In their article Joolay and Stewart report the occurrence of a rare
case of congenital lingual teratoma (1). The 19 mm mass was even
discovered prenatally on ultrasound. In the differential diagnosis of an
oral mass discovered in the fetus or in the neonate, the authors omitted
to mention the possibility of an ectopic lingual thyroid. The occurrence
of an ectopic thyroid is due to abnormal migration of the gland during...
In their article Joolay and Stewart report the occurrence of a rare
case of congenital lingual teratoma (1). The 19 mm mass was even
discovered prenatally on ultrasound. In the differential diagnosis of an
oral mass discovered in the fetus or in the neonate, the authors omitted
to mention the possibility of an ectopic lingual thyroid. The occurrence
of an ectopic thyroid is due to abnormal migration of the gland during
embryogenesis. It can occur in any position in the normal pathway of
descent of the thyroglossal duct, starting at the base of the tongue. This
migration defect is usually associated with congenital hypothyroidism,
likely due to a smaller amount of tissue (absence of lateral lobes) with a
limitation to TSH-induced growth (2). Therefore, the diagnosis of ectopic
thyroid is usually made secondarily, after the detection of hypothyroidism
on the neonatal screening test. However, in some rare cases, the lingual
mass of thyroid origin can be discovered due to obstructive symptoms in
the newborn. To illustrate this, we report the case of a girl born at 41
weeks of gestation, after an uneventful pregnancy. Birth weight was 4170 g
and Apgar scores were 9-9-9. After 24h of life, episodes of oxygen
desaturation (to 85 %) were noted when the baby was supine; these did not
occur when the baby's head was raised to 30 degrees. When transferred to
our institution on Day 6, physical examination was unremarkable except for
a mass at the base of the tongue. On a computerized tomography scan on Day
8, the mass was estimated to measure 6x6 mm and was hyperdense. On an
ultrasound scan on Day 10, the mass was estimated to measure 18x26 mm and
was solid; the thyroid was described as normal. A polysomnogram between
Days 11 and 12 showed central apneas. The baby was discharged on Day 13
with an apnea monitor at home. On Day 16, the results of neonatal
screening for congenital hypothyroidism came back positive (TSH 120 mU/L,
N < 15, total T4 53 nmol/L, N 86-193). These results were confirmed by
measurements of serum TSH (288.2 mU/L, N 0.25-4.5) and free T4 (2.8
pmol/L, N 9.0-27.0). A scintigraphic scan with sodium pertechnetate showed
the etiology of the severe hypothyroidism to be thyroid ectopy, with
uptake at the base of the tongue only, where the mass had been seen
clinically and on computerized and ultrasound scans; there was no uptake
of the radioisotope in the normal thyroid area. Treatment with
levothyroxine 37.5 mcg/kg/d was started and alerts on the apnea monitor
ceased. Growth and development over the subsequent 15 years have been
normal. In conclusion, both during and after the neonatal period,
physicians should include lingual thyroid in the differential diagnosis of
a mass at the base of the tongue (3).
Reference List
(1) Joolay Y, Stewart C. Congenital cystic mass of the tongue. Arch
Dis Child Fetal Neonatal Ed 2011 March 22.
(2) Stoppa-Vaucher S, Lapointe A, Turpin S, Rydlewski C, Vassart G,
Deladoey J. Ectopic thyroid gland causing dysphonia: imaging and molecular
studies. J Clin Endocrinol Metab 2010 October;95(10):4509-10.
(3) Gillis D, Brnjac L, Perlman K, Sochett EB, Daneman D. Frequency
and characteristics of lingual thyroid not detected by screening. J
Pediatr Endocrinol Metab 1998 March;11(2):229-33.
Dear Editor,
in the article by McCarthy it emerged that cerebellar haemorrhage (CBH) is a rare condition typical of extreme prematurity, with male preponderance, and which always results in a very severe prognosis. We would like to present a case of CBH with different characteristics, as it appeared prenatally in a late preterm infant who finally survived. The baby was born at 35 weeks of GA by caesarean section for a worsening v...
