Biomedical subjects

A Ometto

Publications and source records attributed to A Ometto.

At least 19 recordsLinked to original sources

PubMed1998

Obstetric risk factors for periventricular leukomalacia among preterm infants.

OBJECTIVE: To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants. DESIGN: A cohort study of preterm singleton infants born between 25 and 33 weeks gestation. SETTING: Pavia, Italy. POPULATION: Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia. METHOD: The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders. RESULTS: The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98). CONCLUSIONS: This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.

Acidosis↗

PubMed1997

Neurodevelopmental outcome in very low birth weight infants at 24 months and 5 to 7 years of age: changing diagnosis.

We describe the long-term development of 53 very low birth weight premature infants. The children were divided into 2 groups on the basis of ultrasound scan, and classified as: group I, patients with normal ultrasound scan or with uncomplicated hemorrhage; and group II, patients with complicated hemorrhage or only parenchymal lesions. Minor and major sequelae detected at 2 years of age were compared with those observed at 5 to 7 years. Our study confirms that most severely handicapped children are identified by age 2 years. Minor sequelae are more evident at 5 to 7 years and subjects with good outcome, as expressed by a McCarthy General Cognitive Index score > 80, present a discordant cognitive profile with verbal scores higher than performance scores. Therefore, we emphasize the importance of follow-up of very low birth weight premature infants until school age and stress that neonatal ultrasound scan diagnosis of parenchymal damage represents an important diagnostic tool in terms of both short- and long-term neurodevelopmental outcome.

Brain↗

PubMed1997

Significance of low birthweight for gestational age among very preterm infants.

OBJECTIVE: To estimate the risk of specific adverse neonatal events resulting from the combined effects of prematurity and low birthweight in very preterm infants (delivered at 24-31 weeks of gestation). DESIGN: A cohort study of specific adverse neonatal events in preterm infants born at between 24 and 31 weeks of gestation. SETTING: Pavia, Italy. POPULATION: Two hundred and thirty singleton infants with sonographically confirmed gestational age, delivered at 24 to 31 weeks of gestation. METHODS: To evaluate the impact of a lower than expected birthweight on selected neonatal events independently of gestational age, we calculated birthweight standard deviation scores (differences between actual birthweight and fitted birthweight divided by fitted standard deviation) for each week of gestation. RESULTS: After adjustment for gestational age and other confounders, there was a significant linear trend relating a decreasing birthweight SDS to an increased likelihood of neonatal death, intraventricular haemorrhage, severe respiratory distress syndrome, and acidosis. Compared with infants with SDS > or = 0 (> or = 50th centile of birthweight), infants with birthweight SDS < -1 (< 16th centile) had increased odds for neonatal death [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.42-9.6], grade III-IV intraventricular haemorrhage (OR 17.5, 95% CI 4.04-75.9), and neonatal acidosis (OR 3.22, 95% CI 1.41-7.4). The significance of birthweight SDS as a predictor of neonatal outcome, however, was lower than that of gestational age. CONCLUSIONS: A lower than expected birthweight affects the likelihood of several adverse neonatal events in very preterm infants. However, a decreasing birthweight SDS affects neonatal outcome less than decreasing gestation does.

Adult↗

PubMed1995

Value of antenatal corticosteroid therapy in preterm birth.

This prospective observational study was designed to evaluate the magnitude of the corticosteroid-related reduction in the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage and neonatal death according to different etiologic subgroups of preterm delivery. Of 380 patients delivered before 35 weeks' gestation, 155 received a complete course of dexamethasone or betamethasone to promote fetal lung maturation. In logistic models, the steroid-related reduction of RDS was greater among patients with intact membranes as opposed to patients with premature rupture of membranes (excess risk = 0.31; 95% confidence interval (C.I.) = 0.13-0.73; P = 0.007) and in patients with spontaneous preterm labor as compared with other etiologic groups (excess risk = 0.33; 95% C.I. = 0.11-0.98, P = 0.04). On the other hand, the steroid-related reduction of severe (grade III-IV) intraventricular hemorrhage was more marked in growth retarded as opposed to well-grown fetuses (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04), and in planned as compared with spontaneous preterm deliveries (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04). Results show that the greatest benefit from antenatal steroids appears to be in preterm deliveries with intact membranes and in planned preterm deliveries.

