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Antenatal dexamethasone does not appear to decrease the incidence or severity of RDS in surfactant-treated infants delivered at 24-29 weeks' gestation, but may be associated with reduced severity of intraventricular hemorrhages in surfactant-treated singletons in this gestational age range.

Large-aperture, dynamically focused ultrasonic imaging permits noninvasive, anatomic study of the eye at the millimeter level in the second and third trimesters of pregnancy. The authors report their observations of the hyaloid artery in 210 of 219 fetuses examined with this technique. This vessel is seen in fetuses of 20 weeks gestational age or less and regresses spontaneously at the start of the third trimester. The 210 subjects included 100 who were examined at gestational ages of 16-32 weeks or more and 85 healthy fetuses and 25 with pathologic findings at birth who were examined at 34 weeks gestational age to term. The presence of the hyaloid artery in the mid third trimester was uncommon in healthy subjects (less than 1%) and was not seen in any beyond 29.9 weeks gestational age. However, in nine of the 25 fetuses with abnormalities (five with trisomy syndromes), the vessel was seen at 30.8-36.8 weeks gestational age. The temporarily delayed regression of the hyaloid artery may occur with trisomy 21 syndrome and other forms of retarded brain development.

Our data suggest that clonidine may be a reasonable alternative to more traditional agents used to prevent or treat NAS. We agree with the statement of the American Academy of Pediatrics Committee on Drugs that states that larger trials and pharmacologic data are needed before the routine use of clonidine can be recommended.

The lamellar body count compares favorably with traditional phospholipid testing in the prediction of fetal lung maturity. Phospholipid analysis is not needed with lamellar body counts greater than 30,000/microL or less than 10,000/microL, but may be of benefit for values in the intermediate risk range. Advantages of this test include speed, objectivity, small sample volume required, and universal availability of instrumentation.

The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.

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