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Biomedical subjects

G van Wezel-Meijler

Publications and source records attributed to G van Wezel-Meijler.

16 recordsLinked to original sources
PubMed2003

Peri- and intraventricular cerebral sonography in second- and third-trimester high-risk fetuses: a comparison with neonatal ultrasound and relation to neurological development.

OBJECTIVES: To determine whether periventricular leukomalacia (PVL) and peri- and intraventricular hemorrhages can be detected in fetuses at risk for preterm birth and to establish the clinical significance of this finding. METHODS: Prenatal cerebral sonography was performed in 26 fetuses at risk for uteroplacental insufficiency on the day of inclusion into the study and weekly until delivery. Neonatal cerebral ultrasound examination was performed within 24 h of birth and biweekly until discharge. The infants underwent standardized neurological examinations. RESULTS: During 30 observations, 21/26 fetuses presented in a cephalic position. Successful visualization in the coronal and sagittal planes was significantly correlated with that of a control population (r = 0.615; 95% CI, 0.390-0.771). In 20/21 fetuses at least one observation was adequate for analysis. Eleven cerebral abnormalities were found in nine fetuses, periventricular echodensities in four, intraventricular hemorrhage in two, and localized thalamic densities in five. In six of these infants ultrasound abnormalities persisted after birth. Neurological follow-up at 24 months demonstrated abnormalities in three infants, two infants were normal and one was lost to follow-up. The three infants with normal ultrasound results after birth had a normal follow-up. Five infants with normal antenatal ultrasound results showed ultrasound abnormalities during the neonatal period; four of them developed PVL Grade 1 and one developed PVL Grade 2. The follow-up of two of these infants was normal, two died and one developed spastic tetraplegia. Abnormal antenatal brain sonography was significantly correlated with gestational age at birth (r = 0.487; P = 0.029). CONCLUSION: Peri- and intraventricular echodensities can be detected reliably before birth in fetuses at high risk for uteroplacental insufficiency. When abnormalities persist, there is a high risk for an adverse outcome.

Cerebral Hemorrhage↗
PubMed2002

Dietary supplementation of long-chain polyunsaturated fatty acids in preterm infants: effects on cerebral maturation.

AIM: To study the influence of dietary-supplied long-chain polyunsaturated fatty acids on structural brain maturation in preterm infants and to investigate parameters of functional brain development, relating them to structural maturation. Other studies have suggested that dietary supplementation of long-chain polyunsaturated fatty acids in preterm infants may enhance their visual development. The influence on structural brain development has never been evaluated. METHODS: In a prospective, double-blind study, 42 formula-fed premature infants were randomized to be fed either a standard preterm formula without long-chain polyunsaturated fatty acids or an identical formula supplemented with docosahexaenoic acid (0.015 g/100 ml) and arachidonic acid (0.031 g/100 ml). Infants with significant cerebral damage, retinopathy, chronic disease or feeding problems were excluded. Follow-up was focused on assessment of cerebral myelination by MRI. Psychomotor, mental and visual development was analysed and flash-visual evoked potentials were recorded. RESULTS: It was found that progress of myelination, mental and motor development and latencies of visual evoked potentials were not positively influenced by supplementation of long-chain polyunsaturated fatty acids. At each test age, visual acuity was slightly better in the supplemented infants than in the non-supplemented infants, but the difference never reached significance level CONCLUSION: Supplementation of long-chain polyunsaturated fatty acids did not have a demonstrable positive influence on structural brain maturation. Related to this finding, in this small cohort of preterm infants without significant neurological damage, sample size being restricted by strict inclusion criteria and MRI procedures, no significant positive effects were found on psychomotor, mental and visual development.

Analysis of Variance↗
PubMed2001

[Diagnostic imaging of brain maturation in premature infants].

In 3 studies brain maturation in 42 preterm infants with no or minor cerebral deviations was examined with MRI. With a scoring system 5 stadia in gyral development were recognized, which corresponded to the gestational age (duration of amenorrhoea of the pregnant woman). At a gestational age between 30 and 34 weeks, myelin was present in many brain stem, diencephalic and cerebellar structures, but only in a few hemispheric structures. Little progress in myelination was noticed up to the gestational age of 46 weeks. Remnants of the germinal matrix formed a sharp contrast with the immature unmyelinated periventricular white matter and had a characteristic appearance on MR images before term age. Broad periventricular zones with subtle change of signal intensity were also physiological in this age group. Zones with more outspoken signal intensity change compared with the rest of the cerebral white matter were, however, not physiological and represent mild ischaemic change of the periventricular white matter.

