This report describes a full-term newborn with massive fetomaternal hemorrhage. Fetal movements were decreased 48 hr prior to delivery. On the day of delivery, they were absent. The nonstress test was abnormal with low biophysical profile and decreased beat-to-beat variability. The infant presented with extreme pallor, hypotonia, hepatosplenomegaly, and ascites. The initial hemoglobin was 2.2 g/dL, the Kleihauer-Betke stain was 27.6% (highest level ever reported). Right temporal and cerebellar hemorrhages were present. Sequelae include severe developmental delay and asymmetric double hemiplegia.

The objectives of this study were to measure plasma and red blood cell (RBC) zinc concentrations in patients with cystic fibrosis (CF), and examine their relationship to nutritional status and pulmonary function. Plasma and RBC zinc levels were compared in 53 CF patients ranging in age from 0.5-46 years. Their relationships to weight (% ideal weight) and forced expired volume in 1 sec (FEV(1)) (% predicted value) were examined. After excluding improperly handled specimens, RBC zinc levels in 51 patients and plasma zinc concentrations in 40 patients were included for analysis. Sixteen of 51 (31%) patients had low RBC zinc levels compared to 4 of 40 (10%) with low plasma zinc concentrations (P < 0.01). Thirteen of 38 patients (34%) in whom both values were obtained had low RBC zinc concentrations compared to 4 of 38 (11%) with low plasma zinc levels (P < 0.022). Neither low RBC nor plasma zinc levels correlated with nutritional status or lung function. In conclusion, about one third of patients with CF had low RBC zinc levels. Plasma zinc concentrations may not adequately reflect overall zinc status. This deficiency did not appear to be related to either nutritional status or lung function. The significance of low RBC zinc in CF is unknown.

A full-term neonate was born to a 41-year-old woman via elective primary cesarean section for frank breech presentation after a 41-week pregnancy. Starting at 6 hr of age the infant presented with multiple episodes of apnea and cyanosis, in association with moderate hypotonia, subsequently requiring assisted ventilatory support for 2 days. Computerized axial tomography of the brain revealed infarction in the distribution of the left middle cerebral artery. Magnetic resonance imaging of the brain showed a left middle cerebral artery territory infarct and also a small right posterior-temporal infarct. Magnetic resonance angiography of the head and neck was normal, however, inferring that the vascular infarction was peripheral in location. Maternal anticardiolipin antibodies were elevated. This is only the fifth reported case of cerebral infarction in a newborn in association with elevated maternal anticardiolipin antibodies.

Treatment of children with a history of bronchopulmonary dysplasia (BPD) often includes the use of anti-inflammatory medications. However, long-term studies examining their long-term use are few. We conducted a retrospective study to determine the effects of an aerosolized corticosteroid (Pulmicort®) and the leukotriene antagonist montelukast (Singular®) in oxygen-dependent infants followed in the BPD Center at Loma Linda University Children's Hospital. Group A includes 20 infants treated with Pulmicort. Group B includes 13 treated with both Pulmicort and Singular. Group C includes 7 who were not treated with either Singular or Pulmicort. Within these three groups, the following were noted and compared using ANOVA tests: duration of oxygen therapy in days, number of inpatient visits to a hospital, number of ER visits, change in weight in kilograms, and change in height in centimeters. No significant differences were noted in these variables among the three test groups. However, differences in more subjective perimeters such as overall quality of life or control of allergies were not taken into account in this study.

IntroductionAs a pulmonary vasodilator that specifically targets smooth muscles of the lungs by inhibiting PDE-5, sildenafil (Viagra, Pfizer) has brought much hope for patients with pulmonary hypertension (PHTN) within the last few years. The majority of studies on the therapeutic effects of sildenafil have been conducted on adult subjects. Knowledge of its effects on children still remains quite limited.HypothesisWe hypothesized that administering oral sildenafil to pediatric patients for long-term use is safe and effective for treating pulmonary hypertension.MethodsA retrospective chart review was conducted on all patients who were diagnosed with pulmonary hypertension and treated with sildenafil at Loma Linda University Children's Hospital between 8/2001 through 8/2004. To assess the safety of sildenafil, side effects were noted, while its efficacy was determined by noting the change in oxygen requirement and severity of pulmonary hypertension and tricuspid insufficiency as observed by Doppler echocardiogram.ResultsOf the 22 pediatric patients (mean age 4.9 years; females 50%), three patients had primary PHTN and 19 patients had secondary PHTN. The average duration for sildenafil treatment was 5.0 months with an average dose administration of 1.5 mg/kg/day. Three (13.6%) patients reported adverse effects, which included nausea, vomiting, diaphoresis, and tachypnea. No report of systemic hypotension was noted. The oxygen requirement at the start and end of the treatment decreased in 16 (73%) patients, while an increase in oxygen need was present for 5 (23%) patients. The remaining one (5%) patient had no change in oxygen requirement. As observed by Doppler echocardiography, PHTN improved in 12 (55%) patients, worsened in 1 (5%) and remained unchanged or was unknown for 9 (41%). Tricuspid insufficiency improved in 7 (32%) patients, worsened in 1 (5%) patient and remained unchanged or was unknown for 14 (64%) patients.ConclusionThis preliminary retrospective study demonstrates that long-term sildenafil therapy appears to be safe and efficacious for pediatric pulmonary hypertension. However, this pediatric study is under powered to evaluate the potential for irreversible retinal damage linked to PDE-5 inhibition in some adult studies. Additional studies are needed to evaluate for rebound PHTN after withdrawal of sildenafil.