NEJM â Collection Updates for Neonatal Medicine

ORIGINAL ARTICLE: Outcomes after Internal versus External Tocodynamometry for Monitoring Labor

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose...

CORRESPONDENCE: Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer

Ann Thurin-Kjellberg, M.D., Catharina Olivius, and Christina Bergh, M.D., Ph.D. — Thu, 29Â OctÂ 2009 00:00:00 -05:00

To the Editor: We previously reported in the Journal1 the results of a randomized, controlled trial comparing pregnancy outcomes in patients undergoing in vitro fertilization (IVF) involving a fresh single-embryo...

REVIEW ARTICLE: Maternal and Neonatal Herpes Simplex Virus Infections

Lawrence Corey, M.D., and Anna Wald, M.D., M.P.H. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

An estimated 25 to 65% of pregnant women in the United States have genital infection with herpes simplex virus type 1 (HSV-1) or HSV type 2 (HSV-2).1 Neonatal HSV infection,...

ORIGINAL ARTICLE: Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Background: Whether hypothermic therapy improves neurodevelopmental outcomes in newborn infants with asphyxial encephalopathy is uncertain.

Methods: We performed a randomized trial of infants who were less than 6 hours of age...

BOOK REVIEW:

Thu, 06Â AugÂ 2009 00:00:00 -05:00

A woman pregnant with twins, already the mother of a healthy 3-year-old daughter, suddenly finds herself in unstoppable labor at 23 weeks of gestation. Knowing the high morbidity and mortality...

ORIGINAL ARTICLE: Lack of Association between Folate-Receptor Autoantibodies and Neural-Tube Defects

Thu, 09Â JulÂ 2009 00:00:00 -05:00

Background: A previous report described the presence of autoantibodies against folate receptors in 75% of serum samples from women with a history of pregnancy complicated by a neural-tube defect, as...

BOOK REVIEW:

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Normal fetal growth is determined by a number of factors. These include genetic potential, nutritional status of the mother, placental function and transfer of nutrients, and intrauterine hormones and growth...

BOOK REVIEW:

Thu, 18Â JunÂ 2009 00:00:00 -05:00

This book is an entertaining combination of a memoir, an explanation of the physiology and evolution of childbearing, a discussion of fetal and newborn physiology, and a history of the...

ORIGINAL ARTICLE: Evaluation of Universal Antenatal Screening for Group B Streptococcus

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Background: Group B streptococcal disease is one of the most common infections in the first week after birth. In 2002, national guidelines recommended universal late antenatal screening of pregnant women...

IMAGES IN CLINICAL MEDICINE: Neonatal Breast Enlargement

Ahdi Amer, M.D. and Howard Fischer, M.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

An 8-day-old girl presented with bilateral breast enlargement. She was born at term; the 1-minute and 5-minute Apgar scores were 8 and 9, respectively. She was feeding well and showed...

EDITORIAL: One Step Closer to a CMV Vaccine

Cornelia L. Dekker, M.D., and Ann M. Arvin, M.D. — Thu, 19Â MarÂ 2009 00:00:00 -05:00

In this issue of the Journal, Pass and colleagues describe the results of a phase 2 trial of a vaccine containing recombinant cytomegalovirus (CMV) glycoprotein B subunit antigen combined with...

ORIGINAL ARTICLE: Vaccine Prevention of Maternal Cytomegalovirus Infection

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Background: Congenital infection with cytomegalovirus (CMV) is an important cause of hearing, cognitive, and motor impairments in newborns.

Methods: In this phase 2, placebo-controlled, randomized, double-blind trial, we evaluated a vaccine...

CORRESPONDENCE: Iodine Content of Prenatal Multivitamins in the United States

Angela M. Leung, M.D., Elizabeth N. Pearce, M.D., and Lewis E. Braverman, M.D. — Thu, 26Â FebÂ 2009 00:00:00 -05:00

To the Editor: Normal thyroid function in fetuses and breast-fed infants, which is dependent on sufficient maternal dietary intake of iodine, is crucial for normal neurocognitive development.1 Children of mothers...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2009 â A Pregnant Woman with a Large Mass in the Fetal Oral Cavity

Thu, 26Â FebÂ 2009 00:00:00 -05:00

A 29-year-old pregnant woman was transferred to this hospital at 38 weeks 4 days of gestation because of a large mass that had been detected in the fetal oral cavity...

CORRESPONDENCE: Eculizumab for Congenital Atypical HemolyticâUremic Syndrome

Ralph A. Gruppo, M.D. and Russell P. Rother, Ph.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

To the Editor: Atypical hemolyticâuremic syndrome of infancy is a rare disorder that is associated with thrombotic microangiopathy and acute renal failure. It often involves complement dysregulation.12 Plasma infusions have...

CORRESPONDENCE: Elimination of Antibodies to Recombinant Enzyme in Pompe's Disease

Thu, 08Â JanÂ 2009 00:00:00 -05:00

To the Editor: Infantile Pompe's disease is due to a deficiency of lysosomal acid alpha glucosidase (GAA). In patients in whom GAA is not produced, a status called cross-reacting immunologic...

EDITORIAL: Making Small Risks Even Smaller

Michael F. Greene, M.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

Cesarean sections performed without antecedent labor are associated with a higher risk of respiratory distress than those performed after the onset of labor, despite the fact that they may have...

IMAGES IN CLINICAL MEDICINE: Diagnosis of Uterine Rupture on CT

Alexandra Grosvenor Eller, M.D. and Barbra Fisher, M.D., Ph.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

A 34-year-old woman with seven previous cesarean deliveries and a history of scant prenatal care presented at 32 weeks' gestation with constant, vague lower abdominal pain that had worsened over...

ORIGINAL ARTICLE: Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between...

ORIGINAL ARTICLE: Early Antiretroviral Therapy and Mortality among HIV-Infected Infants

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Background: In countries with a high seroprevalence of human immunodeficiency virus type 1 (HIV-1), HIV infection contributes significantly to infant mortality. We investigated antiretroviral-treatment strategies in the Children with HIV...

EDITORIAL: Insulin Infusions in Very-Low-Birth-Weight Infants

Sudha Kashyap, M.D., and Richard A. Polin, M.D. — Thu, 30Â OctÂ 2008 00:00:00 -05:00

Advancements in the care of very-low-birth-weight (<1500 g) infants have resulted in increased survival. The provision of adequate nutrition to meet the growth needs of these infants is one of...

ORIGINAL ARTICLE: Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Thu, 30Â OctÂ 2008 00:00:00 -05:00

Background: It is unclear whether aggressive phototherapy to prevent neurotoxic effects of bilirubin benefits or harms infants with extremely low birth weight (1000 g or less).

Methods: We randomly assigned 1974...

ORIGINAL ARTICLE: Early Insulin Therapy in Very-Low-Birth-Weight Infants

Thu, 30Â OctÂ 2008 00:00:00 -05:00

Background: Studies involving adults and children being treated in intensive care units indicate that insulin therapy and glucose control may influence survival. Hyperglycemia in very-low-birth-weight infants is also associated with...

ORIGINAL ARTICLE: Monovalent Type 1 Oral Poliovirus Vaccine in Newborns

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Background: In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Although substantial progress toward this goal has been made, eradication remains elusive. In 2004, the World Health Organization called...

VIDEOS IN CLINICAL MEDICINE: Umbilical Vascular Catheterization

Thu, 09Â OctÂ 2008 00:00:00 -05:00

...

ORIGINAL ARTICLE: Effectiveness of Maternal Influenza Immunization in Mothers and Infants

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Background: Young infants and pregnant women are at increased risk for serious consequences of influenza infection. Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2008 â An 8-Day-Old Infant with Congenital Deafness, Lethargy, and Hypothermia

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Dr. Sarah M. Barnett (Neurology): An 8-day-old boy was admitted to the neonatal intensive care unit of this hospital because of weakness and lethargy.

The patient was born after a full-term...

EDITORIAL: Antenatal Magnesium Sulfate for Neuroprotection before Preterm Birth?

Fiona J. Stanley, M.D., and Caroline Crowther, F.R.A.N.Z.C.O.G. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

Preterm infants are at increased risk for serious, lifelong neurologic abnormalities such as cerebral palsy.12 As the survival of preterm infants has improved with advances in perinatal care,2 the occurrence...

ORIGINAL ARTICLE: A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy

Thu, 28Â AugÂ 2008 00:00:00 -05:00

Background: Research suggests that fetal exposure to magnesium sulfate before preterm birth might reduce the risk of cerebral palsy.

Methods: In this multicenter, placebo-controlled, double-blind trial, we randomly assigned women at...

ORIGINAL ARTICLE: Long-Term Medical and Social Consequences of Preterm Birth

Dag Moster, M.D., Ph.D., Rolv Terje Lie, Ph.D., and Trond Markestad, M.D., Ph.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

Background: Advances in perinatal care have increased the number of premature babies who survive. There are concerns, however, about the ability of these children to cope with the demands of...

EDITORIAL: Breast-Feeding, Antiretroviral Prophylaxis, and HIV

Glenda E. Gray, M.B., B.Ch., and Haroon Saloojee, M.B., B.Ch. — Thu, 10Â JulÂ 2008 00:00:00 -05:00

More than 200,000 of the 500,000 new human immunodeficiency virus (HIV) infections that occur each year in children are the result of transmission of the virus through the mother's breast...

ORIGINAL ARTICLE: Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt...

ORIGINAL ARTICLE: Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in resource-limited settings.

Methods: Women with HIV-1 infection who were breast-feeding infants...

REVIEW ARTICLE: Effect of In Utero and Early-Life Conditions on Adult Health and Disease

Thu, 03Â JulÂ 2008 00:00:00 -05:00

A long latency period between an environmental trigger and the onset of subsequent disease is widely recognized in the etiology of certain cancers, yet this phenomenon is not generally considered...

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

Jeffrey L. Ecker, M.D., and Michael F. Greene, M.D. — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Pregnancy is associated with relative carbohydrate intolerance and insulin resistance. Gestational diabetes mellitus (carbohydrate intolerance first diagnosed during pregnancy) has long been recognized as a risk factor for a number...

ORIGINAL ARTICLE: Hyperglycemia and Adverse Pregnancy Outcomes

The HAPO Study Cooperative Research Group — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Background: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes.

Methods: A total of 25,505 pregnant women at...

ORIGINAL ARTICLE: Mutations in the Iodotyrosine Deiodinase Gene and Hypothyroidism

Thu, 24Â AprÂ 2008 00:00:00 -05:00

DEHAL1 has been identified as the gene encoding iodotyrosine deiodinase in the thyroid, where it controls the reuse of iodide for thyroid hormone synthesis. We screened patients with hypothyroidism who...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2008 â A Newborn Infant with Intermittent Apnea and Seizures

Thu, 17Â AprÂ 2008 00:00:00 -05:00

A 1-day-old female infant was admitted to the neonatal intensive care unit of this hospital because of intermittent apnea and cyanosis. The day before admission, the patient was born at...

REVIEW ARTICLE: Management and Outcomes of Very Low Birth Weight

Eric C. Eichenwald, M.D., and Ann R. Stark, M.D. — Thu, 17Â AprÂ 2008 00:00:00 -05:00

Approximately 12.5% of births in the United States are preterm (occurring before 37 weeks of gestation). 08041729.xml 08041729.xml 08041729.xml 08041729.xml Preterm infants with âvery lowâ birth weight are those who...

ORIGINAL ARTICLE: Intensive Care for Extreme Prematurity â Moving beyond Gestational Age

Thu, 17Â AprÂ 2008 00:00:00 -05:00

Background: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.

Methods: We...

CLINICAL THERAPEUTICS: Phototherapy for Neonatal Jaundice

M. Jeffrey Maisels, M.B., B.Ch., and Antony F. McDonagh, Ph.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

A male infant weighing 3400 g was born at 37 weeks' gestation after an uncomplicated pregnancy. The mother is a 24-year-old primipara who has type A Rh-positive blood. The infant's...

ORIGINAL ARTICLE: Nasal CPAP or Intubation at Birth for Very Preterm Infants

Thu, 14Â FebÂ 2008 00:00:00 -05:00

Background: Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment. This randomized trial investigated whether nasal continuous positive airway pressure (CPAP), rather than intubation and ventilation, shortly after birth would...

ORIGINAL ARTICLE: Neonatal Diagnosis and Treatment of Menkes Disease

Thu, 07Â FebÂ 2008 00:00:00 -05:00

Background: Menkes disease is a fatal neurodegenerative disorder of infancy caused by diverse mutations in a copper-transport gene, ATP7A. Early treatment with copper injections may prevent death and illness, but...

EDITORIAL: Congenital Heart Disease and Brain Injury

Michael V. Johnston, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

During the past 25 years, remarkable progress has been made in the surgical treatment and survival of infants with congenital heart disease.1 Recent data have shown that in-hospital death rates...

EDITORIAL: On the Caffeination of Prematurity

David K. Stevenson, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

It was recognized more than three decades ago1 that methylxanthines can reduce the frequency of apneic episodes in premature infants. Since that time, methylxanthines have become part of the routine...

