Objective: To investigate risk factors for cerebral palsy in relation to gest ational age. Design: Three case- control studies within a geographically define d cohort. Setting: The former Oxfordshire Health Authority....Objective: To investigate risk factors for cerebral palsy in relation to gest ational age. Design: Three case- control studies within a geographically define d cohort. Setting: The former Oxfordshire Health Authority. Participants: A tota l of 235 singleton children with cerebral palsy not of postnatal origin, born be tween 1984 and 1993, identified from the Oxford Register of Early Childhood Impa irment; 646 controls matched for gestation in three bands: ≤ 32 weeks; 33- 36 weeks; ≥ 37 weeks. Results: Markers of intrapartum hypoxia and infection were a ssociated with an increased risk of cerebral palsy in term and preterm infants. The odds ratio (OR) for hypoxia was 12.2 (95% confidence interval 1.2 to 119) at ≤ 32 weeks and 146 (7.4 to 3651) at ≥ 37 weeks. Corresponding ORs for neona tal sepsis were 3.1 (1.8 to 5.4) and 10.6 (2.1 to 51.9). In contrast, pre- ecla mpsia carried an increased risk of cerebral palsy at ≥ 37 weeks (OR 5.1 (2.2 to 12.0)) but a decreased risk at ≤ 32 weeks (OR 0.4 (0.2 to 1.0)). However, all infants ≤ 32 weeks with maternal pre- eclampsia were delivered electively, and their risk of cerebral palsy was no lower than that of other electively deliver ed ≤ 32 week infants (OR 0.9 (0.3 to 2.7)). Nearly 60% of ≤ 32 week controls were delivered after spontaneous preterm labour, itself an abnormal event. Conc lusion: Inflammatory processes, including pre- eclampsia, are important in the aetiology of cerebral palsy. The apparent red uced risk of cerebral palsy associated with pre- eclampsia in very preterm infa nts is driven by the characteristics of the gestation matched control group. Use of the term “ protective” in this context should be abandoned.展开更多
Aim: To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV)-in extremely low-birthweight (ELBW) infants. Methods: Prospective, longitudinal surveillance study. ELBW in...Aim: To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV)-in extremely low-birthweight (ELBW) infants. Methods: Prospective, longitudinal surveillance study. ELBW infants were recruited in the first week of life. Maternal blood was tested for CMV-specific IgG antibodies. Weekly urine samples were obtained from infants for CMV culture and rapid antigen testing. Data were collected regarding clinical course and breast milk intake. Results: Of 181 eligible infants, 119 infants, born to 101 mothers, were enrolled. Eighty of the 101 mothers had their serum checked for CMV status. Seventy percent of those tested were seropositive for CMV. Of the 65 infants born to seropositive mothers, 94%received breast milk during their hospital stay. Complete urine collection was obtained in 92 infants. CMV was cultured from the urine of only four infants, all of whom were born to seropositive mothers. Only one of these four infants was symptomatic. The range at which CMV was first detected was between 48 and 72 postnatal days of age. Conclusions: Despite a very high CMV seropositivity rate in mothers of ELBW infants, and the previously reported high rate of CMV excretion into breast milk, the incidence of postnatal CMV transmission was extremely low in our study.展开更多
Perinatal infection increases the risk of neonatal neurologic injury. Our objective is to determine whether histologically confirmed chorioamnionitis and funisitis is associated with fetal metabolic acidosis. This is ...Perinatal infection increases the risk of neonatal neurologic injury. Our objective is to determine whether histologically confirmed chorioamnionitis and funisitis is associated with fetal metabolic acidosis. This is a retrospective cohort study of all infants 34 weeks or less born at a single tertiary hospital admitted to the neonatal intensive care unit (NICU) between April 1999 and September 2002. Maternal and neonatal records and placental pathology reports were reviewed. There were 392 infants at 23 to 34 weeks’ gestational age admitted to the NICU during this period of whom 354 had placental pathology reported; 259 infants had umbilical cord gases available. These neonates were placed into 3 groups: group 1 (208 infants) had no signs of placental infection, group 2 (59 infants) had isolated chorioamnionitis, and group 3 (87 infants) had both chorioamnionitis and funisitis. The gestational age (30.2 ± 2.8, 28.3 ± 3.4, 27.8 ± 2.8 weeks, P <. 01) and birth weight (1358 ± 520, 1242 ± 547, 1103 ± 381 g, P <. 