Correlation of basal ganglia magnetic resonance spectroscopy with Apgar score in perinatal asphyxia.

BACKGROUND: Brain metabolite levels are measured by proton magnetic resonance spectroscopy (1H MRS) and include N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and lactate and the ratios NAA to Cho and Cr (NAA-ChoCr), NAA-Cr, NAA-Cho, and Cho-Cr. Brain metabolite levels may correlate with the degree of neonatal asphyxia. OBJECTIVE: To determine which brain metabolite ratios have the strongest correlation with the Apgar scores in infants with possible asphyxia; whether the correlation is stronger with basal ganglia (BG) or anterior border-zone metabolites; and whether a combined approach using routine MR imaging (MRI), diffusion-weighted MRI, and MRS can be used to evaluate the severity of neonatal asphyxia. METHODS: Twenty infants with 1-minute Apgar scores of 6 or less were studied at 2 to 28 days of age. The MRS variables were compared with routine and diffusion-weighted brain MRI. Clinical variables and MRS findings were subjected to factor analysis and stepwise multiple regressions to determine interrelationships. RESULTS: The BG region NAA-Cho and NAA-ChoCr ratios correlated with the 1-minute (P<.001) and 5-minute (P = .01 for NAA-Cho; P = .006 for NAA-ChoCr). There was no correlation between metabolite levels and the 10-minute Apgar scores. The stongest predictions exist between the 1-minute Apgar scores and the NAA-Cho and NAA-ChoCr ratios. In the anterior border zone, the only correlation was between the 1-minute Apgar score and the NAA-Cho ratio, but there was a strong age effect in these data. Lactate was found in the BG of 3 infants, all of whom had 5-minute Apgar scores of 6 or less. Three patients had focal lesions on MRI; 2 of these had elevated lactate levels in the abnormal region; and the third, who had an intrauterine stroke, had no lactate in the region. CONCLUSIONS: Correlations between NAA-Cho and NAA-ChoCr ratios and the 1- and 5-minute Apgar scores are stronger in the BG region than in the frontal border zone. The presence or absence of lactate may indicate the severity of the brain insult, and the combination of MRS, MRI, and diffusion-weighted MRI may assist in localizing and predicting a long-term brain injury.

Preterm very-low-birth-weight neonates: relationship of EEG to intracranial hemorrhage, perinatal complications, and developmental outcome.

EEGs were performed on 102 preterm low-birth-weight neonates within the first 7 days of life. Babies were later separated into those without intracranial hemorrhage, those who had only subependymal hemorrhage (SEH), and those with intraventricular/intracerebral hemorrhage. The incidence and types of EEG abnormalities, 42% overall and including positive rolandic sharp waves, did not differ in the three groups. The incidence and distribution of EEG abnormalities between groups were not influenced by perinatal events. Developmental follow-up of 73 patients was similarly not correlated with neonatal EEG results, although the most severe EEG abnormalities were associated with subsequent mortality or morbidity.

Mortality and follow-up data for neonates weighing 500 to 800 g at birth.

Survival and development of immature premature neonates (birth weight, less than or equal to 800 g) at a single regional center were compared for 2 1/2 years, when such neonates' conditions were considered hopeless, and for the next 4 1/2 years, when aggressive therapy was used. During the first 2 1/2 years, two (4%) of 56 survived, one of whom was profoundly impaired. During the next 4 1/2 years, 65 (44%) of 147 survived. Of 65 survivors, 54 were followed up for at least one year: 43% were normal, 22% had mild developmental delays, and 19 (35%) were impaired. Of the 19 impaired, one was profoundly impaired and four were severely affected. The number of normal survivors and the high level of functioning of most of the impaired survivors suggests intensive care is as appropriate for neonates weighing 800 g or less as for more mature, severely ill newborns

High gentamicin trough concentrations in neonates of less than 28 weeks gestational age.

77 newborns, ranging from 25.5 to 43 weeks gestational age (GA) and receiving gentamicin, were studied prospectively over 4 months. Peak and trough serum concentrations were obtained on days 1, 3, and 5 of therapy. Gentamicin, 2.5 mg/kg/dose, was given at intervals according to GA. 63% of newborns of less than 28 weeks on doses of gentamicin of 2.5 mg/kg every 24 h (q24h), 75% of less than 28 weeks on gentamicin q18h, 90% of newborns of 23-34 weeks (on q18h), and 82% of those of greater than 34 weeks GA (on q12h) had serum gentamicin trough concentrations less than or equal to 2.0 micrograms/ml on day 1. By day 3, 5/5 newborns of less than 28 weeks (q18h) had trough concentrations greater than 2.0 micrograms/ml, whereas only 20% of those on the q24h regimen had high trough concentrations (p less than 0.05). Possible risk factors associated with altered gentamicin disposition in neonates are discussed.

