BACKGROUND: The neonatal period is regarded as the first 4 weeks of extrauterine life. In the literature, there are numerous articles about the skin findings in neonates and the results of these studies show differences according to races and environmental factors. AIMS: Our objective was to evaluate the skin lesions seen in neonates delivered in our hospital and to determine their relationship to gender, gestational age and route of delivery. METHODS: Newborns delivered at the Obstetrics Clinics of our hospital between November 2007 and April 2008 were included in this study. Dermatologic examination was performed and relationship between the 10 most common skin findings and gender, gestational age and route of delivery were statistically evaluated. RESULTS: A total of 572 newborns were examined for the presence of skin lesions. Most common skin findings were Epstein pearls (58.76%), sebaceous hyperlasia (48.45%) and xerosis (31.29%). Milia and sebaceous hyperplasia in girls, desquamation and xerosis in preterms, Epstein pearls, sebaceous hyperplasia and desquamation in vaginally delivered babies were found to be more frequent and the differences were statistically significant. CONCLUSION: We found that 90.7% of the neonates had one or more cutaneous lesions. Maturity and type of delivery of the babies were important factors in their causation. In Turkey, this study is the first study performed on the skin lesions seen during the neonatal period. With this study, we want to increase the awareness about the skin findings in neonates.

With the increasing survival of extremely preterm (EP) birth infants in the surfactant era, the longer-term outcome of infants born at the threshold of viability has become a vital topic of study. The goal of this investigation was twofold. First, while taking into account the influence of sociodemographic confounds, we wished to investigate neuropsychological outcome differences between two groups of EP preschoolers: 23-24 weeks (n = 20), and 25-26 weeks'(n = 21) gestation at delivery. Second, we wished to explore whether, within the population of EP preschoolers, gestational maturity accounts for a unique portion of the variance in neuropsychological outcome, over and above the variance explained by ante-, peri-, and neonatal complications, or treatment factors. The findings revealed group differences, ranging from .70 to .80 of a standard deviation in general intellectual abilities, nonverbal intelligence, and global motor performance, in favor of the more mature EP group. Additionally, gestational maturity was found to explain a unique portion of the variance in global intellectual and motor abilities. These findings are interpreted from the perspective that gestational age is an index of the vulnerability of the central nervous system to disruption of developmentally regulated processes.(JINS, 2009, 1-11.).

BACKGROUND: Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. OBJECTIVE: To report a series of five infants who developed tracheomegaly following FETO. MATERIALS AND METHODS: Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. RESULTS: Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. CONCLUSION: There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition.

AIM: To construct a predictive model for respiratory distress syndrome (RDS) from gestational age (GA) at delivery and TDx-FLM II value. METHODS: Pregnant women who underwent an amniocentesis in which TDx-FLM II was determined were included in the study. A model for the occurrence of RDS was constructed by means of a logistic regression procedure from TDx-FLM II values and GA at delivery. RESULTS: The mean value of TDx-FLM II was 47.11 mg/g. The mean GA at delivery was 33.4 weeks. The incidence of RDS was 7.8%(18/231). The optimal cutoff of predicted risk for respiratory distress was found to be 8.8%, resulting in a sensitivity and specificity of 89 and 83%, respectively. CONCLUSIONS: The adjustment of the TDx-FLM II value for GA at delivery results in a significant improvement in the predictive capacity of the test for the occurrence of RDS. The use of GA-specific cutoff values may simplify clinical decisions.

Chronic lung disease (CLD), defined as chronic oxygen dependency, is a common outcome of neonatal intensive care. It occurs most frequently in infants born very prematurely, but also in infants born at term who had severe lung disease and those with abnormal antenatal lung growth due particularly to reduction in fetal breathing movements, amniotic fluid volume or intrathoracic space. There are, however, other causes and the importance of antenatal infection/inflammation regarding impairment of antenatal lung growth is increasingly recognised. Affected infants can suffer chronic respiratory morbidity including an excess of respiratory symptoms and lung function abnormalities even in adulthood. Antenatal interventions directed at improving lung growth are available, but require testing inappropriately designed trials with pulmonary function at follow-up as an outcome.

OBJECTIVE: Fetal lung maturity (FLM) studies using vaginal pool can guide management in near-term gestations with rupture of membranes. Because an adequate sample may be difficult to collect using a syringe, we tested collection using a sterile sponge. STUDY DESIGN: In this prospective study, vaginal pool was collected via both a syringe and a sponge from each gravida. Study patients experienced rupture of membranes between 34-41 weeks of gestation. Each sample was analyzed using the TDx-FLM II assay and phosphatidylglycerol (PG) testing. RESULTS: Fifty patients were enrolled; 44 demonstrated concordant syringe/sponge results. There was 1 instance of mature TDx-FLM testing using a sponge but not a syringe; PG testing in this case was absent in both samples. Using the kappa statistic, agreement between the methods was "substantial" for TDx-FLM and "almost perfect" for PG. CONCLUSION: Collecting vaginal pool with a sponge may provide clinically useful information, particularly when PG is present.

