RESUMO
OBJECTIVE: To evaluate granulocyte colony-stimulating factor (G-CSF) as an early marker of bacterial or fungal infection in neonates. STUDY DESIGN: We measured G-CSF levels in infants of varying gestational and postnatal ages. We separated the infants into three groups: group 1, positive bacterial or fungal blood culture result; group 2, negative blood culture result but evidence of clinical sepsis; and group 3, negative blood culture result and no or weak evidence of sepsis. Comparison of mean G-CSF levels by group was accomplished by an analysis of variance. RESULTS: One hundred seventy-six evaluations for sepsis were done for 156 infants with gestational ages ranging from 24 to 43 weeks; 50% of these infants were less than 35 weeks of gestational age. The mean G-CSF levels of groups 1 and 2 were significantly higher than those of group 3. The mean G-CSF level of each group was 2278 pg/ml (group 1), 1873 pg/ml (group 2), and 280 pg/ml (group 3) (p < 0.001). On the basis of a cutoff level of 200 pg/ml, the sensitivity of the test was 95%, specificity 73%, positive predictive value 40%, and negative predictive value 99%. CONCLUSION: G-CSF levels represent a sensitive marker of infection in neonates of all gestational ages.
Assuntos
Infecções Bacterianas/diagnóstico , Fator Estimulador de Colônias de Granulócitos/sangue , Doenças do Prematuro/diagnóstico , Bacteriemia/diagnóstico , Bacteriemia/imunologia , Infecções Bacterianas/imunologia , Fungemia/diagnóstico , Fungemia/imunologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/imunologia , Micoses/diagnóstico , Micoses/imunologia , Valor Preditivo dos Testes , Valores de ReferênciaRESUMO
Lateral cerebral ventricular volume in 36 preterm infants with or without an intraventricular hemorrhage, and with or without posthemorrhagic hydrocephalus, was measured longitudinally and compared with the ventricular index measurements of the same ventricles. A poor correlation was found (r2 = 0.67). To determine a reason for this poor relationship, we analyzed the volumes of the regions of the ventricles by a segmental volume analysis. The occipital region of the lateral cerebral ventricle enlarged at a much faster rate (1.904 +/- 0.477 ml/day) than either the anterior region (0.546 +/- 0.253 ml/day; p less than 0.01) or the middle region (-0.209 +/- 0.334 ml/day; p less than 0.01) in infants with posthemorrhagic hydrocephalus. The rate of growth of the middle region of the lateral cerebral ventricles was the same for all infants. Linear indexes, such as the ventricular index and the lateral ventricular ratio, do not allow for accurate serial estimates of ventricular size in posthemorrhagic hydrocephalus because of asymmetric growth of the lateral cerebral ventricle. We conclude that sequential volume measurements are more useful than ventricular index measurements to follow ventricular size sequentially in infants with posthemorrhagic hydrocephalus.
Assuntos
Hemorragia Cerebral/complicações , Ventrículos Cerebrais/crescimento & desenvolvimento , Hidrocefalia/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Humanos , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Modelos Teóricos , UltrassonografiaRESUMO
To develop guidelines that might help predict prospectively which infants with severe intraventricular hemorrhage (IVH) would require intervention, we obtained serial cranial sonograms to measure the rate of growth of cerebral ventricular volumes in 48 preterm infants with and without IVH. The infants were divided into three groups: (1) those with no IVH (22 infants), (2) those with IVH with acute ventricular dilation (13 infants), and (3) those with IVH with progressive ventricular dilation requiring intervention (13 infants). The decision to intervene because of progressive ventricular dilation was based on clinical criteria and the subjective assessment of increasing ventricular size on weekly cranial sonograms. The rate of cerebral ventricular volume growth in infants with IVH who needed intervention was greater (4.2 +/- 3.3 ml/day) than that in infants without IVH (0.0 +/- 0.1 ml/day; p less than 0.001) and in infants with IVH and acute ventricular dilation (0.0 +/- 0.2 ml/day; p less than 0.001). Using these data, we generated guidelines for predicting prospectively which infants with IVH and ventricular dilation will need intervention for posthemorrhagic hydrocephalus. The guidelines were then confirmed prospectively in 10 infants.
Assuntos
Hemorragia Cerebral/patologia , Ventrículos Cerebrais/diagnóstico por imagem , Doenças do Prematuro/patologia , Hemorragia Cerebral/complicações , Ventrículos Cerebrais/patologia , Dilatação Patológica/diagnóstico por imagem , Humanos , Hidrocefalia/etiologia , Hidrocefalia/patologia , Recém-Nascido , Recém-Nascido Prematuro , Valor Preditivo dos Testes , UltrassonografiaRESUMO
We prospectively and longitudinally evaluated neurologic status, cognitive status, and visual-evoked responses in 63 premature infants with cerebral intraventricular hemorrhage, 27 premature infants without hemorrhage, and 22 full-term normal infants. We hypothesized that severe intraventricular hemorrhage (grades III and IV) is associated with impaired visual-motor function, in part because of compression-related injury of the periventricular white matter by ventricular dilation. Infants with grade III or IV hemorrhage had significantly more neurologic sequelae at term and at 3, 7, 12, and 24 months; lower Bayley mental and motor scores at 3, 7, and 12 months; more abnormality on Kohen-Raz subscales for eye-hand coordination, object manipulation, and object relations at 3, 7, and 12 months; and lower Mullen vision-receptive and vision-expressive coordination scores at 24 months. The 12-month visual-evoked response correlated with the 24-month vision-receptive and vision-expressive organization scores for infants with grade III or IV intraventricular hemorrhage (r = -0.49, p less than 0.01, and r = -0.40, p less than 0.05, respectively). The data confirm our hypotheses of increased cognitive and neurologic sequelae, and increased abnormality of visual-motor coordination, during the first 2 years of life in infants with severe (grade III or IV) intraventricular hemorrhage.
Assuntos
Hemorragia Cerebral/fisiopatologia , Deficiências do Desenvolvimento/etiologia , Doenças do Prematuro/fisiopatologia , Doenças do Sistema Nervoso/etiologia , Transtornos Psicomotores/etiologia , Hemorragia Cerebral/complicações , Cognição , Potenciais Evocados Visuais , Humanos , Recém-Nascido , Estudos Longitudinais , Exame Neurológico , Estudos Prospectivos , Fatores Socioeconômicos , UltrassonografiaRESUMO
We tested the hypothesis that Apgar scores are in part related to the newborn infant's level of maturity. Seventy-three pregnant women with normal fetuses of gestational age 22 to 42 weeks were studied. Fetal well-being was documented by a prospectively designed recording of pregnancy history, labor complications, and birth outcome, including cord blood pH and base deficit measurements. The 1- and 5-minute Apgar scores were directly related to gestational age. Respiratory efforts, muscle tone, and reflex were the major determinants for a decreasing Apgar score with declining gestational age. We conclude that the 1- and 5-minute Apgar scores are influenced by the infant's level of maturity and that our data may be useful in evaluating the true value of Apgar scores in assessing the fetal and neonatal condition of low birth weight infants.