Brain↗
PubMed2001

Ultrasonography of the peri- and intraventricular areas of the fetal brain between 26 and 36 weeks' gestational age; a comparison with neonatal ultrasound.

OBJECTIVES: To determine to what extent the peri- and intraventricular areas of the fetal brain can be visualized in coronal and sagittal planes using high-frequency transvaginal ultrasound. DESIGN: In a longitudinal study, fetuses of 30 low-risk pregnancies were studied at 26, 28, 30, 32, 34 and 36 weeks' gestational age. The neonates were examined within the first week of life. Visualization of the peri- and intraventricular areas was systematically scored in six coronal and five sagittal planes. The degree of echogenicity of the periventricular area was assessed. Inter- and intra-observer agreements were calculated. RESULTS: For fetuses in the cephalic position, the highest percentages of visualization of the planes were obtained between 26 and 32 weeks' gestational age (> 70% in four coronal and three sagittal planes). Transient periventricular echodensities were observed at 26 and 28 weeks' gestational age in 6/39 observations in the cephalic position. Small choroid plexus cysts were found in three fetuses with the changes persisting in two until after birth. Seven neonates developed mild periventricular echodensities/translucencies not present during fetal development. The mean interobserver agreement was 0.77 (95% confidence interval (CI) 0.73-0.81). The intra-observer agreement varied between 0.48 and 0.72 (mean 0.6, 95% CI 0.47-0.75). CONCLUSIONS: Transvaginal ultrasonography can be applied as a diagnostic tool to evaluate the peri- and intraventricular areas of the fetal brain. Transient periventricular densities can be encountered between 26 and 28 weeks. Term low-risk neonates may develop transient periventricular densities or translucencies.

Adult↗
PubMed2000

Early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms.

BACKGROUND AND PURPOSE: In the early 1980s, diagnosing periventricular leukomalacia (PVL) in neonates by using cranial sonography was possible for the first time. Our purpose was to investigate the possibility of diagnosing PVL in the acute stage by using MR imaging. We evaluated early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities (flares) on cranial sonograms to determine the added value of MR imaging over sonography alone for early diagnosis of brain damage. METHODS: In a prospective study, infants who showed flares and/or cysts on sonograms underwent MR imaging during the (sub)acute stage. RESULTS: Fifty infants were classified according to the highest sonographic grade up to the day of MR imaging: 23 infants had sonographic grade 1 (flares < 1 week), 15 had sonographic grade 2 (flares > or = 1 week), four had sonographic grade 3 (small localized cysts), and eight had sonographic grade 4 (extensive periventricular cysts); none had sonographic grade 5 (multicystic leukomalacia) on the day of MR imaging. Overall, the additional information provided by MR imaging (over sonography alone) consisted of the depiction of hemorrhagic lesions in 64% of the infants. Extent and severity of the hemorrhages varied from isolated punctate lesions to extensive hemorrhages throughout the white matter; the latter were followed by cystic degeneration at autopsy in two infants. In nine of the 12 infants with cystic PVL, MR images showed more numerous or more extensive cysts. In addition, in two infants, MR images showed cysts not present on sonograms. In 32% of the infants, MR imaging provided no additional information; in these children, all but one had flares on sonograms whereas MR images showed no abnormalities or a zone of mild periventricular signal change. CONCLUSION: MR imaging can depict the precise site and extent of hypoxic-ischemic brain injury at an earlier stage and allows a wider differentiation of lesions as compared with sonography alone. Hemorrhagic PVL is considered to be rare, but was present in 64% of our study population.

Asphyxia Neonatorum↗
PubMed1999

Predictive value of neonatal MRI as compared to ultrasound in premature infants with mild periventricular white matter changes.

A follow-up study was performed in 42 premature infants in whom serial neonatal ultrasound and a single neonatal MRI of the brain was normal, or showed mild periventricular white matter changes. The aim of the study was to evaluate the clinical significance of periventricular signal intensity changes on MRI and to compare the predictive value of neonatal MRI with that of ultrasound. The infants underwent repeated standardised motor assessments and developmental tests. MRI was repeated at the corrected age of 12 months. Pronounced periventricular signal intensity changes on neonatal MRI and periventricular echodensities (flaring) on ultrasound were associated with a high incidence of transient motor problems during infancy. The degree of echogenicity carried the highest predictive value, as compared to duration of flaring on ultrasound and degree of periventricular signal intensity change on MRI. It is concluded that signal intensity changes on neonatal MRI represent the same ischaemic change of the periventricular white matter as flaring on ultrasound and that routine neonatal MRI screening is not warranted in premature infants without clinical evidence of neurological problems and with normal or mildly abnormal ultrasound scans. Recording of the degree of echogenicity should become a routine procedure in neonatal cerebral ultrasonography.

