Arie Bos

Quality of general movements in preterm infants with transient periventricular echodensities

By means of sequential videotape recordings, the relevance of the quality of general movements for neurological outcome was determined in a group of 21 appropriate‐for‐gestational‐age preterm infants with transient periventricular echodensities of variable localization and duration and in 6 infants without echodensities. Echodensities, especially in the parieto‐occipital area, affected the quality of general movements. Echodensities persisting beyond 14 d were associated with abnormal general movements; infants with echodensities up to 14 d had either normal or abnormal general movements. The developmental course of movement quality was correlated to neurological outcome (p < 0:005): normal outcomes were found in 11/12 infants with normal general movements throughout and in 9/11 infants with transient abnormal general movements; all 4 infants with persistent abnormal general movements had impaired outcomes. In infants with transient echodensities, longitudinal assessment of the quality of general movements helps to determine if there is brain dysfunction, either transient or persistent, and identifies infants at risk for impaired neurological outcomes.

Burst suppression on amplitude-integrated electroencephalogram may be induced by midazolam: a report on three cases

Continuous amplitude‐integrated electroencephalogram (aEEG) recording with a cerebral function monitor is a useful tool to evaluate prognoses following perinatal asphyxia in term infants. Drugs may change the pattern of the conventional EEG. This report presents three infants treated with midazolam for status epilepticus and repetitive seizures who proved resistant to other anticonvulsants (phenobarbitone, lidocaine). The infants developed burst suppression patterns on aEEG concurrent with high serum levels of midazolam (900‐7093 μg l‐1). Following discontinuation of midazolam treatment, serum levels normalized and background patterns returned to normal voltage traces.

General movements in the first fourteen days of life in extremely low birth weight (ELBW) infants

OBJECTIVEnTo assess the quality of general movements (GMs) in the first fourteen days of life in relation to obstetric and postnatal risk factors and neurodevelopmental outcome in extremely low birth weight (ELBW) infants.nnnSTUDY DESIGNnThe GMs of nineteen infants were assessed on days 2, 4, 6, 10 and 14 with Prechtls method. Additionally, detailed GM assessment produced optimality scores (OSs). GMs and the OSs were related to obstetric and postnatal data and to neurodevelopmental outcome at 18 months.nnnRESULTSnGMs and OSs fluctuated substantially during the first fourteen days of life. Most infants had abnormal GMs, especially poor repertoire (PR) GMs. No relation was found between GMs and obstetric factors. Regarding postnatal factors, septicaemia correlated to hypokinesia (H) and artificial ventilation correlated to a lower OS.nnnCONCLUSIONSnDue to physiological disturbances the quality of GM in ELBW infants fluctuates substantially during the first fourteen days of life. Abnormal GMs, especially PR GMs, are mostly seen for the same reason. Septicaemia and artificial ventilation are associated with deterioration of the GMs (lower OSs), and in case of septicaemia also with hypokinesia.

Dexamethasone treatment and fluid balance in preterm infants at risk for chronic lung disease

The influence of dexamethasone on diuresis in preterm infants has not been well studied. We examined 15 preterm infants at risk for chronic lung disease with gestational ages ranging from 26 to 29 wk (median 27.6 wk) and birthweights ranging from 700 to 1485 g (median 965 g). Urine output, blood glucose, serum urea, serum creatinine, serum sodium and serum potassium, as well as systolic, diastolic and mean arterial pressure were measured on the day before, and on 4 consecutive days after starting treatment with dexamethasone (0.25 mg kg″1 iv., twice daily). We found an increase of diuresis of 30 ml kg″1 d″1, 48‐96 h after starting dexamethasone treatment. This coincided with a gradual but significant increase of serum urea levels and arterial pressure. During the study period, fluid and protein intake remained constant. Blood glucose and serum creatinine levels did not change. Our findings suggest that the increased urine output following dexamethasone treatment might be caused by two factors: (1) pressure diuresis induced by the increase of arterial pressure and (2) an increase of the osmolar load to the kidney due to an increase of serum urea.

1071 Aeeg During the First 72 Hours After Birth in Infants With Prenatally Diagnosed Congenital Heart Defect

Background and objective Survival in infants with congenital heart defects (CHD) is associated with neurologic morbidity. Hypoxic-ischemia after closure of the ductus arteriosus is probably one of the factors resulting in brain damage. Prenatal diagnosis makes it possible to prevent closure of the ductus arteriosus and therefore cerebral perfusion can be preserved. Amplitude integrated EEG (aEEG) is a method to evaluate brain injury. Abnormal (a)EEG patterns and epileptic activity (EA) are frequently observed in infants with CHD. Our aim was to determine the course of aEEG patterns in infants with prenatally diagnosed CHD. Methods Retrospective cohort study of infants prenatally diagnosed with CHD. aEEGs were assessed by pattern recognition: background pattern (BP), presence of sleep wake cycling (SWC) and EA were appraised. Results Twenty infants (mean GA 39 wks; birth weight 3416 g) were included. Eleven infants had transposition of the great arteries, 7 infants had hypoplastic left heart syndrome, and 2 had aortic valve stenosis. At 6h after birth 80% of infants had normal BPs (continuous normal voltage (CNV)). Only 2 infants had severely abnormal BPs (continuous low voltage). At 24h, 94% had CNV. None of the infants showed EA. SWC was present in 85% and emerged at a median postnatal age of 10.4 hrs. Conclusions aEEGs of infants with a prenatally diagnosed CHD are normal in the majority of infants, with normal emergence of SWC and absence of EA. This indicates that prenatal diagnosis can prevent brain damage in infants with CHD.

331 The Prognostic Value of aEEG and NIRS during Therapeutic Hypothermia in Term Asphyxiated Newborns

Background and objective Infants with hypoxic-ischemic encephalopathy (HIE) are treated with therapeutic hypothermia (HT). Following perinatal asphyxia amplitude-integrated EEG (aEEG) and near-infrared spectroscopy (NIRS) are used to determine prognosis. We aimed to assess the prognostic value of aEEG and NIRS during HT. Methods 40 term infants with HIE and treatment with HT were retrospectively studied. aEEG and NIRS were started immediately following admission. aEEGs were assessed by pattern recognition: background pattern (BP), presence of sleep wake cycling (SWC) and epileptic activity (EA) were appraised. Recordings during HT (72 hrs) were analysed. Results 84% of infants had an abnormal BP (discontinuous normal voltage, burst suppression (BS), continuous low voltage (CLV) or flat trace (FT)) at admission. The LR+ (95% CI) of an severely abnormal BP (BS, CLV, FT) for mortality was 1.97 (1.24–3.12) at 6h after birth and increased to 4.5 (3.16–6.39) at 24h, 6.3 (2.04–19.4) at 48h and 6.19 (1.93–19.8) at 72h. LR+ of BS for mortality was below 1 at any time. LR+ of EA for mortality was 4.95 (2.20–11.1), the type of EA (e.g. status epilepticus) was not predictive. LR+ of SWC for survival was 10.7 (1.62–70). RcSO2 increased from 6 to 72h after birth, but was not different at any time between infants that died or survived. Conclusion aEEG during HT can still be used to predict risk for mortality of HIE, especially beyond 24 hrs. BS is frequently not associated with a fatal outcome. RcSO2 has no additional value to predict mortality.