Alternatives to hexachlorophene bathing of newborn infants.

In controlled trials newborn infants were bathed with Lactacyd, pHisoHex, Hibitane, Lanohex or tap water. Bacteriologic samples were taken from three sites (groin, axilla and cord) immediately after birth, following an initial bath with one of the test agents, and on day 3 or 5 after a water bath. Initial bathing with all agents, including water, reduced the concentration of bacteria on the skin to a similar extent. However, comparisons of bacterial flora at birth versus those on days 3 and 5 indicated differences in the actions of the various agents on pathogenic and nonpathogenic organisms. Lactacyd and Hibitane appeared to be suitable alternatives to hexachlorophene in the control of pathogenic bacteria on the skin of newborns. However, their absorption and toxicity in the newborn are unknown and, unless use of a skin disinfectant is warranted, routine bathing of newborns with tap water appears to be satisfactory.     

Epidemiological aspects of cytomegalovirus infection in babies aged under one

Sreening data obtained on babies aged under one and selected by random (1,910 children) or target (2,658 children) choice for cytomegalovirus (CMV) infection during the period of 10 years (1992-2001) were compared with mortality rate. The methods used were enzyme immunoassay, immunofluorescence and polymerase chain reaction. The babies were divided as follows: newborn infants (group I), babies aged 1-3 months (group II), 4-6 months (group III) and 7-12 months (group IV). Specific clinical features of CMV infection in newborn infants were studied on 69 cases (37--with CMV monoinfection and 32--with mixed infection). The serological screening revealed a 2.1-fold growth of the infection rate among randomly selected newborn infants during the 10 year period. Positive correlation between the infection rate among children of this age group and the neonatal mortality rate was established. High risk factors of CMV infection were revealed as well as increased infection rate and frequency of clinical cases with the prevailing neurological pathology in group III. Early diagnosis, the exclusion of mixed infections and early adequate therapy were shown to play a decisive role in the outcome of the disease. The algorithm of epidemiological surveillance and the regional program of prophylaxis were worked out.     

Lipoid Pneumonia in Infants and Children in South India

Oil-aspiration pneumonia is a common cause of mortality and morbidity in infants and young children in South India. The high incidence of this condition results from the local custom of giving oil baths to infants and of cleansing the mouth, throat, and nose with oil. The clinical findings in 12 cases, 10 of them in babies aged under 8 months, are described. The signs range from an acute segmental collapse of the lung, clearing in a few days, to a chronic picture mimicking pulmonary tuberculosis or mucoviscoidosis. Mothers in South India should be advised to abandon the practice of cleansing their baby''s mouth and nose with oil.     

Serum steroid hormone levels in neonates born from the mother with placental sulfatase deficiency

Placental sulfatase deficiency (PSD) is a rare disorder with low estrogen production due to placental enzymatic deficiency. Although many papers have been published on this enzymatic deficiency, little information is available on steroidal environment in newborn babies from PSD mothers. Seven cases of PSD were confirmed and serum concentrations of nine steroids which included cortisol, free and conjugated pregnenolone, 16 alpha-hydroxypregnenolone, DHA and 16 alpha-hydroxy-DHA in cord blood at delivery and peripheral veins during the neonatal period were measured by radioimmunoassay. In all seven instances, healthy male infants were delivered, but six of the babies developed ichthyosis. Conjugated delta 5-steroid concentrations in cord blood were found to be high, while 16 alpha-hydroxypregnenolone was low when the PSD cases were compared with the controls. In the PSD cases, free 16 alpha-hydroxy-DHA and 16 alpha-hydroxy-pregnenolone were both lower than in controls during the first seven days after birth. These results indicate that the production of delta 5-C21 steroid in PSD infants is limited. In the present study of newborn infants with PSD, the pattern of circulating steroids was first demonstrated and the relationship between the sulfatase activity in the neonates and ichthyosis was discussed.     

Study of Chromosomes in the Newborn after Ultrasonic Fetal Heart Monitoring in Labour

The effect of continuous-wave ultrasound on the chromosomes of newborn infants has been investigated. Twenty-four women were studied during labour. The fetal heart was monitored by a Sonicaid FM2 monitor applied to the abdomen, and continuous monitoring undertaken for intervals varying from 1 hour 5 minutes to 9 hours 25 minutes. There was no increase in the number of chromosome aberrations in cultures of blood taken from the insonated babies when compared with controls.     

