Salomon H. Reisner

Upper limb standards in newborns

The present study assists the clinician in determining an abnormal upper limb in the newborn. To define standards for upper limb measurements in the newborn, 198 term and preterm infants (gestational age range, 27 to 41 weeks) were examined. In every case, the gestational age was determined chronologically and clinically, and the total length of the arm, upper extremity and forearm lengths, and total hand and middle finger lengths were measured by two observers using standard techniques. Normal values were determined by plotting the mean +/- 2 SDs for each gestational week v the gestational age.

Real-time echo-Doppler Duplex Scanner in the evaluation of patients with Poland sequence

In two neonates with partial Poland sequence, an infant with complete Poland sequence and his mother subclavian artery diameter and its flow velocity waveforms were determined by real-time echo-Doppler Duplex Scanner. These measurements were significantly lower than on the normal side in the same patient. Subclavian hypoplasia appears as a local vascular defect which, in addition to thoracic muscle defects and bone defects of the hand, may be one of the main components of the Poland sequence.

THE INCIDENCE OF NEONATAL HYPOGLYCEMIA IN A NURSERY FOR PREMATURE INFANTS.

Two or more blood glucose determinations were obtained during the first 5 days of life from 128 of 166 infants admitted consecutively to the Premature Nursery, Research and Educational Hospitals. Eight infants (6 per cent) had significant hypoglycemia (less than 20 mg. per 100 ml.) and symptoms. The predictive value of signs, symptoms, and gestational age are discussed.

Characteristics of the male genitalia in the newborn: penis.

During a 2-month period all male newborns were examined prospectively to determine the normal characteristics of the penis. Of the 274 neonates examined 3 were excluded because of hypospadias with chordee. The spontaneous direction of the shaft was in the midline in 76.8 per cent, to the left side in 15.5 per cent and to the right side in 7.7 per cent. Partial absence of the prepuce was observed in 10 per cent of the patients, while an unretractable foreskin was seen in 23.2 per cent. The mean meatal aperture was 2.6 plus or minus 0.8 mm. Deviation of the median raphe was present in 10 per cent of the newborns and was associated with deviation of the meatus in 2.2 per cent. Mild torsion of the penis was noted in 1.5 per cent, while isolated torsion of 90 degrees was seen in 0.7 per cent of the patients. Early diagnosis and followup of these newborns might be helpful in determining further treatment.

Crossed sagittal-suture cephalhaematoma

Cephalhaematoma is a traumatic lesion to the newborn skull, occurringmainly during labour. It is characterised by the collection of blood above the outer table of the skull and beneath the periosteal sheath. The haematoma is sharply limited at the edges of the bone where the pericranium (periosteum) is bound down tightly to the membranous tissue of the sutures. It appears as a prominence, most frequently on theparietal bones, confined within the sutural boundaries (Schaffer & Avery, 1977). This paper presents a cephalhaematoma overlying a sagittal suture synostosis in a newborn baby. The practical consequences are discussed.

Philtrum length, intercommissural distance, and ear measurements in newborn infants.

prompts us to report a mother and daughter who presented with very similar features (fig 1). The 4 year old daughter, who showed moderate developmental delay, was referred because of concern over her persisting large anterior fontanelle with wide metopic and sagittal sutures. Additional findings included facial asymmetry, prominent crura of both ears, and short digits with finger-like thumbs showing impaired flexion at the interphalangeal joints. The mother, who was 147 cm tall, recalled being told that her own anterior fontanelle had not closed until the age of 5 years. On examination this lady, who was of limited intellect and experienced difficulty in reading and writing, had a flat receding forehead, bilateral proptosis, right ptosis, prominent crura of both ears, short fingers, and broad halluces. Palpation of her skull revealed bilateral parasagittal parietal defects each admitting a finger tip. Skull x-ray (fig 2) confirmed the presence of

Familial opposable triphalangeal thumbs associated with duplication of the big toes.

A rare association of triphalangeal thumbs and duplication of the big toes is described. The family pedigree confirms autosomal dominant inheritance with marked penetrance. A systematic approach to the diagnosis of this anomaly is presented. The distinction between the two types of triphalangeal thumb, true (opposable) and finger-like (non-opposable), is emphasised.

Retinopathy of Prematurity: Incidence and Risk Factors

A high incidence of retinopathy of prematurity (ROP) was found in the very low-birth-weight infants discharged from the neonatal intensive care unit during the years 1977 to 1980, in spite of frequent monitoring of oxygen use. Although the yearly incidence of ROP in infants weighing less than 1,500 g varied between 35% to 36%, none were blind. The medical records of 65 infants with a birth weight between 501 and 1,250 g; surviving in 1979 to 1980, were reviewed in order to find risk factors for ROP. There were no significant differences between the 34 infants with ROP and the 31 infants who did not have ROP in mean birth weight or mean gestational age. Of 32 possible risk factors examined, the factors significantly associated with ROP were: apnea with mask and bag ventilation; prolonged parenteral nutrition; number of blood transfusions; and episodes of hypoxemia, hypercarbia, and hypocarbia. A highly significant association between hypocarbia and the development of severe ROP was found.