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1
MERCHANT, NAZAKAT, and DENIS AZZOPARDI. "HYPOXIC ISCHAEMIC ENCEPHALOPATHY IN NEWBORN INFANTS." Fetal and Maternal Medicine Review 21, no. 3 (May 19, 2010): 242–62. http://dx.doi.org/10.1017/s0965539510000069.
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Neonatal encephalopathy has been defined as “a clinically defined syndrome of disturbed neurological function in the earliest days of life in the term infant, manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, sub normal level of consciousness and often seizures”. It occurs in about 2–3 per 1000 births in developed countries. In developing countries, neonatal encephalopathy accounts for the largest number of deaths in infancy and childhood – approximately 1 million per year worldwide. Neonatal encephalopathy is associated with significant morbidity and mortality and is an important predictor of long term neurodevelopmental disability in near- and full-term newborn infants. Fifteen to 20 percent of infants with neonatal encephalopathy die in the neonatal period, and a further 25 percent have permanent neurologic deficits.
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Tarca, Elena, Simona Gavrilescu, Laura Florescu, Alina Mariela Murgu, Monica Ungureanu, Vasile Valeriu Lupu, and Dana Elena Mindru. "INFECTIONS AND PREMATURITY, IMPORTANT RISK FACTORS FOR NEONATAL MORBIDITY AND MORTALITY." Romanian Journal of Infectious Diseases 19, no. 4 (December 31, 2016): 222–25. http://dx.doi.org/10.37897/rjid.2016.4.2.
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Infant mortality is a major problem in developing countries and, unfortunately, this is the case of our country as well, given that Romania ranks first in the European Union in this respect, with an infant mortality rate of 9 ‰, compared to an average of roughly 4 ‰. Worldwide, over 15 million babies are born prematurely each year and, out of these, more than a million die due to prematurity and infections, which are the main risk factors for neonatal mortality. The risk of infection is several times higher in preterm newborns than in full-term newborns – about 80% of neonatal infections occur in premature infants. A significant proportion of the survivors of prematurity will have important neurological sequelae because of neonatal infections as well as of intracerebral bleeding or hypoxia at birth. Continuing medical education in both the general population and the medical sector is crucial in preventing premature births and neonatal infections and, consequently, in decreasing infant morbidity and mortality rates in our country.
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Liu, S., K. Benirschke, A. L. Scioscia, and F. L. Mannino. "Intrauterine Death in Multiple Gestation." Acta geneticae medicae et gemellologiae: twin research 41, no. 1 (January 1992): 5–26. http://dx.doi.org/10.1017/s0001566000002464.
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AbstractIntrauterine death of one fetus in a multiple gestation is associated with significant morbidity and mortality in the surviving infant. This study is a retrospective review of 38 twin and 3 triplet gestations involving the intrauterine death of at least one fetus. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed. Three cases involved the recent stillbirth of both twins, the remaining cases involved a surviving infant. In one case, neonatal death of a surviving twin occurred on day 19. In two sets of triplets, two stillbirths occurred, in the third case two infants were liveborn. The incidence of preterm delivery was 34%, which decreased to 18% if fetal cotwin death had occurred before 20 weeks gestation. Cesarean section was the method of delivery in 16 cases. There was an excess of velamentous cord insertions, which was most pronounced in the stillborn twin. Monochorionic placentation was found in 72%, also an excess.Neurological damage was known to have occurred in 19 of the 39 surviving infants. Fifteen of these 19 (79%) were associated with monochorionic placentation. The neurologically damaged twin infants, when compared to the normal infants, had the cotwin die later in gestation (31 vs 16.5 weeks), had a shorter duration between the death of the cotwin and delivery (2.5 vs 21 weeks), and delivered earlier in gestation (36.5 vs 39.5 weeks). The probable cause of neurological damage, in our opinion, was either exsanguination into the dead twin fetus, or disseminated intravascular coagulation which occurred in at least 13 cases. The incidence of antepartum death in a multiple gestation, and the potential for neurological damage is probably higher than previously thought. A review of the literature is presented and the clinical implications of this phenomenon are discussed.
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Vehapoglu, Aysel, Ozden Turel, Turkan Uygur Sahin, Nurettin Onur Kutlu, and Akın Iscan. "Clinical Significance of Human Metapneumovirus in Refractory Status Epilepticus and Encephalitis: Case Report and Review of the Literature." Case Reports in Neurological Medicine 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/131780.
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Encephalitis is a complex neurological disease that is associated with significant morbidity and mortality, and the etiology of the disease is often not identified. Human metapneumovirus (hMPV) is a common cause of upper and lower respiratory tract infections in children. Few reports are available showing possible involvement of hMPV in development of neurologic complications. Here, we describe an infant, the youngest case in literature, with refractory status epilepticus and severe encephalitis in whom hMPV was detected in respiratory samples and review diagnostic workup of patient with encephalitis.
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Yates, Nathanael, Alistair J. Gunn, Laura Bennet, Simerdeep K. Dhillon, and Joanne O. Davidson. "Preventing Brain Injury in the Preterm Infant—Current Controversies and Potential Therapies." International Journal of Molecular Sciences 22, no. 4 (February 7, 2021): 1671. http://dx.doi.org/10.3390/ijms22041671.
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Preterm birth is associated with a high risk of morbidity and mortality including brain damage and cerebral palsy. The development of brain injury in the preterm infant may be influenced by many factors including perinatal asphyxia, infection/inflammation, chronic hypoxia and exposure to treatments such as mechanical ventilation and corticosteroids. There are currently very limited treatment options available. In clinical trials, magnesium sulfate has been associated with a small, significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood but no effect on the combined outcome of death or disability, and longer-term follow up to date has not shown improved neurological outcomes in school-age children. Recombinant erythropoietin has shown neuroprotective potential in preclinical studies but two large randomized trials, in extremely preterm infants, of treatment started within 24 or 48 h of birth showed no effect on the risk of severe neurodevelopmental impairment or death at 2 years of age. Preclinical studies have highlighted a number of promising neuroprotective treatments, such as therapeutic hypothermia, melatonin, human amnion epithelial cells, umbilical cord blood and vitamin D supplementation, which may be useful at reducing brain damage in preterm infants. Moreover, refinements of clinical care of preterm infants have the potential to influence later neurological outcomes, including the administration of antenatal and postnatal corticosteroids and more accurate identification and targeted treatment of seizures.
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Sudhakar, C., and Pallavi Jindal. "Profile of hypoxic ischemic encephalopathy in newborns in a tertiary care centre of Bhilai, Chhattisgarh, India." International Journal of Contemporary Pediatrics 5, no. 6 (October 22, 2018): 2032. http://dx.doi.org/10.18203/2349-3291.ijcp20184268.
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Background: Birth asphyxia is an important cause of static development and neurological handicap in both term and preterm infants. Birth asphyxia is found to be responsible for 28.7% deaths in hospital settings and 20% deaths in rural/tribal areas. Approximately the same number develops serious sequelae which cripples these children both physically and mentally. Children who have suffered moderate encephalopathy had varying rates of infant death and morbidity. Precise determination of the prognosis in the term new born, who sustains a hypoxic ischemic insult is hindered by difficulty in determining the severity of insult.Methods: This was a prospective longitudinal, observational study was conducted in the Department of Paediatrics, CMC Bhilai with close association with the Department of Obstetrics and Gynecology, Department of Radio diagnosis and Department of Neurology. All deliveries taking place in the Department of Obstetrics and Gynecology of CMC Bhilai were enrolled for the study. Each enrolled infant underwent a detailed neurologic examination within the first 12 hours after birth. During the period of data collection 180 babies with birth asphyxia were admitted to NICU. Out of which 126 babies had fulfilled the inclusion criteria and completed one year follow up, hence as cases. Babies who lost follow up were not included in study. The neurological examination was performed 14 days after discharge, then at 1 month, 3-month, 6-month, 9 month and 12 months. Long term outcome in this study is defined as outcome at one year of age in terms of morbidity and mortality.Results: The female and male ratio is 0.4:1. Most of the asphyxiated newborn, 81 (64%) were in 2500-3000gm. Among the study population, maximum number of cases 76 (60%) were suffering from HIE-I. Majority of study population, 87 (69%) were born by LSCS. Normal CUS in 93 babies and abnormal in 33 babies; with normal CUS, there were no death in study population and out of 33 abnormal CUS, 12 deaths occurred. Out of the different complications enlisted in the table convulsions (66.7%) is most common followed by Apnea (65.08%). Recurrent infections (45.24%) is the most common complication followed by seizure disorders (22.63%) and failure to thrive (20.63%).Conclusions: Hypoxic ischemic encephalopathy is one of the major consequences of perinatal asphyxia. Despite of best care, some babies are likely to develop it.
