Ischaemic brain lesions diagnosed at birth in preterm infants: clinical events and developmental outcome
Article Abstract:
Brain damage due to insufficient blood supply (ischemia) or hemorrhage in the region of the ventricles (structures deep within the brain through which cerebrospinal fluid circulates) can occur in a fetus before or during birth. The causes may be maternal hemorrhage, insufficient oxygen for the baby, increased levels of carbon dioxide, or acidosis (in which the body fluids become too acidic). Advances in ultrasound imaging techniques enable detection of brain ischemia in newborn babies at an earlier stage than previous methods. A report is provided of clinical and anatomical studies of an unselected series of 232 babies born before 32 weeks' gestation at one hospital over a period of several years. The infants underwent scanning soon after birth, each day for the first week, and at least two times each week as long as they were hospitalized on the unit. Results showed that 39 infants (17 percent) had ischemic brain lesions or periventricular leucomalacia (softening and deterioration of the brain's white matter, the fibers that conduct nerve impulses). Nine developed these abnormalities within two hours of birth (early onset ischemia group); six survived. The remaining 30 developed lesions between 4 and 70 days after birth (late-onset); 15 survived. Early-onset babies had a higher rate of intrauterine growth retardation, and their birth weights were ''small for dates'' (i.e. they weighed less than normal for their gestational age). Six had recurrent apnea (arrested breathing) and required mechanical ventilation. Late-onset babies tended to suffer from hyaline membrane disease (a condition associated with immaturity of the lungs, leading to respiratory distress syndrome). Four of the six survivors with early-onset ischemic brain lesions developed disabilities later in life, such as partial paralysis, hearing or visual loss, or developmental delay. One late-onset survivor died of sudden infant death syndrome; seven of the remaining 14 had disabilities. Late- and early-onset ischemic brain damage seem to be caused by different conditions. In many cases, it had occurred prior to birth. Obstetrical management should strive to prevent the development of periventricular leucomalacia. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Fetal phenytoin exposure, hypoplastic nails, and jitteriness
Article Abstract:
Congenital, or birth-related, defects have been detected in children of epileptic mothers, and include heart abnormalities; cleft lip or palate; hernia; hypoplastic, or underdeveloped, nails, fingers, or toes; and low hairline. 'Fetal hydantoin syndrome' may develop in infants born to mothers who are treated in pregnancy with the anticonvulsive drug phenytoin (Dilantin). The disorder is characterized by additional abnormalities that include microcephaly, or an abnormally small-sized head; growth deficiency; and mental retardation. These congenital defects may result from drug exposure or may also be genetically linked to epilepsy. The incidence of congenital defects and newborn conditions were assessed in 61 infants with an epileptic mother. A control group of 62 pregnant women was also selected and matched for age, social class, and previous completed pregnancies. Congenital abnormalities were detected in 26 infants, and other disorders were diagnosed in 26 infants. Death occurred in two newborns of epileptic mothers, but in none of the infants of healthy mothers. Hypoplasia, or underdevelopment, of nails was the most common congenital defect, and was detected in 11 of 40 mothers treated with anticonvulsive drugs. In addition, phenytoin levels were higher in mothers of infants with hypoplastic nails. Jitteriness was detected in 11 of 61 infants of epileptic mothers and was the most common newborn condition. Most infants developed normally, with the exception of one child with serious learning problems. These findings suggest that hypoplasia of nails is related to high maternal blood levels of phenytoin. Jitteriness may result from drug withdrawal, or may be the result of other causes in some cases. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1991
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Withdrawal of life support in babies: deceptive signals
Article Abstract:
When a baby is dying, with no hope of recovery even if continuous breathing support is maintained, most people would agree that it is time to allow it to die. Such a decision, of course, must involve the parents; in addition, a senior physician should be identified in all cases as the person in charge with whom parents can talk. In addition to ethical issues regarding the withdrawal of life support, other factors should be considered. Staff despair is notoriously labile, and acute deteriorations in babies' conditions can cause people to react by suggesting withdrawal of life support. Such decisions should not be made on the basis of events that can be reversed, such as temporarily deterioration due to a misplaced breathing tube. Infants who appear to suffer, perhaps because their skin is greenish-yellow or because they have marks on their bodies from electrodes or intravenous needles, can trigger staff emotions. When parents do not visit, staff can lose their sense of shared responsibility, and, as well, their impetus for continuing life support. Decisions concerning the withdrawal of life support should be based on the extent to which the baby is seen to be suffering, its chances of survival, and the kind of life it will most likely have if it survives. Comparisons should not be made with other infants with similar symptoms who could not be saved. An abnormality that appears on an ultrasound brain scan should be evaluated with as much consistency as possible, not interpreted to support predictions of doom for a sick baby or predictions of a good outcome for a baby in better health. In making arguments for withdrawing life support, one should critically ask oneself questions like those discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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