Ultrasound appearance of the brain in very preterm infants and neurodevelopmental outcome at 18 months of age.

Stewart, Ann; Thorburn, RosalindJ.; Hope, P L; Goldsmith, Maria; Lipscomb, A.P.; Reynolds, E. O. R.

doi:10.1136/adc.58.8.598

Cited by 146 publications

(60 citation statements)

References 12 publications

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“…The pattern of moderate flow to the cortex, high flow to the central gray matter and brain stem, and low flow to the white matter has been described previously (1 [2][3][4][5][6][7][8][9][10][11][12][13][14]. There were no significant differences in flow to either side of the brain in control or experimental puppies.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Intraventricular Blood on Cerebral Blood Flow in Newborn Dogs

Batton

Nardis

1987

Pediatr Res

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were tracheostomized, paralyzed with subcutaneous pancuronium bromide, and ventilated with a mixture of 70% nitrous oxide and 30% oxygen using a Harvard small-animal ventilator. The ventilator rate and tidal volume were adjusted to maintain normal blood gases. A femoral artery was exposed and catheterized with a 30-gauge Teflon catheter to monitor blood pressure and blood gases. The other femoral artery and vein were catheterized for administration of [14C]iodoantipyrine and collection of blood samples during rCBF determination. Temperature was controlled by a rectal thermocouple and maintained at 37" by a heat lamp. With the dog's skull in a stereotaxic frame, a small, longitudinal scalp incision was made over the sagittal suture after subcutaneous infiltration with procaine. The scalp and underlying periosteum were retracted to expose a 2-cm area of the calvarium. A 1-mm burr hole was drilled through the calvarium GM-IVH, germinal matrix-intraventricular hemorrhage in the right parasagittal area posterior to the coronal suture. A CBF, cerebral blood flow 20-gauge glass capillary tube with a stylet was then inserted rCBF, regional cerebral blood flow through the burr hole and advanced until spinal fluid was ob-IVP, intraventricular pressure tained. The catheter was attached by a silastic rubber tubing to CPP, cerebral perfusion pressure a T-piece, one arm of which was connected to a pressure trans-GM-IVH occurs in 44-55% of newborns with a birth weight 51500 g (1, 2). Although the hemorrhage is usually limited to the germinal matrix area or contained within the ventricular system, some 15-43% of infants with GM-IVH develop an associated intraparenchymal hemorrhage (1-3). Since this parenchymal lesion is associated with a high incidence of serious longterm neurological sequelae (4-8), understanding its pathogenesis is of extreme importance.Although pathological studies have shown that most parenchymal hemorrhages result from ischemic infarction of the periventricular white matter, rather than rupture of the intraventricular hemorrhage (9), the origin of the ischemia responsible for this lesion is unknown. Volpe et al. (10) have theorized that ischemia may result from either systemic hypotension and loss of autoregulation of CBF or, secondarily, from the effects of blood within the ventricular system. Intraventricular blood could impair perfusion to this area either by compression of periventricular vessels due to ventricular distention or by producing vasospasm. Since little is known about this subject in the newborn, the purpose of this study was to investigate the effect of intraventricular blood on rCBF in the newborn dog. ducer for recording of IVP and the other arm to a Hanard pump for the infusion of blood. Proper position of the intraventricular catheter was confirmed by observing appropriate cardiac and respiratory variations of the pressure waveform. The CPP was defined as the mean arterial blood pressure minus the intraventricular pressure. Through the arterial catheter, 6 ml/kg of blood were slowly wi...

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Section: Resultsmentioning

confidence: 99%

The Effect of Intraventricular Blood on Cerebral Blood Flow in Newborn Dogs

Batton

Nardis

1987

Pediatr Res

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“…Infants with transient VD, which resolved to normal, parenchymal lesions (including haemorrhagic parenchymal infarction [HPI], cystic periventricular leukomalacia [cPVL], and periventricular flares), and infants with hydrocephalus as defined by Levene and Starte (1981) were excluded. To identify infants with mild as well as more marked VD, the definition used was dilatation of the lateral ventricle with CSF such that the depth of the frontal horn immediately anterior to the thalamo-caudate notch was greater than 3mm (97th centile; Stewart et al 1983). …”

Section: Neonatal Cranial Ultrasoundmentioning

confidence: 99%

Neurodevelopmental outcome of preterm infants with ventricular dilatation with and without associated haemorrhage

