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Biomedical subjects

E Fazzi

Publications and source records attributed to E Fazzi.

At least 37 records · Page 2Linked to original sources
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

Perinatal factors and 2-year minor neurodevelopmental impairment in low birth weight infants.

Perinatal factors were investigated in 53 low birth weight infants with minor neurodevelopmental dysfunction at 2-year follow-up and in 106 consecutive controls matched for gestational age and birth weight (within 100-gram intervals). The obstetrical history, as evaluated by the obstetrical optimality score, was significantly worse in the cases than in controls (obstetrical optimality score = 50.9 +/- 5.9 vs. 53.2 +/- 6.9, p = 0.019 by Mann-Whitney test). Multiple conditional logistic regression analysis showed that after adjustment for socioeconomic status and education of the mother, a low number (< 3) of prenatal visits, and a third trimester hemorrhage were the only antenatal factors significantly associated with an increased risk of minor infant neurodevelopmental impairment. Neonatal acidosis (pH < 7.2 in the first 24 h of life) and male gender were additional significant perinatal risk factors. Only a few antenatal and perinatal factors are correlated with subsequent minor neurodevelopmental impairment in low birth weight infants.

Acidosis↗
PubMed1995

Pregnancies complicated by idiopathic intrauterine growth retardation. Severity of growth failure, neonatal morbidity and two-year infant neurodevelopmental outcome.

We evaluated the impact of the severity of intrauterine growth retardation (IUGR) measured as the proportion of expected birth weight (birth weight x 100/median birth weight) on short-term neonatal complications and two-year infant neurodevelopmental outcome. The study was carried out on 236 singleton pregnancies complicated by idiopathic IUGR. The rates of bradycardia, respiratory distress syndrome, hypocalcemia, ventilatory support, apneic crises, transient neurologic signs and poor neonatal outcome (neonatal death or cerebral palsy) significantly correlated with the increasing severity of IUGR. In logistic regression analysis more severely growth retarded infants (< 67.5% of expected birth weight) had higher rates of bradycardia, respiratory distress syndrome, hypocalcemia and bacterial sepsis when compared with those less severely affected (84-67.5% of expected birth weight). In pregnancies complicated by idiopathic IUGR, most short-term neonatal complications are inversely related to the severity of growth failure as evaluated by the proportion of expected birth weight.

Adult↗
PubMed1994

Benign paroxysmal vertigo of childhood: a long-term follow-up.

We examined clinical aspects of Benign Paroxysmal Vertigo (BPV) in infancy and its most frequent differential diagnosis, in particular analogies and differences with forms of "migrainous vertigo" (MV) of later onset. During a long-term follow-up of 7 cases of BPV, diagnosed according to the Basser criteria, 5 of 7 BPV cases spontaneously resolved and 6 of 7 patients later developed migraine and other migraine-related symptoms. This course differs from that described for MV only in the age of onset of headache and in the chronological relationship with vertigo. The authors suggest that BPV can be interpreted as a migraine precursor and MV as a migraine equivalent.

Age of Onset↗
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↗
PubMed1994

Two-year infant neurodevelopmental outcome after expectant management and indicated preterm delivery in hypertensive pregnancies.

BACKGROUND: To evaluate the impact of the expectant management of hypertensive disorders of pregnancy on infant neurodevelopmental outcome. METHODS: The two-year neurodevelopmental outcome of infants delivered prematurely because of complications of maternal hypertension after expectant management was compared with that of infants of uncomplicated age-matched pregnancies delivered after spontaneous preterm labor or premature rupture of membranes. RESULTS: The rate of cerebral palsy was similar between the two groups. Conditional logistic regression analysis of the matched sets showed an increased risk of minor neurodevelopmental impairment among infants delivered after severe hypertension (odds ratio (OR) = 4.0, 95% confidence interval (CI) 1.34-12.1) or preeclampsia (OR = 4.0, 95% CI = 1.61-10.2). Fetal growth retardation was not associated with increasing infant neurodevelopmental morbidity. CONCLUSIONS: Infants delivered prematurely because of preeclampsia or severe hypertension are at increased risk of later minor neurodevelopmental problems.

Cerebral Palsy↗
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↗
PubMed1987

Cerebral lesions in early prematurity: EEG prognostic value in the neonatal period.

The new radiological technics show the incidence of intraventricular hemorrhage (IVH), intraparenchymal hemorrhage (IPH), or of porencephaly (PL), in the neonatal period. Discrepancies between the initial extent of lesions and the outcome have been observed. We tried to appreciate the EEG value in infants having had such lesions during the first month of life. We studied serial EEGs and neuroradiological exams in 34 babies: with IVH (group I, 17 cases), with IPH and/or PL (group II, 17 cases). Their gestational age (GA) was between 27 and 34 weeks; they all had a neurological follow-up between one and five years. Infants with favourable outcome (76% in gr. I, 47% in gr. II) had normal or slightly abnormal EEGs, whatever the extent of lesions. Nine babies had very abnormal EEGs (numerous positive rolandic spikes (PRSs) and/or EEG background without physiological rhythms); one developed moderate sequelae, the other 8 major sequelae (2 with infantile spasms). In gr. II, babies with major sequelae had a higher GA than babies with good outcome. The PRSs were more often observed with periventricular lesions than with IVH only and in babies with higher GA; they lasted up to 12 weeks on serial EEGs in one case with porencephaly (major sequelae with infantile spasms); they appeared before scan abnormality in another case which developed later porencephaly (major sequelae). Thus, EEGs give valuable information on brain function and help to forecast outcome in premature babies.

Brain Diseases↗