Dear Editor,
in the article by McCarthy it emerged that cerebellar haemorrhage (CBH) is a rare condition typical of extreme prematurity, with male preponderance, and which always results in a very severe prognosis. We would like to present a case of CBH with different characteristics, as it appeared prenatally in a late preterm infant who finally survived. The baby was born at 35 weeks of GA by caesarean section for a worsening ventriculomegaly first diagnosed using cUS at 27 weeks and then confirmed with a fetal MRI at 30 weeks of GA. TORCH, thrombophilic screening and all Doppler scans were normal. Soon after birth the baby developed a respiratory distress which required intubation for ventilatory support and surfactant administration. A cUS performed within the first hour of life confirmed the dilation of both lateral ventricles and showed an echo dense lesion in each cerebellar hemisphere suggesting there had been a haemorrhage. Doppler scans of anterior and middle cerebral artery were normal. A second MRI undertaken on the 20th day when the baby was more stable, confirmed the ventriculomegaly without showing any sign of CBH. In our case the CBH occurred as an antenatal event since it was already ultrasonically detectable soon after birth, however its aetiology remains unknown. As reported in the article, CBH may be associated with circulatory disturbance in the extreme preterm brain. Our baby was a late preterm usually less vulnerable to any perfusion-reperfusion injury, and trauma should not have played any role as it was a caesarean section. The infants of the CBH group in the article were extremely preterm, critically unwell and all of them died while our baby survived and is now self ventilated in air.
We have read with interest the paper by Cinzia Auriti et al (1) on
the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial
sepsis in neonates. However, we believe that there are a number of points
that should be addressed.
First, it is not clear which "fast" PCT assay was actually used. The
authors state that it was a quantitative immunoluminometric method
(Lumitest PCT-Q, BRAHMS), but according to the...
We have read with interest the paper by Cinzia Auriti et al (1) on
the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial
sepsis in neonates. However, we believe that there are a number of points
that should be addressed.
First, it is not clear which "fast" PCT assay was actually used. The
authors state that it was a quantitative immunoluminometric method
(Lumitest PCT-Q, BRAHMS), but according to the manufacturer's
specification, PCT-Q is a fast but semi-quantitative test with intervals
pre-defined as <0.5, more or equal to 0.5, more or equal to 2, and
more or equal to 10 ng/ml. It is not clear how, using this test the
authors have arrived at their suggested cut-off values, for example 2.4
ng/ml, or how they have managed to obtain so many points on the ROC curve
with just four categories of measured PCT. If in fact the authors have
used the quantitative Lumitest, this test is not a fast assay as the
authors claim.
Second, to be considered a nosocomial infection, the baby must have been
aged at least 3 days at onset of signs and symptoms of sepsis. In
paragraph 1 of the results it is stated that the mean age at first PCT
blood sampling was 1.97 (SD, 5.23) days with median 0. Was a sample of
blood taken from all babies irrespective of the signs of sepsis?
Furthermore, other studies have shown a physiologic increase in PCT levels
during the first days of life (2,3). Thus the diagnostic cut-off value of
PCT must take account of postnatal age.
A severe limitation of the use of the results is that the authors have not
taken account of gestational age, which is known to influence PCT levels
(3,4). They quote results for "very low birth-weight" and "normal birth
weight" but omit "low birth weight" in table 1. But even if the three
categories were included, gestational age and postnatal age would still be
important determinants of PCT level in both uninfected and infected
babies.
In order to arrive at their recommended cut off levels, the authors have
used the higher of two measures. Is this meant to imply that in day to day
use in neonatal clinics, two repeated measures are to be taken and the
higher used? If only one measure is made, clearly all the results produced
in table 1 are not relevant, since the value of a single measure will tend
to be less than the higher of two observations. Clearly the comparisons
between their results and those quoted by the authors are, for the same
reason, inappropriate.
