We report a case of diffuse hepatic and cerebral infarction in a surviving preterm co-twin with twin-twin transfusion syndrome studied by ultrasound and confirmed by post-mortem examination.

Epidemiological data implicate the viral infection of respiratory tract in aetiology of SIDS. Similar histological findings are found in lungs of respiratory viral illness with fatal issue and lungs of SIDS where respiratory infection is observed for about 60% of cases. The histological appearance of respiratory viral infection is lymphoid inflammatory infiltrates in the upper and the lower respiratory tract. RSV is responsible of a severe bronchiolitis in infants aged 3 months or less, age of the higher incidence of MSN. In older infants alveolar and interstitial pneumonia may be observed. In some cases inflammatory changes in the cardiac conducting system and myocard are present. RSV is identified by different methods-culture, direct-immunofluorescence assay, ELISA on secretions and by culture, immunostaining on tissues. The respiratory viruses were detected with an incidence of 20 to 30%. Conflicting results and probably an underestimation of the true incidence are due to technical difficulties, post-mortem delay, low viral road. Newer more sensitive techniques, such as PCR and detection of IFNa must allow a better evaluation of the incidence of RSV and other viral infections and a better understanding of the mechanism of death in MSN.

PURPOSE To correlate magnetic resonance (MR) imaging and pathologic findings in premature infants with periventricular leukomalacia (PVL). MATERIALS AND METHODS Eight premature infants with PVL who died after 3-7 weeks of life were studied with in vivo T1-weighted MR imaging, and imaging patterns were compared with hypoxic-ischemic injuries at pathologic analysis. RESULTS Cavities were seen as zones of absent or weak signal intensity. Translucent sparsely cellular zones appeared as areas of intermediate intensity, and cellular reactions were seen as limited linear or punctate zones of increased intensity, usually less intense than the cortex. MR imaging provided reliable depiction of these lesions, with adequate estimation of their volume and topography. However, the extent of periventricular cellular lesions was underestimated. In one case, blood seen as hyperintense or isointense zones masked portions of cystic lesions, and in three cases small thalamic lesions were overlooked. CONCLUSION With the above limitations, T1-weighted MR imaging offers precise evaluation of PVL.

Background. Sudden death is the most common form of mortality in the first year of life following the neonatal period; its incidence peaks at 2-4 months of age. Few sudden deaths occur during the first week of life.Patients and methods. All cases of sudden and unexpected death occurring in maternity were studied over a period of 6 years (1985-1991). Anamnestic data, results of clinical examination of the body and findings of bacterial screening of body fluids or tissues were collected. The results at necropsy were also collected following the protocol used, with parental consent, in all cases of sudden infant death syndrome.Results. There were 31 cases of sudden and unexpected death. Of these, 48% occurred before the 24th hour of life, 68% before the 36th hour and 84% before the 72nd hour. The majority of death occurred at night (55% between midnight and 6 AM, 90% between 9 PM and 9 AM). Analysis of the data provided a precise cause of death in 25 cases (81%), and a probable cause in 4 cases (13%). The major causes were perinatal anoxia, generally associated with massive amniotic inhalation (16 cases), and maternal-fetal infection (9 cases). No cause was found in 2 cases. Despite the fact that the death occurred unexpectedly, haff of the newborns showed warning signs, some hours before the event. These signs were either not detected or ignored.Conclusion. The incidence of sudden death in neonates is 0.15 to 0.36/1,000 live births. Its causes are generally correlated with common neonatal diseases. Its occurrence at night and the existence of warning signs raise questions concerning the care of neonates in maternity.

PATIENTS AND METHODS:All cases of sudden and unexpected death occurring in maternity were studied over a period of 6 years (1985-1991). Anamnestic data, results of clinical examination of the body and findings of bacterial screening of body fluids or tissues were collected. The results at necropsy were also collected following the protocol used, with parental consent, in all cases of sudden infant death syndrome.RESULTS:There were 31 cases of sudden and unexpected death. Of these, 48% occurred before the 24th hour of life, 68% before the 36th hour and 84% before the 72nd hour. The majority of death occurred at night (55% between midnight and 6 AM, 90% between 9 PM and 9 AM). Analysis of the data provided a precise cause of death in 25 cases (81%), and a probable cause in 4 cases (13%). The major causes were perinatal anoxia, generally associated with massive amniotic inhalation (16 cases), and maternal-fetal infection (9 cases). No cause was found in 2 cases. Despite the fact that the death occurred unexpectedly, half of the newborns showed warning signs, some hours before the event. These signs were either not detected or ignored.CONCLUSION:The incidence of sudden death in neonates is 0.15 to 0.36/1,000 live births. Its causes are generally correlated with common neonatal diseases. Its occurrence at night and the existence of warning signs raise questions concerning the care of neonates in maternity.

A proper organization has been set up at Antoine-Béclère's hospital in order to study the infants who died suddenly. Between July 1985 and July 1987, 69 cases (10 babies less than 1 week of age) were admitted. The purpose of this work was, for the 59 sudden deaths of infants aged more than 1 week (35 males, 24 females), to present the results of a definite protocol of investigation (past history, clinical examination, laboratory and pathological data) for determining either the etiology or the mechanism of these deaths. A thorough investigation was performed in 45/52 cases (no autopsy in 7 cases). A definite diagnosis was possible in 38/45: 13 viral infections, 5 gastro-esophageal reflux, 13 viral infections associated with reflux, 9 with an additional event (massive alimentary inhalation, slipping under blankets, major hyperthermia) to either a viral infection or a reflux, 1 cardiac malformation, 1 metabolic disorder, 2 accidents and 1 infanticide. With this protocol, 7/45 deaths remained unexplained. This medical approach of the problem of sudden deaths in infants is beneficial to the counselling of the parents and to the management of subsequent children.

Thirty-nine neonates including 29 prematures had correlation studies of trans-fontanelle ultrasounds with post-mortem anatomic findings. Occipital hyper-echogenicity can be physiological when it is symmetric in the premature infant, and may indicate ischemia and/or anoxia when it is asymmetrical. No abnormal pathology went undetected by echo. Cortical gyri were never seen prior to 32 weeks gestational age.

A case of neonatal porencephalia is reported. It was due to antenatal hemorrhage associated with severe thrombocytopenia. Hematologic investigations showed a feto-maternal platelet incompatibility in the PLA1 system.

Various types of ischemic myocardial dysfunction can be observed after perinatal anoxia. Seven such cases are reported: 2 patients with cardiogenic shock due to left ventricle myocardial infarction; 2 patients with transient tricuspid insufficiency; 3 patients with transient myocardial ischemia in the course of a severe respiratory illness.