Esophageal lung is a rare congenital malformation. We present a full-term infant with an esophageal lung presenting as a white lung, dysmorphic features, and VACTER association. Right pneumonectomy was successfully performed. This is the first report of esophageal lung associated with the VACTER group of anomalies combined with dysmorphic features.

Background: Nipple dimensions may be an important factor in breastfeeding (BF) initiation success.Objective: To establish standards of nipple/areola dimensions in early BF and to determine whether maternal age, gestational age (GA), parity, cup size, previous BF experience, and early (<2 hours) BF affect nipple dimensions (assessed on the second day of BF).Design/Methods: A total of 205 consecutive BF women were enrolled. They were all Caucasians, and had uncomplicated pregnancies, labors, and vertex vaginal deliveries. Measurements (immediately before and after BF) of nipple length and diameter and of prefeeding areolas were by sliding calipers.Results: In average, there were no significant differences between right (R) and left (L) side dimensions, except for post-BF nipple length, and post-BF horizontal nipple diameter (significantly higher on the L side). Both R and L nipple length correlated positively with maternal age, gravidity, parity, number of previously breastfed infants, and cumulative number of BF months. Early (<2 hours) first BF did not correlate with increased nipple length. Pre-BF nipple length correlated significantly with post-BF nipple length on both sides. There were significant differences between pre- and post- BF values in terms of nipple length (longer length post-BF), but not in terms of nipple diameter. In stepwise regression analysis, where pre-BF nipple length was the dependent variable, and parity (or maternal age, or previous BF), early first BF, and GA were independent variables, parity, maternal age, gravidity, or previous BF experience were positively and significantly associated with nipple length (p < 0.001). The correlation maternal age-nipple length remained significant in primigravida mothers.Conclusions: This study provided a set of standards for nipple and areola dimensions on day 2 of BF in Caucasian women. The only areola/nipple dimension significantly affected by BF is the nipple length. Increasing parity, maternal age, or previous BF experience is significantly associated with increased nipple length.

Retrognathia (recessed chin) and prognathism (prominent chin) often present as signs of an underlying condition. Accurate clinical definitions are important. Yet their definitions were according to "clinical impression", or to seldom used X-ray criteria. We propose a statistical and anthropometric definition of retrognathia and prognathism based upon the ratio between the goniomaxillar length (distance between the gonion at the mandible angle and the subnasale and the goniomandibular length (distance between the mandible angle and the most anterior point of the bony chin). We assumed that an increase in the ratio indicates retrognathia and a decrease reflects prognathism. We conducted a prospective, observational, anthropometric study in 204 consecutive healthy term infants. Measurements took place on the second day of life, using sliding calipers. Mean ± SD of goniomandibular length (5.1 ± 0.3 cm), goniomaxillar length (5.4 ± 0.3 cm), were calculated. All measurements correlated significantly with gestational age, and with infant birthweight. The mean ± SD goniomaxillar length/goniomandibular length ratio was 1.06 ± 0.05. We defined a normal ratio as being within 2 SD of the mean, that is, between 0.96 and and 1.16. This ratio correlated with neither gestational age nor with birthweight. We conclude that the goniomaxillar length/goniomandibular length ratio can be calculated whenever retro - or prognathism is suspected. A ratio outside of the 95% confidence interval should help in making this diagnosis. An increase in this ratio beyond 2 SD above the mean (1.16) could be interpreted as retrognathia and a decrease beyond 2 SD below the mean (0.96) as prognathism.

Breast milk is an excellent nutritional source for newborns, and a change in its color can be alarming to both mother and physician, and may prevent breastfeeding. Different colors of breast milk have been reported such as blood-stained, blue, and bluish-green. We present the first case of green breast milk caused by maternal ingestion of blue-green algae pills immediately before and after delivery. The score on the Naranjo Adverse Drug Reaction Probability Scale was 5, indicating a probable adverse drug reaction. Laboratory analysis yielded no other abnormalities in the milk. The mother stopped taking the supplement, and the milk returned to its normal appearance 3 days later. This report should alert physicians to include supplement intake as part of the anamnesis for new mothers who present with breast milk changes.

