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Intraventricular Haemorrhage (intraventricular + haemorrhage)

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Medical Sciences	100%

Selected Abstracts

Cerebral tissue oxygenation index and superior vena cava blood flow in the very low birth weight infant

ACTA PAEDIATRICA, Issue 1 2009
M Moran
Abstract Background: Superior vena cava (SVC) flow assesses blood flow from the upper body, including the brain. Near infrared spectroscopy (NIRS) provides information on brain perfusion and oxygenation. Aim: To assess the relationship between cerebral tissue oxygenation index (cTOI) and cardiac output measures in the very low birth weight (VLBW) infant in the first day of life. Methods: A prospective observational cohort study. Neonates with birth weight less than 1500 g (VLBW) were eligible for enrollment. Newborns with congenital heart disease, major congenital malformations and greater than Papile grade1 Intraventricular Haemorrhage on day 1 of life were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. Low SVC flow states were defined as a flow less than 40 mL/kg/min. cTOI was measured using NIRO 200 Hamamatsu. Results: Twenty-seven VLBW neonates had both echocardiography and NIRS performed. The median (range) gestation was 29/40 (25 + 3 to 31 + 5 weeks) and median birth weight was 1.2 kg (0.57,1.48 kg). The mean (SD) TOI was 68.1 (7.9)%. The mean (SD) SVC flow was 70.36(39.5) mLs/kg/min. The correlation coefficient of cerebral tissue oxygenation and SVC flow was r = 0.53, p-value 0.005. There was a poor correlation between right and left ventricular output and cTOI which is not surprising considering the influence of intra- and extracardiac shunts. Conclusion: There is a positive relationship between cerebral TOI values and SVC flow in the very low birth infant on day one of life. [source]

Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g

ACTA PAEDIATRICA, Issue 6 2008
Michael Obladen
Abstract Aim: Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH-associated conditions decreases their frequency and thus the frequency of IVH. Methods: Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH-associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH-associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004. Results: IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3,4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH-associated conditions were reduced during IVH surveillance without reaching significance. Conclusions: IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH-associated conditions. [source]

Ultrasound diagnosis of brain atrophy is related to neurodevelopmental outcome in preterm infants

ACTA PAEDIATRICA, Issue 12 2005
Sandra Horsch
Abstract Background: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear. Aim: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age. Patients and methods: All preterm infants born in 1997 in our institution with a gestational age <32 wk or birthweight <1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II. Results: Eighty-seven infants were enrolled (birthweight 430,2500 g (median 1200 g), gestational age 24,34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting <7 d, in 30 cases >7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neurodevelopmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; p=0.02), PDI (atrophy 91.4, no atrophy 106.5; p=0.001) and Behaviour Rating Scale (atrophy 41.1, no atrophy 66.4; p=0.01) than infants without atrophy. Periventricular echodensities were not related to outcome. Conclusion: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y. [source]

Developmental outcome and types of chronic-stage EEG abnormalities in preterm infants

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2002
Akihisa Okumura MD
The aims of this study were to determine the types of chronic-stage EEG abnormalities that exist and to clarify their relation to neurodevelopmental outcome in preterm infants. We evaluated 183 preterm infants with gestational ages of less than 33 weeks (mean age 29.2 weeks) and weighing less than 2000g (mean weight 1275g). The first EEG was performed within 72 hours of life; thereafter, EEG was performed once every 1 to 4 weeks until the infant reached a post-conceptional age of 40 to 42 weeks. Two kinds of EEG abnormalities, acute- and chronic-stage abnormalities, were evaluated and we assessed mainly the latter. Chronic-stage EEG abnormalities were divided into two patterns: disorganized and dysmature. Periventricular leukomalacia (PVL) and intraventricular haemorrhage (IVH) were diagnosed on the basis of ultrasound findings. Psychomotor development was examined every 3 months after discharge until at least 18 months of the infants'corrected age. Disorganized and dysmature patterns were observed in 52 and 28 infants respectively. Among the 52 infants with disorganized patterns, PVL was observed in 31 and IVH in seven infants. Thirty-nine infants had cerebral palsy (CP). Twenty-six achieved normal cognitive development. Of the 28 infants with dysmature patterns, PVL was seen in one and IVH in 11 infants. CP was seen in five infants. Only eight infants achieved normal cognitive development. Gestational age and birth weight were significantly lower in infants with dysmature patterns than in those with disorganized ones. Results indicate that types of chronic-stage EEG abnormalities are related to types of neurological sequelae and are useful for assessing the mode of brain injury in preterm infants. [source]