REVIEW ARTICLE: Chronic Lung Disease after Premature Birth

Eugenio Baraldi, M.D., and Marco Filippone, M.D. — Thu, 08Â NovÂ 2007 00:00:00 -05:00

In 1967, Northway et al. first described a new chronic respiratory disease, bronchopulmonary dysplasia, that developed in premature infants exposed to mechanical ventilation and oxygen supplementation.1 Two decades later, the...

ORIGINAL ARTICLE: Abnormal Brain Development in Newborns with Congenital Heart Disease

Thu, 08Â NovÂ 2007 00:00:00 -05:00

Background: Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease...

ORIGINAL ARTICLE: Long-Term Effects of Caffeine Therapy for Apnea of Prematurity

Thu, 08Â NovÂ 2007 00:00:00 -05:00

Background: Methylxanthine therapy is commonly used for apnea of prematurity but in the absence of adequate data on its efficacy and safety. It is uncertain whether methylxanthines have long-term effects...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2007 â A Newborn Girl with Skin Lesions

Mathew M. Avram, M.D., J.D., Verena Gobel, M.D., and Alireza Sepehr, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

Dr. Elizabeth A. Buzney (Dermatology): A newborn girl was transferred to this hospital because of a rash that had been present at birth. The infant, who weighed 3105 g, was...

EDITORIAL: Prenatal Corticosteroids â Early Gain, Long-Term Questions

Alan D. Stiles, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A single course of prenatal corticosteroid therapy has been shown to accelerate fetal lung maturation when premature delivery is imminent.123 This therapy reduces morbidity and mortality in premature newborns by...

ORIGINAL ARTICLE: Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids

Thu, 20Â SepÂ 2007 00:00:00 -05:00

Background: Previous trials have shown that repeat courses of antenatal corticosteroids improve some neonatal outcomes in preterm infants but reduce birth weight and increase the risk of intrauterine growth restriction....

ORIGINAL ARTICLE: Outcomes at 2 Years of Age after Repeat Doses of Antenatal Corticosteroids

Thu, 20Â SepÂ 2007 00:00:00 -05:00

Background: We previously reported the results of a randomized, controlled trial showing that repeat doses of antenatal corticosteroids reduced the risk of respiratory distress syndrome and serious neonatal morbidity. However,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2007 â A 30-Year-Old Pregnant Woman with Intrauterine Fetal Death

Ronald S. Gibbs, M.D., and Drucilla J. Roberts, M.D. — Thu, 30Â AugÂ 2007 00:00:00 -05:00

A 30-year-old primigravida was admitted to the hospital in active spontaneous labor at 39.7 weeks' gestation.

The patient had received prenatal care at this hospital since 11.1 weeks' gestation. She had...

ORIGINAL ARTICLE: Medical Abortion and the Risk of Subsequent Adverse Pregnancy Outcomes

Jasveer Virk, M.S., M.P.H., Jun Zhang, Ph.D., M.D., and JÃ¸rn Olsen, M.D., Ph.D. — Thu, 16Â AugÂ 2007 00:00:00 -05:00

Background: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available...

EDITORIAL: Progesterone and Preterm Labor â Still No Definite Answers

Jim G. Thornton, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

In 1930, Willard Allen and George Corner named the steroid hormone that they had extracted from rabbit ovaries âprogestinâ because they believed, rightly, that it helped maintain pregnancy.1 Removal of...

REVIEW ARTICLE: Prevention of Preterm Delivery

Hyagriv N. Simhan, M.D., M.S.C.R., and Steve N. Caritis, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

Preterm birth is defined as birth before the completion of 37 weeks of gestation. The frequency of preterm birth in the United States increased from 10.7% in 1992 to 12.3%...

ORIGINAL ARTICLE: Progesterone and the Risk of Preterm Birth among Women with a Short Cervix

Thu, 02Â AugÂ 2007 00:00:00 -05:00

Background: Previous randomized trials have shown that progesterone administration in women who previously delivered prematurely reduces the risk of recurrent premature delivery. Asymptomatic women found at midgestation to have a...

ORIGINAL ARTICLE: A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins

Thu, 02Â AugÂ 2007 00:00:00 -05:00

Background: In singleton gestations, 17 alpha-hydroxyprogesterone caproate (17P) has been shown to reduce the rate of recurrent preterm birth. This study was undertaken to evaluate whether 17P would reduce the...

ORIGINAL ARTICLE: Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Background: In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the...

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

Michael F. Greene, M.D. — Thu, 28Â JunÂ 2007 00:00:00 -05:00

In the fall of 2005, GlaxoSmithKline called attention to recently collected safety data indicating an increased risk of major congenital malformations among infants exposed during organogenesis to GlaxoSmithKline's selective serotonin...

ORIGINAL ARTICLE: Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: Information regarding the safety of selective serotonin-reuptake inhibitors (SSRIs) in human pregnancy is sparse. Concern has been raised about the risk of congenital heart defects associated with the use...

ORIGINAL ARTICLE: First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.

Methods: We assessed associations between first-trimester maternal use of SSRIs and the risk of birth...

ORIGINAL ARTICLE: A Multicenter, Randomized Trial of Prophylactic Fluconazole in Preterm Neonates

Thu, 14Â JunÂ 2007 00:00:00 -05:00

Background: Invasive candida infections are a major cause of morbidity and mortality in preterm infants. We performed a multicenter, randomized, double-blind, placebo-controlled trial of fluconazole for the prevention of fungal...

SPECIAL ARTICLE: Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants

Thu, 24Â MayÂ 2007 00:00:00 -05:00

Background: There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units....

EDITORIAL: Prematurity and the Legacy of Intrauterine Stress

Julie R. Ingelfinger, M.D. — Thu, 17Â MayÂ 2007 00:00:00 -05:00

In 1960, a neonate weighing 1000 g had a 95% risk of death; today, a neonate with the same birth weight has a 95% chance of surviving. This progress in...

ORIGINAL ARTICLE: Glucose Regulation in Young Adults with Very Low Birth Weight

Thu, 17Â MayÂ 2007 00:00:00 -05:00

Background: The association between small size at birth and impaired glucose regulation later in life is well established in persons born at term. Preterm birth with very low birth weight...

ORIGINAL ARTICLE: Mutations in Associated with Neural-Tube Defects

Thu, 05Â AprÂ 2007 00:00:00 -05:00

Neural-tube defects such as anencephaly and spina bifida constitute a group of common congenital malformations caused by complex genetic and environmental factors. We have identified three mutations in the VANGL1...

ORIGINAL ARTICLE: Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

Thu, 05Â AprÂ 2007 00:00:00 -05:00

Background: Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes.

Methods: In a double-blind...

PERSPECTIVE: Cesarean Delivery and the RiskâBenefit Calculus

Thu, 01Â MarÂ 2007 00:00:00 -05:00

In 1937, an article in the Journal describing 10 years of births at Boston City Hospital revealed an overall rate of cesarean delivery of about 3%.1 Recently released 2005 data...

REVIEW ARTICLE: Parturition

Roger Smith, M.B., B.S., Ph.D. — Thu, 18Â JanÂ 2007 00:00:00 -05:00

The mechanisms that instigate parturition in humans have been remarkably elusive, but some parts of the puzzle have begun to come together. A key change in the field was the...

EDITORIAL: Obstetricians Still Await a Deus ex Machina

Michael F. Greene, M.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

Intrapartum electronic fetal heart-rate monitoring was introduced with great enthusiasm in the early 1970s. Most cases of cerebral palsy were thought to result from asphyxia during the intrapartum period, and...

ORIGINAL ARTICLE: Fetal Pulse Oximetry and Cesarean Delivery

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Background: Knowledge of fetal oxygen saturation, as an adjunct to electronic fetal monitoring, may be associated with a significant change in the rate of cesarean deliveries or the infant's condition...

EDITORIAL: Preterm Birth and Periodontal Disease

Robert L. Goldenberg, M.D., and Jennifer F. Culhane, Ph.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

Preterm births (those occurring before 37 weeks of gestation) make up 12.5% of births in the United States. They account for 70% of perinatal deaths and nearly half of all...

ORIGINAL ARTICLE: Treatment of Periodontal Disease and the Risk of Preterm Birth

Thu, 02Â NovÂ 2006 00:00:00 -05:00

Background: Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth.

Methods: We...

ORIGINAL ARTICLE: Reduced Lung Function at Birth and the Risk of Asthma at 10 Years of Age

Thu, 19Â OctÂ 2006 00:00:00 -05:00

Background: Reduced lung function in early infancy has been associated with later obstructive airway diseases. We assessed whether reduced lung function shortly after birth predicts asthma 10 years later.

Methods: We...

EDITORIAL: Neuroimaging and the Prediction of Outcomes in Preterm Infants

Olaf Dammann, M.D., and Alan Leviton, M.D. — Thu, 17Â AugÂ 2006 00:00:00 -05:00

Among the most pressing questions for the parents and caregivers of extremely preterm infants are those about their children's future. Will they survive? If so, what are their chances of...

ORIGINAL ARTICLE: Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants

Thu, 17Â AugÂ 2006 00:00:00 -05:00

Background: Very preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population.

Methods: We...

ORIGINAL ARTICLE: Neonatal-Onset Multisystem Inflammatory Disease Responsive to Interleukin-1Î² Inhibition

Thu, 10Â AugÂ 2006 00:00:00 -05:00

Background: Neonatal-onset multisystem inflammatory disease is characterized by fever, urticarial rash, aseptic meningitis, deforming arthropathy, hearing loss, and mental retardation. Many patients have mutations in the cold-induced autoinflammatory syndrome 1...

EDITORIAL: ATP-Sensitive Potassium Channels â Neonatal Diabetes Mellitus and Beyond

Mark A. Sperling, M.D. — Thu, 03Â AugÂ 2006 00:00:00 -05:00

The revolution in molecular biology has led to widespread appreciation of a principle first described by the British physician A.E. Garrod approximately 100 years ago â that âinborn errors of...

ORIGINAL ARTICLE: Switching from Insulin to Oral Sulfonylureas in Patients with Diabetes Due to Kir6.2 Mutations

Thu, 03Â AugÂ 2006 00:00:00 -05:00

Background: Heterozygous activating mutations in KCNJ11, encoding the Kir6.2 subunit of the ATP-sensitive potassium (KATP) channel, cause 30 to 58 percent of cases of diabetes diagnosed in patients under six...

ORIGINAL ARTICLE: Activating Mutations in the Gene in Neonatal Diabetes Mellitus

Thu, 03Â AugÂ 2006 00:00:00 -05:00

Background: The ATP-sensitive potassium (KATP) channel, composed of the beta-cell proteins sulfonylurea receptor (SUR1) and inward-rectifying potassium channel subunit Kir6.2, is a key regulator of insulin release. It is inhibited...

EDITORIAL: Inhaled NO for Preterm Infants â Getting to Yes?

Ann R. Stark, M.D. — Thu, 27Â JulÂ 2006 00:00:00 -05:00

Preterm birth, especially at an extremely low gestational age, is often perilous. Despite improved survival associated with contemporary neonatal intensive care, more than one third of survivors with a birth...

ORIGINAL ARTICLE: Early Inhaled Nitric Oxide Therapy in Premature Newborns with Respiratory Failure

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: The safety and efficacy of early, low-dose, prolonged therapy with inhaled nitric oxide in premature newborns with respiratory failure are uncertain.

Methods: We performed a multicenter, randomized trial involving 793...

ORIGINAL ARTICLE: Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: Bronchopulmonary dysplasia in premature infants is associated with prolonged hospitalization, as well as abnormal pulmonary and neurodevelopmental outcome. In animal models, inhaled nitric oxide improves both gas exchange and...

EDITORIAL: ACE Inhibitors and Congenital Anomalies

J.M. Friedman, M.D., Ph.D. — Thu, 08Â JunÂ 2006 00:00:00 -05:00

Angiotensin-convertingâenzyme (ACE) inhibitors are among the most widely prescribed antihypertensive agents in the United States, but when used in the second half of pregnancy, they can cause oligohydramnios, fetal growth...

ORIGINAL ARTICLE: Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Background: Use of angiotensin-convertingâenzyme (ACE) inhibitors during the second and third trimesters of pregnancy is contraindicated because of their association with an increased risk of fetopathy. In contrast, first-trimester use...

EDITORIAL: Necrotizing Enterocolitis in Preterm Infants â Is Laparotomy Necessary?

Alan W. Flake, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

The occurrence of intestinal perforation is a catastrophic event at any age. Its occurrence in a very-low-birth-weight infant with necrotizing enterocolitis, however, is particularly hazardous. Unfortunately, the incidence of necrotizing...

ORIGINAL ARTICLE: Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Background: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes...

EDITORIAL: Caffeine for Apnea of Prematurity

Eduardo Bancalari, M.D. — Thu, 18Â MayÂ 2006 00:00:00 -05:00

Caffeine is one of the most commonly prescribed drugs among premature infants. It is a potent respiratory stimulant indicated primarily to reduce the incidence of episodes of apnea associated with...

