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Ilagan NB, Weyhing B, Liang KC, Womack SJ, Shankaran S. Congenital syphilitic skeletal manifestations in a premature infant revisited. Clin Pediatr (Phila) 1993; 32:312-3. [PMID: 8324979 DOI: 10.1177/000992289303200514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Increasing rates of congenital syphilis have been reported in recent years despite the availability of adequate therapy. In our perinatal-neonatal center, approximately 1.5% of newborns have reactive serologic tests for syphilis. Untreated or partly treated maternal syphilis can adversely affect neonatal outcome since the treponeme can cross the placenta at any time during pregnancy. As a result of hematogenous placental transmission, neonatal manifestations are usually systemic and similar to the secondary stage of syphilis, and include hepatosplenomegaly, jaundice, neurosyphilis, and skeletal changes. A case of early congenital syphilis in an extremely premature infant with primary skeletal involvement is presented.
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Amarapurkar DN, Vishwanath N, Kumar A, Shankaran S, Murti P, Kalro RH, Desai HG. Prevalence of delta virus infection in high risk population and hepatitis B virus related liver diseases. Indian J Gastroenterol 1992; 11:11-2. [PMID: 1551704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Two hundred and fifty four high risk persons or patients with hepatitis B virus related liver disease (209 men, 45 women; age range 1-78 years) were tested for anti-delta antibody and IgM anti-HBc to determine the prevalence of delta agent coinfection and superinfection. The prevalence of delta infection was as follows: acute viral hepatitis 23/148 (16%) and chronic liver disease 17/92 (19%), and asymptomatic HBsAg carriers 1/6 (17%). In the high risk population, the delta antibody prevalence was as follows: multiple transfusion recipients 3/8 (38%), patients with chronic renal failure 1/5 (20%) and medical professionals 2/7 (29%). Of 44 patients (34 men, 10 women; age 3-63 years) with delta infection, 26 (59%) had coinfection and 18 (41%) had superinfection. Six patients with anti-delta antibody had received blood transfusion(s) and six others gave history of parenteral exposure.
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328
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Shankaran S, Elias E, Ilagan N. Subcapsular hemorrhage of the liver in the very low birthweight neonate. ACTA PAEDIATRICA SCANDINAVICA 1991; 80:616-9. [PMID: 1867077 DOI: 10.1111/j.1651-2227.1991.tb11919.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between 1974 and 1989, 15 neonates were found, at autopsy, to have subcapsular hematoma of the liver in a retrospective clinicopathologic study of 644 neonates. The majority (75%) of the neonates were less than 28 weeks gestation, male gender, and were delivered by the vaginal route following a complicated pregnancy and labor including malpresentation. The clinical course included resuscitation at birth, ventilatory support and hypovolemic shock with death occurring within 24 hours in 11 neonates. Other clinical events included air leak (n = 4 infants) and infection (n = 4). Intracranial hemorrhage was suspected in all but was found at autopsy in 8 neonates. The subcapsular hematoma was intact in 7 and ruptured in 8 neonates. Hence, subcapsular hemorrhage of the liver should be considered in the differential diagnosis of hypovolemic shock in very low birthweight infants.
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329
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Shankaran S, Woldt E, Koepke T, Bedard MP, Nandyal R. Acute neonatal morbidity and long-term central nervous system sequelae of perinatal asphyxia in term infants. Early Hum Dev 1991; 25:135-48. [PMID: 1713544 DOI: 10.1016/0378-3782(91)90191-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates had more than three organ systems involved. Twenty-four neonates survived the neonatal course and at NICU discharge all system effects other than the central nervous system had resolved. At 5 years (60 months), 14 children had a normal neurologic examination, 9 had spastic quadriplegia and one had hemiplegia. Nine children had a McCarthy General Cognitive Index (GCI) greater than or equal to 84, 3 had a GCI between 68 and 83 and 12 scored less than 67. Neonatal seizures, renal problems, microcephaly at 3 months, and post-neonatal seizures were associated with an abnormal neurologic outcome or a GCI less than 67. A neurologic examination during the first year of life may reveal whether children with birth asphyxia will be relatively normal at age 5 years or whether they will show considerable delay.
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Abstract
The list of conditions associated with nonimmune hydrops fetalis has been steadily increasing. We describe a liveborn neonate with fetal hepatoblastoma presenting as nonimmune hydrops. The hepatic tumor was diagnosed on prenatal ultrasound. The infant survived for 2 days. The pathophysiology of nonimmune hydrops in this case is also described.
