A priori choice of neuraxial labour analgesia and breastfeeding initiation success: A community-based cohort study in an Italian baby-friendly hospital

Objective To investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth. Design Single-centre community-based cohort study. Setting An Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015. Participants Inclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. Exclusion criteria: women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia. Results Compared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16). Conclusions Compared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS

A case of Hennekam syndrome diagnosed at birth

We report on a male infant with lymphedema, facial anomalies, intestinal lymphangiectasia consistent with a diagnosis of Hennekam syndrome. Lymphedema was particularly severe in the periorbital region, on the lower arms and lower legs, and on the penis and scrotum. The condition was diagnosed very shortly after the patient's birth. We review the literature, consisting of fourteen cases reported

Lymphoscintigraphic evaluation of congenital lymphedema of the newborn.

The authors present a case of the Hennekam syndrome diagnosed in a newborn. Lymphedema is usually present in this syndrome, and the lymphoscintigraphic imaging findings for its detection are discussed. This case confirms the utility of lymphoscintigraphy in providing important physiologic and anatomic information for pre-surgical planning. An etiologic diagnosis could possibly be obtained. The procedure is relatively easy to perform, safe, reliable, minimally invasive, and not uncomfortable for the patient. It should be considered a valuable diagnostic tool, especially in newborns, in whom conventional contrast lymphoangiography is difficult to perform

Congenital chylothorax in neonatal age

Chylothorax is the accumulation of chyle or lymph fluid in the pleural cavity. Congenital chylothorax is a rare cause of respiratory distress in the newborn and is the most common form of pleural effusion in the neonatal period. We report 4 clinical cases of chylothorax of the neonatal age and discuss various congenital malformed conditions that can be associated with chylothorax

Diagnostic protocol for lymphoscintigraphy in newborns.

The purpose of this methods paper is to offer pediatricians and nuclear medicine physicians a diagnostic protocol for performing lymphoscintigraphy in newborns that may be useful for enhancing diagnosis and management of newborns with congenital lymphatic abnormalities. Indications for lymphoscintigraphy, choice of tracer, optimal dose, routes of administration, methods of data acquisition, timing, and interpretation of results for newborns are presented and discussed

Diagnostic protocol for lymphoscintigraphy in newborns

The purpose of this methods paper is to offer pediatricians and nuclear medicine physicians a diagnostic protocol for performing lymphoscintigraphy in newborns that may be useful for enhancing diagnosis and management of newborns with congenital lymphatic abnormalities. Indications for lymphoscintigraphy, choice of tracer, optimal dose, routes of administration, methods of data acquisition, timing, and interpretation of results for newborns are presented and discusse

Erythropoietin therapy in a case of neonatal anemia after exposure to natalizumab throughout pregnancy

Background: Natalizumab is a monoclonal antibody approved for the treatment of patients with relapsing-remitting multiple sclerosis. According to the current clinical recommendations, its use during pregnancy should be carefully evaluated only in women with highly active disease who plan a pregnancy or have an unplanned pregnancy, after accurate counseling about eventual maternal disease relapse due to therapy suspension. Case presentation: This brief case report describes a case of documented anemia that we observed in a newborn whose mother with relapsing-remitting multiple sclerosis was treated with an extended dosing protocol of natalizumab throughout pregnancy. The newborn received the infusion of erythropoietin every seven days from the fortieth day of life; subsequently, the status of anemia underwent clinical resolution. Conclusions: This case report confirmed that natalizumab can cause disorders of hematopoiesis, including anemia, thrombocytopenia, or pancytopenia, in newborns of patients treated during pregnancy. A multidisciplinary team, including experienced pediatricians and pediatric hematologists, has a critical role in managing newborns delivered by women, being treated with natalizumab for treating relapsing-remitting multiple sclerosis during pregnancy