RESUMEN
Aim of the prospective study was to investigate perinatal parameters and outcome of term SGA neonates. 100 term neonates were enrolled into 2 groups: group 1: 50 SGA neonates with birth weight below tenth percentile, group 2: 50 appropriate-for-gestational-age neonates. Both groups were compared concerning parental anamnesis, perinatal parameters, postnatal adaptation and development during the first days of life. After discharge from the hospital all children were observed during the first 15 weeks. In all infants the gain of weight, length, head circumference and the amount and type of nutrition were recorded. It was observed that only 13% of the SGA neonates were small children of small parents. Most of the SGA neonates had a normal target high. We found a significantly increased number of mothers with disturbed uterine or placental perfusion in the SGA group as well as increased problems in postnatal adaptation. SGA children had a significantly faster increase of gaining weight and a higher amount of nutrition during the first 15 weeks of life. This could be an early sign of catch-up-growth in SGA neonates, which could be regard as a part of the complex risk for developing a metabolic syndrome in formerly SGA children.
Asunto(s)
Recién Nacido Pequeño para la Edad Gestacional/crecimiento & desarrollo , Estatura/fisiología , Peso Corporal/fisiología , Lactancia Materna , Estudios de Casos y Controles , Cefalometría , Femenino , Retardo del Crecimiento Fetal/fisiopatología , Alemania , Humanos , Lactante , Recién Nacido , Masculino , Síndrome Metabólico/fisiopatología , Insuficiencia Placentaria/diagnóstico , Insuficiencia Placentaria/fisiopatología , Embarazo , Estudios Prospectivos , Valores de Referencia , Factores de RiesgoRESUMEN
BACKGROUND: Rapid enteral feeding volume advancement in preterm infants can reduce the use of intravenous fluids. This practice may decrease the hazards of intravenous infusion solutions and potentially the morbidity rate. Several cohort trials demand the standardised nutritional regimen to reduce the complications and the time to reach full enteral feeds. AIM: to determine whether using a standardized nutritional regimen the rapid enteral feeding advancement in preterm infants is practicable without increasing the incidence of feeding complications. PATIENTS AND METHODS: A prospective, randomized, controlled trial was performed in 99 preterm infants, birth weight ≤1,750 g. Group ST (standardized nutritional regimen) received breast human milk according to a standardized nutritional regimen. Group IN (individual nutritional regimen) received breast human milk or semi-elemental nutrition (Pregomin(®) Milupa) depending on enteral problems of the infant. The feeding volume advancement in the IN-Group was decided individually. The main outcome measure was time to reach full enteral feedings. RESULTS: Infants in the ST-Group achieved full enteral feedings after 14.93±9.95 (median 12) d, infants in the IN-Group after 16.23±10.86 (median 14) d. The difference between the groups was significant only in small for gestational age (SGA) infants: ST-Group 10.20±4.78 (median 8.5) vs. IN-Group 16.73±8.57 (Median 15) days (p=0.045). The weight gain was similar in both groups. Infants in ST-Group achieved full enteral feedings having 116% of birth weight, infants in IN-Group 122% of birth weight. This difference was not significant (p=0.195). The incidence of NEC (necrotizing enterocolitis, 4%) and other complications were low in both groups. The diagnosis "feeding complications" was described in IN-Group in 14 vs. 7 infants in ST-Group. CONCLUSIONS: SGA-infants profit from the enteral feeding advancement by using a standardized nutritional regimen. These infants achieved full enteral feedings sooner then the SGA-infants, who did not feed by using a standardized nutritional regimen. A standardized nutritional regimen can be realized in clinical routine and is by strict clinical observation practicable without increasing the incidence of feeding complications.