Testing the outcome score of spontaneous intracerebral haemorrhage in haemodialysis patients

INTERNAL MEDICINE JOURNAL, Issue 10 2009
B.-R. Huang
Abstract The aim of this study is to determine the predictive value of the spontaneous intracerebral haemorrhage (ICH) outcome score (which we described previously) in haemodialysis (HD) patients who develop spontaneous ICH. The validation cohort consisted of all HD patients with spontaneous ICH presenting to Chang Gung Memorial Hospital in Taiwan during 2005,2007. The data were collected from one hospital and prospectively analysed, and the predictive model was tested using an external validation dataset. The prognostic factors were confirmed by chi-squared testing. We calculated the 30-day mortality in different groups of the validation cohort divided according to outcome score and tested the predictive value of the outcome score. The overall mortality rate was 52.6% in 38 HD patients. The originally identified prognostic factors were Glasgow Coma Scale score, age ,70 years, systolic blood pressure <130 or ,200 mmHg, ICH volume ,30 mL, presence of intraventricular haemorrhage and serum glucose ,8.8 mmol/L. All but one (serum glucose ,8.8 mmol/L (P= 0.07)) were subsequently found to be associated with 30-day mortality. In patients scoring 6 and 7, mortality was 100%, but in patients scoring 0, it was only 11.1%. The 30-day mortality in the validation cohort increased steadily with score and had good predictive value (correlation coefficient = 0.986, P < 0.001). Similar results in two different cohorts indicate that the ICH outcome score is a reliable outcome measure. [source]

Outcome and hospital cost for infants weighing less than 500 grams: A tertiary centre experience in Taiwan

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007
Wu-Shiun Hsieh
Aim: To determine the outcome and hospital cost for infants weighing ,500 g at a tertiary centre in Taiwan. Methods: We retrospectively reviewed the medical records of infants who were born alive with birthweight ,500 g at the National Taiwan University Hospital from 1997 to 2004. Their outcome and hospital cost were analysed. Results: A total of 168 infants were included for analysis that 146 of them died after compassionate care in the delivery room and 22 received postnatal resuscitation. The infants who received resuscitation were more likely to have higher birthweights, older gestational ages and multiple births compared with those who received compassionate care. After resuscitation, five of the infants died and 17 were admitted to neonatal intensive care unit (NICU) for further management. Subsequently, 12 infants died and five infants survived to discharge. Two infants were discharged against advice and died within days. After exclusion of those receiving compassionate care, the NICU survival rate was 22.7% and the long-term survival rate was 13.6%. The most common early morbidities were respiratory distress syndrome, intraventricular haemorrhage and patent ductus arteriosus, whereas the late morbidities included cholestatic jaundice, retinopathy of prematurity and chronic lung disease. The average total hospital costs for the NICU survivors with birthweight ,500 g was US$ 42 411 and the average hospital cost per day was US$ 350. Conclusion: Exclusive compassionate care was given to the majority of the infants weighing ,500 g in Taiwan. The survival rate remained low in these marginally viable infants. [source]

