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Ford LM, Steichen J, Steichen Asch PA, Babcock D, Fogelson MH. Neurologic status and intracranial hemorrhage in very-low-birth-weight preterm infants. Outcome at 1 year and 5 years. Am J Dis Child 1989; 143:1186-90. [PMID: 2801660 DOI: 10.1001/archpedi.1989.02150220084024] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Twenty-six very-low-birth-weight preterm infants with and without intracranial hemorrhage (ICH) were followed up prospectively from birth to school age to determine the relationship between ICH and subsequent neurologic and cognitive outcomes. All children had sequential cranial ultrasound examinations at birth and neurologic assessments at 3-month intervals during the first year, at 1 year of age, and at 5 to 6 years; psychometric assessments were done at 5 to 6 years. Seventeen children had no ICH, 3 had grade 1 ICH, 1 had grade 3 ICH, and 5 had grade 4 ICH. The 1-year Amiel-Tison neurologic assessment in 25 infants demonstrated that 14 were normal, 3 were suspect, and 8 were abnormal. By 5 to 6 years of age, 5 of 8 children neurologically abnormal at 1 year remained abnormal, 2 of 3 children neurologically suspect at 1 year remained suspect; while 9 of 15 children neurologically normal at 1 year remained normal, the remaining 6 had become suspect. The predominant neurologic abnormality at 5 to 6 years was subtle neurologic dysfunctioning. The Wechsler Preschool and Primary Scale of Intelligence at 5 to 6 years revealed a mean group IQ score of 92.1. The Beery Visual Motor Integration Test results demonstrated that 18 of 26 children had mild to severe visual motor perceptual difficulties. Severe ICH (grades 3 and 4) correlated with abnormal neurologic performances at 1 and 5 to 6 years. Mild ICH (grade 1) and no ICH did not correlate with any one of the 1-year neurologic classifications. The 1-year status correlated with the 5- to 6-year neurologic outcome best for children who were either neurologically suspect or abnormal at age 1 year. The 1-year neurologic score did not correlate with 5- to 6-year IQ and Beery Visual Motor Integration Test scores.
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Affiliation(s)
- L M Ford
- Department of Pediatric Neurology, Children's Hospital Medical Center, Cincinnati, OH 45229
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2
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Abstract
Three infants, ages 3 to 4 months, had nasojejunal feeding tubes placed for recurrent aspiration and/or feeding intolerance after upper gastrointestinal cineradiographs (ugi) had documented gastroesophageal reflux (GER) with normal pyloric channels and prompt gastric emptying. The tubes had been in place for 3 and 4 weeks, respectively, in the first two infants when classic hypertrophic pyloric stenosis (HPS) was found during fundoplication and gastrostomy tube placement. The last child had a failed attempt at nasogastric tube feedings following 3 months of nasojejunal tube feedings. A repeat ugi suggested HPS, which was confirmed by pyloric ultrasound. This infant underwent pyloromyotomy alone. The late presentation of HPS in these infants suggests that transpyloric tubes might cause the development of HPS and exacerbate the symptoms of preexisting GER. In infants who are expected to eat by mouth, pyloromyotomy alone might allow the reinstitution of orogastric feedings without the perioperative morbidity of fundoplication and gastrostomy tube placement.
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Affiliation(s)
- L A Latchaw
- Division of Pediatric Surgery, Tufts University, Boston
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3
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Abstract
The management and follow-up of 12 patients with major aortic thrombus formation occurring in the neonatal period between 1982 and 1987 are reported. Umbilical arterial catheters were inserted in 8 of the 12 patients before thrombus formation. Two patients had congenital thrombi. Hypertension, oliguria, hematuria, and elevated blood creatinine concentration were found at the time of diagnosis of the thrombus; nine of the patients had a patent ductus arteriosus. Supportive care was instituted in seven patients who were hemodynamically stable. Five of the patients had congestive heart failure, shock, or both, and were treated with surgical thrombectomy. Thrombolytic therapy was not used in either group. The five surgically treated patients and six of seven medically treated patients survived. Ultrasound examination suggested resolution of the thrombus in all survivors in 6 to 30 days. Sequelae from thrombus formation were present in all patients at the time of discharge and included hypertension in 9 of the 11 survivors and decreased renal function in six of them. Follow-up at 1 to 3 years revealed normal blood pressure, good growth, and good renal function in 10 of the survivors.
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Affiliation(s)
- R M Payne
- Edward Mallinckrodt Department of Pediatrics of Washington University School of Medicine, St. Louis, MO
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4
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Abstract
Two premature infants were infected with HIV via blood transfusions during the neonatal period. Although neither patient had serum antibody to HIV owing to severe hypogammaglobulinemia, HIV infection was confirmed by finding HIV antigen in the sera of both patients. These cases show that HIV infection can produce severe hypogammaglobulinemia, and illustrate the value of HIV antigen detection in the diagnosis of HIV infection in seronegative patients.
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Affiliation(s)
- F T Saulsbury
- Department of Pediatrics, University of Virginia Medical Center, Charlottesville 22908
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5
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Kennedy KA. Dietary antioxidants in the prevention of oxygen-induced injury. Semin Perinatol 1989; 13:97-103. [PMID: 2662418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- K A Kennedy
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas 75235
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6
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Gibson DL, Sheps SB, Schechter MT, Wiggins S, McCormick AQ. Retinopathy of prematurity: a new epidemic? Pediatrics 1989; 83:486-92. [PMID: 2927986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This study provides the first empiric evidence for the existence of a new epidemic of retinopathy of prematurity-induced blindness. Data from a population-based register of handicapping conditions in the Canadian province of British Columbia, and a birth weight-specific census of live-born infants in British Columbia, were used to determine annual, population-level incidences of retinopathy of prematurity-induced blindness during 1952 to 1983. Changes in incidence since the end of the original epidemic (1954) were determined by subdividing the 29-year period (1955 to 1983) into two intervals (1955 to 1964 and 1965 to 1983). Standardized incidence ratio analyses revealed a marginally significant increase in the overall incidence of retinopathy of prematurity-induced blindness in the later as compared with the earlier period. Infants weighing 750 to 999 g at birth had a significantly increased standardized incidence ratio of 3.07 (95% confidence interval 1.26, 11.06). No increases in risk were observed in heavier or lighter weight infants. Because ascertainment and diagnostic changes do not explain the weight-specific increases in incidence, these results provide the first population-level evidence for a new epidemic.