Asunto(s)
Nutrición Enteral/métodos , Enfermedades del Prematuro/terapia , Recién Nacido de muy Bajo Peso , Estudios de Cohortes , Femenino , Fluidoterapia/métodos , Alemania , Humanos , Fórmulas Infantiles , Recién Nacido , Masculino , Leche HumanaRESUMEN
BACKGROUND: CPAP is widely used in preterm infants on NICUs but it poses a stressful stimulus to the patient, sometimes requiring the use of analgosedative drugs. AIM: The aim of this study is to evaluate the risks and benefits associated with the use of low-dose morphine in preterm infants with CPAP, especially apnea. METHODS: Sixty-four CPAP-treated preterm infants, who received a low single dose of morphine (recommended 0.01 mg/kg), were included in this prospective study. Observation-time was 4 h prior to injection, directly before injecting, until 15 min and 15-30 min, 30 min-1 h, 1-2 h, 2-3 h, 3-4 h, 4-5 h and 5-6 h after injection. For all observation periods incidence of apnea, heart rate, respiratory rate and a score for analgesia and for sedation were recorded. RESULTS: Sixty-four preterm infants (29.6+/-3.3 weeks gestational age (GA), birth weight 1401+/-735 g) received 0.025+/-0.012 mg/kg morphine i.v. on the day 10-13 of life. The decrease in heart and respiratory rate, scores for analgesia and sedation were significant. The overall incidence of apnea did not increase compared to the 4 h pre-morphine period. Six patients (9.3%) experienced considerable delayed apnea. This group was significantly younger in GA (p<0.001) and lighter in birth weight (p=0.002). CONCLUSION: Morphine in dosage less than half of recommended dosage has a high analgetic and sedative potential. The danger of delayed severe apnea has to be taken into consideration in the clinical situation, especially in patients<28 weeks.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Sedación Consciente , Presión de las Vías Aéreas Positiva Contínua , Enfermedades del Prematuro/terapia , Morfina/administración & dosificación , Analgésicos Opioides/efectos adversos , Apnea/inducido químicamente , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Masculino , Morfina/efectos adversos , Respiración/efectos de los fármacos , Trastornos Respiratorios/terapia , Factores de RiesgoRESUMEN
BACKGROUND: Infants of drug abusing mothers are at high risk to suffer from neonatal abstinence syndrome (NAS). Depending on the drug signs of neonatal withdrawal vary but mainly include central nervous system irritability. NAS causes long duration of hospital stay. Severe withdrawal signs are seen in infants exposed to methadone, infants exposed to other opioids like heroin or buprenorphine have been shown to be less symptomatic. Between the years 1997 and 2003 following the border opening there was a dramatic increase in drug exposed newborns seen in the area of Leipzig (East Germany). METHODS: In a retrospective study maternal and infant characteristics, severity of symptoms, duration of withdrawal and hospital stay, duration and kind of treatment as well as modalities for release from hospital were analyzed. RESULTS: From 1997 to 2003 49 drug exposed newborns were admitted to our neonatal care unit. There was an increase of the number of affected infants within these years ( ). Maternal drug abuse (n=48) included mainly methadone (n=33), in second line heroine and benzodiazepines, in a few cases also cocaine and cannabinoides. 3 mothers received substitution therapy with buprenorphine. Additional drug use to substitution therapy was seen in 15 mothers. Drugs of abuse were detected in infant urine specimen (36/48). 35 of exposed newborns showed signs of NAS (incidence of NAS 71%). For evaluation of withdrawal signs and conduction of therapy the Finnegan score was used. As first line pharmacological treatment phenobarbitone was administered (n=42), secondary morphine was used (n=14, treatment failure 33%). Mean duration of hospital stay was 21 days. Mean duration of pharmacological treatment was 14 days with longer duration for methadone exposed infants vs. non-methadone exposed infants (16 vs. 10 days). Hospital stay was longer for non-methadone exposed infants. Maternal intake of more than 20 mg methadone per day vs. up to 20 mg per day caused longer duration of hospital stay (28 vs. 20 days, p=0,015). CONCLUSION: Long duration of hospital stay and pharmacological treatment call for optimised principal guide lines for diagnosis, treatment and long term follow-up. The results also underline the need for further research for an effective pharmacological treatment.
