Eighth Day Of Life Research Articles

Percutaneous Embolization of No Ligated Vertical Veins After Total Anomalous Pulmonary Vein Return Operation and Risk Factors for Its Persistence

Background: The vertical vein (VV) ligation during the total anomalous pulmonary venous return (TAPVR) correction is still controversial. Our study aimed to define the potential risk factors for VV persistence and their percutaneous occlusion. Methods: The retrospective cohort study included 40 patients (26 males) with TAPVR treated at the tertiary referral center from 2005 to 2024. Results: The average days of age at diagnosis was two (IQR 1–8). Complex congenital heart disease with TAPVR was diagnosed in eight patients. A supracardiac type of TAPVR was found in 47% of them. The patients underwent the operation on their eighth day of life (IQR 5–57). The follow-up period was 32 months (IQR 8–99). The early postoperative mortality rate was 17.5%, significantly frequent in the patients’ group with combined CHD (p = 0.002). Four were reoperated on—three due to a postoperative obstruction between the pulmonary venous confluence and the left atrium (LA), while in one patient, a redirection of the VCI was performed. Four patients, aged 12.3 on average (IQR 8.9–14.7), underwent vertical vein embolization. All patients achieved complete occlusion with AVP2. The LA diameter Z score was lower than −4, an increased risk for VV persistence of almost 19 times (OR 18.6, 95% CI 1.6–216.0). Conclusions: We found that an LA diameter Z score of lower than −4 was a major risk factor for VV persistence. Percutaneous VV embolization is a safe and effective procedure in adolescents.

Mixed Heterotopic Gastrointestinal/Respiratory Oral Cysts in Newborns: From Prenatal Diagnosis to Histopathological and Therapeutic Management: A Case Report and Literature Review

Fetal lingual tumors are very rare, and their early prenatal diagnosis is important for defining the subsequent therapeutic strategy. In this study, we aimed to describe a case of a congenital septate lingual cyst and perform an extensive literature review on two main databases (PubMed, Web of Science), analyzing the clinical manifestations, the imaging appearance, the differential diagnosis, and particularities regarding the treatment of these tumors. The electronic search revealed 17 articles with 18 cases of mixed heterotopic gastrointestinal/respiratory oral epithelial cysts that met the eligibility criteria and were included in this review. The clinical case was diagnosed prenatally during second-trimester screening. On the eighth day of life, the fetus underwent an MRI of the head, which revealed an expansive cystic process on the ventral side of the tongue with the greatest diameter of 21.7 mm, containing a septum of 1 mm inside. On the 13th day of life, surgery was performed under general anesthesia, and the lingual cystic formation was completely excised. The postoperative evolution was favorable. The histopathological examination revealed a heterotopic gastric/respiratory-mixed epithelial cyst with non-keratinized respiratory, gastric squamous, and foveolar epithelium. The lingual cyst diagnosed prenatally is an accidental discovery, the differential diagnosis of which can include several pathologies with different degrees of severity but with a generally good prognosis.

Прогностична цінність концентрації NT-proBNP у сироватці крові значно недоношених немовлят щодо гемодинамічної значущості відкритої артеріальної протоки

Hemodynamically significant patent ductus arteriosus (PDA) is a common complication in very preterm infants born at less than 32 weeks of gestation. At the same time, currently, there are no uniform criteria to identify the actual hemodynamic significance of PDA and generally accepted management approaches to such infants. Purpose — to assess the predictive value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels for hemodynamically significant PDA in very preterm infants. Materials and methods. Fifty-two preterm infants with gestational age <32 weeks, chronological age <72 h, and PDA diameter >1.5 mm were involved in a randomized study. Twenty-seven (52%) of them were treated with ibuprofen or paracetamol starting within the first 3 days of life. Expectant management was applied to 25 (48%) infants. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. According to the results of echocardiographic and clinical monitoring, 2 groups of patients were formed retrospectively. In 22 (42%) of them hemodynamically significant PDA (hsPDA) was diagnosed, and 30 (58%) had hemodynamically insignificant ductus arteriosus. Results. The percentage of infants who received pharmacological PDA treatment was not significantly different between the groups (p>0.05). Serum NT-proBNP concentrations at the median age of 2 and 8 days were significantly higher in infants with hsPDA (p<0.01). By the eighth day of life, the NT-proBNP level in both groups significantly decreased but remained considerably higher in newborns with hsPDA. Serum NT-proBNP concentrations on the second-third day of life could reliably predict hsPDA (AUC=0.93; 95% confidence interval: 0.86–1.0; p<0.05). Conclusions. Serum NT-proBNP concentrations on the second day of life >12000 pg/ml could reliably predict hsPDA. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: hemodynamically significant patent ductus arteriosus, PDA, NT-proBNP, prognostic value, very preterm infants.

