Radiofrequency catheter ablation in a haemodynamically compromised premature neonate with hydrops fetalis.

A preterm infant was born at 35 weeks gestation after failed antenatal antiarrhythmic therapy. The infant had an incessant supraventricular tachycardia, impaired ventricular function and hypotension and failed to respond to adenosine, cardioversion and intravenous amiodarone. After resuscitation from cardiovascular collapse, a successful radiofrequency catheter ablation (RFA) of a left free wall atrioventricular pathway was performed at 24 h of age without extracorporeal support. The infant is normal on follow up at 12 months of age. Whilst most fetal and neonatal supraventricular tachyarrhythmias respond to antiarrhythmic medications and RFA is not required, this is the earliest RFA to be performed on a premature infant when antiarrhythmics have failed.

New fontanometer for continuous estimation of intracranial pressure in the newborn.

Intracranial pressure was estimated by a new pneumatic applanation fontanometer in babies in intensive care. A close correlation with cerebrospinal fluid pressure was found on 35 separate occasions. In 12 control babies the mean (SD) fontanelle pressure was 5.2 (2.2) cm H2O, in eight with a hypoxic-ischaemic encephalopathy it was 12.6 (4.3) cm H2O, and in nine with post-haemorrhagic hydrocephalus it was 10.8 (4.3) cm H2O. In four babies monitored continuously over seven days the correlation remained good. The fontanometer enables pressure to be monitored accurately, continuously, and non-invasively in neonates at risk of raised intracranial pressure.

Perinatal events which precede periventricular haemorrhage and leukomalacia in the newborn.

Ultrasound brain scans were obtained daily for the first 5 days after birth, on day 7 and then weekly until discharge from hospital in 86 babies during a 12-month period. The babies weighed less than 1501 g or were less than 34 weeks gestational age. Fifty-one (59%) had normal scans, 34 (40%) developed periventricular haemorrhage, and seven (8%) developed periventricular cysts (associated with periventricular haemorrhage in six). Factors associated with periventricular haemorrhage were perinatal hypoxia, acidosis, hypercapnia and hypoxia after birth. Babies who developed periventricular cysts (periventricular leukomalacia) were more likely to have been hypoxic at birth and in four of the seven there had been a maternal antepartum haemorrhage. The association of perinatal hypoxia with periventricular haemorrhage and leukomalacia suggests that intrapartum events may predispose to the onset of these lesions which then develop postnatally. Prevention of perinatal hypoxia may play an important role in diminishing the disability caused by these conditions.

Development of cerebral palsy after ultrasonographic detection of periventricular cysts in the newborn.

Cysts in the periventricular region of the brain were demonstrated by ultrasound in eight of 102 preterm infants (birthweight less than 1501g or less than 34 weeks gestation) during a 14-month period. All eight babies survived, but developed serious neurological problems: five had spastic quadriplegia and three had spastic diplegia. Six had impaired vision and six had delayed speech development, but there was no evidence of impaired hearing. The cysts probably represent the infarcted lesions of periventricular leukomalacia.

Increased insensible water loss in newborn infants nursed under radiant heaters.

Urine osmolality was studied in 38 babies nursed in conventional incubators or cots and 18 nursed under an overhead radiant heat shield. Among 50 babies receiving a similar fluid intake in the first 48 hours of life mean urinary osmolality was significantly higher in the radiant heater group. In babies weighing less than 1500 g a trend towards higher urinary osmolalities was recorded in those nursed under radiant heaters even though they had received amost double the fluid intake of the incubator group. Severe hypernatraemia occurred in four of the five babies weighing less than 1000 g who were nursed under radiant heaters but in none of the seven babies of similar birth weight nursed in incubators. These findings are consistent with previous observations of an increase in insensible water loss in babies nursed under radiant heaters and emphasise the importance of providing enough extra water for these infants and the need for close monitoring of their fluid balance. The latter may be done at the bedside by measuring urinary specific gravity with a hand refractometer.