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  • 1
    Online Resource
    Online Resource
    Fluctuating Pressure-Passivity Is Common in the Cerebral Circulation of Sick Premature Infants
    Springer Science and Business Media LLC ; 2007
    In:  Pediatric Research Vol. 61, No. 4 ( 2007-4), p. 467-473
    Details
    In: Pediatric Research, Springer Science and Business Media LLC, Vol. 61, No. 4 ( 2007-4), p. 467-473
    Type of Medium: Online Resource
    ISSN: 0031-3998 , 1530-0447
    URL: Article
    DOI: 10.1203/pdr.0b013e31803237f6
    Language: Unknown
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2007
    detail.hit.zdb_id: 2031217-9
    SSG: 12
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  • 2
    Online Resource
    Online Resource
    Current Definitions of Hypotension Do Not Predict Abnormal Cranial Ultrasound Findings in Preterm Infants
    American Academy of Pediatrics (AAP) ; 2007
    In:  Pediatrics Vol. 120, No. 5 ( 2007-11-01), p. 966-977
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 120, No. 5 ( 2007-11-01), p. 966-977
    Abstract: OBJECTIVE. Hypotension is a commonly treated complication of prematurity, although definitions and management guidelines vary widely. Our goal was to examine the relationship between current definitions of hypotension and early abnormal cranial ultrasound findings. METHODS. We prospectively measured mean arterial pressure in 84 infants who were ≤30 weeks’ gestational age and had umbilical arterial catheters in the first 3 days of life. Sequential 5-minute epochs of continuous mean arterial pressure recordings were assigned a mean value and a coefficient of variation. We applied to our data 3 definitions of hypotension in current clinical use and derived a hypotensive index for each definition. We examined the association between these definitions of hypotension and abnormal cranial ultrasound findings between days 5 and 10. In addition, we evaluated the effect of illness severity (Score for Neonatal Acute Physiology II) on cranial ultrasound findings. RESULTS. Acquired lesions as shown on cranial ultrasound, present in 34 (40%) infants, were not predicted by any of the standard definitions of hypotension or by mean arterial pressure variability. With hypotension defined as mean arterial pressure & lt; 10th percentile ( & lt;33 mmHg) for our overall cohort, mean value for mean arterial pressure and hypotensive index predicted abnormal ultrasound findings but only in infants who were ≥27 weeks’ gestational age and those with lower illness severity scores. CONCLUSIONS. Hypotension as diagnosed by currently applied thresholds for preterm infants is not associated with brain injury on early cranial ultrasounds. Blood pressure management directed at these population-based thresholds alone may not prevent brain injury in this vulnerable population.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2007-0075
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2007
    detail.hit.zdb_id: 1477004-0
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  • 3
    Online Resource
    Online Resource
    Ultrasonographic Features and Severity Scoring of Periventricular Hemorrhagic Infarction in Relation to Risk Factors and Outcome
    American Academy of Pediatrics (AAP) ; 2006
    In:  Pediatrics Vol. 117, No. 6 ( 2006-06-01), p. 2111-2118
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 117, No. 6 ( 2006-06-01), p. 2111-2118
    Abstract: OBJECTIVE. Early diagnosis of periventricular hemorrhagic infarction in premature infants is based on bedside neonatal cranial ultrasonography. Currently, evaluation of its morphology and evolution by cranial ultrasound relies largely on data predating major advances in perinatal care and lacks a consistent classification system for determining severity of injury. The objective of this study was to examine the ultrasonographic morphology and evolution of periventricular hemorrhagic infarction in the modern NICU and to determine the value of a cranial ultrasonography-based severity score for predicting outcome. METHODS. We retrospectively evaluated all cranial ultrasounds and medical records of 58 premature infants with periventricular hemorrhagic infarction. We assigned each subject a severity score based on extent of echodensity, unilateral versus bilateral, and presence or absence of midline shift. A neurologic examination was performed after 12 months adjusted age. RESULTS. The parenchymal echodensity of periventricular hemorrhagic infarction most often involved parietal and frontal territories and evolved into single and/or multiple cysts. One quarter of cases were bilateral, and nearly 70% were extensive. Higher severity scores were significantly associated with pulmonary hemorrhage and low bicarbonate levels and with outcomes of fatality, early neonatal seizures, and motor disability. CONCLUSIONS. Despite advances in perinatal medicine, periventricular hemorrhagic infarction remains an important complication of prematurity. Periventricular hemorrhagic infarction can be graded using a scoring system based on sonographic characteristics. Higher severity scores predict worse outcome. Such severity scoring could improve the clinician's ability to counsel parents regarding management decisions and early intervention strategies.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2005-1570
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2006
    detail.hit.zdb_id: 1477004-0
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  • 4
    Online Resource
    Online Resource
    Cerebellar Hemorrhage in the Preterm Infant: Ultrasonographic Findings and Risk Factors
    American Academy of Pediatrics (AAP) ; 2005
    In:  Pediatrics Vol. 116, No. 3 ( 2005-09-01), p. 717-724
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 116, No. 3 ( 2005-09-01), p. 717-724
    Abstract: Cerebellar hemorrhage (CBH) in premature infants is increasingly diagnosed secondary to improved neuroimaging techniques and survival of very small preterm infants. Information is limited, however, on the incidence, topography, and risk factors for CBH in the preterm infant. Objectives. To define the incidence of CBH in preterm infants diagnosed by neonatal cranial ultrasound (US), describe the sonographic features of CBH, and identify maternal and perinatal risk factors associated with this lesion. Methods. A systematic electronic database search identified preterm infants born 1998–2002 with US diagnosis of CBH. For 35 cases of CBH we double-matched (according to gestational age, gender, and year of birth) 70 preterm controls with normal cranial USs and performed detailed medical-record reviews for both patients and controls. Results. Unilateral CBH was seen in 25 patients (71%), vermian hemorrhage was seen in 7 (20%), and combined bihemispheric and vermian hemorrhage was seen in 3 (9%). Isolated CBH occurred in 8 patients (23%); the remaining infants had associated supratentorial lesions. The incidence of CBH in preterm infants weighing & lt;750 g at birth showed significant increase over the study period. Univariate analyses identified maternal, intrapartum, and early postnatal hemodynamic risk factors; multivariate regressions indicated that emergent caesarian section, patent ductus arteriosus, and lower 5-day minimum pH independently increased the odds of CBH. Neonatal mortality and morbidity were significantly higher among patients with CBH compared with preterm controls. Conclusions. CBH is an important complication of extreme preterm birth and has been underrecognized in surviving preterm infants. Predictors of CBH seem to be multifactorial and include combined maternal, intrapartum, and early postnatal factors.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2005-0556
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2005
    detail.hit.zdb_id: 1477004-0
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