No abstract

The aim of this study was to validate the accuracy of real-time ultrasound (US) in the diagnosis of periventricular leukomalacia (PVL). US changes of PVL were correlated with autopsy results. During a 12-month period, all premature infants of 34 weeks' gestation or less (group A) and all neonates of more than 34 weeks' gestation who presented with abnormal neurological signs (group B) were studied with an ATL mechanical sector scanner (5 and 7.5 MHz). The overall incidence of PVL was 13.3%. In group A (n = 83), 13 infants had PVL and 3 died. In group B (n = 36), three developed PVL and two died. Autopsy was performed in the five infants. US revealed the sequence of lesion: - the early stage with increased echogenicity in the periventricular white matter, - the late stage with area of reduced echogenicity appearing in the most echogenic zone and resulting in cystic cavitation. Autopsy confirmed PVL lesions in all five infants. The increased echogenicity corresponded to necrosis with either vascular congestion and/or secondary bleeding, the reduced echogenicity to cystic degeneration with gliosis. US scan be used for the detection of PVL.

No abstract

Previously we showed a decrease in metabolic rate in infants receiving Total Parenteral Nutrition (TPN) containing glucose + lipids vs glucose only. In the present study we measured substrste utilisation b Indirect Calorimetry (IDC) over 5 hr and fr the excretion of 13C02 during a primed constant in usion of U-PIPC-glucose. Glucose oxidation (GO) was measured from the ' ' C O ? enrichtment in breath at plateau and fat oxidation (FO) as the difference of non-protein metabolic rate and glucose oxidation. We compared metabolic rate (MR) and substrate utilisation in two groups of AGA infants on an isocaloric intake. Group I received glucose/aminoacids only, Group I1 received a lipid emulsion as well, fat intake 2.0+0.1 g/kg/d. Birthweight Poor growth in association with child abuse is well recognlsed but eventual outcome in terms of growth parameters has not been clearly defined. The changes in standard deviation scores (SDS) for height and welght were calculated in 95 children who had suffered child abuse. Catch up growth was defined as an lncrease in SDS >1.0. A~e s at presentation ranged from 6 weeks to 12 years and length of follow up from 9 months to 8 years. The mean SDS for height and weight increased significantly between presentation and most recent clinic visit lp <0.001 and p <0.01 respectively). The 64 children who remained at home (group 1) showed a significant increase in height SDS only lp <0.01). The 20 children taken into long term fostercare or adopted (group 2) showed significant increases in both height and weight SDS (p <0.001 and p <0.01 respectively). The remaining 1 1 children who were fostered for short periods only (group 3 ) showed little change in either index. Catch up growth in height occurred in 12% of group 1 compared to 55% group 2 (p <0.001 ) . Catch up growth in weight occurred in 22% group 1 compared to 50% group 2 lp <0.05). Children suffering child abuse show greater catch up growth when taken into long term care. Using these data we have generated a grid to determine the risk of IV-PVH according to birth-weight-gestational age categories. Reasons for the decline in IV-PVH are uncertain, but includea decreasc in outborn admissions and changing attitudes of obstetricians towards extreme prematurity. The decline of IV-PVH without resorting to pharmacologic agents emphasizes the importance of controlled trials in evaluating intervention. . ~. .all babies developed normally. 2)Frontal-parietal areas (n=6): 3 had major handicap. 3)Frontal-parietal-Occipital areas(n=5): all had major handicap. Our study indicate that major sequelae are more closely related to the extent and localisation of PVL than to haemorrhage or ventricular dilatation as previously reported. IOUTCOYE O F PRETERM INFANTS WITH NEONATAL36 APNOEIC ATTACKS.Gillian Levitt, Alan Mushin, Susan Bellman and David Harvey. Queen Charlotte's Maternity Hospital, London United Kingdom. The incidence o f major disability associated with neonatal apnoeic attacks was studied. The infants had been monitored for apnoea by routine n...

A systematic ultrasonographic study and a prospective neurodevelopmental assessment were carried out in a population of high-risk neonates. In group A (82 preterm infants of 34 weeks gestation or less), periventricular-intraventricular hemorrhage (PVH) and periventricular leukomalacia (PVL) were the commonest lesions. The association of PVH, PVL and ventricular dilatation had a variable outcome and the prognosis was found to be poorer in the presence of diffuse or extensive PVL. In group B (115 neonates of more than 34 weeks gestation), miscellaneous ultrasound changes were observed (malformations, infections, hemorrhages and hypoxic-ischemic lesions). Malformations, hypoxic-ischemic damage and prenatal infections had a gloomy prognosis. The main targets of hypoxic-ischemic damage in the immature infant were the germinal layer and the periventricular white matter, while in the mature infant the cortex and basal ganglia were more vulnerable. A relation between the localization and the size of the lesion could be established. In conclusion, basic forms of cerebral damage should therefore be understood in terms of brain maturation, type and timing of the insult, extent and localization of the lesion.