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331
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Shankaran S, Koepke T, Woldt E, Bedard MP, Dajani R, Eisenbrey AB, Canady A. Outcome after posthemorrhagic ventriculomegaly in comparison with mild hemorrhage without ventriculomegaly. J Pediatr 1989; 114:109-14. [PMID: 2462622 DOI: 10.1016/s0022-3476(89)80616-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The neurodevelopmental sequelae in 33 low birth weight neonates with moderate or severe hemorrhage and ventriculomegaly (VM group) and in 39 neonates with mild hemorrhage only (non-VM group) were evaluated prospectively. Both groups were comparable in birth weight, gestational age, and socioeconomic status. Ventriculoperitoneal shunts were inserted in 23 of the 33 VM group infants at a mean age of 26 days. Eighty-two shunt revisions were performed, for obstruction (71 revisions) or infection (11 revisions), in 18 of the 23 children. At a mean age of 50 months, 19 of 33 children in the VM group had sequelae; 14 children had moderate or severe neurologic deficits, and 5 children had mild sequelae. In the non-VM group, only 3 of 39 children had deficits, all of which were mild (p less than 0.05). In the VM group, 19 of 33 children had mental developmental delay in comparison with 8 of 39 in the non-VM group (p less than 0.05), and 17 of 33 children in the VM group had motor developmental delay in comparison with 5 of 39 in the non-VM group (p less than 0.01). Within the VM group, the number of children with neurodevelopmental sequelae did not differ significantly among the 23 children with shunts, in comparison with the 10 who did not require shunting. Among the children with shunts, a higher incidence of sequelae occurred when lack of ventricular decompression was noted immediately after shunt insertion (p less than 0.005) and when shunt infections occurred (p less than 0.01). The most important predictor of mental and motor outcome in the group with shunts was lack of ventricular decompression immediately after shunt insertion. We speculate that, in some infants, loss of brain tissue, cerebral atrophy, or both may occur before insertion of the ventriculoperitoneal shunt, even when the shunt is inserted early.
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332
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Shankaran S, Cohen SN, Linver M, Zonia S. Medical care costs of high-risk infants after neonatal intensive care: a controlled study. Pediatrics 1988; 81:372-8. [PMID: 2449653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Total medical care costs were studied prospectively from neonatal intensive care unit (NICU) discharge to 3 years of age for 60 children, 35 of whom had neurologic and/or developmental deficits detected immediately following NICU discharge and 25 children did not. At the end of the study period the children were classified as unhandicapped (group A), mildly handicapped (group B), or moderately-severely handicapped (group C). Medical costs are reported per infant per month following NICU discharge (mean +/- SD). The outpatient costs in group A were $31 +/- 23 as compared with $86 +/- 93 in group B and $109 +/- 59 in group C (A less than B, A less than C; P less than .001). The greatest contributor to outpatient costs was occupational and physical therapy (with unproven efficiency to date). The inpatient costs were $31 +/- 56 in group A, $328 +/- 574 in group B, and $542 +/- 737 in group C (A less than C; P less than .01). The US Department of Agriculture estimates of medical costs of raising a child at home ranges from $22 to $26.80 per month. The cost of raising one of our NICU infants in an institution was $1,216 per month. Children with and without neurodevelopmental deficits after NICU discharge have significantly higher medical costs than children without.
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333
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Walker PC, Shankaran S. The bilirubin-displacing capacity of bumetanide in critically ill neonates. DEVELOPMENTAL PHARMACOLOGY AND THERAPEUTICS 1988; 11:265-72. [PMID: 3191818 DOI: 10.1159/000457701] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Effects of bumetanide on in vitro bilirubin binding to albumin were studied in pooled sera of critically ill neonates using the hydroxybenzeneazobenzoic acid (HBABA) dye binding method and the horseradish peroxidase assay. Mean HBABA dye binding capacity decreased significantly from 63.75 +/- 5.9% in the absence of drug to 50.8 +/- 6.7% and 44.6 +/- 6.3% with concentrations of 0.25 and 50 micrograms/ml, respectively (p less than 0.005). Bumetanide caused an increase in unbound bilirubin concentration at drug concentrations of 0.5-50 micrograms/ml. Bumetanide is a potent displacer of bilirubin and should be used with caution in jaundiced neonates.
