Connatal periventricular pseudocysts are important sequelae of different noxious insults in the developing brain. Accurate diagnosis of those pathologic entities during early life has therefore become of direct concern to the clinician. Our experience with 12 infants of connatal periventricular pseudocysts provides the basis of this study. They belonged to different pathological entities: focal paraventricular pseudocysts (5 cases), subependymal pseudocyst (3 cases), connatal viral infection (3 cases), and chromosomal abnormality (1 case). When present at birth, they suggest an intrauterine pathology. It has only been with the advent of real-time cranial ultrasound that periventricular pseudocystic lesions can be detected in neonates following an abnormal pregnancy. Some obstetric complications during the second trimester can cause paraventricular or subependymal pseudocyst in the foetus. Neurotrophic viral infection and chromosomal abnormalities have also been implicated in the production of cystic lesions in this region. These lesions are not a terminal event in infants but may be a condition of major clinical importance for further neurological development.

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The enzymes hexokinase (HK), phosphoglucomutase (PGM), pyruvate kinase (PK) and lactate dehydrogenase (LDH) were assayed in villous tissue homogenates and cell fractions of normal human term placentas. Although lowest in activity and probably rate limiting in glycolysis, hexokinase is theoretically adequate to phosphorylate the total amount of glucose metabolized. PGM and PK activity were in the same range exceeding HK by 10-15 times, suggesting a largely increased breakdown of glycogenderived glucose in situations of need. Substantially higher LDH activities may reflect the placental ability to utilize lactate from both mother and fetus. Of all enzymes only hexokinase was found to be associated with the particulate matter in considerable amounts.

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The ability of parameters like umbilical arterial pH and Apgar score to predict and/or to reflect fetal distress are limited. It is known that erythropoietin (EPO) increases when partial pressure of oxygen is insufficient for metabolic demand. Therefore we studied the levels of EPO in the cord blood of stressed neonates (n = 75). In addition, reference values for EPO were established in a group of healthy term infants (n = 54) (mean +/- SD: 20.02 +/- [mU/ml]) and in premature infants (n = 77) according to gestational age. A significant increase in EPO concentrations was found in the stressed group: 153.4 +/- 418.8 [mU/ml], p < 0.003 (n = 27) in acute stress; and 102.6 +/- 127.1 [mU/ml], p < 0.002 (n = 48) in chronic stress. However parameters like hemoglobin, hematocrit, umbilical arterial pH and Apgar-score did not correlate with EPO values. A sensitivity of 59% and a specificity of 92% was calculated. We conclude that serum EPO concentrations are capable of detecting acute and chronic stress and could be useful as a screening method. In part EPO concentrations also allow us to grade stress in pregnancies that are complicated by diseases like preeclampsia.