IMAGES IN CLINICAL MEDICINE: Sympathetic-Nerve Damage in Brachial-Plexus Palsy

Israel Alfonso, M.D. and Ilker Yaylali, M.D., Ph.D. — Thu, 18Â MayÂ 2006 00:00:00 -05:00

A mother brought her three-month-old infant to the clinic because of a persistent difference in temperature between the right and left hand. The child had had a total brachial-plexus palsy...

ORIGINAL ARTICLE: Caffeine Therapy for Apnea of Prematurity

Thu, 18Â MayÂ 2006 00:00:00 -05:00

Background: Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short-...

EDITORIAL: Neonatal Hyperbilirubinemia â What Are the Risks?

Jon F. Watchko, M.D. — Thu, 04Â MayÂ 2006 00:00:00 -05:00

Hyperbilirubinemia is the most common condition requiring evaluation and treatment of newborns, but for the vast majority of neonates, it is a benign, transitional phenomenon of no overt clinical significance....

ORIGINAL ARTICLE: Outcomes among Newborns with Total Serum Bilirubin Levels of 25 mg per Deciliter or More

Thu, 04Â MayÂ 2006 00:00:00 -05:00

Background: The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined.

Methods: We identified 140 infants with neonatal total serum bilirubin levels of at least...

EDITORIAL: Antioxidants and the Prevention of Preeclampsia â Unresolved Issues

Arun Jeyabalan, M.D., and Steve N. Caritis, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

Preeclampsia is a pregnancy-specific, multisystem disorder that can have considerable adverse effects on the mother and the fetus. In developing countries, preeclampsia is a major cause of death among pregnant...

ORIGINAL ARTICLE: Vitamins C and E and the Risks of Preeclampsia and Perinatal Complications

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Background: Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain.

Methods: We conducted a multicenter, randomized...

IMAGES IN CLINICAL MEDICINE: Umbilical-Cord Prolapse at 29 Weeks' Gestation

Michael Belfort, M.D., Ph.D. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

A 23-year-old woman (gravida 1, para 0) was admitted at 29 1/7 weeks' gestation because of preterm premature rupture of the membranes. Her membranes had ruptured four days earlier, as...

EDITORIAL: Depressing Observations on the Use of Selective Serotonin-Reuptake Inhibitors during Pregnancy

James L. Mills, M.D. — Thu, 09Â FebÂ 2006 00:00:00 -05:00

Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that typically occurs in full-term or near-term infants. Before birth, the fetus receives oxygenated blood from the placenta; a...

ORIGINAL ARTICLE: Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with substantial infant mortality and morbidity. A previous cohort study suggested a possible association between maternal use of the selective...

ORIGINAL ARTICLE: Congenital Glutamine Deficiency with Glutamine Synthetase Mutations

Thu, 03Â NovÂ 2005 00:00:00 -05:00

Glutamine synthetase plays a major role in ammonia detoxification, interorgan nitrogen flux, acidâbase homeostasis, and cell signaling. We report on two unrelated newborns who had congenital human glutamine synthetase deficiency...

EDITORIAL: Systemic Hypothermia â A âCoolâ Therapy for Neonatal HypoxicâIschemic Encephalopathy

Lu-Ann Papile, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

Hypoxicâischemic encephalopathy is an important cause of death and disability in full-term infants. The incidence of moderate or severe hypoxicâischemic encephalopathy has remained essentially unchanged over the past 20 years,...

ORIGINAL ARTICLE: Whole-Body Hypothermia for Neonates with HypoxicâIschemic Encephalopathy

Thu, 13Â OctÂ 2005 00:00:00 -05:00

Background: Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain.

Methods: We conducted a randomized...

IMAGES IN CLINICAL MEDICINE: in a Peripheral-Blood Smear

Erez Nadir, M.D. and Miriam Kaufshtein, M.Sc. — Thu, 08Â SepÂ 2005 00:00:00 -05:00

A male infant was born at a gestational age of 26 weeks and weighed 830 g. He required intubation and was transferred to the neonatal intensive care unit. His treatment...

EDITORIAL: Meconium Aspiration Syndrome â More Than Intrapartum Meconium

Michael G. Ross, M.D., M.P.H. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

Meconium, the fecal material that accumulates in the fetal colon throughout gestation, is a term derived from the Greek mekoni, meaning poppy juice or opium. Beginning with Aristotle's observation of...

ORIGINAL ARTICLE: Amnioinfusion for the Prevention of the Meconium Aspiration Syndrome

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Background: It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death,...

PERSPECTIVE: Newborn Screening â Setting Evidence-Based Policy for Protection

Marvin Natowicz, M.D., Ph.D. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

In the early 1960s, a Massachusetts program for testing neonates for phenylketonuria became the first organized effort to screen newborns for genetic or metabolic disease in order to identify treatable...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2005 â A Four-Week-Old Male Infant with Jaundice and Thrombocytopenia

Thu, 14Â JulÂ 2005 00:00:00 -05:00

A four-week-old male infant was admitted to this hospital because of jaundice, hyperbilirubinemia, thrombocytopenia, and abdominal distention.

The patient was born at term at another hospital by spontaneous vaginal delivery to...

IMAGES IN CLINICAL MEDICINE: Small-Bowel Prolapse through a Persistent Omphalomesenteric Duct

Daniel F. Saad, M.D. and Kenneth W. Gow, M.D. — Thu, 07Â JulÂ 2005 00:00:00 -05:00

A 23-day-old term male infant presented to the emergency room with acute small-bowel evisceration through the umbilicus (Panel A). His parents had noted periumbilical erythema and mucus-containing umbilical drainage before...

EDITORIAL: Inhaled Nitric Oxide for Preterm Infants â Who Benefits?

Richard J. Martin, M.B., F.R.A.C.P., and Michele C. Walsh, M.D. — Thu, 07Â JulÂ 2005 00:00:00 -05:00

Endogenously released nitric oxide is widely recognized to play a key role in multiple vertebrate organ systems, and its deficiency disrupts pulmonary parenchymal and vascular development. These observations have suggested...

ORIGINAL ARTICLE: Neurodevelopmental Outcomes of Premature Infants Treated with Inhaled Nitric Oxide

Thu, 07Â JulÂ 2005 00:00:00 -05:00

Background: Chronic lung disease and severe intraventricular hemorrhage or periventricular leukomalacia in premature infants are associated with abnormal neurodevelopmental outcomes. In a previous randomized, controlled, single-center trial of premature infants...

ORIGINAL ARTICLE: Inhaled Nitric Oxide for Premature Infants with Severe Respiratory Failure

Thu, 07Â JulÂ 2005 00:00:00 -05:00

Background: Inhaled nitric oxide is a controversial treatment for premature infants with severe respiratory failure. We conducted a multicenter, randomized, blinded, controlled trial to determine whether inhaled nitric oxide reduced...

EDITORIAL: Early Use of Drastic Therapy

Kenneth I. Weinberg, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Krabbe's disease, or globoid-cell leukodystrophy, is an inborn error of lipid metabolism first described in 1916 in two children with spasticity who died in infancy and were found to have...

SPECIAL ARTICLE: An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan

Thu, 19Â MayÂ 2005 00:00:00 -05:00

Background: There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective...

PERSPECTIVE: Perinatal Mortality in Developing Countries

Jelka Zupan, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Each year, 10.7 million children under the age of five years die â 4 million during the first four weeks of life. Another 3.3 million are stillborn. And these are...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Hans Hartmann, M.D. and Urs Schumacher, M.D. — Thu, 20Â JanÂ 2005 00:00:00 -05:00

A male infant was born at 38 weeks and 1 day of gestation with a weight of 3430 g. When the child was five months old, his mother noticed an...

ORIGINAL ARTICLE: Neurologic and Developmental Disability at Six Years of Age after Extremely Preterm Birth

Thu, 06Â JanÂ 2005 00:00:00 -05:00

Background: Birth before 26 weeks of gestation is associated with a high prevalence of neurologic and developmental disabilities in the infant during the first two years of life.

Methods: We studied...

EDITORIAL: Extreme Prematurity â The Continuing Dilemma

Betty R. Vohr, M.D., and Marilee Allen, M.D. — Thu, 06Â JanÂ 2005 00:00:00 -05:00

The tremendous advances in perinatal and neonatal care that were made beginning in the 1970s and through the 1990s have contributed to the survival of infants as immature as 22...

EDITORIAL: Vaginal Birth after Cesarean Revisited

Michael F. Greene, M.D. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

The U.S. total cesarean delivery rate has risen from 4 percent of deliveries in 1950 to 26 percent in 2002.1 Concerned about the rising rate of cesarean deliveries, and noting...

ORIGINAL ARTICLE: Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery

Thu, 16Â DecÂ 2004 00:00:00 -05:00

Background: The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2004 â A 23-Day-Old Infant with Hypospadias and Failure to Thrive

Joan M. Stoler, M.D., Natalia T. Leach, Ph.D., and Patricia K. Donahoe, M.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

A 23-day-old male infant was admitted to this hospital because of difficulty feeding and failure to thrive.

His weight at birth was 2580 g; he was 45 cm long, the product...

EDITORIAL: Prematurity â A Window of Opportunity?

Mark A. Sperling, M.D. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

Infants born with evidence of restricted fetal growth â those who are small for gestational age â appear to be at increased risk for metabolic disorders (type 2 diabetes mellitus...

ORIGINAL ARTICLE: Premature Birth and Later Insulin Resistance

Thu, 18Â NovÂ 2004 00:00:00 -05:00

Background: Term infants who are small for gestational age appear prone to the development of insulin resistance during childhood. We hypothesized that insulin resistance, a marker of type 2 diabetes...

LEGAL ISSUES IN MEDICINE: Extremely Preterm Birth and Parental Authority to Refuse Treatment â The Case of Sidney Miller

George J. Annas, J.D., M.P.H. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

Disputes between physicians and patients over medical care have tended toward resolution in both the courts and ethics committees, with each of these bodies ultimately deciding that the informed, competent...

ORIGINAL ARTICLE: Mutant Mitochondrial Elongation Factor G1 and Combined Oxidative Phosphorylation Deficiency

Thu, 11Â NovÂ 2004 00:00:00 -05:00

Although most components of the mitochondrial translation apparatus are encoded by nuclear genes, all known molecular defects associated with impaired mitochondrial translation are due to mutations in mitochondrial DNA. We...

REVIEW ARTICLE: Neonatal Brain Injury

Donna M. Ferriero, M.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

The mortality from acute neurologic disorders of childhood, such as status epilepticus and stroke, is highest in infants under one year of age.12 Certain forms of newborn brain injury, such...

ORIGINAL ARTICLE: Fresh Whole Blood versus Reconstituted Blood for Pump Priming in Heart Surgery in Infants

Thu, 14Â OctÂ 2004 00:00:00 -05:00

Background: In an attempt to reduce the coagulopathic and inflammatory responses seen after cardiopulmonary bypass, the use of fresh whole blood during heart operations has become the standard of care...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2004 â Newborn Twins with Thrombocytopenia, Coagulation Defects, and Hepatosplenomegaly

Thu, 09Â SepÂ 2004 00:00:00 -05:00

Newborn identical twin male infants were admitted to the neonatal intensive care unit. They were delivered at 32 weeks of gestation by a healthy 27-year-old primipara. The parents were of...

ORIGINAL ARTICLE: Second-Trimester Maternal Serum Levels of Alpha-Fetoprotein and the Subsequent Risk of Sudden Infant Death Syndrome

Thu, 02Â SepÂ 2004 00:00:00 -05:00

Background: Unexplained stillbirth and the sudden infant death syndrome (SIDS) share some features. A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of...

PERSPECTIVE: SIDS â A Syndrome in Search of a Cause

Michael H. Malloy, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

The sudden infant death syndrome (SIDS) was initially defined in 1969 with the goal of identifying infants who had similar characteristics before sudden death so that a common underlying mechanism...

EDITORIAL: Finding Needles in Haystacks â Gene Variants in Isolated Cleft Lip or Cleft Palate

Aravinda Chakravarti, Ph.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

Human geneticists have been on a long joyride. The power of contemporary genetics and genomics has allowed us to identify the specific causal gene in a dizzying variety of mendelian...

ORIGINAL ARTICLE: Interferon Regulatory Factor 6 () Gene Variants and the Risk of Isolated Cleft Lip or Palate

Thu, 19Â AugÂ 2004 00:00:00 -05:00

Background: Cleft lip or palate (or the two in combination) is a common birth defect that results from a mixture of genetic and environmental factors. We searched for a specific...

PERSPECTIVE: The Changing Faces of Children with Cleft Lip and Palate

John B. Mulliken, M.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

Many expectant parents worry, consciously or unconsciously, that their baby will be born with a malformation. Cleft lip with or without cleft palate is one of the most common birth...

EDITORIAL: Antiretroviral Agents â How Best to Protect Infants from HIV and Save Their Mothers from AIDS

Hoosen Coovadia, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

Preventing transmission of human immunodeficiency virus type 1 (HIV-1) and caring for those already infected are essential services in any comprehensive program, and enhancing the mutually beneficial effect of each...