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Hadley, Mark N., Volker K. H. Sonntag, Harold L. Rekate, and Alan Murphy. "The Infant Whiplash-Shake Injury Syndrome: A Clinical and Pathological Studya." Neurosurgery 24, no. 4 (April 1, 1989): 536–40. http://dx.doi.org/10.1227/00006123-198904000-00008.
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ABSTRACT The cases of 13 infants (median age, 3 months) who sustained nonaccidental trauma were reviewed. All presented with profound neurological impairment, seizures, retinal hemorrhages, and intracranial subarachnoid and/or subdural hemorrhages. Of 8 infants who died, autopsy was performed on 6. No patient had a skull fracture, and only one had an extracalvarial contusion. Five of the 6 patients on whom autopsy was performed had injuries at the cervicomedullary junction consisting of sub- or epidural hematomas of the cervical spinal cord with proximal spinal cord contusions. The authors conclude that direct cranial trauma is not an essential element of the injury mechanism in young patients who sustain severe whiplash-shake injuries. In addition to the classic injuries reported to occur with the shaken-baby syndrome, hemorrhages and contusions of the high cervical spinal cord may contribute to morbidity and mortality.
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Cheong, Jeanie L. Y., Joy E. Olsen, Li Huang, Kim M. Dalziel, Rosemarie A. Boland, Alice C. Burnett, Anjali Haikerwal, et al. "Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s." BMJ Open 10, no. 9 (September 2020): e037507. http://dx.doi.org/10.1136/bmjopen-2020-037507.
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ObjectivesIt is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22–27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s.DesignProspective longitudinal cohort study.SettingThe State of Victoria, Australia.ParticipantsAll EP births offered intensive care in four discrete eras (1991–1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016–March 2017 (12 months): n=250).Outcome measuresConsumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated.ResultsMedian duration of any respiratory support increased from 22 days (1991–1992) to 66 days (2016–2017). The increase occurred in non-invasive respiratory support (2 days (1991–1992) to 51 days (2016–2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016–2017. Survival to discharge home increased (68% (1991–1992) to 87% (2016–2017)). Cystic periventricular leukomalacia decreased (6.3% (1991–1992) to 1.2% (2016–2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991–1992) to 10.0% (2016–2017)). The average additional costs associated with one additional infant surviving in 2016–2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991–1992, 1997 and 2005, respectively.ConclusionsConsumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined.
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K. T., Naheeda Mohammed, Lalithambica Karunakaran, and Varghese P. Punnoose. "Proportion and risk factors of postnatal depression among women delivering in a government tertiary care hospital in Kerala, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 6 (May 27, 2021): 2395. http://dx.doi.org/10.18203/2320-1770.ijrcog20212182.
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Background: The burden of postpartum depression is significant because it remains unrecognized and it not only affects the mother adversely but also has a negative consequence on the family life and the development of the infant. This research aims to aid the early diagnosis of postnatal depression using Edinburgh postnatal depression scale (EPDS) and the psychosocial and reproductive risk factors of postnatal depression among women delivering in a tertiary hospital in Kerala state, India.Methods: 500 women were subjected to a standard questionnaire for assessing psychosocial and reproductive characteristics. The diagnosis of postnatal depression was made using a pretested and validated Malayalam version of EPDS with a score cut off of 13 or more.Results: The proportion of postnatal depression six weeks after delivery at TD Medical College, Alappuzha was found to be 8.6%. Marital harmony (p value=0.002) was significantly associated with postnatal depression. Diabetes (p value=0.037), hypertensive disorders (p value=0.013), antepartum hemorrhage (p value=0.036), neurological disorders (p value <0.001), type of delivery (p value=0.042), postpartum complications (p value=0.003), mode of infant feeding (p value=0.001), infant illness (p value=0.001), symptoms of maternity blues (p value <0.0001), premenstrual syndromes (p value=0.008) and infertility treatment (p value=0.03) were significantly associated with postnatal depression.Conclusions: Early screening of the women and counselling of women and their family will reduce the maternal morbidity and adverse child outcomes.
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Șerbănescu, Alina, Romina-Marina Sima, and Liana Pleș. "Substances abuse in HIV positive pregnant women." Infectio.ro 56 (4), no. 1 (December 30, 2018): 36–39. http://dx.doi.org/10.26416/inf.56.4.2018.2192.
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Substances abuse and HIV infection are major health issues globally, with a significant increase in morbidity and mortality. But what are the consequences of the association between the two, especially in a pregnant woman? Substance abuse in a pregnant HIV positive woman, regardless of the substance used (tobacco, alcohol, marijuana, cocaine, opioids etc.) is at greater risk of HIV maternal-fetal transmission, as well as obstetric, neonatologic and pediatric complications, such as miscarriage, abruptio placentae, premature birth, eclampsia, fetal alcohol syndrome, stillbirth, sudden infant death syndrome and neurological deficits. For these reasons cessation of substance abuse is mandatory before planning a pregnancy, especially for HIV infected women. This can be achieved through counselling, guidance towards rehab facilities and prenatal screening programs, often with optimistic results, as pregnancy is the time with the highest success rate regarding substance abuse cessation than any other time in a woman’s life.
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Panthee, Kiran, Kiran Sharma, Balkrishna Kalakheti, and Kul Thapa. "Clinical Profile and Outcome of Asphyxiated Newborn in a Medical College Teaching Hospital." Journal of Lumbini Medical College 4, no. 1 (June 30, 2016): 1. http://dx.doi.org/10.22502/jlmc.v4i1.78.
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Introduction: Perinatal asphyxia, a major topic in neonatology, is a severe condition which has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. It is defined by WHO as "failure to initiate and sustain breathing at birth". It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to identify the occurrence, clinical profile and, immediate outcome of perinatal asphyxia in Lumbini Medical College Teaching Hospital.
Methods: It was a retrospective study where 82 cases who fulfilled the inclusion criteria were included between December 2014 to November 2015. Inclusion criteria included newborns with: a) Apgar score equal to or less than six at five minutes, b) requirement of more than one minute of positive pressure ventilation, c) signs of fetal distress (heart rate of less than 100 beats per minute, late decelerations).
Results: Out of total 425 neonatal intensive care unit (NICU) admissions, 82 (19.3%) cases were of asphyxia among which 56 were inborn and 26 were referred from outside. Of those 82 cases, 47 (57.3%) cases developed hypoxic ischemic encephalopathy (HIE); HIE stage I had good outcome with survival rate of 95% and HIE stage III had poor outcome with survival rate of only 25%.
Conclusion: Despite advances in management of neonates, perinatal asphyxia is still the leading cause of neonatal intensive care unit admission and mortality and morbidity in neonates.
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Adhualia, Aishvarya, Manisha Maurya, and A. D. Tewari. "Development delay in children with severe acute malnutrition and its association with Vitamin B12 deficiency." International Journal of Contemporary Pediatrics 6, no. 6 (October 21, 2019): 2484. http://dx.doi.org/10.18203/2349-3291.ijcp20194721.