Claudio Chiesa 1, Lucia Pacifico 2, John F. Osborn 3, Fabio Natale
2, Mario De Curtis 2
1 Institute of Translational Pharmacology, National Research
Council, Rome, Italy;
Departments of 2 Pediatrics and 3 Public Health Sciences, Sapienza
University of Rome, Italy
Correspondence to Claudio Chiesa,MD Institute of Translational
Pharmacology, National Research Council, Via Fosso del Cavaliere, 100
00133-Rome, Italy; claudio.chiesa@ift.cnr.it
Competing interests: none
References
1.Auriti C, Fiscarelli E, Ronchetti MP, et al. Procalcitonin in
detecting neonatal nosocomial sepsis. Arch Dis Child Fetal Neonatal Ed
2011.Published online First: 15 March 2011 doi:10.1136/adc.2010.194100.
2.Chiesa C, Panero A, Rossi N, et al. Reliability of procalcitonin
concentrations for the diagnosis of sepsis in critically ill neonates.
Clin Infect Dis 1998;26:664-72.
3.Chiesa C, Natale F, Pascone R, et al. C reactive protein and
procalcitonin: Reference intervals for preterm and term newborns during
the early neonatal period. Clin Chim Acta 2011. Published online First:
19 February 2011 doi:10.1016/j.cca.2011.02.020
4.Turner D, Hammerman C, Rudensky B, et al. Procalcitonin in preterm
infants during the first few days of life: introducing an age related
nomogram. Arch Dis Child Fetal Neonatal Ed 2006;91:F283-6.
The analysis by Yates and Newell points out the need for new trials to determine if there is a safe and effective way to give postnatal steroids for preterm infants. A conclusion that I can only agree with. However their article is limited by one major error, and by the failure to describe one of the serious limitations of the available evidence.
The Major error is contained in the section "CLD severity and CP risk". The authors s...
The analysis by Yates and Newell points out the need for new trials to determine if there is a safe and effective way to give postnatal steroids for preterm infants. A conclusion that I can only agree with. However their article is limited by one major error, and by the failure to describe one of the serious limitations of the available evidence.
The Major error is contained in the section "CLD severity and CP risk". The authors state that the meta-analysis of Doyle et al "found in babies at high risk of CLD that steroid treatment reduces the risk of CP". This is untrue. It would indeed have been a remarkable result as there is not one single individual trial in their review which has shown a reduction in CP with postnatal steroids.
The meta-regression which these authors are referring to was a comparison of control group CLD frequency to the COMBINED OUTCOME OF DEATH OR CP. This has clearly very different implications. If we examine the data used by Doyle et al for that meta-analysis, the studies with a greater than 50% rate of CLD among controls, CP frequency INCREASED among the steroid treated babies by 36%, while mortality decreased. The combined outcome of death or CP among this subgroup of trials is in fact 65/206 steroid treated, and 69/197 controls.
The serious limitation of all the current evidence that was not discussed is the very high frequency of contamination (treatment of control babies with steroids) in the majority of the studies. Many of the studies having over 50% (and up to 75%)rates of contamination. Such an enormous exposure of controls to steroids, has been one of the major hindrances to understanding the effects on long term outcomes. This rate of contamination also affects meta-regression discussed above, as the studies with higher rates of control group CLD also had high rates of contamination.
The multiple systematic reviews of steroid therapy do show certain circumstances where mortality appears to be reduced, and under certain circumstances the reduction in mortality may be greater than the increase in CP. Future studies of postnatal steroids should target such circumstances and should severely limit the use of steroids among controls, as far as ethically appropriate.
The author has read with great interest the report of Leow and Ward
Platt (1), who accurately studied the incidence of sudden, unexpected and
unexplained early neonatal deaths in the North of England giving an
overall rate of 0.35/10,000 live births.
While several works have stressed the importance of post-mortem
examination in every case of suspected sudden infant death syndrome
(SIDS), little, if any, attention has bee...
The author has read with great interest the report of Leow and Ward
Platt (1), who accurately studied the incidence of sudden, unexpected and
unexplained early neonatal deaths in the North of England giving an
overall rate of 0.35/10,000 live births.
While several works have stressed the importance of post-mortem
examination in every case of suspected sudden infant death syndrome
(SIDS), little, if any, attention has been given to the mandatory need to
apply the same investigational protocol also in all cases of sudden
perinatal unexplained death, i.e., sudden neonatal unexplained death
(SNUD) and sudden intrauterine unexplained death (SIUD) (2-5).
