Cerebellar hemorrhage in the preterm infant: ultrasonographic findings and risk factors.

Unlabelled: Cerebellar hemorrhage (CBH) in premature infants is increasingly diagnosed secondary to improved neuroimaging techniques and survival of very small preterm infants. Information is limited, however, on the incidence, topography, and risk factors for CBH in the preterm infant.

Objectives: To define the incidence of CBH in preterm infants diagnosed by neonatal cranial ultrasound (US), describe the sonographic features of CBH, and identify maternal and perinatal risk factors associated with this lesion.

Use of di(2-ethylhexyl) phthalate-containing medical products and urinary levels of mono(2-ethylhexyl) phthalate in neonatal intensive care unit infants.

Objective: Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used in medical products made with polyvinyl chloride (PVC) plastic and may be toxic to humans. DEHP is lipophilic and binds noncovalently to PVC, allowing it to leach from these products. Medical devices containing DEHP are used extensively in neonatal intensive care units (NICUs).

Phase transition between nanostructures of titanate and titanium dioxides via simple wet-chemical reactions.

Titanate nanofibers of various sizes and layered structure were prepared from inorganic titanium compounds by hydrothermal reactions. These fibers are different from "refractory" mineral substances because of their dimension, morphology, and significant large ratio of surface to volume, and, surprisingly, they are highly reactive. We found, for the first time, that phase transitions from the titanate nanostructures to TiO(2) polymorphs take place readily in simple wet-chemical processes at temperatures close to ambient temperature.

In vivo visualization of white matter fiber tracts of preterm- and term-infant brains with diffusion tensor magnetic resonance imaging.

Objective: The goal of this study was to test the feasibility of visualizing a 3-dimensional structure of cerebral white matter fiber tracts in preterm infants, postconceptional age (PCA) 28 weeks to term, by using volumetric diffusion tensor magnetic resonance imaging (DTI) data.

Materials And Method: We combined tractography algorithms and visualization methods, currently available for adult DTI data, to trace the pixelated principal direction of a diffusion tensor originating from regions-of-interest with high fractional anisotropy. Consequently, white matter fiber bundles from the genu and the splenium of corpus callosum, the corticospinal tracts, the inferior fronto-occipital fasciculi, and optic radiations were visualized.

On the role of characterization in the design of interfaces in nanoscale materials technology.

This work reviews recent research on the design and control of interfaces in engineering nanomaterials. Four case studies are presented that demonstrate the power of a multimodal approach to the characterization of different types of interfaces. We have used a combination of conventional, high resolution, and analytical transmission electron microscopy, microbeam electron diffraction, and three-dimensional atom probe to study polymer-clay nanocomposites, turbine rotor steels used for power generation, multicomponent aluminum alloys, and nanocrystalline magnetic materials.

Quantifying uncertainty: physicians' estimates of infection in critically ill neonates and children.

To determine the diagnostic accuracy of physicians' prior probability estimates of serious infection in critically ill neonates and children, we conducted a prospective cohort study in 2 intensive care units. Using available clinical, laboratory, and radiographic information, 27 physicians provided 2567 probability estimates for 347 patients (follow-up rate, 92%). The median probability estimate of infection increased from 0% (i.

Strength, fracture toughness and microstructure of a selection of all-ceramic materials. Part II. Zirconia-based dental ceramics.

Objective: The present study is the second part of an investigation of strength, fracture toughness and microstructure of nine all-ceramic materials. In the present study, DC Zirkon, an experimental yttria partially stabilized zirconia, In-Ceram Zirconia slip and In-Ceram Zirconia dry-pressed were compared.

Methods: Strength was appraised on ten bar-shaped specimens for each material (20 x 4 x 1.

Strength, fracture toughness and microstructure of a selection of all-ceramic materials. Part I. Pressable and alumina glass-infiltrated ceramics.

Objective: The present study, divided into two parts, aimed to compare the strength, fracture toughness and microstructure of a range of all-ceramic materials. In part I, three hot-pressed glass-ceramics (IPS-Empress, Empress 2 and a new experimental ceramic) and alumina glass-infiltrated ceramics (In-Ceram Alumina), processed by both slip casting and dry pressing, were compared.

Methods: Tensile strength was appraised on 10 bar-shaped specimens (20 x 4 x 1.

Narrowing of sex differences in infant mortality in Massachusetts.

Objectives: To examine whether the improved survival of preterm infants has influenced the known male excess in infant mortality.

Study Design: We analyzed sex-specific infant mortality using linked birth and death certificates for all 619,811 live born infants in Massachusetts between 1989 and 1995.

Results: Between 1989 and 1995 the male excess in infant mortality decreased by 50%, from 1.

A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects.

Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function.

Neonatal outcome after trial of labor compared with elective repeat cesarean section.

Background: Trial of labor after cesarean section has been an important strategy for lowering the rate of cesarean delivery in the United States, but concerns regarding its safety remain. The purpose of this study was to evaluate the outcome of newborns delivered by elective repeat cesarean section compared to delivery following a trial of labor after cesarean.

Methods: All low-risk mothers with 1 or 2 previous cesareans and no prior vaginal deliveries, who delivered at our institution from December 1994 through July 1995, were identified.

Fetuses subsequently born premature are smaller than gestational age-matched fetuses not born premature.