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Background: About half of the under five children are malnourished in India and so is morbidity associated with it. Malnutrition is also associated with multiple vitamin deficiency one of which is vitamin B12. Vitamin B12 is essential for DNA, RNA and protein synthesis; and for myelination of brain during the early childhood period. Deficiency of vitamin B12 can lead to megaloblastic anemia and neurological problems. So, authors aimed to look prevalence of vitamin B12 deficiency and; its hematological and neurological effects in severe acute malnourished children.Methods: it was an observational case control study, in which severe acute malnourished (SAM) children aged 0- 59 months who were admitted in Nutritional Rehabilitation Centre (NRC) were enrolled. Vitamin B12 levels were estimated and levels <200 pg/ml, 200-350 pg/ml, and >350 pg/ml were considered deficient, insufficiency and sufficient. Complete blood count was done for hematological effects and; developmental assessment was done to look for neurological effects.Results: Vitamin B12 was deficient, insufficient, normal in 15(16.3%), 25 (27.5%) and 52 (56.5%) children respectively. Vitamin B12 deficiency was significantly associated with hyperpigmentation and glossitis. Infant and young child feeding practices were not associated vitamin B12 deficiency. Macrocytic anemia was found in 23.4% SAM children and macrocytosis was not significantly associated with vitamin B12 deficiency. Developmental delay was found in 55.3 % children and was not significantly associated with severe acute malnutrition. Conclusions: There is high prevalence of Vitamin B12 deficiency and insufficiency in children with severe acute malnourished children. Macrocytic anemia and developmental delay are not significantly associated with vitamin B12 deficiency.
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Wade, Mark, Heather Prime, and Sheri Madigan. "Using Sibling Designs to Understand Neurodevelopmental Disorders: From Genes and Environments to Prevention Programming." BioMed Research International 2015 (2015): 1–16. http://dx.doi.org/10.1155/2015/672784.
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Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders—autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)—to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Specifically, we examine how twin, recurrence risk, and infant prospective tracking studies have contributed to our understanding of genetic and environmental liabilities towards neurodevelopmental morbidity through their impact on neurocognitive processes and structural/functional neuroanatomy. It is suggested that the siblings of children with ASD and ADHD are at risk not only of clinically elevated problems in these areas, but also of subthreshold symptoms and/or subtle impairments in various neurocognitive skills and other domains of psychosocial health. Finally, we close with a discussion on the practical relevance of sibling designs and how these might be used in the service of early screening, prevention, and intervention efforts that aim to alleviate the negative downstream consequences associated with disorders of neurodevelopment.
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Chamkhaleh, Maryam Alizadeh, Samileh Noorbakhsh, Mohammad Vafaee-Shahi, Aina Riahi, Negar Hajinasab, Alireza Gandomi-Mohammadabadi, and Mehrsa Shiasi. "The Epidemiology and Outcomes of Meningitis among Iranian Children in a Period of 10 Years." Open Neurology Journal 15, no. 1 (July 7, 2021): 37–42. http://dx.doi.org/10.2174/1874205x02115010037.
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Background: One of the important causes of childhood febrile illness is meningitis. It causes bacterial, viral, fungal, parasitic, and non-infectious agents. Pediatric bacterial meningitis is one of the most important causes of infant mortality, especially in premature infants. This study aimed to identify the outcome and mortality of children with meningitis. Methods and Materials: All children with meningitis in the Pediatric Department of Rasool Akram Hospital from December 23, 2007, to December 16, 2017, were included. Signs and symptoms (fever, consciousness, neck rigidity, and seizure) were collected and Cerebrospinal fluid analysis in children was made. Based on these findings, patients were divided into two groups, which include bacterial and non-bacterial meningitis. Then we recalled all families and examined them to discover the child’s outcome and complications at least after two years. Results: During the ten-year study period, 202 children were included in the study. Patients aged less than 12 months were found to be more frequently affected. Fever was the most common presentation (83.4%) followed by seizure (51.5%) and vomiting (49%). 119 (58.9%) of the patients were male and 83 (41.1%) were female. Definite bacterial meningitis was the final diagnosis in 35.6% (72) of patients (mean age 34.1± 48.3 months), and non-bacterial meningitis was diagnosed in 64.4% (130) of cases (mean age 46.3± 52.4 months). The most common organism in bacterial meningitis (by all methods) was Streptococcus pneumonia. Among children, 187 (92.1%) were survivors and 15 (%7.9) were non-survivors. Neurological sequelae such as motor deficit and epilepsy were identified in 9 (4.8%) and 5 (2.6%) subjects, respectively, and that they were all caused by bacterial meningitis. There was no death or neurological sequelae observed during follow-up in children with non-bacterial meningitis. Gender, age, signs and symptoms of patients at the time of admission were not significantly different between the bacterial and non-bacterial meningitis groups (p>0.05). Hydrocephalus, CSF characteristic, morbidity and mortality were significantly different between the bacterial and non-bacterial meningitis groups. Conclusion: This study showed that elevated LDH and low glucose levels in CSF are characteristic of bacterial meningitis. Increased LDH is significantly related to death in children (P-value > 0.001) with meningitis. Beneficial empirical antibiotics and sufficient follow-up by parents cause good prognosis in children with meningitis. Also in a child with fever and seizure, we should think of meningitis, even though in the absence of positive neurological examinations. It seems that increased CSF LDH, elevated CSF protein and age under one year are significant mortality risk factors in children with meningitis.
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Malla, Anagha Pradhan, Laxmi RC, Alka Singh, Reena Shrestha, Padma Gurung, Sushma Lama, Sarada Duwal Shrestha, and Binita Pradhan. "Outcome of breech delivery: caesarean section versus vaginal delivery at Patan Hospital, Patan Academy of Health Sciences." Journal of Patan Academy of Health Sciences 3, no. 1 (June 15, 2016): 4–9. http://dx.doi.org/10.3126/jpahs.v3i1.20282.
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Introductions: Obstetricians have long debated the role of caesarean section as a potentially safer mode of delivery for the fetus with breech presentation. However, the experience of the health care provider remains a critical element in the decision to pursue a vaginal breech delivery, and it may still be a viable option. The aim of this study is to determine the incidence of breech delivery at Patan Hospital and compare maternal and neonatal outcomes subjected to either vaginal or caesarean section.Methods: This was a five-year retrospective study of breech deliveries covering the year 2010 to 2014. Patient’s charts were retrieved from the medical record section and reviewed.Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154 (17.18%) preterm breech deliveries including 27 (17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher in caesarean section group. Conclusions: In well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different.Journal of Patan Academy of Health Sciences, Vol. 3, No. 1, 2016. page: 4-9
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Lemmon, Monica, Hannah Glass, Renee A. Shellhaas, Mary Carol Barks, Bria Bailey, Katie Grant, Lisa Grossbauer, et al. "Parent experience of caring for neonates with seizures." Archives of Disease in Childhood - Fetal and Neonatal Edition 105, no. 6 (June 5, 2020): 634–39. http://dx.doi.org/10.1136/archdischild-2019-318612.
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ObjectiveNeonates with seizures have a high risk of mortality and neurological morbidity. We aimed to describe the experience of parents caring for neonates with seizures.DesignThis prospective, observational and multicentre (Neonatal Seizure Registry) study enrolled parents of neonates with acute symptomatic seizures. At the time of hospital discharge, parents answered six open-ended response questions that targeted their experience. Responses were analysed using a conventional content analysis approach.Results144 parents completed the open-ended questions (732 total comments). Four themes were identified. Sources of strength: families valued medical team consensus, opportunities to contribute to their child’s care and bonding with their infant. Uncertainty: parents reported three primary types of uncertainty, all of which caused distress: (1) the daily uncertainty of the intensive care experience; (2) concerns about their child’s uncertain future and (3) lack of consensus between members of the medical team. Adapting family life: parents described the many ways in which they anticipated their infant’s condition would lead to adaptations in their family life, including adjusting their family’s lifestyle, parenting approach and routine. Many parents described financial and work challenges due to caring for a child with medical needs. Emotional and physical toll: parents reported experiencing anxiety, fear, stress, helplessness and loss of sleep.ConclusionsParents of neonates with seizures face challenges as they adapt to and find meaning in their role as a parent of a child with medical needs. Future interventions should target facilitating parent involvement in clinical and developmental care, improving team consensus and reducing the burden associated with prognostic uncertainty.