First of all, it should be underlined that there is a clear continuum
between unexplained perinatal death and SIDS, as developmental
abnormalities have been detected to be common to both, particularly in the
cardiac conduction system and in the brainstem centers regulating vital
functions. From the analysis of the conducting tissue, the following
pathological findings emerged: accessory atrio-ventricular pathways,
mostly Mahaim fibers, cartilaginous hypermetaplasia, abnormal resorptive
degeneration, junctional islands, persistent fetal dispersion, hypoplasia
of the cardiac conduction system or of the central fibrous body, splitting
of the atrio-ventricular node or of the His bundle, and the Zahn node. All
of these cardiac conduction findings may be isolated incidents, but they
are frequently associated with autonomic nervous system alterations of the
brainstem (2-5).
There is evidence to hypothesize the presence of a preexisting damage
in the cardiac conduction system and brainstem of vulnerable subjects, not
only in infants - newborns 0-1 month-old and infants 1-12 month-old - but
also, and at a greater frequency, in fetuses(2-5). This preexisting
vulnerability, if associated to a supervening pathology, such as a
bronchus-pneumonic or a placental infection act as triggering phenomenon
in particularly vulnerable infants and fetuses. The SIUD/SNUD/SIDS event
would occur, in subjects with preexisting still quiescent and undetected
abnormality in the conducting tissue and/or brainstem, when a new
pathological event, itself not deadly, concurs.
REFERENCES
1. Leow JY, Ward Platt MP. Sudden, unexpected and unexplained early
neonatal deaths in the North of England. Arch Dis Child Fetal Neonatal Ed
2011 Mar 11. [Epub ahead of print]
2. Matturri L, Ottaviani G, Lavezzi AM. Guidelines for neuropathologic
diagnostics of perinatal unexpected loss and sudden infant death syndrome
(SIDS): a technical protocol. Virchows Arch 2008;452:19-25.
3. Ottaviani G. Crib death. Sudden unexplained death of infants: the
pathologist's viewpoint, Springer-Verlag, Berlin Heidelberg, Germany 2007.
4. Matturri L, Ottaviani G, Ramos SG, Rossi L. Sudden Infant Death
Syndrome (SIDS): a study of cardiac conduction system. Cardiovasc Pathol
2000;9:137-45.
5. Ottaviani G, Matturri L. Histopathology of the cardiac conduction
system in sudden intrauterine unexplained death. Cardiovasc Pathol
2008;17:146-55.
The article "Global Burden of Rh hemolytic disease" is an excellent
article, highlighting the problem, statistics of the problem and
preventive aspect. No doubt rh hemolytic disease is preventable as
examplified in developing countires by antenatal rh group testing of
mothers,use of anti-d and iv immunoglobulin in affceted neonates, along
with effective phototherapy .
In developing countries and in India, data from inst...
The article "Global Burden of Rh hemolytic disease" is an excellent
article, highlighting the problem, statistics of the problem and
preventive aspect. No doubt rh hemolytic disease is preventable as
examplified in developing countires by antenatal rh group testing of
mothers,use of anti-d and iv immunoglobulin in affceted neonates, along
with effective phototherapy .
In developing countries and in India, data from instituional deliveries
from neonatal units shows a high incidence of hyperbilirubinemia (hbil)
,almost 0ne fourth to one third of nursery admissions need phototherapy.
With a high burden of low birth weight babies ,problem of hbil is further
increased. A study from Northern India (Narang et al 2001 Ind Pediatr)
noted that 76.6% of vlbw babies devloped hbil in nicu,37%of them required
exchange transfusion. They further noted that hbil incidence increased
with decreasing birth weight and 12.8% of vlbw had g6pd deficiency .Nnf
Database 2002-2003,showed incidence of hbil 3.3%in a large multi
institutinal study of nearly 1.5 lac neonates. Pathological hbil was
noted by Murki etal(2009 jour neonatology) in 2-10% of nicu babies and
1/3rd of total needed phototherapy . Similar observations were made by
Timan et al from pakistan(Tropical and International health 2010).