Objective: To evaluate maternal and breastfed infant's outcome following post-partum maternal use of methylergonovine.Methods: A prospective, controlled observational study design was used. Mothers who contacted Beilinson Teratology Information Service (BELTIS) were followed by phone interview. Data on lactation, neonatal symptoms and outcomes at the age of 1-3 years were obtained. Mothers' breastfeeding while treated with methylergonovine and their infants were compared to a matched control group of breastfeeding mothers using a drug known to be safe during lactation (amoxicillin).Results: Follow-up was obtained for 38 of 42 women (90.5%). Of whom, six stopped breastfeeding because of concerns regarding drug treatment and three refused to participate. The remaining 29 women and infant pairs were compared to a control group of 58 women and their infants. Comparison showed no effect of methylergonovine on lactation and similarly showed no difference in rate of neonatal complications (p = 1). At time of follow-up there were no differences in growth or in adverse neurodevelopment outcomes (p = 0.26).Conclusions: No increase in adverse long-term outcomes was found in infants exposed to methylergonovine through breastfeeding. Our data in conjunction with previous estimates of very low drug exposure support continuation of breastfeeding in women requiring treatment with methylergonovine.

The association between maternal diabetes mellitus and congenital malformations in newborns may well be causal; however, the teratogenic mechanism remains unclear. The prevalence and the described type of malformations vary among different studies, and a predictable malformation syndrome has not been identified. The chapter discusses the prevalence and types of structural congenital malformations in infants of mothers with diabetes mellitus (IDM) or gestational diabetes mellitus (IGDM). The congenital malformations of IDM and IGDM constitute a spectrum known as diabetic embryopathy. This spectrum implies errors of morphogenesis that appear between the third and the seventh week of embryonic development. Cardiac malformations are the most common congenital malformations of IDM, and they occur significantly more often in IDM than in infants of nondiabetic mothers. Maternal diabetes mellitus and gestational diabetes with fasting hyperglycemia are associated with a twofold to threefold increase in the risk of congenital malformations in offspring compared with the general population.

OBJECTIVE:To investigate pregnancy outcomes following maternal use of pregabalin.METHODS:This multicenter, observational prospective cohort study compared pregnancy outcomes in women exposed to pregabalin with those of matched controls (not exposed to any medications known to be teratogenic or to any antiepileptic drugs). Teratology Information Services systematically collected data between 2004 and 2013.RESULTS:Data were collected from 164 exposed pregnancies and 656 controls. A significantly higher major birth defect rate in the pregabalin group was observed after exclusion of chromosomal aberration syndromes, and when cases with exposure during first trimester of pregnancy were analyzed separately (7/116 [6.0%] vs 12/580 [2.1%]; odds ratio 3.0, 95% confidence interval 1.2-7.9, p = 0.03). The rate of live births was lower in the pregabalin group (71.9% vs 85.2%, p < 0.001), primarily due to a higher rate of both elective (9.8% vs 5.0%, p = 0.02) and medically indicated (5.5% vs 1.8%, p = 0.008) pregnancy terminations. In the Cox proportional cause specific hazards model, pregabalin exposure was not associated with a significantly higher risk of spontaneous abortion.CONCLUSIONS:This study demonstrated a signal for increased risk of major birth defects after first trimester exposure to pregabalin. However, several limitations such as the small sample size, differences across groups in maternal conditions, and concomitant medication exposure exclude definitive conclusions, so these results call for confirmation through independent studies.

This chapter studies treatment with anticoagulants (heparin and derivatives), as well as with thrombin- and factor Xa-inhibitors, all of which are acceptable during breastfeeding, while decisions on limiting breastfeeding should be made in individual cases. Except for low dose acetylsalicylic acid, all other thrombocyte aggregation inhibitors should be used during lactation only if other alternatives are lacking. There are no human studies on the usage of fibrinolytics and antihemorrhagics during lactation, although animal experimental data using some antihemorrhagics like eltrombopag reaches rat pups through the mother’s milk. However, indications are that limitation on breastfeeding while taking these compounds are not justifiable.

