RESUMEN
Fetal lung interstitial tumor (FLIT) is a rare fetal malignancy that is typically diagnosed in the postnatal period, or, if recognized prenatally can mimic a benign lesion such as congenital pulmonary airway malformation. We present the earliest case of a FLIT tumor described by ultrasound and MRI at 26 weeks of gestation. Our case highlights features suggestive of FLIT including presentation later in gestation in combination with findings on fetal MRI such as a solid appearance with radiating curved bands of high signal within and along the periphery of the lesion (not as intensely high signal as the typical CPAM), possibly detailing a radiographic signature for these tumors. The role of betamethasone for these tumors is not known.
Asunto(s)
Betametasona/uso terapéutico , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Glucocorticoides/uso terapéutico , Neoplasias Pulmonares/diagnóstico por imagen , Embarazo Gemelar , Síndrome de Dificultad Respiratoria del Recién Nacido/cirugía , Adulto , Cesárea Repetida , Malformación Adenomatoide Quística Congénita del Pulmón/patología , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Diagnóstico Diferencial , Femenino , Edad Gestacional , Humanos , Recién Nacido , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Imagen por Resonancia Magnética , Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Toracotomía , Resultado del Tratamiento , Ultrasonografía PrenatalRESUMEN
OBJECTIVE: The relationship between placental and fetal brain growth is poorly understood and difficult to assess. The objective of this study was to interrogate placental and fetal brain growth in healthy pregnancies and those complicated by fetal growth restriction (FGR). STUDY DESIGN: In a prospective, observational study, pregnant women with normal pregnancies or pregnancies complicated by FGR underwent fetal magnetic resonance imaging (MRI). Placental, global and regional brain volumes were calculated. RESULTS: A total of 114 women (79 controls and 35 FGR) underwent MRI (median gestational age (GA) 30 weeks, range 18 to 39). All measured volumes increased exponentially with advancing GA. Placental, total brain, cerebral and cerebellar volumes were smaller in FGR compared with controls (P<0.05). Increasing placental volume was associated with increasing cerebral and cerebellar volumes (P<0.05). CONCLUSION: Quantitative fetal MRI can accurately detect decreased placental and brain volumes in pregnancies with FGR and may provide insight into the timing and mechanisms of brain injury in FGR.
Asunto(s)
Encéfalo/diagnóstico por imagen , Desarrollo Fetal , Retardo del Crecimiento Fetal/diagnóstico por imagen , Imagenología Tridimensional , Imagen por Resonancia Magnética/métodos , Placenta/diagnóstico por imagen , Adolescente , Adulto , Encéfalo/patología , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Estudios Longitudinales , Masculino , Tamaño de los Órganos , Placenta/patología , Valor Predictivo de las Pruebas , Embarazo , Estudios Prospectivos , Ultrasonografía Prenatal , Adulto JovenRESUMEN
BACKGROUND: Due to the high-frequency of routine interventions in an intensive care setting, electrocardiogram (ECG) recordings from sick infants are highly non-stationary, with recurrent changes in the baseline, alterations in the morphology of the waveform, and attenuations of the signal strength. Current methods lack reliability in identifying QRS complexes (a marker of individual cardiac cycles) in the non-stationary ECG. In the current study we address this problem by proposing a novel approach to QRS complex identification. METHOD: Our approach employs lowpass filtering, half-wave rectification, and the use of instantaneous Hilbert phase to identify QRS complexes in the ECG. We demonstrate the application of this method using ECG recordings from eight preterm infants undergoing intensive care, as well as from 18 normal adult volunteers available via a public database. We compared our approach to the commonly used approaches including Pan and Tompkins (PT), gqrs, wavedet, and wqrs for identifying QRS complexes and then compared each with manually identified QRS complexes. RESULTS: For preterm infants, a comparison between the QRS complexes identified by our approach and those identified through manual annotations yielded sensitivity and positive predictive values of 99% and 99.91%, respectively. The comparison metrics for each method are as follows: PT (sensitivity: 84.49%, positive predictive value: 99.88%), gqrs (85.25%, 99.49%), wavedet (95.24%, 99.86%), and wqrs (96.99%, 96.55%). Thus, the sensitivity values of the four methods previously described, are lower than the sensitivity of the method we propose; however, the positive predictive values of these other approaches is comparable to those of our method, with the exception of the wqrs approach, which yielded a slightly lower value. For adult ECG, our approach yielded a sensitivity of 99.78%, whereas PT yielded 99.79%. The positive predictive value was 99.42% for both our approach as well as for PT. CONCLUSIONS: We propose a novel method for identifying QRS complexes that outperforms common currently available tools for non-stationary ECG data in infants. For stationary ECG our proposed approach and the PT approach perform equally well. The ECG acquired in a clinical environment may be prone to issues related to non-stationarity, especially in critically ill patients. The approach proposed in this report offers superior reliability in these scenarios.
Asunto(s)
Electrocardiografía/métodos , Adulto , Humanos , Lactante , Recien Nacido Prematuro , Estudios RetrospectivosRESUMEN
Elevated cerebral lactate is increasingly detected by magnetic resonance spectroscopy in the human fetus diagnosed with various pathologic conditions. However, the significance of detectable cerebral lactate remains uncertain. We present two cases of fetal cerebral lactate with adverse pregnancy outcomes.
Asunto(s)
Encéfalo/embriología , Encéfalo/metabolismo , Retardo del Crecimiento Fetal/metabolismo , Retardo del Crecimiento Fetal/patología , Ácido Láctico/metabolismo , Resultado Fatal , Femenino , Feto/metabolismo , Humanos , Recién Nacido , Espectroscopía de Resonancia Magnética , EmbarazoRESUMEN
OBJECTIVE: To evaluate whether heart rate variability (HRV) measures are predictive of neurological outcome in babies with hypoxic ischemic encephalopathy (HIE). STUDY DESIGN: This case-control investigation included 20 term encephalopathic newborns treated with systemic hypothermia in a regional neonatal intensive care unit. Electrocardiographic data were collected continuously during hypothermia. Spectral analysis of beat-to-beat heart rate interval was used to quantify HRV. HRV measures were compared between infants with adverse outcome (death or neurodevelopmental impairment at 15 months, n = 10) and those with favorable outcome (survivors without impairment, n = 10). RESULT: HRV differentiated infants by outcome during hypothermia through post-rewarming, with the best distinction between groups at 24 h and after 80 h of life. CONCLUSION: HRV during hypothermia treatment distinguished HIE babies who subsequently died or had neurodevelopmental impairment from intact survivors. This physiological biomarker may identify infants in need of adjuvant neuroprotective interventions. These findings warrant further investigation in a larger population of infants with HIE.