Brian A. Lupton

White Matter Injury in Term Newborns With Neonatal Encephalopathy

White matter injury (WMI) is the characteristic pattern of brain injury detected on magnetic resonance imaging in the premature newborn. Focal noncystic WMI is increasingly recognized in populations of term newborns. The aim of this study was to describe the occurrence of focal noncystic WMI in a cohort of 48 term newborns with encephalopathy studied with magnetic resonance imaging at 72 ± 12 h of life, and to identify clinical risk factors for this pattern of injury. Eleven newborns (23%; 95% CI 11–35) were found to have WMI (four minimal, three moderate, and four severe). In 10 of the 11 newborns, the WMI was associated with restricted diffusion on apparent diffusion coefficient maps. An increasing severity of WMI was associated with lower gestational age at birth (p = 0.05), but not lower birth weight. Newborns with WMI had milder encephalopathy and fewer clinical seizures relative to other newborns in the cohort. Other brain injuries were seen in three of the 11 newborns: basal nuclei predominant pattern of injury in one and cortical strokes in two. These findings suggest that WMI in the term newborn is acquired near birth and that the state of brain maturation is an important determinant of this pattern of brain injury.

The effect of electrode position on flash visual evoked potentials in the newborn

We examined how changes in electrode position affected the visual evoked potential in 74 high-risk newborns using a multiple electrode technique. The variation in the visual evoked potential across the occiput was documented. Visual evoked potentials that were visible at one occipital electrode position were absent at a different electrode position in 21 of 87 recordings (24%). Changes of > 20 msec between electrodes in latency of waves P1 or N2 occurred in 34% and 29% of recordings, respectively. The amplitude of response varied by a factor of 2.36 between mid occipital and lateral occipital electrodes. The results demonstrated that large changes in morphologic characteristics, latency, and amplitude in the visual evoked potential of the newborn result from small changes in the position of recording electrodes. These findings underscored the importance of electrode position and accurate electrode placement. Our observations also indicated that recordings from a single electrode are inadequate in providing an accurate representation of the neonatal visual evoked potential.

Hypoxic-Ischemic Encephalopathy in the Term Newborn in British Columbia throughout a Three Year Period: Regional Incidence and Sociodemographic Factors 1061

Hypoxic-Ischemic Encephalopathy in the Term Newborn in British Columbia throughout a Three Year Period: Regional Incidence and Sociodemographic Factors 1061

PLACENTAL ABNORMALITIES ASSOCIATED WITH CYSTIC PERIVENTRICULAR LEUKOMALACIA IN PREMATURE NEWBORNS. |[bull]| 2265

Periventricular leukomalacia (PVL) occurs commonly in premature infants. The white matter injury is considered to be principally a consequence of ischemic insult to vascular watershed zones with high intrinsic vulnerability. However, other factors, eg., bacterial endotoxins, have also been implicated. In premature newborns with PVL, we observed a high incidence (50%) of presumed antenatal infection compared with controls, based on clinical data. In this study, we describe placental abnormalities associated with cystic PVL and assess their clinical relevance in its pathogenesis.