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Bhagwat, Chandana, and Naveen Sankhyan. "Vitamin responsive conditions in pediatric neurology." Karnataka Pediatric Journal 36 (June 2, 2021): 42–48. http://dx.doi.org/10.25259/kpj_34_2020.
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Vitamin responsive conditions can be either due to inherited defects in the metabolic pathways resulting in vitamin dependency or due to acquired deficiency states. Due to widespread malnutrition and predominantly vegetarian population in India, vitamin deficiency state is quite common and early identification is essential. Inherited defects, if treated earlier, lead to reduced morbidity and mortality and improvement in long-term neurocognitive outcomes. Various vitamin responsive conditions in pediatric neurology shall be discussed in this review. Infantile presentation of thiamine deficiency results in beriberi, and in adults, it leads to Wernicke’s encephalopathy and Korsakoff psychosis. Biotin thiamine-responsive basal ganglia disease is a defect of thiamine transporter 2, which leads to neuroregression and characteristic neuroimaging features of basal ganglia involvement, it responds to high doses of biotin and thiamine. Riboflavin is an enzyme involved in mitochondrial energy synthesis and is supplemented in various mitochondrial metabolic conditions. Brown-Vialetto-Van Laere syndrome is progressive pontobulbar palsy caused by defect in riboflavin transporters responsive to high doses of riboflavin. Pyridoxine responsive epilepsy presents with pharmacoresistant seizures in neonatal or early infantile age, biotinidase deficiency also presents with similar neurological manifestations, but typical cutaneous symptoms of rash and seborrheic dermatitis also occur. Both are epileptic encephalopathies and any infant presenting with epilepsy not responding to conventional AEDs must be given a trial of pyridoxine, biotin, and folinic acid. Vitamin B12 responsive conditions can include deficiency states, such as those manifesting with peripheral neuropathy and the syndrome of infantile tremor syndrome (developmental delay or regression, tremors, and megaloblastic anemia) as well as inherited disorders of homocysteine and cobalamin metabolism. These disorders are differentiated on the basis of clinical phenotype and laboratory parameters (serum B12, homocysteine levels, methylmalonic acid levels, etc.). Infantile tremor syndrome responds drastically to mega doses of Vitamin B12 and other multivitamins. Vitamin E deficiency causes ataxia with Vitamin E deficiency, other vitamins which can neurological symptoms include Vitamin C (pseudoparalysis) and Vitamin K (central nervous system bleeds). It is imperative for a practicing pediatrician to be well versed with these conditions, as these are potentially treatable conditions.
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Stout, Molly, Methodius Tuuli, Julia López, George Macones, Alison Cahill, and Adam Lewkowitz. "Risk of Neonatal Neurologic Morbidity in Advancing Term Gestations." American Journal of Perinatology 35, no. 07 (December 29, 2017): 599–604. http://dx.doi.org/10.1055/s-0037-1617429.
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Objective Placental insufficiency is associated with neonatal neurologic morbidity and late-term gestations (410/7–416/7 weeks). Whether late-term infants are at increased risk of neurologic morbidity compared with term infants (390/7–406/7 weeks) remains unclear. We aim to compare risk of neurologic morbidity among late-term and term infants. Study Design This secondary analysis of a single-institution prospective cohort study included all liveborn, nonanomalous singleton term and late-term infants, with data on adverse neonatal outcomes up until 28 days of life. The primary outcome was a neonatal neurologic morbidity composite, defined by having one of these conditions: neonatal seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, and neonatal hypothermic therapy. Secondary outcomes were the composite's individual components and nonneurologic neonatal morbidity. Multivariable logistic regression adjusted for delivery mode, nulliparity, and labor type. Results Of 5,529 infants included, 747 were late term and 4,782 were term. The risk of composite neurologic morbidity was not significantly different among late-term or term infants (0.5 vs. 0.6%; adjusted odds ratio: 0.59, 95% confidence interval: 0.21–1.71). Overall neonatal morbidity was not significantly different in the two groups, though late-term infants had a nonsignificantly higher prevalence of respiratory distress syndrome (5.5 vs. 3.3%) and meconium aspiration syndrome (0.7 vs. 0.2%). Conclusion Neonatal neurologic morbidity is uncommon after 39 weeks. Risk does not increase after 41 weeks.
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Zahan, Gulsan Ara, Taskina Mosleh, Khaleda Akter, Iqbal Bari, MA Mannan, and Abdul Maleq. "Validity of New Ballard Score Untill 7th Day of Postnatal Life In Preterm Neonate." Bangladesh Journal of Child Health 41, no. 1 (August 20, 2017): 24–27. http://dx.doi.org/10.3329/bjch.v41i1.33631.
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Background: Premature infant mortality & morbidity is influenced by intrauterine growth & maturation. In our perspective unavailability of accurate LMP from mother, early USG report or home delivered preterm baby that admitted after 4th day of postnatal age create great dilemma regarding the assessment of gestational age (GA).Objective: To validate the New Ballard Score (NBS) until 7th day of postnatal age in preterm neonate.Methods: This observational cross sectional study was conducted in pediatric ward, Rajshahi Medical College Hospital from 1st January 2009 to 31st December 2009. A total of 129 preterm neonate, GA ranging from 29wk to 35 wk, without any medical problem were included in this study. Accurate documentation of LMP of mother and USG during early pregnancy period were available for each study sample. GA of the babies were determined by NBS on 1st, 5th and 7th postnatal age and compaired with LMP & USG based GA. Various raw score was obtained from broken total score in D1 compared with D5 & D7. LMP based GA also compared with USG based GA.Results: Total NBS of D1 were tested with D5 & D7 for level of agreement & degree of correlation. For D1 with D5, r value was 0.97 and for D1 with D7, r value was 0.681. So, NBS of D1 positively correlated with NBS of D5 and D7. The total physical score also positively correlated with D1 versus D5 & D7 (r value 0.975 & 0.796). The total neurological score positively correlated with D1 versus D5 & D7 (r value 0.893 & 0.630). Neurological score were more significant than physical score. All p values were statistically significant (p value ?0.001). GA by NBS & LMP was positively correlated (r=0.94) as well as GA by NBS & USG (r=0.94). GA by NBS did not differ more than 2 weeks from LMP or USG based GA of any particular subjects.Conclusions: The tendency of over estimates the GA by NBS increased from Day 1 to Day 5 to Day 7. But the GA calculated from LMP & USG did not differ more than 2 weeks from GA by NBS. Thus NBS can be used as a clinical tool to detect GA up to Day 7 of postnatal life.Bangladesh J Child Health 2017; VOL 41 (1) :24-27
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Trindade, Evelinda, Luiz Fernando Caneo, Aida Luiza Turquetto, Luciana Amato, Fabio Carmona, Ribeirão Preto, Walter Vincente, et al. "PD34 São Paulo Congenital Heart Corrections: Three-Years' Assist Registry." International Journal of Technology Assessment in Health Care 34, S1 (2018): 141–42. http://dx.doi.org/10.1017/s0266462318003069.