01) were significantly higher in group 1. There was an increase in neurologic morbidity in groups 2 and 3 (25.2% , 34.4% , 43.7% ), which was not significant when corrected for gestational age. Groups 2 and 3 had a small but significant increase in umbilical arterial pH (7.25 ± 0.10, 7.29 ± 0.10, 7.30 ± 0.08, P <. 01) and base excess (- 3.5 ± 3.6, - 2.2 ± 3.6, - 2.3 ± 2.7 mmol/L, P =. 02). When a single pathologist reviewed all placentas with any inflammation and staged them on the basis of the degree of the fetal inflammatory response, no relationship was found between the degree of fetal inflammation and umbilical arterial pH (stage 1, 7.27 ± 0.09; stage 2, 7.30 ± 0.09; stage 3, 7.30 ± 0.08; P =. 41) or base excess (stage 1, - 2.82 ± 3.47 mmol/L; stage 2, - 1.95 ± 3.17 mmol/L; stage 3, - 2.23 ± 3.07 mmol/L; P =. 62). When stepwise multiple linear regression was performed, neither histologic chorioamnionitis nor histologic funisitis were associated with a change in umbilical cord pH or base excess. Intrauterine infection, as confirmed by histologic chorioamnionitis and funisitis, is not associated with fetal metabolic acidosis. Intrauterine infection may represent a nonhypoxic form of encephalopathy that produces neurologic morbidity by a mechanism independent of hypoxia- ischemia leading to metabolic acidosis.展开更多
We describe 3 cases of neonatal respiratory distress syndrome (RDS) in near-term infants, born from mothers with severe intrahepatic cholestasis of pregnancy.Common pictures of the cases were: good indices of lung mat...We describe 3 cases of neonatal respiratory distress syndrome (RDS) in near-term infants, born from mothers with severe intrahepatic cholestasis of pregnancy.Common pictures of the cases were: good indices of lung maturity in the amniotic fluid; severe RDS requiring mechanical ventilation; high serum bile acid (BA) levels in the early days of life; no meconium aspiration; negative cultures; and absence of indirect labora-tory signs of infection.After the first case, we hypothesized that abnormally high BA levels could have reversed the action of phospholipase A2 in the lungs, causing a degradation of phosphatidylcholines to lysophosphatidylcholines and the consequent lack of surfactant activity, leading to the severe respiratory distress.Consequently, in cases 2 and 3, we gave intratracheal surfactant to the infants, which, although administered around the first 24 hours of life, showed to be helpful.Our experience suggests that a high level of attention in the management of newborn infants (even near-term infants) born from women with intrahepatic cholestasis of pregnancy is necessary to detect as soon as possible signs and symptoms of this "unexpected" RDS, which can assume a very severe clinical picture.In such instances, we recommend that the diagnosis of BA pneumonia be kept in mind and that exogenous surfactant be given as soon as possible, even in the presence of indices of normal lung maturity in the amniotic fluid.Finding high levels of BA and lysophosphatidylcholines in the bronchoalveolar lavage of affected infants would aid in support of the diagnosis.展开更多
文摘Objective: To investigate risk factors for cerebral palsy in relation to gest ational age. Design: Three case- control studies within a geographically define d cohort. Setting: The former Oxfordshire Health Authority. Participants: A tota l of 235 singleton children with cerebral palsy not of postnatal origin, born be tween 1984 and 1993, identified from the Oxford Register of Early Childhood Impa irment; 646 controls matched for gestation in three bands: ≤ 32 weeks; 33- 36 weeks; ≥ 37 weeks. Results: Markers of intrapartum hypoxia and infection were a ssociated with an increased risk of cerebral palsy in term and preterm infants. The odds ratio (OR) for hypoxia was 12.2 (95% confidence interval 1.2 to 119) at ≤ 32 weeks and 146 (7.4 to 3651) at ≥ 37 weeks. Corresponding ORs for neona tal sepsis were 3.1 (1.8 to 5.4) and 10.6 (2.1 to 51.9). In contrast, pre- ecla mpsia carried an increased risk of cerebral palsy at ≥ 37 weeks (OR 5.1 (2.2 to 12.0)) but a decreased risk at ≤ 32 weeks (OR 0.4 (0.2 to 1.0)). However, all infants ≤ 32 weeks with maternal pre- eclampsia were delivered electively, and their risk of cerebral palsy was no lower than that of other electively deliver ed ≤ 32 week infants (OR 0.9 (0.3 to 2.7)). Nearly 60% of ≤ 32 week controls were delivered after spontaneous preterm labour, itself an abnormal event. Conc lusion: Inflammatory processes, including pre- eclampsia, are important in the aetiology of cerebral palsy. The apparent red uced risk of cerebral palsy associated with pre- eclampsia in very preterm infa nts is driven by the characteristics of the gestation matched control group. Use of the term “ protective” in this context should be abandoned.