Asunto(s)
Hipnóticos y Sedantes/uso terapéutico , Metadona/efectos adversos , Morfina/efectos adversos , Fenobarbital/uso terapéutico , Complicaciones del Embarazo , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Femenino , Humanos , Incidencia , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Tiempo de Internación , Masculino , Síndrome de Abstinencia Neonatal/diagnóstico , Síndrome de Abstinencia Neonatal/tratamiento farmacológico , Síndrome de Abstinencia Neonatal/epidemiología , Síndrome de Abstinencia Neonatal/orina , Embarazo , Estudios RetrospectivosRESUMEN
Uteroplacental insufficiency leads to fetal growth retardation which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal hemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small for gestational age neonates. Prospectively, 124 preterm neonates with a birth weight below 1500 g were assigned to one of two groups according to the prenatal Doppler sonographic measurements: neonates with or without prenatal hemodynamic disturbances. We defined a pathological fetal perfusion using a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and a pulsatility index of the middle cerebral artery below the 10th percentile of a normal group. We compared intestinal adaptation in both groups as well as the blood flow velocity wave forms of the superior mesenteric artery in all neonates. Postnatally, all 42 neonates with prenatal hemodynamic disturbances were classified to be small for gestational age. Thirty-seven of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating enteral feeding within the first days of life. Five of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates born after normal prenatal perfusion were classified as appropriate for gestational age. Only 19 of 82 neonates of this group showed signs of intestinal disturbances postnatally. Doppler sonography demonstrated significantly lower systolic, mean and END-diastolic flow velocities, and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal hemodynamic disturbances. This may occur as a result of a postnatally persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.
Asunto(s)
Motilidad Gastrointestinal , Recién Nacido Pequeño para la Edad Gestacional , Enfermedades Intestinales/fisiopatología , Insuficiencia Placentaria/complicaciones , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Embarazo , Estudios Prospectivos , Flujo Pulsátil , Ultrasonografía Doppler , Ultrasonografía PrenatalRESUMEN
BACKGROUND: The aim of the study was the description and review of a diagnostic management for treatment of patent ductus arteriosus in preterm neonates. Indomethacin, widely used to effect nonoperative closure of patent ductus arteriosus, has been implicated in vasoactive side effects and requires an accurate diagnosis. PATIENTS AND METHODS: Firstly, the hemodynamic significance of the ductus arteriosus was assessed by clinical signs, such as tachycardia, disturbed microcirculation and a high difference of central and peripheral temperature. The patent ductus arteriosus was confirmed by echocardiography. The left ventricular systolic time intervals and the cerebral perfusion were obtained by pulsed doppler recordings. 48 preterm infants below 1500 g were investigated within the first 12 hours of life and during the first week. RESULTS: In 32 preterm neonates (67 %) a patent ductus arteriosus without hemodynamic significance and in 9 neonates a patent ductus arteriosus with hemodynamic changes was detected. In 9 neonates there were no signs of patent ductus arteriosus. Neonates with typical clinical signs of patent ductus arteriosus exhibited significantly diminished preejection time, prolonged ejection time and a decreased quotient of preejection and ejection time. We found pathologically changed parameters of anterior cerebral artery in neonates with clinical signs of patent ductus arteriosus. To judge the efficiency of the diagnostic management the groups of neonates were compared concerning the evidence of complications. Neonates with ductus arteriosus but without therapy did not reveal more pulmonary problems as well as intracerebral hemorrhages, renal or intestinal disturbances than the group of neonates with treated ductus arteriosus. CONCLUSIONS: Summarizing, we suggest that the described criteria are to be taken into account before treatment of ductus arteriosus in preterm neonates. In this way a wide clinical and echocardiographical investigation will be performed in risk neonates and a useless therapy can be avoided.
