The electrocardiogram in preterm infants with intraventricular hemorrhage and apnea

To determine the relationship of electrocardiographic changes to both intraventricular hemorrhage (IVH) and neonatal apnea, continuous electrocardiographic monitoring, serial electrocardiograms, and cranial echoencephalograms were obtained on 41 consecutive preterm neonates with birth weight below 1,250 g. Nineteen patients (46%) were diagnosed as having an IVH within the first postnatal week. Six patients died while still requiring mechanical ventilation. Of the 35 surviving infants, 21 experienced apnea. Though the QRS axis was significantly different in the two groups, in both groups it was within the normal range. Of note, 69% of those surviving neonates with IVH experienced apnea, while 53% of those surviving without IVH had apnea. Unlike adult patients with subarachnoid hemorrhage, there are no characteristic electrocardiographic changes in preterm neonates with IVH. Therefore, the neonatal electrocardiogram could not be used to predict neonatal apnea. Continuous electrocardiographic monitoring was useful in detecting transient arrhythmias and episodes of bradycardia in apneic infants. Infants with IVH appeared to be at higher risk for neonatal apnea than their non-IVH peers. The authors stress the importance of continuous electrocardiographic monitoring in all preterm neonates at risk for IVH.     

Corpus callosum alterations in very preterm infants: perinatal correlates and 2 year neurodevelopmental outcomes

The aim of this study was to relate altered corpus callosum (CC) integrity in 106 very preterm (VPT) infants (< 30 weeks' gestational age or < 1250 g birth weight) at term equivalent to perinatal predictors and neurodevelopmental outcomes at two years. T1 and diffusion magnetic resonance images were obtained. The CC was traced, and divided into six sub-regions for cross-sectional area and shape analyses. Fractional anisotropy, mean, axial and radial diffusivity were sampled within the CC, and probabilistic tractography was performed. Perinatal predictors were explored. The Bayley Scales of Infant Development (BSID-II) was administered at two years. Intraventricular hemorrhage was associated with a smaller genu and altered diffusion values within the anterior and posterior CC of VPT infants. White matter injury was associated with widespread alterations to callosal diffusion values, especially posteriorly, and radial diffusivity was particularly elevated, indicating altered myelination. Reduced CC tract volume related to lower gestational age, particularly posteriorly. Reduced posterior callosal skew was associated with postnatal corticosteroid exposure. This more circular CC was associated with delayed cognitive development. Higher diffusivity, particularly in splenium tracts, was associated with impaired motor development. This study elucidates perinatal predictors and adverse neurodevelopmental outcomes associated with altered callosal integrity in VPT infants.     

Activity of liver enzymes in multiple sclerosis patients with Hot-nature diet and co-supplemented hemp seed,evening primrose oils intervention

1. Download : Download high-res image (157KB)
2. Download : Download full-size image