CASE REPORTA female infant was born by normal vaginal delivery at Waikato Hospital at 40 weeks gestation to a 17-year-old primigravida following an uneventful pregnancy. Labour was complicated by the presence of thick meconium. Apgar scores were 6 and 8 at 1 and 5 minutes, birthweight 2920 g and head circumference 34 cm. Neonatal intensive care unit admission was not required in the immediate postnatal period. As it was Christmas day, at 14 h of age mother and baby transferred to a peripheral hospital to be closer to home. There were comments in the infant's notes that she had not fed well and was very sleepy but this was not thought to be significantly abnormal. However, midwifery staff attending the child following this transfer were also concerned about her poor feeding, floppiness and lethargy. Thus, at 36 h of age, the infant was referred back to the tertiary institution where she was admitted to the neonatal intensive care unit. Examination revealed a non-toxic child with moderate hypotonia and poor reactivity. Deep tendon reflexes were normal. There were no dysmorphic features. On review of the antenatal history, there was no alcohol or drug use in pregnancy and the parents were not related. Mother reported a history of Chlamydia and genital herpes prior to this pregnancy.Complete blood count, electrolytes, urea, glucose, liver function tests, serum lactate and arterial blood gas were normal. Serum ammonia was 97 µ mol/L (0-50). A urine toxicology screen for amphetamines, opiates, benzodiazepines and cannabinoids was negative. Cerebral ultrasound showed unusual grey-white matter differentiation with slit like ventricles. The initial impression was of an unrecognized asphyxial insult. On day 3, the infant began to have short generalized seizures and apnoeas. In addition, her level of consciousness had deteriorated further and hypotonia worsened. Phenobarbitone was commenced but a midazolam infusion was also required to control seizure activity. CSF cell count, protein and glucose were normal however, penicillin, cefotaxime and acyclovir were given until CSF culture and Herpes simplex virus (HSV) DNA were reported as negative. Her apnoeas were managed initially with nasal prong oxygen but by 6 days of age she required intermittent positive pressure ventilation.The infant was discussed with a metabolic paediatrician and although an underlying metabolic diagnosis was considered unlikely, a more extensive metabolic work up was initiated. Tests performed included urinary organic and amino acids, plasma very long chain fatty acids, plasma and CSF glycine, serum uric acid and plasma carnitine and acylcarnitine.

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Background and aims To investigate the association between serum mean platelet volume (MPV) levels and meconium stained amniotic fluid (MSAF). Methods MPV, serum reactive protein and haemoglobin levels, leukocyte and thrombocyte counts were measured in 106 infants with MSAF and 78 healthy control infants for comparison. Demographic factors including gestational age, birth weight, gender, delivery mode, parity, maternal pregnancy diseases, intrauterine infections, maternal smoking and severity of meconium aspiration syndrome were recorded. Results The mean values of MPV in infants with MSAF were significantly lower than in the control group statistically (p < 0.001). There was no statistically significant difference in haemoglobin levels, and leukocyte and thrombocyte counts in the study group compared to the control group (p > 0.05). There was no statistically significant difference in MPV levels in the infants with meconium aspiration syndrome (MAS) compared to the study group (p > 0.05). A 9.90 fl [area under the curve (AUC: 0.788)] optimal cutoff value of MPV with a sensitivity of 78.1% and specificity of 74.3% was determined in infants with MSAF. Conclusions Our data suggest that the MPV levels were significantly lower in infants with MSAF than that in healthy infants. This might be associated with hypoxic process. However, the MPV levels were statistically similar between MSAF and MAS, leading to a failure of detecting patients with or without severe disease. Objective To evaluate feasibility and safety of patent ductus arteriosus (PDA) occlusion in very low birth weight newborns < 2500 g when surgery was indicated by PDA occluder under X ray and ultrasounds Methods After ultrasound evaluation and Ibuprofen treatment when required, significant haemodynamic PDA were defined by high flow in pulmonary artery branch >45 cm/sec, absence or reverse flow in middle cerebral artery, renal and mesenteric arteries, left to right shunt, and DA diameter. Interventional catheterism was proposed as first option. Babies were anaesthetised with ketamine and sufenta. Femoral vein access by 4F Desilets. A catheter was positionned in descending thoracic aorta and the PDA II AS occluder positionned under horizontal X ray and ultrasound. Temperature was kept between 35.5 and 36°C along the procedure. Results Twelve newborns had a PDA closure. Mean weight was 1740 g (850-2480). The series started at the highest weight. Mean diameter of the duct was 3,3 mm (2,2-4) and length 6 (2-11). PDA ADO IISA used were 3 Â 4(2) 4 Â 2(1), 4 Â 4(4), 4 Â 6(2), 5 Â 2(2) and 5 Â 6(1). Two were repositioned. Mean duration of the entire procedure was 32 min (10-90). X ray exposure was 12 min (3-24) and dose 1,5 grey/cm2 (0.2-4). Two transitional paraprothetic shunts closed spontaneously after few days. One premature infant already in renal failure, died ten days later despite ductal closure. In the others the follow up showed improvement in cerebral and pulmonary blood flows without any haemodynamic problems such as observed after surgical procedure...

