[Retinal hemorrhage in full-term newborn infants].
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Cerebral computed tomography was performed in 10 neonates with large retinal hemorrhages compared with a control group of 10 full-term neonates without such hemorrhage. No signs of intra-cranial hemorrhage were found. The cerebral ventricles were poorly visualized in both groups. Periventricular low attenuation areas was a frequent finding in both groups.
Maternal smoking during pregnancy is associated with greater rates of premature deliveries, low birth weight, perinatal morbidity and mortality, and impaired intellectual development. It also causes a three-fold greater risk for intracranial hemorrhage in neonates. To our knowledge no neonatal case with intracranial hemorrhage and hematuria related to heavy maternal smoking has been published to date. In this case report we present a neonate with intracranial hemorrhage and hematuria, which were associated with heavy maternal smoking, to emphasize the importance of heavy maternal smoking as a causal factor in neonatal bleeding.
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Follow-up examinations of 21 non-squinting children aged six revealed, that most children who had had extensive bilateral post-partum retinal hemorrhages had a significantly higher incidence of impaired range of fusion (25 degrees max.) as compared to the cases without perinatal hemorrhages. Not a single case of impaired fusion could be improved by orthoptic treatment. The disorder is assumed to be due to a discrete perinatal impairment of the cerebral optomotor centers.
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Neonatal adrenal hemorrhage is common. Relatively large size and extensive vascularity of the gland results in its vulnerability to trauma and traumatic asphyxial injuries. The reported incidence from necropsies is 1.7 per 1000 births. Ultrasound scans were performed on each of 8374 consecutive newborns delivered throughout 48 months ending December 31, 1993, in the Department of Obstetrics and Gynaecology. During our screening, 16 cases of adrenal hemorrhage (10 males and 6 females) were noted at an incidence of 1.9 per 1000. All of the cases of adrenal hemorrhages remained intracapsular with spontaneous resolution. Thirteen cases were right sided, two cases were left sided, and one case was bilateral. None required surgical exploration. Neonatal treatment included further phototherapy in 12 cases, blood transfusions in five cases, and antibiotics in three cases. Signs of transient adrenocortical insufficiency were observed in one child.
To assess the incidence of postneonatal epilepsy in term infants treated with antiepileptic drugs for neonatal seizure discharges that were detected with amplitude-integrated electroencephalography (aEEG), 206 term infants were monitored using this modality. They received antiepileptic drugs for clinical as well as subclinical neonatal seizures. Follow-up data were analyzed for the development of postneonatal epilepsy and for their neurodevelopmental outcome, assessed at 3, 9, 18 months, and 3 and 5 years of age. A total of 169 (82%) neonates received two or more antiepileptic drugs. Overall mortality was 39% (n = 80). Forty-one of the 126 survivors (33%) were abnormal at follow-up, and 12 of them developed postneonatal epilepsy (9.4%). Eighty-four children survived after hypoxic-ischemic encephalopathy grade II (n = 92), and 6 (7%) developed postneonatal epilepsy. In this subgroup, no postneonatal epilepsy was observed if seizures were controlled within 48 hours after birth and when not more than two antiepileptic drugs were required. Twenty-four children survived after an intracranial hemorrhage (n = 28), and only 1 (4%) developed postneonatal epilepsy. Eleven children survived after perinatal arterial stroke (n = 13), and 2 (18%) developed postneonatal epilepsy. In conclusion, the incidence of postneonatal epilepsy after treatment of clinical and subclinical neonatal seizures detected with continuous amplitude-integrated electroencephalography was 9.4%; This figure is lower than previously reported in children who only received treatment for clinical seizures.
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