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Affiliation(s)
- D L Gibson
- Department of Health Care, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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7
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Brault D, Danan C, Ponet M, Janaud JC, Canet J. [Spontaneous perforation of the bile ducts]. Arch Fr Pediatr 1989; 46:209-10. [PMID: 2735809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Spontaneous perforation of the extra-hepatic bile ducts in infancy is rare and of unknown etiology. Its finding at laparotomy in a 2 month-old premature with artificial ventilation allows to underline that the diagnosis may be difficult and may necessitate ultrasonography and even hepatobiliary scintigraphy.
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Affiliation(s)
- D Brault
- Service de Réanimation Néonatale, Centre Hospitalier Intercommunal de Créteil
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8
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Jobe A. Protein leaks and surfactant dysfunction in the pathogenesis of respiratory distress syndrome. Eur Respir J Suppl 1989; 3:27s-32s. [PMID: 2742683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article reviews the phenomenon of surfactant inactivation by soluble proteins. Following surfactant treatment of preterm lambs, the initial clinical response was not maintained. The surface tensions that were low in the lungs following surfactant treatment increased to high values concurrently with the return of severe respiratory failure. The surface properties of the surfactant that remained in the airways and alveoli could be restored if the soluble proteins were removed. These soluble proteins inactivated different surfactants to different degrees and the interaction was very concentration dependent. The proteins entered the lungs of the preterm lamb because of the tendency of these lungs to form pulmonary oedema. Similar surfactant inactivation occurred in the lungs of infants with respiratory distress syndrome. A variety of manipulations influenced the formation of proteinaceous pulmonary oedema, suggesting that new therapeutic strategies could be developed to treat infants with RDS.
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Affiliation(s)
- A Jobe
- Harbor-UCLA Medical Centre, Torrance
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9
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Abstract
A premature infant presented with non-immune hydrops fetalis, a liver mass, thrombocytopenia, and hypofibrinogenemia. Histologic examination of the liver tumor showed an infantile hemangioendothelioma. The clinical features of this case can be explained by anemia, hypoalbuminemia, and coagulopathy. The association with Kasabach-Merritt syndrome, the pathophysiology of non-immune hydrops fetalis, and primary hepatic neoplasms of the neonate are discussed.
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Affiliation(s)
- L L Skopec
- Department of Anatomical and Clinical Pathology, St. Paul-Ramsey Medical Center, Minneapolis, Minnesota 55101
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10
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Tan KL, Boey KW. Clinical experience with phototherapy. Ann Acad Med Singap 1989; 18:43-8. [PMID: 2712517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Clinical experience with phototherapy in 3,999 infants with non-haemolytic hyperbilirubinaemia and 427 infants with hyperbilirubinaemia associated with G6PD deficiency is presented. For non-haemolytic hyperbilirubinaemia, phototherapy was extremely effective in extremely preterm infants with very low birth weight (gestation less than or equal to 32 weeks, birth weight less than or equal to 1,500 gm) and least effective in full term infants with very low birth weight (gestation greater than 37 weeks, birth weight less than or equal to 1,500 gm) and large preterm infants (gestation less than 37 weeks, birth weight greater than 2,270 gm). The failure rate of phototherapy for non-haemolytic hyperbilirubinemia was only 2.00/1,000 infants. The bilirubin rebound was usually mild; repeat phototherapy was required in only 30 infants (7.50/1,000) with the response to the second exposure comparable to that of the first. No infant required a third exposure. Phototherapy was effective in reducing bilirubin levels in hyperbilirubinaemia associated with G6PD deficiency, the effectiveness being, however, less than in babies with non-haemolytic hyperbilirubinaemia (G6PD normal status). There was no failure in this group of babies. Only a small proportion of infants required a second exposure (4.68/1,000). All the infants tolerated phototherapy well with none developing any illness that could be attributed to the exposure. This clinical experience demonstrates that phototherapy is effective and safe for the treatment of non-haemolytic hyperbilirubinaemia or hyperbilirubinaemia associated with G6PD deficiency.
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MESH Headings
- Bilirubin/blood
- Glycogen Storage Disease Type I/blood
- Glycogen Storage Disease Type I/complications
- Glycogen Storage Disease Type I/therapy
- Humans
- Infant, Low Birth Weight/blood
- Infant, Newborn
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/complications
- Infant, Premature, Diseases/therapy
- Jaundice, Neonatal/blood
- Jaundice, Neonatal/complications
- Jaundice, Neonatal/therapy
- Phototherapy
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Affiliation(s)
- K L Tan
- Department of Paediatrics, National University of Singapore
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11
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Abstract
The brain pathology in very prematurely born infants with intraventricular hemorrhage (IVH) was studied particularly as to the severity and site of the complicated brain lesions responsible for the prognosis. A high frequency of leukomalacia, pontosubicular necrosis and/or olivocerebellar neuronal loss was found in the cases of IVH, and these non-hemorrhagic brain lesions showed an increasing frequency with the grade of IVH. However, there was marked reduction of IVH, periventricular leukomalacia and, in particular, brainstem lesions in prematurely born cases of sudden infant death. These IVH and associated conditions have different pathogenesis, but factors responsible for their occurrence may be present together in each case.
