Variability of plasma cortisol levels in extremely low birth weight infants.

Cortisol is secreted by children and adults in a pulsatile pattern of 15-30 peaks and nadirs each day with a circadian rhythm. Newborns are known to lack the circadian pattern, leading to uncertainty about the appropriate time for blood sampling for assessment of adrenal function. Because extremely low birth weight (ELBW) infants may manifest signs of adrenal insufficiency, knowledge of the pattern of cortisol levels is necessary to guide the appropriate timing of blood sampling.

Subgaleal hematoma: the need for increased awareness of risk.

Subgaleal hematoma, also known as subaponeurotic hemorrhage, is a serious complication of birth that is associated with vacuum-assisted delivery. Despite a high rate of mortality associated with subgaleal hematoma, it has received relatively little attention in the medical literature. Lack of awareness may lead to delayed diagnosis and serious consequences for infants.

A scoring system for evaluating the condition of transported neonates.

A scoring system for the evaluation of the clinical status of transported small premature infants was modified to make it applicable to the evaluation of both premature and term infants. Blood glucose concentration, systolic blood pressure, blood pH and PO2, and body temperature were assessed and given scores of 0, 1 or 2 for abnormal, borderline and normal values, respectively. The scoring system was used for quality assurance studies of changes in patient status during transport from community hospitals to the neonatal intensive care unit and proved useful in identifying inadequate attention to body-temperature maintenance.