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Objective: To test the effect on pregnancy outcome of a policy of very early commencement of postdate surveillance testing, and induction of labor at 42 weeks. Methods: Retrospective analysis of 2776 consecutive cephalic deliveries at 38–42 weeks of gestation. Management of the postdate pregnancies included twice-weekly antenatal testing beginning at 40 completed weeks and elective induction of labor at 42 completed weeks. Pregnancy outcome parameters were compared between the groups delivered at 38–40 weeks and at 41–42 weeks. Results: There were 2138 pregnancies delivered at 38–40 weeks and 638 at 41–42 weeks. The latter group had a statistically significant increase in the rate of cesarean section, mainly accounted for by an increased rate of fetal distress and failure to progress in labor. Similarly the rate of instrumental vaginal delivery, meconium in labor and macrosomia had a statistically significantly higher incidence in the postdate group. These differences in outcome were already apparent at 41 weeks of gestation. Conclusion: Despite early initiation of fetal surveillance, starting at 40 completed weeks, postdate pregnancies are associated with an increased rate of emergency cesarean section, macrosomia and meconium in labor.

AmBisone (2.5–7 mg/kg/day as a continuous 1 h infusion) was evaluated prospectively from September 1994 to January 1998 in 24 very low birth weight infants (mean birth weight 847±244 g, mean gestational age 26 weeks) with systemic candidiasis. Mean age at onset of candidemia was 17 days. One patient had two episodes of candidiasis. Thirteen infants failed previous antifungal therapy with amphotericin B (with or without 5-flucytosine). Candida spp. were isolated from the blood in all 25 episodes and from skin abscesses and urine in four infants each, respectively. There were 13 isolates of Candida albicans, ten of Candida parapsilosis, two of Candida tropicalis and one of Candida glabrata. One infant had a mixed infection with C. albicans and C. parapsilosis. The mean duration of therapy was 21 days; the cumulative AmBisome dose was 94 mg/kg. Fungal eradication was achieved in 92% of the episodes; mean duration of AmBisome therapy until achieving eradication was 9 days. Twenty (83%) infants were considered clinically cured at the end of treatment. No major adverse effects were recorded; one infant developed increased bilirubin and hepatic transaminases levels during therapy. Four (17%) infants died; in two of them (8%) the cause of death was directly attributed to systemic candidiasis. Conclusion: AmBisome represents an effective, safe and convenient antifungal agent in the therapy of systemic fungal infections in very low birth weight infants.

Although the onset of fever in children often prompts parents to seek immediate treatment, the general level of parental knowledge on pediatric fever and administration of antipyretic medications is unknown. Parents without a basic understanding of treatment principles may give their children incorrect doses of medication. Overdosing may cause drug toxicity, while underdosing may lead to unnecessary, repeated clinic and/or emergency room visits.To assess parental decision-making with regard to treating fever in children, and its effectiveness, and to suggest methods for improving the level of treatment.In this cross-sectional self-reported survey, questionnaires were completed by 650 parents who sought medical assistance for a child under the age of 10 years. Parents represented various socioeconomic levels, educational backgrounds and religious affiliations.Ninety-six percent of parents treated fevers that reached 38.5 degrees C, and 77.6% treated fevers of only 38 degrees C. Acetaminophen was the treatment of choice for 96% and dipyrone for 4%. Parental sources of information for managing and administering antipyretic drugs were medical personnel (40.7%), mother's or grandmother's experience (30%), and the enclosed leaflet or instructions on the bottle (29.3%). Forty-three percent of the parents administered the recommended dosage (10-20 mg/kg), whereas 24.3% used less and 32.7% used more; 11% exceeded a daily dosage of 120 mg/kg.A total of 57% of parents treated children with incorrect doses of antipyretic drugs. In 11% of the children treated, the daily dose was at a level that could cause severe toxicity. Parental knowledge of the treatment of fever must be improved.

Xanthine oxidoreductase is an important cytoplasmic source of reactive oxygen species, and has been implicated in the pathogenesis of ischemia-reperfusion damage. Because the cellular localization of this protein remains unclear, our aim was to study its distribution in fresh normal human tissue obtained at surgery. For immunohistochemical studies we purified the protein from human milk and raised a polyclonal antibody in rabbits. In the liver the protein was preferentially localized to the periportal hepatocytes and it was absent from the perivenous region. In the proximal intestine, the protein was expressed in epithelial cells and goblet cells. Lactating mammary gland acinar cells showed intense staining. Small vessel vascular endothelial cells of the intestine, mammary gland, and skeletal muscle showed immunoreactivity, but in the kidney, glomerular endothelial cells were negative. No cells in the heart, brain, or lung expressed the enzyme protein. The observed localization of the xanthine oxidoreductase protein is consistent with previously observed enzyme activities in the organs studied. The widely assumed exclusive localization to capillary endothelium obviously does not apply to humans.

