Eunice Woldt

Acute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants.

Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates had more than three organ systems involved. Twenty-four neonates survived the neonatal course and at NICU discharge all system effects other than the central nervous system had resolved. At 5 years (60 months), 14 children had a normal neurologic examination, 9 had spastic quadriplegia and one had hemiplegia. Nine children had a McCarthy General Cognitive Index (GCI) greater than or equal to 84, 3 had a GCI between 68 and 83 and 12 scored less than 67. Neonatal seizures, renal problems, microcephaly at 3 months, and post-neonatal seizures were associated with an abnormal neurologic outcome or a GCI less than 67. A neurologic examination during the first year of life may reveal whether children with birth asphyxia will be relatively normal at age 5 years or whether they will show considerable delay.

Outcome after posthemorrhagic ventriculomegaly in comparison with mild hemorrhage without ventriculomegaly

The neurodevelopmental sequelae in 33 low birth weight neonates with moderate or severe hemorrhage and ventriculomegaly (VM group) and in 39 neonates with mild hemorrhage only (non-VM group) were evaluated prospectively. Both groups were comparable in birth weight, gestational age, and socioeconomic status. Ventriculoperitoneal shunts were inserted in 23 of the 33 VM group infants at a mean age of 26 days. Eighty-two shunt revisions were performed, for obstruction (71 revisions) or infection (11 revisions), in 18 of the 23 children. At a mean age of 50 months, 19 of 33 children in the VM group had sequelae; 14 children had moderate or severe neurologic deficits, and 5 children had mild sequelae. In the non-VM group, only 3 of 39 children had deficits, all of which were mild (p less than 0.05). In the VM group, 19 of 33 children had mental developmental delay in comparison with 8 of 39 in the non-VM group (p less than 0.05), and 17 of 33 children in the VM group had motor developmental delay in comparison with 5 of 39 in the non-VM group (p less than 0.01). Within the VM group, the number of children with neurodevelopmental sequelae did not differ significantly among the 23 children with shunts, in comparison with the 10 who did not require shunting. Among the children with shunts, a higher incidence of sequelae occurred when lack of ventricular decompression was noted immediately after shunt insertion (p less than 0.005) and when shunt infections occurred (p less than 0.01). The most important predictor of mental and motor outcome in the group with shunts was lack of ventricular decompression immediately after shunt insertion. We speculate that, in some infants, loss of brain tissue, cerebral atrophy, or both may occur before insertion of the ventriculoperitoneal shunt, even when the shunt is inserted early.

Prenatal cocaine exposure and BMI and blood pressure at 9 years of age

Background Prenatal cocaine exposure has been linked to intrauterine growth retardation and poor birth outcomes; little is known about the effects on longer-term medical outcomes, such as overweight status and hypertension in childhood. Our objective was to examine the association between prenatal cocaine exposure and BMI and blood pressure at 9 years of age among children followed prospectively in a multisite longitudinal study evaluating the impact of maternal lifestyle during pregnancy on childhood outcome. Design/methods This analysis includes 880 children (277 cocaine exposed and 603 with no cocaine exposure) with blood pressure, height, and weight measurements at 9 years of age. Regression analyses were conducted to explore the relationship between prenatal cocaine exposure and BMI and blood pressure at 9 years of age after controlling for demographics, other drug exposure, birth weight, maternal weight, infant postnatal weight gain, and childhood television viewing, exercise, and dietary habits at 9 years. Path analyses were used to further explore these relationships. Results At 9 years of age, 15% of the children were prehypertensive and 19% were hypertensive; 16% were at risk for overweight status and 21% were overweight. A small percentage of women were exposed to high levels of prenatal cocaine throughout pregnancy. A higher BMI was noted in children born to these women. Path analysis suggested that high cocaine exposure has an indirect effect on systolic and diastolic blood pressures that is mediated through its effect on BMI. Conclusion High levels of in-utero cocaine exposure are a marker for elevated BMI and blood pressure among children born full term.

Maintaining Participation and Momentum in Longitudinal Research Involving High-Risk Families

PURPOSE The purpose of the current study was to identify and describe strategies available to optimize retention of a high-risk research cohort and assist in the recovery of study participants following participant dropout. DESIGN AND METHODS The Maternal Lifestyle Study (MLS), which investigated the effects of prenatal substance exposure (cocaine or opiates) on child outcome, is a prospective longitudinal follow-up study that extended from birth through 15 years of age. Retention strategies to maximize participation and factors that might negatively impact compliance were examined over the course of five follow-up phases. FINDINGS At the conclusion of the 15-year visits, MLS had successfully maintained compliance at 76%. Retention rates did not differ by exposure group. CONCLUSIONS Maintaining ongoing participation of enrolled study subjects is a critical element of any successful longitudinal study. Strategies that can be used to reengage and maintain participants in longitudinal research include persistence, flexibility with scheduling, home visits, long-distance trips, increased incentives, and development of a computerized tracking system. Establishing rapport with families and ensuring confidentiality contributed to overall participant retention. The use of multiple tracking techniques is essential. CLINICAL RELEVANCE Researchers are challenged to maintain participants in longitudinal studies to ensure the integrity of their research.