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334
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Walker PC, Perry BL, Shankaran S. Safety of amrinone for treating congestive heart failure in a premature neonate. CLINICAL PHARMACY 1987; 6:327-31. [PMID: 3665386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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335
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Del Bianco LA, Shankaran S. The design, organization and evaluation of a support group for parents of critically neonates. CANADIAN CRITICAL CARE NURSING JOURNAL 1987; 4:13-5. [PMID: 3649258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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336
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Shankaran S. Prevention of neonatal intracerebral hemorrhage. Indian J Pediatr 1987; 54:134-7. [PMID: 3583366 DOI: 10.1007/bf02750793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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337
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Shankaran S, Cepeda EE, Poland RL. Reply. Am J Obstet Gynecol 1987. [DOI: 10.1016/0002-9378(87)90326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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338
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Shankaran S, Cepeda EE, Ilagan N, Kauffman RE. Pharmacokinetic basis for antenatal dosing of phenobarbital for the prevention of neonatal intracerebral hemorrhage. DEVELOPMENTAL PHARMACOLOGY AND THERAPEUTICS 1986; 9:171-7. [PMID: 3709336 DOI: 10.1159/000457089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The transplacental and elimination pharmacokinetics of phenobarbital administered antenatally was analyzed in both mothers and infants as part of a study evaluating the efficacy of antenatally administered phenobarbital in the prevention of neonatal intracerebral hemorrhage. Twenty-five pregnant women in labor less than 35 weeks' gestation received 500 mg phenobarbital administered intravenously. The maternal serum phenobarbital level at delivery was 8.76 +/- 1.99 micrograms/ml and cord serum phenobarbital level was 9.0 +/- 1.75 micrograms/ml (all values are mean +/- SD). There was no correlation between the time from phenobarbital administration to delivery (5.6 +/- 4.6 h) and the cord:maternal serum phenobarbital ratio (1.05 +/- 0.21) (r = -0.03; p greater than 0.05). The mean apparent half-life of phenobarbital estimated in 11 infants was 175.5 +/- 45.6 h. The present study documents the ability to predict serum levels in the fetus and neonate from the serum concentrations achieved in the mother.
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339
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Shankaran S, Cepeda EE, Ilagan N, Mariona F, Hassan M, Bhatia R, Ostrea E, Bedard MP, Poland RL. Antenatal phenobarbital for the prevention of neonatal intracerebral hemorrhage. Am J Obstet Gynecol 1986; 154:53-7. [PMID: 3511706 DOI: 10.1016/0002-9378(86)90392-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Forty-six pregnant women less than 35 weeks of gestation were enrolled in a prospective randomized controlled study evaluating the effects of antenatal phenobarbital on neonatal intracerebral hemorrhage. The women were randomly assigned to control (n = 22) or treatment (n = 24) groups; the treatment group received 500 mg of phenobarbital intravenously. The time interval between the dose of phenobarbital and delivery was 5.5 +/- 4.8 hours (mean +/- SD). The infants in the control group (n = 23) and those in the phenobarbital-treated group (n = 25) were comparable regarding birth weight, gestational age, and other obstetric and neonatal risk factors associated with intracerebral hemorrhage. The incidence of intracerebral hemorrhage was 56.5% (13 of 23 infants) in the control group and 32% (eight of 25 infants) in the phenobarbital-treated group (p = 0.08). Moderate or severe hemorrhage was diagnosed in six of 13 control infants and in none of the phenobarbital-treated infants (p less than 0.01). The mortality rate was significantly lower in the phenobarbital-treated group (two of 25 infants) than in the control group (eight of 23 infants; p less than 0.05). Our study suggests that antenatal phenobarbital administration results in a decrease in mortality and in the severity of intracerebral hemorrhage in the preterm neonate.
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340
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Cepeda EE, Shankaran S. The effect of multiple exchange transfusions on bilirubin binding. ACTA PAEDIATRICA SCANDINAVICA 1985; 74:545-8. [PMID: 4024925 DOI: 10.1111/j.1651-2227.1985.tb11026.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Three bilirubin binding tests (hydroxybenzene-azobenzoic acid dye binding method, the estimation of unbound bilirubin by horseradish peroxidase assay and the saturation of albumin by the salicylate saturation index) were performed on pre-exchange samples of blood and repeated 24 hours after the procedure. No significant improvement in bilirubin binding was found even in infants receiving as many as four exchange transfusions. Based on these bilirubin binding tests, we find no evidence that the criteria for subsequent exchange transfusions should be different from the first exchange transfusion.
