Malcolm L. Chiswick

Association of human parvovirus B19 infection with acute meningoencephalitis

To find out the incidence and clinical presentation of parvovirus B19 meningoencephalitis, we tested samples of cerebrospinal fluid from 162 patients (one from each patient) with undiagnosed meningoencephalitis, who presented between March, 1997, and March, 1998 (an outbreak period) using nested PCR for B19 genes. Seven patients were positive; an incidence of 4.3%. Five additional cases of meningoencephalitis were detected from other years. Three patients with underlying disorders (haemophagocytic lymphohistiocytosis, Cockaynes syndrome, and Turners syndrome) died. Neurological sequelae were observed in three surviving patients, all of whom had had striking abnormalities detected on brain scans done during the acute phase.

The development of ultradian and circadian rhythms in premature babies maintained in constant conditions

Twenty very premature babies, born at 24-29 weeks gestation, have been studied while they were maintained in intensive care with continuous intravenous feeding and constant ambient lighting and temperature. Hourly records of insulated skin temperature and heart rate were made for a continuous period of 6-17 weeks, always starting the recording within 24 h of birth. The development of rhythms within the ultradian, circadian and infradian domains was sought by methods including maximum entropy spectral analysis and autocorrelation. Circadian and ultradian rhythms were present, but not regularly so; rather they appeared and disappeared erratically in successive weeks. As a consequence, the group as a whole did not show an increasing rhythmicity with chronological age. In some cases, babies were later placed in a ward in which the lighting was dimmed at night, and feeding by mouth at regular intervals was instituted. There was some evidence for increases in circadian and ultradian rhythmicity after these changes. These results enable inferences to be drawn as to the origin of fetal rhythms in the third trimester of pregnancy, as well as speculation to be made on the ontogeny of ultradian and circadian rhythms in the neonate.

Computerized transverse axial tomography in the newborn

7 babies, aged 6 days--8 wk, who presented with abnormal neurological signs during the first days of life were investigated by computerized transverse axial tomography. 3 babies had suffered perinatal asphyxia. Only 1 baby required a general anaesthetic to facilitate the investigation. Structural intracranial lesions were seen in 6 babies and comprised hydranencephaly, cerebral agenesis with grossly dilated lateral ventricles, unilateral cerebral oedema, subarachnoid cyst of localized cerebral atrophy.

Developmental delay in congenital myotonic dystrophy after neonatal intensive care

Six infants with congenital myotonic dystrophy survived after neonatal intensive care. In later childhood they were assessed by the Griffiths Mental Development Scales: five children were functioning in the mildly handicapped to borderline range of development (DQ 64.0 to 79.0) and the remaining child was severely delayed in development (DQ 33.0). The five children with higher DQ values had a history of ventilatory support of 30 days or less after birth. By contrast, the remaining child with the lowest DQ value had been ventilated for 43 days. This study provides further evidence that prolonged ventilation after birth has prognostic significance in identifying severely affected cases with congenital myotonic dystrophy.

Dietary vitamin E and polyunsaturated fatty acid (PUFA) in newborn babies with physiological jaundice

We studied 69 term babies aged 2-8 days who had physiological jaundice and who were fed formula A (Ostermilk Complete; vitamin E, 0.46 mg per 100 ml; polyunsaturated fatty acid (PUFA), approximately 0.08 g per 100 ml), or formula B (Cow and Gate Premium; vitamin E, 1.0 mg per 100 ml; PUFA, approximately 0.55 g per 100 ml) or breast milk. Babies fed formula B, with the greatest vitamin E and PUFA content, had a significantly higher mean plasma vitamin E level compared with those fed formula A, even as early as the second and third day. Breast fed babies, 2-3 days old, had a lower mean plasma vitamin E level compared with formula B fed babies, thereafter vitamin E levels in breast fed babies rose. The RBCs of babies fed formula B and breast milk were significantly less susceptible to hydrogen peroxide (H2O2) haemolysis compared with the RBCs of those fed formula A. Reduced susceptibility to H2O2 haemolysis in formula B fed babies was observed in those as young as 2-3 days. Susceptibility to H2O2 haemolysis did not correlate with haemoglobin concentration, plasma bilirubin nor with the reticulocyte count in babies on different feeds. We conclude that in term newborn babies the vitamin E and PUFA contents of the milk feeds influence plasma vitamin E levels and susceptibility of RBCs to H2O2 haemolysis, but do not have an important bearing on the occurrence of physiological jaundice.

Value of cranial ultrasound in newborn baby

Ultrasound imaging technique is considered to be the modafity of choice in the study of brain injury in newborn babies. Its increasing acceptance in most of the neonatal units both as a research tool and as a procedure is based on convenience (portability), safety 1 and the excellent correlation of scan findings with pathological studies. 2 It not only provides the neonatologists with an early diagnosis of various brain lesions, but also their evolution and prognostic significance can be studied by serial scannings. Perhaps the nlost important application of this technique has been in elucidating the mechanism and evaluation of preventive measures against perinatal brain damage.