Adrenal Cortex Hormones↗

PubMed1995

Antenatal risk factors for germinal matrix hemorrhage and intraventricular hemorrhage in preterm infants.

OBJECTIVES: This study was designed to evaluate the effect of antenatal risk factors on the occurrence of germinal matrix hemorrhage or intraventricular hemorrhage in preterm infants. STUDY DESIGN: Antenatal factors were evaluated in 302 infants delivered between 24 and 33 completed weeks gestation. Ultrasonographic screening of intracranial hemorrhage was carried out in all the infants. The association between risk factors and neonatal intracranial hemorrhage was evaluated with both univariate and multivariate models. RESULTS: In stepwise logistic regression analysis, birthweight was a better predictor of neonatal germinal matrix hemorrhage than gestational age. Conversely, gestational age better predicted intraventricular hemorrhage than did birthweight. Risk factors for neonatal germinal matrix hemorrhage and intraventricular hemorrhage were dissimilar. A history of heavy (> 10 cigarettes/day) maternal smoking on admission increased the risk of germinal matrix hemorrhage three-fold (odds ratio = 3.35; 95% C.I. 1.24-9.07). Antenatal corticosteroid use reduced the risk of intraventricular hemorrhage by 76% (odds ratio = 0.24; 95% C.I. 0.09-0.61). Among patients with spontaneous preterm delivery or premature rupture of fetal membranes, the presence of labor was a significant effect modifier of the gestational-age associated risk of germinal matrix hemorrhage-intraventricular hemorrhage. CONCLUSIONS: Risk factors for neonatal germinal matrix hemorrhage are different from those for intraventricular hemorrhage. Most antenatal factors, especially those affecting fetal maturity, could influence the progression rather than the onset of intracranial hemorrhage.

Adult↗

PubMed1995

Epidemiologic association between maternal smoking during pregnancy and intracranial hemorrhage in preterm infants.

The objective of this study was to evaluate the effect of maternal smoking during pregnancy on the risk of intracranial hemorrhage in preterm infants (born at 24 to 33 weeks of gestation). We conducted a case-control study of 96 preterm infants with intracranial hemorrhage and 96 gestational age-matched control subjects with negative cranial ultrasonographic findings. In conditional multiple logistic regression models, heavy maternal smoking ( > 10 cigarettes per day) during the latter half of pregnancy was associated with an increased risk of mild (grade I or II) intracranial hemorrhage (odds ratio = 5.96, 95% confidence interval 1.72 to 20.76; p = 0.005). After adjustment for the confounding effect of birth weight and respiratory distress syndrome, the risk of any intracranial hemorrhage (grade I to IV) was three times higher (adjusted odds ratio = 3.63, 95% confidence interval 1.37 to 9.63; p = 0.009) in infants of heavy smokers ( > 10 cigarettes per day) than in control subjects. The results of this study indicate that cigarette smoking during the latter half of pregnancy increases the risk of intracranial hemorrhage in preterm infants. The deleterious effect of smoking was greater for mild hemorrhages (grade I or II) and was confined to infants of heavy smokers.

Case-Control Studies↗

PubMed1995

Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age.

OBJECTIVE: To evaluate the impact of preterm premature rupture of membranes on the neurodevelopmental outcome of infants, assessed at two years of age. DESIGN: A prospective observational study of surviving preterm infants born after premature rupture of membranes and of infants born after spontaneous preterm labour with intact membranes. The study was carried out in the period 1986 to 1991. SETTING: Pavia, Italy. SUBJECTS: One hundred and forty singleton infants born prematurely after premature rupture of membranes between 24 and 34 weeks of gestation and 120 controls of similar gestational age born after spontaneous preterm labour with intact membranes. MAIN OUTCOME MEASURES: Infant neurodevelopmental outcome at two-year follow up. RESULTS: After adjustment, by logistic analysis for the effect of gestational age and birthweight, infants born after premature rupture of membranes were more likely to have severe neurodevelopmental impairment (spastic tetraplegia and/or Bayley mental developmental index < 71) than controls (adjusted OR 5.75, 95% CI 1.22-27.18). Multivariate analysis of linear trend showed a statistically significant relation of duration of membrane rupture to occurrence of severe intraventricular haemorrhage, cystic periventricular leucomalacia and moderate to severe infant neurodevelopmental impairment. CONCLUSION: Infants born after prolonged premature rupture of membranes are at higher risk of subsequent moderate to severe neurodevelopmental impairment than those born after spontaneous labour with intact membranes.