Survey of the management of neonatal hyperglycaemia in Australasia

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007
Jane M Alsweiler
Aim: Hyperglycaemia is a common problem in very low birthweight (VLBW) preterm neonates and has been associated with an increase in intraventricular haemorrhage and mortality. There are few data to guide clinicians on the best range of blood glucose levels to aim for when treating hyperglycaemic preterm babies with insulin. The aim of this study was to survey all Australasian tertiary neonatal intensive care units for their current practice in the definition and management of neonatal hyperglycaemia to aid in the design of a randomised controlled trial of the effect of tight glycaemic control on long-term outcome in VLBW babies. Methods: An online survey was sent to the 27 tertiary neonatal units in Australasia asking the respondents for details of their unit's definition and management of hyperglycaemia in VLBW infants. Results: Twenty-three tertiary neonatal units responded to the questionnaire. There were six different definitions of hyperglycaemia, with most units defining neonatal hyperglycaemia as a blood glucose level greater than 10 mM. There were large variations in the criteria for commencing insulin (blood glucose level 8,15 mM ± glycosuria) and target blood glucose ranges for babies on insulin (ranging from 2.5,8 mM to 8,15 mM). Conclusions: There is a wide variation in the management of neonatal hyperglycaemia between tertiary neonatal units in Australasia. This reflects the paucity of data available in this area. Further research on the management of neonatal hyperglycaemia is needed. [source]

Effect of an early intervention programme on low birthweight infants with cerebral injuries

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2004
S Ohgi
Objective: To determine the effect of an early intervention programme (EIP) on low birthweight infants with cerebral injuries. Methods: Subjects were 23 high-risk low birthweight infants (periventricular leukomalacia 15, intraventricular haemorrhage 5, both 3) receiving care in the neonatal intensive care unit (NICU) at Nagasaki University Hospital. Subjects were randomly assigned to the EIP group (n = 12) or the control group (n = 11). Participants in the EIP group received a Neonatal Behavioral Assessment scale (NBAS)-based intervention combined with developmental support designed to enhance the infants' development and the quality of the parent,infant relationship. The control group received routine medical nursing care without the EIP. The EIP began prior to discharge from the NICU and lasted until 6 months of corrected age. All children were examined on the NBAS preintervention and again at 44 weeks postconceptional age. Maternal anxiety status (STAI) and maternal feelings of confidence in dealing with her baby (LCC) were measured pre and postintervention. Mental and motor development was assessed postintervention using the Bayley Scale of Infant Development. Results: Orientation and State Regulation of infant behavioural profiles, the STAI and LCC scores significantly improved in the EIP group (mean difference (95% CI): Orientation 0.7 (0.4, 1.1), State Regulation 0.9 (0.3, 1.5), STAI ,5.5 (, 9.1, ,1.9, LCC 5.3 (4.2, 6.5)), but not in the control group. Bayley mental developmental index (MDI) score in the EIP group was higher than in the control group, but there was no significant difference between the two groups (mean difference (95% CI): MDI 8.5 (, 0.8, 17.8), PDI 6.7 (, 1.9, 15.4)). Conclusion: The EIP has beneficial effects on neonatal neurobehavioural development and maternal mental health of low birthweight infants with cerebral injuries. This evidence suggests that short-term changes in maternal mental health and infant neurobehaviour promoted by an EIP may serve to initiate a positive interaction between parents and infants. [source]

Suspected pituitary apoplexy in a German shorthaired pointer

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 11 2003
S. N. Long
Pituitary apoplexy is a syndrome which has been described in humans caused by acute haemorrhage or infarction within a pituitary tumour or a non-tumorous pituitary gland. This report describes the authors'observations of a dog in which vomiting, visual disturbances, seizures, altered consciousness and diencephalic dysfunction occurred in association with haemorrhage originating from a pituitary macroadenoma. The clinical signs were thought to be consistent with disruption of the hypothalamus and brainstem, together with raised intracranial pressure due to intraventricular haemorrhage. These signs, and the pathological findings, bear a striking resemblance to those associated with the syndrome of pituitary apoplexy, seen in humans. [source]

Incorporating nutrition into delivery care: delivery care practices that affect child nutrition and maternal health

