Urinary ß-2-microglobulin as an alternative marker for fetal inflammatory response and development of bronchopulmonary dysplasia in premature infants.

OBJECTIVE: To evaluate the clinical utility of urinary ß-2-microglobulin (B2M) at birth, an alternative to proinflammatory cytokines, as an indicative marker of fetal inflammatory response and subsequent higher risk of bronchopulmonary dysplasia (BPD) in premature infants. STUDY DESIGN: The relationship between urinary B2M at birth and the occurrence of BPD was examined in 96 premature infants with a description of perinatal backgrounds. Constructing a receiver-operating characteristic curve to determine the cutoff value of urinary B2M at birth for the development of BPD, a multivariate logistic regression analysis was performed to evaluate whether elevated urinary B2M at birth can be used as a predictor of BPD. RESULTS: BPD was diagnosed in 34% (33/96) of the infants. Neonates with BPD had a significantly higher occurrence rate of chorioamnionitis and greater levels of median urinary B2M at birth than did those without BPD. The selected cutoff value of urinary B2M at birth correlated with the development of BPD, even after adjusting for gestational age and other confounding factors. CONCLUSIONS: Elevated urinary B2M levels at birth can be used as an alternative marker of fetal inflammatory response and subsequent higher risk of BPD in premature infants.

Transient neonatal diabetes mellitus in an extremely preterm infant.

The present report concerns transient neonatal diabetes mellitus in an extremely preterm infant (gestational age 27 weeks, birth weight 718 g). The patient had intrauterine growth retardation and developed hyperglycaemia on the first day of life. Insulin administration was discontinued on the 89th day of life, which was 1 day before the original due date. This case suggests that (a) insufficient insulin secretion started at least from the second trimester of the pregnancy, and (b) the duration needed for recovery of insulin secretion was not dependent on the maturity.

Transient neonatal diabetes mellitus in extremely preterm infant.

A report of transient neonatal diabetes mellitus in an extremely preterm infant (gestational age 27 weeks, birth weight 718 g). The patient had intrauterine growth retardation and developed hyperglycaemia on the first day of life. Insulin administration was discontinued on the 89th day of life, which was 1 day before the original due date. This case suggests that (a) insufficient insulin secretion started at least from the second trimester of the pregnancy; (b) the duration needed for recovery of insulin secretion was not dependent on the maturity.

Cerebral blood flow velocity in two patients with neonatal cerebral infarction.

Cerebral blood flow velocity was measured in the middle cerebral artery of two patients who exhibited unilateral neonatal cerebral infarction during the neonatal period. Doppler studies demonstrated increases in cerebral blood flow velocity but decreases in the resistance index on the affected side of the middle cerebral artery in the neonate who developed hemiplegia with cystic encephalomalacia, although the neonate with normal neurologic outcome exhibited symmetric cerebral blood flow velocity and resistance index. The asymmetry in cerebral blood flow velocity measurements of both middle cerebral arteries may be useful to evaluate the severity of brain damage and predict the neurodevelopmental prognosis of unilateral neonatal cerebral infarction.

An imbalance between prostacyclin and thromboxane in relation to cerebral blood flow in neonates with maternal preeclampsia.

OBJECTIVE: A disturbance of prostacyclin (PGI2) and thromboxane A2 (TXA2) balance has been reported in preeclampsia. However, little is known about the concentrations of these prostanoids in neonates born to preeclamptic pregnant women. The purpose of this study is to determine whether the PGI2 and TXA2 concentrations are altered and whether the prostanoid balance correlates to the cerebral blood flow in neonates born to preeclampsia. METHODS: Spontaneously voided urine samples were collected from 20 neonates of normotensive and 16 neonates of preeclamptic women during the first 24 h after birth. We measured by radioimmunoassay the concentrations of urinary 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) and 11-dehydro-thromboxane B2 (11-dehydro-TXB2), respectively. Blood flow velocity in the middle cerebral artery was studied by pulsed Doppler ultrasonography in the neonates between 17 and 38 h after birth. RESULTS: There was no significant difference between the urinary 6-keto-PGF1alpha in the neonates of mothers with and without preeclampsia (median, 5.3 vs. 3.6 ng/mg of creatinine). In contrast, the urinary 11-dehydro-TXB2 and the ratio of 11-dehydro-TXB2 to 6-keto-PGF1alpha in the neonates of mothers with preeclampsia were significantly lower as compared with the neonates without preeclampsia, respectively (13.7 vs. 20.6 ng/mg of creatinine and 3.0 vs. 5.2, median). The resistance index in the middle cerebral artery was significantly reduced in the neonates with preeclampsia than without preeclampsia (0.67 +/- 0.01 vs. 0.74 +/- 0.02, mean +/- SEM). CONCLUSIONS: There was an association between maternal preeclampsia and the imbalance in the neonatal urinary excretion of PGI2 and TXA2 metabolites. This imbalance may contribute to the regulation of cerebral blood flow.

Blood flow velocities in the cerebral arteries and descending aorta in small-for-dates infants.