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Affiliation(s)
- S Takashima
- Division of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, Tokyo, Japan
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12
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Abstract
There has been considerable debate over whether asymptomatic neonatal hypoglycaemia results in neurological damage. In a detailed multicentre study of 661 preterm infants hypoglycaemia was found to be common. Moderate hypoglycaemia (plasma glucose concentration less than 2.6 mmol/l) occurred in 433 of the infants and in 104 was found on three to 30 separate days. There was considerable variation among the centres, implying differences in decisions to intervene. The number of days on which moderate hypoglycaemia occurred was strongly related to reduced mental and motor development scores at 18 months (corrected age), even after adjustment for a wide range of factors known to influence development. When hypoglycaemia was recorded on five or more separate days adjusted mental and motor developmental scores at 18 months (corrected age) were significantly reduced by 14 and 13 points respectively, and the incidence of neurodevelopmental impairment (cerebral palsy or developmental delay) was increased by a factor of 3.5 (95% confidence interval 1.3 to 9.4). These data suggest that, contrary to general belief, moderate hypoglycaemia may have serious neurodevelopmental consequences, and reappraisal of current management is urgently required.
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Affiliation(s)
- A Lucas
- Medical Research Council, Dunn Nutrition Unit, Cambridge
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13
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Abstract
The follow-up records of 605 infants with birth weights of less than 1,500 g, with data available for 2 years after birth, were examined for evidence of abnormal pulmonary signs or symptoms. A total of 119 infants were identified and the neonatal oxygen requirements of these infants were compared with those of 486 infants who had normal pulmonary function. A requirement for oxygen at 28 days of life had a positive predictive value for abnormal pulmonary findings at the time of follow-up of only 38%, whereas 31% of those with normal pulmonary findings at the time of follow-up were still receiving oxygen at this age. The need for oxygen at 28 days was a good predictor of abnormal findings in infants of ≥3O weeks' gestational age at birth but became increasingly less useful as gestational age decreased It was found that, irrespective of gestational age at birth, the ment for additional oxygen at 36 weeks' corrected postnatal gestational age was a better predictor of abnormal outcome, increasing the positive predictive value to 63%. The prediction of a normal outcome remained 90% for infants not receiving oxygen at this corrected gestational age.
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Affiliation(s)
- A T Shennan
- Regional Perinatal Unit and Follow-Up Programme, Women's College Hospital, University of Toronto Perinatal Complex, Ontario, Canada
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14
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Abstract
A retrospective study of 55 patients with congenital constriction band syndrome was performed. Multiple extremity involvement was found to be the most common clinical feature associated with the disease, and 34% of the patients studied were premature at birth. Malformations included constriction bands, clubfoot, intrauterine amputation, syndactyly, and acrosyndactyly (fenestrated syndactyly). The extremities were most often affected distally, involving the longer central fingers and medial two toes. More proximal involvement with constriction bands was associated with a higher frequency of neurologic deficit. Significant leg-length discrepancy exceeding 2.5 cm was seen in 9 of 38 patients (24%) with lower extremity involvement, a condition that has not been previously reported.
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Affiliation(s)
- G Askins
- Department of Medical Education, Alfred I. duPont Institute, Wilmington, DE 19899
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15
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Shields JR, Schifrin BS. Perinatal antecedents of cerebral palsy. Obstet Gynecol 1988; 71:899-905. [PMID: 3285270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The dramatic reduction in perinatal morbidity and mortality over the last decade has not been accompanied by any diminution in the incidence of cerebral palsy. We investigated retrospectively the relationship of certain perinatal events to the subsequent development of cerebral palsy in 75 infants. Cerebral palsy occurred in association with acute intrapartum asphyxia in 8% and traumatic delivery in 11%. Thirty-five percent of cases were associated with chronic fetal distress, defined by a unique fetal heart rate (FHR) pattern consisting of a normal baseline rate with persistently absent variability and mild variable decelerations with overshoot. This pattern was found frequently in association with postmaturity, meconium staining, intrauterine growth retardation, and neonatal seizures. Acid-base studies, when available, did not reveal acidosis. Twenty-seven percent of the cases involved a combination of chronic fetal distress, acute intrapartum fetal asphyxia, and/or traumatic delivery. We postulate that antenatal intermittent umbilical cord compression secondary to oligohydramnios results in repetitive transient central nervous system ischemia, insufficient to cause death, but resulting in a characteristic FHR pattern and impaired neurologic development. If these data are confirmed, this FHR pattern may be an important marker for the development of subsequent neurologic handicap or other adverse outcome.
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Affiliation(s)
- J R Shields
- Department of Maternal-Fetal Medicine, AMI--Tarzana Regional Medical Center, California
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16
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Abstract
Retrospective study of infants who survived the neonatal period after delivery at 24-26 weeks gestation revealed patency of the ductus arteriosus (PDA) in 44%. The mean birthweight of infants who developed PDA was lower. Retinopathy of prematurity (ROP) was seen in 79% of survivors with 24% having grade III or IV involvement. All but one of the more severe grades of ROP occurred among infants with PDA. Infants with PDA required more prolonged ventilatory support. Perinatal factors did not have a significant role in the development of these complications.
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Affiliation(s)
- E John
- Department of Paediatrics, Westmead Hospital, New South Wales, Australia
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17
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Ogino T, Kanda Y, Kawakita A, Yamaguchi N, Futamura M, Goto H. Ultrasonographic findings in periventricular leukomalacia in the newborn: two cases associated with early onset group B streptococcal sepsis. Acta Paediatr Jpn 1988; 30:89-93. [PMID: 3148267 DOI: 10.1111/j.1442-200x.1988.tb02503.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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18
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Itani Y, Fujioka M, Nishimura G, Niitsu N, Oono T. Upper GI examinations in older premature infants with persistent apnea: correlation with simultaneous cardiorespiratory monitoring. Pediatr Radiol 1988; 18:464-7. [PMID: 3186322 DOI: 10.1007/bf00974080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Upper gastrointestinal examinations with simultaneous cardiorespiratory monitoring were performed in 39 older premature infants with persistent apnea. Swallowing incoordination was documented to be causatively related to persistent apnea in such infants, especially with feeding. Direct relationship between apnea and gastroesophageal reflux was not documented in this study.