OBJECTIVE: A lamellar body count (LBC)>or=50,000/microl is suggested to document fetal lung maturity (FLM). We sought to determine the LBC threshold for FLM with the Cell-dyn 4000 hematology analyser. METHODS: We queried our database for patients who underwent LBC testing from 2001 to 2007. Included were deliveries between 35 and 38 weeks gestation with testing <or=7 days from delivery. We excluded twins, anomalies and cases of ruptured membranes. Data were analysed for sensitivity and specificity of predicting respiratory distress syndrome (RDS) and plotted on a receiver operating characteristic curve. RESULTS: There were 209 patients meeting study criteria. Of these, 120 had diabetes. Five neonates experienced RDS, all born to non-diabetic mothers with LBC values <or=72,000/microl. At this value the sensitivity is 100%, false positive rate 18% and the p value is 0.0146. CONCLUSION: Our results question the 50,000/microl threshold and demonstrate the need for hematology analyser specific thresholds.

The reported incidence of the preterm deliveries in Bulgaria is 7-11% and it has increased in the recent years. The neonatal respiratory distress syndrome (NRDS) is the most frequent pulmonary disease caused by the biological immaturity. It affects 40-50% of the neonates born before 32 weeks of gestation and results in high morbidity and mortality. There is plenty of evidence, proving that the antenatal corticosteroid (CS) administration decreases the incidence of NRDS in preterm infants. OBJECTIVE: To study the influence of the implicated algorithm for antenatal prophylaxis of NRDS on the neonatal morbidity and mortality in premature infants. MATERIALS AND METHODS: Two groups of preterm neonates were studied. First group included preterm neonates either without or with a single application of CS before delivery. Second group consisted of preterm newborns with completed CS prophylaxis. The applied antenatal corticosteroid treatment included 4 doses of Betamethazon 7 mg i.m. in 12 hour intervals. It was indicated in cases of a preterm labor between 24-32 gestational weeks. The neonatal mortality, the incidence of NRDS and intraventricular hemorrhage (IVH), the neonatal intensive care unit (NICU) stay and treatment were compared between both groups. RESULTS: The incidence of NRDS, the need of exogenous surfactant treatment, and the incidence of severe IVH (grades II-IV) were significantly lower in the group with completed CS prophylaxis compared to the control group (p < 0.05). The neonatal mortality rate and the duration of NICU stay and treatment were also reduced among infants with antenatal CS. CONCLUSIONS: The antenatal treatment with CS reduces significantly the risk of development of NRDS and IVH 3d-4th degrees and the neonatal mortality rate of the prematurely born infants. It has also important influence on the duration of NICU stay and treatment and decreases the cost of the neonatal intensive treatment.

The increasing rates of repeat cesarean delivery necessitate, more than ever, the need to time deliveries to optimize neonatal outcomes. A recent large multicenter cohort study demonstrated that, contrary to current recommendations, a high proportion of elective cesarean deliveries in the USA are performed before 39 weeks' gestation. These early deliveries are associated with a significant increase in several adverse neonatal events, including respiratory complications, treated hypoglycemia, newborn sepsis and admission to the neonatal intensive care unit. This, together with results of previous studies, supports the recommendation to delay elective delivery to 39 weeks' gestation. From the current data, it is uncertain whether delivery before 39 weeks' gestation with documented fetal lung maturity will prevent the increased neonatal morbidity.

OBJECTIVES: The lecithin/sphingomyelin (L/S) ratio and the lamellar body count (LBC) can be used to predict respiratory distress syndrome (RDS). DESIGN: We performed a retrospective cohort study among consecutive women who underwent amniotic fluid sampling for the assessment of fetal lung maturity. Logistic regression was used to construct models for the prediction of RDS in three gestational age categories, with models based on clinical characteristics only, clinical characteristics and the LBC, and on clinical characteristics and L/S ratio. RESULTS: When amniotic fluid was collected <30 weeks, the specificity of the LBC was 30% and the sensitivity 100%. Addition of the L/S ratio increased the specifity to 60%, for a sensitivity of 100%. When amniocentesis was performed between 30 and 33 weeks, addition of the L/S ratio only marginally improved the performance of the LBC. CONCLUSIONS: At a gestational age <30 weeks, the L/S ratio has additional value over the LBC. Above 30 weeks of gestation, single use of the LBC seems sufficient.

