Aspirated debris in the middle ear was seen commonly in infants of over 28 weeks' gestation who bad suffered from intrapartum asphyxia, and was usually associated with evidence of pulmonary aspiration of amniotic squames. Most of these infants were stillborn or had died in the first 2 days of postnatal life, but amniotic debris persisted for a longer period in some, and in 8 cases it had excited a foreign body histiocyte reaction.The 17 cases with otitis media could be divided into two groups on the basis of middle ear findings: 11 cases with an admixture of amniotic debris and purulent exudate (P/A group) and 6 with purulent exudate only. The P/A group showed many clinical features in common with the infants of the aspiration group, with a high incidence of pregnancy complications and of need for prolonged ventilation.All 17 cases with otitis media had evidence of infection elsewhere, including pneumonia (12) and meningitis (6). In 13 of the 14 cases with positive bacteriology, the organisms cultured were Gram-negative (Esch. coli or Pseudomonas aeruginosa).It is argued that amniotic debris may be aspirated into the middle ear in asphyxiated babies and this may explain some of the unusual metaplastic changes noted in the epithelium of the middle ear cavities. Furthermore, stagnant amniotic debris may become secondarily infected by organisms, particularly if the infant requires ventilation.While infections of the middle ear are known to be common in older children, relatively little attention has been paid to similar infections occurring in newborn infants. This is surprising since it has been shown by many writers that middle ear infections are common in this age group (Benner, 1940;Allen, Morison, and Rutherford, 1946;McLellan et al., 1962 The left middle ear cavity was examined using the procedure described by Morison (1970). Smears of any fluid or exudate present were taken, and whenever purulent exudate was present bacteriological samples were taken for culture. The petrous temporal bone on the right side was dissected away from the skull so as to include the terminal portion of the extemal auditory canal and the tympanic membrane in continuity with the 872 on 11 May 2018 by guest. Protected by copyright.

SUMMARY In a detailed study of the coronary arterial tree and myocardium in 256 stillbirths and infants, abnormalities of the coronary arterial tree were noticed in 79 infants, and necrotic lesions of the myocardium in 111 infants. Of the 79 infants with arterial lesions, 70 had associated myocardial necrosis or scarring, or both; the group with coronary arterial lesions, therefore, accounted for the majority of cases with myocardial damage.The myocardial lesions varied from small zones of subendocardial damage, to larger 'geographical' zones of necrosis scattered haphazardly through the myocardium, and a small group where massive necrotic lesions of the papillary muscles were present. While the coronary arterial lesions were associated with all three patterns, they were particularly found in association with the 'geographical' and papillary muscle changes.The coronary arterial lesions varied from zones of acute focal, medial necrosis to severe proliferative intimal lesions and medial defects, with a distinct progression of changes from the acute to the more established lesions. The coronary arterial lesions were seen most commonly in association with conditions that could produce severe hypoxia, and it is argued that they result from hypoxia. It is suggested further that the myocardial damage, so commonly associated with the coronary arterial lesions, could compromise the ability ofthe hypoxic infant to respond to such an insult.The coronary arterial lesions seen in this group of young infants could offer one explanation for the later development of a variety of other pathological conditions seen in adolescents and young adults.In 1946 Dock described proliferative intimal changes in the coronary arterial tree of infants and young adults, and his findings were confirmed and extended by many others (Fangman

SUMMARY The adrenal glands of 41 fresh stillbirths were studied and a 'stress response' pattern could be seen in 28. In these glands the stress response was characterised by compact cell change, lipid depletion, excess pyroninophilia, and dilatation of the very prominent granular endoplasmic reticulum. Scattered areas of cytolysis of cells, especially of the definitive cortex, gave rise to the commonly seen cystic (pseudofollicular) change and it was obvious that cells undergoing lysis were severely 'stressed'. In 2 infants there was a 'clear cell reversal' pattern. Histological and ultrastructural changes of the stress response were not identified in 11. Infants of low birthweight score were somewhat more commonly represented in the group that did not show a stress response. Cytolytic changes accompanying a stress response were commoner in immature infants. It is argued that cystic (pseudofollicular) change in the adrenal cortex of the newborn signifies a previous stress reaction.

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