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Affiliation(s)
- Y Itani
- Division of Neonatology, Saitama Children's Medical Center, Japan
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19
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Abstract
In a randomized prospective trial, we studied the effect of early high-dose phenobarbital treatment on the early (intraventricular hemorrhage) and late (neurodevelopmental abnormalities) manifestations of hypoxic-ischemic encephalopathy in preterm infants weighing 1500 g or less at birth. The first intravenous dose of 15 mg/kg was given at a mean age of 110 minutes, followed by 15 mg/kg after 4 hours and then by 5 mg/kg at 24-hour intervals for 5 days. The overall incidence of intraventricular hemorrhage was 32% in treated and 46% in control infants, a nonsignificant difference. An ultrasound brain scan at 9 months old revealed no significant difference in the incidence of ventricular dilatation between treated (19%) and control (29%) infants. At 27 months, a similar incidence of mild (10%) and severe (10%) neurodevelopmental handicaps was found in both treated and control groups. Since beneficial effects could not be documented by any of the criteria used, we conclude that routine administration of phenobarbital to low birth weight infants is not justified.
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Affiliation(s)
- V Ruth
- Children's Hospital, University of Helsinki, Finland
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20
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Abstract
We report significant neurological abnormality at 18 months of age in 3 of 7 very low birth weight infants (less than or equal to 1,500 g), who during mechanical ventilation inadevertently became severely hypocarbic (arterial carbondioxide tension less than 2.0 kPa (15 mmHg)) at some time during the first 24 h of life. Although the number is small the outcome was significantly worse than the outcome in two fairly similar groups of infants selected as controls (p = 0.026). The infants in one of the control groups were also mechanically ventilated but remained normocapnic. Germinal layer haemorrhage (GLH) was more frequent among these infants compared with the severely hypocarbic infants (p = 0.022). The infants in the other control group was not mechanically ventilated. In all the severely hypocarbic infants the Bayley mental developmental index uncorrected for prematurity was at or below the median for the total sample (p = 0.01). The results suggest that neonatal cerebral ischaemia, for instance due to hypocarbia, is of greater prognostic significance than GLH.
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21
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Abstract
We report the ocular findings in 11 preterm infants who sustained intraventricular hemorrhages. The defects were similar to those in adults who suffer from hypertensive thalamic hemorrhages. All 11 infants showed tonic downward and esotropic deviations of their eyes. Upgaze response could not be elicited in any of the infants. Although the role of secondary hydrocephalus cannot be discounted, we conclude that the direct effect of the hemorrhage on thalamic and mesencephalic structures is essential in the production of these oculomotor deficits. The prognosis for recovery of the upgaze palsy in these patients is good, although the time course may vary. However, the large-angle esotropia usually persists and requires surgical correction.
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22
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Phelps DL, Rosenbaum AL, Isenberg SJ, Leake RD, Dorey FJ. Tocopherol efficacy and safety for preventing retinopathy of prematurity: a randomized, controlled, double-masked trial. Pediatrics 1987; 79:489-500. [PMID: 3547300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P less than .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P less than .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.
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23
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Janowsky JS, Nass R. Early language development in infants with cortical and subcortical perinatal brain injury. J Dev Behav Pediatr 1987; 8:3-7. [PMID: 3818962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To understand better the cognitive sequelae of mild perinatal brain injury, we studied three groups of high-risk infants, using the Early Language Milestone Scale (ELM Scale). Premature infants with Grades I and II intraventricular hemorrhages (IVH) were delayed on the expressive but not the receptive subscale of the ELM Scale. Mildly asphyxiated full-term infants were slightly delayed on both the expressive and receptive subscales. Premature infants without IVH performed the same as the normal sample on which the scale was based. Although normal intellectual functioning has been reported in infants with Grade I-II IVH, this study demonstrates early specific deficits in expressive language in these children. These results are discussed in relation to localization of language in the adult brain, and the influence of subcortical structures on development and maturation of the cortex.
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24
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Kaplan M, Glaser J, Eidelman AI, Goren A, Appelbaum A. Systemic to pulmonary shunting masquerading as patent ductus arteriosus: a pitfall in clinical diagnosis. J Perinatol 1987; 7:296-7. [PMID: 3505265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patent ductus arteriosus (PDA) frequently complicates the course of respiratory distress syndrome in premature infants. A 920-g, 28 weeks' gestation infant with clinical and radiographic evidence of left to right shunting, was presumed to have a patent ductus arteriosus. Following ductal ligation the signs persisted. Aortic angiogram demonstrated multiple collateral vessels arising from the systemic circulation and communicating with pulmonary vessels. Accurate diagnosis of left to right shunting is imperative if such collateral shunting is not to go undiagnosed.
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Affiliation(s)
- M Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
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25
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Abstract
During an 18 month period, 120 preterm infants of 34 weeks' gestation or less were prospectively examined for periventricular leucomalacia (PVL) by cerebral ultrasound. Neurological and developmental assessment was carried out at 18 months of age corrected for prematurity in 82 surviving neonates. The developmental outcome (Griffiths development quotient) was above 80 and similar in infants with normal scans (n = 41), isolated periventricular-intraventricular haemorrhage (n = 13), and post-haemorrhagic hydrocephalus (n = 4), and no major handicap was diagnosed in these groups. By contrast, the prognosis was variable and poorer in infants with PVL (n = 24) and depended on the extent and site of the lesion. Infants with frontal PVL (n = 13) developed normally. Major sequelae (n = 8) were closely related to frontal-parietal PVL and frontal-parietal-occipital PVL and could be ascribed to the presence of cysts as well as to a persistent hyperechogenic ultrasonographic PVL appearance. A relation between size and site of the lesion and type and severity of the handicap was established.