Cerebral Ventricles↗
PubMed1999

Unilateral thalamic lesions in premature infants: risk factors and short-term prognosis.

The aim of the study was to assess incidence, risk factors, clinical symptomatology and short-term outcome of unilateral thalamic lesions in preterm infants, as detected by ultrasound. Sixteen preterm infants, born after a gestational age of less than 35 weeks, with a unilateral thalamic lesion, but without additional significant cerebral lesions, were included. Their follow-up data were compared to those of a selected control group consisting of healthy premature infants. In addition, the neonatal clinical data of the patients with a thalamic lesion were compared to data of the healthy control group and of a general control group, consisting of a non-selected year-cohort of preterm infants. During the study period, the incidence of unilateral thalamic lesions was 5.3% among preterm infants. Ultrasound was not able to distinguish between hemorrhagic and ischemic lesions. The infants with a unilateral thalamic lesion had a more complicated respiratory course and were ventilated significantly longer than infants without such a lesion. The infants with a thalamic lesion had disturbances in tone, persisting throughout infancy, while the healthy control group showed only transient disturbances in tone.

Case-Control Studies↗
PubMed1999

Delayed interval delivery in multiple pregnancies. Is optimism justified?

OBJECTIVE: Evaluation of the success of delayed interval delivery in multiple pregnancies. METHOD: Retrospective analyses of all multiple pregnancies with the birth of one child at a gestational age of 16-31 weeks (n=80). Three groups were defined: group I, unsuccessful attempt to temporize delivery, group II, interval between the first child and the other child or children 3 hours or more, with delivery of the remaining children before 28 weeks and group III, prolongation of pregnancy beyond 28 weeks. RESULTS: In 15 multiple pregnancies (ten sets of twins, five sets of triplets), the aim was to postpone the delivery of the second (and third) child. The mean gestational age at admittance was 25 weeks. Delay of the delivery of the second child was achieved in ten cases, five in group II and five in group III. In groups II and III, the mean interval of delivery was 12 days; the gestational age at the delivery of the remaining children in these ten patients was 27 5/7 weeks. No relation could be found between the reason for admittance and the interval in delivery between the first and the other children. The only severe maternal complication was blood loss exceeding 2 liters. In the neonatal outcome of first and second children (with a gestational age of 28 weeks or more) no striking differences were observed. CONCLUSION: Delayed delivery in multiple pregnancies after the birth of the first child is only successful in a minority of patients and should be considered prior to the birth of the first child.

Birth Intervals↗
PubMed1998

Magnetic resonance imaging of the brain in premature infants during the neonatal period. Normal phenomena and reflection of mild ultrasound abnormalities.

An MRI study was performed in 34 preterm infants who were clinically and neurologically normal and whose cranial ultrasound revealed no or only mild abnormalities. The postconceptional age at MRI varied between 30.6 and 37 weeks. The purpose of the study was to evaluate the significance of periventricular changes in signal intensity on MRI, comparing MRI with ultrasound. T1-weighted and T2-weighted images were assessed for changes in signal intensity of the periventricular white matter relative to the remainder of the cerebral hemispheric white matter. Cerebral MRIs of 13 postterm infants were additionally investigated. In all preterm infants small localized areas of high signal intensity on T1-weighted images and low signal intensity on T2-weighted images were seen adjacent to the frontal horns of the lateral ventricles. They faded with increasing age and were no longer seen one month after term in the group of postterm infants. The areas were considered normal before term age and probably represent remnants of the germinal matrix. Periventricular echodensities corresponded with a zone of changed signal intensity within the periventricular white matter on MRI. MRI signal change correlated with the presence and location of echodensities; the MRI signal changes slowly faded away after the echodensities disappeared.

Brain↗
PubMed1997

[Atrioventricular conduction time in premature infants is about half of that in adults].