Harlequin fetus, with an incidence of about 1 in 300.000 births, is an extremely severe form of congenital ichtyosis. We report a case of malignant keratoma: a male infant was born at 40 weeks' gestational age. The parents were first cousins. This infant was covered with massive thick, waxy, plate-like scales and deep fissures. There was striking facial distortion including severe eclabium and ectropion. The baby was transferred to the Neonatal Intensive Care Unit but he died at 2 days of age. There is limited information regarding the course and prognosis of neonates affected with Harlequin ichthyosis because most affected patients die within the first days or weeks of life. However, it is now evident that these infants, may have extended survival potential with intensive supportive measures as well as the addition of retinoids. Prenatal diagnosis for malignant keratoma had been performed by fetal skin biopsy and electron microscopic observation at 19-23 weeks estimated gestational age. In 2005, ABCA12 was identified as the causative gene for this disease. It has now become possible to make DNA-based prenatal diagnosis for Harlequin ichthyosis by chorionic villus or amniotic fluid sampling procedures in the earlier stages of pregnancy with a lower risk to fetal health and with a reduced burden on the mothers.

The aim is to present a document, which is based on current evidence and serves as a guideline for use in clinical practice. The following questions are addressed: Is the use of antenatal corticosteroids (ACS) an effective therapy? Who are the candidates for antenatal corticosteroid therapy? Is there benefit after 34 weeks' gestation? When is the optimal time to treat? Which are the optimal steroids; what is the ideal dose and route of administration? Are there any contraindications to the administration of ACS? Are antenatal corticosteroids indicated in women with premature rupture of membranes (PROM)? Is the use of ACS recommended in pregnancies complicated by maternal diabetes mellitus? Should the treatment with corticosteroids be repeated?

In Switzerland, the rate of respiratory distress in neonates needing hospitalization has doubled over the last thirty years, concerning in particular babies weighing more than 2500 g. In the same time, the rate of Caesarean section (CS) has also multiplied. We suppose that a link between the two evolutions might be the increase of elective CS. They tend to be planned early at term to avoid the onset of spontaneous labour As a consequence, the foetus is deprived of different mechanisms helping pulmonary transition around birth. The potential benefits of CS regarding morbidity of foetus and mother should not overshadow that CS is a significant risk factor for respiratory problems of the neonate. This risk could be dramatically decreased by planning elective CS only after completed 39 weeks of gestation.

Objective:In our laboratory, a decrease in fetal lung maturity (FLM) testing on amniotic fluid occurred over a 10-year period, and we desired to determine if this was a national phenomenon and, if present, ascertain possible etiologies.Study Design:Society of Maternal-Fetal Medicine fellows, both in academic centers and private practice, were surveyed with regard to current usage of FLM testing.Result:Of 680 surveys, 417 (61%) responses were returned and 60% noted a decrease in FLM testing (range of reduction-foam stability index 65%, fluorescence polarization 35%, phosphatidyl glycerol 71%, lecithin/sphingomyelin ratio 70%). The most common reason suggested for the decline is that the tests were not needed for patient management.Conclusion:Obstetric patterns of FLM testing have declined, principally in near-term pregnancies, and this could adversely affect neonatal outcome.Journal of Perinatology advance online publication, 15 November 2007; doi:10.1038/sj.jp.7211880.

Aim: To clarify the clinical features of pregnancy and neonatal respiratory problems associated with diffuse chorioamniotic hemosiderosis (DCH). Methods: Sixteen singleton cases of DCH without chorioamnionitis (CAM) were retrospectively analyzed and compared with gestation- and birthweight-matched controls (32 cases of CAM and 32 cases of non-DCH-non-CAM). Maternal symptoms and respiratory problems of the infants were investigated. Results: All 16 cases with DCH resulted in preterm delivery from 23 to 35 weeks' gestation. The presence of subchorionic hematoma in the first trimester (P < 0.001), recurrent vaginal bleeding (P < 0.001), brownish amniotic fluid (P < 0.001) and amniotic necrosis or degeneration (P < 0.001) were significantly more frequent in the DCH group compared to the CAM and non-DCH-non-CAM groups. The incidence of dry lung syndrome and persistent pulmonary hypertension of the newborn (PPHN) was significantly higher in the DCH group than in the CAM (P < 0.001) and non-DCH-non-CAM (P < 0.001) groups. Conclusion: Long-term exposure to degenerating red blood cells is supposed to damage amnion, fetal alveolar epithelial cells and fetal pulmonary arteries, and may lead to dry lung syndrome and PPHN in the infant complicated by DCH.