Estimation of gluconeogenesis in newborn infants

The rate of glucose turnover (R(a)) and gluconeogenesis (GNG) via pyruvate were quantified in seven full-term healthy babies between 24 and 48 h after birth and in twelve low-birth-weight infants on days 3 and 4 by use of [(13)C(6)]glucose and (2)H(2)O. The preterm babies were receiving parenteral alimentation of either glucose or glucose plus amino acid with or without lipids. The contribution of GNG to glucose production was measured by the appearance of (2)H on C-6 of glucose. Glucose R(a) in full-term babies was 30 +/- 1.7 (SD) micromol. kg(-1). min(-1). GNG via pyruvate contributed approximately 31% to glucose R(a). In preterm babies, the contribution of GNG to endogenous glucose R(a) was variable (range 6-60%). The highest contribution was in infants receiving low rates of exogenous glucose infusion. In an additional group of infants of normal and diabetic mothers, lactate turnover and its incorporation into glucose were measured within 4-24 h of birth by use of [(13)C(3)]lactate tracer. The rate of lactate turnover was 38 micromol. kg(-1). min(-1), and lactate C, not corrected for loss of tracer in the tricarboxylic acid cycle, contributed approximately 18% to glucose C. Lactate and glucose kinetics were similar in infants that were small for their gestational age and in normal infants or infants of diabetic mothers. These data show that gluconeogenesis is evident soon after birth in the newborn infant and that, even after a brief fast (5 h), GNG via pyruvate makes a significant contribution to glucose production in healthy full-term infants. These data may have important implications for the nutritional support of the healthy and sick newborn infant.     

Sister-chromatid exchange (SCE) analysis in mothers exposed to DNA-damaging agents and their newborn infants

The incidence of SCE in the lymphocytes of mothers and their newborn infants was determined. A detailed antenatal history of parental habits such as smoking, alcohol consumption and possible exposure to DNA-damaging agents was documented. The results showed that the SCE rate in the newborn is significantly less than that of their mothers. Mothers who consumed alcohol, but not cigarette smokers, had a significantly increased SCE rate compared to control mothers. However, these maternal habits did not affect the SCE rate of their infants. Neonates with neural tube defects showed a significantly increased SCE rate compared to normal babies.     

Effect on Neonatal Jaundice of Oestrogens and Progestogens Taken before and after Conception

Study of 182 newborn babies has shown that among bottle-fed infants the mean plasma bilirubin concentration was slightly but significantly higher (P <0·01) in those whose mothers had previously used steroid contraceptives. A similar finding was not noted among breast-fed infants.A further 16 infants whose mothers had received progestogen therapy during their pregnancy had a mean plasma bilirubin concentration which was significantly higher than each of the four other groups of infants studied (P <0·01). Icterus occasionally reached clinically important levels in these babies.     

Neonatal Eye Infections due to Mycoplasma hominis

In one year Mycoplasma hominis was isolated from 8 out of 250 clinically infected eyes of newborn infants. This infection occurred in only a small proportion of babies whose mothers carried the organism in the vagina. Probably mycoplasma infection of the eye in neonates is commoner than is realized.     

Normal values for total hand length, palm length and middle finger length in Malaysian newborns from 34-42 weeks of gestation.

Early identification of a syndrome at birth is of paramount importance for genetic counselling and possible prevention. Often malformation of the hands and fingers are cardinal manifestations of recognizable syndromes. As there are no published standards for hand and finger size for Malay newborn infants, this study was undertaken to establish normal values for hand, middle finger and palmar lengths, and their indices. A cross-sectional study was done on 509 consecutive newborn Malay babies between 34 and 42 weeks of gestation. Measurements were made on the right hand according to the recommended guidelines of Bergsma & Feingold (1975). The mean values for the measurements did not differ significantly between boys and girls, or change with gestation. For the whole group the mean value for total hand length was 64.4 +/- 3.42 mm, middle finger length 37.1 +/- 2.91 mm, palmar length 27.4 +/- 2.15 mm, finger index 0.425 +/- 0.03 and palmar index 0.58 +/- 0.03. A comparison with published measurements for newborns of different racial origin shows significant differences for the total hand length, middle finger length and palm length from Indian and Jewish infants, but not from Japanese infants. The indices were similar in Malay, Indian, Jewish and Japanese newborn infants.     

Passive smoking in utero: its effects on neonatal appearance.

