Standard pharmacologic closure of the patent ductus arteriosus currently involves the administration of 1 of 2 cyclooxygenase inhibitors: either indomethacin or ibuprofen. However, both of these drugs can be associated with potentially significant adverse effects. We present here the cases of 5 preterm infants (gestational age: 26-32 weeks; postnatal age: 3-35 days) with large, hemodynamically significant patent ductus arteriosus who had either failed or had contraindications to ibuprofen therapy. Each of these infants was treated with off-label oral paracetamol (15 mg/kg per dose every 6 hours). Ductal closure was achieved within 48 hours in all the treated infants. No toxicity was observed.

AMA, especially primiparous, has more adverse maternal and neonatal outcomes than younger women; however, these did not include mortality. Consistent antenatal care may explain this.

Objective: To determine normal concentrations of procalcitonin in preterm infants shortly after birth and to assess its accuracy in detecting bacterial infection. Methods: Blood samples of 100 preterm infants were prospectively drawn during the first 4 days of life for determination of procalcitonin concentration. Infants were classified into four groups according to their sepsis status. Results: Mean (SD) gestational age and birth weight were 32 (2.9) weeks and 1682 (500) g respectively. A total of 283 procalcitonin concentrations from healthy infants were plotted to construct nomograms of physiologically raised procalcitonin concentration after birth, stratified by two groups to 24-30 and 31-36 weeks gestation. The peak 95th centile procalcitonin concentration was plotted at 28 hours of age; values return to normal after 4 days of life. Only 12 infants were infected, and 13 of their 16 procalcitonin concentrations after birth were higher than the 95th centile, whereas samples taken at birth were lower. In a multivariable analysis, gestational age, premature rupture of membrane, and sepsis status influenced procalcitonin concentration independently, but maternal infection status did not. Conclusions:The suggested neonatal nomograms of preterm infants are different from those of term infants. Procalcitonin concentrations exceeding the 95th centile may be helpful in detecting congenital infection, but not at birth.

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The annual rate of Down syndrome (DS) births in Jerusalem is stable, regardless of prenatal screening, and diagnostic measures. We aimed to evaluate our historical cohort for obstetrical characteristics and the neonatal course and complications. We reviewed computerized medical files of neonates with the diagnosis of DS born in the four main hospitals in Jerusalem between the years 2000 and 2010 and evaluated for maternal history and primary neonatal hospitalization. A total of 403 neonates were diagnosed with DS. The average maternal age was 35.6 years, 73% were born via spontaneous vaginal delivery. In all gestational ages, the mean birth weight and head circumference percentiles were significantly lower than the general population (P < 0.001 for both) and at each week the HC percentile was lower than the weight percentile (P < 0.0001), worse among males. Mortality during the primary hospitalization was 3.7%. The most common anomalies were cardiac (79%) with either congenital defects or functional abnormalities, neither influenced the length of hospitalization. The main reasons for prolonged hospitalization were prematurity and anomalies of other (non-cardiac) organs. Common perinatal complications included respiratory failure or need for oxygen supplementation (32%), hyperbilirubinemia (23%), sepsis (6.4%), and feeding difficulties (13%). About 84% were fed by human milk; of those, two thirds were exclusively breast-fed and one third were supplemented with infant formula. In conclusion, infants with DS were small for gestational age with relatively reduced head circumference. Despite the increased rate of congenital anomalies and perinatal complications, most infants were discharged home in good medical condition and were exclusively breastfed.

Mild idiopathic lateral ventriculomegaly in the mid-trimester fetus can be accurately detected using modern prenatal ultrasonography. Since an abnormal karyotype has been reported in some of these cases, the present prospective study was designed to evaluate, first, the prevalence of mild idiopathic lateral ventriculomegaly in the general obstetric population and, second, to determine the incidence of abnormal fetal karyotype associated with mild idiopathic lateral ventriculomegaly. Eight cases of mild idiopathic lateral ventriculomegaly (0.15%) were detected among 5400 routine prenatal sonographic examinations, between 16 and 22 weeks' gestation. Three newborn infants were found to be normal; in one baby, spontaneous resolution of the lesion occurred in utero, and, among the other five cases, two had an abnormal karyotype: one had Down's syndrome, and one trisomy 18. A review of the English literature revealed that 12% of fetuses with mild idiopathic lateral ventriculomegaly have an abnormal karyotype. Since 3% of the fetuses with Down's syndrome can be visualized in utero with mild idiopathic lateral ventriculomegaly, the calculated risk for Down's syndrome when such lesions appear is about 3%. We, therefore, conclude that karyotypic study is warranted in the mid-trimester fetus with incidental findings of mild idiopathic lateral ventriculomegaly.

Aim: To determine the incidence of post-phototherapy neonatal plasma total bilirubin (PTB) rebound. Methods: A prospective clinical survey was performed on 226 term and near-term neonates treated with phototherapy in the well baby nursery of the Shaare Zedek Medical Center from January 2001 to September 2002. Neonates were tested for PTB 24 hours (between 12 and 36 hours) after discontinuation of phototherapy, with additional testing as clinically indicated. The main outcome measure, significant bilirubin rebound, was defined as a post-phototherapy PTB >256 mmol/l. Phototherapy was not reinstituted in all cases of rebound, but rather according to clinical indications. Results: A total of 30 (13.3%) neonates developed significant rebound (mean (SD) PTB 287 (27) mmol/l, upper range 351 mmol/l). Twenty two of these (73%) were retreated with phototherapy at mean PTB 296 (29) mmol/l. Multiple logistic regression analysis showed significant risk for aetiological risk factors including positive direct Coombs test (odds ratio 2.44, 95% CI 1.25 to 4.74) and gestational age ,37 weeks (odds ratio 3.21, 95% CI 1.29 to 7.96). A greater number of neonates rebounded among those in whom phototherapy was commenced (72 hours (26/152, 17%) compared with .72 hours (4/74, 5.4%) (odds ratio 3.61, 95% CI 1.21 to 10.77). Conclusion: Post-phototherapy neonatal bilirubin rebound to clinically significant levels may occur, especially in cases of prematurity, direct Coombs test positivity, and those treated (72 hours. These risk factors should be taken into account when planning post-phototherapy follow up.

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