ORIGINAL ARTICLE: Single-Dose Perinatal Nevirapine plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: Although zidovudine prophylaxis decreases the rate of transmission of the human immunodeficiency virus (HIV) type 1 substantially, a large number of infants still become infected. We hypothesized that the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2004 â A Newborn Girl with a Large Cutaneous Lesion, Thrombocytopenia, and Anemia

Thu, 22Â AprÂ 2004 00:00:00 -05:00

A newborn girl was transferred to this hospital because of a large cutaneous lesion, thrombocytopenia, and anemia.

The infant had been born at another hospital to a 33-year-old woman (gravida 2,...

EDITORIAL: Postnatal Corticosteroids for Preterm Infants â Do What We Say, Not What We Do

Alan H. Jobe, Ph.D. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

Physicians caring for pregnant women and their preterm infants have used corticosteroids since Liggins and Howie reported in 1972 that prenatal betamethasone decreased the incidence of the respiratory distress syndrome...

ORIGINAL ARTICLE: Gene Mutations in Newborns with Fatal Surfactant Deficiency

Thu, 25Â MarÂ 2004 00:00:00 -05:00

Background: Pulmonary surfactant forms a lipid-rich monolayer that coats the airways of the lung and is essential for proper inflation and function of the lung. Surfactant is produced by alveolar...

PERSPECTIVE: Lung Surfactant, Respiratory Failure, and Genes

Mikko Hallman, M.D., Ph.D. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

After the first observation of surfactant deficiency in infants who were dying of the respiratory distress syndrome (also known as hyaline membrane disease), a series of investigations led to effective...

ORIGINAL ARTICLE: Previous Preterm and Small-for-Gestational-Age Births and the Subsequent Risk of Stillbirth

Thu, 19Â FebÂ 2004 00:00:00 -05:00

Background: Some causes of stillbirth may also lead to fetuses that are small for gestational age (have a low birth weight with respect to their gestational age) or are delivered...

PERSPECTIVE: Small-for-Gestational-Age Infants and Risk of Fetal Death in Subsequent Pregnancies

Jun Zhang, Ph.D., M.D., and Mark A. Klebanoff, M.D., M.P.H. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

One of the triumphs of modern obstetrics has been the dramatic reduction in late fetal mortality (defined as the rate of antepartum or intrapartum fetal death at 20 weeks of...

IMAGES IN CLINICAL MEDICINE: Congenital Lymphedema

Jeffrey S. Upperman, M.D. and Edward M. Barksdale, Jr., M.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

A full-term infant born to a woman (gravida 1, para 1) with a history of gestational diabetes presented with edema of the right leg (Panel A). When the infant was...

IMAGES IN CLINICAL MEDICINE: True Hermaphroditism

Jose A. Karam, M.D. and Linda A. Baker, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

A 17-day-old black neonate presented with ambiguous genitalia. A sharp line separated hypopigmented skin on the left side of the abdomen from normally pigmented skin on the right side. A...

REVIEW ARTICLE: Sex Determination and Differentiation

David T. MacLaughlin, Ph.D., and Patricia K. Donahoe, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Sex determination, which depends on the sex-chromosome complement of the embryo, is established by multiple molecular events that direct the development of germ cells, their migration to the urogenital ridge,...

ORIGINAL ARTICLE: Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth

William G. Reiner, M.D., and John P. Gearhart, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Background: Cloacal exstrophy is a rare, complex defect of the entire pelvis and its contents that occurs during embryogenesis and is associated with severe phallic inadequacy or phallic absence in...

ORIGINAL ARTICLE: Autoantibodies against Folate Receptors in Women with a Pregnancy Complicated by a Neural-Tube Defect

Thu, 08Â JanÂ 2004 00:00:00 -05:00

Background: In the absence of clinical folate deficiency, periconceptional supplementation with folic acid reduces a woman's risk of having an infant with a neural-tube defect. Since antiserum to folate receptors...

PERSPECTIVE: Folic Acid and the Prevention of Neural-Tube Defects

Nicholas J. Wald, D.Sc., F.R.C.P. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

In 1991, a randomized trial funded by the Medical Research Council demonstrated that folic acid supplementation before pregnancy and during its early stages markedly reduced the risk of neural-tube defects...

SOUNDING BOARD: Systematic Identification of Drugs That Cause Birth Defects â A New Opportunity

Allen A. Mitchell, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

Patients, prescribers, and policymakers often assume that the most serious short-term adverse effects of a drug are identified in pre-marketing studies, so recognition of unexpected harm after widespread use raises...

ORIGINAL ARTICLE: IGF-I Receptor Mutations Resulting in Intrauterine and Postnatal Growth Retardation

Thu, 04Â DecÂ 2003 00:00:00 -05:00

Background: Approximately 10 percent of infants with intrauterine growth retardation remain small, and the causes of their growth deficits are often unclear. We postulated that mutations in the gene for...

PERSPECTIVE: Insulin-like Growth Factors and the Basis of Growth

Ron G. Rosenfeld, M.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

Growth in any species is an extraordinarily complex process, but growth in humans is characterized by a number of unique features. These include dramatic fetal growth (the most rapid phase...

EDITORIAL: Nitric Oxide for Preemies â Not So Fast

Richard J. Martin, M.B., F.R.A.C.P. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

The past three decades have seen the emergence of neonatology as a vibrant subspecialty of pediatrics, highlighted by advances in the management of the respiratory distress syndrome in preterm infants....

ORIGINAL ARTICLE: Inhaled Nitric Oxide in Premature Infants with the Respiratory Distress Syndrome

Thu, 27Â NovÂ 2003 00:00:00 -05:00

Background: Inhaled nitric oxide improves gas exchange, decreases pulmonary vascular lability, and reduces pulmonary inflammation. We hypothesized that the use of inhaled nitric oxide would decrease the incidence of chronic...

ORIGINAL ARTICLE: A Randomized Trial of Fetal Endoscopic Tracheal Occlusion for Severe Fetal Congenital Diaphragmatic Hernia

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Experimental and clinical data suggest that fetal endoscopic tracheal occlusion to induce lung growth may improve the outcome of severe congenital diaphragmatic hernia. We performed a randomized, controlled trial...

PERSPECTIVE: Fetal Surgery for Congenital Diaphragmatic Hernia

Katharine D. Wenstrom, M.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Diaphragmatic hernia occurs when any of the four separate structures making up the diaphragm (the septum transversum, pleuroperitoneal membranes, dorsal mesentery of the esophagus, and body wall) fail to grow...

IMAGES IN CLINICAL MEDICINE: The Harlequin Color Change

Jaggi Rao, M.D. and Alfons Krol, M.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

On the third day of life, balloon dilatation of the pulmonary valve was performed in a full-term newborn with pulmonary atresia. Eight days later, asymptomatic, macular, blanchable erythema developed, involving...

ORIGINAL ARTICLE: Oxygen-Saturation Targets and Outcomes in Extremely Preterm Infants

Thu, 04Â SepÂ 2003 00:00:00 -05:00

Background: Physiological studies have shown that chronic hypoxemia may occur in preterm infants who require supplemental oxygen for extended periods and that this hypoxemia may contribute to poor growth and...

REVIEW ARTICLE: Congenital Adrenal Hyperplasia

Phyllis W. Speiser, M.D., and Perrin C. White, M.D. — Thu, 21Â AugÂ 2003 00:00:00 -05:00

Congenital adrenal hyperplasia is a group of autosomal recessive disorders resulting from the deficiency of one of the five enzymes required for the synthesis of cortisol in the adrenal cortex....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2003 â A Newborn Boy with Petechiae and Thrombocytopenia

Thu, 14Â AugÂ 2003 00:00:00 -05:00

A newborn boy was admitted to a special-care nursery because of petechiae and thrombocytopenia.

The boy had been delivered at this hospital at 39 weeks' gestation to a 32-year-old woman who...

IMAGES IN CLINICAL MEDICINE: A Fetus with Hypogenesis of the Corpus Callosum

Christine M. Glastonbury, M.B., B.S. and Anne M. Kennedy, M.R.C.P. — Thu, 07Â AugÂ 2003 00:00:00 -05:00

On routine prenatal ultrasonography, the cavum septum pellucidum was absent and a possible posterior fossa malformation was noted in a 31-week male fetus with a normal karyotype. A magnetic resonance...

IMAGES IN CLINICAL MEDICINE: Complex Umbilical-Cord Knot

William Camann, M.D. and James Marquardt, M.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

A 29-year-old woman was in spontaneous labor at term after an uncomplicated pregnancy. The second stage of labor was notable for persistent, severe, and variable decelerations in the fetal heart...

ORIGINAL ARTICLE: A Report of Dizygous Monochorionic Twins

Thu, 10Â JulÂ 2003 00:00:00 -05:00

It is an accepted medical doctrine that monochorionic twins are exclusively monozygous. This doctrine is supported by two studies that assessed placental pathological features and multiple serologic markers of zygosity...

PERSPECTIVE: Nonidentical Twins with a Single Placenta â Disproving Dogma in Perinatal Pathology

Raymond W. Redline, M.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

Generations of trainees have been taught that monochorionic twin placentas are monozygotic. A report by Souter et al. in this issue of the Journal (pages 154â158) invalidates this simple rule...

EDITORIAL: Treatment of Acute Bronchiolitis

Mary Ellen B. Wohl, M.D., and Victor Chernick, M.D. — Thu, 03Â JulÂ 2003 00:00:00 -05:00

In this issue of the Journal, Wainwright et al.1 provide data from a clinical trial in which 194 infants hospitalized with bronchiolitis were treated with inhaled epinephrine or placebo. In...

ORIGINAL ARTICLE: A Multicenter, Randomized, Double-Blind, Controlled Trial of Nebulized Epinephrine in Infants with Acute Bronchiolitis

Thu, 03Â JulÂ 2003 00:00:00 -05:00

Background: The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2003 â A Five-Day-Old Girl with Leukocytosis and a Worsening Rash from Birth

Lawrence C. Wolfe, M.D., Howard J. Weinstein, M.D., and Judith A. Ferry, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

A five-day-old girl was admitted to the hospital because of a worsening rash from birth and leukocytosis with blasts.

The infant was delivered at 40 weeks' gestation by a 24-year-old woman...

EDITORIAL: Progesterone and Preterm Delivery â DÃ©jÃ Vu All Over Again

Michael F. Greene, M.D. — Thu, 12Â JunÂ 2003 00:00:00 -05:00

It has become almost a platitude to lament the complexity and intractability of the problem of preterm delivery, the poor predictive value of screening tests for its occurrence, its resistance...

ORIGINAL ARTICLE: Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate

Thu, 12Â JunÂ 2003 00:00:00 -05:00

Background: Women who have had a spontaneous preterm delivery are at greatly increased risk for preterm delivery in subsequent pregnancies. The results of several small trials have suggested that 17...

ORIGINAL ARTICLE: Screening Newborns for Inborn Errors of Metabolism by Tandem Mass Spectrometry

Thu, 05Â JunÂ 2003 00:00:00 -05:00

Background: The recent development of electrospray tandem mass spectrometry makes it possible to screen newborns for many rare inborn errors of metabolism, but the efficacy and outcomes of screening remain...

REVIEW ARTICLE: Population Screening in the Age of Genomic Medicine

Thu, 02Â JanÂ 2003 00:00:00 -05:00

Physicians in the era of genomic medicine will have the opportunity to move from intense, crisis-driven intervention to predictive medicine. Over the next decade or two, it seems likely that...

SPECIAL ARTICLE: Effects of a Law against Early Postpartum Discharge on Newborn Follow-up, Adverse Events, and HMO Expenditures

Thu, 19Â DecÂ 2002 00:00:00 -05:00

Background: Concern about harm to newborns from early postpartum discharges led to laws establishing minimum hospital stays in the mid-1990s. We evaluated the effects of an early-discharge protocol (a hospital...

EDITORIAL: High-Frequency Oscillatory Ventilation to Prevent Bronchopulmonary Dysplasia â Are We There Yet?

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Bronchopulmonary dysplasia, also known as chronic lung disease of infancy, is an important cause of illness in preterm infants. This condition, usually defined by the need for supplemental oxygen at...

IMAGES IN CLINICAL MEDICINE: Neonatal Rash Due to Herpes Gestationis

Nissa I. Erickson, M.D. and Richard L. Ellis, M.D. — Thu, 29Â AugÂ 2002 00:00:00 -05:00

Figure 1. A 6-day-old infant with a 48-hour history of facial lesions had been born at 37 weeks of gestation after a spontaneous vaginal delivery without complications. According to her...

ORIGINAL ARTICLE: High-Frequency Oscillatory Ventilation versus Conventional Mechanical Ventilation for Very-Low-Birth-Weight Infants

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Background: The efficacy and safety of early high-frequency oscillatory ventilation as compared with conventional synchronized intermittent mandatory ventilation for the treatment of infants with very low birth weight have not...