Although neonatal hbil is a problem, rh hemolytic disease is not a
major factor in hospital studies . Among 1060 inborn nicu admissions in a
govt hospital in Delhi, 24% had serum bilirubin >12.0 mg/dl, only 12
babies developed bilirubin level>20.0mg/dl. Etiology of hbil was
prematurity in 65%, abo incompatibility in 11% ,rh in 2.2% of cases. A
recent observation from NICU with intramural and extramural births among
1852 neonates, 22.0 % had hbil, of these rh hemolytic diseae was noted in
6.0% of cases only and of 34 babies who needed exchange transfusion, only
6 were due to rh incompatibility. Incidence of pathological hbil is noted
to be higher in extramural births , almost 20-30 cases of bilirubin
encephalopathy were noted in a nicu with only extramural admissions.
All these observations reveal that in our setup neonatal hbil is a
major issue and its anticipation and early managemant are the priority
issue. While rhhdn is an important and preventable issue, other causes are
also important specially prematurity, sepsis, birth asphyxia etc. Trends
in early discharge of neonates in hospital births with poor followup in
resource poor counties adds up to the problem. Incience of institutional
and supervised birhs is still less than 50%, the data is mostly among
hospital births, what about home births, majority in case of
illness or hbil either do not seek help or reach hospital too late for
intact survial. High bilirubin level can cause neurological damage and
later sequalae,. It was noted earlier that prolonged hbil is also harmful
with hearing problems later, and developmental dealy.(Ghosh et al ind
pediar 1971). In a study of 400 nicu graduates, among 90 with cerebral
palsy .50% had hbil,along with other risk factors.
Hence , efforts be made to create universal issue of yellow alert in
neonates ,by creating public awareness through media, educational
instituions and health education .Also to reduce burden of hbil and
intact survival later health professionals should try to deliver babies at
term as burden of late preterms is increasing and antenatal care for
managing complications of pregnancy is the pragmatic approach along with
making mother aware of danger signs in newborn at delivery,and attention
to feeding problems.
sudershan.kumari@gmail.com
We read the article by Jones et al with great interest describing
Ibuprofen may increase the risk of chronic lung disease (CLD) compared to
Indomethacin. We are unsure whether the data presented is fully supportive
of the conclusion that Ibuprofen poses a greater risk of CLD compared to
Indomethacin and whether this is clinically significant.
In Figure 4 the pooled risk ratio (RR) was 1.28 (95...
We read the article by Jones et al with great interest describing
Ibuprofen may increase the risk of chronic lung disease (CLD) compared to
Indomethacin. We are unsure whether the data presented is fully supportive
of the conclusion that Ibuprofen poses a greater risk of CLD compared to
Indomethacin and whether this is clinically significant.
In Figure 4 the pooled risk ratio (RR) was 1.28 (95% confidence
interval (95%CI) 1.03-1.60) and the p value p=0.03. However only 6 studies
were used, of these only 3 showed a higher risk ratio with Ibuprofen, with
the other 3 studies in fact showing a protective effect. The lower end of
the pooled RR 95% CI was also somewhat close to 1.0. In addition all the
studies' 95% confidence intervals of the RR include 1.0, further reducing
the statistical significance despite the p value being significant.
During the past five years, therapeutic hypothermia (TH) was shown to be effective and safe in improving neurodevelopmental outcome after hypoxic ischaemic encephalopathy (HIE) in newborns.(1) The use of this
therapy has been rapidly incorporated into clinical practice in many countries, even though many doubts related to clinical management and monitoring remain unanswered.(2) The lack of a national appro...
