Risk factors for cerebral palsy in premature infants identified during the pre and perinatal periods: a case-control study.

BACKGROUND: The aim of this paper was to assess the pre and perinatal risk factors for cerebral palsy in premature infants, comparing them with full-term infants. METHODS: This was a prospective cross-sectional cohort study on 48 infants between four and eight months of life, of whom 20 were born prematurely (<37 weeks of gestational age) and 28 at full term (37 to 42 weeks). A questionnaire was used, which investigated maternal reproductive, obstetric and neonatal factors, along with an evaluation scale for neurosensory-motor development of infants at risk of neuromotor alterations. For the statistical analysis, the Student's t, chi-square, Fisher's exact and Cramer's V tests were used. RESULTS: All the newborns that were small for their gestational age (35%) were in the premature group (P=0.001). Hyperbilirubinemia (P=0.000), anemia (P=0.009), respiratory distress syndrome (P=0.000) and periventricular hemorrhage (P=0.025) were more frequent in the premature newborn group. Phototherapy and blood transfusion were more frequent among the premature infants: 70.0% vs. 25.0% (P=0.002) and 20.0% vs. 0.0% (P=0.025), respectively. Among the premature infants, 50.0% presented neuromotor development alterations, against only 14.3% of the full-term infants. CONCLUSIONS: Prematurity is an important risk factor for the development of neurosensory-motor alterations that are suggestive of cerebral palsy.

Fetal thigh and upper arm volumes by 3D-sonography: comparison between multiplanar and XI VOCAL methods.

OBJECTIVE: To compare fetal upper arm and thigh volume measurements acquired by three-dimensional (3D) ultrasound using the multiplanar and the eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL) methods with different number of sectional planes. METHODS: This study enrolled 40 healthy pregnant women between 20 and 40 weeks of gestation. The volume of fetal limbs was calculated using the multiplanar (with 5.0 mm intervals) and the XI VOCAL (with 5, 10, 15, and 20 slice planes) methods. Comparison between the techniques was made by analysis of variance and Bonferroni statistical tests. RESULTS: Mean fetal upper arm volume measured by the 15 sectional planes XI VOCAL method was lower than the same method using 5 and 10 planes instead (p = 0.025 and 0.039, respectively). Fetal thigh volume showed no statistically significant differences among all studied methods. CONCLUSION: The XI VOCAL using 15 sectional planes method underestimated the fetal upper arm volume by 5 and 10 planes XI VOCAL techniques.

Fetal cerebral ventricle volumetry: comparison between 3D ultrasound and magnetic resonance imaging in fetuses with ventriculomegaly.

OBJECTIVES: The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with those obtained by magnetic resonance imaging (MRI). METHODS: This cross-sectional study evaluated 30 fetuses with atrial width (AW) between 10 and 30 mm, from 20 to 36 gestational weeks. Fifty-nine ventricles were measured by two observers. Sonographic volumetric measurements using VOCAL 30° were performed with an ACCUVIX XQ machine (Medison, Korea) and MRI assessments with a Sonata system using ARGUS software (Siemens, Germany). Agreement between both techniques was assessed by intraclass correlation coefficient (ICC) calculation, and proportionate Bland-Altman plots were constructed. RESULTS: A high degree of reliability was observed between VOCAL and MRI measurements (ICC 0.928, 95%CI [0.876;0.958]). Bland-Altman plots confirmed the high correlation (mean of differences: 1.62 cm(3) and standard deviation: ± 8.41 cm(3)). CONCLUSION: Three-dimensional volumetry of fetal LVs by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly and may be used as an additional tool in patient counseling and prognosis prediction.

Reproducibility of fetal heart volume by 3D-sonography using the XI VOCAL method.

BACKGROUND: To assess the reliability of fetal heart volume measurement by three-dimensional sonography (3DUS) using the eXtended Imaging Virtual Organ Computer-aided AnaLysis (XI VOCAL) method. METHODS: This reliability study enrolled 30 pregnant women with singleton healthy pregnancies between 19 and 34 weeks of gestation. All volume acquirements were performed with a convex volumetric transducer (C3-7ED) coupled to an Accuvix XQ sonography device (Medison, Korea). The XI VOCAL 10 planes was the method of choice for volumetric measurement. 3D datasets were analyzed by two observers (EQSB and HJFM); fetal heart volume was measured twice by the first and once by the second observer to calculate intra and interobserver reproducibility. Statistical analysis used pareated Student's t test (p) and calculated Intraclass correlation coefficients (ICC). Bland-Altman plots were also constructed. RESULTS: We observed an excellent intra- and interobserver reliability for fetal cardiac volume assessed by XI VOCAL. For the intraobserver the ICC was 0.998 (95% CI: 0.997; 0.999), with mean of differences of 0.12 cm3 (95% limits of agreement: -0.84; +0.84; p = 0.130). For interobserver the ICC was 0.899 (95%CI: 0.996; 0.998), mean of differences 0.05 cm3 (95% limits of agreement: -0.84; +0.84; p = 0.175). CONCLUSION: Fetal cardiac volume assessed by 3DUS using XI VOCAL method is highly reproducible between 19 to 34 gestational weeks.