Transcranial Doppler evaluation of cerebral infarction in the neonate

We recorded cerebral artery flow velocities (CAFV) in two neonates with cerebral infarction, using transcranial Doppler sonography (TCD). Cerebral infarction was diagnosed by brain imaging. The arteries investigated were the middle cerebral artery (MCA), the internal carotid artery (ICA) and the anterior cerebral artery (ACA). The whole territory of right MCA was involved. A decrease in CAFV was noted in MCA and ICA of the affected side. Furthermore, early recordings of CAFV allowed us to distinguish perinatal infarction from antenatal infarction: in the former, Doppler signal was completely absent during the first days of life whereas in the latter, Doppler signal was reduced but present. The process of recanalization could be followed. The asymmetry of CAFV recorded in the neonatal period seems to persist definitively at least in MCA. These Doppler data correlate well with the evolutive stages of cerebral infarction shown by brain imaging. Beside US, CT and MRI scans, TCD may be a useful adjunct for identifying and following infants with suspected occlusion of major cerebral vessels.

[Biological indicators of bacterial infection in newborn infants]

Biological markers of neonatal bacterial infection are useful if they bring early indications and if they are sensitive and specific. There are two kinds of tests: hematological signs and acute phase proteins. The most specific hematological signs are, in chronological order: leuconeutropenia--myelemia--neutrophilic polynucleosis. Gestational and post-natal ages have to be taken in consideration for correct interpretation of white cell count and differential. Several acute phase proteins increase in infected newborns: fibrinogen, C reactive protein, orosomucoïd. If determined quantitatively, C reactive protein is a sensitive, specific and early marker allowing, in addition, to follow the reaction to treatment: the return to normal range of CRP and later of orosomucoïd attest for recovery. These biological tests have to be sequentially determined during the first days in order to obtain a maximal information.

[Indications of magnetic resonance imaging in congenital cardiopathies in neonatal period. Apropos of 54 cases]

Between February 1988 and July 1989, the authors used magnetic resonance imaging (MRI) to study 54 newborn infants aged between 2 and 35 days and suspected of congenital heart disease. All children also underwent echocardiography and 7 angiography during the neonatal period (13% of children studied). MRI was well tolerated and there were no adverse events. MRI proved to be complementary to echocardiography in several lesions affecting the great vessels of the base and the left atrial region. Agreement between angiography and MRI results was very good, with MRI being more useful in one case. MRI enables full and non-invasive postoperative follow-up. In conclusion, despite the great heterogenicity of the cardiac malformations studied and which requires a degree of caution, the authors feel that MRI is a second line investigation after echocardiography. It may limit the indications of angiography. Its own indications are the retrocardiac region, the main arteriovenous vessels of the base and postoperative follow-up in congenital heart disease. The development of techniques such as angio RM will further modify data in the future.

[Contribution of transcranial Doppler sonography to the diagnosis of brain death in children]

Brain death can be characterized by cessation of cerebral blood flow. We have measured blood flow velocity in cerebral arteries of 17 comatous children with a transcranial pulsed Doppler equipment. In 11 children who progressed to brain death, we have recorded a progressive decrease of Doppler signal with the following steps: decrease of diastolic velocity, no diastolic velocity, reverse diastolic flow, decrease of systolic signal, no signal at all. In the 6 surviving children (all except one with severe deficits), after an initial reduction but never to a retrograde flow, arterial cerebral blood flow velocity increased to high diastolic values before normalization. Transcranial Doppler technique is non invasive, reliable, can be used at the bedside and repeated; it allows evaluating the cerebral blood flow in comatous children and represents a useful adjunct to brain death diagnosis.

Neonatal echovirus encephalitis with white matter necrosis

The authors report a case of neonatal echovirus encephalitis associated with white matter necrosis. The pattern of illness in the neonatal period was diphasic, marked by hyperthermia and the occurrence of seizures. Echovirus was recovered from the cerebrospinal fluid. Cerebral magnetic resonance imaging (MRI) performed at one month of age showed right periventricular white matter necrosis. The infant exhibited mild left hemiparesis. Cerebral MRI at 6 months of age showed a delay in myelination in the right hemisphere. Echovirus encephalitis in the neonate can cause brain damage.

[Psychosocial factors and sudden infant death syndrome]

Sudden infant death (SID) is a multifactorial syndrome in which the role of psychosocial factors should be taken into consideration. Deep changes in mores and in the way infants are cared for occurred in the second half of the XXth century. Fragmentation of the traditional family has led to increased isolation of the infant. Significant changes have also occurred in the status of women and have translated into increasingly early separation of the mother from her baby. These factors, together with economic difficulties that carry a risk of preterm birth and intrauterine growth retardation, may be involved in the genesis of SIDS. Difficulties experienced by the mother in relating with her child during the first few months of life, a critical period for interaction, may also play a role. Prevention of SIDS should take psychosocial factors into account and attempt to minimize their effect.

Neonatal renal dysfunction and intrauterine exposure to prostaglandin synthesis inhibitors

Three cases of renal dysfunction at birth were observed in premature babies exposed in utero to prostaglandin synthetase inhibitors (PSI) and corticosteroids. Transient water and sodium retention with uraemia occurred in one patient, and severe acute renal failure with marked hyperkalaemia in twins. These findings may be due to impairment of prostaglandin (PG)-mediated renal adaptation to stress conditions after transplacental passage of PSI. Corticosteroids may also have affected PG synthesis inhibition.