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26
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Guzzetta F, Shackelford GD, Volpe S, Perlman JM, Volpe JJ. Periventricular intraparenchymal echodensities in the premature newborn: critical determinant of neurologic outcome. Pediatrics 1986; 78:995-1006. [PMID: 3537951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Controversy exists concerning the degree of importance of periventricular intraparenchymal echodensities (IPE) observed on neonatal ultrasound scans in the determination of subsequent neurologic disability in premature infants. In this report, IPE was studied in 75 infants weighing less than 2,000 g at birth to determine the basic characteristics of the lesion, the likely pathogenesis, the outcome, and the aspects of the ultrasonographic appearance in the acute period of neonatal illness that are important for prediction of outcome. IPE was defined as any periventricular echodensity greater than 1 cm in at least one dimension. IPE was strikingly associated with large areas of intraventricular hemorrhage (IVH) (81% of cases). IPE was distinctly asymmetric. Thus, the lesion was either exclusively unilateral (67%) or bilateral with marked predominance on one side. The associated IVH was asymmetric in approximately 80% of cases, and in all 50 cases of large asymmetric IVH, IPE occurred on the same side as the larger amount of intraventricular blood. Moreover, more than 50% of such cases of IPE associated with large asymmetric IVH were progressive. Neuropathologic correlation showed that IPE represented hemorrhagic necrosis of periventricular tissue. Concerning pathogenesis, these data raise the possibility that large asymmetric IVH is related etiologically to IPE. Outcome varied with the severity of the IPE. Thus, the mortality rate among the 38 infants with extensive IPE was 79%. Of the survivors with extensive IPE, all had subsequent major motor deficits and all but one exhibited cognitive function less than 80% of normal. Among the 37 infants with localized IPE, the mortality rate was 38%. Of the survivors, although 79% had major motor deficits, 43% had cognitive function greater than 80% of normal. Thus, the findings demonstrate that with extensive IPE there is little or no chance for survival with normal neurologic and cognitive outcome, but with localized IPE, although major motor deficits are common, an appreciable proportion of infants have cognitive function in the normal range. Careful, quantitative assessment of the ultrasonographic features of IPE in the acute period of illness in the premature infant is of major value in estimating outcome.
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Johnson SJ, Hosford-Dunn H, Paryani S, Yeager A, Malachowski N. Prevalence of sensorineural hearing loss in premature and sick term infants with perinatally acquired cytomegalovirus infection. Ear Hear 1986; 7:325-7. [PMID: 3021553 DOI: 10.1097/00003446-198610000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Audiologic follow-up was obtained on 40 premature or sick term infants with perinatally acquired cytomegalovirus (CMV) infection and on 40 prospectively matched control subjects. Final evaluation was postponed until 3 years of age to assess any long-term hearing sequelae of perinatal CMV infection in this population, and to obtain reasonably complete audiometric results. One experimental subject had a bilateral sensorineural hearing loss above 4000 Hz. Four control subjects had sensorineural hearing losses, three requiring binaural hearing aids. The prevalence of confirmed hearing loss requiring amplification (3.75%) in this study group was consistent with that observed in all graduates of the Intensive Care Nursery who were considered at risk for hearing loss in the same time period (4.2%). These data suggest that perinatally acquired CMV infection is not associated with significant sensorineural hearing loss in premature or full term infants through age 3.
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St Cyr JA, Ferrara TB, Thompson TR, Johnson DE, Foker JE. Nissen fundoplication for gastroesophageal reflux in infants. J Thorac Cardiovasc Surg 1986; 92:661-6. [PMID: 3639272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Some degree of gastroesophageal reflux is very common in infants and tends to reverse with time. Therefore, the indications for an antireflux operation are not well defined. Furthermore, the complication rate and the ability of the fundoplication to grow remain to be determined. To answer these questions, we reviewed the records of patients 6 months of age or younger who underwent a Nissen fundoplication with gastrostomy tube placement between 1979 and 1985. There were 45 patients (25 boys and 20 girls) with birth weights of 0.65 to 4.3 kg. The consequences of gastroesophageal reflux were more varied than in older children. Severe respiratory problems were common, including recurrent aspiration or bronchopulmonary dysplasia in 60% and frequent apneic and bradycardiac spells in 17%. Failure to gain weight was present in 20% and intractable vomiting in 2.0%. As expected, 78% of these patients had congenital anomalies or acquired problems which, in many cases, were important to the prognosis. The diagnosis was confirmed by barium swallow in all but one patient in whom gross reflux during feedings was present. Initially, medical management was tried for 3 to 4 weeks. In one patient, however, the severity of the respiratory problems precluded trial beyond 12 days. The recommendation for operation was based only on the severity of symptoms attributed to gastroesophageal reflux. All patients underwent Nissen fundoplication with gastrostomy tube placement at 2 weeks to 6 months of age and weighing 1.02 to 6.95 kg. The only surgical complication was one gastrostomy leak. Prematurity or preexisting anomalies led to a 20% incidence of late unrelated deaths between 2 weeks and 23 months postoperatively. Improvement in symptoms occurred in our survivors with follow-up of 5 to 72 months. We conclude: Significant gastroesophageal reflux in infancy most frequently produces respiratory problems that can be life threatening. Nissen fundoplication can be a safe and effective procedure in infants 6 months of age or younger. Fundoplication appears to have good growth potential, and no late complications or feeding problems have occurred. Consequently, surgical correction can be recommended for infants not responding to conservative medical therapy.
