Search

Objective: The aim of this study is to compare respiratory illness-related hospitalization (RIH) and respiratory syncytial virus (RSV)-related hospitalization (RSVH) in multiple births versus singletons, who received palivizumab during the RSV season and participated in the Canadian registry of palivizumab (CARESS)., Study Design: Prospective, observational study of infants aged <2 years recruited across 32 centers over 12 RSV seasons from 2005 to 2017. Demographic data were collected at enrolment and RIH events were recorded monthly., Results: A total of 25,003 infants were enrolled of whom 6,949 (27.8%) were of multiple birth, and 18,054 (72.2%) were singletons. A significantly larger proportion of the multiple births were premature (80.2%) compared with the singleton group (56.8%). Multiples had a lower gestational age (mean ± standard deviation): 31.2 ± 3.2 versus 33.2 ± 5.5 weeks and birth weight (mean: 1,590 ± 606.8 vs. 2,069.4 ± 1068.5 g; both p  < 0.0005). They were younger at enrolment (4.5 ± 5.0 vs. 6.1 ± 6.8 months), and fewer attended daycare (1.9 vs. 4.6%), and experienced exposure to smoking (24.5 vs. 29.9%), but more lived in a crowded household (36.7 vs. 19.4%); all p  < 0.0005. Multiples had a longer length of neonatal stay (51.1 ± 65.9 vs. 47.9 ± 67.8 days), and more required respiratory support (65.7 vs. 57.7%), but for shorter duration (22.6 ± 32.9 vs. 24.7 ± 40.6 days); all p  < 0.001. RIH and RSVH rates (%) in multiples versus singletons were 4.7; 7.7 and 1.4; and 1.6, respectively. Cox regression showed that multiples had a lower risk of RIH compared with singletons (hazard ratio [HR] = 0.616, 95% confidence interval [CI]: 0.543-0.698, p  < 0.0005), but not RSVH (HR: 0.77, 95% CI: 0.57-1.02, p  = 0.071)., Conclusion: Multiple birth infants, who are known to be at greater risk for severe RSVH compared with singletons, are well protected by palivizumab, provided adherence to the monthly injection scheme is guaranteed., Competing Interests: B.P., I.M., and K.L.L. have received investigator initiated research funding or received compensation as advisors or lecturers from AbbVie Corporation, Merck and MedImmune. A.L. and D.K. have no conflict of interest to declare. B.P. wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript., (Thieme. All rights reserved.)

Healthy, premature infants ≤35 weeks' gestational age (wGA) are universally recognized to be at an increased risk of perinatal morbidity and mortality. Serious respiratory syncytial virus (RSV) lower respiratory tract infection imposes an additional burden of illness on these infants following hospitalization. Incurred morbidities relative to term infants include longer lengths of hospital stay, admission to intensive care, and need for oxygen and mechanical ventilation, all of which are associated with increased hospital costs. The highest morbidities are experienced by premature infants who are youngest (<3 months' chronological age) and are of lower gestational age. Short- and long-term follow-up indicates that healthy preterm infants both of lower gestational age and who are late preterm have obstructive lung function at baseline, which is further compromised by RSV-related infection during infancy. There is increasing evidence that childhood exposure to an episode of RSV infection may set the stage for an abnormal respiratory function trajectory, which, in adulthood, leads to chronic obstructive pulmonary disease. Healthy premature infants <32 wGA merit RSV prophylaxis based on existing data, whereas moderate- and high-risk preterm infants 32 to 35 wGA should be selectively and cost-effectively targeted for prophylaxis using validated risk scoring tools and country-specific thresholds for funding., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in an otherwise healthy newborn. The most serious complication is intracranial hemorrhage, which can occur either in the fetus or the newborn. Despite the known serious sequelae, both antenatal management and neonatal treatment modalities are plagued by the lack of gold standard evidence to appropriately direct therapy. Maternal, risk-based therapeutic approaches range from invasive protocols to relatively benign noninvasive strategies to avoid serious procedural complications. Intravenous immunoglobulin (IVIG) with or without steroids and fetal blood sampling constitute the mainstay of antenatal management. Neonatal interventions principally focus on the use of antigen-negative compatible or random donor platelets and IVIG. While awaiting the results of controlled trials, each institution must develop a standardized, collaborative, multidisciplinary approach to the screening, diagnostic evaluation, and management of unexpected and anticipated NAIT based on experience, product availability, and emerging scientific data., (© Thieme Medical Publishers.)

