Intestinal perforation, exchange transfusion, and P.V.C

Necrotising enterocolitis after neonatal cardiac catheterisation

Evidence of necrotising enterocolitis was found in 14 of 111 neonatal cardiac catheterisations. A close temporal relationship between investigation and the onset of necrotising enterocolitis was apparent in many cases but no predisposing factors could be identified.

Iatrogenic disease in the newborn

The role of intrapartum asphyxia and cerebral birth trauma as an important cause of perinatal mortality is well known and its contribution to perinatal morbidity as a cause of cerebral palsy is widely appreciated. This has led to more careful monitoring of pregnancy and labour, although monitoring techniques are not without hazard. The widespread availability of intensive care facilities for the newborn has resulted in the survival of many infants, particularly those of low birth weight, who might previously have died. Efficacious modes of treatment may, unfortunately, bring in their wake serious problems in the form of iatrogenic disease which may cause or contribute to rapid demise or whose effects may be fully apparent for many years. Ante natal investigations have also become frequently used and have their own hazards.

Evidence for an immune complex vasculitis in neonatal necrotising enterocolitis

Despite many attractive hypotheses, neonatal necrotising enterocolitis (NNEC) remains a disease of unknown aetiology. By means of the immunofluorescent direct sandwich technique we have demonstrated immune complex deposition in the small vessels of the diseased bowel wall. We believe this is the first report of evidence of an immunological reaction occurring in this disease.

Outbreak of necrotising enterocolitis caused by Clostridium butyricum

12 hospital-born babies had necrotising enterocolitis, of varying severity, within six weeks, 5 of them within ten days. The usually described predisposing causes were absent in most, though no baby was exclusively breast -fed. Evidence of the presence of Clostridium butyricum was found in the blood of 9 out of 10 babies examined. Cl. butyricum is probably a primary, not a secondary invader.

Necrotizing enterocolitis. Controlled study of 3 years' experience in a neonatal intensive care unit

During the 3 years 1972-74, 17 infants were treated for necrotizing enterocolitis (NEC) in the Neonatal Unit at University College Hospital. The incidence of the illness was 0.2% of live births in the hospital and 2.7% of those referred from elsewhere. The mean birthweight of the affected infants was 1832 g (range 878-3850 g) and mean gestational age 33 weeks (range 28-40 weeks). The illness was diagnosed at a mean age of 16 days (range 3-33 days). 14 infants (82%) survived. One infant developed NEC because of a volvulus, and another because of an apparently abnormal arterial supply to a segment of bowel. Each of the remaining 15 infants was matched with 3 control infants in order to see whether any factors predisposing to the development of NEC could be identified. Birth asphysia, the use of umbilical catheters, the length of time that these catheters were in place, and complications of catheterization were all significantly more frequent in the infants who developed NEC than in the controls. These findings support the view that hypoxia and ischaemia of the gut wall are important in the pathogenesis of NEC.

Neonatal necrotizing enterocolitis: 2. Perinatal risk factors

Forty-four infants were diagnosed as having necrotizing enterocolitis (NEC) during a 33 months' period; these represented 4% of all neonatal admissions. An increase in incidence was observed during this period, particularly in low-birth-weight infants weighing under 1,500 g. Perinatal risk factors occurring in infants preceding their onset of NEC are found also to be significantly more common in infants under 1,500 g compared with those between 1,500 and 2,499 g. When the incidence of these clinically associated conditions in infants with NEC are compared with the incidence in infants who did not have NEC in the same birth weight category, a difference can be demonstrated only in 4 out of the 23 analysed: prolonged rupture of membranes with amnionitis; birth asphyxia; hypertonic milk feeds; exchange transfusion. As NEC is possibly a disease of multifactorial aetiology, a multivariant analysis of the data is indicated to define the role of combined perinatal risk factors in the pathogenesis of this disease.

Determination of di-(2-ethylhexyl)phthalate in human placenta

A simple method has been devised for the analysis of di-(2-ethylhexyl)phthalate (DEHP) in human placenta which relies entirely on three rapid partition steps prior to gas chromatography with electron capture detection. The use of adsorption chromatography with all its attendant disadvantages for sample clean-up is eliminated in this procedure. Placental samples taken from women who had given birth to a normal baby contained 0.06 +/- 0.02 ppm of DEHP. The principal limitation of this method, and of any others, is the high blanks given by laboratory equipment and solvents. The reduction of contamination to workable levels is described.

Polyvinyl chloride T-tubes

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