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29
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Bühlmeyer K, Schöber JG, Lorenz HP, Müller KD, Vogel M. Early diagnosis and medical treatment of the persistent ductus arteriosus in infants. Cardiovasc Intervent Radiol 1986; 9:273-8. [PMID: 3100041 DOI: 10.1007/bf02577957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diagnosis of an isolated patent ductus arteriosus (PDA) is usually straightforward. If at later age it is associated with pulmonary hypertension, however, the symptoms may be variable and more difficult to assess. In the age group primarily discussed here, pulmonary hypertension is frequently present, so diagnosis cannot be based on physical findings alone. Echocardiography and Doppler echocardiography are essential diagnostic procedures; however, cardiac catheterization and angiography may still be needed especially in cases with associated heart defects. At present, surgical closure of the PDA is the therapy of choice in infants. In preterm newborns, an attempt by medical treatment is indicated and often promising. Unfortunately, there are no interventional techniques available at present for duct closure in this age group, whereas in some centers catheter closure of a PDA is successfully employed in older children.
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MESH Headings
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/drug therapy
- Ductus Arteriosus, Patent/surgery
- Echocardiography
- Heart Septal Defects/complications
- Humans
- Infant
- Infant, Newborn
- Infant, Premature, Diseases/complications
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/therapy
- Prostaglandins E/therapeutic use
- Radiography, Thoracic
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Abstract
Gastroesophageal reflux (GER) is a well-recognized problem in infants and children. Only scant mention of the premature infant with GER can be found in the literature. Of 760 preterm infants admitted to the NICU between 1980 and 1984, 22 had documented GER. These infants all underwent medical management including upright positioning, small frequent feeds, and often, nasojejunal feedings. Seventeen babies did not respond to medical management and underwent surgical therapy to control the reflux. Of the 17 babies requiring fundoplication, 15 had been initially intubated for treatment of respiratory distress syndrome. Eight of these 15 were extubated in less than 25 days and were improving until they exhibited sudden episodes of deteriorating pulmonary status requiring reintubation. The other seven intubated patients developed striking bronchopulmonary dysplasia (BPD) in the first month and required prolonged ventilatory support. Pulmonary deterioration, failure to grow, and refusal to eat became the herald of GER in these infants. Fundoplication dramatically improved the pulmonary status in all but one infant. Three late deaths can be attributed to cor pulmonale and pulmonary failure. BPD was striking predisposing factor for severe GER in these premature infants. In the total premature population without BDP only 8 of 684 (1.2%) had GER with five responding to medical management and three others undergoing fundoplication for apnea-bradycardia spells. Fourteen of the 76 infants with BPD (18.4%) had significant GER and all required surgical management for control of symptoms. Premature infants who develop deteriorating pulmonary function, poor growth, and/or refusal to eat should be evaluated for GER.
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31
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Krasnitskaia LN. [Functional state of the thyroid in premature children with early anemia]. Pediatriia 1986:76-7. [PMID: 3639391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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32
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Abstract
Perinatal factors associated with death or disability at 2 years were identified in an inborn cohort of 196 live births with a birth weight of 500-999 g. Antepartum haemorrhage, multiple pregnancy, breech presentation, perinatal asphyxia, hypothermia on admission, hyaline membrane disease, persistent pulmonary hypertension, severe respiratory failure, and intraventricular haemorrhage were associated with increased mortality. Factors associated with increased survival included maternal hypertension, caesarean birth, increasing maturity or size at birth, female sex, and fetal growth retardation. Stepwise multiple discriminant function analysis showed that six factors correctly classified the outcome in 83% of infants: intraventricular haemorrhage was the most important factor followed by the presence of acidosis and hypoxia in the early neonatal period, birth weight, pre-eclamptic toxaemia, and caesarean birth. This study also showed that intraventricular haemorrhage, seizures, antepartum haemorrhage and delay in regaining birth weight were associated with increased disability among survivors.
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33
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Abstract
The ultrasonographic findings and neurological development of 15 preterm infants, born between August 1981 and July 1984, who developed periventricular leukomalacia (P.V.L.) are described. The incidence of P.V.L. in infants with a birth weight less than 1 500 g was 2.3%. Nine of the 15 infants demonstrated areas of increased echogenicity in the periventricular regions prior to the development of cystic changes. The mean age for the appearance of cysts was 26 days. At follow-up 14 infants showed evidence of abnormal motor development and 8 infants had visual defects. All infants appear to have normal hearing, but 3 infants show signs of delayed speech. To date, only 2 infants demonstrate signs of mental retardation, but many of the infants are too young to assess intelligence accurately.
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34
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Abstract
Bradycardia occurred during 363 of 1520 apnoeas of 10 seconds' duration recorded in 28 preterm infants. The incidence increased with increasing duration of apnoea (10% of 10-14 seconds, 34% of 15-20 seconds, and 75% of greater than 20 seconds, p less than 0.001). This was similar for each type of apnoea--central, mixed, and obstructive. During 133 apnoeas in five infants the time from the start of the apnoea to the onset in the fall in oxygen saturation (mean 6.9 seconds) was significantly related to the onset of the fall in heart rate (mean 9.3 seconds) (r = 0.67, p less than 0.001). Recovery in heart rate coincided with resumption of air flow rather than breathing efforts and preceded the recovery in oxygen saturation. These results suggest that bradycardia occurs during apnoea as a response to falling oxygen saturation, probably through a peripheral chemoreceptor reflex that is manifest when breathing efforts are absent or ineffective.
