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Although spontaneous chylothorax is a rare entity in the neontal period, it is the most common cause for pleural effusion in the first few days of life. 1 In a recent review of 34 cases of congenital chylothorax, 2 there were three instances in which this condition was associated with maternal polyhydramnios. This report describes two additional cases of congenital chylothorax that were associated with polyhydramnios in the mother. Report of Cases .—Case1.—A 2,693-g boy was born at 34 to 35 weeks' gestation to a 21-year-old primigravida mother who took diazepam during her pregnancy for her "nervous condition." One month prior to delivery she developed a urinary tract infection and was treated with ampicillin. A diagnosis of polyhydramnios was also considered at that time; the diagnosis was confirmed when spontaneous rupture of the membranes occurred on the morning of delivery. Monitoring techniques disclosed fetal bradycardia shortly after saddle

We have performed weekly computed tomographic brain scans on 28 surviving low-birth-weight infants with cerebral intraventricular hemorrhage and acute ventricular dilatation. Evolving hydrocephalus was observed in 15 infants. Twelve of the 15 infants were treated by removing large volumes of cerebrospinal fluid with serial lumbar punctures. Arrest in the progression of hydrocephalus was evident in 11 of the 12. Clinical hydrocephalus requiring surgical intervention occurred in one of the treated infants and in all three untreated infants. No complications of serial lumbar punctures were noted, whereas shunt-related morbidity was 100%. Our results suggest that serial lumbar punctures are effective in arresting the development of posthemorrhagic hydrocephalus.

• Traumatic perforation of the esophagus follows oropharyngeal suctioning or endotracheal intubation. The diagnosis frequently is made from a routine chest roentgenogram that shows a nasogastric tube in the right pleural space with or Without a pneumothorax. The lesion is seen most often in infants of low birth Weight. ( Am J Dis Child 134:367-368, 1980)

A 5 MHz range-gated portable pulsed Doppler velocity meter was used to measure mean ascending aortic blood flow velocity noninvasively. Studies were performed from a suprasternal approach in 18 preterm infants with patent ductus arteriosus. Measurements were made in each patient before and after medical or surgical closure of the PDA. The internal ascending aortic diameter was determined echocardiographically and aortic cross-sectional area calculated according to the equation AAo = pi d2/4. Ascending aortic blood flow was computed as QAo (ml/min) = VAo (cm/sec) x AAo (cm2) x 60 (sec/min). Prior to PDA closure, QAo averaged 343 ml/min/kg, well above predicted normal values. After PDA closure, QAo fell to 252 ml/min/kg, significantly lower than the preclosure level (P less than 0.001), but slightly higher than the mean cardiac output of healthy newborn infants. The mean QAo after surgical ligation of the PDA was closer to the predicted normal value than after treatment with indomethacin alone. This study reflects the effect of left-to-right ductus shunting on left ventricular output and emphasizes the demands placed on the neonatal left ventricle by PDA.

The purpose of the present study was to determine if autoregulation of cerebral blood flow (CBF) is present in the preterm fetal lamb and, if present, to measure the range of mean arterial blood pressure over which autoregulation exists. Thirty-seven measurements of CBF were made in seven preterm fetal lambs (118–122 days gestation) over a mean carotid arterial blood pressure (CBP) range of 18–90 mm Hg. CBF was measured by the radionuclide-labeled microsphere technique. CBP was altered by graduated inflation of balloons placed around the brachiocephalic trunk and the aortic isthmus. To eliminate the effects of reflex changes in heart rate, the carotid sinus and aortic nerve were ablated bilaterally. CBF was linearly related to mean CBP from 18–45 mm Hg, constant over a mean CBP of 45–80 mm Hg, and again linear from 80–90 mm Hg. Resting mean CBP (normotension) was 53.8 ± 1.9 mm Hg during the control period and 51.7 ± 0.8 mm Hg during the equillibration periods. This study demonstrates that although autoregulation of CBF is intact in the preterm fetal lamb, the range is narrowed compared to the term lamb and resting mean CBP lies close to the lower limit of autoregulation.

The outcome in 198 surviving very-low-birth-weight (less than 1501 gm) infants with and without cerebral intraventricular hemorrhage was compared to determine whether CVH is associated with early childhood developmental or neuromotor handicaps. Major handicaps were noted in 10% of the infants without and 28% of the infants with CVH. Among the infants with CVH, a major handicap was present in 9% with grade 1, 11% with grade 2, 36% with grade 3, and 76% with grade 4 CVH. Infants with posthemorrhagic hydrocephalus had the same incidence of major handicaps (59%) as did comparable infants with no hydrocephalus (57%). Our data indicate that grades 1 and 2 CVH do not increase an infant's risk for major handicaps, and there is a direct relationship of grades 3 and 4 CVH and major handicaps.

