Volume 97, Issue 3

This study evaluates the effect of maternal depression on neonatal health status in premature infants during their initial hospitalization. Infants younger than 34 weeks' gestation born to nondrug abusing mothers were enrolled in the study. Thirty-one mother-infant pairs were identified. Maternal depression was evaluated by the Center for Epidemiologic Studies-Depression Scale (CES-D). Scores ~ 16 defined maternal depression. Initial infant physiologic health status was determined by the Score for Neonatal Acute Physiology (SNAP). In-hospital health status was assessed by the following variables: days receiving supplemental oxygen, days on mechanical ventilation (VENT), and days not on enteral feeding (NPO). Health status variables evaluated for long-term outcome included bronchopulmonary dysplasia at 28 days (BPD), BPD at 34 weeks' postmenstrual age (BPD-34), and intraventricular hemorrhage (IVH). Seventeen (55%) of 31 mothers manifested depression on the CES-D. No epidemiologic differences were found between this group and the nondepressed mothers. No differences in gestation or birth weight was detected between the preterm infants of depressed versus nondepressed others. The CES-D scores correlated significantly with SNAP (r = .36, P < .02). Infants of depressed mothers experienced significantly worse outcomes in the occurrence of BPD (P = .015), BPD-34 (P = .049), and IVH (P = .055). This study confirms that maternal depression occurs frequently in mothers of preterm infants and adversely affects the presenting neonatal health status of their babies during the initial hospitalization. Maternal depression was related to the severity of the initial neonatal illness and was significantly related to IVH and BPD. These factors may have long-term consequences for subsequent growth, neurodevelopment, and recurrence of related health problems.

To determine the influence of swimming on the incidence of otitis media in children, the authors designed a case control survey involving 32 children, aged 1 to 4 years, who were participating in swimming classes. Thirty control subjects were matched for age, race, and sex. The participants were pooled from the general pediatrics clinic and toddler swimming classes in Nassau County, New York. Parents completed it questionnaire gathering data over a 12-week study period during the winter months. Information was gathered regarding demographics, number of ear infections, history and frequency of swimming during the study period, presence of head submersion, day care center attendance, allergies, chronicmedical conditions, otolaryngology consultations, ear surgery, and air travel. Forty-three percent of nonswimmers compared with 19% of swimmers had one or more ear infections during the study period (P < .02). The remaining factors surveyed did not differ significantly between groups. A review of the literature yieldedtwo studies suggesting that swimming may have a beneficial effect on eustachian tube function and may indirectly decrease the occurrence of otitis media. Based on these findings, the authors conclude that there appears to be no basis to the commonly held belief that swimming may induce or exacerbate otitis media. In fact, the converse may be true.

Diagnosis of diastasis symphysis pubis in the postpartum period need not depend on radiographic findings. This diagnosis can be made with simple observation techniques. Entertaining a high index of suspicion and observation of the patient are the most important contributions the physician can make. Parameters triggering a tentative diagnosis would include, but not be limited to, a large infant, a small pelvis, a rapid second stage of delivery, or application of forces to abduct the thighs. The diagnosis of diastasis symphysis pubis should be ruled out if thefollowing conditions are present postpartum: the flattened abdomen (the postpartum "pooch" is absent); the patient is incontinent of urine when changing position from supine/prone to upright; the patient has pain in the hips or sacral region when walking; or the patient waddles when walking. The change in gait, or the pain on walking may not be noticed until 24 hours or more after delivery. However, the change in abdominal contour and incontinence is noticed immediately. Using these observational clues, the physician can institute treatment sooner, thereby expediting recovery.

Lyme disease is a multisystem illness that may affect the heart. Borrelia burgdorferi infection should be suspected in all patients with unexplained cardiac symptoms who are or who have been exposed to endemic areas. Prompt diagnosis and treatment are needed to avoid potentially life-threatening complications, as well as the inappropriate insertion of a permanent pacemaker. The author reviews the cardiac complications associated with Lyme disease, and provides diagnostic and therapeutic approaches for effective patient care.

Vascular headaches are a relatively common phenomenon. Increasing numbers of patients with headache are being considered for treatment with the selective serotonin-receptor agonist sumatriptan succinate because of its potential for pronounced therapeutic efficacy in selected patients. Sumatriptan-associated myocardial infarction occurred in a 50-year-old woman with a history of migraine headaches. Cardiac risk factors that must be considered in all patients with migraine before initiation of therapy include concomitant ergotamine use, postmenopausal state, male gender older than 40 years, family history of heart disease, cigarette smoking, hypertension, diabetes mellitus, as reviewed in this report.

A patient with a remote history of Hodgkin's lymphoma was seen with recurring bilateral pleural effusions, finally diagnosed as chylothorax after many thoracenteses. The patient also had a previous history consistent with chylous ascites. The only plausible etiology of the chylous effusions (and ascites) was previous radiation therapy to the chest and abdomen. This cause of nontraumatic chylothorax is unusual and has been described infrequently in the medical literature.