Urinary gas chromatography mass spectrometry metabolomics in asphyxiated newborns undergoing hypothermia: from the birth to the first month of life.

Perinatal asphyxia is a severe clinical condition affecting around four million newborns worldwide. It consists of an impaired gas exchange leading to three biochemical components: hypoxemia, hypercapnia and metabolic acidosis. The aim of this longitudinal experimental study was to identify the urine metabolome of newborns with perinatal asphyxia and to follow changes in urine metabolic profile over time. Twelve babies with perinatal asphyxia were included in this study; three babies died on the eighth day of life. Total-body cooling for 72 hours was carried out in all the newborns. Urine samples were collected in each baby at birth, after 48 hours during hypothermia, after the end of the therapeutic treatment (72 hours), after 1 week of life, and finally after 1 month of life. Urine metabolome at birth was considered the reference against which to compare metabolic profiles in subsequent samples. Quantitative metabolic profiling in urine samples was measured by gas chromatography mass spectrometry (GC-MS). The statistical approach was conducted by using the multivariate analysis by means of principal component analysis (PCA) and orthogonal partial least square discriminant analysis (OPLS-DA). Pathway analysis was also performed. The most important metabolites depicting each time collection point were identified and compared each other. At birth before starting therapeutic hypothermia (TH), urine metabolic profiles of the three babies died after 7 days of life were closely comparable each other and significantly different from those in survivors. In conclusion, a plethora of data have been extracted by comparing the urine metabolome at birth with those observed at each time point collection. The modifications over time in metabolites composition and concentration, mainly originated from the depletion of cellular energy and homeostasis, seems to constitute a fingerprint of perinatal asphyxia.

Congenital Hemangiopericytoma

The congenital/infantile form of hemangiopericytoma has more benign features than the adult form.1Fernandez-Pineda I. Parida L. Jenkins J.J. Davidoff A.M. Rao B.N. Rodriguez-Galindo C. Childhood hemangiopericytoma: review of St Jude Children’s Research Hospital.J Pediatr Hematol Oncol. 2011; 33: 356-359Crossref PubMed Scopus (28) Google Scholar Infantile hemangiopericytoma has a favorable outcome, even in cases of unresectable tumors, characterized by a high response to chemotherapy.2Ferrari A. Casanova M. Bisogno G. Mattke A. Meazza C. Gronchi A. et al.Hemangiopericytoma in pediatric ages: a report from the Italian and German Soft Tissue Sarcoma Cooperative Group.Cancer. 2001; 92: 2692-2698Crossref PubMed Scopus (50) Google Scholar, 3Bien E. Stachowicz-Stencel T. Godzinski J. Balcerska A. Izycka-Swieszewska E. Kazanowska B. et al.Retrospective multi-institutional study on hemangiopericytoma in Polish children.Pediatr Int. 2009; 51: 19-24Crossref PubMed Scopus (18) Google Scholar A newborn was diagnosed prenatally as having a nuchal tumor (Figure, A). At birth, the results of physical examination were normal, except for a 3.5- by 3.0-cm ulcerated lesion in the nuchal area (Figure, B), which was confirmed as extracranial with magnetic resonance imaging (Figure, C). Complete surgical excision was performed on the eighth day of life. The postoperative course was uneventful, and the patient was discharged from the hospital after 3 days. Pathology showed an infiltrating hypercellular tumor with a lobulated-nodular pattern with staghorn vessels and capillaries and extensive necrotic areas (Figure, D). Morphologic and immunohistochemical results confirmed the diagnosis of infantile hemangiopericytoma. When the patient was 20 months of age, there was no sign of local or systemic recurrence.

Jaundice in a neonate with congenital diaphragmatic hernia

A six-week-old boy presented to the emergency department with worsening jaundice. His medical history included congenital diaphragmatic hernia repaired shortly after birth. Significant jaundice, unresponsive to phototherapy, was noted on the eighth day of life. His total bilirubin level decreased when he was advanced to full oral feeds. However, on the 23rd day of life, the patient's conjugated bilirubin level had tripled. This was attributed to total parenteral nutrition, and the patient was discharged home. Over the next month, his jaundice worsened. The patient was readmitted and ultimately diagnosed with cytomegalovirus (CMV) hepatitis. After treatment with ganciclovir, his hepatitis completely resolved. CMV infection is a common cause of neonatal hepatitis and congenital malformation. Prolonged neonatal jaundice that does not improve with transitioning from total parenteral nutrition to oral feeds warrants further evaluation. Simple laboratory investigation can avoid unnecessary and potentially harmful medical and surgical interventions. Early treatment of neonatal CMV infection reduces the risk of long-term neurological and hepatic complications.