文摘Aim: To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV)-in extremely low-birthweight (ELBW) infants. Methods: Prospective, longitudinal surveillance study. ELBW infants were recruited in the first week of life. Maternal blood was tested for CMV-specific IgG antibodies. Weekly urine samples were obtained from infants for CMV culture and rapid antigen testing. Data were collected regarding clinical course and breast milk intake. Results: Of 181 eligible infants, 119 infants, born to 101 mothers, were enrolled. Eighty of the 101 mothers had their serum checked for CMV status. Seventy percent of those tested were seropositive for CMV. Of the 65 infants born to seropositive mothers, 94%received breast milk during their hospital stay. Complete urine collection was obtained in 92 infants. CMV was cultured from the urine of only four infants, all of whom were born to seropositive mothers. Only one of these four infants was symptomatic. The range at which CMV was first detected was between 48 and 72 postnatal days of age. Conclusions: Despite a very high CMV seropositivity rate in mothers of ELBW infants, and the previously reported high rate of CMV excretion into breast milk, the incidence of postnatal CMV transmission was extremely low in our study.
文摘Perinatal infection increases the risk of neonatal neurologic injury. Our objective is to determine whether histologically confirmed chorioamnionitis and funisitis is associated with fetal metabolic acidosis. This is a retrospective cohort study of all infants 34 weeks or less born at a single tertiary hospital admitted to the neonatal intensive care unit (NICU) between April 1999 and September 2002. Maternal and neonatal records and placental pathology reports were reviewed. There were 392 infants at 23 to 34 weeks’ gestational age admitted to the NICU during this period of whom 354 had placental pathology reported; 259 infants had umbilical cord gases available. These neonates were placed into 3 groups: group 1 (208 infants) had no signs of placental infection, group 2 (59 infants) had isolated chorioamnionitis, and group 3 (87 infants) had both chorioamnionitis and funisitis. The gestational age (30.2 ± 2.8, 28.3 ± 3.4, 27.8 ± 2.8 weeks, P <. 01) and birth weight (1358 ± 520, 1242 ± 547, 1103 ± 381 g, P <. 01) were significantly higher in group 1. There was an increase in neurologic morbidity in groups 2 and 3 (25.2% , 34.4% , 43.7% ), which was not significant when corrected for gestational age. Groups 2 and 3 had a small but significant increase in umbilical arterial pH (7.25 ± 0.10, 7.29 ± 0.10, 7.30 ± 0.08, P <. 01) and base excess (- 3.5 ± 3.6, - 2.2 ± 3.6, - 2.3 ± 2.7 mmol/L, P =. 02). When a single pathologist reviewed all placentas with any inflammation and staged them on the basis of the degree of the fetal inflammatory response, no relationship was found between the degree of fetal inflammation and umbilical arterial pH (stage 1, 7.27 ± 0.09; stage 2, 7.30 ± 0.09; stage 3, 7.30 ± 0.08; P =. 41) or base excess (stage 1, - 2.82 ± 3.47 mmol/L; stage 2, - 1.95 ± 3.17 mmol/L; stage 3, - 2.23 ± 3.07 mmol/L; P =. 62). When stepwise multiple linear regression was performed, neither histologic chorioamnionitis nor histologic funisitis were associated with a change in umbilical cord pH or base excess. Intrauterine infection, as confirmed by histologic chorioamnionitis and funisitis, is not associated with fetal metabolic acidosis. Intrauterine infection may represent a nonhypoxic form of encephalopathy that produces neurologic morbidity by a mechanism independent of hypoxia- ischemia leading to metabolic acidosis.
文摘We describe 3 cases of neonatal respiratory distress syndrome (RDS) in near-term infants, born from mothers with severe intrahepatic cholestasis of pregnancy.Common pictures of the cases were: good indices of lung maturity in the amniotic fluid; severe RDS requiring mechanical ventilation; high serum bile acid (BA) levels in the early days of life; no meconium aspiration; negative cultures; and absence of indirect labora-tory signs of infection.After the first case, we hypothesized that abnormally high BA levels could have reversed the action of phospholipase A2 in the lungs, causing a degradation of phosphatidylcholines to lysophosphatidylcholines and the consequent lack of surfactant activity, leading to the severe respiratory distress.Consequently, in cases 2 and 3, we gave intratracheal surfactant to the infants, which, although administered around the first 24 hours of life, showed to be helpful.Our experience suggests that a high level of attention in the management of newborn infants (even near-term infants) born from women with intrahepatic cholestasis of pregnancy is necessary to detect as soon as possible signs and symptoms of this "unexpected" RDS, which can assume a very severe clinical picture.In such instances, we recommend that the diagnosis of BA pneumonia be kept in mind and that exogenous surfactant be given as soon as possible, even in the presence of indices of normal lung maturity in the amniotic fluid.Finding high levels of BA and lysophosphatidylcholines in the bronchoalveolar lavage of affected infants would aid in support of the diagnosis.