ORIGINAL ARTICLE: High-Frequency Oscillatory Ventilation for the Prevention of Chronic Lung Disease of Prematurity

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Background: There remains uncertainty concerning the safety and efficacy of high-frequency oscillatory ventilation as compared with those of conventional ventilation for the respiratory support of very preterm infants. We conducted...

PERSPECTIVE: Ventilation with Small Tidal Volumes

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Human survival depends on the exchange of fresh air with carbon dioxide in the blood. Since this exchange takes place in the alveoli, one of the first concepts taught in...

EDITORIAL: Prevention of Neonatal Group B Streptococcal Infection

Thu, 25Â JulÂ 2002 00:00:00 -05:00

The highest annual death rate before the sixth decade of life occurs during the first year of life.1 Most deaths during the first year occur during the perinatal period, particularly...

ORIGINAL ARTICLE: Changes in Pathogens Causing Early-Onset Sepsis in Very-Low-Birth-Weight Infants

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Background: It is uncertain whether the rates and causes of early-onset sepsis (that occurring within 72 hours after birth) among very-low-birth-weight infants have changed in recent years, since antibiotics have...

ORIGINAL ARTICLE: A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Background: 02072522.xml Guidelines issued in 1996 in the United States recommend either screening of pregnant women for group B streptococcal colonization by means of cultures (screening approach) or assessing clinical...

PERSPECTIVE: Fetal Surgery for Myelomeningocele

Thu, 25Â JulÂ 2002 00:00:00 -05:00

The most common nonlethal malformation in the spectrum of neural-tube defects is myelomeningocele. This defect, caused by failure of the neural tube to close completely at about four weeks of...

ORIGINAL ARTICLE: Absence of Association of Thrombophilia Polymorphisms with Intrauterine Growth Restriction

Thu, 04Â JulÂ 2002 00:00:00 -05:00

Background: Previous data have demonstrated associations between thrombophilia polymorphisms in pregnant women and an increased risk of intrauterine growth restriction in their offspring, but this finding remains uncertain.

Methods: We performed...

REVIEW ARTICLE: Management of Human Immunodeficiency Virus Infection in Pregnancy

D. Heather Watts, M.D. — Thu, 13Â JunÂ 2002 00:00:00 -05:00

An estimated 16.4 million women worldwide are living with human immunodeficiency virus (HIV) infection; 600,000 children are infected annually, most of them by mother-to-child transmission.1 Interventions designed to reduce perinatal...

ORIGINAL ARTICLE: Antiretroviral Therapy during Pregnancy and the Risk of an Adverse Outcome

Thu, 13Â JunÂ 2002 00:00:00 -05:00

Background: Some studies suggest that combination antiretroviral therapy in pregnant women with human immunodeficiency virus type 1 (HIV-1) infection increases the risk of premature birth and other adverse outcomes of...

ORIGINAL ARTICLE: Central Nervous System Infection in Congenital Syphilis

Thu, 06Â JunÂ 2002 00:00:00 -05:00

Background: Identification of infants with Treponema pallidum infection of the central nervous system remains challenging.

Methods: We used rabbit-infectivity testing of the cerebrospinal fluid to detect T. pallidum infection of the...

EDITORIAL: Specialists, Technology, and Newborns â Too Much of a Good Thing

Thu, 16Â MayÂ 2002 00:00:00 -05:00

A joyous event at a hospital is a reunion of the âgraduatesâ of the neonatal intensive care unit. The 1000-g preemie who spent the first two months of her life...

IMAGES IN CLINICAL MEDICINE: Neonatal Vein of Galen Malformation

Bernhard Fischer, M.D. and Stefan Palkovic, M.D., Ph.D. — Thu, 16Â MayÂ 2002 00:00:00 -05:00

Figure 1. Sonographic imaging of the brain of a neonate showed a dilated hypoechoic venous lesion within the tentorial hiatus. Computed tomographic (CT) angiography demonstrated a large arteriovenous malformation of...

ORIGINAL ARTICLE: The Relation between the Availability of Neonatal Intensive Care and Neonatal Mortality

Thu, 16Â MayÂ 2002 00:00:00 -05:00

Background: There is marked regional variation in the availability of neonatal intensive care in the United States. We conducted a study to determine whether a greater supply of neonatologists or...

EDITORIAL: Infertility Treatment â More Risks and Challenges

Thu, 07Â MarÂ 2002 00:00:00 -05:00

Infertility is defined by the failure to conceive after 12 months of unprotected intercourse, and it affects an estimated 10 percent of the population of reproductive age in the United...

IMAGES IN CLINICAL MEDICINE: Massive Air Embolism in a Neonate with Pulmonary Hypoplasia

Gim H. Tan, M.D. and Jeffrey B. Sussmane, M.D. — Thu, 07Â MarÂ 2002 00:00:00 -05:00

Figure 1. A baby girl was born weighing 2.5 kg at 31 weeks' gestation to a 31-year-old woman (gravida 2, para 1). Hydrops fetalis had been diagnosed at 28 weeks'...

ORIGINAL ARTICLE: Low and Very Low Birth Weight in Infants Conceived with Use of Assisted Reproductive Technology

Thu, 07Â MarÂ 2002 00:00:00 -05:00

Background: The increased risk of low birth weight associated with the use of assisted reproductive technology has been attributed largely to the higher rate of multiple gestations associated with such...

ORIGINAL ARTICLE: The Risk of Major Birth Defects after Intracytoplasmic Sperm Injection and in Vitro Fertilization

Thu, 07Â MarÂ 2002 00:00:00 -05:00

Background: It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally.

Methods: We...

EDITORIAL: Premature Infants Grow Up

Thu, 17Â JanÂ 2002 00:00:00 -05:00

Infants of very low birth weight (less than 1500 g) account for 1 percent of the annual births in the United States (about 40,000 births per year) and for the...

ORIGINAL ARTICLE: Outcomes in Young Adulthood for Very-Low-Birth-Weight Infants

Thu, 17Â JanÂ 2002 00:00:00 -05:00

Background: Very-low-birth-weight infants (those weighing less than 1500 g) born during the initial years of neonatal intensive care have now reached young adulthood.

Methods: We compared a cohort of 242 survivors...

PERSPECTIVE: Outcomes of Very Low Birth Weight in Young Adults

Thu, 17Â JanÂ 2002 00:00:00 -05:00

Preterm delivery remains the primary public health challenge in obstetrics. Infants who weigh less than 2500 g account for 11 percent of all births in the United States but for...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2001 â A Newborn Girl with Seizures and Persistent Hypoglycemia

Ab Sadeghi-Nejad and Fiona M. Graeme-Cook — Thu, 20Â DecÂ 2001 00:00:00 -05:00

A two-day-old girl was admitted to the hospital because of persistent hypoglycemia.

The infant had been born at 34 weeks' gestation to a 35-year-old mother after an uneventful pregnancy. The birth...

ORIGINAL ARTICLE: Fluconazole Prophylaxis against Fungal Colonization and Infection in Preterm Infants

Thu, 06Â DecÂ 2001 00:00:00 -05:00

Background: Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. We evaluated the efficacy of prophylactic fluconazole in preventing fungal colonization and invasive infection in extremely-low-birth-weight...

ORIGINAL ARTICLE: Long-Term Effects of Indomethacin Prophylaxis in Extremely-Low-Birth-Weight Infants

Thu, 28Â JunÂ 2001 00:00:00 -05:00

Background: The prophylactic administration of indomethacin reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage in very-low-birth-weight infants (those with birth weights below 1500 g). Whether prophylaxis with...

IMAGES IN CLINICAL MEDICINE: Neonatal Pneumomediastinum

Doug Hacking, M.D. and Michael Stewart, M.D. — Thu, 14Â JunÂ 2001 00:00:00 -05:00

Figure 1. A male infant who had been delivered by elective cesarean section to a healthy 41-year-old woman at 38 weeks' gestation presented at 23 hours of age with increasing...

ORIGINAL ARTICLE: Neonatal Pulmonary Hypertension â Urea-Cycle Intermediates, Nitric Oxide Production, and Carbamoyl-Phosphate Synthetase Function

Thu, 14Â JunÂ 2001 00:00:00 -05:00

Background: Endogenous production of nitric oxide is vital for the decrease in pulmonary vascular resistance that normally occurs after birth. The precursor of nitric oxide is arginine, a urea-cycle intermediate....

ORIGINAL ARTICLE: Neonatal Diabetes Mellitus Due to Complete Glucokinase Deficiency

Thu, 24Â MayÂ 2001 00:00:00 -05:00

Diabetes mellitus is a heterogeneous disorder that can occur at any age.1 Neonatal diabetes mellitus, defined as insulin-requiring hyperglycemia within the first month of life, is a rare disorder that...

ORIGINAL ARTICLE: The Teratogenicity of Anticonvulsant Drugs

Thu, 12Â AprÂ 2001 00:00:00 -05:00

Background: The frequency of major malformations, growth retardation, and hypoplasia of the midface and fingers, known as anticonvulsant embryopathy, is increased in infants exposed to anticonvulsant drugs in utero. However,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2001 â A Male Infant with a Right Maxillary Mass

Mark S. Volk, G. Petur Nielsen — Thu, 08Â MarÂ 2001 00:00:00 -05:00

A 10-week-old boy was evaluated at Massachusetts Eye and Ear Infirmary because of progressive swelling in the region of the right side of the upper lip of two weeks' duration.

The...

REVIEW ARTICLE: Neonatal Hyperbilirubinemia

Phyllis A. Dennery, M.D., Daniel S. Seidman, M.D., and David K. Stevenson, M.D. — Thu, 22Â FebÂ 2001 00:00:00 -05:00

Icterus neonatorum, or neonatal jaundice, has long been recognized.1 The term âkernicterusâ was introduced in the early 1900s to refer to the yellow staining of the basal ganglia observed in...

ORIGINAL ARTICLE: Adverse Effects of Early Dexamethasone Treatment in Extremely-Low-Birth-Weight Infants

Thu, 11Â JanÂ 2001 00:00:00 -05:00

Background: Early administration of high doses of dexamethasone may reduce the risk of chronic lung disease in premature infants but can cause complications. Whether moderate doses would be as effective...

IMAGES IN CLINICAL MEDICINE: Neonatal Necrotizing Enterocolitis

Husam Salama, M.D. and Orlando da Silva, M.D. — Thu, 11Â JanÂ 2001 00:00:00 -05:00

Figure 1. A baby required active resuscitation when he was born at 26 weeks of gestation weighing 918 g. The Apgar scores were 2, 3, and 7 at 1, 5,...

ORIGINAL ARTICLE: A Trial of Shortened Zidovudine Regimens to Prevent Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1

Thu, 05Â OctÂ 2000 00:00:00 -05:00

Background: The optimal duration of zidovudine administration to prevent perinatal transmission of human immunodeficiency virus type 1 (HIV-1) should be determined to facilitate its use in areas where resources are...

EDITORIAL: Preventing Vertical Transmission of HIV Infection

Thu, 05Â OctÂ 2000 00:00:00 -05:00

The complex clinical trial described by Lallemant and colleagues in this issue of the Journal 1 was designed to determine the optimal duration of treatment with zidovudine to prevent the...

EDITORIAL: Perinatal Exposure to Zidovudine â Benefits and Risks

Thu, 14Â SepÂ 2000 00:00:00 -05:00

Mother-to-child transmission of the human immunodeficiency virus (HIV) causes a chronic and ultimately fatal pediatric infection that is now essentially preventable with antiretroviral prophylaxis. In more developed countries, prophylaxis has...

EDITORIAL: Ibuprofen and Patent Ductus Arteriosus

Thu, 07Â SepÂ 2000 00:00:00 -05:00

The ductus arteriosus connects the pulmonary artery to the descending aorta. During fetal life it diverts most of the combined ventricular output away from the lungs toward the placenta. In...

ORIGINAL ARTICLE: Endemic Infection in a Neonatal Intensive Care Unit

Thu, 07Â SepÂ 2000 00:00:00 -05:00

Background: Nosocomial infections due to Pseudomonas aeruginosa have been well described, but the environmental reservoir of the organism varies. We conducted an epidemiologic and molecular investigation of endemic P. aeruginosa...

ORIGINAL ARTICLE: A Comparison of Ibuprofen and Indomethacin for Closure of Patent Ductus Arteriosus

Thu, 07Â SepÂ 2000 00:00:00 -05:00

Background: Indomethacin is the conventional treatment for patent ductus arteriosus in preterm infants. However, its use is associated with various side effects. In a prospective study, we compared ibuprofen and...

EDITORIAL: Extremely Preterm Birth â Defining the Limits of Hope

Thu, 10Â AugÂ 2000 00:00:00 -05:00

Despite an increase in the frequency of premature birth,2 new techniques, including surfactant-replacement therapy and increased use of antenatal glucocorticoids, have led to continued improvement in the survival of extremely...