Birth Weight↗

PubMed1995

Early neonatal complications after elective preterm delivery in hypertensive pregnancies.

We evaluated the rates of short-term neonatal complications, neonatal brain damage or mortality in a group of 96 singleton pregnancies complicated by hypertension and electively delivered before 36 weeks gestation. The neonatal outcome of these pregnancies was compared with that of a matched control group of 192 uneventful pregnancies delivered because of spontaneous preterm labor or premature rupture of membranes. Although the rates of acidosis, apneoic crises, bradycardia and ventilatory support were higher among cases than controls, the risk of intraventricular hemorrhage, severe brain damage (grade III-IV intraventricular hemorrhage or periventricular leucomalacia) or neonatal mortality were comparable between the two groups. Neonatal complications were more frequent among infants born to mothers with severe hypertension or severe proteinuria. In conclusion, this study has shown that short term neonatal complications after elective preterm delivery in hypertensive pregnancies are increased in comparison with low risk controls. However, these complications, which were well managed in our intensive care nursery, did not affected neonatal mortality or severe brain damage.

Acidosis↗

PubMed1994

Early morbidity and neurodevelopmental outcome in low-birthweight infants born after third trimester bleeding.

Neonatal mortality, morbidity, and neurodevelopmental sequelae were compared between a consecutive series of 77 liveborn, low-birthweight (less than 2500 g) infants delivered after third trimester bleeding and 154 appropriate control infants of similar gestational age. Infants born after abruptio placentae had lower Apgar scores at 1 minute and higher rates of acidosis in comparison with control infants. In multivariate analysis, the infants in this group had higher risks of severe intraventricular hemorrhage and poor outcome (neonatal death or cerebral palsy) in comparison with control infants. In placenta previa, the infants had a higher prevalence of respiratory distress syndrome, whereas unclassified antepartum bleeding was associated with a high rate of neonatal hypoglycemia. After adjustment, by logistic regression analysis, for the effect of confounding factors (gestational age, birthweight, social class, and education of the mother), the risk of minor infant neurodevelopmental abnormalities at 2-year follow-up was increased in infants delivered after total or partial placenta previa or after unclassified antepartum bleeding. Third trimester bleeding should be considered a strong risk factor for both short-term neonatal morbidity and subsequent infant neurodevelopmental impairment in the low-birthweight infant population.

Abruptio Placentae↗

PubMed1994

Neurodevelopmental outcome at 5-7 years in preterm infants with periventricular leukomalacia.

We describe outcome at 5-7 years of 37 subjects with periventricular leukomalacia (PVL). Children were divided into 3 groups based on PVL type and clinical outcome. Subjects with cystic PVL > or = 5 mm-1 cm or more (n = 14) all developed CP. CP was found in only 2 subjects out of 11 with cystic PVL < 5 mm. One had GII < 70 according to McCarthy's Scales of Children's abilities. Mild neurological signs were present in 7 and 1 child was normal. Subjects with so-called "prolonged flare" (n = 12) included 6 CP cases, 4 with mild neurological signs and 2 normal subjects. Prognosis was related to site and number of cysts. Cognitive profiles tended to be disharmonic, with discrepancies between verbal, performance and motor scores. We conclude that PVL represents an important diagnostic tool in both short and long-term neurodevelopmental outcome.

Child↗

PubMed1993

Severity of abruptio placentae and neurodevelopmental outcome in low birth weight infants.

The short term neonatal morbidity and 2-year neurodevelopmental outcome were evaluated in 40 low birthweight (< 2500 g) liveborn infants delivered after abruptio placentae and in 80 control infants of similar gestational age. Apgar scores at 1' and 5' were lower in infants born to mothers with severe abruption. The prevalence of intraventricular hemorrhage (Grades I-IV) was 17.5% (7/40) in the cases and 5% (4/80) in the controls (P = 0.035). Cystic periventricular leukomalacia was diagnosed in two cases (5%) and in none of the controls (P = 0.1). At 2-year follow-up, among surviving infants, cerebral palsy (spastic diplegia, hemiplegia or tetraplegia with or without mental retardation) was diagnosed in 11.1% (4/36) of the cases and in none of the 76 controls (P = 0.011). After adjustment by logistic regression analysis for the effect of confounders (gestational age, birthweight, social class and duration of mother's education) the odds ratio of a poor outcome defined as neonatal death or cerebral palsy was 4.4 (95% confidence interval, 1.2-17.0) in index cases as a whole and 8.0 (95% confidence interval, 1.5 to 43.0) in the subgroup of infants born after severe abruption. Mild abruption did not affect the 2-year infant outcome in both univariate and multivariate analysis.

