Search

Since 1963 there are reports in the literature about the syndrome of breast milk jaundice. The factors that may contribute to this phenomenon are still unclear. In our study the effect of interruption of breast-feeding in 25 jaundiced full-term infants was compared to the effect of phototherapy in 25 jaundiced otherwise healthy full-term infants. The results show that this treatment has the same therapeutic effect as phototherapy (p greater than 0.05) without its stressful complications and can be recommended as alternative treatment of this type of hyperbilirubinemia.

The clinical usefulness of transcutaneous bilirubinometry with the Minolta-Air Shield bilirubinometer was evaluated at four obstetrical neonatology units (Basle, Berne, Lucerne and Zurich). Transcutaneous bilirubin (TcB), expressed as bilirubin index, was compared with simultaneous serum bilirubin estimations in healthy Caucasians babies born at term with a birth weight of more than 2500 g. TcB measured over the forehead: 926 determinations in 629 newborns. TcB measured over the sternum: 404 estimations in 260 newborns. TcB estimations over the sternum produced a closer correlation (r = 0.93) with serum bilirubin than estimations over the forehead (r = 0.81). Mean serum bilirubin value as well as the corresponding 5th and 95th percentiles were calculated for each TcB index. From the data obtained the following practical conclusions can be drawn: TcB estimations are reliable for giving the indication to perform serum bilirubin determinations. In patients with risk factors for kernikterus serum bilirubin should be determined at a TcB index of greater than or equal to 18, in babies without risk factors at a TcB index of greater than or equal to 21.

The irradiation of jaundiced infants with fluorescent lights is currently the most common method of treating neonatal hyperbilirubinemia. To investigate whether phototherapy is capable of damaging the genetic material, peripheral lymphocytes of ten jaundiced newborns were studied. Chromosomal analyses were carried out before and after 24 h of treatment with double blue light phototherapy at wavelengths from 420 to 500 nm. Using the BrdU technique for chromosomal culture, no detectable aberrations on genetic material of circulating lymphocytes were observed. This study doesn't, however, exclude potential deleterious effects of phototherapy on other tissues such as skin fibroblasts or immature ovaries in female infants.

Creatine kinase brain isoenzyme (CK-BB) may be released into the serum after brain injury. Its concentration was measured serially in a group of 80 term infants at risk of perinatal hypoxic damage. Their neurodevelopmental outcome was furthermore assessed at 12 months of age. Our results are consistent with the hypothesis that infants with high CK-BB concentration, measured in serum with a new and very sensitive method for enzyme analysis, have more frequently poor short-term outcome (p less than 0.02). These data suggest that early CK-BB measurement may be clinically useful to identify newborns at high risk for neurologic or developmental sequelae.

Since the first description by Rubinstein and Taybi in 1963 more than 250 cases of this syndrome have been reported in the literature, but only few cases in the neonate. We present a patient with the typical clinical aspect who was diagnosed at birth. Early recognition of this condition is important for counselling the parents.

The purpose of this study was to investigate the effect of "intensive phototherapy" (blue double light, 2 X 30 microW/cm2) on neonatal hyperbilirubinemia in 41 infants, compared to a control group treated with "single light" phototherapy (1 X 30 microW/cm2). The double light treatment enhances the photodegradation of bilirubin. The number of exchange transfusions was reduced, and no further exchange transfusions had to be carried out. No significant clinical side effects during the phototherapy were observed.

The effectiveness of early single volume exchange transfusion (ET; 80 ml/kg) was compared with that of early double volume exchange transfusion (160 ml/kg) for treatment of hemolytic disease of the newborn caused by AB0 incompatibility. Twenty full-term infants with AB0 hemolytic disease were randomized into the two treatment groups. The groups were comparable for gestational age, body weight, hemoglobin values, reticulocyte count, maximum serum bilirubin levels, rate of rise of serum bilirubin before ET, antibody titer, and age at time of ET (all p greater than 0.05). The efficacy of treatment was similar in both groups taking into account the mean bilirubin level after ET, post-ET bilirubin, duration of phototherapy following ET, and frequency of second ET (all p greater than 0.05). However, platelet count immediately after ET was lower in the double volume ET group as compared to the single volume ET group (p less than 0.01). Hemoglobin values immediately after ET were higher in the double volume ET group (p less than 0.01). At ten days of life no differences were detectable. The results of this study indicate that the effectiveness of single volume ET for treatment of full-term infants with jaundice due to AB0 incompatibility is at least comparable to that of double exchange ET. Furthermore, the lesser aggressive approach determines less complications such as a decrease of platelet count.

Ceftazidime, a new cephalosporin antibiotic, was used as monotherapy to treat 75 term neonates with suspected perinatal bacterial infection. Septicemia was documented in ten patients (13%). Ceftazidime was administered as 25 mg/kg doses intravenously every 12 h. Peak serum concentrations at 0.5 h after dose ranged from 57 to 115 micrograms/ml and trough serum concentrations prior to next dose from 2 to 15 micrograms/ml. The overall clinical, bacteriological and laboratory response to ceftazidime was satisfactory and the drug was well tolerated. However, reservations with regard to study design, limited gram-positive drug activity and potential emergence of drug resistance require further well-controlled clinical evaluations of ceftazidime in neonatal intensive care units, before definite recommendations for the use of this antibiotic in perinatal infection can be formulated.

Peri-intraventricular hemorrhage (PIVH) is a major problem of preterm neonates: over 40% of infants with birth weight less than 1500 g have been found to experience this disorder. The posthemorrhagic hydrocephalus (PHH) is generally believed to occur secondary to obliterative posterior fossa arachnoiditis. Its management in critically ill premature infants with multiple medical problems has thus become quite significant. This paper reports the results of the placement of a temporary external ventricular drainage in three patients in whom progressive ventricular dilatation began within two weeks after severe neonatal PIVH. In all patients the hydrocephalus and increased intracranial pressure were controlled within three weeks of treatment. One infant died from other problems associated with his prematurity. Early demonstration of progressive ventricular dilatation by ultrasound and prompt external drainage has been found to be a safe initial method to treat PHH in preterm infants.