Influence of anesthetics on cerebral blood flow velocity in infancy. Effects of halothane versus thiopental-fentanyl

We studied the effects of 2 anesthetic protocols on blood flow velocity of the middle cerebral artery, measured with a pulsed Doppler sonograph in infants. A first group of 10 infants (mean age 64 days) was anesthetized with halothane and nitrous oxide. A second group of 10 infants (mean age 88 days) was anesthetized with thiopental-fentanyl i.v. and nitrous oxide. Heart rate, mean arterial blood pressure (MABP) and mean velocity (MV) decreased during both types of anesthesia. Decrease of MV was of the same magnitude in the 2 groups but MABP decreased more under halothane. After skin incision MABP and MV increased in both groups but MV followed MABP more closely under halothane than under thiopental. These results suggest cerebral blood flow (CBF) reduction after both inductions but by a different mechanism. In spite of cerebral arteriolar dilation with halothane, CBF decreases by means of severe reduction of MABP: CBF is pressure-passive and autoregulation seems to be impaired. In contrast, thiopental induces cerebral arteriolar constriction but CBF is less dependent of MABP changes.

[Meningomyocarditis caused by Coxsackie virus B4 in perinatology. Value of anti-Coxsackie virus B IgM]

The authors report a case of meningocarditis in a neonate caused by a Coxsackie virus B4. Outcome was favorable. Diagnosis was possible by detecting Coxsackie B4 specific IgM using an ELISA test with the sera of the infant and his mother. This assay allows rapid diagnosis and prevention of maternal and neonatal enterovirus infection.

[The transfer of newborn infants. Experience of a department of neonatology]

The results of 6 years of neonatal transport to the neonatology unit of the Hautepierre hospital (January, 1980 to December, 1985) are reported. During that period 1866 neonates were transferred from maternities of Strasbourg and its region to the neonatology unit, representing 23.77% of total admissions. The 350 premature babies born before or at 32 weeks of pregnancy amount to 55% of babies born at the same gestational age. Mortality in that group (46.52%) was associated mainly with hyaline membrane disease and intraventricular haemorrhage. Neonatal infections and congenital malformations were seen in children born after 32 weeks. To improve the quality of transport and reduce morbidity and mortality, the biological and haemodynamic parameters of the neonates should be stabilized prior to their transfer, and all the necessary precautions (i.e. ventilation, oxygenation, temperature, glycaemia, asepsis) should be observed at every stage of their journey. In high-risk pregnancies, "transfer in utero" to a neonatal intensive care unit undoubtedly is the best solution.

[Persistent hyperbilirubinemia after intrauterine intraperitoneal transfusions in 4 newborn infants. Role of intraperitoneal red cells present at birth]

Four neonates who had undergone intra-uterine peritoneal blood transfusions for Rhesus disease and hydrops fetalis presented, during the first days of life, with intractable hyperbilirubinemia in spite of multiple exchange transfusions. The hyperbilirubinemia was due to delayed absorption and hemolysis of peritoneal red cells. This unusual complication can be successfully managed with peritoneal lavage which should be performed when the antenatal history is contributive for low absorption of transfused blood.

[Chickenpox and pregnancy. Perinatal aspects and prevention]

Five neonates born to women who had had varicella late in pregnancy or in the post-partum were admitted to our unit during the last year. In utero transmission of varicella-zoster virus occurred in 2 cases. One of them had no clinical eruption but specific IgM at a titer of 1/200. The mother presented with varicella 15 days before delivery. The other developed severe neonatal congenital varicella (with disseminated eruption, pneumonia and seizures). She was treated by Aciclovir (15 mg/kg/8 h). The mother presented with chickenpox 24 hours after birth. Varicella occurring in a pregnant woman from 4 days before to 2 days after delivery is dangerous because the baby will lack maternal antibodies. It may develop severe neonatal varicella (mortality: 20-30%). A neonate in critical condition was successfully given a prophylactic treatment by Aciclovir IV (15 mg/kg/8 h for 5 days) and varicella-zona immunoglobulins (2 ml on days 1, 2, 3). This approach may be the best treatment for babies at risk for severe neonatal varicella.

Evaluation of single sensor transcutaneous measurement of PO2 and PCO2 in the neonate

A single combined transcutaneous sensor for PO2 and PCO2 was evaluated in a neonatal intensive care unit. The values obtained with the combined sensor were compared with the values obtained with two separate electrodes monitoring respectively PO2 and PCO2. Adequate correlations were found. The combined sensor represents an improvement on individual electrodes as it spares available skin surface and needs less handling.

Erythrocytic sedimentation rate as a measure of clinical activity in inflammatory bowel disease

To assess the reliability of the erythrocytic sedimentation rate (ESR) as a measure of clinical activity in inflammatory bowel disease, we analyzed the correlations of ESR with a global assessment of clinical activity in 77 patients with varying extents of Crohn's disease and ulcerative colitis. Analysis of all 141 ESR determinations in all 77 patients showed a highly significant correlation between mean ESR and clinical activity score (r = 0.54, p less than 0.001). Analysis of 133 ESR determinations in these 77 patients when their disease activity was either mild, moderate, or severe showed some significant differences among certain disease categories. The highest mean ESRs were in patients with the most extensive colon involvement (Crohn's colitis 40.7 +/- 3.3, universal ulcerative colitis 31.0 +/- 3.9), whereas the lowest mean ESRs were in patients with the most limited disease (ulcerative proctitis and proctosigmoiditis 19.2 +/- 2.1). The rate of increase in ESR with progressively increasing clinical activity from mild to moderate was the same in all disease categories, with the exception of Crohn's disease limited to the small bowel (ileitis or jejunoileitis), in which the ESR was relatively unchanged in a small sample of patients. By the time clinical activity became severe, however, patients in all disease categories manifested similarly high ESRs, with the exception of ulcerative proctitis in which the ESR remained low in the single patient tested.(ABSTRACT TRUNCATED AT 250 WORDS)