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Revised UK neonatal screening guidelines recommend that a second blood sample for assay of thyroid stimulating hormone (TSH) be taken when preterm infants reach a postmenstrual age of 36 weeks.To examine the results of a regional screening programme to see whether a rise in TSH concentration was observed in some preterm infants between the first sample taken around 5 days after delivery and the second sample taken at around 36 weeks.Whole-blood TSH concentrations in preterm infants born over a 2-year period (April 2005 to March 2007) were assessed, and the number of infants in whom there was a fall or rise to values below or above the local screening threshold (6 mU/l) was determined.Baseline TSH samples were obtained from 2238 preterm infants (median gestational age 32 weeks, range 21-35) with second samples obtained from 2039 (median gestational 32 weeks, range 23-35). In 19 infants, TSH concentrations fell from above to below the screening threshold, and in five infants values rose from below the screening threshold to 6-10 mU/l. However, TSH concentrations fell to6 mU/l on a further blood spot in four of these infants, and the remaining infant had a serum TSH of 6.8 mU/l. Three infants had raised TSH concentrations on both occasions with unequivocal hypothyroidism (serum TSH80 mU/l). The initial TSH concentration in one of these infants was 6-10 mU/l.No infant with a normal TSH concentration on first sampling had a TSH concentration that rose above 10 mU/l on second sampling, and no infants with a normal TSH concentration on first screening are receiving long-term thyroxine treatment. This study suggests that a second sample may not be necessary with a screening threshold of 6 mU/l.

Background Infection is a major cause of perinatal, neonatal and infant deaths, but the viral contribution to these deaths is poorly described. Objective To describe the contribution of viruses to perinatal, neonatal and infant deaths in one Region of the UK (1985–2008). Methods Using Regional Perinatal Mortality Survey – a population based database of fetal deaths ≥20 weeks gestation and in live-born individuals within the first year. Deaths from viral infection were identified, verified and specified. Results From 819 890 live births and 4478 stillbirths (>24 weeks) 1123 deaths were infectious: 585 bacterial, 102 viral. Of viral deaths 29% were parvovirus (mostly stillbirths); 23% were cytomegalovirus (CMV) (mostly stillbirths). 92% of CMV cases were congenital (cCMV). 23 infant deaths were due to respiratory viruses (table 1). Conclusions Viruses caused 9% of all infective deaths: 6% of fetal losses 24 weeks, 5% of neonatal deaths and 15% of non-neonatal infant deaths. In this population viral deaths occur in ∼7:100 000 live-births and 6:1000 stillbirths ≥24 weeks, most commonly from parvovirus or CMV. By comparison 13% of these deaths were attributed to GBS infection. Morbidity from cCMV is more common than mortality: this population has considerable burden from cCMV.

I could have entitled this Editorial ‘Fissures in perinatal medicine’, because in spite of the rhetoric of physicians taking a unified approach to maternal and infant health, the depressing truth is that in many countries paediatricians, obstetricians, and obstetric anaesthetists inhabit their own academic silos, and all too seldom collaborate constructively in research to improve the lot of mothers and babies. There is at least some historical interplay between obstetrics and neonatology. For instance the neonatal and long term developmental effects of maternal steroid administration has required close collaboration; so have neonatal outcomes for the mode of delivery of twins, and babies in breech presentation. Readers will recall other examples. But of course it is not just obstetric issues that impact on the neonate: depending on local factors and availability, between a third and a half of women delivering in developed nations now either receive epidural anaesthesia, or have a caesarean section, or both. So it is germane to consider the impact not …

Doctors and members of ethics committees need guidance that is underpinned by sound evidence on parental attitudes to research In recent years, the journal has carried several papers on parental consent (assent) for participation of their babies in clinical trials.1,2 This is important because Archives is read by many of those who organise neonatal research projects. The approach to parents is often fraught with ethical dilemmas. Clinicians and members of ethics committees alike need guidance that is underpinned by sound research evidence on parental attitudes and beliefs about participating in research, rather than well meant assumptions about how parents might feel. Readers of the Journal of Medical Ethics would find little of direct use when confronted by the clinical realities and research questions of neonatal care—although this journal once published a neonatal study on the variability of ethics committee views. Rather, it is to specialist or …