Asunto(s)
Conducto Arterioso Permeable/diagnóstico por imagen , Ecocardiografía Doppler , Enfermedades del Prematuro/diagnóstico por imagen , Arteria Cerebral Anterior/diagnóstico por imagen , Conducto Arterioso Permeable/tratamiento farmacológico , Conducto Arterioso Permeable/fisiopatología , Ecocardiografía Doppler de Pulso , Femenino , Hemodinámica/fisiología , Humanos , Indometacina/efectos adversos , Indometacina/uso terapéutico , Recién Nacido , Enfermedades del Prematuro/tratamiento farmacológico , Enfermedades del Prematuro/fisiopatología , Masculino , Valores de Referencia , Flujo Sanguíneo Regional/fisiología , Ultrasonografía Doppler TranscranealRESUMEN
UNLABELLED: The aim of this study was to evaluate the accuracy and safety of transcutaneous bilirubinometry in preterm infants using the new bilirubin analyser BiliCheck. The study included 145 preterm children (23-36 wk gestation). Capillary blood sampling for determination of serum bilirubin (BS) was combined with transcutaneous bilirubin measurement (BTc) every morning until the sixth postnatal day and related to several clinical data (phototherapy (PT), infection signs, breathing disturbances, skin bleeding, etc.). Overall bilirubin concentration ranged from 17 to 371 micromol/l, and from 21 to 325 micromol/l for BS and BTc, respectively. Mean values obtained by BTc were significantly higher than BS values. The correlation coefficient between BS and BTc was r= 0.64 for the whole group, and r = 0.73 in infants without PT. As demonstrated by multiple regression analysis, BS-BTc correlations were related only to gestational age (beta -0.32) and breathing disturbances (beta 0.29), indicating that the lower the gestational age and the more seriously ill the baby, the higher the incoherence between BS and BTc. CONCLUSION: BiliCheck provides a convenient, non-invasive possibility for bilirubin estimation in preterm infants. However, there are limitations: the method gives reliable results only in newborns older than 30 wk gestation, without PT and artificial ventilation.
Asunto(s)
Bilirrubina/análisis , Enfermedades del Prematuro/diagnóstico , Ictericia Neonatal/diagnóstico , Bilirrubina/sangre , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , MasculinoRESUMEN
Doppler sonographic investigations have presented cerebral hyperperfusion in neonates after severe asphyxia. Neonates with disturbed cerebral blood flow velocity (CBFV) tend to have poor outcomes. The purpose of this clinical study was to examine the influence of aminophylline on cerebral hyperperfusion. An intravenous bolus of 4 mg/kg aminophylline was given to nine neonates with Doppler sonographic signs of cerebral hyperperfusion. CBFV was determined before, 5 min, 60 min and 120 min after aminophylline administration and on the following day. After aminophylline the mean systolic (56.5 vs. 41.6 cm/s) and end diastolic (21.0 vs. 12.3 cm/s) blood flow velocity decreased and the mean pulsatility index (0.83 vs. 1.1) increased significantly. Repeated measurements showed a decrease in blood flow velocities and an increase in pulsatility index on the following days. Heart rate, mean arterial blood pressure and pCO2 were not significantly changed. We conclude that aminophylline influences cerebral hyperperfusion in neonates with disturbed autoregulation.
Asunto(s)
Aminofilina/farmacología , Asfixia Neonatal/fisiopatología , Broncodilatadores/farmacología , Circulación Cerebrovascular/efectos de los fármacos , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Humanos , Recién Nacido , Flujo Sanguíneo Regional/efectos de los fármacos , Telencéfalo/irrigación sanguínea , Ultrasonografía Doppler DúplexRESUMEN
Uteroplacental insufficiency leads to fetal growth retardation, which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal haemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small-for-gestational-age neonates. Prospectively, 114 preterm neonates with a birthweight below 1500 g were assigned to one of two groups according to their prenatal Doppler sonographic measurements: neonates with or without prenatal haemodynamic disturbances. We defined a pathological fetal perfusion by a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and by a pulsatility index of middle cerebral artery below the 10th percentile of a normal group. We compared the postnatal respiratory and intestinal adaptation in both groups as well as the blood flow velocity waveforms of the superior mesenteric artery in all neonates. Postnatally, all 36 neonates with prenatal haemodynamic disturbances were classified to be small for gestational age. Thirty-one of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating in enteral feeding within the first days of life. Six of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates after normal prenatal perfusion were classified to be appropriate for gestational age. Only 19 of 78 neonates of this group showed signs of intestinal disturbances postnatally. By Doppler sonographic investigations we found significant lower systolic, mean and end-diastolic flow velocities and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal haemodynamic disturbances. This may occur as a result of postnatal persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.