Abruptio Placentae↗

PubMed1993

Infant neurodevelopmental outcome in pregnancies complicated by gestational hypertension and intra-uterine growth retardation.

The neonatal outcome of 78 consecutive singleton pregnancies complicated by intrauterine growth retardation (IUGR) and gestational hypertension were compared with the outcome of 78 adequately matched pregnancies complicated by idiopathic IUGR. The rate of low (< 5) 1-minute Apgar scores was higher in infants born to hypertensive mothers (12.8% vs 2.6% p = .035). No differences in the prevalence of other perinatal factors such as acidosis, respiratory distress syndrome, hypoglycemia, pneumothorax, bronchopulmonary dysplasia, intracranial hemorrhage, requirement for assisted ventilation or survival were found between cases and controls. After two years' follow-up, the rate of major neurological neonatal handicaps, was 2.8% in the cases and 1.4% in the controls (p = 0.56). Mild neurodevelopmental abnormalities were more frequent in infants born to hypertensive mothers (14.3% vs 2.9% p = .025). After adjustment by multiple logistic regression, to eliminate the effect of confounding factors, the probability of normal neurodevelopmental outcome was reduced by 82% in infants born to hypertensive mothers as compared to controls (Odds Ratio = 0.18; 95% confidence interval 0.05 to 0.82 p = .028). These findings suggest that pregnancies complicated by IUGR and gestational hypertension are associated with a high prevalence of subsequent neurodevelopmental problems among infants.

Adult↗

PubMed1992

The influence of presentation and method of delivery on neonatal mortality and infant neurodevelopmental outcome in nondiscordant low-birthweight ( < 2500 g) twin gestations.

The effects of birth order, presentation and method of delivery on neonatal mortality and neurodevelopmental outcome in nondiscordant low birthweight ( < 2500 g) twin gestations were evaluated. Sixty-four sets of twins were included in the study; 29 sets were in vertex/vertex presentation (Group I), 25 sets in vertex/breech (Group II) and in 10 pregnancies the first twin was nonvertex (Group III). The rate of favorable neonatal outcome (survival and normal neurodevelopmental outcome after a 2-year follow-up) was lower in pregnancies in which at least one twin was in nonvertex presentation (50/70 vs. 52/58 P = 0.02). However, after adjustment by multiple logistic regression analysis for the effects of gestational age, birthweight, birth order and educational level of the mother, this difference was not statistically significant (odds ratio = 0.6; 95% confidence interval 0.44 to 5.9; P = 0.5). In pregnancies in which at least one of the twins was in nonvertex presentation, delivery by cesarean section did not affect the rate of favorable neonatal outcome (odds ratio = 1.8; 95% confidence interval 0.48 to 12.9; P = 0.8). The results of this study suggest that in low birthweight twin gestations, method of delivery in relation to fetal presentation has little or no effect on neonatal mortality and subsequent neonatal neurodevelopmental outcome.

Birth Order↗

PubMed1992

Neurodevelopmental outcome in very-low-birth-weight infants with or without periventricular haemorrhage and/or leucomalacia.

The aim of the study was to verify the predictive value of ultrasound performed in the neonatal period for short-term neurodevelopmental prognosis in 122 preterm very-low-birth-weight infants followed-up at 36 months. Neuromotor development was favourable in 53 (87%) subjects with normal ultrasound findings and in 21 (81%) subjects presenting uncomplicated haemorrhage. However, sensory and/or cognitive sequelae developed in 13% and 19% of the two groups, respectively. Outcome was unfavourable in 14 (50%) of 28 patients with ultrasound findings of complicated cerebral haemorrhages and in 5 (71%) of those (7) with ultrasound findings of parenchymal lesions without haemorrhage. Neonatal ultrasound examination seems to be fundamental in predicting neuromotor, but not cognitive, outcome in very-low-birth-weight infants.

