Cranial ultrasound abnormalities in full term infants in a postnatal ward: outcome at 12 and 18 months

OBJECTIVE: To investigate whether cranial ultrasound abnormalities found in low risk full term infants had any influence on neurodevelopmental outcome. METHODS: For 103 infants who had a neurological assessment, a cranial ultrasound examination, and for whom antenatal and perinatal data were collected within 48 hours of delivery, neurodevelopmental status was evaluated at 12 and 18 months. The results of a scored neurological examination and the Griffiths mental developmental scale were correlated with the presence and type of ultrasound abnormality found in the neonatal period. RESULTS: None of the infants with ultrasound abnormalities showed any signs of cerebral palsy or severe developmental delay. There was also no significant difference between the overall neurological and neurodevelopmental scores of the infants with normal and abnormal ultrasound findings. However, when the individual subscales of the Griffiths test were analysed, all infants with bulky choroid or intraventricular haemorrhage had normal scores in all subscales, four of eight with periventricular white matter lesions had low scores on the locomotor subscale, and three of five with asymmetrical ventricles had low scores on the performance subscale. The presence of adverse antenatal and perinatal factors did not affect the outcome in this group. CONCLUSION: Incidental ultrasound abnormality in full term neonates, in particular intraventricular haemorrhage, although common, appear to have a good prognosis. Longer follow up studies are needed to see whether some of these infants, in particular those with white matter lesions, develop dyspraxia or other minor neurological impairments at school age.     

新生儿缺氧缺血性脑病危险因素Logistic回归分析

目的分析围产期各种危险因素对新生儿缺氧缺血性脑病(HIE)发病的影响,寻求预防HIE发生及改善预后的方法.方法对179例HIE患儿性别、出生体重、临床表现、母亲孕期病史及分娩情况进行回顾性分析.同时随机抽取102例同期住院的新生儿肺炎、新生儿黄疸患儿作对照,应用Logistic回归分析的方法筛选HIE 发病的危险因素.结果两组患儿中9个围产因素存在统计学差异.应用Logistic 回归分析结果显示分娩方式、羊水污染、胎膜早破、脐带异常、Apgar评分异常等为主要危险因素.结论增强孕妇自我保健意识,加强围产期保健,提高基层医疗机构产科质量,根据不同产妇和胎儿的具体情况,采取适当的个体化干预措施,对预防和减少新生儿HIE的发生,降低围产儿死亡率和致残率具有重要意义.     

Early prediction of neurological outcome by term neurological examination and cranial ultrasound in very preterm infants

Aim: To assess the value of term neurological examination and cranial ultrasound in the early prediction of neurological outcome at 12 months corrected age in a cohort of very preterm infants.
Methods: A cohort of 102 preterm infants born at <32 weeks gestation or with a birth weight of <1500 g were assessed using the Hammersmith Term Neurological Examination. They underwent cranial ultrasound examinations according to local guidelines. The Hammersmith Infant Neurological Examination was performed at 12 months corrected age. Scores for the term examinations were compared with scores derived from healthy infants born at term and with scores from low-risk preterm infants at term equivalent age. Term neurological scores and cranial ultrasound findings were compared in the prediction of 12-month neurological outcome.
Results: Seventy-eight (76.5%) preterm infants had suboptimal total neurological scores at term when compared to healthy infants born at term. However, most went on to have optimal neurological scores at 12 months corrected age. When our cohort was compared with low-risk preterm infants at term equivalent age only 14 (13.7%) scored outside the normal range. Neither system of scoring predicted neurological outcome at 12 months corrected age as reliably as cranial ultrasound (sensitivity 0.83, specificity 0.87).
Conclusion: Neurological examination of preterm babies at term may be unreliable in the prediction of neurological outcome at 12 months corrected age. For early prediction of neurological outcome cranial ultrasound examination was found to be more reliable.     

Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review

OBJECTIVE: Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece. DESIGN AND PATIENTS: All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA<34 weeks (group A) and GA>34 (group B), and study period: 1989-1996 (period I) and 1997-2003 (period II, during which intrauterine transfer and prenatal steroids were used). RESULTS: CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA<34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period I, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period II, and for group B: SGA (3.6, 1.3-9.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16). CONCLUSION: Improvement in survival without CP was observed in infants of GA<34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA<34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA>34 weeks.     

