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.

Brain Damage, Chronic↗

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[Artificial amniotic fluid instillation in premature rupture of fetal membranes and extreme prematurity as alternative therapy].

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.

Amniotic Fluid↗

PubMedDate not supplied

[Normal Doppler ultrasound values of the anterior cerebral artery of premature and newborn infants with reference to cardiac function parameters and intestinal blood flow profile].

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.

Anterior Cerebral Artery↗

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[Fetal systolic time intervals in threatened premature labor and their relation to therapeutic efforts].

In a total of 113 single pregnancies we determined foetal systolic time intervals (pre-ejection period, left ventricular ejection time, a quotient of both) in order to investigate the impact of threatened premature labour and the different therapeutic regimen (betamimetics, maternal O2-inhalation, maternal transcutaneous dorsal nerve stimulation) on the myocardial performance capacity. Prolonged systolic time intervals (significant for pre-ejection period) in threatened premature labour (compared with control) supplement the concept of a chronic respiratory impairment of the foe-to-materno-placental relationships. Therapeutic prolongation of the pregnancy by betamimetics led to further impairment of the myocardial contractility while additional oxygen inhalation brought about a positive effect. As indicated by "no changes" after transcutaneous dorsal nerve stimulation, the decisive effect apparently seems not to be in the improvement of the uteroplacental perfusion but more on the direct influence of the raised O2-provision on the foetal myocardium. Non-demonstrable obvious relations to the cardiotocographic findings, such as to the postnatal evaluation criteria, speak against a serious threat to the foetus as the advantages of a reasonable prolongation of the gestational period by betamimetics preponderate. More than that the foetal myocardial impairments are to be favourably influenced by additional O2-therapy.

Acid-Base Equilibrium↗

PubMedDate not supplied

[Antepartal cardiotocographic studies in threatened premature labor and intravenous tocolysis].

In view of the connection which exists between premature birth and placental insufficiency and the means which are available for determining the respiratory performance of the fetoplacental unit by way of cardiotocography, the authors investigated the incidence of prepathological findings in the fetal heart frequency parameters for 81 cases of imminent premature delivery before, during and after intravenous tocolysis, and for 10 normal pregnancies between the 28th and 36th week. The greater number of prepathological cardiotocograms (oscillation amplitude and frequency, periodic acceleration and deceleration) found at the beginning of a trend toward premature delivery beginning with the 30th week of pregnancy, confirms the assumption of a restricted respiratory function of the fetoplacental unit. This restriction is, however, slight. The increase which is observed in these changes, particularly during up to 7 days of intravenous tocolysis in the 28th/29th week of pregnancy, and which continues after the end of intravenous therapy in the further course of pregnancy, is not seen as a result of the effect of betamimetics. The latter obviously do not succeed in positively influencing respiratory insufficiency in the event of imminent premature delivery. Neither the cardiotocographic findings from the beginning of the therapy nor later results permit conclusions to be drawn with regard to its possible success. On the other hand, a prepathological finding, especially where this occurs immediately before delivery, suggests possible larger disturbances of respiratory performance intrapartum, and problems with neonatal adaptation.

Electrocardiography↗

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[Myocardial contractility in newborns following tokolysis with beta-sympathicomimetics].

Using non-invasive methods (carotic pulse sphygmography, electro- and phonocardiography) the effect of maternal tokolysis with beta-sympathicomimetics (Fenoterol in combination with Verapamil) on the systolic intervals in neonates was investigated as a global measurement of cardiac capacity. In 39 newborns (gestational age 35.1 +/- 1.7 weeks), after an average duration of tokolysis of 37.5 days (1-210) with normal birth and normal primary adaptation, the findings as compared with a control group of 22 neonates were as follows: increased pre-ejection time (80.7 +/- 20 as compared with 67.5 +/- 7.5 ms), increased intraventricular time (38.6 +/- 14.3 as compared with 34.9 +/- 7.0 ms) and a higher quotient of pre-ejection and left-ventricular ejection time (0.476 +/- 0.127 as compared with 0.369 +/- 0.06). There are statistically established correlations with the duration of tokolysis. The findings suggest a myocardial is as a rule successfully compensated for by an increase in heart rate, and which disappears in the course of the first week of life.

Ethanolamines↗

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[Severe protracted intrauterine impaired perfusion--a cause of enteral motility disorder in the premature infant].

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)

Birth Weight↗

PubMedDate not supplied

[Impaired postnatal cerebral perfusion after prenatal centralization-- increased risk of neonatal brain injury?].

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.

Acid-Base Equilibrium↗