OBJECTIVE: To determine the atrioventricular (AV) conduction time in prematurely born infants as part of a comparative electrocardiological study of conduction times versus heart size. DESIGN: Recording and analysis of electrocardiograms. SETTING: Department of Neonatology, University Hospital of the Free University of Amsterdam, the Netherlands. METHODS: Using bipolar precordial leads of standard monitoring equipment in 28 babies, born at a gestational age of 26-36 weeks, ECGs were recorded as soon after birth as possible. The ECGs were analysed and relevant conduction times, such as PR intervals and QRS durations, were measured by hand. These data were related to the birth weights of the infants. (The heart weight amounts to approximately 0.6% of body weight.) RESULTS: Average birth weight of the babies was 1374 g (SD: 491), average PR interval 93 ms (9), QRS duration 40 ms (4), and average heart rate 148/min (14). CONCLUSION: Human hearts weighing 6-10 g have conduction times half that of the adult human heart which weighs 50 times as much. The contribution of the AV node to the total AV conduction time increases with diminishing heart size.

Atrioventricular Node↗
PubMed1997

MRI assessment of myelination of motor and sensory pathways in the brain of preterm and term-born infants.

A study was performed in 48 neurologically normal preterm and term-born infants, with a postconceptional age at MRI varying between 30 2/7 and 46 weeks and a mean age of 34 2/7 weeks. The purpose of the study was to determine the normal progress of myelination on MRI in that age range. T1- and T2-weighted images of the brain were assessed for changes in signal intensity of white matter relative to gray matter. Multiple sites in the brainstem, cerebellum and cerebral hemispheres were assessed separately. The findings were correlated with the ages of the infants. As judged from relative signal intensities, myelin was present at the post-conceptional age of 30-34 weeks in the following structures: tegmentum pontis (in particular medial lemniscus), superior and inferior colliculi, decussation of the superior cerebellar peduncles, crura cerebri, ventrolateral thalamus, lateral globus pallidus, dorsolateral putamen, dentate nucleus, middle and superior cerebellar peduncles, vermis cerebelli, cortex bordering the central sulcus and hippocampus. Little progress in myelination was noticed up to the post-conceptional age of 46 weeks. Between 34 and 46 weeks, myelin appeared in the lateral part of the posterior limb of the internal capsule and in the central part of the corona radiata and became more prominently visible in the cortex bordering the central sulcus.

Age Factors↗
PubMed1996

Normal gyration and sulcation in preterm and term neonates: appearance on MR images.

PURPOSE: To provide a practical standard for normal development of gyri and sulci in preterm and term neonates. MATERIALS AND METHODS: Thirty-nine living preterm infants without substantial neurologic problems underwent magnetic resonance (MR) imaging of the brain. Five infants who were born at term but died of a nonneurologic disorder within 1 week and who underwent autopsy were examined after death with MR imaging. Seven cerebral surface areas were defined, and the development of gyri and sulci in each area was assigned a score between 1 and 5. RESULTS: The postconceptional age (PCA) range of the newborns was 30-42 weeks. When the gyral development scores were assessed as a function of PCA, four transition points could be discerned for the brain as a whole; these transitions occurred at PCAs of 32, 34, 37, and 40 1/2-41 weeks. These four transition points allowed the general gyral development to be divided into five stages. Development of gyri and sulci was most advanced in the area of the central sulcus and the medical occipital area. Development was latest in the frontobasal and frontopolar areas and the anterior part of the temporal lobe. CONCLUSION: A simple staging system allows easy assessment of the progress of cerebral gyration and sulcation in preterm and term infants.

Brain↗
PubMed1990

[Feeding problems in infants with bronchopulmonary dysplasia and other chronic respiratory disorders].

Long lasting feeding problems can occur in children who, in the neonatal period, needed intensive treatment for severe respiratory disease. In some of these children long-term (months) gavage feeding is needed. Retrospectively a group consisting of 16 children with extended feeding problems after neonatal respiratory disease was examined. The results are being described in this article.

Bronchopulmonary Dysplasia↗
PubMed1989

The offspring of mothers with anorexia nervosa: a high-risk group for undernutrition and stunting?

Seven children from three families presented with stunting and low weight-for-height. Their mothers had a history of anorexia nervosa (AN). Evidence was gathered that the children were nourished insufficiently, possibly in combination with psychosocial deprivation. Low growth hormone secretion was documented in three cases. With the increasing ability to induce fertility in anorectic women one should be aware of the effects of maternal AN on the offspring.

Adult↗