复杂性胎粪性腹膜炎胎儿产前超声征象与新生儿结局的探讨

目的 探讨复杂性胎粪性腹膜炎胎儿产前超声征象与新生儿结局的关系.方法 20例产前超声诊断复杂性胎粪性腹膜炎,出生后经影像学检查或开腹手术确诊的胎儿.产前行动态B超监测,大量腹水胎儿行腹水减量.新生儿怀疑肠梗阻或穿孔者,行剖腹探查术.结果 复杂性胎粪性腹膜炎产前超声声像包括腹腔内钙化17/20(85%)、羊水过多13/20(65%)、腹水11/20(55%)、肠管扩张8/20(40%)、胎粪性假性囊肿3/20(15%).新生儿手术率为10/20(50%),新生儿术后病死率2/10(20%).Kamata I型和Ⅱ型较Ⅲ型手术率更高,分别为71.4%和41.7%,但差异无统计学意义(P=0.22).Kamata Ⅰ型和Ⅱ型较Ⅲ型生后病死率稍高,分别为14.3%和8.3%,但差异无统计学意义(P=0.61).结论 产前超声能预测胎儿复杂性胎粪性腹膜炎新生儿期手术风险.三级医院分娩、生后禁食、对有手术指征者及早手术有助于降低新生儿病死率.     

Preschool neurological assessment in congenital diaphragmatic hernia survivors: Outcome and perinatal factors associated with neurodevelopmental impairment

Objective

To evaluate the preschool neurodevelopmental outcome in CDH survivors between 2 and 5 years of age and to identify perinatal and postnatal factors that may be predictive of persistent neurological deficits.

Methods

The study cohort consists of 60 CDH survivors that were enrolled in our prospective, follow-up program between January 2006 and September 2012. Developmental assessment of study participants between 2 and 3 years of age was performed using the Bayley Scales of Infant Development, 3rd Edition (BSID-III). Cognitive outcomes of CDH children older than 3 years of age were evaluated using The Wechsler Preschool and Primary Scale of Intelligence, 3rd Edition (WPPSI-III). Neurodevelopmental delay was defined by a score of ≤ 85 in any of the evaluated composite scores. Severe impairments were defined as a score of ≤ 69 in at least one domain tested.

Results

Mean follow-up for children assessed by BSID-III (n = 42) and WPPSI-III (n = 18) was 28 ± 4.5 months and 58 ± 4.0 months, respectively. As a group, mean composite and subdomain BSID-III and WPPSI-III scores were within the expected normal range. For the BSID-III group, 9 (22%) had mild deficits in at least one domain, and 6 (14%) had severe deficits in at least one. Only 3 (7%) patients demonstrated severe neurological delays for all BSID-III composite scales. For the WPPSI-III group, 4 (22%) patients scored within the borderline-delayed range for at least one subscale and only one (6%) child had a WPPSI-III VIQ score in the severe delay range. Abnormal muscle tonicity was found in 35% (hypotonicity 33%, hypertonicity 2%). Need for ECMO, prolonged ventilation, hypotonicity, and other surrogate markers of disease severity (P < 0.05) were associated with borderline or delayed neurological outcome.

Conclusion

The majority of CDH children are functioning in the average range at early preschool and preschool age. Neuromuscular hypotonicity is common in CDH survivors. CDH severity appears to be predictive of adverse neurodevelopmental outcome.     

Neonatal cranial ultrasound abnormalities: association with developmental delay at age one in low birth weight infants.

Relationships between abnormalities on neonatal serial cranial ultrasound and cognitive development at age one year were examined in 153 low birth weight (LBW) infants. Infants with complex injury (persistent parenchymal echogenicity, lucency, or persistent ventricular enlargement) scored significantly lower on the Bayley Mental Development Index than noninjured infants. Nine of 11 infants with complex injury had severe developmental delay in contrast to 3/110 of the noninjured. Adjusting for birth weight, gestational age, head circumference and social class, infants with complex injury were 33 times more likely to be severely delayed than noninjured infants. Risk for severe delay associated with LBW appeared to be indirect, through increased probability of ultrasonographic abnormality. The poorest developmental outcome was seen in infants with both complex perinatal brain injury and either very LBW or very young gestational age. However, very LBW infants with normal neonatal ultrasounds were at negligible risk for severe delay at age one.     

