No abstract

Between 1974 and 1989, 15 neonates were found, at autopsy, to have subcapsular hematoma of the liver in a retrospective clinicopathologic study of 644 neonates. The majority (75%) of the neonates were less than 28 weeks gestation, male gender, and were delivered by the vaginal route following a complicated pregnancy and labor including malpresentation. The clinical course included resuscitation at birth, ventilatory support and hypovolemic shock with death occurring within 24 hours in 11 neonates. Other clinical events included air leak (n = 4 infants) and infection (n = 4). Intracranial hemorrhage was suspected in all but was found at autopsy in 8 neonates. The subcapsular hematoma was intact in 7 and ruptured in 8 neonates. Hence, subcapsular hemorrhage of the liver should be considered in the differential diagnosis of hypovolemic shock in very low birthweight infants.

The transplacental and elimination pharmacokinetics of phenobarbital administered antenatally was analyzed in both mothers and infants as part of a study evaluating the efficacy of antenatally administered phenobarbital in the prevention of neonatal intracerebral hemorrhage. Twenty-five pregnant women in labor less than 35 weeks’ gestation received 500 mg phenobarbital administered intravenously. The maternal serum phenobarbital level at delivery was 8.76 ± 1.99 μg/ml and cord serum phénobarbital level was 9.0 ± 1.75 μg/ml (all values are mean ± SD). There was no correlation between the time from phénobarbital administration to delivery (5.6 ± 4.6 h) and the cord:maternal serum phénobarbital ratio (1.05 ± 0.21) (r = -0.03; p > 0.05). The mean apparent half-life of phenobarbital estimated in 11 infants was 175.5 ± 45.6 h. The present study documents the ability to predict serum levels in the fetus and neonate from the serum concentrations achieved in the mother.