During the past five years, therapeutic hypothermia (TH) was shown to be effective and safe in improving neurodevelopmental outcome after hypoxic ischaemic encephalopathy (HIE) in newborns.(1) The use of this
therapy has been rapidly incorporated into clinical practice in many countries, even though many doubts related to clinical management and monitoring remain unanswered.(2) The lack of a national approach to TH, such as its inclusion in protocols shared among NICUs, is widely recognized.(3)
TH is employed in 1-3/1000 births in the north of the world and is 10-20
times more frequent in low resources settings. In such critical contexts, TH may be useful, but its utility needs to be proven. Wilkinson et al. addressed the difficulties in applying trial results from developed to developing countries and underlined the need for formal, randomized
controlled trials of TH in low- and middle income countries.(4)
The problem with transferring findings from an experimental context to clinical practice is one of the major challenges of modern evidence based medicine and TH is a fitting example. TH is effective if:
a) the management of multiorgan dysfunction is guaranteed;
b) appropriate interventions to confirm the diagnosis and routinely monitor cerebral function are carried out;
c) counseling and support to the family are provided. These are the essential responsibilities and rights that must be present when TH is employed, both in the North and South of the world.
Difficulties in generalizing TH are still present in the North and are amplified in the South, where priorities and resources are different.
There are low-cost interventions shown to be effective in reducing neonatal death and perinatal impairment outcomes in developing countries that must be implemented, diffused, and adequately monitored over the time.(5) According to the principles of equity, a global use of TH should be expected if and when other essential procedures are guaranteed. Thus, ethical and practical priorities, especially in settings in which HIE occurs more often (i.e. rural or isolated villages), suggest that, before focusing on randomized controlled trials of TH, more effective means to
provide and guarantee basic perinatal care over time in order to reduce HIE and the need for its treatment must be met.
Reference
1. Azzopardi D. Clinical management of the baby with hypoxic ischaemic encephalopathy. Early Human Develp 2010; 86:345-50.
2. Barks JD. Current controversies in hypothermic neuroprotection. Semin Fetal Neonatal Med 2008; 13:30-4.
3. Allen NM, Foran A, O'Donovan DJ. Neonatal therapeutic hypothermia: practice and opinions in the Republic of Irealand. Arch Dis Child Fetal Neonatal Ed doi:10.1136/adc.2010.195354.
4. Wilkinson DJ, Thayyil S, Robertson NJ. Ethical and practical issues relating to the global use of therapeutic hypothermia for perinatal asphyxia encephalopathy. Arch Dis Child Fetal Neonatal Ed 2011;96 F75-F78.
5. Waldemar CA et al. Newborn-care training and perinatal mortality in developing countries. N Engl J Med 2010; 362:614-23.
We read this paper with interest and would like to comment. The
authors have concluded that there is little evidence that early postnatal
hypotension indicators are associated with developmental delay at 24
months corrected in their large cohort of extremely low gestational age
newborns.
We agree with their conclusion as our recent study in 11 asphyxiated
term infants demonstrated the simila...
We read this paper with interest and would like to comment. The
authors have concluded that there is little evidence that early postnatal
hypotension indicators are associated with developmental delay at 24
months corrected in their large cohort of extremely low gestational age
newborns.
We agree with their conclusion as our recent study in 11 asphyxiated
term infants demonstrated the similar results (1): there were no
significant differences in mean arterial blood pressure (ABP) nor mean
cerebral blood flow (CBF) during the first 4 days of life between 5
infants with delayed development and 6 infants with normal development at
20 months of age. Interestingly enough, however, significant difference
(p=0.04) was found in an average stability index during the first 48 hours
of life (SI), arbitrarily defined as a coefficient of variation of CBF
monitored by a newly developed laser doppler flowmeter system (CDF Trend,
LIBMECH Inc. Tokyo, Japan) (2).
Cerebral blood passivity develops when changes in blood pressure
exceed the capacity of the intact cerebral autoregulatory system or the
system is impaired by illness such as HIE. In such a situation, ABP may
directly affect and are expected to correlate with CBF. Contrary to our
expectation, however, there was no significant relationship between the
mean ABP and CBF even in the 5 infants with HIE in the present study.
Thus, function of cerebral autoregulatory system, which is expected
to be a good predictor for neurological prognosis, cannot be assessed by
simple measurements of ABP. Serial monitoring of CBF stability during
early neonatal period assessed as SI by a novel laser doppler flowmeter
can be sensitive indicator for cerebral autoregulatory system as it
reflects instability of CBF in the vulnerable period. Further study will
be worthwhile.
