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Twelve newborn infants with clinical evidence of hypoxic ischemic brain injury had conventional and diffusion-weighted magnetic resonance imaging (MRI) performed one to six (median two) days and 7-42 days after birth. The extent and conspicuity of the early abnormalities was greater with diffusion-weighted than with conventional imaging in each of the four infants with neonatal infarction and in four of the infants with Grades II or III hypoxic ischemic encephalopathy (HIE). No abnormality was seen with either technique in the other four infants who had Grades I or II HIE. Diffusion weighted MRI may be important for the early diagnosis and grading of infants with hypoxic ischemic brain injury.

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Sixteen cases of postnatal cytomegalovirus (CMV) infection were identified in a neonatal intensive care unit population over a five year period. Eleven of these infants had gastrointestinal signs at the time of presentation. These ranged from minor and transient (abdominal distension and enteral feed intolerance) to severe and life threatening (protein losing enteropathy, diarrhoea, and hypernatraemic dehydration). An initial diagnosis of necrotising enterocolitis was common, but no infant showed intestinal or hepatic portal pneumatosis. The gestational age of the infants was 24-38 weeks. All had received fresh maternal breast milk. It is suggested that CMV enteritis is added to the spectrum of clinical manifestations of postnatal CMV infection. Signs suggestive of necrotising enterocolitis with atypical features should prompt investigations for CMV infection. P ostnatal cytomegalovirus (CMV) infection has not attracted the attention received by congenital infection as it is held to result in low morbidity. The recognition of severe gastrointestinal symptoms in a small number of preterm infants with postnatal CMV infection prompted a search of the literature and a review of infants admitted to our neonatal unit over a five year period who were known to have postnatally acquired CMV infection. METHODSInfants were identified as a result of CMV screening in the presence of symptoms such as prolonged jaundice, unexplained enteritis, or signs of systemic sepsis in the absence of positive blood cultures for bacterial sepsis. The standard screen test was the urine CMV DEAFF (detection of early antigen fluorescent foci) test. This is a rapid culture test whereby early CMV antigens are detected by immunofluorescence after the inoculum on a cell sheet is spun for two to four days. The diagnosis of CMV infection was based on the fact that a previously negative urine CMV DEAFF test became positive coincidentally with the onset of clinical symptoms. Urine CMV DEAFF screening of infants at admission was not performed routinely although many of the infants had early screening. However, all of our cases had negative urine CMV DEAFF tests before the positive tests. In cases where the symptomatology was severe, additional tests such as CMV blood IgM and antigen detection were carried out. As the infants were sick preterm babies, it was not feasible to obtain gastrointestinal biopsy samples to confirm the diagnosis of CMV gastrointestinal disease.Our unit feeding policy is to start enteral feeds early once the infant is clinically stable. The preference is for the mother's own breast milk. If not available, then with parental consent, banked breast milk is given. The mother's own milk is given fresh within 48 hours of expression. This milk would have been stored at 4˚C. If fresh mother's milk is unavailable or insufficient, frozen maternal breast milk or banked donor milk is used. Our unit has its own milk bank on site. Milk is obtained from donors who are screened for a panel of viruses (hepatitis B, hepatitis C, HIV-1 and HIV-2,...

Neonatal stroke encompasses a range of focal and multifocal ischaemic and haemorrhagic tissue injuries. This review will concentrate on focal brain injury that occurs as a consequence of arterial infarction, most frequently the left middle cerebral artery, or more rarely as a consequence of cerebral sinus venous thrombosis (CSVT). Both conditions are multifactorial in origin. The incidence of both acquired and genetic thrombophilic disorders in both mothers and infants is high although rarely causal in isolation. Neurodevelopmental morbidity occurs in over 50% of children. Specific therapy in the form of anticoagulation is currently only recommended in CSVT and needs to be carefully monitored in the presence of haemorrhage.