MATERNAL & CHILD NUTRITION, Issue 4 2009
Camila M. Chaparro
Abstract Delayed umbilical cord clamping, early skin-to-skin contact and early initiation of exclusive breastfeeding are three simple and inexpensive delivery care practices which have the potential to improve short-term and long-term nutrition and health outcomes in mothers and infants. In preterm infants, delayed clamping prevents intraventricular haemorrhage and improves haematological status, and in full-term infants, delayed clamping improves iron status through 6 months of age. Early skin-to-skin contact, in addition to regulating neonatal temperature, improves early breastfeeding behaviours, which has important implications for long-term infant nutrition and health. Finally, early exclusive breastfeeding prevents neonatal mortality and morbidity and provides numerous health and nutritional benefits to the infant, throughout infancy and beyond, as well as to the mother. Though each practice has been the subject of controlled trials and systematic reviews, with evidence of benefit from their implementation, these practices are not common in many delivery settings, nor are their long-term effects on infant and maternal nutrition and health status adequately recognized. We discuss the immediate and long-term health and nutrition benefits of each practice, and identify the policy and programme changes needed for integration and implementation of these practices into standard delivery care. [source]

Primary intracranial angiosarcoma of the Pineal gland: an unusual cause of recurrent intraventricular haemorrhage and superficial haemosiderosis

NEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 5 2006
K. M. Kurian
First page of article [source]

The case for tocolysis in threatened preterm labour

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2003
Nicholas M. Fisk
The failure of tocolytics to improve neonatal outcomes in placebo-controlled trials has wrongly been interpreted as evidence that they do not work. While delivery is unequivocally prolonged by 24 hours, 48 hours and 7 days, the time gained was not exploited to optimise neonatal outcome. These trials typically studied women at relatively advanced gestational ages with predictably good outcomes, enrolled them in tertiary centres where they could not benefit from in-utero transfer, and had low levels of corticosteroid administration. No study has been powered to detect clinically meaningful differences that might be expected to accrue from 1,7 days prolongation of gestation. Despite this, Bayesian interpretation suggests that tocolytics do improve neonatal outcome. The largest placebo-controlled study showed clear trends towards better survival in fetuses <28 weeks, lower rates of cerebral palsy and higher Bayley mental scores. Meta-analysis of neonatal morbidity in the beta-agonist trials suggests a near-significant reduction in respiratory distress syndrome (RDS), together with trends towards reduced intraventricular haemorrhage, necrotising enterocolitis, and patent ductus arteriosus. Finally, there is the Orwellian analogy that tocolytics don't work, but some work better than others. Although calcium antagonists have not been evaluated against placebo, meta-analysis of comparative trials with beta-agonists demonstrate a significantly lower incidence of RDS and neonatal jaundice, presumably mediated through the reduced chance of delivery within 48 hours and 7 days. Development of tocolytics that are safe for mother and baby should facilitate adequately-powered placebo-controlled studies, which both focus on women most likely to benefit and capitalise on the 1,7 days gained. [source]

Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)

ACTA PAEDIATRICA, Issue 7 2010
The EXPRESS Group
Abstract Aims:, The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods:, Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004,2007. Results:, Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ,3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion:, Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted. [source]

Complications affecting preterm neonates from 1991 to 2006: what have we gained?

ACTA PAEDIATRICA, Issue 3 2010
F Groenendaal
Abstract Aim:, In this study, we determined whether outcome of preterm neonates has improved over a period of 16 years. Study design:, Inborn neonates with a gestational age of 25.0,29.9 weeks were included. Patients with severe congenital malformations were excluded. Mortality and morbidity (chronic lung disease; CLD, intraventricular haemorrhage: IVH grade III or IV, cystic periventricular leukomalacia: cPVL, perforated necrotizing enterocolitis: NEC, severe retinopathy of prematurity needing surgery: ROP and cerebral palsy: CP) were compared in three periods (period 1: 1991,1996 n = 434; period 2: 1997,2001 n = 356; period 3: 2002,2006 n = 422). Results:, Infant mortality decreased from 15.2% to 10.9%. CLD did not differ significantly between periods (14.1,14.8%). Perforated NEC decreased from 2.8% to 1.6%. IVH grade III and IV both remained at 5.7% in period 3, whereas cPVL decreased significantly from 4.5% to 1.6%. Cerebral palsy decreased from 5.8% to 3.5% in period 3. Two neonates in each period were in need of surgery for ROP. Conclusion:, Inborn preterm patients showed an improved survival and a significant reduction in cPVL and CP. Perforated NEC showed a trend to decrease. CLD and IVH grade III and IV remain a matter of concern. [source]