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341
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Poland RL, Slovis TL, Shankaran S. Normal values for ventricular size as determined by real time sonographic techniques. Pediatr Radiol 1985; 15:12-4. [PMID: 3881723 DOI: 10.1007/bf02387846] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Seventy-three real time sonographic scans were performed through the anterior fontanelle of 67 infants between 28 and 48 weeks post-conception who had no evidence of intracranial disease. Several anatomical measurements were plotted against independent variables such as post-conception age, weight and head circumference at the time of the examination. All of the measurements increased as age, weight and head circumference increased. Ratios formed by dividing transventricular diameters by transcalvarial diameters at the two levels in the coronal plane and by dividing occipital mantle thickness by frontal mantle thickness in the parasagittal planes remained stable as all of the independent variables increased. In 88% of cases the occipital mantle could not be measured since the occipital horns of the lateral ventricles could not be identified. Since dilation of the ventricular system starts in the occipital horns of the lateral ventricles, non-visualization of this area is an important negative finding.
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342
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Shankaran S, Szego E, Eizert D, Siegel P. Severe bronchopulmonary dysplasia. Predictors of survival and outcome. Chest 1984; 86:607-10. [PMID: 6478903 DOI: 10.1378/chest.86.4.607] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Predictors of survival and outcome were evaluated following severe bronchopulmonary dysplasia in 35 neonates, 15 of whom died during the initial hospitalization and four following discharge. There was no difference in the clinical characteristics between those infants who survived or died. The survival rate was 47 percent when the length of stay in the hospital was three months and was 17 percent when the length of stay was five months. The survival rate was 27 percent when the time receiving oxygen was three months. There were no survivors when the time receiving oxygen was longer than five months. Follow-up of 13 survivors revealed that four had neurologic sequelae, and two had severe retrolental fibroplasia. When comparing infants with a mean mental developmental index of less than 84 (n = 8) to those with more than 85 (n = 5) on the Bayley Scales of Infant Development, mean length of hospitalization was 125 days vs 72 days (p less than 0.05), and the time receiving oxygen was 84 days vs 46 days (p less than 0.05). When comparing infants with growth parameters below the 5th percentile (n = 4) to those above the 5th percentile (n = 9), the mean time receiving oxygen was 94 days compared to 58 days (p less than 0.05). Severe bronchopulmonary dysplasia is associated with a high mortality and morbidity, both in and beyond the neonatal period.
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343
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Abstract
The absorption and disposition of orally administered chloramphenicol palmitate (chloramphenicol-P) was studied in seven neonates (four preterm, three term). The highest measured chloramphenicol serum concentrations occurred greater than or equal to 4 hours after the dose, and ranged from 5.5 to 23 micrograms/ml after doses of chloramphenicol-P 50 mg/kg/day orally. The dosage had to be increased in all preterm neonates from 25 mg/kg/day to 50 mg/kg/day to obtain adequate serum levels during therapy. In four neonates the apparent half-life could not be estimated, because there was no decline in serum concentrations. The apparent half-life was 3 and 6 hours, respectively, in two neonates in whom the serum concentration declined during the dosing interval. Urinary excretion of chloramphenicol and the glucoronide ester in three neonates varied from 24% to 55% of the total dose administered. These preliminary data suggest considerable variability in serum chloramphenicol levels when chloramphenicol-P is administered orally in neonates. The delay in achieving the maximum serum concentration, nondeclining serum curve, and low renal recovery is indicative of incomplete, prolonged, and erratic absorption, possibly related to delayed gastric emptying or decreased intraluminal hydrolysis of the palmitate ester.
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344
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Slovis TL, Shankaran S, Bedard MP, Poland RL. Intracranial hemorrhage in the hypoxic-ischemic infant: ultrasound demonstration of unusual complications. Radiology 1984; 151:163-9. [PMID: 6701309 DOI: 10.1148/radiology.151.1.6701309] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Seven neonates (four preterm and three term) with severe hypoxic-ischemic parenchymal brain changes are presented to illustrate the kinds of parenchymal lesions demonstrable on ultrasound, to show the similarity of parenchymal lesions in preterm and term infants, and to correlate the severe neurologic deficits with the parenchymal changes. The lesions demonstrated are periventricular leukomalacia, large-vessel infarction, isolated parenchymal hemorrhage, multiple cystic encephalomalacia, and parenchymal atrophy. Parenchymal changes should be sought in such infants during any stage of their disease.