This multicenter, observational prospective cohort study addresses the risk associated with exposure to mirtazapine during pregnancy. Pregnancy outcomes after exposure to mirtazapine were compared with 2 matched control groups: (1) exposure to any selective serotonin reuptake inhibitor (SSRI, control subjects with a psychiatric condition) and (2) no exposure to medication known to be teratogenic or any antidepressant (general control subjects). Data were collected by members of the European Network of Teratology Information Services between 1995 and 2011. Observations from 357 exposed pregnancies were compared with 357 pregnancies from each control group. The rate of major birth defects between the mirtazapine and the SSRI group did not differ significantly (4.5% vs 4.2%; odds ratio [OR], 1.1; 95% confidence interval [95% CI], 0.5–2.3; P = 0.9). A trend toward a higher rate of birth defects in the mirtazapine group compared with general control subjects (4.5% vs 1.9%; OR, 2.4; 95% CI, 0.9–6.3; P = 0.08) reached statistical significance after exclusion of chromosomal or genetic anomalies (4.1% vs 1.3%; OR, 3.3; 95% CI, 1.04–10.3; P = 0.03), but this difference became again nonsignificant if cases of exposure not comprising the first trimester were excluded from the analysis (3.4% vs 1.9%; OR, 1.8; 95% CI, 0.6–5.0; P = 0.26). The crude miscarriage rate did not differ significantly between the mirtazapine, the SSRI, and the general control groups (12.1% vs 12.0% vs 9.3%; P = 0.44). However, a higher rate of elective pregnancy termination was observed in the mirtazapine group compared with SSRI and general control subjects (7.8% vs 3.4% vs 5.6%; P = 0.03). This study did not observe a statistically significant difference in the rate of major birth defects after first-trimester exposure between mirtazapine, SSRI-exposed, and nonexposed pregnancies. A marginally higher rate of birth defects was, however, observed in the mirtazapine and SSRI groups compared with the low rate of birth defects in our general control subjects. Overall pregnancy outcome after mirtazapine exposure was similar to that of the SSRI-exposed control group.

This multicenter, observational prospective cohort study addresses the risk associated with exposure to mirtazapine during pregnancy. Pregnancy outcomes after exposure to mirtazapine were compared with 2 matched control groups: (1) exposure to any selective serotonin reuptake inhibitor (SSRI, control subjects with a psychiatric condition) and (2) no exposure to medication known to be teratogenic or any antidepressant (general control subjects). Data were collected by members of the European Network of Teratology Information Services between 1995 and 2011. Observations from 357 exposed pregnancies were compared with 357 pregnancies from each control group. The rate of major birth defects between the mirtazapine and the SSRI group did not differ significantly (4.5% vs 4.2%; odds ratio [OR], 1.1; 95% confidence interval [95% CI], 0.5-2.3; P - 0.9). A trend toward a higher rate of birth defects in the mirtazapine group compared with general control subjects (4.5% vs 1.9%; OR, 2.4; 95% CI, 0.9-6.3; P = 0.08) reached statistical significance after exclusion of chromosomal or genetic anomalies (4.1% vs 1.3%; OR, 3.3; 95% CI, 1.04-10.3; P = 0.03), but this difference became again nonsignificant if cases of exposure not comprising the first trimester were excluded from the analysis (3.4% vs 1.9%; OR, 1.8; 95% CI, 0.6-5.0; P = 0.26). The crude miscarriage rate did not differ significantly between the mirtazapine, the SSRI, and the general control groups (12.1% vs 12.0% vs 9.3%; P = 0.44). However, a higher rate of elective pregnancy termination was observed in the mirtazapine group compared with SSRI and general control subjects (7.8% vs 3.4% vs 5.6%; P = 0.03). This study did not observe a statistically significant difference in the rate ofmajor birth defects after first-trimester exposure between mirtazapine, SSRI-exposed, and nonexposed pregnancies. A marginally higher rate of birth defects was, however, observed in the mirtazapine and SSRI groups compared with the low rate of birth defects in our general control subjects. Overall pregnancy outcome after mirtazapine exposure was similar to that of the SSRI-exposed control group.

