Craig L. Anderson

Neonatal burst suppression: Its developmental significance

Burst suppression was recorded on electroencephalograms of 15 of 274 term infants (5.4%) in our hospital within a 5 year period. These 15 infants were examined, their perinatal histories reviewed, and detailed neurodevelopmental testing performed to examine the prognostic significance of burst suppression. Fourteen children (93%) had poor outcomes. Four (26%) died in infancy. Ten survivors were followed for a mean of 30 months (range: 18-61 months). Nine have severe motor deficits, 6 require total custodial care, 5 have intractable epilepsy, and 3 are blind. Their mean Gesell Developmental Quotient was 28; a score of less than 68 suggests severe retardation. A single patient, the only 1 with a perinatal history complicated by an easily-treated bacterial meningitis, achieved normal growth and development. This study documents the dire prognosis of neonatal burst suppression. The appearance of burst suppression, though transient, portended death or severe neurodevelopmental disability in 93% of our patients.

Meningitis in premature infants with respiratory distress: Role of admission lumbar puncture

tress may be the only sign of sepsis, we would prefer to see more data on the yield of CSF examination in infants with respiratory distress before CSF examination is completely discarded, although a selective or delayed approach may be appropriate. Infants with bacteremia who are symptom free may have a sufficient concentration of organisms in the blood to seed the meninges.! ~ Lumbar puncture for sepsis workup of newborn infants currently has a yield of less than 3%. 1, z Therefore it seems appropriate to exclude a group of infants in whom the probability of meningitis is extremely small. In this review we found no cases of meningitis in 284 infants who were symptom free at the time lumbar puncture was performed. Although 284 is not a large number for statistical purposes, it represents only those infants who were examined. The denominator is larger if one includes all symptom-free infants with risk factors who did not undergo lumbar punctures and presumably did not have meningitis. The probability of meningitis in this group is less than 4:1000 and likely to be zero. We conclude that CSF examination is not indicated in the diagnostic evaluation of symptom-free infants born to mothers with chorioamnionitis or other risk factors for neonatal infection.

An analysis of maternal transport within a suburban metropolitan region

Data on 185 infants transported for perinatal and/or neonatal care from suburban metropolitan hospitals were analyzed. Following birth, 100 infants were transferred from community hospitals. A total of 85 infants were transported in utero and delivered at a tertiary (Level III) perinatal center. Survival rate was 90% for infants transported in utero contrasted with 81% for the infant transports. This difference was not significant. When hospitalization cost and length of stay were used as an index of morbidity, there was a significant difference between the two groups. The mean hospitalization cost of survivors was

Tracheal Atresia Associated with Congenital Absence of the Radii An Addition to the VATER Syndrome

6,473 for in utero transports compared to

1323 NEURODEVELOPMENTAL OUTCOME AT 2 YEARS IN PRETERM INFANTS WITH INTRAVENTRICULAR HEMORRHAGE

12,208 for infant transports (p less than 0.005). The mean length of stay for in utero transports was 19 days contrasted to 27 days for infant transports (p less than 0.05). The findings of this study indicate that in utero transports resulted in reduced morbidity for infants of high-risk pregnancies.

High-dose intravenous gammaglobulin (IVG) in neonatal immune thrombocytopenia

A case report of tracheal atresia with congenital absence of the radii is described. The authors suggest that this represents an addition to the VATER association.

Urokinase therapy for a central venous catheter thrombus

Forty-six infants with b. w. < 1,501 gm were prospectively studied to determine if the presence and grade of IVH adversely affected neurodevelopmental outcome. CT scans were done on all infants and hemorrhages graded according to Papiles method. Twenty-six infants had no hemorrhage (Group 1); 12 had Grade I or II (Group 2), and 8 had Grade III or IV (Group 3). Groups did not differ in x b. w., obstetrical complications, or socioeconomic status. The following were significantly different between groups:In spite of significant mean differences in Bayley scores and abnormal neurological examinations among the groups, 3 of 7 (43%) patients in Group 3 were completely normal. We suggest that although Papiles method of grading IVH is useful it is not reliably predictive of abnormal outcome.