ORIGINAL ARTICLE: Separation of Conjoined Twins with the Twin Reversed-Arterial-Perfusion Sequence after Prenatal Planning with Three-Dimensional Modeling

Thu, 10Â AugÂ 2000 00:00:00 -05:00

There are two congenital anomalies specific to multifetal pregnancies: twin reversed-arterial-perfusion sequence and conjoined twinning. The twin reversed-arterial-perfusion sequence is a rare complication of monozygous twinning in which one fetus...

ORIGINAL ARTICLE: Neurologic and Developmental Disability after Extremely Preterm Birth

Thu, 10Â AugÂ 2000 00:00:00 -05:00

Background: Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks...

EDITORIAL: Neonatal Group B Streptococcal Disease â Screening and Prevention

Thu, 20Â JulÂ 2000 00:00:00 -05:00

During the 1990s, the incidence of disease caused by mother-to-child transmission of group B streptococcus fell by 65 percent, from 1.7 to 0.6 case per 1000 live births.1 The decline...

REVIEW ARTICLE: Drug Therapy for Breast-Feeding Women

Shinya Ito, M.D. — Thu, 13Â JulÂ 2000 00:00:00 -05:00

Breast-feeding is the best method of feeding neonates and young infants.1 Its popularity has increased in recent years,2 although in 1995 only about 60 percent of new mothers in the...

IMAGES IN CLINICAL MEDICINE: Patent Urachus

Tatsuo Morita, M.D. and Akihiko Tokue, M.D. — Thu, 06Â JulÂ 2000 00:00:00 -05:00

Figure 1. The urachus is an epithelial tube that connects the apex of the urinary bladder with the allantois in the fetus and is involved in forming the umbilical structures....

ORIGINAL ARTICLE: Protection against Pemphigus Foliaceus by Desmoglein 3 in Neonates

Thu, 06Â JulÂ 2000 00:00:00 -05:00

Pemphigus foliaceus is an autoantibody-mediated blistering disease in which antibodies against desmoglein 1 cause loss of adhesion among keratinocytes in the superficial epidermis.1 Desmogleins are transmembrane glycoproteins found in desmosomes,...

REVIEW ARTICLE: Intrauterine Infection and Preterm Delivery

Thu, 18Â MayÂ 2000 00:00:00 -05:00

Preterm delivery is the chief problem in obstetrics today, accounting for 70 percent of perinatal mortality and nearly half of long-term neurologic morbidity.12 Approximately 10 percent of all births are...

ORIGINAL ARTICLE: Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension of the Newborn

Thu, 17Â FebÂ 2000 00:00:00 -05:00

Background: Inhaled nitric oxide improves gas exchange in neonates, but the efficacy of low-dose inhaled nitric oxide in reducing the need for extracorporeal membrane oxygenation has not been established.

Methods: We...

ORIGINAL ARTICLE: Group B Streptococcal Disease in the Era of Intrapartum Antibiotic Prophylaxis

Thu, 06Â JanÂ 2000 00:00:00 -05:00

Background: Group B streptococcal infections are a leading cause of neonatal mortality, and they also affect pregnant women and the elderly. Many cases of the disease in newborns can be...

EDITORIAL: Birth Injury and Method of Delivery

Thu, 02Â DecÂ 1999 00:00:00 -05:00

In May 1998, the Food and Drug Administration (FDA) issued a public health advisory to all practitioners who deliver babies. The advisory, entitled âNeed for Caution When Using Vacuum Assisted...

ORIGINAL ARTICLE: Effect of Mode of Delivery in Nulliparous Women on Neonatal Intracranial Injury

Thu, 02Â DecÂ 1999 00:00:00 -05:00

Background: Infants delivered by vacuum extraction or other operative techniques may be more likely to sustain major injuries than those delivered spontaneously, but the extent of the risk is unknown.

Methods:...

ORIGINAL ARTICLE: Reduction of False Negative Results in Screening of Newborns for Homocystinuria

M. Judith Peterschmitt, M.D., Jane R. Simmons, B.S., and Harvey L. Levy, M.D. — Thu, 18Â NovÂ 1999 00:00:00 -05:00

Background: Mental retardation and other medical problems (including ectopia lentis, osteoporosis, and thromboembolism) in patients who have homocystinuria as a result of a deficiency of cystathionine Î²-synthase can be prevented...

EDITORIAL: Periventricular Leukomalacia â Prospects for Prevention

Thu, 14Â OctÂ 1999 00:00:00 -05:00

Modern perinatal care, including careful fetal surveillance, antenatal administration of glucocorticoids, surfactant therapy, and ventilatory assistance, has improved survival rates for infants with very low birth weights (less than 1500...

ORIGINAL ARTICLE: Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants

Thu, 14Â OctÂ 1999 00:00:00 -05:00

Background: Antenatal glucocorticoid therapy decreases the incidence of several complications among very premature infants. However, its effect on the occurrence of cystic periventricular leukomalacia, a major cause of cerebral palsy,...

ORIGINAL ARTICLE: The Influence of Gestational Age and Smoking Habits on the Risk of Subsequent Preterm Deliveries

Thu, 23Â SepÂ 1999 00:00:00 -05:00

Background: Previous preterm delivery and maternal smoking are associated with increased risks of preterm delivery. It is not known whether gestational age at the time of a preterm delivery is...

ORIGINAL ARTICLE: Obstetrical Outcomes among Women with Extrapulmonary Tuberculosis

Thu, 26Â AugÂ 1999 00:00:00 -05:00

Background: The prevalence of tuberculosis, especially extrapulmonary tuberculosis, is increasing worldwide. Because information on the outcome of pregnancy among women with extrapulmonary tuberculosis is limited, we studied the course of...

ORIGINAL ARTICLE: Phenobarbital Compared with Phenytoin for the Treatment of Neonatal Seizures

Thu, 12Â AugÂ 1999 00:00:00 -05:00

Background: Seizures occur in 1 to 2 percent of neonates admitted to an intensive care unit. The treatment is usually with either phenobarbital or phenytoin, but the efficacy of the...

EDITORIAL: Reducing the Risk of MaternalâInfant Transmission of HIV by Attacking the Virus

Thu, 05Â AugÂ 1999 00:00:00 -05:00

The findings of AIDS Clinical Trials Group (ACTG) Protocol 0761 opened the door to a major effort to reduce perinatal infection with the human immunodeficiency virus (HIV). We have witnessed...

ORIGINAL ARTICLE: Maternal Levels of Plasma Human Immunodeficiency Virus Type 1 RNA and the Risk of Perinatal Transmission

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Background: The importance of plasma levels of human immunodeficiency virus type 1 (HIV-1) RNA in pregnant women in relation to the other factors known to influence the risk of transmission...

ORIGINAL ARTICLE: Risk Factors for Perinatal Transmission of Human Immunodeficiency Virus Type 1 in Women Treated with Zidovudine

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Background: Maternal, obstetrical, and infant-related factors associated with the risk of perinatal transmission of human immunodeficiency virus type 1 (HIV-1) were identified before the widespread use of zidovudine therapy in...

EDITORIAL: Markers of Asphyxia and Neonatal Brain Injury

Thu, 29Â JulÂ 1999 00:00:00 -05:00

Neonatal brain injury due to intrapartum asphyxia is an important cause of cerebral palsy, mental retardation, and epilepsy.1 Despite advances in perinatal care over the past three decades, the incidence...

ORIGINAL ARTICLE: Measurement of the Urinary Lactate:Creatinine Ratio for the Early Identification of Newborn Infants at Risk for HypoxicâIschemic Encephalopathy

Thu, 29Â JulÂ 1999 00:00:00 -05:00

Background: Newborn infants with perinatal asphyxia are prone to the development of hypoxicâischemic encephalopathy. There are no reliable methods for identifying infants at risk for this disorder.

Methods: We measured the...

ORIGINAL ARTICLE: Transplacental Transmission of Natural-Killer-Cell Lymphoma

Thu, 08Â JulÂ 1999 00:00:00 -05:00

The placenta is an organ of embryonic origin that supports the growing fetus by facilitating the transfer of nutrients from the mother. It is not well understood how the allogeneic...

ORIGINAL ARTICLE: Cytomegalovirus Infection and HIV-1 Disease Progression in Infants Born to HIV-1âInfected Women

Thu, 08Â JulÂ 1999 00:00:00 -05:00

Background: and Methods: Cytomegalovirus (CMV) has been implicated as a cofactor in the progression of human immunodeficiency virus type 1 (HIV-1) disease. We assessed 440 infants (75 of whom were...

ORIGINAL ARTICLE: Vitamin A Supplementation for Extremely-Low-Birth-Weight Infants

Thu, 24Â JunÂ 1999 00:00:00 -05:00

Background: Vitamin A supplementation may reduce the risk of chronic lung disease and sepsis in extremely-low-birth-weight infants. The results of our pilot study suggested that a dose of 5000 IU...

ORIGINAL ARTICLE: A Fetal Fatty-Acid Oxidation Disorder as a Cause of Liver Disease in Pregnant Women

Thu, 03Â JunÂ 1999 00:00:00 -05:00

Background: Acute fatty liver of pregnancy and the HELLP syndrome (hemolysis, elevated liver-enzyme levels, and a low platelet count) are serious hepatic disorders that may occur during pregnancy in women...

ORIGINAL ARTICLE: Birth Weight in Relation to Morbidity and Mortality among Newborn Infants

Thu, 22Â AprÂ 1999 00:00:00 -05:00

Background: At any given gestational age, infants with low birth weight have relatively high morbidity and mortality. It is not known, however, whether there is a threshold weight below which...

EDITORIAL: The Causes of Neonatal Hypoglycemia

Thu, 15Â AprÂ 1999 00:00:00 -05:00

The risk of hypoglycemia in neonates is high. If their first feeding is delayed for as little as three to six hours after birth, 10 percent of normal neonates cannot...

ORIGINAL ARTICLE: Clinical Features of 52 Neonates with Hyperinsulinism

Thu, 15Â AprÂ 1999 00:00:00 -05:00

Background: Neonatal hyperinsulinemic hypoglycemia is often resistant to medical therapy and is often treated with near-total pancreatectomy. However, the pancreatic lesions may be focal and treatable by partial pancreatic resection.

Methods:...

IMAGES IN CLINICAL MEDICINE: Congenital Hemangioma

Ernesto Bonifazi, M.D. and Francesco Mileti, M.D. — Thu, 08Â AprÂ 1999 00:00:00 -05:00

Figure 1. A newborn presented with a 9-by-12.5-cm mass in the frontal region that completely covered her right eye (Panel A). The diagnosis of hemangioma was confirmed by ultrasonography and...

ORIGINAL ARTICLE: The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 â A Meta-Analysis of 15 Prospective Cohort Studies

The International Perinatal HIV Group — Thu, 01Â AprÂ 1999 00:00:00 -05:00

Background: To evaluate the relation between elective cesarean section and vertical transmission of human immunodeficiency virus type 1 (HIV-1), we performed a meta-analysis using data on individual patients from 15...

EDITORIAL: Bronchopulmonary Dysplasia â No Simple Solution

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Progress in the treatment of neonates with the respiratory distress syndrome has been one of the medical success stories of the past 15 years. During this time, the widespread use...

EDITORIAL: Elective Cesarean Delivery to Reduce the Transmission of HIV

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Each year in the United States 6000 to 7000 women with human immunodeficiency virus (HIV) infection give birth. Worldwide, about 2.3 million HIV-infected women give birth each year. The transmission...

ORIGINAL ARTICLE: Early Inhaled Glucocorticoid Therapy to Prevent Bronchopulmonary Dysplasia

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Background: The safety and efficacy of inhaled glucocorticoid therapy for asthma stimulated its use in infants to prevent bronchopulmonary dysplasia. We tested the hypothesis that early therapy with inhaled glucocorticoids...

EDITORIAL: The Interval between Pregnancies and the Outcome of Subsequent Births

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Is there a ânaturalâ interval between pregnancies in humans? Our nearest animal relatives, the chimpanzees and gorillas, breast-feed their offspring for long periods, and the median time from the birth...

ORIGINAL ARTICLE: Effect of the Interval between Pregnancies on Perinatal Outcomes

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Background: A short interval between pregnancies has been associated with adverse perinatal outcomes. Whether that association is due to confounding by other risk factors, such as maternal age, socioeconomic status,...

SOUNDING BOARD: The Risks of Lowering the Cesarean-Delivery Rate

Thu, 07Â JanÂ 1999 00:00:00 -05:00

In 1995, the rate of cesarean delivery in the United States was 21 percent.1 The goal of Healthy People 2000, a project of the Department of Health and Human Services,...

ORIGINAL ARTICLE: First-Trimester Growth and the Risk of Low Birth Weight

Thu, 17Â DecÂ 1998 00:00:00 -05:00

Background: Previous studies have demonstrated a correlation between first-trimester size and birth weight. It is not known, however, whether low birth weight is related to first-trimester growth. We sought to...

EDITORIAL: RhD Hemolytic Disease of the Newborn

Thu, 10Â DecÂ 1998 00:00:00 -05:00

Hemolytic disease of the fetus and newborn was first described in 1609 in a set of twins by a French midwife: the first twin was hydropic and stillborn, and the...

