OBJECTIVE: To evaluate electroencephalograms (EEG), evoked potentials (EPs) and Doppler findings in the cerebral arteries as predictors of a 1-year outcome in asphyxiated newborn infants. METHODS: EEG and EPs (brain stem auditory (BAEP), somatosensory (SEP), visual (VEP) evoked potentials) were assessed in 30 asphyxiated and 30 healthy term infants during the first days (range 1-8). Cerebral blood flow velocities (CBFV) were measured from the cerebral arteries using pulsed Doppler at â¼24h of age. EEG, EPs, Doppler findings, symptoms of hypoxic ischemic encephalopathy (HIE) and their combination were evaluated in predicting a 1-year outcome. RESULTS: An abnormal EEG background predicted poor outcome in the asphyxia group with a sensitivity of 67% and 81% specificity, and an abnormal SEP with 75% and 79%, respectively. Combining increased systolic CBFV (mean+3SD) with abnormal EEG or SEP improved the specificity, but not the sensitivity. The predictive values of abnormal BAEP and VEP were poor. Normal EEG and SEP predicted good outcome in the asphyxia group with sensitivities from 79% to 81%. The combination of normal EEG, normal SEP and systolic CBFV<3SD predicted good outcome with a sensitivity of 74% and 100% specificity. CONCLUSIONS: Combining abnormal EEG or EPs findings with increased systolic CBFV did not improve prediction of a poor 1-year outcome of asphyxiated infants. Normal EEG and normal SEP combined with systolic CBFV<3SD at about 24 h can be valuable in the prediction of normal 1-year outcome. SIGNIFICANCE: Combining systolic CBFV at 24 h with EEG and SEP examinations can be of use in the prediction of normal 1-year outcome among asphyxiated infants.
Asphyxia Neonatorum/diagnostic imaging , Asphyxia Neonatorum/physiopathology , Electroencephalography , Evoked Potentials , Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Cerebrovascular Circulation , Evoked Potentials, Auditory, Brain Stem , Evoked Potentials, Somatosensory , Evoked Potentials, Visual , Female , Humans , Infant , Infant, Newborn , Male , Predictive Value of Tests , Seizures/drug therapy , Seizures/physiopathology , Treatment Outcome , Ultrasonography, Doppler, Pulsed
We investigated the association of intracranial arterial end-diastolic block with mean arterial pressure (MAP), patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) in infants with birth weights <1000 g. End-diastolic block was diagnosed when end-diastolic flow was found to be absent from the Doppler waveforms in cerebral arteries by pulsed Doppler ultrasound examinations. Cranial ultrasonography and pulsed Doppler examination of anterior cerebral and basilar arteries were performed in 55 preterm infants (gestational age range 24-31 wk) one to four times during the first four days of life. Of these, 22 (40%) developed an end-diastolic block at least once (block group); in 33 no block was detected (control group). Echocardiography was performed and MAP recorded concomitantly. The block group infants had significantly lower mean MAPs than the controls and 59% of those had MAP of 30 mm Hg or lower. In the block group, IVH developed more often in infants with MAP <30 mm Hg (46%) than in infants with MAPs >30 mm Hg (0%). However, in the control group IVH developed equally frequently in infants with MAP < or =30 mm Hg (33%) and in infants with MAP >30 mm Hg (30%). PDA was a significant risk factor for IVH. An end-diastolic block in the cerebral circulation, together with a MAP of < or =30 mm Hg or less and the presence of PDA during the first four days of life, might be associated with IVH in extremely-low-birth-weight infants.
Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/etiology , Cerebrovascular Circulation , Infant, Extremely Low Birth Weight , Infant, Premature, Diseases/diagnostic imaging , Anterior Cerebral Artery/diagnostic imaging , Anterior Cerebral Artery/physiopathology , Birth Weight , Blood Pressure , Cerebral Hemorrhage/physiopathology , Diastole , Ductus Arteriosus, Patent/complications , Ductus Arteriosus, Patent/diagnostic imaging , Ductus Arteriosus, Patent/physiopathology , Epidemiologic Methods , Humans , Hypotension/complications , Hypotension/diagnostic imaging , Hypotension/physiopathology , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/physiopathology , Ultrasonography, Doppler, Pulsed/methods , Ultrasonography, Doppler, Transcranial/methods
We analysed the utility of procalcitonin (PCT) assay, either alone or in combination with 2 simple blood assays, for the diagnosis of culture-proven neonatal septicaemia. Tests for serum PCT concentration, serum CRP concentration and blood immature to total neutrophil leucocyte ratio all had reasonable (58-77%) sensitivity, reasonable (62-84%) specificity, good (94-97%) negative predictive value and poor (16-24%) positive predictive value for the diagnosis of sepsis. Algorithms combining various tests produced slight improvements in sensitivity or specificity. Although the PCT test appeared to be useful for the diagnosis of neonatal sepsis in this small study, it did not offer any significant advantages over traditional tests for the diagnosis of infection.
Bacteremia/diagnosis , C-Reactive Protein/metabolism , Calcitonin/blood , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Leukocyte Count , Protein Precursors/blood , Bacteremia/microbiology , Biomarkers/blood , Blood/microbiology , C-Reactive Protein/analysis , Calcitonin/metabolism , Calcitonin Gene-Related Peptide , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Male , Predictive Value of Tests , Prospective Studies , Protein Precursors/metabolism , Sensitivity and Specificity , Severity of Illness Index
