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Biomedical subjects

W Cumming

Publications and source records attributed to W Cumming.

8 recordsLinked to original sources
PubMed1999

Cranial ultrasound abnormalities identified at birth: their relationship to perinatal risk and neurobehavioral outcome.

OBJECTIVES: Minor cranial ultrasound abnormalities, such as mild ventricular enlargement, choroid plexus cysts, and subependymal cysts, have been identified in 3% to 5% of the newborn population. Although clinicians generally consider these abnormalities to be insignificant for the outcome of the newborn, few convincing data have been published to support this optimism. The objectives of this study were to identify potential risk factors associated with the identification of cranial ultrasound abnormalities at birth and to determine if the abnormalities were related to neurobehavioral sequelae in the newborn. METHODS: Three hundred eight women were enrolled in this prospective, longitudinal maternal-infant health and development study either at the time they entered the public health care system for prenatal care or at delivery if they had no prenatal care. Each woman participated in an in-depth psychosocial interview at the end of each trimester of pregnancy. Retrospective chart review by experienced medical personnel was used to compile data for the Hobel perinatal risk score for each study participant after delivery. Offspring underwent cranial ultrasound evaluation, the Amiel-Tison Neurologic Assessment, and the Brazelton Neonatal Behavioral Assessment Scale within 96 hours of birth by experienced examiners blinded to any maternal-infant history. RESULTS: Of the 308 women originally enrolled in the study, 301 delivered living infants. Of these, 266 infants (88%) underwent a cranial ultrasound evaluation and are the subject of this article. For the purposes of the current study, infants were divided into those with normal (n = 239) and those with abnormal (n = 27) ultrasound results. Abnormal ultrasound results included the following lesions: subependymal cyst (n = 13); mild ventricular enlargement (n = 6); choroid plexus cysts (n = 3); a combination of cysts and increased ventricular size (n = 2); a 7-mm midline cyst in the superior posterior portion of the third ventricle (n = 1); subependymal hemorrhage and ventricular enlargement (n = 1); and increased ventricular size, subependymal hemorrhage and cysts, and two small, right thalamic calcifications (n = 1). There were no significant differences between those with an abnormal ultrasound and those with a normal ultrasound for birth weight, length, gestational age, rate of prematurity, frequency of nulliparity, or frequency of small for gestational age infants. However, infants with an abnormal ultrasound had a significantly smaller mean head circumference than those with a normal ultrasound (34.5 +/- 1.9 cm vs 33.7 +/- 1.9 cm). The infants with an abnormal ultrasound had a higher median prenatal (50 vs 45), neonatal (14 vs 8), and total (94 vs 77) Hobel risk score but not a higher labor-delivery score. There were no significant differences when these groups were compared on additional risk factors not included in the Hobel scoring system such as race and socioeconomic status. In addition, mothers who used a greater number of drugs during the first trimester of pregnancy were more likely to have an infant with an abnormal ultrasound at birth such that the probability of having an abnormal ultrasound rose to 22% by the time the pregnant women were using four drugs. Neurologic examinations revealed no differences between the infants with normal and abnormal ultrasounds. There were also no group differences for five of the seven Brazelton cluster scores, the excitable or depressed clusters, or eight of the nine qualifier scores. However, infants with abnormal ultrasounds performed significantly better on the habituation (7.3 +/- 0.8 vs 6.6 +/- 1.5) and autonomic regulation (6.5 +/- 0.8 vs 6.0 +/- 1.0) clusters but more poorly on the cost of attention qualifier score (4.9 +/- 1.2 vs 5.5 +/- 1.2) on the Brazelton Neonatal Behavioral Assessment Scale. CONCLUSION: Infants with an abnormal cranial ultrasound at birth had higher perinatal risk scores. (ABSTRACT TRUNCATED)

Brain Diseases↗
PubMed1998

Incidence and description of structural brain abnormalities in newborns exposed to cocaine.

OBJECTIVE: This study was undertaken to determine whether an increased incidence of structural brain abnormalities could be demonstrated in newborns exposed to cocaine. STUDY DESIGN: This study was part of a prospective, longitudinal study of 154 cocaine users matched to 154 control subjects on prenatal risk level, race, parity, and socioeconomic status. Subjects were enrolled prenatally from a rural public health department population or at delivery. Drug exposure was determined by means of repeated, detailed histories and urine screening for drug metabolites. Ultrasonographic examinations were performed within 4 days of birth by experienced technologists and were read by one experienced radiologist, each blinded to drug use history. RESULTS: Cranial ultrasonography results were available for 266 infants (134 cocaine-exposed; 132 control). Only 27 infants had ultrasonography results that were not considered normal, and there were no significant differences between groups (17 cocaine-exposed vs 10 control; p = 0.119). Identified abnormalities included choroid plexus cysts, subependymal cysts, mildly dilated ventricles, and a cyst of the third ventricle. CONCLUSIONS: The incidence of abnormal cranial ultrasonography results in our cocaine-exposed group was lower than that previously reported in the literature and not significantly different from the control group. In addition, the identified lesions were less severe than previously reported, despite a wide range of cocaine use in our sample, including heavy use.

Brain↗
PubMed1991

Guidelines for hemophilia care.

The patient with hemophilia has a multitude of medical and psychosocial concerns. The HIV epidemic has drastically exacerbated his needs. Physicians must continue to educate themselves to keep apace of the rapidly changing treatments for hemophilia and for HIV detection and treatment. These recommendations highlight changes that have taken place in the past several months and are up-to-date as of July 1990. It is likely that they will change, however, as more information becomes known about current factor products and better care for HIV infections.

AIDS Serodiagnosis↗
PubMed1984

A variant of Bartter's syndrome. Bartter's syndrome associated with hydramnios, prematurity, hypercalciuria and nephrocalcinosis.

A case of early onset Bartter's syndrome associated with hydramnios, prematurity, hypercalciuria and nephrocalcinosis is reported. A literature review of Bartter's syndrome supports the hypothesis that the findings in this infant constitute a specific variant of Bartter's syndrome inherited in an autosomal recessive mode. Fetal polyuria in Bartter's syndrome leads to hydramnios, and the excess fluid causes premature birth. This variant of Bartter's syndrome should be included in the differential diagnosis of hydramnios, especially if the woman has had previous hydramnios resulting in a perinatal death. The disorder responds to treatment with indomethacin.

Bartter Syndrome↗