RESUMO
Computed tomography brain scans were done during the first two weeks of life in 145 asphyxiated or apneic newborn infants with birth weights less than 1,500 gm. Sixty-two survived and were assessed neurodevelopmentally at 18 months from the term date. Follow-up CT scans were done at six months post term. There were major neurodevelopmental defects in 15 children, minor defects in 10, and no gross abnormalities in 37. The neonatal CT scans showed germinal layer hemorrhage in 45 (73%) of the survivors and was combined with ventricular bleeding in 29 cases (47%). Areas of hypodensity of brain tissue were present in all neonatal CT and were extensive in 84%. Ventricular dilatation occurred in 31%. There was a significant relationship between hydrocephalus and CT findings of IVH and dilated ventricles, but no relationship between outcome at 18 months and any other features of the neonatal CT. Only four of 56 CT scans done at six months post term were normal. Dilatation of the ventricles and subarachnoid spaces was common but was not related to subsequent neurodevelopmental status.
Assuntos
Asfixia Neonatal/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Doenças do Prematuro/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Asfixia Neonatal/complicações , Encefalopatias/etiologia , Isquemia Encefálica/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais , Humanos , Hidrocefalia/diagnóstico por imagem , Recém-Nascido , Prognóstico , Estudos ProspectivosRESUMO
During 1974-1977, 158 infants of birth weights less than 801 gm were referred from outlying hospitals. The survival rate was 25% for the whole group and 35% for those weighing 700 to 800 gm. Many were in a poor condition on arrival. One hundred and nineteen died. The most common causes of death were intracranial hemorrhage (39), RDS (26), and infection (13). Thirty-seven of the 39 survivors were followed until 18 months postterm. Growth failure was common--57% were below the third percentile in weight, 37% in length, and 17% in head circumference. Three had retrolental fibroplasia. Five children (14%) had major neurologic sequelae. Eight were severely handicapped with a Bayley score of less than 70 and ten were moderately handicapped with a Bayley score between 70 and 84, resulting in a neurodevelopmental handicap rate of 49%. Significant factors correlating with survival and intact outcome were birth weight greater than or equal to 700 gm, gestation greater than or equal to 26 weeks, the absence of asphyxia, and good condition on arrival at the NICU. There was no intact survival below 700 gm birth weight. The handicap rate of survivors between 700 and 800 gm was only 39%. Although intensive care in a referral unit may not be justified for those less than 700 gm, every effort should be made in the care of those 700 to 800 gm.
Assuntos
Recém-Nascido de Baixo Peso , Unidades de Terapia Intensiva Neonatal , Avaliação de Processos e Resultados em Cuidados de Saúde , Estatura , Peso Corporal , Doenças do Sistema Nervoso Central/etiologia , Cefalometria , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/complicações , Doenças do Recém-Nascido/mortalidade , Doenças do Recém-Nascido/terapia , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Ontário , Encaminhamento e ConsultaRESUMO
Prospective follow-up studies were done on 62 term infants who were treated as neonates for clinical evidence of postasphyxial encephalopathy. Computed tomographic studies were done during the first two weeks of life and repeated at six months of age. All children were followed a minimum of 18 months, at which time they underwent a psychometric and a neurologic evaluation. Major neurodevelopmental sequelae consisted of: hydrocephalus; spastic quadriplegia, hemiplegia, or diplegia; or a mean Bayley score less than 70. Major sequelae were present in 29 (47%) of the children: all were severely handicapped. Five other children scored between 70 and 85 on the Bayley test. Computed tomographic scans were highly predictive of status at 18 months. Eleven of the 15 with intraventricular or parenchymal hemorrhage were severely handicapped. Eighteen of 20 with extensive areas of hypodensity of the white and gray matter (neonatal CT) were abnormal at 18 months. All but two were severely handicapped. The results suggest that CT studies are very useful in the care of the asphyxiated term infant who has clinical signs of encephalopathy.
Assuntos
Asfixia Neonatal/complicações , Encefalopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Encefalopatias/complicações , Encefalopatias/etiologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Humanos , Lactente , Recém-Nascido , Doenças do Sistema Nervoso/etiologia , PrognósticoRESUMO
A two-year follow-up study of 43 infants of birth weight less than or equal to 1,000 gm born during 1974 revealed the following: average height at two years was between the tenth and twenty-fifth percentiles; average weight between the third and tenth percentiles. Fifteen (35%) developed lower respiratory tract infections during the first two years. Seven (16%) had retrolental fibroplasia. Major neurologic defects occurred in four (9%); severe developmental delay (mean developmental quotient less than 80) was found in nine others (21%). Defects of the central nervous system were closely associated with a neonatal history of intracranial hemorrhage or seizures or both.
Assuntos
Recém-Nascido de Baixo Peso , Morbidade , Estatura , Peso Corporal , Doenças do Sistema Nervoso Central/epidemiologia , Feminino , Seguimentos , Crescimento , Humanos , Lactente , Recém-Nascido , Respiração com Pressão Positiva Intermitente , Masculino , Doenças do Sistema Nervoso/epidemiologia , Ontário , Respiração com Pressão Positiva , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Retinopatia da Prematuridade/epidemiologiaRESUMO
A two-year follow-up study of 73 low-birth-weight ( less than 1,501 gm) infants treated with positive pressure ventilation as neonates revealed the following: 24% incidence of lower respiratory tract infections during the first year; weight and height at two years averaging between tenth and twenty-fifth percentiles; major neurologic defects diagnosed in 14 boys (39%) and seven girls (18%) with one-year Bayley scores of less than 80. Major neurologic sequelae were closely associated with a neonatal history of seizures and intracranial hemorrhage and were more common in boys, survivors weighing more than 1,000 gm and following high-risk pregnancies.