Asunto(s)
Feto/fisiología , Enfermedades Gastrointestinales/etiología , Motilidad Gastrointestinal/fisiología , Hemodinámica , Recién Nacido Pequeño para la Edad Gestacional , Velocidad del Flujo Sanguíneo , Femenino , Enfermedades Gastrointestinales/fisiopatología , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Arteria Mesentérica Superior/fisiología , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/fisiología , Estudios Prospectivos , Flujo Sanguíneo Regional , Ultrasonografía Doppler/métodos , Ultrasonografía Prenatal , Útero/irrigación sanguíneaRESUMEN
BACKGROUND: Recent advances in perinatology have been associated with a decrease in perinatal mortality. However, nowadays detailed assessments are of major importance for accurate prediction of neurologic development of extreme low birth weight infants and term infants with severely disturbed postnatal adaptation. This study examined the role of cranial ultrasound for the prediction of developmental progress during the first year of life. PATIENTS AND METHODS: Fifty nine infants with gestational age less than 33. weeks and fifty seven infants with gestational age above 32. weeks were studied. Each infant was classified as normal, suspect or abnormal using cranial ultrasound and a specialized scoring system during the first days and twelve month of life. Repeated structured neurological examination were carried out during the first year of corrected age. By statistical analysis was investigated the correlation between the degree of ultrasound abnormalities and neurological outcome of neonates of both different gestational age groups. RESULTS: We diagnosed the same share of pathological ultrasound scans in both groups within the first days of life. In contrast there were remarkable differences concerning the results of sonographic investigation at the end of the first year of life. We demonstrated a significant higher incidence of abnormal findings in neonates with a gestational age less than 33 weeks at this point of time. The neurological progress of neonates of both groups was significantly disturbed in cases of major sonographic abnormalities. Cases of mild or moderate ultrasound abnormalities were significantly associated with a poor neurologic outcome only in neonates with a gestational age less than 33 weeks. By statistical analysis we proved a significant value of cranial ultrasound for prediction of neurological development of preterm neonates with gestational age less than 33 weeks. The certainty prediction of neurodevelopmental sequelae in neonates with gestational age above 32 weeks was associated with major sonographic abnormalities but not with mild or moderate sonographic pathology. CONCLUSION: The prognostic accuracy of ultrasound scans performed in the first week of life is important for preterm neonates with gestational age less than 33 weeks. In neonates with gestational age above 32 weeks we revealed no significant predictive value of the method. This limits the value of this technique in this patients as a reliable method for recognising of the infants with the need of early rehabilitation.
Asunto(s)
Daño Encefálico Crónico/diagnóstico por imagen , Ecoencefalografía , Síndrome de Adaptación General/diagnóstico por imagen , Recién Nacido de Bajo Peso , Enfermedades del Prematuro/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Masculino , Examen Neurológico , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Hemodynamic impairements play an important role in the development of cerebral lesions. These changes may be detected by dopplersonographic flow measurements in cerebral arteries. For that reason it is necessary to establish normal values in relation to cardiac function and intestinal perfusion. METHODS & PATIENTS: 62 neonates with uncomplicated postnatal adaptation were investigated by dopplersonographic measurements of ant. cerebral artery (ACA) at the 1st, 2nd, 3rd and 5th day of life. Relations to left ventricular ejection time (LVET) and systemic blood pressure were described. An index of parameters from ACA and sup. mesenteric artery was determined. RESULTS: We demonstrated a significant increase of flow velocities and a decrease of pulsatility index in relation to increased gestational and postnatal age. There was a positive correlation between LVET and systemic blood pressure to peak flow velocities and a negative correlation to pulsatility index. The index of the parameters from ACA to sup. mesenteric artery was not depended on gestational age. The index of the flow velocities of both arteries increased from first to fifth day of life, whereas the index of the pulsatility index decreased. CONCLUSION: With these results it is possible to evaluate cerebral hemodynamic changes by dopplersonographic measurements in relation to gestational and postnatal age and under consideration of cardiac function and mesenteric perfusion.
Asunto(s)
Arteria Cerebral Anterior/diagnóstico por imagen , Hemodinámica/fisiología , Recien Nacido Prematuro/fisiología , Intestinos/irrigación sanguínea , Ultrasonografía Doppler Transcraneal , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Arterias Mesentéricas/diagnóstico por imagen , Valores de Referencia , Volumen Sistólico/fisiologíaRESUMEN
We report two cases of premature rupture of membranes and oligohydramnios (gestational age: 23rd/24th week). In both pregnancies artificial instillation of amniotic fluid (AIF) was performed once a week. We hypothesize that fetal head compression with impaired cerebral perfusion due to oligohydramnios causes periventricular leukomalacia. Prolongation of gestation of 36/23 days without neurological lesion support this method. Surveillance of these pregnancies in a perinatal center has to include very early detection of chorioamnionitis. If not so, gained prolongation of pregnancy with a lower rate of cerebral damage becomes harmful due to infection. Clinical benefits and disadvantages of this technique have to be evaluated in a prospective randomized trial.
