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Biomedical subjects

C L Fawer

Publications and source records attributed to C L Fawer.

48 records · Page 3Linked to original sources
PubMed1984

Correlation of neurologic assessment in the preterm newborn infant with outcome at 1 year.

A prospective study was undertaken of the outcome at 1 year in 129 preterm infants of less than 34 weeks gestation (range 27 to 34 weeks) who underwent detailed neurologic assessment and ultrasound scanning in the neonatal period and again at 40 weeks postmenstrual age, and an independent neurodevelopmental assessment at 12 months chronologic age. Of the 129 infants, 37 (29%) had ultrasound evidence of periventricular hemorrhage. At 40 weeks postmenstrual age the infants were classified as neurologically normal, abnormal, or borderline on the basis of the neurologic examination. Of the 62 infants considered normal at 40 weeks, 57 (91%) were assessed as normal at one year, compared to only 14 (35%) of the 39 infants considered abnormal (P less than 0.001). Ten (85%) of the 12 normal infants with associated periventricular hemorrhage were normal at 1 year, compared to 47 (94%) of the 50 normal infants without periventricular hemorrhage, whereas 5 (25%) of 20 abnormal infants with associated periventricular hemorrhage and 9 (47%) of the 19 without periventricular hemorrhage were normal at 1 year. There was no direct correlation in individual cases between the severity of neurologic deficit and the presence or severity of periventricular hemorrhage. Infants with a cluster of abnormal signs were more likely to have later dystonia or cerebral palsy than those with marked hypotonia but no other abnormality.

Cerebral Hemorrhage↗
PubMed1984

Neurodevelopmental abnormalities in preschool children with high perinatal risk. Prognostic value and consequences on education at 8 years of age.

Two groups of 41 children with high perinatal risk were studied. All children of the study group (SG) had neurodevelopmental abnormalities (NDA) at the age of 5 years, without major handicap. The control group (CG) consisted of 41 children matched for sex, neonatal pathology, birthweight, gestational age and socioeconomic status, without NDA at 5 years. In the SG 85.4% of the children had persistent NDA at school age. In the CG 36.6% of the children presented NDA, but less severe than those of the SG. The SG children had more often associated NDA than those of the CG. The outcome of NDA diagnosed at preschool age and the results of psychometric tests are described. Associated NDA or a borderline IQ, with emotional and behavioral problems, have a gloomy school prognosis. 46.3% of the children in the SG had major schooling problems and 12.2% of children in the CG. These results show the possibility to detect children at risk of school achievement problems before school entrance; they might be useful in counselling and preventing behavioral and educational difficulties.

Achievement↗
PubMed1984

Real-time ultrasonography in the neonate: a systematic study of a high-risk infants population.

During a 12-month period a prospective and systematic study was carried out by means of portable real-time ultrasound (US) scanner in order to detect cerebral lesions in a population of high-risk neonates. Newborn infants were allocated into two groups: group A: all premature infants (n = 83) of less than or equal to 34 weeks' gestation or less and group B: neonates (n = 36) of more than 34 weeks' gestation presenting with abnormal neurological signs. Group A: the overall incidence of periventricular haemorrhage (PVH) was 47% (15 grade I, 16 grade II, 3 grade III, 1 Plexus choroid haemorrhage, 1 isolated intraventricular haemorrhage). Infants of 30 weeks or less were at highest risk to develop a PVH. The degree of severity did not depend on gestational age. Repeated scans accurately timed the onset of PVH; 67% developed a PVH within the first 24 hours of life and 31% within the first 6 hours. A post-haemorrhagic ventricular dilatation was noted in 50% of the 28 infants who survived more than 28 days (4 transient, 7 arrested and 3 rapidly progressive). Group B: 15 of 36 infants had US abnormalities. Cerebral lesions were miscellaneous. Diagnosis of PVH, leukomalacia, agenesis of corpus callosum, calcifications in the basal ganglia, hydranencephaly were made and confirmed at autopsy in 9 fatal cases. US has proved useful for the detection of cerebral lesions among high-risk newborn infants in a Neonatal Unit.

Birth Weight↗
PubMed1983

Auditory brainstem responses in neurologically abnormal infants.

Abnormal auditory brainstem responses (ABR) were recorded in 33 of 59 infants with neurological abnormality in the newborn period compared with a 5 per cent incidence in infants who were neurologically optimal. Abnormality of ABR was most common in infants with intraventricular hemorrhage (17/21) but showed no correlation to size of hemorrhage. Abnormal ABRs were also frequent in infants with apnoeic syndrome (5/8) and in infants with abnormal tone patterns in the absence of intraventricular hemorrhage (7/13). All the infants with birth asphyxia had normal ABRs. Although some infants with midbrain signs had abnormal ABRs, the degree of abnormality did not correlate with the severity of clinical signs. ABR may be a useful adjunct in assessing function in neurologically abnormal infants and in confirming early major hearing deficit. Further studies should show whether the abnormal ABR reflects a primary neurological defect or is secondary to recognisable neurological lesions such as intraventricular hemorrhage. Follow-up studies are also needed to establish whether infants who are clinically abnormal and have abnormal ABR will have a worse prognosis than those without associated abnormality in ABR.

