William A. Blanc

A controlled clinical trial was designed to test the relative effectiveness of two prophylactic antibacterial regimens administered to premature infants in the first 5 days of life. Infants who received penicillin/sulfisoxazole (diethanolamine) died at a significantly higher rate than those who received oxytetracycline. The incidence of kernicterus was significantly higher among infants who received penicillin/sulfisoxazole (diethanolamine).

Sixty-four cases of necrotizing enterocolitis are reviewed. The diagnosis was based on tissue examination in 57 and on the clinical syndrome, including pneumatosis, in 7. Three factors are important in the development of the disease: injury to the intestinal mucosa, bacteria, and feedings. The indications for surgical intervention are pneumoperitoneum, signs of peritonitis, and intestinal obstruction. The importance of stress in the etiology of the disease is confirmed by the high incidence of perinatal complications, particularly hypoxia. The mortality was high, but results are improving with the institution of early aggressive treatment.

Male infants have an excessive risk of neonatal death by comparison with females. It has never been clear whether this male disadvantage is due to specific disease processes or is a general biologic feature of being male. In an analysis of 2,735 consecutive newborn autopsies, the ratio of males to females was 1.28:, which differs significantly from the 1.05:1 ratio for all U.S. livebirths. There was a near equal male to female ratio for most disorders in stillborn infants while disorders arising after birth demonstrated a strong male disadvantage. The still-born ratios presumably reflect a predominant maternal influence while birth and removal from the maternal environment uncovers an inherent biologic disadvantage of being male, a disadvantage not selectively related to specific disease processes. This nonspecificity is confirmed by the finding of several disorders in which sex ratios for stillborns are quite different than the ratios recorded for liveborn infants. The sex ratio for liveborn Caucasians was significantly greater than for nonwhites, and the nonpoor had a significantly greater ratio than the poor. About half of these differences appear related to a greater incidence of prenatal bacterial infections in the poor and nonwhites.

A new congenital syndrome characterized by the simultaneous failure of control of ventilation (Ondine's curse) and intestinal motility (Hirschsprung's disease) is reported in three infants, all of whom died in the first few months of life; two were siblings. Detailed studies in one also revealed markedly decreased esophageal motility and abnormal control of heart rate. In one infant, minute ventilation was lower in quiet than in REM sleep and lower in both states of sleep than in wakefulness. Although the mean inspiratory flow was decreased in quiet sleep, the hypoventilation resulted primarily from a decrease in respiratory frequency. Intravenous doxapram increased ventilation but did not reverse respiratory failure. Aminophyllin, progesterone, physostigmine and chlorpromazine did not change ventilation significantly; imipramine resulted in a significant decrease. Both long and short-term variability of the heart rate were markedly decreased when compared with the normal infant. Although neuropathologic studies postmorten did not reveal an anatomic defect, we postulate that a developmental abnormality in serotonergic neurons is responsible for this new syndrome.