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Introduction:Death from congenital heart disease (CHD) can be avoided, contributing to reduced infant mortality. The objective of this study was to identify the profile of patients undergoing surgical correction for CHD in three São Paulo State hospitals, and to determine factors that contribute to morbidity and mortality.Methods:The Voluntary Pediatric Cardiovascular Surgery Multicenter Registry (ASSIST) was created in 2014 through a Research Grant Program for the Public Healthcare System (Pesquisas para o Sistema Único de Saúde, PPSUS)* project, a federal-state joint strategic public policies research grant, coordinated by the Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo (InCor-HCFMUSP-SP) and Ribeirão Preto's Hospital das Clínicas, both linked to the São Paulo University Medical School.Results:We analyzed 1,842 patients, with an average age of 1.2 (range 0.4–8.6) years, 50.9 percent were male. Procedural complexity was classified as “Risk Adjustment in Congenital Heart Surgery” version 1 score, RACHS-1: 18.2 percent RACHS1, 25.5 percent RACHS2, 41.2 percent RACHS3, 9.6 percent RACHS4 and 5.4 percent RACHS5–6. Overall hospital mortality was 12.2 percent, and preoperative risk factors included: age <30 days (Odds Ratio, OR = 1.7 p = 0.012), prolonged ICU admission (OR = 3.3 p = 0.001). Other significant factors were RACHS score >4 (OR = 5.3 p < 0.001), heart dysfunction (OR = 3.4 p = 0.001), sepsis (OR = 3 p = 0.001), hemodynamic or surgical re-intervention required (OR = 6.2 p < 0.001), cardiorespiratory arrest (CPR, OR = 24.9 p < 0.001) and renal failure (OR = 5.4 p<0.001). The frequency of related morbidity was 16.2 heart failure, 7.1 percent arrythmia, 5.9 percent pneumonia, 5.9 percent pneumotórax, 4.2 percent pleural and pericardial effusion, 10 percent mechanical ventiation > 7 days, 13.2 percent late sternal closure, 2.8 percent had wound infection, 3.7 percent neurological alterations, 2.3 percent diaphragmatic dysfunction, 11.5 percent CPR, 3.2 percent renal failure, 4.5 percent sepsis, 55.1 percent length of hospital stay longer than 5 days with 45.8 percent postoperative hospital admission longer than 15 days and 6.1 percent needed surgical or hemodynamic re-intervention.Conclusions:The information collected in the ASSIST registry was of great importance in the São Paulo State CHD surgical practice evaluation. Morbi-mortality related factors elicited critical points and allowed improvement actions. Excluding age and intrinsic procedure complexity, identified outcome modifier factors can be manageable, aiming to increase patient safety and program resolubility or performance.
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Persson, Bengt. "Longterm morbidity in infants of diabetic mothers." Acta Endocrinologica 113, no. 3_Suppl (August 1986): S156—S158. http://dx.doi.org/10.1530/acta.0.111s0156.
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Abstract. A study of the five year morbidity experience by a group of 73 children born to diabetic and gestational diabetic mothers in one institution between 1969 and 1972 is reported. Only one child was found to be remarkably obese. No severe neurological deficit was found and intellectual performance was normal. None had developed diabetes. Five years later the prevalence of diabetes was reassessed. Two children (3%) had developed insulin-dependent diabetes.
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Goepfert, Alice, Robert Goldenberg, John Hauth, Sidney Bottoms, Jay Iams, Brian Mercer, Cora MacPherson, Atef Moawad, J. Van Dorsten, and Gary Thurnau. "Obstetrical Determinants of Neonatal Neurological Morbidity in ≤1000-Gram Infants." American Journal of Perinatology 16, no. 01 (1999): 33–42. http://dx.doi.org/10.1055/s-2007-993833.
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Kattimani, Vijaya S., and Ushakiran C. B. "Hemolytic disease of the new-born due to ABO incompatibility." International Journal of Contemporary Pediatrics 5, no. 2 (February 22, 2018): 605. http://dx.doi.org/10.18203/2349-3291.ijcp20180564.
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Background: Better understanding of the clinical characteristics of HDN due to ABO incompatibility helps to optimise care. The objective of this study was to investigate the clinical manifestations and outcome of treatment modalities.Methods:This study was a hospital based cross sectional study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute. A total of 50 neonates with blood group A or B born to mothers with blood group O; with jaundice and or anemia were enrolled during the period from January 2015 to December 2015. The various maternal and neonatal parameter and their association with development of jaundice and or anemia was studied. The outcome of treatment modalities was studied.Results: Out of 50 ABO Incompatible neonates 24 (48%) were male and 26 (52%) were female. The percentage of O–A and O–B incompatible neonates were 38% (19) and 72% (31), respectively. Jaundice was detected within the first 24 hours in 6% and 18% neonates had anemia. The mean age of presentation was 2.9±0.89 days. The various maternal and neonatal factors had no significant association with development of jaundice and or anemia due to ABO Incompatibility. The mean initial Indirect Bilirubin was 21.26±3.97, initial hemoglobin was 14.3±2.31 and the mean Reticulocyte count was 16.6±5.3. Total 22 (44%) neonates had laboratory evidence of hemolysis (microspherocytosis). DCT was positive in 4 (8%) neonates. The main clinical manifestation was jaundice and was treated with phototherapy in 49 (98%) of the cases. The mean duration of phototherapy was 53.84±9.82 hours. Only one infant required exchange transfusion and on follow up had no neurological sequelae. The mean total duration of stay was 3.6±1.2 days. There was no significant difference in the HDN due to either O–A or O–B incompatibility.Conclusions:Early identification of high risk neonates with ABO Incompatibility, diagnosis and early intervention can reduce morbidity and mortality.
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Boskabadi, Hassan, Jalil Tavakol Afshari, Majid Ghayour-Mobarhan, Gholamali Maamouri, Mohammad T. Shakeri, Amirhossein Sahebkar, and Gordon Ferns. "Association between serum interleukin-6 levels and severity of perinatal asphyxia." Asian Biomedicine 4, no. 1 (February 1, 2010): 79–85. http://dx.doi.org/10.2478/abm-2010-0009.
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Abstract Background: Perinatal asphyxia is a major cause of neurologic morbidity and mortality in infants. Objective: Determine the serum level of interleukin-6 (IL-6) in neonates with perinatal asphyxia and its relation to the severity of hypoxic-ischemic encephalopathy and short term neurological outcome. Methods: Serum IL-6 levels were measured at birth, and at 24 and 48 hour post-partum in 37 consecutive uninfected neonates with peri-natal asphyxia and 45 randomly selected healthy newborns. Results: Serum IL-6 concentrations in the infants who developed hypoxic-ischemic encephalopathy was 43 folds higher compared to values in the normal infants (p < 0.001) and 1.9 folds higher as compared to infants with asphyxia who did not subsequently develop hypoxic-ischemic encephalopathy (p <0.001). Serum IL-6 concentrations were also related to the degree of hypoxic-ischemic encephalopathy and neurologicaldevelopmental outcomes at the time of discharge. Conclusion: Serum levels of IL-6 increased in neonates with asphyxia, and this was most pronounced in neonates with adverse outcomes.
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Ambalavanan, Namasivayam, Kathleen G. Nelson, Greg Alexander, Susan E. Johnson, Fred Biasini, and Waldemar A. Carlo. "Prediction of Neurologic Morbidity in Extremely Low Birth Weight Infants." Journal of Perinatology 20, no. 8 (December 2000): 496–503. http://dx.doi.org/10.1038/sj.jp.7200419.
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Zer, Shiran, Tamar Wainstock, Eyal Sheiner, Shayna Miodownik, and Gali Pariente. "Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery." Journal of Clinical Medicine 10, no. 13 (June 29, 2021): 2919. http://dx.doi.org/10.3390/jcm10132919.
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We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.
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Nair, Jayasree, and Vasantha Kumar. "Liver Failure and Conjugated Hyperbilirubinemia in a Preterm Neonate: Role of Early IVIG and Exchange Transfusion." American Journal of Perinatology Reports 08, no. 02 (April 2018): e95-e98. http://dx.doi.org/10.1055/s-0038-1649339.