The following case study reports on the survival of a male infant following complete fetoplacental abruption of 75 minutes' duration. The mechanisms by which he survived are unclear. CASE REPORT At 30 to 32 weeks' gestation a 16-year-old female who claimed she was unaware of this, her first pregnancy, had a spontaneous and complete fetoplacental separation, with delivery into a toilet. Not realizing the significance of what had happened, she phoned her mother who lived approximately 30 minutes from the site of the delivery. In the meantime she removed the fetoplacental mass from the toilet without rupturing the chorioamnion and placed it in a paper sack.

This study was undertaken to assess the Idiopathic Respiratory Distress Syndrome (IRDS) in premature infants whose birth weights exceeded 1820 gms (4 lbs). During the past 3 years 66 (41%) of 160 infants admitted to our Newborn ICU with IRDS weighed more than 1820 gms. Thirty of the 66 were transferred from outlying hospitals. Estimated gestational ages ranged from 34-38 wks with a mean of 35.7. Birth weights ranged from 1820-3856 gms with a mean of 2358 gms. There was a predominance of males. Of the various prenatal conditions assessed, 80% of the 66 mothers were > 20 yrs of age and 67% were multigravid. Twenty percent of the mothers had complications of pregnancy including 4 diabetics, 2 narcotic addicts, and 1 toxemic. Thirty-three percent were delivered by c-section. The severity of IRDS in this group of infants was variable. Half of the infants required oxygen in concentrations > 60%. Assisted ventilation was needed in 87% of those transferred and 47% of those delivered at our hospital. Apgar scores and initial blood gases were not useful in predicting the subsequent need for ventilation assistance. Seven of the 66 infants expired. Pneumothorax and cerebral hemorrhage were encountered in 4 of the 7. It is concluded that IRDS may be severe in a surprising number of large birthweight prematures. It is unclear whether IRDS occurs more frequently at higher altitudes (5000 ft) and is more severe. It is recommended that these infants be evaluated and followed as closely as their smaller-weight counterparts.

A prospective study using Computed Tomography (CT) was initiated to determine the incidence of sub-ependymal (SEH) and intraventricular hemorrhage (IVH) in infants ≤ 1500 grams. All 38 infants ≤ 1500 grams who were admitted to the Newborn Intensive Care Unit during a five month period have been evaluated. The initial CT waa performed between the third and seventh postnatal day. If a CVH was noted, follow-up CT was done at one and three weeks after the initial CT. Nine of the 23 infants who survived had SEH and/or IVII present on the initial CT. Only one of these nine infants was suspected of having a CVU on clinical findings. Of these nine, five who had a small SEH and/or IVH with nornal ventricular size, had complete resolution of the hemorrhage at three weeks. The other four infants who demonstrated some degree of ventricular dilatation with the hemorrhage on the initial CT, required medical intervention to prevent the development of clinical hydrocephalus. This study documents, for the first time, the relatively high incidence of CVH in infants ≤ 1500 grams and indicates that there are at least two types of CVH: 1) CVH with no ventricular dilatation which resolves spontaneously and 2) CVH with ventricular dilatation which requires medical intervention to prevent the development of clinical hydrocephalus.

Serial lumbar puncture (LP) as a method of treating hydrocephalus was evaluated in ten infants of birthweights ≤ 1500 grams, who had a cerebral intraventricular hemorrhage(CVH) and ventricular dilatation identified by computed tomography (CT).Each of the infants had an initial CT scan within the first ten days of life. Follow-up CT scans were done at weekly intervals. If progressive ventricular dilatation was observed, daily LP was attempted. Ventricular size remained stable or decreased throughout the tapping period and remained so after the cessation of tapping in eight of the ten infants. Follow-up CT scans at six months of age on eight of the ten infants showed no increase in ventricular size and an increase in the thickness of the cerebral mantle. The two infants from whom cerebrospinal fluid could not be obtained had progressive ventricular dilatation and required the placement of a ventriculo-peritoneal shunt. This approach to early intervention of progressive ventricular dilatation secondary to CVH by means of serial LP may arrest the development of hydrocephalus and eliminate the need for a shunt.

To assess the impact of supraventricular tachycardia (SVT) on cardiac output in the neoante, we measured noninvasively ascending aortic blood flow (QAo) pre and post cardioversion (cv) in 4 neonates with paroxysmal atrial tachycardia (PAT) or atrial flutter (AF). Ascending aortic blood flow velocity (VAo) was determined using a portable, 5MHz, pulsed Doppler velocimeter and suprasternal transducer. Aortic cross sectional area (AAo) was calculated from echographic measurements of the internal diameter of the ascending aorta. Left ventricular output was computed as QAo(ml/min)=VAo (cm/sec)×AAo (cm2)×60sec/min. The infants ranged in age from 1 to 14 days, mean 5 days, and ranged in weight from 2.9 to 3.7kg, mean 3.5kg. 2 patients had PAT and 2 had AF with 2:1 block. Conversion required DC countershock in 2 patients, digoxin in 1, and facial ice application in 1. This study demonstrates that SVT impairs significantly cardiac output and stroke volume in the neonate and emphasizes the impact of successful cardioversion in returning systemic blood flow to normal levels.