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Ultrasonic evaluation of neonatal intracranial hemorrhage and its complications.

High resolution, real-time ultrasound scans were obtained through the anterior fontanelle to examine the intracranial anatomy of 100 neonates. Of 43 patients with abnormalities, 26 had intracranial hemorrhage (subependymal, intraventricular, or cerebral). Of the 51 patients also studied by CT, the sensitivity of ultrasound in detecting hemorrhage was 96% and the specificity 94%. This ultrasound technique was also very useful for detecting complications such as porencephalic and subependymal cysts, ventricular septations, and hydrocephalus. In normal premature neonates (25 to 35 weeks gestation) the lateral ventricles appear as slit-like structures on the coronal scan. The midline-lateral dimension of normal lateral ventricles was 8.6 mm (range 7-11 mm) and the depth of 1.9 mm (range 1-3 mm). Follow-up scans in patients with intraventricular hemorrhage show that in mild hydrocephalus, the lateral ventricle becomes rounded rather than slit-like. This change occurs before the midline-lateral dimension of the ventricle increases.

Brain Diseases↗

Beagle puppy model of perinatal cerebral insults. Cerebral blood flow changes and intraventricular hemorrhage evoked by hypoxemia.

Asphyxia, with its attendant hypoxemia, is by far the most common cause of neonatal cerebral infarction, and frequently results in lesions of the parieto-occipital white matter in addition to other neuropathological changes. This study examines the effects of hypoxemia on regional cerebral blood flow (CBF) in the newborn beagle pup. The animals were anesthetized, underwent a tracheotomy, and were paralyzed. Pups were randomly divided into two groups: one group was subjected to hypoxemia produced by altering the oxygen concentration in the inspired air, and the other received no insult. In the hypoxemic pups, the pO2 was 13.1 +/- 2.1 mm Hg (mean +/- standard deviation). Autoradiographic determinations of CBF were performed by the carbon-14-iodoantipyrine technique 15 minutes after randomization. Significant increases in CBF were found throughout the brains of the hypoxemic pups. The CBF was increased to cortical and central gray regions and to frontal and temporal white matter but was unchanged in the parietal white matter, one of the classic sites of radiological and neuropathological injury in neonates with perinatal asphyxia. An unexpected finding was the increased incidence of germinal matrix and/or intraventricular hemorrhages in the hypoxemic pups.

Animals↗

[Changes of platelet endothelial cell adhesion molecule-1, tissue type plasminogen activator and plasminogen activator inhibitor-1 expression in the lung tissue of neonatal rats after intraperitoneal injection with lipopolysaccharide].

OBJECTIVE: To further explore the pathogenesis of neonatal acute lung injury and neonatal pulmonary hemorrhage by establishing the animal model of neonatal acute lung injury (ALI) and by investigating the changes of platelet endothelial cell adhesion molecule-1 (PECAM-1), tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in ALI. METHODS: Totally 88 neonatal rats which were divided into 8 groups randomly including one normal saline control group and 30 min, 1 h, 2 h, 4 h, 8 h, 16 h and 24 h post injection groups. The changes of lung pathology in newborn rats were observed at different time after LPS was injected intraperitoneally. The changes of PECAM-1 protein, t-PA and PAI-1 mRNA expression were measured by immunohistochemistry and RT-PCR. RESULTS: The expression of PECAM-1 protein and mRNA was decreased and the lowest level was reached at 8 h and 16 h post injection, respectively. The average values were 95.1 +/- 9.76 and 0.861 +/- 0.016, respectively, which were significantly lower than those in the control group (129.5 +/- 6.15, 1.192 +/- 0.035, P < 0.01). The expression of t-PA and PAI-1 mRNA was increased after LPS was injected. The highest level of t-PA mRNA expression was observed at 2 h after injection. The average value was 1.195 +/- 0.036, which was significantly higher than that in the control group (0.781 +/- 0.017, P < 0.01). The highest level of PAI-1 mRNA expression was observed at 2 h, 4 h and 8 h post injection. The average values were 1.178 +/- 0.069, 1.153 +/- 0.036 and 1.176 +/- 0.044, respectively, which was significantly higher than those of the control group (0.681 +/- 0.019, P < 0.01). CONCLUSIONS: The expression of PECAM-1 protein and mRNA was decreased after LPS injection, suggesting the disruption of the tissue protective mechanism; the expression of t-PA and PAI-1 mRNA was increased, indicating the presence of a hypercoagulability state. At the same time, the expression of t-PA mRNA was increased which caused the extra-cellular matrix degradation at the early phase after LPS injection. These three phenomena might be the contributory factors to pulmonary hemorrhage.