References
1. Ohashi A, Kuroyanagi Y, Kitamura N, Kinoshita Y, Kaneko K, Yabuta K.
Cerebral blood flow monitoring using a novel laser Doppler flowmeter in
asphyxiated infants. Pediatr Int. 2009; 51: 715-719
2. Niwayama J, Sanaka Y. Development of a new method for monitoring blood
purification: the blood flow analysis of the head and foot by laser
Doppler blood flowmeter during hemodialysis. Hemodial Int. 2005; 9: 56-62
The article by Prendergast et al describes an important outcome following
a very common antenatal complication. However, there is no description of
the proportion of infants surviving in the two groups which may overshadow
any lack of difference in BPD development between the two groups.
In the statistical methods no assessment appears to have been made in the
regression model between duration of membrane...
The article by Prendergast et al describes an important outcome following
a very common antenatal complication. However, there is no description of
the proportion of infants surviving in the two groups which may overshadow
any lack of difference in BPD development between the two groups.
In the statistical methods no assessment appears to have been made in the
regression model between duration of membrane rupture and BPD risk. An
interaction could also have also been tested within the regression model
to assess whether any effect modification exists between duration of
membrane rupture and presence of chorioamnionitis.
This additional information would be of use for counselling parents
following delivery in the presence of chorioamnionitis.
In their article Joolay and Stewart report the occurrence of a rare case of congenital lingual teratoma (1). The 19 mm mass was even discovered prenatally on ultrasound. In the differential diagnosis of an oral mass discovered in the fetus or in the neonate, the authors omitted to mention the possibility of an ectopic lingual thyroid. The occurrence of an ectopic thyroid is due to abnormal migration of the gland during...
We have read with interest the paper by Cinzia Auriti et al (1) on the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial sepsis in neonates. However, we believe that there are a number of points that should be addressed. First, it is not clear which "fast" PCT assay was actually used. The authors state that it was a quantitative immunoluminometric method (Lumitest PCT-Q, BRAHMS), but according to the...
The author has read with great interest the report of Leow and Ward Platt (1), who accurately studied the incidence of sudden, unexpected and unexplained early neonatal deaths in the North of England giving an overall rate of 0.35/10,000 live births. While several works have stressed the importance of post-mortem examination in every case of suspected sudden infant death syndrome (SIDS), little, if any, attention has bee...
The article "Global Burden of Rh hemolytic disease" is an excellent article, highlighting the problem, statistics of the problem and preventive aspect. No doubt rh hemolytic disease is preventable as examplified in developing countires by antenatal rh group testing of mothers,use of anti-d and iv immunoglobulin in affceted neonates, along with effective phototherapy . In developing countries and in India, data from inst...
Dear Sir,
We read the article by Jones et al with great interest describing Ibuprofen may increase the risk of chronic lung disease (CLD) compared to Indomethacin. We are unsure whether the data presented is fully supportive of the conclusion that Ibuprofen poses a greater risk of CLD compared to Indomethacin and whether this is clinically significant.
In Figure 4 the pooled risk ratio (RR) was 1.28 (95...
Dear Editor,
During the past five years, therapeutic hypothermia (TH) was shown to be effective and safe in improving neurodevelopmental outcome after hypoxic ischaemic encephalopathy (HIE) in newborns.(1) The use of this therapy has been rapidly incorporated into clinical practice in many countries, even though many doubts related to clinical management and monitoring remain unanswered.(2) The lack of a national appro...
Dear Sir,
We read this paper with interest and would like to comment. The authors have concluded that there is little evidence that early postnatal hypotension indicators are associated with developmental delay at 24 months corrected in their large cohort of extremely low gestational age newborns.
We agree with their conclusion as our recent study in 11 asphyxiated term infants demonstrated the simila...
Dear Sir,
The article by Prendergast et al describes an important outcome following a very common antenatal complication. However, there is no description of the proportion of infants surviving in the two groups which may overshadow any lack of difference in BPD development between the two groups. In the statistical methods no assessment appears to have been made in the regression model between duration of membrane...
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