Asunto(s)
Líquido Amniótico , Rotura Prematura de Membranas Fetales/terapia , Trabajo de Parto Prematuro/terapia , Oligohidramnios/terapia , Femenino , Rotura Prematura de Membranas Fetales/diagnóstico por imagen , Humanos , Recién Nacido , Recién Nacido de muy Bajo Peso , Instilación de Medicamentos , Trabajo de Parto Prematuro/diagnóstico por imagen , Oligohidramnios/diagnóstico por imagen , Embarazo , Segundo Trimestre del Embarazo , Ultrasonografía PrenatalRESUMEN
The attitude of medical professionals towards natural infant feeding is decisive in the support of mothers who want to breastfeed. The atmosphere in a "Baby-Friendly Hospital" is determined by the creation of conditions for breastfeeding on demand and for early, undisturbed mother-child contact. At the University Women's Hospital in Leipzig the development of good breastfeeding management was supported by the employment of a "breastfeeding nurse" and enhanced by continuing education for physicians, nurses and midwives in lactation and breastfeeding. In this way comprehensive, uniform information as well as practical guidance important for breastfeeding success were ensured for pregnant and young mothers.
Asunto(s)
Lactancia Materna , Adulto , Actitud del Personal de Salud , Femenino , Alemania , Promoción de la Salud , Historia del Siglo XX , Maternidades/historia , Humanos , Enfermería Obstétrica/historia , EmbarazoRESUMEN
Within the last years Doppler sonographic studies in high risk pregnancies had been included into obstetrical management strategies. Especially the high fetal risk in cases with severe intrauterine perfusion disturbances with signs of hemodynamic centralization--the brain sparing effect--had been established. In 11 premature newborns with prenatal sonographic recorded vasodilatation of cerebral vessels as a sign of hemodynamic centralization flow velocity waveforms of the anterior cerebral artery as well as left cardiac functional parameters (LVET, PEP) were measured at the 1st, 2nd, 3rd, 5th and 6th day of life. For the evaluation of the peripheral circulation the perfusion of the superior mesenteric artery was recorded by Doppler ultrasound. Additionally, the blood pressure, heart rate, pH and acid base status was considered. We used 25 premature newborns of corresponding gestational age and normal prenatal Doppler sonographic findings as a control group. In the group with prenatal brain sparing effect we could demonstrate a remarkable increase of the pulsatility index as a result of extreme diminished diastolic blood flow velocity. 5 newborns showed signs of reverse diastolic flow. The difference to the control group was highly significant. Perfusion measurements in the superior mesenteric artery demonstrated corresponding results at the first day of life with significant increased PI and diminished diastolic flow velocities. Our results demonstrate the great importance of prenatal diagnosis for the understanding of postnatal disturbances. The birth is not the endpoint of fetal hemodynamic centralization and the compensational mechanism is still continuing. Despite a well adapted cardiac function, normal hemodynamic situation and balanced metabolic findings remarkable changes of the impedance of the cerebral vessels are evident. Especially for the very immature newborns this may lead to the risk of leasions of the germinal matrix with following hemorrhage or ischaemic injury.