Acute Lung Injury↗

Perinatal haemorrhagic necrosis of the adrenal gland. A clinical and radiological evaluation of 24 consecutive cases.

Up to 1970 only13 fully verified and successfully treated cases of neonatal adrenal haemorrhage were on record. As uniform diagnostic and therapeutic guiding principles are still lacking, our experience of 24 consecutive cases appears worth presentation.--The most frequent clinical signs were a palpable mass in 21 cases, jaundice in 14 patients and urinary infection or sepsis in 10 neonates.--Intravenous urography revealed the diagnosis with a reasonable degree of reliability in all our cases. No additional information of significance was obtained at aortography, employed in 2 of our cases.--Surgical exploration with drainage of the haematoma or adrenalectomy was performed in 18 cases, 6 were treated conservatively.--Recovery was uneventful in all but for one conservatively treated patient. In this case death was caused by a second profuse bleeding, which proved fatal in spite of all life saving efforts.

Adrenal Gland Diseases↗

Cerebrospinal fluid glutamine in intracranial hemorrhage in the newborn.

Cerebrospinal fluid concentration of glutamine was measured in 43 premature and mature babies suffering from intracranial hemorrhage. Compared with a control group of 38 infants we found elevated levels in all infants with intraparenchymal and subarachnoid hemorrhages. Two out of ten children with subependymal hemorrhages and approximately half of the children with intraventricular hemorrhages also had elevated levels. Elevated levels of cerebrospinal fluid glutamine persisted for up to three weeks and maximum levels were reached two days to two weeks after birth. The analysis of cerebrospinal fluid glutamine concentration might be useful in the early diagnosis of intraparenchymal and subarachnoid hemorrhage in the newborn infant.

Cerebral Hemorrhage↗

An early rim sign in neonatal adrenal hemorrhage.

Neonatal adrenal hemorrhage can usually be diagnosed on excretory urography without resorting to surgical exploration or invasive diagnostic procedures. In the typical case an avascular mass is seen between the liver and kidney. A case is presented in which a vascular rim surrounded the avascular mass, giving an appearance similar to that of an obstructed upper pole renal duplication. This early vascular rim, not as well known as the calcified rim which develops days to weeks after the acute hemorrhage, is probably created by compression and displacement of adrenal tissue by the central hemorrhage.

Adrenal Gland Diseases↗

Intracranial hemorrhage in premature infants: accuracy in sonographic evaluation.

The real-time high resolution mechanical sonographic sector scanner is a convenient and useful instrument for the detection of intracranial hemorrhage in premature infants. Experience with 27 infants with intracranial hemorrhage detected by sonography and confirmed by computed tomography (CT) or by autopsy is analyzed. The severity of the hemorrhage shown by those methods was graded by an accepted classification for standardized reporting. The extent of intraparenchymal and intraventricular hemorrhage was accurately assessed by sonography in all cases except for small amounts of blood in normal sized ventricles in five of 12 instances. Sonography also failed to detect subarachnoid hemorrhage in each of 13 cases. There were no known false-positive sonograms. From this experience the authors believe sonographic sector scanning should be the initial examination in all infants at high risk for intracranial hemorrhage. When the ventricles are of normal size, CT scanning is recommended to search for small intraventricular hemorrhage that may not be detected by sonography. For subarachnoid bleeding, CT is preferable to sonography.

Cerebral Hemorrhage↗