Smoking causes changes in the appearance of adults and has profound effects on the fetus, but little is known about its effects on the appearance of newborn infants. Two colour photographs (face and whole body) of 15 newborn infants (seven born to mothers who had smoked during pregnancy and eight born to mothers who had not) were shown to 100 medical and nursing staff, who in a double blind trial were asked to identify which babies had been born to smokers. The mean number correctly identified was 9.1, which was significant compared with the number expected by random selection (7.5). No specific features were identified that distinguished the two groups of infants; selection was intuitive. Nevertheless, the fact that differences can be detected in some way may be useful for antismoking health education.     

Peripheral Blood Mononuclear Cell Traffic Plays a Crucial Role in Mother-to-Infant Transmission of Hepatitis B Virus

The role of peripheral blood mononuclear cells (PBMCs) in HBV intrauterine infection is not fully defined. Particularly the origin of PBMCs in HBV-infected neonates remains to be addressed. We carried out a population-based nested case-control study by enrolling 312 HBsAg-positive mothers and their babies. PBMC HBV DNA as well as serum HBsAg and HBV DNA was tested in cohort entry samples. Totally, 45.5% (142/312) of the newborns were found to be infected with HBV in perinatal transmission. 119 mother-infant pairs were identified to be different in the genetic profile of maternal and fetal PBMCs by AS-PCR and hemi-nested PCR. Among them, 57.1% (68/119) of the maternal PBMCs in index cases were positive for HBV DNA while 83.8% (57/68) of the HBV DNA positive maternal PBMCs passed the placental barrier and entered the fetus. Furthermore, maternal PBMC HBV infection was significantly associated with newborn infants HBV infection. PBMC traffic from mother to fetus resulted in a 9.5-fold increased risk of HBV infection in PBMC HBV DNA positive newborn infants. These data indicate that maternal PBMCs infected with HBV contribute to HBV intrauterine infection of newborn infants via PBMC traffic from mother to fetus.     

Study of cardiac arrhythmias and other forms of conduction abnormality in newborn infants.

In an unselected population of 2030 newborn infants studied by electrocardiography (ECG) between April 1975 and April 1977, 35 were found to have arrhythmias or other cardiac conduction abnormalities. Further investigation by means of 24-hour ECG monitoring showed that apparently serious tachyarrhythmias, such as ventricular tachycardia and slow heart rates associated with sinoatrial block, may be present without clinical disturbance in some newborn babies. Six infants had both bradycardia and tachycardia in the 24-hour recording, although the screening ECG had shown only one of these abnormalities. The alarming ECG appearance of some of the arrhythmias suggested a possible aetiological link with some unexplained sudden infant deaths: a multicentre study could determine this more readily and is therefore recommended.     

Incidence of major chromosome aberrations in 12,319 newborn infants in Tokyo

Summary In order to ascertain the frequency of chromosome aberrations among newborn infants in Japan, a chromosome survey of a large number of newborn infants is in progress. A consecutive series of 12,319 newborn babies, 6382 male and 5937 female, have been screened for clinical manifestations of autosomal aberrations and for sex chromatin and sex chromosome aberrations. Chromosome studies were carried out on 694 infants with suspected chromosome aberrations. The clinically abnormal infants were screened by conventional staining, and banding techniques have been used in the part of the study performed since 1974. Of the clincally abnormal infants, 25 had abnormal karyotypes, including two males with a 47,XXY complement, one female with a 45,X complement, three male infants with a 47,XYY complement, two with trisomy 13 syndrome, three with trisomy 18 (including one case of mosaicism), eleven with Down's syndrome (including one case of mosaicism), one with B5p partial trisomy, one with cri-du-chat syndrome, and one with Y/D translocation. The overall results are comparable to those of previous population cytogenetic studies only in the autosomal trisomies and sex chromosome abnormalities and in that the observed frequencies were comparable to those found in studies in Caucasians.To whom offprint requests should be sent     

Influence of maternal obesity on subcutaneous fat in the newborn.

