus (apart from fetal growth retardation) with appropriate replacement therapy and adequate steroid cover at the time of delivery.