Objective: To determine whether singleton fetuses in pregnancies that subsequently deliver prematurely are smaller than singleton fetuses of the same gestational age who are not born premature.

Methods: Our study population consisted of singleton pregnancies meeting the following criteria: at least 1 first-trimester sonogram (to ensure accurate dating), at least 1 sonogram after 24 weeks' gestation, and a known delivery date. Controlling for gestational age at sonography using analysis of covariance, we compared very premature fetuses (delivery at 24-29.

The role of intrapartum fever in identifying asymptomatic term neonates with early-onset neonatal sepsis.

Objective: To assess the role of intrapartum fever in identifying asymptomatic term neonates with early-onset neonatal sepsis.

Study Design: Retrospective review of all term neonates with sepsis over a 7-year period to evaluate the significance of symptoms at delivery and intrapartum sepsis risks factors in identifying neonates with sepsis.

Results: Fifty-three of 90 term neonates with sepsis (59%) were asymptomatic at delivery.

Maternal epidural use and neonatal sepsis evaluation in afebrile mothers.

Objective: Epidural use has been associated with a higher rate of neonatal sepsis evaluation. Epidural-related fever explains some of the increase but not the excess of neonatal sepsis evaluations in afebrile women

Methods: We studied 1109 women who had singleton term pregnancies and who presented in spontaneous labor and were afebrile during labor (<100.4 degrees F).

Cord blood leptin and insulin-like growth factor levels are independent predictors of fetal growth.

The insulin-like growth factor (IGF) system is the dominant endocrine regulator of fetal growth, whereas insulin has a permissive role. Although a role for leptin in fetal growth has been suggested recently, the mechanism by which leptin may be related to fetal growth is not known; but leptin may interact with the IGF system in utero as it does in the extrauterine life. In the context of a hospital-based case control study, we collected anthropometric and demographic data and measured serum leptin, IGF-I, IGF-II, insulin, cortisol, and IGF binding protein 3 concentrations in 142 cord blood samples from full-term deliveries.

Neonatal outcome of infants born at 23 weeks' gestation.

Objective: To determine the neonatal outcome in accurately dated 23-week deliveries.

Methods: We reviewed the records of consecutive births between 23 0/7 and 23 6/7 weeks at Brigham & Women's Hospital, Boston, Massachusetts, from January 1995 to December 1999. Women were excluded if they presented for elective termination or had known fetal death or poor dating criteria.

Variations in transfusion practice in neonatal intensive care.

Objective: To compare the transfusion practices between two neonatal intensive care units (NICUs) to assess the impact of local practice styles on the timing, number, and total volume of packed red cell transfusions in very low birth weight infants. To derive multivariate models to describe practice and to identify potential areas for improvement in the future.

Methodology: We reviewed phlebotomy losses and transfusion rates between two NICUs (A and B) for 270 consecutive admissions of birth weight < 1500 g.

Improved birth weight table for neonates developed from gestations dated by early ultrasonography.

Most previously published tables of birth weight percentiles as a function of gestational age have been derived from neonates with imprecise gestational dating. In order to improve the accuracy of neonatal birth weight percentiles, we developed a birth weight table based on measurements from a group of neonates who had accurate gestational dating by prenatal first trimester ultrasonography. By matching a database of obstetrical ultrasonograms over a 5 year period to birth records at our institution, 3718 newborn infants with gestational dating by first trimester ultrasonography were identified.

Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation.

Objective: Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics.

Methods: We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery.

Normal birth weight intensive care unit survivors: outcome assessment.

Unlabelled: RATIONALE/OBJECTIVE: Although the short- and long-term outcome of low birth weight neonatal intensive care unit (NICU) survivors has been extensively studied, much less information is available for normal birth weight (NBW) infants (greater than or equal to 2500 g) who require NICU care.

Methods: To address this issue, we retrospectively examined the neonatal hospitalizations and 6-month health status of 521 consecutive NBW admissions to a single NICU. Information on the neonatal hospitalization was obtained from a review of medical records.

The effects of glutamine-supplemented parenteral nutrition in premature infants.

Background: Glutamine (GLN) is the primary fuel for rapidly dividing cells, yet it is not a constituent of parenteral nutritional formulas administered to newborns. The aims of this prospective, randomized, double-blind trial were (1) to confirm the safety of glutamine supplementation for premature infants and (2) to examine the effects of glutamine-supplemented parenteral nutrition on length of stay, days on total parenteral nutrition (TPN), days on the ventilator, and other clinical outcomes.

Methods: Premature infants received either standard or glutamine-supplemented TPN and were monitored throughout length of stay for various health and biochemical indices.

A clinical trial of active management of labor.

Background: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.

Methods: We randomly assigned 1934 nulliparous women at low risk of complications of pregnancy, before 30 weeks' gestation, to active management of labor or to a usual-care group.

Urinoma drainage for neonatal respiratory insufficiency.

This report describes two newborn males with posterior urethral valves, perirenal urinomas and respiratory distress. A 400 cc urinoma was drained percutaneously with resolution of respiratory symptoms in the first case. A 120 cc urinoma was drained in the second case but the infant died of pulmonary hypoplasia at 22 h of age.

Intrapartum and delivery room management of the very low birthweight infant.

The management of a pregnant woman in premature labor is a challenge. The roles of the perinatologist as well as support people is discussed in this article.