Life support and maternal death during pregnancy.

KIE: The authors are physicians affiliated with the State University of New York at Buffalo and the Children's Hospital of Buffalo. They describe the clinical management of two brain-dead pregnant women and suggest guidelines to help physicians decide whether to treat such women. Based on the dramatically increasing chances for fetal survival from the 24th to the 27th weeks of gestation, they recommend vigorous life support during this period to permit fetal viability and prognosis to be assessed. Fetuses of 28 weeks should be delivered by cesarean section as soon as practicable after confirmation of maternal brain death.^ieng

[Activity of the creatine kinase isoenzyme CK-BB in the serum of neonates as an indicator of perinatal damage to the central nervous system]. / Die Aktivität des Creatinkinase (EC 2.7.3.2)-Isoenzyms CK-BB im Serum Neugeborener als Indikator einer frühkindlichen Schädigung des zentralen Nervensystems.

By means of the immunoprecipitation method significantly higher activities of creatine kinase BB isoenzyme were measured in the sera of neonates with CNS symptoms than in the sera of healthy or sick neonates without CNS symptoms. The activity of CK-BB inversely correlated with the one-minute Apgar score. These results suggest a leakage of CK-BB from the damaged CNS tissue into the blood circulation. Determination of CK-BB might be helpful in the assessment of perinatal brain damage.

A multicenter randomized, masked comparison trial of natural versus synthetic surfactant for the treatment of respiratory distress syndrome.

OBJECTIVE: To compare the efficacy and safety of two surfactant preparations in the treatment of respiratory distress syndrome (RDS). METHODS: We conducted a randomized, masked comparison trial at 21 centers. Infants with RDS who were undergoing mechanical ventilation were eligible for treatment with two doses of either a synthetic (Exosurf) or natural (Infasurf) surfactant if the ratio of arterial to alveolar partial pressure of oxygen was less than or equal to 0.22. Crossover treatment was allowed within 96 hours of age if severe respiratory failure (defined as two consecutive arterial/alveolar oxygen tension ratios < or = 0.10) persisted after two doses of the randomly assigned surfactant. Four primary outcome measures of efficacy (the incidence of pulmonary air leak (< or = 7 days); the severity of RDS; the incidence of death from RDS; and the incidence of survival without bronchopulmonary dysplasia (BPD) at 28 days after birth) were compared by means of linear regression techniques. RESULTS: The primary analysis of efficacy was performed in 1033 eligible infants and an analysis of safety outcomes in the 1126 infants who received study surfactant. Preentry demographic characteristics and respiratory status were similar for the two treatment groups, except for a small but significant difference in mean gestational age (0.5 week) that favored the infasurf treatment group. Pulmonary air leak (< or = 7 days) occurred in 21% of Exosurf- and 11% of infasurf-treated infants (adjusted relative risk, 0.53; 95% confidence interval, 0.40 to 0.71; p < or = 0.0001). During the 72 hours after the initial surfactant treatment, the average fraction of inspired oxygen (+/-SEM) was 0.47 +/- 0.01 for Exosurf- and 0.39 +/- 0.01 for infasurf-treated infants (difference, 0.08; 95% confidence interval, 0.06 to 0.10; p < 0.0001); the average mean airway pressure (+/-SEM) was 8.6 +/- 0.1 cm H2O; for Exosurf- and 7.2 +/- 0.1 cm H2O for Infasurf-treated infants (difference, 1.4 cm H2O; 95% confidence interval, 1.0 to 1.8 cm H2O; p < 0.0001). The incidences of RDS-related death, total respiratory death, death to discharge, and survival without bronchopulmonary dysplasia at 28 days after birth did not differ. The number of days of more than 30% inspired oxygen and of assisted ventilation, but not the duration of hospitalization, were significantly lower in Infasurf-treated infants. CONCLUSION: Compared with Exosurf, Infasurf provided more effective therapy for RDS as assessed by significant reductions in the severity of respiratory disease and in the incidence of air leak complications.