A Newborn Male with Possible Hirschsprung’s Disease

<P>This newborn boy was transferred here for evaluation of possible Hirschsprung’s disease. He was the 2,120-g product of a 33-week gestation to a 33-year-old gravida 3 para 3 female. The pregnancy was complicated by gestational diabetes that was controlled with insulin. An amniocentesis was reportedly normal. He was born by cesarean section at 33 weeks due to a failed non-stress test. The infant was vigorous at birth and had Apgar scores of 8 at 1 and 5 minutes. A renal ultrasound after birth showed significant right-sided hydronephrosis with possible ureteropelvic junction obstruction and mild dilation of the left collecting system. He remained well, and feedings were started on the second day of life. On the eighth day of life, he started developing abdominal distension. Abdominal x-rays at that time showed dilated loops of bowel. The following day he had two bloody stools, and he was transferred here.</P> <H4>Key Learning Points</H4> <OL> <LI>Mothers who have a hemoglobin A1C of less than 6 during pregnancy tend to minimize the risk of congenital anomalies. However, they may still have the complications of abnormal in utero glucose metabolism such as macrosomia, hypoglycemia, and hypertrophic cardiomyopathy.</LI> <LI>Congenital anomalies from uncontrolled hyperglycemia include ventricular septal defects, transposition of the great arteries, spinal agenesis-caudal regression syndrome, neural tube defects, and urinary tract malformations.</LI> <LI>Failure to view a transition zone on barium enema does not rule out Hirschsprung’s disease. A transitional zone with associated megacolon may not be seen until 6 weeks.</LI> <LI>Chronic intestinal pseudo-obstruction syndrome is characterized by repeated episodes of what appears to be bowel obstruction without evidence of a physical blockage.</LI> <LI>Megacystis microcolon intestinal hypoperistalsis syndrome is an autosomal recessive disease characterized by chronic intestinal pseudo-obstruction coupled with bilateral hydronephrosis, hydroureter, and a thick-walled dilated bladder.</LI> </OL> <H4>ABOUT THE AUTHOR</H4> <P>Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL</P>

A Brief History of Urology at Baylor University Medical Center

A Brief History of Urology at Baylor University Medical Center

Pancreatoduodenectomy for neonatal myofibromatosis of the pancreas

Myofibromatosis is a rare congenital disorder consisting of one or more fibrous nodules in the skin, foft tissues, bones, and internal organs. The authors report the unique case of a newborn who presented with obstructive jaundice caused by a single myofibroma in the head of the pancreas that was treated successfully by pancreatoduodenectomy on the eighth day of life.

Ritscher-Schinzel cardio-cranio-cerebellar (3C) syndrome: Report of three new cases

Ritscher-Schinzel syndrome is also known as the 3C syndrome because it involves principally the cardiac, cerebellar and cranio-facial structures. However, a review of the 29 published cases shows considerable variability in its clinical manifestations. As many as half of all cases may involve only two of the three systems. Here we wish to report on three new cases, two of which were siblings diagnosed prenatally.Cases 1 and 2. Baby R. was identified when autopsy studies following delivery at 31 weeks because of intrauterine fetal demise confirmed prenatally detected Dandy-Walker malformation, large atrial septal defect, cleft palate and hydronephrosis. During the subsequent pregnancy of this non-consanguineous, healthy Caucasian couple with a negative family history of malformations the fetus was found to have Dandy-Walker cyst, hypoplastic left heart, cleft palate and bilateral renal hypoplasia. Both fetuses had normal male karyotypes. Our third case is black male infant born at 38 weeks of gestational age to a 30-year-old primipara mother with no family history of birth defects or consanguinity. The infant weighed 1970 gm. at birth and was noted to have cleft palate, micrognathia, low set ears, tricuspid atresia with hypoplastic right ventricle, Dandy-Walker malformation and hydrocephalus. Other noted anomalies were a single umbilical artery, hypospadias, hemivertebrae and rib anomalies. Chromosomes were normal. The infant died following withdrawal of life support on the eighth day of life and no autopsy was performed. All three cases were seen during a one year period suggesting that the syndrome may be more common than is generally recognized.We will present a detailed review of the 29 published cases and differential diagnosis of the 3C syndrome.

