Perinatal asphyxia is the most common cause of neurologic injury and neurodevelopmental delay. The signs of injury are nonspecific at birth, and most indicators take hours to days before they become manifest. Early recognition of the injury is important in guiding management during those critical first days of life. Over a five‐year period, we investigated 16 term neonates with a history of asphyxia on the first day of life who demonstrated on intracranial Doppler sonography cerebral vessel high diastolic flow with a resistive index below 60. Two infants died and one was lost to follow‐up. Three of the remaining 13 patients were normal at 8 months to 1 year follow‐up. The remaining 10 patients had severe neurodevelopmental delay with profound handicaps at follow‐up periods from 3 months to 32 months. This study has confirmed earlier reports that in the first days of life, a very low resistive index combined with history of asphyxia is associated with an adverse outcome and may be considered one of the earliest markers for poor neurodevelopmental outcome. Only 50% of these patients demonstrated abnormal sonographic imaging.

A B S T R A C T The purpose of this study was to evaluate the effect of hyperosmolality on the performance of, and the collateral blood flow to, ischemic myocardium. The myocardial response to mannitol, a hyperosmolar agent which remains extracellular, was evaluated in anesthetized dogs. Mannitol was infused into the aortic roots of 31 isovolumic hearts and of 15 dogs on right heart bypass, before and during ischemia. Myocardial ischemia was produced by temporary ligation of either the proximal or mid-left anterior descending coronary artery.Mannitol significantly improved the depressed ventricular function curves which occurred with left anterior descending coronary artery occlusion. Mannitol also significantly lessened the S-T segment elevation (epicardial electrocardiogram) occurring during myocardial ischemia in the isovolumic hearts and this reduction was associated with significant increases in total coronary blood flow (P < 0.005) and with increased collateral coronary blood flow to the ischemia area (P < 0.005).Thus, increases in serum osmolality produced by mannitol result in the following beneficial changes during myocardial ischemia: (a) improved myocardial function, (b) reduced S-T segment elevation, (c) increased total coronary blood flow, and (d) increased collateral coronary blood flow.

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Under the specific conditions of this study, SC as a single agent was inactive in patients with advanced-stage cancer and had no salutary effect on quality of life. The 16.7% rate of SD was similar to results in patients with advanced cancer treated with supportive care alone.

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