Hepatoblastoma accounts for less than 1% of all pediatric malignancies. However, it remains the most common malignant tumor of the liver in newborns. Less than 10% of hepatoblastoma cases are diagnosed in the neonatal period. The diagnosis can be very difficult due to the wide spectrum of presentation and differences in the size of the lesion at the time of detection either antenatally or during an infant's neonatal course. In this review, we describe the current investigations used to establish the diagnosis of congenital hepatoblastoma and the role of a nuclear red cell scan as an additional strategy in the evaluation of this malignant condition. The report uses two cases of neonatal hepatoblastoma to highlight both the clinical and pathologic findings, and the problems encountered in the evaluation of this disorder.

Streptococcus pneumoniae is an uncommon organism identified in neonatal bacteremia, but when it occurs, it has serious implications for both the infant and the mother. Despite the similarities in the manifestations between group B streptococcus and S. pneumoniae sepsis, the latter appears to be more virulent and of marked severity, resulting in significant neonatal mortality. In the absence of a routine maternal screening protocol for S. pneumoniae colonization, aggressive newborn management constitutes the mainstay of treatment.

Cerebral infarction is a rare complication following a vacuum-assisted delivery occurring on the side of the vacuum application and often accompanied by a cephalhematoma. We report a case of cerebral infarction that was contralateral to the side of the vacuum application in a term baby. The baby presented with seizures in the immediate neonatal period. There was no fracture of the skull to account for a contusion injury. We discuss the mechanisms of intracranial vascular injuries during the process of natural and assisted birth.

We describe a case of spontaneous rupture of the liver in a neonate, presenting with features consistent with testicular torsion. Ruptured liver has been well described in neonates following birth trauma, coagulation defects, and Group B Streptococcal infection. The etiology in our case remains undefined.

Hereditary surfactant protein B (SP-B) deficiency is an uncommon autosomal recessive lung disorder that causes hypoxemic respiratory failure in mature, morphologically normal infants. Recognition and diagnosis of this condition is of paramount importance, as it has significant implications for future pregnancies with a recurrence risk of 25%. In a family with three neonatal deaths over 20 years, SP-B deficiency was diagnosed following the death of the fourth affected infant. Previous deaths were mistakenly attributed to hyaline membrane disease (HMD), congenital Mycoplasma hominis infection, and pulmonary hypertension, however, following the diagnosis in the proposita, SP-B deficiency was also confirmed in her deceased siblings by immunohistochemical staining of autopsy specimens. This case highlights the presentation, postnatal course, diagnosis, and therapeutic options of SP-B deficiency in addition to the mode of inheritance and the possibility of antenatal diagnosis. Genetic consultation is imperative in the investigations of recurrent neonatal deaths, especially in cases of remote events. The recent enormous advances in human genetics have shown that many conditions previously ascribed to environmental agents have a genetic basis.

An unusual case of congenital varicella syndrome with significant central nervous system involvement, but without dermatological features at birth is described. The mother contracted chicken pox at 15 weeks' gestation. Congenital varicella syndrome involves multiple systems, but rarely without skin lesions identifiable at birth. Although varicella infection in pregnant women is an uncommon complication, the fetal embryopathy that may result can be devastating. Antenatal diagnosis of fetal embryopathy during the first 20 weeks of pregnancy should be established by amniocentesis or cordocentesis when a mother presents in the first trimester with chicken pox, and appropriate risk counselling provided.