ABC of General Surgery in Children: PROBLEMS WITH THE PENIS AND PREPUCE

Non-retractile foreskin of infant boy (normal for age). The foreskin envelops the glans from the fifth month of gestation. It begins dorsally and ends by fusing ventrally to cover the newly formed urethra. Actual fusion between the two epithelial layers of glans and foreskin is apparent at birth and has been termed physiological phimosis. This non-retractility remains in most boys for at least the first two years of life until natural separation ensues. Two conditions that are related to the process of preputial separation may give cause for concern. Firstly, the process may be uneven, with adhesions between glans and prepuce persisting even up to adolescence. Secondly, the desquamation of epithelial cells between the glans and non-retractile foreskin leads to accumulation of “pearls” of a white smegma-like substance. Both conditions are usually without actual symptoms and, as they are usually harmless, should not precipitate undue intervention. View this table: Natural course of foreskin separation Circumcision is one of the earliest operations, being recorded by the ancient Egyptians and other peoples of the Near East. Neonatal circumcision on the eighth day of life is a tenet of the Jewish faith and is performed by a mohel, often a vocation which is passed from father to son. In order to emulate the prophet Mohammed, Muslims also perform circumcision, and, though the timing is less strict, it is usually done well before puberty. “And God said unto Abraham, Thou shalt keep my covenant therefore, thou and thy seed after thee in their generations. This is my covenant, which ye shall keep, between me and you and thy seed after thee; Every man child among you shall be circumcised. And ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you.” Holy Bible. Genesis xvii, 9-11 The …

Gastrointestinal mucormycosis causing an acute abdomen in the immunocompromised pediatric patient—Three cases

Mucormycosis is an infection caused by a ubiquitous fungus in immunocompromised individuals. Typically, it invades blood vessels, producing thrombosis and tissue infarction. This infection spans all pediatric age groups and can lead to hollow viscus perforation and bowel obstruction. A 30-month old male with large cell anaplastic lymphoma had a bowel obstruction. During emergency laparotomy, an ileoileal intussusception was identified, which required resection and anastomosis. In the pathological specimen, fungi of the Mucorales order were found to be associated with tissue necrosis. On the eighth day of life, a premature infant had abdominal distension secondary to bowel perforation. Partial gastric resection and multiple intestinal stomas were performed. Death occurred soon after, secondary to multiorgan failure. The autopsy and surgical specimens showed widespread mucormycosis. An adolescent had meningococcemia-induced septic shock. During recovery, hemorrhagic colitis developed, which led to perforation. The subtotal colectomy specimen showed widespread mucormycosis. The laparotomy findings are typical (black necrotic tissue involving the bowel), and when seen in the immunocompromised patient, should make one suspect gastrointestinal mucormycosis. Aggressive surgical debridement of devitalized tissue augmented by intravenous antifungal medication is the main-stay of treatment.

Influence of bromocriptine administration to mothers on the development of pup thymocyte and splenocyte subsets and on mitogen-induced proliferation in the mouse