Remifentanil for INSURE in preterm infants: a pilot study for evaluation of efficacy and safety aspects

ACTA PAEDIATRICA, Issue 9 2009
L Welzing
Abstract Aim:, To evaluate intubating conditions, extubation times and outcome in preterm infants receiving remifentanil as induction agent for the INSURE procedure. Methods:, In twenty-one preterm infants of 29 to 32 weeks gestation and signs of respiratory distress, we utilized remifentanil as induction agent for the INSURE procedure. Following intubation and surfactant application, the infants were mechanically ventilated until respiratory drive was judged to be satisfactory for continuing CPAP therapy. Intubating conditions were classified by our own scoring system by rating limb movements, coughing and breathing. Heart rate, blood pressure and oxygen saturation were recorded during the entire INSURE procedure. Results:, Remifentanil provided excellent or good intubating conditions in all patients. We observed no serious side effects after remifentanil infusion, in particular, no thorax rigidity, clinically significant bradycardia or arterial hypotension. Average extubation time after surfactant administration was 16.9 min (1,45 min); none of the infants had to be reintubated. Following extubation, the infants required only 3.3 days (1,8 days) of CPAP therapy. None exhibited serious complications of prematurity like periventricular leucomalacia, intraventricular haemorrhage >I°, necrotizing enterocolitis or retinopathy. Conclusion:, In this pilot study, INSURE with remifentanil was associated with good intubating conditions and early extubation resulting in an excellent neonatal outcome. [source]

Most very low birth weight subjects do well as adults

ACTA PAEDIATRICA, Issue 9 2009
P-O Gäddlin
Abstract Aim:, To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap. Methods:, This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987,1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence. Results:, VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function. Conclusion:, The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health. [source]

Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g

Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants

ACTA PAEDIATRICA, Issue 11 2006
Tsugumichi Koshinaga
Abstract Aim: To elucidate how spontaneous localized intestinal perforation (SLIP) is related to intestinal morphological features such as dilatation in very-low-birthweight (VLBW) infants. Methods: The medical records of 13 VLBW infants (<1500 g) undergoing laparotomy between 1983 and 2003 for presumed SLIP were retrospectively reviewed. Clinical findings including maternal, prenatal and perinatal factors were analysed, and the clinical and surgical findings upon laparotomy were compared. Results: Postnatal pathological conditions included patent ductus arteriosus (n= 7), sepsis (n= 2), respiratory distress syndrome (n= 7), intraventricular haemorrhage (n= 2), an indwelling catheter via the umbilical vein (n= 1) and pneumonia (n= 1). Indomethacin was used in seven neonates with patent ductus arteriosus, and dexamethasone preventive therapy was employed in one neonate for bronchopulmonary dysplasia. Operative findings revealed a localized small punched-out perforation in the ileum. Five patients had intestinal dilatation: two with a perforation in the middle of the dilated intestine, and three with a perforation proximal to the region of dilatation. The muscularis propria was absent in the dilated intestine of four patients. Conclusion: This study found no significant relationship between perforation and dilatation of the intestine. Perforation may occur in any portion of the ischaemic intestine when circulatory failure becomes severe, and is not necessarily restricted to the dilated intestine. We believe that SLIP and intestinal dilatation may occur on the same basis in low-birthweight infants; however, the disease process may be aetiologically different. [source]