Real time ultrasound scanning of the head in neonates and infants,including a correlation between ultrasound and computed tomography

The results of ultrasound (US) head scans performed in a children's hospital over a 6 month period have been reviewed and correlated with the results of computed tomography (CT). Two hundred and twenty-four scans were performed on 141 children ranging in age from a few days to 18 months. The clinical indications with which these children were referred were: abnormal neurological symptoms or signs, screening for hydrocephalus in neural tube defects (NTD), enlarging heads, suspected intra-cranial haemorrhage (ICH) and its sequelae, suspected complications of meningitis, investigations of suspected syndromes and following trauma. Twenty-nine of these children also had CT scans. There was good correlation between the two examinations and in only one case (a subdural collection) was a serious abnormality missed by US. US head scanning has been found to be a very reliable technique. It is the initial investigation of choice for imaging the brain of neonates and infants and in many instances it is the only investigation necessary.     

围产因素对早期早产儿淋巴细胞亚群演变趋势的影响

目的 了解早期早产儿淋巴细胞亚群变化趋势及围产因素的影响。方法 流式细胞术检测61例早期早产儿生后第1、7、14、28 天以及其中17 例早期早产儿出生后6 个月的淋巴细胞亚群水平。分析围产期因素的影响。结果 早期早产儿出生时除自然杀伤（NK）细胞外各亚群淋巴细胞绝对计数均处于最低水平,1 周时迅速升高,6 个月升至正常;NK 细胞至6 个月方增高。与胎龄P P 0.05）;第7、14 天的B 细胞绝对计数以宫内感染组较高（P P 结论 早期早产儿出生时免疫细胞数量不足,以后逐渐增高,6 个月左右达正常。母亲产前使用激素以及出生胎龄、宫内感染、UU 定植等多种围产因素对早期早儿淋巴细胞亚群水平有较长时间的影响。     

新生儿细菌感染早期临床表现与围产期高危因素的关系

目的 探讨新生儿细菌感染早期临床表现、血象变化及与围产期高危因素的关系.方法 本院新生儿病房2004年1月至2009年8月诊断为新生儿感染的患儿为感染组,同期入院的非感染性患儿为对照组,每组不同发病日龄随机选出至少25例进行病例对照研究.分析新生儿细菌感染早期的临床表现、血象变化及与围产期高危因素间的关系.结果 感染组患儿母亲胎盘绒毛膜炎、胎心率＞160次/min或＜120次/min、晚期减速、母亲产程中CRP＞8 mg/L的发生率明显高于对照组(P＜0.05),其中母亲胎盘绒毛膜炎对感染的影响最大;感染组患儿体温＞37.9℃的发生率高于对照组(P＜0.05),其他症状、体征和对照组相比差异无统计学意义;出生后前3天发病的感染组患儿外周血WBC均明显高于对照组,差异有统计学意义(P＜0.05),感染组患儿L/T比值平均为5.4%,明显高于对照组的2.4%,差异有统计学意义(P＜0.05).结论 母亲胎盘绒毛膜炎、胎心率＞160次/min或＜120次/min、晚期减速、母亲产程中CRP＞8 mg/L是新生儿感染的高危因素;新生儿细菌感染早期无特异症状和体征;出生后前3天新生儿细菌感染早期的外周血白细胞总数有参考意义.     

Early cranial ultrasound changes as predictors of outcome during first year of life in term infants with perinatal asphyxia

OBJECTIVES: To identify the types of early cranial ultrasound changes that were significant predictors of adverse outcome during the first year of life in asphyxiated term infants. METHODOLOGY: This was a prospective cohort study. Shortly after birth, cranial ultrasonography was carried out via the anterior fontanelles of 70 normal control infants and 104 asphyxiated infants with a history of fetal distress and Apgar scores of less than 6 at 1 and 5 min of life, or requiring endotracheal intubation and manual intermittent positive pressure ventilation for at least 5 min after birth. Neurodevelopmental assessment was carried out on the survivors at 1 year of age. RESULTS: Abnormal cranial ultrasound changes were detected in a significantly higher proportion (79.8%, or n = 83) of asphyxiated infants than controls (39.5%, or n = 30) (P < 0.0001). However, logistic regression analysis showed that only three factors were significantly associated with adverse outcome at 1 year of life among the asphyxiated infants. These were: (i) decreasing birthweight (for every additional gram of increase in birthweight, adjusted odds ratio (OR) = 0.999, 95% confidence interval (CI) 0.998, 1.000; P = 0.047); (ii) a history of receiving ventilatory support during the neonatal period (adjusted OR = 8.3; 95%CI 2.4, 28.9; P = 0.0009); and (iii) hypoxic-ischaemic encephalopathy stage 2 or 3 (adjusted OR = 5.8; 95%CI 1.8, 18.6; P = 0.003). None of the early cranial ultrasound changes was a significant predictor. CONCLUSIONS: Early cranial ultrasound findings, although common in asphyxiated infants, were not significant predictors of adverse outcome during the first year of life in asphyxiated term infants.     