Background and aims Preterm birth with very low birth weight. Methods We studied the association of preterm birth with 24-hour ambulatory BP and variabilityof BP in 42 young adults (mean age 23.2y) born early preterm (=37 weeks) in Northern Finland population. Wake and sleep period were distinguished with accelerometry in 72.4% of subjects, and for others by time (awake 9 am-11 pm, sleep 01 am-07 am). Results Adults born early preterm had 5.6 mmHg (95% CI 1.9-9.3) higher 24-hour SBP, 2.9 mmHg (0.4-5.4) higher 24-hour DBP, 6.4 mmHg (2.8-10.1) higher awake SBP and 4.0 mmHg (0.4-7.5) higher sleep DBP when adjusted for age, sex and use of an accelerometer. Adults born early preterm had also higher within-subject standard deviation (SD) of 24-hour SBP and DBP, awake SBP and DBP and sleep DBP (Figure). Also adults born late preterm had higher SD of 24-hour DBP and sleep SBP and DBP when adjusted for age, sex and use of an accelometer. When adjusted for maternal BMI, smoking during pregnancy and hypertensive pregnancy disorder, parental education, subject's height and BMI, physical activity and smoking, the results were somewhat attenuated. Conclusions Higher 24-hour ambulatory blood pressure and variability of BP may indicate that adults born early preterm are in greater risk for later cardiovascular outcomes. Background and aims Intrauterine transfusion for rhesus disease is not uncommon, but long-term health and socioeconomic status in adulthood have not previously been reported. This study aimed to compare these outcomes in adult survivors of intrauterine transfusion to that of unaffected siblings. Methods Participants were adults who received intrauterine transfusion for rhesus disease, and their unaffected sibling (s). Data regarding socioeconomic status, lifestyle and medical history were collected and compared using Chi-squared and T-tests. Results Affected participants (n = 95) were younger than unaffected (n = 92) (mean ± SD 33.7 ± 9.3 vs 40.1 ± 10.9 years, p < 0.001) and born at lower gestation (34.5 ± 1.6 vs 39.5 ± 2.1 weeks, p < 0.001) but similar in sex distribution (%male: 54% affected vs 45% unaffected, p = 0.21). There were no differences between groups in socioeconomic status and lifestyle variables (Table 1), or health outcomes (Table 2). Conclusions This study provides the first evidence that survivors of intrauterine transfusion for rhesus disease show no evidence of adverse effects on general health or socioeconomic status in early to middle adulthood. Background and aim Preterm birth has been associated with psychiatric disorders involving emotion regulation, social competence and communicative skills throughout the first three decades of life. However, the exact neuro-anatomical mechanisms underlying socio-emotional impairments in individuals who were born very preterm (VPT) are still unknown. Therefore, the aim of this study was to investigate the functional integrity of an emotion-processing brain network comprising the amygdala and prefrontal cortex and to test whether it correlated with part...

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