Objective: To assess the association between gestational age at delivery and adverse neonatal outcome among term low-risk singleton neonates.Methods: A retrospective cohort study design was used. The study group included all low-risk singleton term (37 + 0 to 41 + 6 weeks) newborns delivered in a single tertiary university-affiliated medical center over a 5-year period. Outcome of neonates delivered at 37 + 0 to 37 + 6 weeks of gestation (early term) and 41 + 0 to 41 + 6 weeks of gestation (late term) was compared to that of neonates delivered at 39 + 0-39 + 6 weeks of gestation (control).Results: Overall, the outcome of 30 229 neonates was analyzed. The incidence of neonatal mortality was 1.0 per 1000 live-born neonates, with no significant difference between the various gestational age groups. Early term newborns were at higher risk for respiratory morbidity, hypoglycemia, hypocalcemia, thrombocytopenia and unexplained jaundice, and had higher rates of prolonged hospital stay, NICU admission, sepsis workup and antibiotic treatment. On multivariate analysis, early term delivery was an independent predictor for composite respiratory morbidity (OR = 2.4, 95% CI 1.6-3.8, p < 0.001), unexplained jaundice (OR = 2.1, 95% CI 1.7-2.5, p < 0.001), hypoglycemia (OR = 2.5, 95% CI 1.5-4.3, p < 0.001) and NICU admission (OR = 1.9, 95% CI 1.5-2.5, p < 0.001). Late term neonates had a significantly higher rate of large for gestational date, but did not differ from controls with respect to the rate of composite neurologic or respiratory complications, NICU admission, birth trauma or infectious morbidity.Conclusion: Even in low-risk singleton deliveries, early term is associated with an increased risk of neonatal morbidity.

BACKGROUND:Monitoring infant growth is essential for evaluation of development and is an important indicator of health and illness. Length is an essential indicator of infant growth, however, length measurement methods suffer from limitations which restrict their use.OBJECTIVE:To improve infant length measurement by development of a novel, accurate, precise and practical measurement technique.METHODS:A new system based on stereoscopic vision was developed. The system is comprised of two digital still cameras combined with software that calculates the infant's length from two simultaneously taken pictures. Length measurements of 54 healthy newborns were performed using a standard length board and the stereoscopic system. The two measurement methods were compared.RESULTS:Mean infant length was 473.1 (SD=29.1) mm versus 473.3 (SD=29.3) mm by length board and by the stereoscopic system, respectively. The mean difference between measurements was 0.2 (SD=2.5) mm and the mean of the absolute values of differences was 2.0 (SD=1.4) mm. Bland-Altman analysis showed good agreement between the two measurement methods. Precision of the new technique was demonstrated by a technical error of measurement of 2.57 mm.CONCLUSIONS:The stereoscopic system is accurate, reliable, easy to use, and involves less handling and discomfort to the newborns. It has the potential to measure premature infants or sick neonates through incubators.

BACKGROUND Diclectin (pyridoxine 10 mg and doxylamine 10 mg) has traditionally been used to treat nausea and vomiting of pregnancy (NVP); however, this drug is unavailable in many countries. OBJECTIVES To evaluate the efficacy and safety of a simple bi-daily treatment regimen with the combination of pyridoxine (50 mg twice daily) and doxylamine (25-50 mg) as an alternative treatment for NVP. METHODS A prospective case-controlled observational study of mother-infant pairs was conducted between February 2008 and December 2010. All women who contacted the Beilinson Teratology Information Service (BELTIS) regarding treatment of NVP were eligible for inclusion. Using data on NVP severity, treatment efficacy and outcomes, we compared the two groups of women: those treated with the combination of pyridoxine and doxylamine (treatment group, n=29) and those treated with metoclopramide (control group, n=29). RESULTS Moderate to severe symptoms were present in 97% of the treatment group women vs. 69% of control group women (P < 0.01). Despite increased symptom severity in the treatment group, the combination regimen was efficacious: 20/29 (69%) vs. 18/25 (72%) in the treatment vs. control women respectively (P = 0.65). There were no congenital anomalies in the treatment group. Follow-up was normal for all infants. CONCLUSIONS Bi-daily combination therapy with pyridoxine and doxylamine for NVP is safe, has comparable efficacy to metoclopramide, and is a treatment alternative in countries where Diclectin is not available. Despite symptoms warranting counseling by a teratology information service, more than a third of women do not take the suggested treatment.

