Ventriculitis in newborns with myelomeningocele

Article Abstract:

Infants born with myelomeningocele, a defect in the vertebrae with accompanying protrusion of the spinal cord and its surrounding membranes, require surgical closure of the spinal opening. The condition is associated with a variable degree of paralysis, mental retardation, and hydrocephalus (fluid accumulation in brain). Quick closure is generally advocated, as the incidence of central nervous system (brain and spinal cord) infection has been reported to increase from 8 percent to as much as 40 percent if surgery is not done within two days of birth. However, a recent study suggested that the condition does not require emergency surgery; the rate of illness and death is not dependent on the time of surgery, and prophylactic antibiotics may decrease the rate of complications and death. To better determine the factors that are associated with one serious complication, ventriculitis (infection of ventricles, fluid-filled cavities in brain), the records of 186 infants with myelomeningocele were evaluated. The sac enclosing protruding spinal cord was intact in 44 percent and was leaking in 56 percent. Sixty percent had no adverse criteria at birth such as widespread leg paralysis, hydrocephalus, or spinal curvature, while the remainder had one or more. Shunts to treat hydrocephalus were placed in 87 percent of infants within eight weeks after birth. Early (within 48 hours of birth) surgical closure was performed in 46 percent of newborns, while 42 percent had delayed (between three and seven days after birth) and 12 percent had late (after one week) closure. The timing of surgery was not significantly different between infants with intact or leaking sacs. Significantly more infants without adverse criteria had early surgery. Prophylactic antibiotics were given to 70 percent of newborns before surgical closure without apparent association to the medical status. Ventriculitis occurred in 7 percent of infants within one month after birth. Medical severity, time of back closure, and whether or not the sac was intact was not associated with the development of ventriculitis. However, of infants treated with delayed or late surgery, significantly fewer infants who were given antibiotics developed ventriculitis. The study indicates that preventive antibiotic therapy may decrease ventriculitis in patients with delayed surgical closure; considerations for the selection of antibiotics are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Infection, Brain, Myelomeningocele, Meningomyelocele

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Urine drug screening in mothers and newborns

Article Abstract:

Evidence regarding the negative effects of drug abuse on the fetus and newborn is mounting. However, little is known about the types of drugs found in newborn drug testing and the concordance of drugs found in the urine of both mothers and newborns. An analysis of urine drug screening was performed on 601 mothers and 339 newborns. Results were positive for any drug in 68.2 percent of the mothers; 38.8 percent tested positive for more than one drug; and 45.8 percent were positive for cocaine. Among the newborns, 15.3 percent tested positive for any drug; 21.1 percent were positive for more than one drug; and 41.6 percent were positive for cocaine. The increased urine sampling of irritable and hyperactive infants or cocaine's slow excretion from the body may explain the high concordance of cocaine in mothers and infants (84 percent). Mother-infant concordance for methadone was 67 percent, but for other drugs concordance was less than 21 percent. A lack of concordance could be explained by increased drug uptake in maternal tissues and kidneys, poor drug transfer through the placenta to the fetus, and delayed collection of urine from the infant. Newborn urine collection is often delayed when signs and symptoms of cocaine exposure withdrawal are delayed. A large number of urine samples had evidence of drugs commonly given in the hospital: meperidine (narcotic pain reliever), acetaminophen (pain reliever) and lidocaine (anesthetic). Cocaine is the most common drug found in the urine of mothers and newborns immediately after delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Case studies, Testing, Infants (Newborn), Newborn infants, Mandatory drug testing, Drug testing, Cocaine abuse, Urine, Urinalysis

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Cocaine's lethality increases during late gestation in the rat: a study of "critical periods" of exposure

Article Abstract:

Use of cocaine may be associated with more serious side effects in late pregnancy because of changes in estrogen or progesterone. Researchers administered various amounts of cocaine to pregnant rats in midpregnancy and late pregnancy. Rats receiving cocaine in midpregnancy did not experience any deaths. Rats in late pregnancy experienced deaths in proportion to the amount of cocaine received, with more deaths in the highest cocaine dosage group. Pregnancy-related hormones such as estrogen or progesterone are at their highest levels during late pregnancy. Estrogen levels may also be increased in oral contraceptive users.

Causes of, Pregnancy, Complications of, Pregnancy complications

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