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Abstract
Charts of all infantile esotropes who received their primary surgical procedure at the North Carolina Memorial Hospital, between February 1978 and June 1984 were reviewed. Neurologic problems (general and ocular) were identified in 29 of the 47 patients (61.7%) followed a minimum three months (mean = 25.0 +/- 2.9 mos). Frequent general neurologic problems were prematurity, hydrocephalus, mental retardation, cerebral palsy, meningomyelocele, intraventricular hemorrhage, and seizures (neonatal and/or postnatal). Abducens nerve palsy was the most common ocular neurologic impairment. Neurologic impaired esotropes were older (mean = 31.9 +/- 3.8 mos) than the "normal" group (mean = 17.0 +/- 3.3 mos) at the time of surgery. Recession/resection procedures were performed on 13 (44.8%) of the neurologically impaired and nine (50.0%) of the normal esotropes. Bimedial recessions were employed on 12 (41.4%) of the patients with neurologic problems and seven (38.8%) of the normal esotropes. Unilateral medial recessions and/or inferior oblique recessions were performed on six patients. At last follow-up, orthophoria (+/- 10 delta) was present in 16 (55.2%) neurologically impaired patients and 15 (83.3%) normal esotropes (p less than 0.05 by the normal deviate (z) test). Seven (24.1%) neurologically impaired patients had residual esotropia, while consecutive exotropia was present in six (20.7%) patients. Among normal esotropes, residual esotropia was found in one patient and consecutive exotropia in two (11.1%) patients. DVD's occurred in nine patients while four subjects developed a postoperative accommodative component.
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36
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Abstract
Unilateral spontaneous corneal perforation with expulsion of intraocular contents is reported in two very small, high risk premature neonates. The one surviving infant demonstrated unilateral microphthalmos with aphakia and a small leukoma. The cause of this phenomenon is not clear, and measures which might be taken to prevent its occurrence are not obvious.
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37
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Abstract
Transient gallbladder distention in sick premature infants has been reported with increasing frequency over the last few years. It is important to be aware of this entity of gallbladder disease which resolves spontaneously and to be able to differentiate it from other problems that require surgical correction. We believe that ultrasonography is most helpful in confirming the diagnosis, excluding stone formation, and documenting any changes in size or appearance. However, there are no reliable ultrasonic criteria for distinguishing inflamed or pathologically distended gallbladders from noninflamed or temporarily enlarged gallbladders. Radioisotope imaging, though useful in demonstrating malfunction of the hepatobiliary system, should be interpreted with caution. In the final analysis, the dilemma as to whether gallbladder distention is a transient or persistent malfunction can be settled best by thoughtful clinical judgement.
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38
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39
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Sinha SK, Davies JM, Sims DG, Chiswick ML. Relation between periventricular haemorrhage and ischaemic brain lesions diagnosed by ultrasound in very pre-term infants. Lancet 1985; 2:1154-6. [PMID: 2865617 DOI: 10.1016/s0140-6736(85)92680-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ultrasound brain scans were carried out serially during the first month of life on 219 newborn infants of 32 weeks' gestation or less. Periventricular haemorrhage (PVH) alone was observed in 36.1% and ischaemic lesions in 17.8%. By comparison with PVH, ischaemic lesions evolved later (median 7 days vs 2 days), and were associated with a significantly higher frequency of persistent ventricular enlargement and increased mortality. Birth asphyxia, antepartum haemorrhage, recurrent apnoea, and septicaemia--events which are known to promote systemic hypotension--were all strongly associated with ischaemic lesions but not with PVH alone.
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40
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Bennet R, Forsgren M, Herin P. Herpes zoster in a 2-week-old premature infant with possible congenital varicella encephalitis. Acta Paediatr Scand 1985; 74:979-81. [PMID: 4090975 DOI: 10.1111/j.1651-2227.1985.tb10072.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This report concerns a case of neonatal herpes zoster associated with maternal gestational varicella. The child developed skin lesions at 18 days of age virologically confirmed to be varicella-zoster. The baby also had encephalitis and aspiration probably due to bulbar paralysis. Multiple small necrotic areas were found in the thalamus at post-mortem examination.
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41
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Fabre JM. [Etiology of mental debilities in children and adolescents admitted into a medico-educational institute]. Soins Psychiatr 1985:12-6. [PMID: 3853897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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42
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Ontell SJ, Gauderer MW. Iatrogenic arteriovenous fistula after multiple arterial punctures. Pediatrics 1985; 76:97-8. [PMID: 4011360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Multiple arterial punctures in the neonate can result in iatrogenic arteriovenous fistula formation. In one case, a 3-month-old infant who had been born prematurely was noted to have physical findings consistent with arteriovenous malformation following approximately 90 arterial blood gas determinations over a 13-week period. The area was explored and the lesion was treated surgically with good results.
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Ment LR, Scott DT, Ehrenkranz RA, Duncan CC. Neurodevelopmental assessment of very low birth weight neonates: effect of germinal matrix and intraventricular hemorrhage. Pediatr Neurol 1985; 1:164-8. [PMID: 3880401 DOI: 10.1016/0887-8994(85)90058-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During a recent 36-month interval, all neonates of less than or equal to 1250 gram birth weight who were admitted to our Newborn Special Care Unit and survived the first 36 postnatal hours underwent either computed tomography or echoencephalography or both for the assessment of neonatal germinal matrix hemorrhage and intraventricular hemorrhage. Seventy of the 164 long-term surviving infants experienced neonatal germinal matrix and/or intraventricular hemorrhage (GMH/IVH Group), whereas 94 infants had studies that were negative (Non-hemorrhage Group). Serial neurodevelopmental assessments were performed on 142 (87%) of the 164 long-term surviving infants; these assessments included the Bayley Scales of Infant Development at 3, 6, 12, and 18 months (corrected age) and the Stanford-Binet and Peabody Picture Vocabulary examinations at 30 months (corrected age). At 30 months (corrected age), the incidence of major neurologic abnormalities was extremely low in both the GMH/IVH and the Non-hemorrhage groups. In addition, although there were few survivors of the more severe grades of intraventricular hemorrhage, we could detect no difference between the developmental scores of the GMH/IVH and the Non-hemorrhage Group infants.
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Affiliation(s)
- L R Ment
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT
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44
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Garcia VF, Howell CG, Barbot D, Ziegler MM. Small tube peritoneovenous shunting for the management of neonatal intractable ascites. Surg Gynecol Obstet 1985; 160:273-4. [PMID: 3975801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A ventriculoperitoneal shunt for infants has been successfully adapted to function in a reversed manner by sending ascitic fluid back into the circulation of the premature infant. This technique permits successful peritoneovenous shunting in the smallest infant.
