Perinatal Idiopathic Hemochromatosis

We report the clinicopathologic features of an infant who died of a rare form of perinatal cirrhosis associated with idiopathic hepatic and extrahepatic parenchymal siderosis. The infant appeared normal at birth but soon became severely ill, following a progressively downhill course associated with hypoglycemia, metabolic acidosis, bleeding diathesis, jaundice, and shock. The infant died at 7 days of age. The manifestations were those of hepatic failure but mimicked sepsis and disseminated intravascular coagulation. Cirrhosis, giant cell transformation, and parenchymal iron deposition characteristic of perinatal idiopathic hemochromatosis, a recently emerging clinicopathologic entity of unknown etiology, were present in this infant. These clinical and pathologic features differ from other neonatal liver diseases in their acute onset immediately after birth, a catastrophic clinical course ending fatally, and the morphologic manifestation of significant iron overload

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Background: Maternal opioid exposure during pregnancy has various effects on neonatal health. Buprenorphine/naloxone and methadone are examples of medications for opioid use disorder (MOUD) used for the treatment of opioid use disorder (OUD). Research comparing the impacts of these MOUD modalities on neonatal outcomes when used to treat pregnant people with OUD remains limited. We evaluated the differences in outcomes between neonates with in-utero exposure to buprenorphine/naloxone versus methadone. Methodology: We performed a retrospective cohort chart review between October 15, 2008, and October 15, 2019, evaluating mother/neonate dyads at two medical centers in Michigan. The charts of female patients, aged 18+, with OUD and buprenorphine/naloxone or methadone treatment, were examined. The charts of the corresponding neonates were also examined. Multiple regression analysis was performed. Results: In total, 343 mother/infant dyads were included: 99 patients were treated with buprenorphine/naloxone and 232 patients were treated with methadone. The buprenorphine/naloxone group had significant differences in maternal age, hepatitis status, asthma, gestational age in weeks, neonatal intensive care unit (NICU) length of stay (LOS), neonatal opioid withdrawal syndrome (NOWS) peak score, birth head circumference, and birth weight compared to the methadone group at baseline. Adjusted multivariable regression analysis demonstrated neonates with exposure to buprenorphine/naloxone had a NOWS peak score 3.079 points less (95% confidence interval (CI): -4.525, 1.633; p = 0.001) and NICU LOS 8.955 days less (95% CI: -14.399, -3.511; p = 0.001) than neonates exposed to methadone. Conclusions: Neonates with in-utero exposure to buprenorphine/naloxone had significantly lower NOWS scores and shorter NICU LOS compared to neonates with in-utero exposure to methadone. These findings demonstrate that buprenorphine/naloxone is potentially a more favorable treatment for the reduction in metrics representing adverse neonatal outcomes in pregnant people with OUD than methadone

Psychiatric sequelae of low birth weight at 6 years of age

The study examined the association between low birth weight (LBW) (≤2,500 g) and attention deficit hyperactivity disorder (ADHD) in two socioeconomically disparate populations. LBW and normal birth weight (NBW) children from the 1983 to 1985 newborn lists of an urban and a suburban hospital in Southeast Michigan were randomly selected. A total of 823 children, 473 LBW and 350 NBW, participated. Data were gathered in 1990 to 1992, when the children were 6 to 7 years of age. The National Institute of Mental Health Diagnostic Interview Schedule for children—Parent version (DISC-P) was used to elicit information on DSM-III-R diagnoses of simple phobia, overanxious, separation anxiety, oppositional defiant, and ADHD. Teachers' ratings of behavior problems were obtained. LBW was associated with ADHD but not with childhood anxiety disorders or oppositional defiant disorder. The association was stronger in the urban than in the suburban population. Data from teachers' ratings revealed an association between LBW and attention problems. The prognostic significance of the observed psychopathology at 6 years of age requires follow-up assessment as the children mature.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44584/1/10802_2005_Article_BF01441637.pd