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AbstractNeonatal liver failure (NLF) is a rare diagnosis but carries with it significant risks of mortality and morbidity. Common etiologies for NLF include metabolic causes, gestational alloimmune liver disease (GALD or neonatal hemochromatosis), and viral infections. We report a case of liver failure in a premature infant with abnormal iron profile within 48 hours of birth. Lack of accepted guidelines for the initial management of severe jaundice with a high direct component in the first week after birth made treatment challenging. The infant underwent intensive phototherapy along with four exchange transfusions (ET) and two courses of intravenous immunoglobulins (IVIG). The clinical goals were to keep total bilirubin values ≤ 20 mg/dL in this premature neonate and to minimize the risk of bilirubin-induced neurologic dysfunction and decompensated liver failure. Abnormal iron studies and later magnetic resonance imaging were suggestive of GALD. Liver functions improved over time with normal neurodevelopmental assessment at 3 years of age. To conclude, in infants with NLF soon after birth, earlier consideration of IVIG/ET in the first few days may be beneficial. Larger multicenter data analyses are required to formulate treatment guidelines and indications for phototherapy, ET, and IVIG in sick neonates with NLF.
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Kane, Stefan C., Alicia Dennis, Fabricio da Silva Costa, Louise Kornman, and Shaun Brennecke. "Contemporary Clinical Management of the Cerebral Complications of Preeclampsia." Obstetrics and Gynecology International 2013 (2013): 1–10. http://dx.doi.org/10.1155/2013/985606.
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The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition.
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Baergen, Rebecca N., Denise Malicki, Cynthia Behling, and Kurt Benirschke. "Morbidity, Mortality, and Placental Pathology in Excessively Long Umbilical Cords: Retrospective Study." Pediatric and Developmental Pathology 4, no. 2 (March 2001): 144–53. http://dx.doi.org/10.1007/s100240010135.
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The purpose of this study was to compare specific fetal, maternal, and placental factors, including neonatal morbidity and mortality, in infants with umbilical cords (UCs) of normal length to the same factors in infants with excessively long umbilical cords (ELUCs). We performed an 18-year retrospective chart review of the medical records of mothers and infants with ELUCs (926 cases) and normal-length UCs (200 cases) and recorded maternal factors, fetal factors, and neonatal outcomes. Corresponding placental pathologic reports and slides were reviewed. Statistical analysis comparing the two groups included univariate and multivariate analyses. ELUCs were significantly associated with certain maternal factors (systemic diseases, delivery complications, increased maternal age), fetal factors (non-reassuring fetal status, respiratory distress, vertex presentation, cord entanglement, fetal anomalies, male sex, increased birth weight), gross placental features (increased placental weight, right-twisted cords, markedly twisted cords, true knots, congestion), and microscopic placental features (nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increased syncytial knots, single umbilical artery). Some of these histopathologic features have previously been associated with fetal hypoxia and/or altered blood flow in the placenta. Infants with ELUCs were found to be at a significantly increased risk of brain imaging abnormalities and/or abnormal neurological follow-up. In addition, mothers with a history of an ELUC are at increased risk of a second long cord.
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Zeng, Yan, Huiqing Wang, Li Zhang, Jun Tang, Jing Shi, Dongqiong Xiao, Yi Qu, and Dezhi Mu. "The optimal choices of animal models of white matter injury." Reviews in the Neurosciences 30, no. 3 (April 24, 2019): 245–59. http://dx.doi.org/10.1515/revneuro-2018-0044.
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AbstractWhite matter injury, the most common neurological injury in preterm infants, is a major cause of chronic neurological morbidity, including cerebral palsy. Although there has been great progress in the study of the mechanism of white matter injury in newborn infants, its pathogenesis is not entirely clear, and further treatment approaches are required. Animal models are the basis of study in pathogenesis, treatment, and prognosis of white matter injury in preterm infants. Various species have been used to establish white matter injury models, including rodents, rabbits, sheep, and non-human primates. Small animal models allow cost-effective investigation of molecular and cellular mechanisms, while large animal models are particularly attractive for pathophysiological and clinical-translational studies. This review focuses on the features of commonly used white matter injury animal models, including their modelling methods, advantages, and limitations, and addresses some clinically relevant animal models that allow reproduction of the insults associated with clinical conditions that contribute to white matter injury in human infants.
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Ambalavanan, Namasivayam, Kathleen Nelson, Greg Alexander, and Waldemar A. Carlo. "Prediction of Neurologic Morbidity and its Determinants in ELBW Infants & 1197." Pediatric Research 43 (April 1998): 205. http://dx.doi.org/10.1203/00006450-199804001-01218.
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Patel, Amy P., Jeffrey S. Hudson, Howard M. Stein, Dagmar T. Stein, and William T. Gunning. "A Retrospective Evaluation of Children Who Have Suffered a Grade III or IV Intraventricular Hemorrhage and Their Parents for Platelet Dysfunction." Blood 116, no. 21 (November 19, 2010): 1440. http://dx.doi.org/10.1182/blood.v116.21.1440.1440.
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Abstract Abstract 1440 This study is intended to evaluate children that have survived a grade III or IV intraventricular head bleed and their parents for a potential autosomal dominant inherited platelet dysfunction due to platelet dense granule deficiency (δ-SPD). Intraventricular hemorrhage (IVH) poses a significant risk in premature neonates less than 32 weeks gestation. Infants suffering from high grade (III-IV) periventricular or intraventicular bleeding have mortality rates approaching 50%. In addition, survivors of high grade IVH may suffer severe brain damage or a multitude of other long term neurological sequelae. Thus, we believe that investigation into the pathogenesis of neonatal IVH is not only crucial for the survival of these infants, but also for their quality of life in the future. Current data suggest that the pathogenesis of IVH in the premature infant is related to a loss of ability to regulate cerebral blood flow. Changes in local blood pressure, which would otherwise be autoregulated, remain unrestrained and result in capillary bleeding. Previous prospective studies from our lab have shown that full term neonates have a transient platelet dysfunction at the time of birth (Blood, 100(11), 691a, 2002), which appears to be related to a platelet dense granule storage pool deficiency (δ-SPD). We have also found that 1 day old, full term neonates have mature platelets similar to adults. Our prospective data suggests that at day 3–5 after birth, premature infants of gestational age 26–33 weeks (n=29) have a δ-SPD similar to that observed in full-term umbilical cord blood platelets suggesting a delay in platelet maturation. Only one preemie included in the study had suffered an IVH (grade I); all preemies who suffered Grade III/IV IVH during our study died before we could obtain blood (Blood 108(11):1113, 2006). Parents evaluated had normal platelet storage pools. Our current and on-going retrospective study of children that have survived a grade III/IV IVH and their parents supports our hypothesis that platelet dysfunction may play a significant role in the etiology of IVH. Survivors were identified from a database and parents sent a letter requesting their participation in the study. For those agreeing to participate, informed consent was obtained for this Institutional Review Board approved project. A vial of peripheral blood was obtained from both the IVH surviving child and their parent(s) to determine the platelet dense granule storage pool using the electron microscopy whole mount technique. Parents completed a vetted bleeding questionnaire for assessment of bleeding history/tendencies. Our preliminary data from 6 families reveals that all children surviving a grade III/IV IVH have a δ-SPD with an average of 2.64 ± 0.14 dense granules per platelet (DG/PL) whereas normal = 4–6 DG/PL. Their mothers also have a tendency for δ-SPD (5/6 δ-SPD and 1 within normal limits) with an overall average of 2.93 ± 0.35 DG/PL. Data collected from the questionnaires substantiate the laboratory results with a history of menorrhagia (determined by an established numerical pictorial method) the most significant correlation in 4/6 mothers. The fathers (4/5) tend to have normal numbers of DG/PL (4.06 ± 0.61; 1 had δ-SPD at 1.72 DG/PL). Interestingly, for the one mother with a normal number of DG/PL, the father had δ-SPD. Thus, all children evaluated to date in this study have δ-SPD and a parent who also has δ-SPD. The implication of these preliminary data suggest that potential identification of platelet dysfunction in women at risk for premature delivery could allow for prophylactic intervention for the premature neonate to reduce the morbidity and mortality related to IVH. As this study is currently ongoing, it is anticipated that additional data will be available for presentation. Disclosures: No relevant conflicts of interest to declare.