Birth Defects Research Part A: Clinical and Molecular TeratologyVolume 94, Issue 11 p. 961-961 Correspondence Letter to the editor: Neurodevelopmental outcomes following prenatal exposure to serotonin reuptake inhibitor antidepressants: A “social teratogen” or moderator of developmental risk Gil Klinger, Corresponding Author Gil Klinger [email protected] Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel Beilinson Teratology Information Service, Rabin Medical Center, Petach Tikva, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelNeonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva, Israel, 49202===Search for more papers by this authorPaul Merlob, Paul Merlob Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel Beilinson Teratology Information Service, Rabin Medical Center, Petach Tikva, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this author Gil Klinger, Corresponding Author Gil Klinger [email protected] Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel Beilinson Teratology Information Service, Rabin Medical Center, Petach Tikva, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelNeonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva, Israel, 49202===Search for more papers by this authorPaul Merlob, Paul Merlob Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel Beilinson Teratology Information Service, Rabin Medical Center, Petach Tikva, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this author First published: 25 October 2012 https://doi.org/10.1002/bdra.23089Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES Hanley GE,Oberlander TF. 2012. Neurodevelopmental outcomes following prenatal exposure to serotonine reuptake inhibitor antidepressants: A “social teratogen” or moderator of developmental. Birth Defects Res A Clin Mol Teratol 94: 651– 659. Levinson-Castiel R,Merlob P,Linder N, et al. 2006. Neonatal abstinence syndrome following in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adol Med 160: 173– 176. Klinger G,Frankenthal D,Merlob P, et al. 2011. Is selective serotonin reuptake inhibitor induced neonatal abstinence syndrome associated with adverse long-term outcome? J Perinatol 31: 615– 620. Volume94, Issue11November 2012Pages 961-961 ReferencesRelatedInformation

OBJECTIVE:To investigate the association between gender and birth trauma in full-term infants.METHODS:A retrospective, cohort, case-control study was conducted. All singleton full-term neonates born in 1986-2009 and diagnosed with birth trauma (ICD9-CM codes 767.0-767.9) were identified from the hospital's computerized birth-discharge records. The study group was matched in a 2:1 ration with neonates delivered immediately after each index case of neonatal trauma.RESULTS:Of the 118, 280 singleton full-term infants delivered during the study period, 2876 (24/1000) experienced birth trauma. The most frequent birth traumas were scalp injury (63.9%) and clavicle fracture (32.1%). The overall risk of birth trauma was unrelated to fetal gender. However, fetal male gender was a significant and independent risk factor for scalp injury (OR=1.31, 95%-CI 1.15-1.49), and female fetal gender was a significant and independent risk factor for clavicle fracture (OR=1.27, 95%-CI 1.09-1.49). The significance of these associations persisted even after adjustment for potential confounders including mode of delivery, gestational age, neonatal length, timing of delivery, head circumference, parity, and birth weight.CONCLUSION:Fetal gender appears to be a predisposing risk factor for specific types of birth trauma. Further studies are needed to investigate the reasons for this observation.

BACKGROUND:The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS:The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS:Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35-2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS:On average, EA affected 1 in 4099 births (95% CI, 1 in 3954-4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. Birth Defects Research (Part A), 2012.

Use of 17-alpha-hydroxyprogesterone caproate for the prevention of spontaneous preterm birth in women at risk is reviewed. Early studies regarding this topic reached contradicting conclusions, however recent studies showed that weekly injections of 17-alpha-hydroxyprogesterone caproate beginning at 16-20 weeks' gestation resulted in a substantial reduction in the rate of spontaneous recurrent preterm birth. Long-term follow-up of children exposed in-utero to the drug has shown normal growth and development and normal scores for gender specific roles. In conclusion, 17-alpha-hydroxyprogesterone caproate is currently the only drug with sufficient evidence to support its use for prevention of spontaneous recurrent preterm birth. (C) 2011 Elsevier Inc. All rights reserved.