Apnea↗
PubMed1983

Intraventricular haemorrhage in a preterm neonate: discordance between clinical course and ultrasound scan.

A 30-week-gestation preterm infant developed bilateral periventricular haemorrhage with massive right sided parenchymal extension and subsequent porencephaly; yet his subsequent development was unexpectedly good, with a developmental quotient in the normal range and only mild motor delay. He showed no asymmetry of motor function until 10 weeks of age, and the signs were still mild at one year of age.

Cerebral Hemorrhage↗
PubMed1982

Auditory brain stem response in neurologically normal preterm and full-term newborn infants.

A study has been completed on auditory brain stem responses (ABR) in preterm and full-term newborn infants. We have drawn up a regression score for latencies of waves I and V and the I-V interval both at 80 dB and 60 dB stimulation in infants considered neurologically optimal using stringent criteria on both clinical and sequential ultrasound assessment. The 80 dB stimulus gave more consistent results with a narrower standard deviation. Hearing thresholds were difficult to establish with consistency in this population. A parallel study of a neurologically suboptimal population with transient neurological abnormality showed deviations in the ABRs from those of the optimal population. This data should provide a baseline for assessment of abnormal infants.

Audiometry↗
PubMed1982

Elusive blood clots and fluctuating ventricular dilatation after neonatal intraventricular haemorrhage.

Two cases are described of a previously unrecognised sequel of posthaemorrhagic ventricular dilatation. The first case documents freely mobile blood clots within the lateral ventricular system, the second variable asymmetry in the size of the dilated lateral ventricle. The unilateral ventricular dilatation depended on which side the infant was lying, the dependent ventricle being considerably larger than the upper one within 4 hours of head turning. Each of these conditions spontaneously resolved with no specific treatment.

Cerebral Hemorrhage↗
PubMed1982

Risk factors in the development of intraventricular haemorrhage in the preterm neonate.

One hundred and forty-six infants of 34 weeks' gestation or less were repeatedly scanned by means of real-time ultrasound to diagnose the presence of intraventricular haemorrhage (IVH), its severity, and the timing of onset of the condition. We describe a new method for grading the extent of the IVH which does not depend on ventricular size. IVH was clearly present in 52 (36%) of the 146 infants and in 32 (50%) of the 64 infants of 30 weeks' gestation or less. Repeated scans accurately timed the onset of IVH in 41 infants, and 32 (78%) had the first sign of IVH before 72 hours of age. Thirty-two clinical factors were analysed for possible correlation with the development of IVH: outborn compared with inborn, administration of sodium bicarbonate, hypothermia, intermittent positive pressure ventilation, continuous positive airways pressure, hypercapnia, severe acidosis, and respiratory distress syndrome all reached statistical significance. Analysis of variance showed that respiratory distress syndrome was the most important factor, but severe acidosis had some independent action on the development of IVH. Seventeen (81%) of 21 infants with hypercapnia (PCO2 greater than 6 kPa) together with severe acidosis (pH less than 7.1) developed IVH, of which more than half was moderate or severe in degree.

Acidosis↗
PubMed1979

Single injection clearance in the neonate.

The single injection clearance of inulin was compared to the standard clearance in neonates aged 1--20 days. In the first 3 days of life, the single injection method overestimated glomerular filtration rate by approximately 30%. From the 2nd week of life, values obtained by the two techniques were not significantly different. We conclude that caution should be paid when interpreting results obtained by the single injection technique during the very first days of life.

Age Factors↗
PubMed1979

Maturation of renal function in full-term and premature neonates.

The development of renal function was studied in neonates with gestational ages ranging from 28 to 43 weeks. The effect of gestational age on the maturation of renal function was assessed in newborn infants studied during the first 72 h of life. Postnatal maturation was examined during the first 3 weeks of life. None of these neonates presented any cardiopulmonary or renal disturbances. Inulin and PAH were used as markers of glomerular filtration rate and effective renal plasma flow, respectively. From the 28th to the 35th week of gestation, there is a progressive increase in inulin and PAH clearances (r = 0.93; p less than 0.001 and r = 0.81; p less than 0.005, respectively), which then level off up to the end of gestation. A linear increase in systemic blood pressure is observed during the last 12 weeks of gestation (r = 0.88; p less than 0.001). There is a positive significant correlation between the rise in blood pressure and inulin or PAH clearance (p less than 0.005). Postnatal maturation of renal function is similar in preterm and term neonates. In both groups birth is followed by a sharp rise in inulin and PAH clearances, a twofold increase of these parameters being observed during the first two weeks of life.

Gestational Age↗
PubMed1975

[Urinary infections following bladder catheterization].

The incidence and the prophylaxis of urinary tract infection following bladder catheterization have been studied in 142 patients admitted for voiding cystourethrography (VCU). 71 children received a prophylactic treatment of 2 mg/kg nitrofurantoin daily for 4 days, while 71 received no treatment following bladder catheterization. Bacteriologic examination of the urine 4-9 days after catheterization showed significant bacteriuria in 5 untreated children. The germs responsible were E. coli, Proteus, and Klebsiella. None of the treated patients presented with significant bacteriuria. It is concluded that the incidence of significant bacteriuria after a VCU is not inconsiderable, that this urinary tract infection is often asymptomatic, and that the prophylactic administration of a disinfectant is justified.

Adolescent↗