Comparative outcome study between triplet and singleton preterm newborns

ACTA PAEDIATRICA, Issue 11 2002
A Maayan-Metzger
Aim: To evaluate the outcome of triplet versus singleton preterm newborns. Methods: The study population included 64 sets of preterm triplet (gestational age 25-34 wk) and 64 singleton controls. Data on prenatal and perinatal findings, neonatal complications, duration of hospitalization, and neonatal mortality were collected by chart review. Results: Mothers of triplets were more likely to receive prenatal tocolytic treatment and more antenatal steroids for foetal lung maturation, and to be delivered by caesarean section. No differences were found between the groups in perinatal parameters (cord pH, Apgar score, respiratory support after birth), respiratory parameters (severity of acute and chronic lung disease, use and duration of oxygen treatment and assisted ventilation), or neonatal complications (patent ductus arteriosus, intraventricular haemorrhage, periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity, meningitis, sepsis and jaundice). This was also true for duration of hospitalization and neonatal mortality. No differences were recorded by birth order among the triplets for any of these parameters. Conclusion: The study indicates that good prenatal care can lead to a good outcome for preterm triplets, close to that of preterm singleton infants. Families and physicians should consider this information when foetal reduction is offered. [source]

Trends in outcomes for very preterm infants in the southern region of Sweden over a 10-year period

ACTA PAEDIATRICA, Issue 4 2009
Pia Lundqvist
Abstract Aim: To investigate trends in mortality and morbidity in very preterm infants. Methods: Population-based perinatal register; liveborn infants 22 + 0 to 31 + 6 gestational weeks were investigated (time period 1995,2004). Time trends for mortality and common morbidities were explored using logistic regression analyses. Results: Data from 1614 liveborn infants were included. There was an increase in live born infants below 25 gestational weeks, annual odds ratio (OR) 1.15 (95% CI: 1.08,1.23) and a decrease in mortality annual OR 0.82 (95% CI: 0.69,0.98). The rates of bronchopulmonary dysplasia (BPD) and sepsis increased during the study period, annual ORs of 1.10 (95% CI: 1.04,1.17) and 1.09 (95% CI: 1.03,1.16). The duration of mechanical ventilation increased for surviving infants <25 gestational weeks (p = 0.003), while the duration of continuous positive airway pressure (CPAP) increased for infants <28 gestational weeks (p = <0.001). There were no changes in the rates of intraventricular haemorrhages (IVH, 3,4), retinopathy of prematurity (ROP, 3,5), seizures or necrotizing enterocolitis (NEC). Conclusion: During the 10-year period changes in mortality and morbidity were most pronounced for infants with GA <28 gestational weeks. The increasing rate of sepsis was present in infants <28 gestational weeks, whereas the increase in BPD was demonstrated in the whole study population <32 gestational weeks. [source]

Brain abnormalities in extremely low gestational age infants: a Swedish population based MRI study

ACTA PAEDIATRICA, Issue 7 2007
Sandra Horsch
Abstract Aims: Brain abnormalities are common in preterm infants and can be reliably detected by magnetic resonance (MR) imaging at term equivalent age. The aim of the present study was to acquire population based data on brain abnormalities in extremely low gestational age (ELGA) infants from the Stockholm region and to correlate the MR findings to perinatal data, in order to identify risk factors. Methods: All infants with gestational age <27 weeks, born in the Stockholm region between January 2004 and August 2005, were scanned on a 1.5 T MR system at term equivalent age. Images were analysed using a previously established scoring system for grey and white matter abnormalities. Results: No or only mild white matter abnormalities were observed in 82% and moderate to severe white matter abnormalities in 18% of infants. The Clinical Risk Index for Babies (CRIB II) score, use of inotropes, the presence of high-grade intraventricular haemorrhages and posthaemorrhagic ventricular dilatation were associated with white matter abnormalities. Conclusion: The incidence of moderate to severe white matter abnormalities in a population-based cohort of ELGA infants from the Stockholm region was 18%. To examine the clinical relevance of these promising results, neurodevelopmental follow up at 30 month corrected age, is ongoing. [source]