Feasibility of invasive monitoring of intracranial pressure in term neonates

Seven term neonates with encephalopathy resulting from asphyxia and/or intracranial hemorrhage underwent invasive monitoring of intracranial pressure through the epidural or intracerebral space. The average age (in hours) at insertion of the monitor was 27 h in the 3 neonates with asphyxia and 70 h in the 4 neonates with hemorrhage. Intracranial hypertension was noted in 6 neonates. The management of the hypertension included hyperventilation followed by mannitol for pressures that were sustained above 20 mmHg and pentobarbital for pressures above 30 mmHg. The duration of the hypertension varied in 5 neonates from 4 to 72 h, while in the remaining neonates, the pressure remained elevated until death at 70 h. All 4 survivors with intracranial hemorrhage have minimal neuromotor deficits on follow up and 2 survivors with asphyxia have cognitive deficits and are microcephalic. From this small series, it appears that in the management of term neonates with intracranial hemorrhage, monitoring of intracranial pressure should be considered.

Effects of maternal medication use on NGF and IL-6 levels in human breast milk

Abstract Background: The objective of this study was to evaluate the effect of maternal medications on nerve growth factor (NGF) and interleukin-6 (IL-6) levels in human breast milk (HBM). Methods: A total of 30 samples of HBM were collected after consent from consecutively born term newborns. NGF and IL-6 concentrations were analyzed using ELISA assays from R&D Systems. The HBM samples were centrifuged, and the clear portion of the HBM after discarding the fat was analyzed and cytokine data were expressed as NGFC or IL-6C. Ten samples of HBM, which were not centrifuged, were also used in ELISA assays and cytokine data were expressed as NGFF or IL-6F. Results: After exposure to NSAIDs (7636 ± 9610, mean ± SD, pg/mL), the NGFC levels in HBM were significantly higher as compared to those who were exposed to narcotics (522 ± 1000) (p = 0.008). NGFC and IL-6C levels positively correlated with each other in HBM (R = 0.194 p < 0.0001). NGFC levels (360 ± 237) were significantly lower than NGFF levels (888 ± 751) (p < 0.0001). IL-6F was higher than IL-6C levels without statistical significance. Conclusion: Further studies are warranted to elucidate effect of maternal medications on cytokine changes in HBM and effect of these cytokine changes on newborn gastrointestinal milieu.

Visual-motor abnormalities in VLBW infants with grade III-IV intracranial hemorrhage. |[dagger]| 1245

The objective of our study was to evaluate visual-motor abnormalities at 18 mo corrected age in VLBW infants after grade III-IV intracranial hemorrhage(ICH) in the neonatal period. 14 VLBW infants (BW 700-1565g; GA 27-33 wk) diagnosed to have grade III-IV ICH and progressive posthemorrhagic ventriculomegaly (PHVM) were treated with reservoir placement (with daily reservoir taps) followed by ventriculoperitoneal shunt (VPS) insertion. VPS revisions were performed after NICU discharge whenever shunt infection or obstruction occurred. All infants had detailed ophthalmologic evaluations at 3,6 and 18 mo to evaluate vision and ocular movements and presence of strabismus, nystagmus, optic atrophy and residual retinopathy of prematurity(ROP).

USEFULNESS OF MAGNETIC RESONANCE IMAGING FOLLOWING NEONATAL BRAIN INJURY IN TERM AND PRETERM INFANTS. ▴ 1663

The objective of our study was to perform MRI in 2 groups of infants, A) term AGA with neonatal asphyxia (cord blood ph<7.1, 5 min Apgar ≤4, need for CPR at birth and hypoxic encephalopathy) and B) very low birth weight infants (VLBW) with grade III-IV intracranial hemorrhage (ICH) and posthemorrhagic ventriculomegaly requiring shunt insertion, and correlate MRI with neurologic outcome. MRI was performed at 6 mo corrected age with sagittal T1 weighted images and axial T1 and T2 weighted images (± contrast). Neurologic exams were categorized as normal, neuromotor impairment (with no developmental delay) and cerebral palsy (CP) MRI readings and neurologic exams were performed by independent examiners.

OCULAR FINDINGS IN VERY LOW BIRTHWEIGHT INFANTS WITH GRADE III-IV INTRACRANIAL HEMORRHAGE. 1659

OCULAR FINDINGS IN VERY LOW BIRTHWEIGHT INFANTS WITH GRADE III-IV INTRACRANIAL HEMORRHAGE. 1659