Asunto(s)
Daño Encefálico Crónico/etiología , Encéfalo/embriología , Circulación Cerebrovascular , Hemodinámica , Embarazo de Alto Riesgo , Equilibrio Ácido-Base , Puntaje de Apgar , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Encéfalo/irrigación sanguínea , Daño Encefálico Crónico/epidemiología , Femenino , Edad Gestacional , Frecuencia Cardíaca , Humanos , Recién Nacido , Perfusión , Embarazo , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Ultrasonografía Doppler , Ultrasonografía PrenatalRESUMEN
The importance of measurement of blood flow in the fetal and uteroplacental circulations for the assessment of fetal wellbeing has been undisputed since some years. The present study is designed to prove if any relationship exists between severe hemodynamic disturbance in fetal as well as uteroplacental vessels and the occurrence of postnatal impairment of intestinal motility. The progress of 130 children, born in the University Women's Hospital Leipzig between 1991-1993 and with birth weights below 1500 g, has been analyzed. Doppler ultrasound examinations for detection of impairment in fetal and uteroplacental circulation were performed in all cases during pregnancy. A severe impairment of blood flow in the above mentioned circulations was defined by the presence of pathological pulsatility or resistance indices in both fetal and uteroplacental vessels as well as absent end diastolic flow in the umbilical artery and signs of centralization in the fetus. A severe hemodynamic impairment was found in 27 children and 26 of these were classified as severe hypotrophic after birth. The progress of these children was compared with this of other hypotrophic and euthrophic premature babies who had not revealed hemodynamic abnormalities. The incidence of disturbed postnatal intestinal motility (delayed meconium excretion, abdominal distention, retrograde peristalsis, subileus) was significantly higher in hypotrophic neonates with hemodynamic abnormalities in the course of pregnancy. Four of these newborns underwent surgery and surgical findings did not correlate with enterocolitis. The resumption of oral food intake for neonates who had hemodynamic impairments during pregnancy was delayed compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enterocolitis Seudomembranosa/congénito , Feto/irrigación sanguínea , Motilidad Gastrointestinal/fisiología , Enfermedades del Prematuro/diagnóstico por imagen , Obstrucción Intestinal/congénito , Intestinos/irrigación sanguínea , Intercambio Materno-Fetal/fisiología , Ultrasonografía Doppler , Ultrasonografía Prenatal , Peso al Nacer/fisiología , Enterocolitis Seudomembranosa/diagnóstico por imagen , Enterocolitis Seudomembranosa/fisiopatología , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/fisiopatología , Vaciamiento Gástrico/fisiología , Tránsito Gastrointestinal/fisiología , Edad Gestacional , Hemodinámica/fisiología , Humanos , Recién Nacido , Enfermedades del Prematuro/fisiopatología , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/fisiopatología , Isquemia/congénito , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Embarazo , Factores de RiesgoRESUMEN
7 premature infants with progressive posthaemorrhagic hydrocephalus were treated by means of external ventricular drainage (birth weight: 1050 gms, gestational age: 27.7 wks). All infants were generally unwell and were ventilated. The progression of hydrocephalus was well controlled during the drainage period in each patient. We believe external ventricular drainage is an effective form of therapy in premature infants with posthaemorrhagic hydrocephalus until the time of insertion of a ventriculo-peritoneal shunt.
Asunto(s)
Hemorragia Cerebral/congénito , Hidrocefalia/cirugía , Enfermedades del Prematuro/cirugía , Ventriculostomía/instrumentación , Catéteres de Permanencia , Hemorragia Cerebral/cirugía , Femenino , Edad Gestacional , Humanos , Recién Nacido , Presión Intracraneal/fisiología , MasculinoRESUMEN
A total of 332 extrauterine pregnancies were treated between 1973 and 1975 (32) and between 1981 and 1987 (300). Of these, 195 (58.74% or of 300 = 65%) were operated on while employing endoscopy. The incidence of extrauterine pregnancy in relation to the total number of operations increased from 1.48% to 2.59%; in relation to the deliveries, the incidence rate increased from 0.99% to 4.15%. Diagnosis in an early stage where signs are only few, was made possible by specific determination of human chorionic gonadotropin in the urine (1981-1987: 84.1% positive) and by sonography (in 195 extrauterine pregnancies, 91.3% were found to be suspicious). Laparoscopic treatment, which has since become a standard method in extrauterine pregnancy, was possible in 45.7% of the cases in 1982 and in 89.9% of the patients in 1986. 11 relapses were seen after laparoscopic procedure while preserving the salpinges, whereas after laparotomy there were 20 recurrences. In four women intrauterine pregnancies became possible and were successful even after bilateral extrauterine pregnancy. In endoscopically conducted operations both the duration of anaesthesia and the postoperative course were clearly shortened, less associated with complications and subjectively easier for the patients. Complications were largely confined to repeated operations in cases where the pregnancy had not been fully removed, which could have been avoided (5.12%). Endoscopic treatment of extrauterine pregnancy is recommended.