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45
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Khoss AE, Ponhold W, Pollak A, Schlemmer M, Weninger M. Abdominal aortic aneurysm in a premature neonate with disseminated candidiasis: ultrasound and angiography. Pediatr Radiol 1985; 15:420-1. [PMID: 3903641 DOI: 10.1007/bf02388367] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
When using ultrasound for detection of kidney enlargement, we found an acute abdominal aortic aneurysm secondary to aortitis following umbilical artery catheterisation in a premature neonate with systemic candidiasis. Aortography was performed to provide vascular details such as involvement of celiac, renal, iliac and femoral arteries.
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46
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Bozynski ME, Nelson MN, Rosati-Skertich C, Genaze D, O'Donnell K, Naughton P. Two year longitudinal followup of premature infants weighing less than or equal to 1,200 grams at birth: sequelae of intracranial hemorrhage. J Dev Behav Pediatr 1984; 5:346-52. [PMID: 6210308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intracranial hemorrhage (ICH) is a major problem for the premature infant, occurring in more than one-third of surviving infants weighing less than or equal to 1,500 g at birth. The literature on perinatal ICH, as it relates to neurodevelopment outcome, is briefly reviewed, and preliminary results from our two-year followup of 75 less than or equal to 1,200-g infants are summarized. An analysis of pathophysiology, diagnosis, classification, and followup indicates that risk for ICH and its sequelae increases as gestational age and birth weight decrease. Hydrocephalus apparently no longer presents significant risk beyond that conveyed by the original hemorrhage. However, persistent posthemorrhagic ventriculomegaly and/or periventricular abnormalities serve as significant "markers" of risk for neuromotor delay through two years of age. In contrast, recovery of normal ventricular morphology by term gestational age apparently indexes a degree of recovery from ICH and predicts a more normal developmental outcome through the first two postnatal years.
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47
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Moazam F, Glenn JD, Kaplan BJ, Talbert JL, Mickle JP. Inguinal hernias after ventriculoperitoneal shunt procedures in pediatric patients. Surg Gynecol Obstet 1984; 159:570-2. [PMID: 6505943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The results of this study of 134 patients confirm the increased incidence of previously unrecognized inguinal hernias after ventriculoperitoneal shunting procedures. Infants with intraventricular hemorrhage appeared to be the most susceptible, although associated prematurity may play an additional role. Close observation of infants and children who undergo ventriculoperitoneal shunting is required, to allow early detection and repair of inguinal hernias. Inguinal herniorrhaphy can be performed safely with few or no postoperative complications and no deleterious effects to the VP shunt.
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48
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Abstract
The pulmonary course and respiratory management of 65 asphyxiated infants with at least one arterial pH less than or equal to 7.00 within the first 2 hours of life was determined. Asphyxia in the preterm and term infants in the absence of respiratory distress syndrome or meconium aspiration syndrome was associated with a transient respiratory insufficiency requiring assisted ventilation which markedly improved in the first 24 hours of life. In contrast, infants with asphyxia complicated by respiratory distress syndrome or meconium aspiration syndrome developed profound lung disease including pulmonary hemorrhage and persistence of the fetal circulation. The course of their illness was significantly worse than control infants without asphyxia. Ineffective neonatal resuscitation allowing for the development of meconium aspiration syndrome and persistent respiratory acidosis contributed to the severity of illness in more than 50% of the infants. Central nervous system pathologic conditions were present in asphyxiated infants with and without severe pulmonary disease. We conclude that severe asphyxia in the absence of underlying lung disease results in a predictable postasphyxial transient respiratory insufficiency, with marked improvement in the first 24 hours of life.
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49
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Langdon DR. Fungal infections in premature infants. Pediatrics 1984; 74:443. [PMID: 6472981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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50
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Peckham GJ, Miettinen OS, Ellison RC, Kraybill EN, Gersony WM, Zierler S, Nadas AS. Clinical course to 1 year of age in premature infants with patent ductus arteriosus: results of a multicenter randomized trial of indomethacin. J Pediatr 1984; 105:285-91. [PMID: 6379136 DOI: 10.1016/s0022-3476(84)80134-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Reported are 1-year follow-up results of a randomized clinical trial comparing three strategies of managing clinically significant patent ductus arteriosus at the time of diagnosis in premature infants: (1) immediate administration of a three-dose course of intravenously administered indomethacin in addition to usual medical therapy (fluid restriction and use of diuretics or digitalis or both), with surgery as a backup measure, (2) usual medical therapy alone initially, with indomethacin as the first and surgery as the final backup measure, and (3) usual medical therapy alone initially, with surgery alone as backup. Of primary concern were the relative merits of these three managements strategies in the terms of the long-term occurrence of a wide range of health problems. Although at the time of neonatal hospitalization there was a significant excess of bleeding episodes in infants receiving indomethacin as part of initial treatment, and a significantly higher rate of retrolental fibroplasia in the those given usual medical therapy with surgery as backup, there were no statistically significant differences at 1 year of age related to these intermediate outcomes. In other regards, too, the treatment strategies appeared interchangeable in terms of the 1-year outcome.
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MESH Headings
- Bronchopulmonary Dysplasia/etiology
- Child Development
- Clinical Trials as Topic
- Combined Modality Therapy
- Ductus Arteriosus, Patent/complications
- Ductus Arteriosus, Patent/drug therapy
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/therapy
- Female
- Follow-Up Studies
- Humans
- Indomethacin/adverse effects
- Indomethacin/therapeutic use
- Infant, Newborn
- Infant, Premature, Diseases/complications
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/therapy
- Male
- Patient Readmission
- Random Allocation
- Retinopathy of Prematurity/chemically induced
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