Skin-to-skin mother/infant contact as a means of warmth for newborns of low birth weight (less than or equal to 2500 g) was studied in 132 infants admitted consecutively during the cold season July/September at the Central Hospital in Maputo. The mean (+/- SD) birth weight was 1788 g (+/- 304 g) and the gestational age 34 weeks (+/- 2.7). Fifty-seven (43 per cent) infants were born outside the hospital and were referred. The ambient temperature ranged from less than 22 degrees C to 32 degrees C. Skin-to-skin contact as the principal means of warmth commenced in more than a third by age 3 days and in more than a half by age 5 days after periods of observation to exclude clinical problems. The infants were kept warm using conventional methods during observation. Re-admission to the intensive care unit was required in nine cases: four for diarrhoea; two for respiratory infection; two with jaundice; and one for poor suckling. Infants were discharged home at a mean (+/- SD) weight of 1864 g (+/- 227), and age 15.6 d (+/- 7.9). Skin-to-skin contact, either by itself or in combination with other methods of warmth, was reportedly followed at home by 67 per cent of the mothers who received home visits. No infant needed readmission for hypothermia either from the neonatal wards or after being discharged home. At follow-up, when body weight had reached greater than or equal to 2500 g, the outcome was graded as 'good' in 64; 'satisfactory' in 6; and 'poor' in 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction Despite its rare ocurrence, thromboembolic events are more frequent in newborns than in any other paediatric age group, and can results of diverse congenital or acquired prothrombotic factors. We report a case of deep venous thrombosis (DVT) in a previously healthy newborn admitted with Streptococcus pyogenes infection. Case Report 7-day old term female infant, born by vacuum delivery (birth weight 3780 g, Apgar 9/10), referred to our NICU with a 24 h history of grunting, anorexia and painful, swollen and purple discoloration of left lower limb. Laboratory findings showed leucopenia (1750/uL), neutrophilia (88%), C Reactive Protein 4.5 mg/dL, normal haematocrit and platelet count. Remaining lab values, including electrolytes and coagulation tests were normal. Soft tissue infection was suspected and antibiotics started. Lower limb ultrasound and Doppler showed extensive DVT in the left side. Subcutaneous enoxaparin was started and dosage was adjusted according with anti-Xa factor levels. Homocisteyne, protein S, protein C and antithrombin levels were normal. Factor V Leiden, G2021A prothrombin and antiphospholipid antibodies were absent. Streptococcus pyogenes was isolated in blood and cerebrospinal fluid cultures confirming the diagnosis of sepsis and meningitis. Discussion Thrombosis in neonatal period can cause significant morbidity and be life threatening. Early diagnosis and optimal treatment strategies are important to avoid complications. Streptococcus pyogenes has been associated with thromboembolic events in adults and older children. Despite being an uncommon cause of infection in neonates, this agent should be considered as the possible aetiology of DVT in previously healthy newborns.

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Background Hypoxic Ischaemic Encephalopathy (HIE) remains a significant cause of neonatal death and long term disability. Heart rate variability (HRV) may help identify the presence and severity of encephalopathy. Our aim was to analyse HRV features in full-term neonates with HIE and assess its ability to grade severity of HIE and predict neurodevelopmental outcome at 2-years of age. Methods This was a retrospective study of healthy full-term neonates and full-term neonates with HIE. All neonates had multichannel EEG and ECG monitoring from as soon as possible after birth. EEGs were graded at 12, 24, and 48 h (mild, moderate, severe) and 1 h epochs of EEG and ECG data were extracted. Features of HRV were calculated from ECG recordings in each epoch. A comparison of HRV features between HIE and healthy groups and within HIE groups (mild/moderate/ severe) was performed. The ability of HRV features to predict neurodevelopmental outcome at 2-years of age was also assessed. Results 44 neonates with HIE and 17 healthy controls were included. Measures of HRV were significantly negatively correlated with EEG grade of HIE severity. HRV was significantly reduced between mild and moderate HIE groups. EEG grade of HIE measured at 12, 24, and 24 h after birth has a strong positive predictive value and reduced HRV at 24 and 48 h has a strong negative predictive value for 2 year neurodevelopmental outcome. Conclusion HRV features significantly correlate with the grade of HIE severity and may be useful for the prediction of long term outcome. Background Cerebellar haemorrhages (CBH) are increasingly recognised in extremely preterm infants with advances in early ultrasound neuroimaging. Information on incidences, risk factors, mortality and neurodevelopmental sequelae remains limited. Aim To investigate the incidence of cerebellar haemorrhage in preterm infants diagnosed by ultrasound and identify risk factors and outcomes in a Tertiary Neonatal Intensive Care Unit. Methods Preterm infants with cerebellar haemorrhage over 5 years (January 2009 to December 2013) were identified from a systematic electronic radiological database. Cases of cerebellar haemorrhage were diagnosed by cranial-ultrasound using the mastoid window and detailed medical record reviews were done. Results A total of 13 cases were identified to have cerebellar haemorrhages (2641 infants <35 weeks were born during the study period). The gestation ranged from 23 to 28 weeks and birth weight ranged from 500 to 1940 grams. Isolated Cerebellar haemorrhages were seen in 4 cases (30%) with a preponderance of right sided haemorrhages (55%) and associated supra-tentorial lesions in 9 cases (70%). Analysis identified early postnatal haemodynamic risk factors. Neonatal mortality was significantly high amongst cases with combined cerebellar and supra-tentorial haemorrhage. Conclusion In our study cerebellar haemorrhages is predominantly seen in the extreme preterm infants. It is associated with high mortality and predictors of risk factors appear to be multifactorial and i...

Background Intraventricular haemorrhage (IVH) is a significant cause of morbidity and mortality in premature infants. There is a well known correlation between IVH grade and neurodevelopmental outcome. However, to our knowledge, there are only a few studies taking into account the side of the lesion. Methods Data of 178 infants with grade III IVH with and without parenchymal involvement were retrospectively analysed. Diagnosis was based on cerebral ultrasound. 36% (n = 64) of neonates showed equal IVH severity on both brain sides, the remaining 64% (n = 114) had IVH severity which differed between the hemispheres (right > left, n = 53; left > right, n = 61).Neurodevelopmental outcome was evaluated at 2 years corrected age via Bayley Scales of Infant development II (BSID II). The data was corrected for influence of gestational age by multiple regression analyses. Results Mental Development Index (MDI) and Psychomotor Development Index (PDI) were compared between the groups and infants with a larger lesion within the right hemisphere showed statistically significant lower developmental scores at the age of two years (mean (median) ± SD for 'right > left' vs. 'left > right ': MDI 64,2 (54,0) ± 19,6 vs. 78,8 (84,0) ± 17,6 [p = 0,047] and PDI 59,7 (56,5) ± 11,4 vs. 75,9(80,0) ± 17,1 [p = 0,021]). Conclusion Laterality of IVH has a significant influence on neurodevelopmental outcome in preterm infants. Further studies referring to outcome at school age based on more sophisticated imaging techniques are warranted.