EDITORIAL: Short (And Shorter) Courses of Zidovudine

Thu, 12Â NovÂ 1998 00:00:00 -05:00

In this issue of the Journal, Wade and colleagues1 present data on the outcomes of short, prophylactic courses of zidovudine administered to infants born to women infected with the human...

ORIGINAL ARTICLE: Determinants of Preterm Birth Rates in Canada from 1981 through 1983 and from 1992 through 1994

Thu, 12Â NovÂ 1998 00:00:00 -05:00

Background: The rates of preterm birth have increased in many countries, including Canada, over the past 20 years. However, the factors underlying the increase are poorly understood.

Methods: We used data...

ORIGINAL ARTICLE: Abbreviated Regimens of Zidovudine Prophylaxis and Perinatal Transmission of the Human Immunodeficiency Virus

Thu, 12Â NovÂ 1998 00:00:00 -05:00

Background: The Pediatric AIDS Clinical Trials Group Protocol 076 reported a reduction in the rate of perinatal transmission of the human immunodeficiency virus (HIV) from 25.5 percent to 8.3 percent...

ORIGINAL ARTICLE: Risk Factors for Preeclampsia, Abruptio Placentae, and Adverse Neonatal Outcomes among Women with Chronic Hypertension

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: Women with chronic hypertension who become pregnant have an increased risk of preeclampsia and adverse neonatal outcomes. However, within this group, the risk factors for these adverse events are...

ORIGINAL ARTICLE: Perinatal Transmission of the Agent of Human Granulocytic Ehrlichiosis

Thu, 06Â AugÂ 1998 00:00:00 -05:00

Human granulocytic ehrlichiosis was first described in the United States, in the northern Midwest, in 1994.1 Human granulocytic ehrlichiosis is caused by an organism, still referred to as the agent...

REVIEW ARTICLE: Prevention of Premature Birth

Robert L. Goldenberg, M.D., and Dwight J. Rouse, M.D. — Thu, 30Â JulÂ 1998 00:00:00 -05:00

Preterm birth, which occurs in 11 percent of all pregnancies, is responsible for the majority of neonatal deaths and nearly one half of all cases of congenital neurologic disability, including...

ORIGINAL ARTICLE: Use of Misoprostol during Pregnancy and MÃ¶bius' Syndrome in Infants

Thu, 25Â JunÂ 1998 00:00:00 -05:00

Background: Patients with upper gastrointestinal ulceration may be treated with misoprostol, but it is not recommended for pregnant women because it may stimulate uterine contractions and cause vaginal bleeding and...

EDITORIAL: Preventing Blindness in Premature Infants

Thu, 28Â MayÂ 1998 00:00:00 -05:00

In 1942 Terry reported a retinal vasculopathy causing blindness in premature infants.1 The condition was called retrolental fibroplasia, because a fibrovascular mass could be seen behind the crystalline lens. Hundreds...

ORIGINAL ARTICLE: Lack of Efficacy of Light Reduction in Preventing Retinopathy of Prematurity

Thu, 28Â MayÂ 1998 00:00:00 -05:00

Background: Hospital-nursery lighting has been suggested as a factor in causing retinopathy of prematurity. Despite ongoing debate, a causal relation has not been established.

Methods: We conducted a prospective, randomized, multicenter...

ORIGINAL ARTICLE: A Multicenter Trial of Two Dexamethasone Regimens in Ventilator-Dependent Premature Infants

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Background: Ventilator-dependent premature infants are often treated with dexamethasone. However, the optimal timing of therapy is unknown.

Methods: We compared the benefits and hazards of initiating dexamethasone therapy at two weeks...

EDITORIAL: Hemolytic Disease of the Newborn: Progenitor Cells and Late Effects

Thu, 19Â MarÂ 1998 00:00:00 -05:00

The history of hemolytic disease of the newborn dates to the 1600s, when a French midwife described the birth of twins, one of whom had fatal hydrops fetalis and the...

ORIGINAL ARTICLE: Inhibition of Erythroid Progenitor Cells by Anti-Kell Antibodies in Fetal Alloimmune Anemia

Thu, 19Â MarÂ 1998 00:00:00 -05:00

Background: In alloimmune anemia of the newborn, the level of hemolysis caused by the presence of antibodies to antigens of the Kell blood-group system is less than that caused by...

REVIEW ARTICLE: Premature Rupture of the Fetal Membranes

Samuel Parry, M.D., and Jerome F. Strauss III, M.D., Ph.D. — Thu, 05Â MarÂ 1998 00:00:00 -05:00

The membranes surrounding the amniotic cavity are composed of the amnion and the chorion, which are closely adherent layers consisting of several cell types, including epithelial cells, mesenchymal cells, and...

ORIGINAL ARTICLE: Antenatal Thyrotropin-Releasing Hormone to Prevent Lung Disease in Preterm Infants

Thu, 19Â FebÂ 1998 00:00:00 -05:00

Background: Pulmonary disease is common in preterm infants, despite antenatal glucocorticoid therapy. The addition of antenatal thyrotropin-releasing hormone therapy has been reported to decrease pulmonary morbidity in these infants.

Methods: We...

EDITORIAL: Prevention of Preterm Birth

Thu, 01Â JanÂ 1998 00:00:00 -05:00

Advances in the care of preterm infants have blunted what otherwise should have been a constant public outcry about the static rate of preterm birth, the leading cause of perinatal...

ORIGINAL ARTICLE: Increased Nuchal Translucency as a Marker for Fetal Chromosomal Defects

Thu, 04Â DecÂ 1997 00:00:00 -05:00

Background: Screening for trisomy 21 (Down's syndrome) by measuring maternal serum alpha-fetoprotein, chorionic gonadotropin, and estriol concentrations and then performing chorionic-villus sampling or amniocentesis identifies approximately 60 percent of fetuses...

EDITORIAL: The Enigma of Low Birth Weight and Race

Thu, 23Â OctÂ 1997 00:00:00 -05:00

In an article in this issue of the Journal,1 David and Collins examine the relation of race to birth weight among blacks and whites. Their laudable but difficult undertaking is...

SPECIAL ARTICLE: Differing Birth Weight among Infants of U.S.-Born Blacks, African-Born Blacks, and U.S.-Born Whites

Richard J. David, M.D., and James W. Collins, Jr., M.D., M.P.H. — Thu, 23Â OctÂ 1997 00:00:00 -05:00

Background: In the United States, the birth weights of infants of black women are lower than those of infants of white women. The extent to which the lower birth weights...

IMAGES IN CLINICAL MEDICINE: A Little Survivor

Marc A. Levitt, M.D. and Andrew R. Hong, M.D. — Thu, 23Â OctÂ 1997 00:00:00 -05:00

Figure 1. The hand of an infant girl who was born at 24 weeks of gestation and weighed 540 g (1 lb 3 oz) at birth is shown. The infant...

EDITORIAL: Screening for Cystic Fibrosis â Time to Change Our Position?

Thu, 02Â OctÂ 1997 00:00:00 -05:00

Cystic fibrosis is one of the most common inheritable diseases among white people, and without treatment most patients with this disease die in infancy or early childhood. The steadily increasing...

ORIGINAL ARTICLE: Nutritional Benefits of Neonatal Screening for Cystic Fibrosis

Thu, 02Â OctÂ 1997 00:00:00 -05:00

Background: Many patients with cystic fibrosis are malnourished at the time of diagnosis. Whether newborn screening and early treatment may prevent the development of a nutritional deficiency is not known.

Methods:...

SOUNDING BOARD: Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries

Thu, 18Â SepÂ 1997 00:00:00 -05:00

It has been almost three years since the Journal1 published the results of AIDS Clinical Trials Group (ACTG) Study 076, the first randomized, controlled trial in which an intervention was...

SOUNDING BOARD: Welfare Reform and the Obstetrical Care of Immigrants and Their Newborns

Thu, 04Â SepÂ 1997 00:00:00 -05:00

On August 22, 1996, President Bill Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act. Although it does not affect the ability of low-income citizens to obtain Medicaid health...

ORIGINAL ARTICLE: The Effect of Antenatal Phenobarbital Therapy on Neonatal Intracranial Hemorrhage in Preterm Infants

Thu, 14Â AugÂ 1997 00:00:00 -05:00

Background: The administration of phenobarbital to pregnant women before delivery has been thought to decrease the frequency of intracranial hemorrhage in preterm infants. To evaluate this potential neuroprotective therapy further,...

ORIGINAL ARTICLE: Fetal Alloimmune Thrombocytopenia

Thu, 03Â JulÂ 1997 00:00:00 -05:00

Background: Alloimmune thrombocytopenia is a serious fetal disorder resulting from platelet-antigen incompatibility between the mother and fetus. The diagnosis is usually made after the discovery of unexpected neonatal thrombocytopenia. Approximately...

ORIGINAL ARTICLE: Aluminum Neurotoxicity in Preterm Infants Receiving Intravenous-Feeding Solutions

Thu, 29Â MayÂ 1997 00:00:00 -05:00

Background: Aluminum, a contaminant of commercial intravenous-feeding solutions, is potentially neurotoxic. We investigated the effect of perinatal exposure to intravenous aluminum on the neurologic development of infants born prematurely.

Methods: We...

EDITORIAL: Circumcision Circumspection

Thu, 24Â AprÂ 1997 00:00:00 -05:00

Historically, infants undergoing circumcision have not been given analgesia. The rationale was that infants do not feel, localize, or remember pain. In reality, they have all the anatomical and functional...

ORIGINAL ARTICLE: Efficacy and Safety of LidocaineâPrilocaine Cream for Pain during Circumcision

Thu, 24Â AprÂ 1997 00:00:00 -05:00

Background: Neonatal circumcision is a painful surgical procedure often performed without analgesia. We assessed the efficacy and safety of 5 percent lidocaineâprilocaine cream (Emla) in neonates undergoing circumcision.

Methods: We carried...

ORIGINAL ARTICLE: Inhaled Nitric Oxide and Persistent Pulmonary Hypertension of the Newborn

Thu, 27Â FebÂ 1997 00:00:00 -05:00

Background: Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of increased pulmonary vascular resistance and right-to-left shunting of deoxygenated blood. Inhaled nitric oxide decreases pulmonary vascular resistance...

ORIGINAL ARTICLE: Inhaled Nitric Oxide in Full-Term and Nearly Full-Term Infants with Hypoxic Respiratory Failure

The Neonatal Inhaled Nitric Oxide Study Group — Thu, 27Â FebÂ 1997 00:00:00 -05:00

Background: Neonates with pulmonary hypertension have been treated with inhaled nitric oxide because of studies suggesting that it is a selective pulmonary vasodilator. We conducted a randomized, multicenter, controlled trial...

IMAGES IN CLINICAL MEDICINE: Thoracoscopic Clipping of Patent Ductus Arteriosus

Redmond P. Burke, M.D. and Gil Wernovsky, M.D. — Thu, 16Â JanÂ 1997 00:00:00 -05:00

Figure 1. A continuous murmur heard on the 10th day of life in a 590-g infant delivered at 25 weeks' gestation led to the diagnosis of patent ductus arteriosus. The...

ORIGINAL ARTICLE: Effects of Thyroxine Supplementation on Neurologic Development in Infants Born at Less Than 30 Weeks' Gestation

Thu, 02Â JanÂ 1997 00:00:00 -05:00

Background: Premature infants who have transient hypothyroxinemia in the first weeks of life may have developmental delay and neurologic dysfunction. Whether thyroxine treatment during this period results in improved developmental...

EDITORIAL: Beginning to Make Progress against HIV

Thu, 28Â NovÂ 1996 00:00:00 -05:00

For nearly three years we have known that zidovudine is efficacious in preventing transmission of the human immunodeficiency virus (HIV) from mother to infant.1 A randomized, placebo-controlled trial, AIDS Clinical...

ORIGINAL ARTICLE: Maternal Viral Load, Zidovudine Treatment, and the Risk of Transmission of Human Immunodeficiency Virus Type 1 from Mother to Infant

Thu, 28Â NovÂ 1996 00:00:00 -05:00

Background: and Methods: A placebo-controlled trial has shown that treatment with zidovudine reduces the rate at which human immunodeficiency virus type 1 (HIV-1) is transmitted from mother to infant. We...

ORIGINAL ARTICLE: Birth Outcomes in Pregnant Women Taking Fluoxetine

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Background: Although fluoxetine is the most frequently prescribed antidepressant drug in the United States, its safety in pregnant women has not been established.

Methods: From 1989 through 1995, we prospectively identified...

EDITORIAL: Partial Liquid Ventilation â The Future is Now

Thu, 12Â SepÂ 1996 00:00:00 -05:00

These are exciting times in neonatology. During the past decade, treatment with exogenous surfactant has improved survival among infants with very low birth weight and respiratory distress syndrome, and new...

ORIGINAL ARTICLE: Partial Liquid Ventilation with Perflubron in Premature Infants with Severe Respiratory Distress Syndrome

Thu, 12Â SepÂ 1996 00:00:00 -05:00

Background: The intratracheal administration of a perfluorocarbon liquid during continuous positive-pressure ventilation (partial liquid ventilation) improves lung function in animals with surfactant deficiency. Whether partial liquid ventilation is effective in...

