Intrauterine growth and gestational age in preterm infants with cerebral palsy

In a case-control study, gestational age and intrauterine growth of 191 preterm singleton infants 1971–1982 with cerebral palsy were compared to all preterm live-born singletons in Denmark in 1982 (N = 2203). The distribution of gestational age among preterm cases was slightly bimodal with maximum values at 29 and 32 weeks. The risk for cerebral palsy was highest in the infants with gestational age 28–30 weeks (OR = 5.6 (4.0 – 7.8), 95% confidence interval). Birth weight deviation, in the 34–36 weeks infants, expressed as the number of standard deviations from the mean birth weight for gestational age, was more negative in cases than in controls (P < 0.001). The frequency of small for gestational age (SGA) was 13% in cases and 9% in controls (OR = 1.5 (0.96 – 2.3), 95% confidence interval). The odds for cerebral palsy being SGA, was lower in 28–30 weeks (OR = 0.22 (0.06 – 0.86), 95% confidence interval), the same in 31–33 weeks (OR = 0.83 (0.35 – 2.0), 95% confidence interval) and higher in 34–36 weeks (OR = 5.2 (2.9 – 9.5), 95% confidence interval). In conclusion, preterm infants with cerebral palsy are born earlier than other preterm infants. Small for gestational age is associated with cerebral palsy in preterm infants only above 33 weeks.     

Intrauterine growth retardation and brainstem auditory-evoked response in preterm infants

Intrauterine growth retardation is frequently associated with intrauterine undernutrition, and can deleteriously affect brain function. Twenty-eight premature small for gestational age infants were compared with 28 premature appropriate for gestational age infants to determine whether intrauterine growth retardation was associated with abnormalities in the auditory pathway in the early neonatal period. The auditory pathway was studied between 4-18 wk of life by analysis of brainstem auditory-evoked potentials elicited by a 10/s 75 decibel above normal adult hearing level (dB nHL) click stimulus presented at the infants' ears. Peak latencies of components I, III and V, and interpeak latencies I-III, III-V and I-V, yielded no statistically significant differences between groups. The present study indicates that intrauterine growth-retarded premature infants may not have abnormalities of brainstem auditory-evoked response in the early neonatal period.     

Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants

Background

The role of chorioamnionitis in neurodevelopment of preterm infants is not fully understood.

Aim

To examine the association between different indicators of intrauterine inflammation (clinical chorioamnionitis, histological chorioamnionitis and funisitis) and neurodevelopmental impairment in very preterm infants.

Methods

Preterm infants with a birth weight of < 1500 g or a gestational age of < 32 weeks were included. Follow-up evaluation up to 2 years of age consisted of neurological examination, neurodevelopmental assessment and visual and audiologic tests. Outcome data were compared between the chorioamnionitis and the control groups, controlling for gestational age, birth weight and Apgar score at 5 min.

Results

One hundred seventy-seven patients comprised the study population (mean gestational age 29 ± 2 weeks, mean birth weight 1167 ± 344 g). Histological chorioamnionitis was present in 49% of placentas, whereas funisitis was observed in 25%. In 57% cases clinical maternal chorioamnionitis was suspected. Follow-up was available for 130 (82%) patients. Infants with funisitis, compared with controls, had a significantly higher incidence of moderate to severe disability (18% vs 5%, OR 4.07; 95% CI 1.10-15.09).

Conclusion

The results of this study suggest that, unlike a broad definition of histological chorioamnionitis including inflammation of maternal or fetal placental tissues, funisitis may entail a higher risk of moderate to severe disability at 2 years of age in preterm infants.     

绒毛膜羊膜炎对早产儿脑损伤的影响

目的：探讨绒毛膜羊膜炎与早产儿脑损伤的相关性。方法：选取2008年6月至2011年6月出生的早产儿（28~34周）共88例。根据是否存在绒毛膜羊膜炎,分为病例组(41例)和对照组（47例）。所有的病例生后定期行头颅B超检查,生后3~7 d行颅脑弥散加权成像（DWI）检查,且于纠正胎龄 40 周时行颅脑MRI 检查,比较两组脑室周围白质软化（PVL）和脑室周围-脑室内出血（PVH-IVH）的发生情况。结果：病例组PVL的发生率为32%,对照组PVL的发生率为6%,两组比较差异有统计学意义（P<0.05）。而两组PVH-IVH的发生率分别为27%和23%,差异无统计学意义（P＞0.05）。结论：绒毛膜羊膜炎与早产儿脑损伤有一定的关系,可使早产儿PVL的发生率增加,而对PVH-IVH的影响不大。     