The UCLA-University of Utah epidemiologic survey of autism: prenatal, perinatal, and postnatal factors

In a recent epidemiologic survey conducted in Utah, 241 autistic patients (DSM-III criteria) were found. Medical records of 233 autistics were surveyed for the presence of 36 potentially pathologic prenatal, perinatal, and postnatal factors. These results were compared with those of an identical survey of 62 of their nonautistic siblings, with the results of four previously published surveys, and with normative data. No potentially pathologic factor or group of factors occurred significantly more frequently among the autistic patients. Also, previous observations of significant differences in the occurrence of certain factors in the histories single vs multiple siblings with autism were not confirmed, with the exception of increased viral-type illness during gestation in single-incidence cases. Thus, the etiology of the brain pathology that characteristically disrupts normal development and produces the syndrome of autism remains obscure. Other data from the epidemiologic survey, however, suggest that the role of genetic factors needs to be explored further.     

Extracranial vascular malformation: value of antenatal and postnatal MRI in management

We report a case where fetal MRI using a low-field-strength magnet (0.5 T) accurately confirmed a large extracranial vascular malformation, which was suspected on antenatal US. Fetal MRI enabled better counselling of the parents and allowed suitable plans to be made regarding method of delivery and early management of the neonate. To our knowledge this is the first case of an extracranial vascular malformation imaged using fetal MRI. Received: 14 April 2000 Revised: 10 October 2000 Accepted: 19 March 2001     

新生儿高胆红素血症再入院的现状和危险因素分析

目的 探讨新生儿高胆红素血症再入院情况及相关危险因素。方法 选择2017年1月至2019年12月新生儿高胆红素血症再入院患儿85例作为研究组,按1：2比例在同期新生儿高胆红素血症未再入院病例中配对随机选取170例作为对照组,分析比较两组患儿的临床资料及再入院的危险因素。结果 研究期间新生儿高胆红素血症再入院率为2.30%,中位再入院间隔天数为5 d。研究组首次出院时总胆红素和间接胆红素水平明显高于对照组（P < 0.05）;首次住院期间蓝光治疗时间长于对照组（P < 0.05）。研究组出生体重、胎龄、首次入院时年龄均低于对照组（P < 0.05）,研究组合并葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏症比例和合并溶血病比例高于对照组（P < 0.05）。多因素logsitic分析显示,胎龄小、首次入院时年龄小、合并G-6-PD缺乏症是新生儿高胆红素血症再入院的危险因素（分别OR=1.792、1.415、2.829,P < 0.05）。结论 对存在胎龄小、首次入院时年龄小、合并G-6-PD缺乏症等高危因素的高胆红素血症新生儿,应加强住院及出院后管理,防止该病再入院的发生。     

新生儿高胆红素血症再入院的现状和危险因素分析

目的 探讨新生儿高胆红素血症再入院情况及相关危险因素。方法 选择2017年1月至2019年12月新生儿高胆红素血症再入院患儿85例作为研究组,按1：2比例在同期新生儿高胆红素血症未再入院病例中配对随机选取170例作为对照组,分析比较两组患儿的临床资料及再入院的危险因素。结果 研究期间新生儿高胆红素血症再入院率为2.30%,中位再入院间隔天数为5 d。研究组首次出院时总胆红素和间接胆红素水平明显高于对照组（P < 0.05）;首次住院期间蓝光治疗时间长于对照组（P < 0.05）。研究组出生体重、胎龄、首次入院时年龄均低于对照组（P < 0.05）,研究组合并葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏症比例和合并溶血病比例高于对照组（P < 0.05）。多因素logsitic分析显示,胎龄小、首次入院时年龄小、合并G-6-PD缺乏症是新生儿高胆红素血症再入院的危险因素（分别OR=1.792、1.415、2.829,P < 0.05）。结论 对存在胎龄小、首次入院时年龄小、合并G-6-PD缺乏症等高危因素的高胆红素血症新生儿,应加强住院及出院后管理,防止该病再入院的发生。