ORIGINAL ARTICLE: Outcome of Pregnancy in Women with Moderate or Severe Renal Insufficiency

David C. Jones, M.D., and John P. Hayslett, M.D. — Thu, 25Â JulÂ 1996 00:00:00 -05:00

Background: Pregnant women with mild preexisting renal disease have relatively few complications of pregnancy, but the risks of maternal and obstetrical complications in women with moderate or severe renal insufficiency...

EDITORIAL: Reducing Mother-to-Infant Transmission of HIV â The Door Remains Open

Thu, 20Â JunÂ 1996 00:00:00 -05:00

As of the end of 1995, over 90 percent of the reported cases of AIDS in children were acquired through mother-to-infant transmission of the human immunodeficiency virus (HIV).1 Nearly all...

ORIGINAL ARTICLE: The Influence of the Wider Use of Surfactant Therapy on Neonatal Mortality among Blacks and Whites

Thu, 20Â JunÂ 1996 00:00:00 -05:00

Background: Surfactant therapy reduces morbidity and mortality among premature infants with the respiratory distress syndrome (RDS). Fetal pulmonary surfactant matures more slowly in white than in black fetuses, and therefore...

ORIGINAL ARTICLE: Obstetrical Factors and the Transmission of Human Immunodeficiency Virus Type 1 from Mother to Child

Thu, 20Â JunÂ 1996 00:00:00 -05:00

Background: A substantial proportion of perinatally acquired infections with the human immunodeficiency virus type 1 (HIV-1) occur at or near delivery, which suggests that obstetrical factors may have an important...

EDITORIAL: Premature Rupture of the Membranes at Term

Thu, 18Â AprÂ 1996 00:00:00 -05:00

Premature rupture of the membranes, which is defined as rupture before the onset of labor, complicates 5 to 10 percent of all pregnancies. Preterm rupture of the membranes has received...

ORIGINAL ARTICLE: Induction of Labor Compared with Expectant Management for Prelabor Rupture of the Membranes at Term

Thu, 18Â AprÂ 1996 00:00:00 -05:00

Background: As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing...

EDITORIAL: Prematurity-Associated Neurologic and Developmental Abnormalities and Neonatal Thyroid Function

Thu, 28Â MarÂ 1996 00:00:00 -05:00

The first complete description of transient hypothyroxinemia in low-birth-weight infants dates from 1981,1 and there has since been much speculation about the causes of the phenomenon. The hypothyroxinemia may be...

ORIGINAL ARTICLE: The Relation of Transient Hypothyroxinemia in Preterm Infants to Neurologic Development at Two Years of Age

Thu, 28Â MarÂ 1996 00:00:00 -05:00

Background: Transient hypothyroxinemia, a common finding in premature infants, is not thought to have long-term sequelae or to require treatment. We investigated whether hypothyroxinemia in premature infants is a cause...

EDITORIAL: Cerebral Palsy and Intrapartum Fetal Monitoring

Thu, 07Â MarÂ 1996 00:00:00 -05:00

LaÃ«nnec's invention of the stethoscope in 1806 was soon followed by auscultation of the fetal heart, which was pioneered by Kergaradec. Hoping to hear the fetus crying and splashing about...

ORIGINAL ARTICLE: Uncertain Value of Electronic Fetal Monitoring in Predicting Cerebral Palsy

Thu, 07Â MarÂ 1996 00:00:00 -05:00

Background: Electronic monitoring of the fetal heart rate is commonly performed, in part to detect hypoxia during delivery that may result in brain injury. It is not known whether specific...

NEJM â Collection Updates for Neonatal Medicine

ORIGINAL ARTICLE: Outcomes after Internal versus External Tocodynamometry for Monitoring Labor

CORRESPONDENCE: Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer

REVIEW ARTICLE: Maternal and Neonatal Herpes Simplex Virus Infections

ORIGINAL ARTICLE: Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy

BOOK REVIEW:

ORIGINAL ARTICLE: Lack of Association between Folate-Receptor Autoantibodies and Neural-Tube Defects

BOOK REVIEW:

BOOK REVIEW:

ORIGINAL ARTICLE: Evaluation of Universal Antenatal Screening for Group B Streptococcus

IMAGES IN CLINICAL MEDICINE: Neonatal Breast Enlargement

EDITORIAL: One Step Closer to a CMV Vaccine

ORIGINAL ARTICLE: Vaccine Prevention of Maternal Cytomegalovirus Infection

CORRESPONDENCE: Iodine Content of Prenatal Multivitamins in the United States

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2009 â A Pregnant Woman with a Large Mass in the Fetal Oral Cavity

CORRESPONDENCE: Eculizumab for Congenital Atypical HemolyticâUremic Syndrome

CORRESPONDENCE: Elimination of Antibodies to Recombinant Enzyme in Pompe's Disease

EDITORIAL: Making Small Risks Even Smaller

IMAGES IN CLINICAL MEDICINE: Diagnosis of Uterine Rupture on CT

ORIGINAL ARTICLE: Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

ORIGINAL ARTICLE: Early Antiretroviral Therapy and Mortality among HIV-Infected Infants

EDITORIAL: Insulin Infusions in Very-Low-Birth-Weight Infants

ORIGINAL ARTICLE: Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

ORIGINAL ARTICLE: Early Insulin Therapy in Very-Low-Birth-Weight Infants

ORIGINAL ARTICLE: Monovalent Type 1 Oral Poliovirus Vaccine in Newborns

VIDEOS IN CLINICAL MEDICINE: Umbilical Vascular Catheterization

ORIGINAL ARTICLE: Effectiveness of Maternal Influenza Immunization in Mothers and Infants

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2008 â An 8-Day-Old Infant with Congenital Deafness, Lethargy, and Hypothermia

EDITORIAL: Antenatal Magnesium Sulfate for Neuroprotection before Preterm Birth?

ORIGINAL ARTICLE: A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy

ORIGINAL ARTICLE: Long-Term Medical and Social Consequences of Preterm Birth

EDITORIAL: Breast-Feeding, Antiretroviral Prophylaxis, and HIV

ORIGINAL ARTICLE: Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia

ORIGINAL ARTICLE: Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission

REVIEW ARTICLE: Effect of In Utero and Early-Life Conditions on Adult Health and Disease

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

ORIGINAL ARTICLE: Hyperglycemia and Adverse Pregnancy Outcomes

ORIGINAL ARTICLE: Mutations in the Iodotyrosine Deiodinase Gene and Hypothyroidism

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2008 â A Newborn Infant with Intermittent Apnea and Seizures

REVIEW ARTICLE: Management and Outcomes of Very Low Birth Weight

ORIGINAL ARTICLE: Intensive Care for Extreme Prematurity â Moving beyond Gestational Age

CLINICAL THERAPEUTICS: Phototherapy for Neonatal Jaundice

ORIGINAL ARTICLE: Nasal CPAP or Intubation at Birth for Very Preterm Infants

ORIGINAL ARTICLE: Neonatal Diagnosis and Treatment of Menkes Disease

EDITORIAL: Congenital Heart Disease and Brain Injury

EDITORIAL: On the Caffeination of Prematurity

REVIEW ARTICLE: Chronic Lung Disease after Premature Birth

ORIGINAL ARTICLE: Abnormal Brain Development in Newborns with Congenital Heart Disease

ORIGINAL ARTICLE: Long-Term Effects of Caffeine Therapy for Apnea of Prematurity

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2007 â A Newborn Girl with Skin Lesions

EDITORIAL: Prenatal Corticosteroids â Early Gain, Long-Term Questions

ORIGINAL ARTICLE: Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids

ORIGINAL ARTICLE: Outcomes at 2 Years of Age after Repeat Doses of Antenatal Corticosteroids

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2007 â A 30-Year-Old Pregnant Woman with Intrauterine Fetal Death

ORIGINAL ARTICLE: Medical Abortion and the Risk of Subsequent Adverse Pregnancy Outcomes

EDITORIAL: Progesterone and Preterm Labor â Still No Definite Answers

REVIEW ARTICLE: Prevention of Preterm Delivery

ORIGINAL ARTICLE: Progesterone and the Risk of Preterm Birth among Women with a Short Cervix

ORIGINAL ARTICLE: A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins

ORIGINAL ARTICLE: Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

ORIGINAL ARTICLE: Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

ORIGINAL ARTICLE: First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects

ORIGINAL ARTICLE: A Multicenter, Randomized Trial of Prophylactic Fluconazole in Preterm Neonates

SPECIAL ARTICLE: Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants

EDITORIAL: Prematurity and the Legacy of Intrauterine Stress

ORIGINAL ARTICLE: Glucose Regulation in Young Adults with Very Low Birth Weight

ORIGINAL ARTICLE: Mutations in Associated with Neural-Tube Defects

ORIGINAL ARTICLE: Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

PERSPECTIVE: Cesarean Delivery and the RiskâBenefit Calculus

REVIEW ARTICLE: Parturition

EDITORIAL: Obstetricians Still Await a Deus ex Machina

ORIGINAL ARTICLE: Fetal Pulse Oximetry and Cesarean Delivery

EDITORIAL: Preterm Birth and Periodontal Disease

ORIGINAL ARTICLE: Treatment of Periodontal Disease and the Risk of Preterm Birth

ORIGINAL ARTICLE: Reduced Lung Function at Birth and the Risk of Asthma at 10 Years of Age

EDITORIAL: Neuroimaging and the Prediction of Outcomes in Preterm Infants

ORIGINAL ARTICLE: Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants

ORIGINAL ARTICLE: Neonatal-Onset Multisystem Inflammatory Disease Responsive to Interleukin-1Î² Inhibition

EDITORIAL: ATP-Sensitive Potassium Channels â Neonatal Diabetes Mellitus and Beyond

NEJM â Collection Updates for Neonatal Medicine

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2009 â A Pregnant Woman with a Large Mass in the Fetal Oral Cavity

CORRESPONDENCE: Eculizumab for Congenital Atypical HemolyticâUremic Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2008 â An 8-Day-Old Infant with Congenital Deafness, Lethargy, and Hypothermia

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2008 â A Newborn Infant with Intermittent Apnea and Seizures

ORIGINAL ARTICLE: Intensive Care for Extreme Prematurity â Moving beyond Gestational Age

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2007 â A Newborn Girl with Skin Lesions

EDITORIAL: Prenatal Corticosteroids â Early Gain, Long-Term Questions

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2007 â A 30-Year-Old Pregnant Woman with Intrauterine Fetal Death

EDITORIAL: Progesterone and Preterm Labor â Still No Definite Answers

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

PERSPECTIVE: Cesarean Delivery and the RiskâBenefit Calculus

EDITORIAL: ATP-Sensitive Potassium Channels â Neonatal Diabetes Mellitus and Beyond

EDITORIAL: Inhaled NO for Preterm Infants â Getting to Yes?

EDITORIAL: Necrotizing Enterocolitis in Preterm Infants â Is Laparotomy Necessary?

EDITORIAL: Neonatal Hyperbilirubinemia â What Are the Risks?

EDITORIAL: Antioxidants and the Prevention of Preeclampsia â Unresolved Issues

EDITORIAL: Systemic Hypothermia â A âCoolâ Therapy for Neonatal HypoxicâIschemic Encephalopathy

ORIGINAL ARTICLE: Whole-Body Hypothermia for Neonates with HypoxicâIschemic Encephalopathy

EDITORIAL: Meconium Aspiration Syndrome â More Than Intrapartum Meconium

PERSPECTIVE: Newborn Screening â Setting Evidence-Based Policy for Protection

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2005 â A Four-Week-Old Male Infant with Jaundice and Thrombocytopenia

EDITORIAL: Inhaled Nitric Oxide for Preterm Infants â Who Benefits?

EDITORIAL: Extreme Prematurity â The Continuing Dilemma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2004 â A 23-Day-Old Infant with Hypospadias and Failure to Thrive

EDITORIAL: Prematurity â A Window of Opportunity?

LEGAL ISSUES IN MEDICINE: Extremely Preterm Birth and Parental Authority to Refuse Treatment â The Case of Sidney Miller

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2004 â Newborn Twins with Thrombocytopenia, Coagulation Defects, and Hepatosplenomegaly

PERSPECTIVE: SIDS â A Syndrome in Search of a Cause

EDITORIAL: Finding Needles in Haystacks â Gene Variants in Isolated Cleft Lip or Cleft Palate

EDITORIAL: Antiretroviral Agents â How Best to Protect Infants from HIV and Save Their Mothers from AIDS

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2004 â A Newborn Girl with a Large Cutaneous Lesion, Thrombocytopenia, and Anemia

EDITORIAL: Postnatal Corticosteroids for Preterm Infants â Do What We Say, Not What We Do

SOUNDING BOARD: Systematic Identification of Drugs That Cause Birth Defects â A New Opportunity

EDITORIAL: Nitric Oxide for Preemies â Not So Fast