The method of collection of the urine sample is of paramount importance in making a diagnosis of urinary tract infection in infants and children. Squeezing urine out of disposable diapers can provide a urine sample that can be used to detect chemical abnormalities as well as a specimen suitable for microscopic examination. To date there have been no reported studies on the use of this technique for urine culture as compared with samples collected by suprapubic aspiration and catheterization.Urine was obtained from 38 infants aged under 2 years who presented with fever with no obvious cause. All infants had urine collected either by catheterization or suprapubic aspiration and by extraction from a disposable diaper. The urine samples were cultured using standard bacteriologic techniques.Five infants had a urinary tract infection, as shown by a pure growth of more than 10(5) colonies/mL of a single species of bacterium. In all the cases the same result was obtained from both the diaper urine sample and the sample obtained by suprapubic aspiration or catheter. In 31 infants the urine samples collected by both techniques (diaper and catheter or suprapubic aspiration) were negative, and in only 2 infants did the diaper specimen yield a positive result, while the urine obtained by suprapubic aspiration or catheter was sterile.Urine obtained from a disposable diaper can provide a valid sample for diagnosing urinary tract infection. The technique is simple, and can be carried out readily in ambulatory settings with minimal equipment and expense.

The objective of this study was to prospectively evaluate the incidence of neonatal sepsis after prolonged premature rupture of membranes (PROM), to correlate sepsis with gestational age and with the duration of PROM, and to evaluate the necessity for prophylactic antibiotic therapy in neonates born after PROM. Of 12,182 infants, 135 (1.1%) were delivered after PROM with a latency period of24 hours. Neonatal sepsis occurred in 11 infants (8.1%), 10 of whom were premature. The only term, septic newborn was a small-for-gestational-age infant. A latency period72 hours was not associated with an increased incidence of sepsis. Maternal fever, neonatal signs of infection including leukopenia, leukocytosis, thrombocytopenia, and positive gastric aspirate cultures, were not good predictors of sepsis. Of premature infants with PROM, 15% had sepsis, and thus the administration of prophylactic antibiotic therapy in these cases may be warranted. However, it may be unnecessary to administer prophylactic antibiotics to term, appropriate-for-gestational-age infants born after PROM.

Israel has no official prevention policy at present against perinatal and horizontal transmission of hepatitis B virus (HBV) infection in newborns and children at risk. The present study was designed to assess the prevalence of HBV carrier state in a population of 11,123 pregnant women at term. Among this population (mean age 29.7 +/- 5.9), 98 women (0.88%) were found to be asymptomatic HBsAg+ carriers, and 97% of these carriers were anti-HBe+. Evidence for HBV replication, as determined by serum HBV-DNA, was established in 6.6% of the HBsAg+/anti-HBe+ population. The HBsAg carrier rate was strongly influenced by religion, continent, and country of birth of the carrier mothers. The highest relative carrier rate was found among women of Moslem origin (4.3%), as compared to Jewish women (0.67%). Most carrier women were born in Israel (56.1%) to mothers who had emigrated from regions with intermediate or high endemicity of HBV, such as North Africa or the Middle East. In these groups, the HBsAg carrier rate ranged between 1.2 and 3.0%. Ninety-three percent of newborns receiving passive/active vaccination against HBV developed protective levels of anti-HBs. Finally, evidence for horizontal transmission of HBV was found in 19.3% of 83 non-vaccinated children in families of HBsAg carriers. The present study therefore establishes HBsAg prevalence rates in specific risk groups of women at term and confirms the need for an official policy on immunization against HBV in Israel. Since over 50% of women at term belong to the defined risk groups, universal active vaccination of the entire newborn population each year is suggested as the most rational and needed policy in Israel.

The effect of prostaglandin E2 on fetal urine production was examined in women undergoing labor induction. An effect may be expected, because the administration of indomethacin, a potent antiprostaglandin, has been shown to cause a decrease in fetal urine production and subsequent oligohydramnios. The mean hourly fetal urine production before and 4 hours after vaginal application of prostaglandin E2 were similar (38 and 43 ml per hour, respectively). The application of prostaglandin E2 need not be taken into consideration when fetal urine production is assessed.