The influence of prolactin (PRL) on the development of the immune system in the mouse was studied by injecting mothers with bromocriptine (CB-154) to produce hypoprolactinemic milk. Alterations in pup thymocyte and splenocyte cell subsets were observed to graded doses of CB-154 administered to mothers. There was an increase in the relative percentages of neonate thymic CD4 and CD8 cells at 5 days of age when mothers were injected with 100 μg of CB-154 2 x daily from day 1 to 5 of lactation, however, there was no alteration in absolute thymic subset cell numbers. The relative percentage of pup spleen CD4, CD8 and B cells were increased when mothers were administered 50 or 100 μg of CB-154 and the 50 μg dose resulted in a significant increase in the absolute number of CD4 cells while the 100 μg dose induced a significant decrease in the three splenic cell subsets examined. Graded doses of CB-154 administered to mothers resulted in decreases in the PRL concentration of stomach milk as measured by the Nb2 cell proliferation assay. The serum PRL level of the pups, however, was not altered by any dose of CB-154 injected to the mothers. The administration of PRL to pups nursing mothers given the 100 μg dose of CB-154 did not alter the pup thymocyte and splenocyte subset population from that of litter-mate controls. The administration of mouse PRL and mouse growth hormone antisera to pups nursing saline-injected mothers did not alter thymocyte and splenocyte subsets from that of saline-injected litter mate controls. The proliferation of neonatal thymocytes by Con-A stimulation was not altered by CB-154 injection to mothers and PRL administration to pups. However, since the percentage of thymic CD4 and CD8 cells in the thymus was increased 2 to 3 fold, the apparent lack of effect was in fact a decrease in the responsiveness of the thymocytes. Con-A stimulation of neonatal splenocytes resulted in a significant increase in proliferation for mothers administered CB-154 in keeping with the increase relative percentage of CD4 and CD8 cells observed. Prolactin administration to the pups did not alter the response. LPS stimulation of neonatal splenocytes increased the proliferation of B cells taken from pup nursing mothers administered CB-154 and PRL administration appeared to partially block this proliferation. The data suggest that the changes observed in thymocyte and splenocyte subsets of pups nursing mothers receiving CB-154 was not due to the hypoprolactinemic milk but may be due to other factors such as undernutrition. A growing body of evidence in the adult has implicated prolactin (PRL) in the regulation of the immune system (1). The involvement of PRL in the development of the immune system has not been extensively studied. In the neonatal mouse the secretion of pituitary PRL is not detected until after the eighth day of life (2) although a number of investigators have detected PRL in the serum of rat pups (3,4) and mouse pups (5) by radioimmunoassay prior to this time. This apparent contradiction was resolve when it was determined that milk, from a wide number of species, contained high levels of PRL (6–9) and that it was biologically active (10,11). In addition, it was also reported that the PRL in milk was transferred to the circulation of the neonatal rat (12) and that pup serum PRL was biologically active (13). Grosvenor and associates (14) demonstrated that the administration of low doses of bromocriptine, a drug that specifically suppresses pituitary prolactin, to lactating mother rats would decrease the level of PRL in the milk. They also observed that when the pups reach adulthood they had hyperprolactinemia and a disruption in tuberoinfundibular dopamine neural activity (15). Thus, a decrease in milk PRL exposure during early neonatal life resulted in the disruption of the physiologic regulation of PRL when the pups reached adulthood. The involvement of PRL in the development of the immune system during the neonatal period has been examined in rats and mice (16, 17). The purpose of this study was to determine the effect of PRL on the neonatal development of the immune system in the mouse. To accomplish this bromocriptine was administered to lactating mothers and alterations in thymocyte and splenocyte subset populations were examined as well as their in vitro proliferation to mitogens. In addition we also examined the administration of anti-mouse PRL and anti-mouse growth hormone (GH) sera as well as replacement injections of PRL to pups nursing mothers who received bromocriptine.

Jewish custom linked to urinary tract infection

PETACH TIKVA, ISRAEL--- Traditional Jewish circumcision in Israeli male infants is associated with an increased risk of neonatal urinary tract infections, according to a recently published study. In Israel, Jewish males are traditionally circumcised on the eighth day of life. Researchers found that this custom may predispose newborn males to urinary tract infections during the 12-day period following circumcision.

Factors influencing genetic counseling attendance rate: A geographically based study

A study of factors influencing genetic counseling attendance rate has been conducted in the Bouches-du-Rhône area, in the south of France. In this area, a birth defects monitoring system (Eurocat n. 22) annually covers 23,000 births. All the genetic services are delivered by only one genetic center located in Marseilles, and the data collected are computerized. The comparison of these two data bases gives an opportunity to estimate the rate of genetic counseling attendance after the occurrence of an affected stillbirth or live birth. Among the parents of 358 infants born in 1983-84 in this area with a pathology requiring genetic counseling, 226 (63 per cent) attended the Genetic Center within the first year after birth. The rate of attendance is statistically higher (p less than 0.01) for the parents who had a stillbirth (78 per cent) than for those who had a live birth (57 per cent). It is also higher (p less than 0.01) for the Marseilles maternities group (68 per cent) than for the group outside Marseilles (50 per cent). The referral delays are also analyzed according to malformation etiology and to viability of the child by the eighth day of life. Besides evaluating a particular genetic center's effectiveness in diffusing information to the public concerned, this work shows that couples' request is strongly dependent on a psychological need.

Increased periventricular echogenicity (periventricular halos) in neonatal brain: a sonographic study.

