Neurology and behaviour of newborn infants delivered by vacuum extraction on maternal indication

Retinal hemorrhages and traction forces in vacuum extraction

The relationship between the traction forces used in 53 clinically indicated vacuum extractions and the incidence and degree of retinal hemorrhages observed in the neonates within 24 hours after birth was examined. A Vacuum Extractor Recorder (Type SF 30, Knick), was used to measure the traction force necessary for delivery of the fetal head. No relationship could be demonstrated between the force time integral and the appearance and grading of retinal bleedings.

Mortality in the first week of life and mode of delivery

11 923 singletons with birthweight greater than 775 g born consecutively at the 2nd School of Medicine of Naples during a four-year period (November 1975 to October 1979) were the subjects of the study. Mortality in the first week of life was 10.9, 9.7, 6.7 and 10.7 per 1 000 respectively in the four years. The total variability of the crude death rates was reduced by 21.4% after standardization for birthweight distribution alone and by 28.6% when both birthweight and mode of delivery were taken into account. Therefore only a small fraction of the variations in mortality can be ascribed to changes in the distribution of modes of delivery during the study period. Most of these variations are probably related to the quality of perinatal care, which seems to have improved only for babies under 1 526 g. Birthweight specific mortality in relation to mode of delivery is further discussed.

Cranial ultrasound after forceful midpelvis vacuum extraction at term

The heads of 28 non-hypoxic, full-term infants of normal gravidas delivered by forceful vacuum extraction were examined with ultrasound during the early neonatal period. All echographic findings were normal and all neonates had an uneventful evolution during the first week of life. Addendum: Since this article was completed, a massive intracranial haemorrhage occurred in a non-hypoxic full-term newborn after elective midpelvic vacuum extraction. The intervention was performed by a resident who, despite the guidelines did not call the senior obstetrician after three unsuccessful attempts to extract the fetus. The head was stationed, 2 cm above the level of the ischial spines, not completely flexed with the occiput in the right-anterior position. The newborn died at the age of 3 hours. Autopsy showed a tear of the tentorium cerebelli and the vena cerebri magna.

Assessment of behaviour on the Brazelton scale in healthy preterm infants from 32 conceptional weeks until full-term age

20 healthy preterm infants were assessed weekly by the Brazelton Neonatal Behavioural Assessment Scale from 1-2 weeks after birth until they reached their expected date of birth. The gestational age of the infants ranged from 28 to 34 weeks. Although the full scale could not be used before 36 conceptional weeks, obvious progress in development was found for most items of the scale. In particular there was improvement in orienting responses and in motor performance during the observation period. At full-term age comparisons were made with a group of normal-term infants (n = 80). All premature infants underwent standard neonatal neurological examination at full term, and tests of neurological function and psychomotor development up to the age of 18 months.

Correlation between neurological examination and behavioural assessment of the newborn infant

A modified Prechtl neurological examination and the Brazelton Neonatal Behavioural Assessment Scale (BNBAS) were used on days 1 and 5 in 78 healthy newborn infants. Correlations between variables in the neurological examination and the behavioural items and subscales in the BNBAS were calculated. Especially the total neurological score and optimality score were significantly correlated to motor performance (days 1 and 5) and to orienting responses to animate and inanimate stimuli (day 1) in the BNBAS. The neurological variables showed poor or no correlation to the habituation items and to certain items concerned with changes of behavioural state in the BNBAS.