Effect of chorioamnionitis on neurodevelopmental outcome in preterm infants

OBJECTIVE: To assess the association of neurodevelopmental outcome with the placental diagnosis of chorioamnionitis in very low-birth-weight infants. METHODS: One hundred seventy-seven surviving very low-birth-weight infants, 22 to 29 weeks' gestational age, born after varying severity of chorioamnionitis, were evaluated at a mean +/- SD age of 19 +/- 6 months' corrected age with Bayley Scales of Infant Development II and neurologic examination. Select maternal and infant variables were abstracted from the medical records. Neonatal morbidities, Mental Developmental Index (MDI) score, Psychomotor Developmental Index (PDI) score, probability of normal MDI and PDI scores (>84), and cerebral palsy between the chorioamnionitis and the control groups were assessed, controlling for gestational age, sex, and the maternal use of steroids and antibiotics. RESULTS: The chorioamnionitis group of 102 infants was compared with 75 control infants (mean +/- SD birth weight, 947 +/- 236 g and 966 +/- 219 g, respectively; mean +/- SD gestational age, 26.1 +/- 2.8 weeks and 27.1 +/- 1.5 weeks, respectively). Infants with chorioamnionitis, compared with controls, had a significantly higher incidence of intraventricular hemorrhage (30% vs 13%) and retinopathy of prematurity (68% vs 42%). Cerebral palsy was diagnosed in 8.6% of the infants with chorioamnionitis and 6.6% of the controls. The MDI and PDI scores were similar between the chorioamnionitis and control groups (mean +/- SD MDI score, 96 +/- 16 vs 97 +/- 18 and mean +/- SD PDI score, 94 +/- 19 vs 92 +/- 19, respectively). CONCLUSIONS: In very low-birth-weight infants we found a higher incidence of intraventricular hemorrhage and retinopathy of prematurity but similar MDI and PDI scores and risk of cerebral palsy associated with chorioamnionitis.     

Intrauterine growth retardation

Two cases of severe intrauterine growth retardation, a boy and a girl studied for 7 and 10 years respectively, are reported. Both patients showed peculiar cranio-facial abnormalities as observed in the socalled Seckel's syndrome, an appearance of premature aging, peripheral GH resistance which was probably due to deficiency in Somatomedin A production, sella areas and volumes consistently at the upper limits of normal when related to the patients' height, and dysharmonic skeletal maturation and ivory cone-shaped epiphyses of the tubular bones of the hands.     

���������ٻ�

1概念与流行病学宫内生长迟缓(IUGR)是指胎儿的生长发育因各种原因未能达到其基因所决定的生长发育程度[1]。但这一概念在临床实践中无法应用,其命名与概念通常与小于胎龄儿(SGA)互用。后者是一个统计学概念,是指一组出生体重低于相应胎龄第10百分位数的新生儿。不同作者有不同的观点,如有人认为更合理的是将出生身长减低也考虑在内。由于概念和采用标准(受种族、地域海拔高度、经济水平等因素影响)的不统一,IUGR的流行病学资料也各不相同。美国第三次全国健康与营养调查(采用出生体重低于相应胎龄第10百分位数)报告其发生率为8·6%[2]…     

Intrauterine growth of twins

In a retrospective study of 150 twins born between 1970–1977, birth weight, length, and head circumference was plotted against gestational age. In comparison to singletons, all 3 parameters were low normal. While length and head circumference values follow the growth pattern of singletons, prenatal birth weight shows a progressive decline toward maturity.The intrauterine growth pattern of twins resembles that of intrauterine growth retardation of singletons.Dedicated to Prof. Dr.H.-R. Wiedemann on the occasion of his 65th birthday     

Intrauterine growth curves for Turkish infants born between 25 and 42 weeks of gestation

Intrauterine growth curves should be specific to each population and are needed for the Turkish population. An analysis of birthweight, crown-heel length, and head circumference in newborns between 25 and 42 weeks of gestational age was made. A total of 2481 babies were evaluated. Mean, standard deviation, and percentile values were calculated for each gestational age and smoothed curves were obtained for each parameter. In our country, the use of these new curves is more appropriate than those obtained in other countries.     

Intrauterine growth in children with cerebral palsy

The risk of cerebral palsy in connection with intrauterine growth retardation has been analysed in a case-control study. The case series comprised 519 children with cerebral palsy born in 1967-1982 in the west health-care region of Sweden and the control series 445 children born during the same years in the same region. The risk of cerebral palsy in small-for-gestational-age infants was significantly increased in term and moderately preterm infants. The highest proportion among infants with cerebral palsy born at term was found in tetraplegia, followed by diplegia and dyskinetic cerebral palsy. It was concluded that small for gestational age on the one hand reflects early prenatal brain damage, and on the other mediates prenatal risk factors compatible with foetal deprivation of supply and also potentiates adverse effects of birth asphyxia and neonatal hypoxia.