Resistive indices (RI) in the anterior cerebral artery (ACA), basilar artery (BA), middle cerebral artery (MCA) and descending aorta (DA) were obtained in 15 small-for-dates (SFD) infants who were, growth retarded because of maternal pregnancy-induced hypertension and in 20 appropriate-for-dates (AFD) infants matched for gestational age between 24 h and 48 h after birth. The RIs in the MCA, ACA and BA were significantly lower, while the RI in the DA was significantly higher, in the SFD infants than in the AFD infants. These changes in RIs in the SFD infants might be similar to the "brain sparing" effect as reported in growth-retarded fetuses.

[Cerebral blood flow velocities in the anterior cerebral arteries and basilar artery. III. Investigation in hydrocephalus (Part 2)].

We made 10 measurements of Pourcelot's index of resistance (RI) in the anterior cerebral artery (RI-ACA) and basilar artery (RI-BA), and RI ratio (= RI-ACA/RI-BA) in seven cases of hydrocephalus before and after treatment. The mean values of RI-ACA (0.831 +/- 0.050, mean +/- SD), RI-BA (0.800 +/- 0.053) and RI ratio (1.039 +/- 0.030) before treatment were significantly higher than in normal infants. Two hours after treatment, the mean RI-ACA (0.654 +/- 0.099) was lower than in normal infants, and RI-BA (0.684 +/- 0.101) were normalized. Before treatment, the mean value of RI-ACA was higher than that of RI-BA. All RI ratios were higher than 1.00. After treatment, the mean RI-ACA was lower than the mean RI-BA. All RI ratios were normalized and lower than 1.00 (0.957 +/- 0.024).

[Cerebral blood flow velocities in the anterior cerebral arteries and basilar artery. II. Investigation in very low birth weight infants].

We studied the values of the Pourcelot's index of resistance in the anterior cerebral artery (RI-ACA) and basilar artery (RI-BA) in very low birth weight infants weighing less than 1,500 g at birth. At the time of measurements, their postconceptional ages were 32, 34, 36, 38, 40 and 42 weeks. The mean value of RI-ACA (0.744 +/- 0.026, +/- SD) was significantly lower than that of RI-BA (0.766 +/- 0.026) (p less than 0.001), and they were higher than those in normal term infants. However, the mean value of RI-ACA and RI-BA, averaged from the measurements of postconceptional ages at 38, 40 and 42 weeks, showed no significant difference from those of normal term infants. In contrast, the mean value of RI ratio (= RI-ACA/RI-BA) in very low birth weight infants showed no significant difference from that of normal term infants.

[Cerebral blood flow velocities in the anterior cerebral arteries and basilar artery. I. Investigation in term infants].

We studied the value of Pourcelot's index of resistance in the anterior cerebral arteries (RI-ACA) and basilar artery (RI-BA) in 69 measurements of term infants on days 1, 5, 10, 15, 20, 30 and 60. The mean value of RI-ACA (0.723 +/- 0.038, +/- SD) was significantly lower than that of RI-BA (0.750 +/- 0.041) (p less than 0.001). RI-ACA values were higher than RI-BAs in only five measurements (7.2%). The values of RI-ACA and RI-BA decreased from the first day to the fifth day of life. They increased continuously and showed their highest values on the day 15. After the 15th day, they decreased mildly again. The values of RI ratio (= RI-ACA/RI-BA) were stable (0.96-0.97).

Cerebral blood flow velocities in the anterior cerebral arteries and basilar artery in hydrocephalus before and after treatment.

We studied Pourcelot's index (PI), which shows cerebral vascular resistance, in the anterior cerebral arteries and basilar artery, and the PI ratio (Pourcelot's index in the anterior cerebral artery/Pourcelot's index in the basilar artery) in 11 measurements of hydrocephalus. The mean values of PI in the anterior cerebral artery, basilar artery, and the PI ratio before treatment were significantly higher than those after treatment and those in normal infants. Before treatment, the mean PI in the anterior cerebral arteries was significantly higher than the mean PI in the basilar artery. All PI ratios increased to 1.00 or more. After treatment and in normal infants, the mean PI in the anterior cerebral arteries was significantly lower than the mean PI in the basilar artery. All PI ratios decreased to less than 1.00. We believe that the PI ratio is useful to evaluate the need or effect of treatment in hydrocephalus.

A case of Dandy-Walker malformation associated with occipital meningocele, microphthalmia, and cleft palate.

We present a case of Dandy-Walker malformation associated with occipital meningocele, microphthalmia, and cleft palate. Small numbers of cases of Dandy-Walker malformation with occipital meningocele have been described in the literature, but to our knowledge, non of these also had microphthalmia or cleft palate. This association suggests that time of intrauterine origin of Dandy-Walker syndrome was in the sixth or seventh embryonic week. In the diagnosis, both CT cisternography and direct neurosonography over the occipital meningocele was useful for the demonstration of a posterior fossa cyst which communicated with the fourth ventricle and the occipital meningocele.