Changes of zinc in body fluids were evaluated in 12 patients with extensive psoriasis and compared with those of 11 healthy volunteers, using an oral zinc loading test. Plasma zinc levels and urinary zinc excretion were measured by atomic absorption spectrophotometry. No significant difference was found between plasma zinc levels and urinary zinc excretion following an overnight fast. Both groups showed extensive increases in urinary zinc excretion following the loading test. The peak levels of plasma zinc were significantly lower in the psoriatic patients two and four hours after zinc ingestion (P less than .01 and P less than .02, respectively).

During an outbreak of Flavobacterium meningosepticum septicaemia in a neonatal intensive care unit 9 infants were treated with intravenous trimethoprim sulphamethoxazole. Bacteriological cure was achieved in 8 patients; one infant died of massive intraventricular haemorrhage on the first day of treatment. Apart from prolonged persistence of pre-existing thrombocytopenia there was no evidence of side effects. Trimethoprim sulphamethoxazole should be considered in the treatment of neonatal F meningosepticum sepsis in view of its activity against this organism, good penetration of the blood brain barrier, and the absence of serious side effects.

Breast milk and plasma levels of dipyrone metabolites in 8 mothers given a single oral dose of the drug were determined by HPLC. Four metabolites were demonstrated by the analytical method: 4-methylaminoantipyrine (MAA), 4-aminoantipyrine (AA), 4-formylaminoantipyrine (FAA) and 4-acetylaminoantipyrine (AAA). A good correlation was found between the plasma and milk concentrations of the metabolites. The mean (+/- SD) milk to plasma concentration ratios were: MAA = 1.37 +/- 0.28, AA = 1.15 +/- 0.40, FAA = 1.03 +/- 0.09, AAA = 0.97 +/- 0.24. The disposition pattern of the dipyrone metabolites in milk was studied in two mothers. None of the metabolites was detectable 48 h after drug administration.

Three women with neurohypophyseal diabetes insipidus, treated for prolonged periods, including pregnancy, with L-deamino-8-d-arginine vasopressin, gave birth in our hospital. Two of the infants had severe congenital heart disease, one of which was associated with trisomy 21. The third baby, born prematurely, presented with mild intrauterine growth retardation; at the age of 21 months, the boy had severe failure to thrive, hypotonia, and motor retardation. These three cases raise doubts as to the safety of diabetes insipidus or its treatment in pregnancy.

The use of the vacuum extractor at cesarean section has been advocated in order to avoid extension of the uterine incision and to facilitate the delivery of a floating head. We have evaluated, prospectively and retrospectively, the neonatal outcome of vacuum extraction at cesarean section in comparison with regular cesarean section. The interval between the final uterine incision and complete delivery (U-D interval) was significantly prolonged (P less than 0.01) in 8 cases of vacuum extraction (Group A) when prospectively compared with 10 cases of regular cesarean section (Group B). The Apgar scores, the acid-base values at delivery and the clinical course of the two groups were not significantly different. Although analysis of our prospective data suggests a trend of an association between prolongation of the U-D interval and neonatal depression, our retrospective data of 34 neonates delivered by vacuum extraction at cesarean section and 44 neonates delivered by regular cesarean section, showed no significant untoward effect when the vacuum extractor was utilized. Since prolongation of the U-D interval may have an undesireable effect on the fetus, we advocate extra caution in the use of this method.

This prospective study was performed to determine the frequency of unexplained unconjugated hyperbilirubinemia associated with bacterial infection during the first week of life. Of 5805 infants delivered between September 1984 and December 1986, 93 jaundiced newborns without evidence of septicemia fulfilled the following criteria to be enrolled in the study: weight greater than 2500 g, gestational age greater than 38 weeks, age less than 7 days, and unexplained unconjugated bilirubin greater than 170 mumol/L (greater than 10 mg/dL) during the first 48 hours of life and/or greater than 255 mumol/L (greater than 15 mg/dL) thereafter. Evaluation for septicemia included blood and urine cultures, and white cell and thrombocyte counts. The study disclosed three (3.2%) infants who developed septicemia before any clinical suspicion had been aroused. It is concluded that bacterial infections should be considered a possible cause of neonatal unconjugated hyperbilirubinemia during the first week of life, regardless of the clinical condition of the infant.

The fetal heart rate response to externally applied vibratory acoustic stimulation is currently being evaluated as a test of fetal well-being. We have examined the safety of this procedure by subsequent testing of the auditory nerve and brain stem evoked responses in the neonates. The results demonstrated no differences in auditory acuity when control infants were compared with infants previously exposed to antenatal vibratory acoustic stimulation.