This study was designed in order to evaluate frequency and natural development of periventricular increased echogenicity (periventricular halos) as a sonographic feature. Sixty healthy term neonates were examined sonographically through the open fontanel within the first twelve hrs of life (phase I). Out of this group, forty-three infants were again studied between the twenty-fourth and forty-eighth hr of life (phase II), forty between third and eighth day of life (phase III), twenty between third and sixth week of life (phase IV) and twelve between third and fifth months of life (phase V). Halos were found in occipital areas in 83% in I, in 86% in II, in 85% in III, in 35% in IV and in 0% in V. They presented as increased echogenicity predominantly occipitally and frontally at the external angles of both lateral ventricles. There was no correlation to the mode of delivery. The differential diagnosis (haemorrhage, hypoxicischaemic injury, oedema) is discussed. Periventricular increased echogenicity represents a common sonographic finding in clinically healthy term infants. When present in the typical form as described here it seems to have no pathological significance. Each clinician examining neonatal heads sonographically should be familiar with his phenomenon and its interpretation.

Manometric diagnosis of Hirschsprung's disease in the neonatal period

A newly designed semiconductor manometer was assembled for anorectal manometry in the neonatal period. Sixty apparently healthy neonates and 17 patients who presented gastrointestinal obstructive symptoms were examined by the eighth day of life. All 60 apparently healthy neonates showed a normal fluctuating wave and rectoanal reflex. Prematurity and postnatal age do not influence the normal rectoanal reflex. Among 17 patients, 5 were diagnosed as having Hirschsprung's disease based on absence of the reflex. There were no false negative or false positive results among these cases. It appears that anorectal manometry could be a reliable diagnostic test of Hirschsprung's disease even in the neonatal period.

Prognostic significance of polygraphic recordings in newborn infants on ventilation.

In a prospective study, 79 preterm and fullterm newborn infants who had been on assisted ventilation for at least five days were recorded polygraphically between the fifth and eighth day of life. 73 were still intubated and on assisted ventilation at the time of recording. 61 of the infants were again recorded polygraphically between 14 and 34 days after birth. The findings of both first and second recordings correlated with psychomotor development up to one year, or with postmortem examinations. The first recordings were highly significant to the prognosis, especially for infants whose gestations were more than 33 weeks. The second polygram showed a similar correlation with later development. Neurological examinations were performed on the same day as the first polygraphic recording: they were less significant prognostically for the preterm infants compared with polygraphic findings, and of no prognostic significance for the fullterm infants.

Phospholipids in tracheal effluent from infants with severe respiratory distress syndrome.

The physiologic aberration that causes abnormal alveolar surface tension in the lungs of infants with RDS was investigated by measuring relative quantities of surfactant-related phospholipids in tracheal effluent from infants with RDS. A preliminary study in premature lambs demonstrated that the percent DSPC (molar ratio of DSPC to total phospholipid) is similar in tracheal effluent and lung lavagate. The percent DSPC in tracheal effluent from human infants with RDS was similar to the percent DSPC in effluent from non-RDS infants on the first day of life (47.4% +/- 2.9 vs 46.7% +/- 1.2), and remained constant during the first 8 days of life. Phosphatidylglycerol (PG) was universally absent in effluent from RDS infants on the first and second day of life but appeared by the eighth day of life in all infants who remained intubated. PG was present in tracheal effluent from only 10 of 16 non-RDS infants on the first day of life. These findings suggest that, in regard to the surface-active lecithin content, surfactant from RDS infants is qualitatively normal and that the absence of RDS is not dependent on the presence of PG.

Bacteriologic Considerations in Perforated Necrotizing Enterocolitis

During a ten-year period, 61 infants with perforated necrotizing enterocolitis were managed by bowel resection, enterostomy, and intravenous antibiotics. Aerobic and anaerobic cultures were taken of venous blood, from the peritoneal cavity at operation, and of any subsequent wound and/or intraperitoneal infection. No significant differences between fatal and nonfatal cases were noted with respect to presence of anaerobes in the peritoneal flora (six babies with two deaths) or culture-confirmed bacteremia (73% of the total). However, peritonitis participated in by Pseudomonas aeruginosa (ten babies), or beta-hemolytic streptococcus (five babies) was -niformly lethal, as were complicating bacteremias due to P aeruginosa, beta-hemolytic streptococcus, and Staphylococcus aureus (two each). Anaerobic peritoneal isolates (all gram-positive cocci) were never noted if performation occurred before the eighth day of life; they did not appear to adversely affect survival. Based upon these data, antibiotic therapy should include either gentamicin or tobramycin, with penicillin, until subsequent culture reports dictate otherwise.