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Levin, Shai, Eyal Sheiner, Tamar Wainstock, Asnat Walfisch, Idit Segal, Daniella Landau, Ruslan Sergienko, Eliahu Levitas, and Avi Harlev. "Infertility Treatments and Long-Term Neurologic Morbidity of the Offspring." American Journal of Perinatology 36, no. 09 (November 16, 2018): 949–54. http://dx.doi.org/10.1055/s-0038-1675159.
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Objective To determine the risk of long-term neurologic morbidity among children (up to 18 years) born following in vitro fertilization (IVF) or ovulation induction (OI) treatments as compared with spontaneously conceived. Study Design A population-based cohort analysis was performed, including data from the perinatal computerized database on all singleton infants born at the Soroka University Medical Center (SUMC) between the years 1991 and 2014. This perinatal database was linked and cross-matched with the SUMC computerized dataset of all pediatric hospitalizations. Results Neurologic morbidity was significantly more common in IVF (3.7%) and OI (4.1%) offspring as compared with those following spontaneous pregnancies (3.1%; p = 0.017). In particular, attention deficit/hyperactivity disorders and headaches were more common in the OI group and sleep disorders in the IVF group, whereas autism and cerebral palsy were comparable between the groups. In the Weibull multivariable analysis, while controlling for maternal age, preterm delivery, birthweight centile, maternal diabetes, and hypertensive disorders, IVF (adjusted hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.14–1.71; p = 0.001), but not OI (adjusted HR: 1.17' 95% CI: 0.92–1.48; p = 0.196), was noted as an independent risk factor for long-term pediatric neurologic morbidity. Conclusion IVF offspring appear to be at an increased risk of long-term neurologic morbidity up to 18 years of age.
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Roescher, A. M., A. Timmer, M. M. Hitzert, N. K. S. de Vries, E. A. Verhagen, J. J. H. M. Erwich, and A. F. Bos. "Placental pathology and neurological morbidity in preterm infants during the first two weeks after birth." Early Human Development 90, no. 1 (January 2014): 21–25. http://dx.doi.org/10.1016/j.earlhumdev.2013.11.004.
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Dunckley, Matthew G., Kapil M. Rajwani, and Anies A. Mahomed. "Laparoscopic Watson Fundoplication Is Effective and Durable in Children with Gastrooesophageal Reflux." Minimally Invasive Surgery 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/409727.
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Gastroesophageal reflux (GOR) affects 2–8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen’s operation. However, this technique has a significant incidence of mechanical complications and has a reoperation rate of approximately 7%, leading to the development of alternative approaches. Watson’s technique of partial anterior fundoplication has been shown to achieve long-lasting reflux control in adults with few mechanical complications, but there is limited data in the paediatric population. We present here short- and long-term outcomes of laparoscopic Watson fundoplication in a series of 76 children and infants, 34% of whom had a degree of neurological impairment including severe cerebral palsy and hypoxic brain injury. The overall complication rate was 27.6%, of which only 1 was classified as major. To date, we have not recorded any incidences of perforation and no revisions. In our experience, Watson’s laparoscopic partial fundoplication can be performed with minimal complications and with durable results, not least in neurologically compromised children, making it a viable alternative to the Nissen procedure in paediatric surgery.
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Dag, Zeynep Ozcan, Yuksel Işik, Yavuz Simsek, Ozlem Banu Tulmac, and Demet Demiray. "HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy." Case Reports in Obstetrics and Gynecology 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/582890.
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Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy.
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DIJXHOORN, M. J., G. H. A. VISSER, V. J. FIDLER, B. C. L. TOUWEN, and H. J. HUISJES. "Apgar score, meconium and acidaemia at birth in relation to neonatal neurological morbidity in term infants." BJOG: An International Journal of Obstetrics and Gynaecology 93, no. 3 (March 1986): 217–22. http://dx.doi.org/10.1111/j.1471-0528.1986.tb07896.x.
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DIJXHOORN, M. J., G. H. A. VISSER, V. J. FIDLER, B. C. L. TOUWEN, and H. J. HUISJES. "Apgar Score, Meconium and Acidaemia at Birth in Relation to Neonatal Neurological Morbidity in Term Infants." Obstetrical & Gynecological Survey 41, no. 11 (November 1986): 699–701. http://dx.doi.org/10.1097/00006254-198611000-00013.
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Martens, S. E., M. Rijken, G. M. S. J. Stoelhorst, P. H. T. van Zwieten, A. H. Zwinderman, J. M. Wit, M. Hadders-Algra, and S. Veen. "Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?" Early Human Development 75, no. 1-2 (December 2003): 79–89. http://dx.doi.org/10.1016/j.earlhumdev.2003.09.005.
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Wisoff, Jeffrey H., Rick Abbott, and Fred Epstein. "Surgical management of exophytic chiasmatic-hypothalamic tumors of childhood." Journal of Neurosurgery 73, no. 5 (November 1990): 661–67. http://dx.doi.org/10.3171/jns.1990.73.5.0661.
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✓ Sixteen children underwent 18 operations for radical resection of chiasmatic-hypothalamic tumors. The clinical presentation correlated with age: infants under 1 year of age presented with macrocephaly, failure to thrive, and severe visual failure; children aged 1 to 5 years predominantly had precocious puberty with mild visual deficits; and older children (> 5 years old) had slowly progressive loss of vision. All three infants had biologically aggressive tumors in spite of low-grade histology, and died from progressive tumor growth. Eleven of the 13 children aged 1 year or over are alive and well, without clinical or radiographic evidence of disease progression, 4 months to 4½ years following surgery. Six of these patients, with a follow-up period of 10 months to 4½ years (mean 27 months), have had no adjuvant therapy following radical surgical resection. The authors conclude that: 1) radical surgical resection of chiasmatic-hypothalamic tumors can be performed with minimal morbidity; 2) radical resection may delay the time to disease progression in older children and postpone the need for irradiation; 3) resection of postirradiation recurrent tumors may provide neurological improvement and long-lasting clinical remission; and 4) chiasmatic-hypothalamic tumors of infancy are aggressive neoplasms that require multimodality therapy.
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Hussamy, Deana J., David B. Nelson, and Stephan A. Shivvers. "Hyperammonemia: A Report of Maternal Biliary Cirrhosis and Neonatal Outcome." Case Reports in Critical Care 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/507169.
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Although uncommon during pregnancy, cirrhosis results in multiple medical complications impacting both mother and fetus. Previous reports suggest liver dysfunction in pregnancy causes accumulation of neurotoxins within the maternal compartment that increases neonatal morbidity through placental transfer. We present a case of a 36-year-old G2P1female with history of biliary cirrhosis presenting at 32-weeks' gestation with hepatic congestion progressing to hepatic encephalopathy prompting delivery. Umbilical cord sampling and postnatal infant testing demonstrated elevated ammonia levels which resolved by 12 hours of life without intervention. At discharge, the infant did not demonstrate evidence of neurologic deficit. We conclude that acute maternal hepatic encephalopathy and hyperammonemia due to chronic liver disease do not portend adverse neonatal outcomes, notably encephalopathy.
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Amin, Tahsinul, Asim Kumar Shaha, and Ayesha Najma Nur. "Use of Prophylactic Phenobarbitone for Prevention of Morbidity and Mortality in Term Neonates Following Perinatal Asphyxia." Bangladesh Journal of Child Health 41, no. 3 (June 10, 2018): 165–69. http://dx.doi.org/10.3329/bjch.v41i3.36952.