Vollmer

Roth²,

Riley³

et al. 2006

Develop Med Child Neuro

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This study investigated whether in preterm children who had ventricular dilatation (VD) on neonatal cranial ultrasound outcome at age 8 years was influenced by the additional presence of germinal matrix haemorrhage -intraventricular haemorrhage (GMH-IVH). Six-hundred and ninety-nine preterm infants (<33wks' gestation, mean 29.6wks [SD 2.1]) with either normal cranial ultrasound (n=616; 286 females, 330 males), or with VD with (n=66; 32 females, 34 males) or without (n=17; 4 females, 13 males) GMH-IVH were enrolled in the study. At age 8 years outcome was assessed in 567 (81%) of the 699 children by neurological examination, the Test of Motor Impairment (TOMI), the test of Visuo-Motor Integration (VMI), and the Wechsler Intelligence Scales for Children. Results showed that the proportion of children with disabling impairments was higher in the group with VD and GMH-IVH. Performance on TOMI and VMI (even in those without disabling impairments) was poorer in those with VD and GMH-IVH than in children with normal scans or those with VD only. Children with VD and GMH-IVH had significantly lower performance IQ than children with normal ultrasound, whereas those with VD only were not different from those with normal scans. Results suggest the presence of subtle white matter injury that has not been identified by neonatal cranial ultrasound. Although this study did not investigate biochemical markers of haemorrhage, we hypothesize that non-proteinbound iron is likely to be a contributing factor to white matter damage in preterm infants.

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“…The 38 surviving infants were enrolled into a neurodevelopmental follow-up clinic for repeated examinations. At 49-67 (median 53) wk of age, corrected for preterm birth, a full clinical and neurologic assessment was carried out as previously described (8), including a Griffiths test (9) by an independent observer. Outcome was classified into four groups as follows: normal: no demonstrable impairment; minor impairments: disorders of tone or reflexes not causing disability; major neuromotor impairments: isolated neuromotor impairments causing disability; multiple major impairments: more than one disabling impairment, including neuromotor, neurosensory (visual or hearing), neurobehavioral, and psychometric, often together with microcephaly.…”

Section: Methodsmentioning

confidence: 99%

Prognosis of Newborn Infants with Hypoxic-Ischemic Brain Injury Assessed by Phosphorus Magnetic Resonance Spectroscopy

Azzopardi¹,

Wyatt²,

Cady³

et al. 1989

Pediatr Res

Self Cite

342

176

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ABSTRACT. To investigate the prognostic significance of abnormalities of oxidative phosphorylation, the brains of 61 newborn infants born at 27-42 wk of gestation and suspected of hypoxic-ischemic brain injury were examined by surface-coil phosphorus magnetic resonance spectroscopy. Of these infants, 23 died, and the neurodevelopmental status of the 38 survivors was assessed at 1 y of age. Of the 28 infants whose phosphocreatine/inorganic orthophosphate (PCr/Pi) ratios fell below 95% confidence limits for normal infants, 19 died, and of the nine survivors, seven had serious multiple impairments (sensitivity 74%, specificity 92%, positive predictive value for unfavorable outcome 93%). Of the 12 infants with ATP/total phosphorus ratios below 95% confidence limits 11 died (sensitivity 4774 specificity 97%, positive predictive value 91%). Among the 46 infants with increased cerebral echodensities, PCr/Pi was more likely to be low, and prognosis poor, in infants whose echodensities were diffuse or indicated intraparenchymal hemorrhage than in infants whose echodensities were consistent with periventricular leukomalacia. We conclude that when reduced values for PCr/ Pi indicating severely impaired oxidative phosphorylation are found in the brains of infants suspected of hypoxicischemic injury, the prognosis for survival without serious multiple impairments is very poor, and that when ATP/ total phosphorus is reduced, death is almost inevitable. (Pediatr Res 25445-451, 1989) Abbreviations 31P MRS, phosphorus magnetic resonance spectroscopy PCr, phosphocreatine Pi, inorganic orthophosphate PME, phosphomonoester PDE, phosphodiester total P, total mobile phosphorus pHi, intracellular pH BE, base excess SDS, standard deviation score GQ, Griffiths general quotient PVL, periventricular leukomalacia energy metabolism in the brain tissue of newborn infants (1, 2). pH, can also be estimated.In previous investigations, we found that abnormalities indicating abnormal oxidative phosphorylation were detectable in the brain after birth asphyxia (3) and in the presence of cerebral echodensities detected by ultrasound that are associated with various forms of hypoxic-ischemic brain injury (4). In the latter study, it was shown that evidence of severely abnormal oxidative phosphorylation was related to subsequent loss of brain tissue. The purpose of the present investigation was to explore the prognostic significance of abnormalities of oxidative phosphorylation for survival and for neurodevelopmental status at 1 y of age in a group of infants suspected of hypoxic-ischemic brain injury.

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Ultrasound appearance of the brain in very preterm infants and neurodevelopmental outcome at 18 months of age.

Cited by 146 publications

References 12 publications

The Effect of Intraventricular Blood on Cerebral Blood Flow in Newborn Dogs

The Effect of Intraventricular Blood on Cerebral Blood Flow in Newborn Dogs

Neurodevelopmental outcome of preterm infants with ventricular dilatation with and without associated haemorrhage

Prognosis of Newborn Infants with Hypoxic-Ischemic Brain Injury Assessed by Phosphorus Magnetic Resonance Spectroscopy

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