Skinfold thickness measurements were made at biceps, triceps, subscapular, and suprailiac sites on both sides on 265 full-term newborn infants. The mothers were classified as thin (25), normal (179), or obese (61) on the basis of their triceps skinfold thicknesses. At all skinfold sites the babies of the obese mothers were significantly fatter than the babies of normal mothers, and the babies of the normal mothers were significantly fatter than those of the thin mothers. There was a highly significant positive correlation between maternal triceps thickness and the baby''s sum of skinfold thicknesses. Hypertension was common during the pregnancies of the obese mothers and was associated with a significant reduction in the babies'' skinfold thicknesses. When each of the 61 obese mothers were matched for parity, blood pressure, and smoking habit with 61 non-obese mothers the babies of the obese mothers still had significantly greater skinfold thicknesses than the babies of non-obese mothers.     

Problems in the Early Recognition of Congenital Hip Dislocation

Seven cases of infants whose hips were clinically normal at birth, and in whom hip dislocation was later recognized, are reported. In spite of the widespread practice of routine examination of the hips of newborn babies, infants and young children are still presenting with congenital dislocation of the hip. This is probably owing to there being two aetiological types. Every opportunity to re-examine the hips of children under 2 or even 3 years of age must be taken and a high level of suspicion maintained.     

Massive transplacental hemorrhage: clinical manifestations in the newborn.

Thirteen newborn infants had transplacental hemorrhage in excess of 30 ml. Fetal blood in the maternal circulation was demonstrated in all cases by the acid elution technique. Anemia was noted in five babies either at birth or within the first 24 hours of life. One baby was stillborn, the death possibly being related to fetal hemorrhage. The other seven babies were clinically normal in spite of massive transplacental hemorrhage. The hemoglobin values and reticulocyte counts were normal at birth and the first 5 days of life. The data on this group of babies suggest that the clinical manifestations of transplacental hemorrhage are related not only to the size of the hemorrhage but also to the time at which the hemorrhage occurs.     

Haemorrhagic disease of the newborn in the British Isles: two year prospective study.

OBJECTIVE--To determine the incidence of haemorrhagic disease of the newborn in the British Isles, study risk factors, and examine the effect of vitamin K prophylaxis. DESIGN--Prospective survey of all possible cases of haemorrhagic disease of the newborn as reported by consultant paediatricians using the monthly notification cards of the British Paediatric Surveillance Unit and a follow up questionnaire for each case to validate the diagnosis and accrue further data. SETTING--Britain (England, Scotland, and Wales) and Ireland (Northern Ireland and the Irish Republic) during December 1987 to March 1990. PATIENTS--27 infants classified as having confirmed (n = 25) or probable (n = 2) haemorrhagic disease of the newborn. RESULTS--24 of the 27 infants were solely breast fed. 10 suffered intracranial haemorrhage; two of these died and there was clinical concern about the remainder. 20 infants had received no vitamin K prophylaxis, and seven had received oral prophylaxis. Relative risk ratios for these groups compared with babies who had received intramuscular vitamin K were 81:1 and 13:1 respectively. Six infants had hepatitis (alpha 1 antitrypsin deficiency in four), unsuspected until presentation with haemorrhagic disease of the newborn, of whom four had received oral prophylaxis. One other baby had prolonged jaundice. One mother had taken phenytoin during pregnancy. CONCLUSIONS--All newborn infants should receive vitamin K prophylaxis. Intramuscular vitamin K is more effective than oral prophylactic regimens currently used in the British Isles.     

Effect of immersion in water on the rudimentary reflexes of infants in the 1st months of life

Seizing and myotatic reflexes differ in their intensities in the right and left hands already from the first month of life in babies. It was shown that disappearing seizing and myotatic reflexes together with Moro's and Babinsky's reflexes in 3 1/2-4 months old babies can be elicited again during bathing. In the course of adaptation of babies to the water these reflexes disappear.     

Virologic and serologic studies on an outbreak of echovirus type 11 infection in a hospital maternity unit.

An outbreak of echovirus type 11 (E-11) infection occurred among newborn babies in a hospital maternity unit in the summer of 1971. The results of studies are as follows: 1) Forty-one of 188 infants developed febrile illness with stomatitis during one and a half months from July to September. E-11 was isolated from stool specimens of 14 infants and two throat swabs. Antibody response to the virus was shown in all the 19 cases examined. Some of their mothers were suffering from subclinical infection. 2) The isolates were identified as a variant of E-11 which is not neutralized with antiserum against prototype E-11. Antiserum against the current virus neutralized both current and prototype viruses. 3) Sucrose gradient centrifugation of sera from infants revealed that the neutralizing antibody activity resided more predominantly in 19S than in 7S fractions. These antibodies reacted more specifically with the current strain than with the prototype Gregory strain.