Aviva Litwin

Transient Hepatic Dysfunction in an Infant of an Epileptic Mother Treated with Carbamazepine during Pregnancy and Breastfeeding

OBJECTIVE: A case is reported of a carbamazepine (CBZ)-treated epileptic mother whose newborn presented with transient hepatic dysfunction characterized by direct hyperbilirubinemia and high concentrations of gamma-glutamyltransferase (GGT). DATA SOURCES: Information was obtained from case reports, clinical trials, and relevant bibliographic laboratory studies. DATA EXTRACTION: Data from case reports were evaluated and compared with those from our patient. The hepatotoxic reactions together with the microsomal enzymatic induction of CBZ were reviewed. DATA SYNTHESIS: A female infant bom to an epileptic mother treated with CBZ throughout pregnancy and breastfeeding presented with transient direct hyperbilirubinemia and high concentrations of GGT. The characteristics of her transient hepatic dysfunction were: early appearance (during the first day of life); discrepancy between the normal liver enzymes and high GGT concentrations; slow decrease of GGT, which nevertheless remained at above-normal concentrations even after the complete disappearance of direct hyperbilirubinemia; and spontaneous resolution in spite of only occasional breastfeeding. The possible explanations of this transient hepatic dysfunction (like enzymatic induction) are discussed. CONCLUSIONS: CBZ-induced hepatic dysfunction in neonates appears to have different clinical expressions. Infants of epileptic mothers treated with CBZ throughout pregnancy and breastfeeding should be carefully monitored for possible adverse effects.

Phototherapy for Neonatal Nonhemolytic Hyperbilirubinemia Analysis of Rebound and Indications for Discontinuing Therapy

Phototherapy, an effective treatment for neonatal indirect hyperbilirubinemia, has guidelines for its initiation but none for its discontinuation. In our study, phototherapy was begun at a mean age of 90 hours in 28 full-term and 30 preterm infants with indirect nonhemolytic hyperbilirubinemia. After three days, phototherapy was halted at a mean bilirubin concentration of 13.0 ± 0.7 mg/dL in term and 10.7 ± 1.2 mg/dL in preterm infants, levels higher than those used by other investigators. Bilirubin rebound then occurred at a mean of 12.5 hours to a level of 0.86 ± 1.0 mg/dL in term and at a mean of 14.1 hours to a level of 0.83 ± 0.56 mg/dL in preterm infants. No complications were observed nor was there a need for reinstitution of phototherapy. Based on these data, discontinuation of phototherapy at higher bilirubin concentrations and earlier home discharge than previously described appear harmless for both term and preterm neonates.

Possible association between acetazolamide administration during pregnancy and metabolic disorders in the newborn

Development of metabolic acidosis, hypocalcemia and hypomagnesemia in a preterm infant whose mother was treated with acetazolamide throughout pregnancy is described. These neonatal metabolic alterations possibly related to acetazolamide administration in pregnancy have not been previously described in the literature. The metabolic acidosis was transient and resolved spontaneously despite breast feeding and continued administration of acetazolamide to the mother. Hypocalcemia and hypomagnesemia resolved quickly with appropriate treatment with calcium gluconate and magnesium sulphate, respectively. At follow-up at ages 1, 3 and 8 months, the baby showed mild hypertonicity of the lower limbs requiring physiotherapy.

Clitoral length assessment in newborn infants of 30 to 41 weeks gestational age

Clitoromegaly in the neonatal period is an important morphological sign. There are only few reports establishing an objective assessment of clitoral size. The present study establishes normal standards for clitoral length in healthy premature and full-term infants. The data are expressed at the same time in relation to both gestational age and birth weight, two variables which are strictly intercorrelated. Appropriate curves, which permit an easy and rapid objective determination of clitoral size, are presented.

Complete absence of external genitalia in limb-body wall complex: two cases.

Two neonates with limb-body wall complex (LBWC) and complete absence of the external genitalia are presented. Our patients are the sixth and seventh cases of complete absence of the external genitalia recorded in English publications and the first two cases associated with LBWC. The incidence of complete absence of the external genitalia in our newborn population during a period of 12 years (1975 to 1986) was one case per 13 420 births.

Prevalence of minor congenital anomalies in newborns of diabetic mothers

Minor congenital anomalies (MCA) were assessed in the offspring of 802 gestational diabetic mothers, 117 pre-gestational diabetic mothers, and 380 offspring born to normal mothers. The prevalence of infants with MCA ranged between 19.4% and 20.5% in the three groups without any significant difference between them. There was no correlation between the prevalence and type of MCA and the severity of the diabetic state. Neither was there any correlation between the prevalence or type of MCA and the appearance or type of major congenital anomalies.

Limb-body wall complex with complete absence of external genitalia after in vitro fertilization

The first case of limb-body wall complex (a combination of a body wall defect, neural tube defect, and limb abnormalities) after IVF is described. This is the third reported patient with this complex anomaly associated with complete absence of external genitalia. The possible pathogenic mechanisms are discussed.

Time of separation of the umbilical cord: a comparative study of treatment with alcohol and Rikospray

The time of cord separation and the umbilical changes post cord falling were studied in 394 infants, 35 to 42 weeks gestation, 1900 to 4500 g birth weight. Two methods of treatment; alcohol 70% with 0.5% chlorhexidine, and Rikospray were compared. The mean +/- SD age of cord separation was 6.36 +/- 2.64 days (range 3-20 days) in all infants studied. The time of cord separation and post fall umbilical complications were similar in the two treated groups. The only point of difference was the repulsive odor in the alcohol-treated group, making handling of the infants very unpleasant.

Neonatal ABO Incompatibility Complicated by Hemoglobinuria and Acute Renal Failure

The authors present two infants with isoimmune hemolytic disease due to ABO incompatibility complicated by massive hemoglobinuria and secondary acute renal failure. This represents an incidence of 0.36% of all neonates with ABO hemolytic disease in the authors newborn population. Only two patients have been reported previously to have similar complications. Analysis of data of these four infants revealed the clinical characteristics of this complication of ABO incompatibility: 1) very low frequency ; 2) early onset of hemoglobinuria (first voided urine) and of acute renal failure (first 2 days of life); 3) lack of correlation between the clinical presentation of hemolytic disease and appearance and severity of renal failure; 4) complete recovery of renal functions following intravenous fluid administration; and 5) normal renal radiologic investigations.

Blood-stained maternal milk: prevalence, characteristics and counselling

Blood-stained maternal milk at delivery and during lactation was prospectively studied in 7774 livebirths over a period of 2 years (1986-1988). Eight mothers had this atypical breast discharge, a prevalence rate of 1:971 livebirths (0.1%). The characteristics of this phenomenon were: early appearance (frequently a short time after delivery), with normal bacteriologic and cytologic investigations, disappearance in 2 to 5 days, without adverse effects on the mothers and their babies, no recurrence after cessation, and occurrence in the previous pregnancies (3 of the 5 multipara). As a result, the best policy is to reassure the parents about the benign and transient course of this condition and to recommend continuation of breast feeding.