RESUMEN
Newborn infants admitted for neonatal intensive and high dependency care are reliant on intravenous therapy for medications, hydration and nutrition. Adopting a structured approach to gaining neonatal vascular access can improve efficiency and potentially reduce complications. In this article, we discuss an algorithm for decision-making in neonatal vascular access.
Asunto(s)
Neonatología , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Derivación y ConsultaAsunto(s)
Unidades de Cuidado Intensivo Neonatal , Neonatología , Humanos , Recién Nacido , ResucitaciónRESUMEN
AIM: To determine the aetiological associations, neurological sequelae and role of magnetic resonance imaging (MRI) in term newborn infants with seizures. METHODS: Cohort study of infants ≥37 weeks' gestation delivered in a tertiary level centre, prospectively identified and followed longitudinally for 18-24 months. RESULTS: An underlying aetiology was found in 95% of the 77 infants identified with seizures (3.0/1000 live births). The most common diagnosis was hypoxic-ischaemic encephalopathy (HIE) (65%), followed by neonatal stroke (12%). Nine infants died, 28 of the 68 survivors developed neurodevelopmental impairment (NDI), and 15 had recurrent seizures in the first 2 years, with both outcomes more likely in those with a diagnosis other than HIE. Abnormal MRI findings were found in 45 of the 70 infants imaged. The absence of major cerebral lesions was highly predictive of a normal neurological outcome. CONCLUSION: We report the first cohort of term infants with seizures fully investigated by MRI. The universal use of MRI enabled a cause to be identified in 95% of cases. The probability of having NDI or recurrence of seizures was extremely low with absence of major cerebral lesions on MRI. This study demonstrates the added value of MRI for diagnosis of aetiology and the prediction of neurological outcome.