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345
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Bedard MP, Shankaran S, Slovis TL, Pantoja A, Dayal B, Poland RL. Effect of prophylactic phenobarbital on intraventricular hemorrhage in high-risk infants. Pediatrics 1984; 73:435-9. [PMID: 6369238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Forty-two premature infants less than 24 hours of age, with normal admission echoencephalograms, were randomly assigned to control or phenobarbital treatment groups. Infants in the treated group received two loading doses of 10 mg/kg of phenobarbital 12 hours apart, followed by a maintenance dose of 2.5 mg/kg every 12 hours for 6 days. Serial echoencephalograms were obtained in both groups. The groups were comparable with regard to birth weight, gestational age, and potential risk factors for subependymal-intraventricular hemorrhage. Ten infants (48%) in each group developed hemorrhage. The hemorrhages in the phenobarbital-treated group were significantly less severe than those in the control group. The phenobarbital-treated infants who bled, however, were also significantly larger and more mature than control infants who bled. The results of this study indicate no effect of phenobarbital on the incidence of subependymal-intraventricular hemorrhage, but a possible beneficial effect on the severity of hemorrhage.
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346
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Slovis TL, Shankaran S. Ultrasound in the evaluation of hypoxic-ischemic injury and intracranial hemorrhage in neonates: the state of the art. Pediatr Radiol 1984; 14:67-75. [PMID: 6374596 DOI: 10.1007/bf01625809] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The ultrasonic diagnosis of hypoxic-ischemic injury and intracranial hemorrhage in neonates is reviewed. The technical and pertinent anatomical data are presented. The need to diagnose parenchymal lesions is emphasized. A sonographic classification as well as current recommendations for evaluation of intracranial contents in neonates suspected of hypoxic-ischemic injury and/or hemorrhage are presented.
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347
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348
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Bedard MP, Shankaran S. Closure of PDA re risk of IVH. J Pediatr 1983; 102:1015-6. [PMID: 6854443 DOI: 10.1016/s0022-3476(83)80049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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349
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Shankaran S, Farooki ZQ, Desai R. beta-hemolytic streptococcal infection appearing as persistent fetal circulation. AMERICAN JOURNAL OF DISEASES OF CHILDREN (1960) 1982; 136:725-7. [PMID: 7102624 DOI: 10.1001/archpedi.1982.03970440069020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sixty neonates who were transferred to a neonatal intensive care unit during a four-year period had diagnoses of persistent fetal circulation (PFC). Six of these 60 neonates had beta-hemolytic streptococcal infection. The clinical appearance of these six neonates included respiratory distress, cyanosis, and/or apnea. The chest roentgenograms showed mild to moderate lung disease. All six neonates had progressive acidosis with hypoxemia. The diagnosis of PFC was made by cardiac catheterization or contrast echoangiography. The neonates were treated with mechanical ventilation, antibodies, and supportive therapy, including tolazoline hydrochloride. Mortality was high; only one of the six neonates survived. Streptococcal infection should be added to the growing list of conditions associated with PFC.
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350
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Shankaran S, Slovis TL, Bedard MP, Poland RL. Sonographic classification of intracranial hemorrhage. A prognostic indicator of mortality, morbidity, and short-term neurologic outcome. J Pediatr 1982; 100:469-75. [PMID: 7062184 DOI: 10.1016/s0022-3476(82)80462-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sixty-two neonates diagnosed to have periventricular-intraventricular hemorrhage were classified by sonographic findings as follows: mild, confined to the subependymal region or accompanied by a small amount of blood in the normal-sized lateral ventricle (10); moderate, intermediate amount of blood in the enlarged lateral ventricle (26); and severe, hemorrhage filling the entire ventricle forming a cast (12) or intraventricular hemorrhage with an intracerebral extension (14). Twenty-six of 35 surviving neonates had posthemorrhagic hydrocephalus, and 11 infants required shunt insertion. The survival rate of neonates with periventricular-intraventricular hemorrhage and the incidence of posthemorrhagic hydrocephalus correlated with the severity of the hemorrhage (P less than 0.05). The highest mortality rate was seen in the group with ventricular casts. All surviving neonates with casts developed hydrocephalus. All surviving neonates with intracerebral hemorrhage developed porencephaly. The severity of the hemorrhage correlated with short-term neurologic outcome (P less than 0.05), the group most severely affected being the one with intracerebral extension of hemorrhage. The severity of the hemorrhage also correlated with abnormal ventricular size by sonography on follow-up (P less than 0.05). However, posthemorrhagic hydrocephalus and abnormal ventricular size on follow-up did not correlate with neurologic outcome in the moderate and severe hemorrhage groups.
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