Cerebral Hemorrhage↗

PubMed1991

Correlation between clinical and ultrasound findings in preterm infants with cystic periventricular leukomalacia.

Cystic periventricular Leukomalacia (CPVL), a hypoxic-ischemic lesion of the neonatal brain, which can now be diagnosed in life thanks to ultrasound brain scanning, is considered to be one of the main causes of cerebral palsy (CP), especially in preterm infants. The purpose of our study was to verify this assumption in a population of 337 of gestational age greater than or equal to 32 weeks. The frequency of CPVL proved to be 5.4% for lesions with a diameter of greater than or equal to 3 mm or 9.3% including those of smaller diameter. The development of CPVL infants was favorable in 29% and adverse in 71% of cases. In the latter cases neuromotor sequelae (CP in 62.5% and motor retardation in 8.5%) were accompanied by various other neuropsychic deficits. Prognosis depends on the site and size of the cysts, being harsher for posterior lesions and those exceeding 1 cm in diameter.

Cerebral Palsy↗

PubMed1990

Early predictors of neurodevelopmental outcome at 12-36 months in very low-birthweight infants.

We followed-up 71 preterm survivors, 36 (50.7%) females and 35 (49.3%) males, correlating the results of neurological examinations (NE) at 40 weeks of corrected gestational age (GA) and the cerebral ultrasound (US) diagnosis with the neurodevelopmental outcome at 12-36 months of life. All 34 children with normal NE at term presented adequate neurodevelopmental outcome; these subjects have a normal US scan or a scan that is pathologic for uncomplicated hemorrhage. Of the 6 children with pathologic NE, but a normal US, 3 (50%) had a normal outcome, while 2 (34%) had mild impairments and 1 (16%) grave neurodevelopmental deficits. Of the 31 subjects with pathologic NE and US, 12 (39%) showed a normal outcome, and 6 (19%) had mild and 13 (42%) grave neurodevelopmental deficits; signs of parenchymal lesions with or without periventricular hemorrhage were particularly correlated to US. We conclude that the combination of the results of NE at 40 weeks GA and brain US are useful in early neurodevelopmental prognosis in very low-birthweight infants.

Child, Preschool↗

PubMed1990

[Infantile cerebral palsy and neuromotor development in very low birth weight infants].

One hundred twenty-seven children born between September 1st 1980 and August 31st 1985 weighing less than or equal to 1500 g at birth and submitted to intensive neonatal care were followed-up to the age of 12-36 months of corrected age with a follow-up program to assess their neuromotor and cognitive development. The incidence of cerebral palsy (CP) in the population in question was 15.7% at 12 and 24 months and 14.6% at 36 months. A peak CP rate was observed among those born in 1982 with a steady decline in the number of CP cases among those born in the last years of this study. The group of children with a birth weight of 1001-1500 g (VLBWI) was more heavily affected by CP than those whose weight was less than or equal to 1000 g (ELBWI). Statistical analysis revealed a significant correlation between neuromotor development and the following factors relative to the perinatal period: type of birth, sex, respiratory distress requiring assisted ventilation, acidosis, ultrasound, neurological examination at the 40th week of gestational age.

Age Factors↗

PubMed1986

Ultrasound-clinical correlations in the assessment of the newborn at risk for brain damage.

In the Pavia Neonatal Intensive Care Unit all newborns at risk for brain damage have, since 1983, undergone transfontanellar ultrasound scanning regularly for the early diagnosis of hemorrhage and/or anoxia-ischemia. They have also been assessed clinically by a child neuropsychiatrist during the hospital stay and every two months at outpatients' for the first year of life as a check on the prognostic value of ultrasound scanning. The results relating to a sample of 56 at risk newborns, with normal and abnormal ultrasound scans, who have now reached 12 months corrected age are reported. A normal ultrasound scan presupposes normal neuropsychic development in 87% of cases, as happens in the event of uncomplicated hemorrhage. Major sequelae occur in as many as 83% of cases of complicated hemorrhage. The diagnosis of severe anoxia-ischemia likewise argues for a pathological neuropsychic development. Our results convince us that transfontanellar ultrasound scanning is an indispensable tool not only for the early diagnosis of brain damage but also as a guide to prognosis in the newborn at risk.

Atrophy↗