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Background: Seizures are common following perinatal asphyxia and may exacerbate secondary neuronal injury. Barbiturate therapy has been used for infants with perinatal asphyxia in order to prevent seizures. However, barbiturate therapy may adversely affect neurodevelopment leading to concern regarding its aggressive use in neonates. The objective of the study was to determine the effect of administering prophylactic barbiturate therapy on seizure control and mortality in term neonates following perinatal asphyxia.Methodology: This was a randomized controlled trial (RCT) of prophylactic phenobarbitone therapy in term asphyxiated neonates without clinical evidence of seizures when compared to controls conducted in the neonatal ward of Sher-e-Bangla Medical College Barisal from 1st January 2016 to 30th June 2016.Results: Among the 100 neonates equally divided into two groups, there was no significant difference found in clinical outcome e.g. seizures (8% vs. 12%, p > 0.05), neurological abnormality at discharge (10% vs. 14%, p >0.05), mortality (12% vs. 14%, p >0.05) and major neurological disability (14% vs. 18%, p >0.05).Conclusion: In this study, prophylactic phenobarbitone therapy did not significantly prevent seizures in asphyxiated neonates.Bangladesh J Child Health 2017; VOL 41 (3) :165-169
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Guardiola, Ana, Vanessa Koltermann, Paula Musa Aguiar, Sérgio Pilla Grossi, Valéria Fleck, Elisabeth C. Pereira, and Lúcia Pellanda. "Neurological congenital malformations in a tertiary hospital in south Brazil." Arquivos de Neuro-Psiquiatria 67, no. 3b (September 2009): 807–11. http://dx.doi.org/10.1590/s0004-282x2009000500005.
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BACKGROUND: Congenital anomalies are one of the main causes of morbidity and mortality among infants. The involvement of the central nervous system (CNS) occurs in 21% of cases. OBJECTIVE: To identify incidence of CNS malformations and associated factors in newborns at a Terciary Hospital of Porto Alegre. METHOD: Case-control study conducted between 2000 and 2005 based on the Latin American Collaborative Study of Congenital Malformations database. RESULTS: Among 26,588 births registered in this period, 3.67% presented with malformations (IC=95%; 3.44-3.9), being 0.36% of the CNS (IC=95%,(0.29-0.43)). The most common CNS malformation was meningomielocele (10.4%). Young maternal age (p=0.005); low birth weight (p=0.015); large cephalic perimeter (p=0.003); post term birth (p=0.000) and low APGAR indexes at the 1st and 5th minutes were associated with CNS malformations. CONCLUSION: We found an incidence of CNS malformations similar as compared to literature.
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Dijxhoorn, M. J., G. H. A. Visser, H. J. Huisjes, V. Fidler, and B. C. L. Touwen. "The relation between umbilical pH values and neonatal neurological morbidity in full term appropriate-for-dates infants." Early Human Development 11, no. 1 (May 1985): 33–42. http://dx.doi.org/10.1016/0378-3782(85)90117-3.
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Rostas, Sara E., and Christopher McPherson. "Systemic Corticosteroids for the Prevention of Bronchopulmonary Dysplasia: Picking the Right Drug for the Right Baby." Neonatal Network 35, no. 4 (2016): 234–39. http://dx.doi.org/10.1891/0730-0832.35.4.234.
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AbstractBronchopulmonary dysplasia is a morbidity of prematurity with implications into adulthood on respiratory and neurologic health. Multiple risk factors contribute to the development of bronchopulmonary dysplasia leading to examination of various strategies of prevention. Systemic corticosteroids are one prevention strategy with a large body of data, creating an ongoing controversy regarding the risks and benefits of therapy. Careful consideration of the available data along with the clinical characteristics of the individual infant is required before using this powerful therapy.
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Sousa, Derijulie Siqueira, Airton Salviano Sousa Júnior, Arielly Duarte Rabelo Santos, Enaldo Vieira Melo, Sônia Oliveira Lima, Marcos Antônio Almeida-Santos, and Francisco Prado Reis. "Morbidity in extreme low birth weight newborns hospitalized in a high risk public maternity." Revista Brasileira de Saúde Materno Infantil 17, no. 1 (March 2017): 139–47. http://dx.doi.org/10.1590/1806-93042017000100008.
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Abstract Objectives: to determine the prevalence of the most common morbidities in extremely low birth weight (ELBW) infants hospitalized in a newborn intensive care unit (NICU) and to evaluate the influence of these morbidities through the length of in-hospital stay. Methods: observational, longitudinal, prospective and analytical study in a high risk reference maternity NICU from Sergipe, realized with 158 ELBW infants admitted between March 2014 and April 2015. The analysis of the hospitalization time was realized through the Kaplan-Meier method. Results: the average weight of premature was 785,2g ± 138,2g. The gestational age vary from 22 to 35 weeks and the average was 26,8 weeks. Of those admitted at NICU, sixty three (39,9%) were discharged and 95 (60,1%) died. The time of hospitalization was influenced for morbidities as: patent ductus arteriosus (PDA), intraventricular hemorrhage and sepsis. Acute respiratory distress syndrome was the most common complication (157 - 99,4%). The incidence of persistent arterial duct, intraventricular hemorrhage, sepsis, hypothermia, hypoglycemia and retinopathy of prematurity was 39,2%, 17,1%, 32,3%,50,3%, 52,3% e 16,6% respectively. Conclusions: the morbidities from respiratory tract, cardiac, neurological and infectious were the most prevalent, whilst PDA, intraventricular hemorrhage and sepsis were the morbidities that significantly influenced the time of hospitalization.
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Holcroft, C. "Association of prematurity and neonatal infection with neurologic morbidity in very low birth weight infants." Obstetrics & Gynecology 101, no. 6 (June 2003): 1249–53. http://dx.doi.org/10.1016/s0029-7844(03)00354-5.
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Holcroft, Cynthia J., Karin J. Blakemore, Marilee Allen, and Ernest M. Graham. "Association of Prematurity and Neonatal Infection With Neurologic Morbidity in Very Low Birth Weight Infants." Obstetrics & Gynecology 101, no. 6 (June 2003): 1249–53. http://dx.doi.org/10.1097/00006250-200306000-00019.
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Lasjaunias, P. L., H. Alvarez, G. Rodesch, R. Garcia-Monaco, K. terBrugge, P. Burrows, and W. Taylor. "Aneurysmal Malformations of the Vein of Galen." Interventional Neuroradiology 2, no. 1 (March 1996): 15–26. http://dx.doi.org/10.1177/159101999600200102.
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The Vein of Galen Aneurysmal Malformation (VGAM) is regarded as a lesion with high morbidity and mortality, both spontaneously and under treatment, in part due to an incomplete appreciation of the effects of the lesion on the specific physiology of young children. In addition, various techniques have been applied over a short period of time to treat the lesion rather than the disorders it creates. We report experience with 120 consecutive cases of VGAM managed over the past ten years: 24 were diagnosed antenatally; 50 presented in the neonatal period with haemodynamic disturbance; 35 in infants presented with secondary hydrovenous disorders (macrocrania, subependymal atrophy and ventricular dilatation); 12 were seen in children. We were unable to follow 10% of the patients because the referring teams decided not to follow our therapeutic advice. Treatment was contra-indicated in 17% of cases (with early brain damage and a rapidly fatal outcome). There were five (4%) which thrombosed spontaneously (but only two of these were neurologically normal). Embolisation was performed in 78 patients via a transarterial femoral approach using glue. Anatomical cure has already been achieved in 53%. Of the treated patients, even when treatment has not been completed, 80% are growing neurologically normal. Permanent neurological deficit or irreversible neurocognitive delay related to the natural history of the lesion were evident in 8.5%. Overall mortality was 9%. These figures confirm that previous views on the prognosis of VGAM should be revised. Endoarterial embolisation, is the preferred treatment to date.
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S., Ramya H., Rajendra Prasad T. C., Nisar Ahamed A. R., Muragesh Awati, and Maria George. "Neuro developmental outcome of preterm babies with hypoxic ischemic encephalopathy." International Journal of Contemporary Pediatrics 6, no. 3 (April 30, 2019): 1315. http://dx.doi.org/10.18203/2349-3291.ijcp20192035.
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Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.