Brain ultrasound features in multiple births due to spontaneous conception compared with assisted reproductive techniques: a cross-sectional, population-based study

AIM

Multiple pregnancies from spontaneous conception and obtained by assisted reproductive techniques (ART) are associated with a disproportionate share of complications compared with natural singleton pregnancies. The outcome of multiple pregnancies obtained by ART is still the subject of controversial opinions in the medical literature as they are associated with increased rates of perinatal complications, and perinatal mortality, as well as maternal complications. Aim of this study was to determine whether there are differences between these two groups of infants.

METHODS

We examined the imaging findings by means of brain ultrasound (performed at birth and sequentially up to their 6th month of age) in a cohort of 296 twins and triplets born following different techniques of assisted fertilization (63 pregnancies; 119 neonates) vs. spontaneous conception (94 pregnancies; 177 neonates).

RESULTS

We did record, by means of X square corrected test, statistically significant differences (P=0.002) between the two populations at birth in the number of normal ultrasound scans (ART<spontaneous neonates); transient hyperechogenecity (spontaneous<ART neonates) and persistent hyperechogenecity (ART<spontaneous neonates).

CONCLUSION

No differences in brain ultrasound findings between the two groups of ART and between spontaneous vs. assisted conceptions (P=0.959) at long-term follow-up have been noticed.

[Neonatal thrombosis of the middle cerebral artery. Three clinical cases with a 24-month follow up]

Three patients with neonatal thrombosis of the middle cerebral artery are described. In two patients the thrombosis was secondary to neonatal asphyxia. The third patient had a porencephalic cyst twenty days after birth suggesting a prenatal origin of the thrombotic event. The follow-up was carried out for two years. In the first year, two patients had infantile spasms and hyparrhythmic pattern of EEG. This type of epilepsy has never been previously reported. Futhermore, all three patients presented hemiplegia and reduction of cranial circumference. The neuroradiologic procedures showed to be very useful for the diagnosis and long term follow-up. These patients must be followed carefully since the development of a subsequent epilepsy is reported to be approx 11%.

Caudal regression syndrome and annular pancreas: a rare association

A female infant with caudal regression syndrome and annular pancreas is described. This is the first time this association appears to have been described.

Vein of Galen aneurysmal malformation. Different clinical expressiveness. Three case reports

The vein of Galen aneurysmal malformation (VGAM) is a rare cerebro-vascular disorder in neonates. It is characterized by an abnormal direct communication between one or several cerebral arteries and the vein of Galen. It may appear in the neonatal period or afterwards. Three cases of patients affected by VGAM with different clinical expression are presented. Two of them were treated successfully with endovascular embolization. It was not possible to provide the same treatment to the third patient for an intractable congestive heart failure already existing when VGAM was diagnosed.

[The importance of using the cerebral function monitor (CFM) in the neurological prognosis of neonates in intensive care]

Cerebral function monitor (CFM), unlike traditional EEG, allows a long-term evaluation of electric brain activity, without interfering with the nursing of the newborn in the intensive care unit. Our aim was to evaluate the prognostic value of CFM for neurological outcome. We studied 102 newborns (gestational age 34.5 +/- 4.36 weeks; weight 1980 +/- 720 grams) by Multitrace CFM (Lectromed) 5 hours daily in the first week following admission. The patients also underwent cerebral echography, EEG and neurological follow-up to the 24th month. CFM was found to correlate well with the EEG recorded 3 months later. The persistence for at least one week of an I.C. tracing or the normalization of initial tracing have a good prognostic value (positive predictive value 95.23%), a persistently pathologic registration has a negative prognostic value (negative predictive value 85.18%), that even increases if cerebral echographic alterations are demonstrated (98.57%). The association of CFM and ultrasound abnormalities determines a relative risk for neurological motor impairment of 69.14, whereas CFM alone gives a relative risk of 6.4.

[THe echographic diagnosis of diaphragmatic eventration in newborn infants. 2 cases]

The authors report two cases of neonatal partial diaphragmatic eventration. The diagnosis in both two cases was echographic more than radiographic. The authors underline the role of B-mode echography in the diagnosis and follow-up of diaphragmatic anomalies, especially eventration, and suggest that examination of diaphragm and of its motion should complete any abdominal and thoracic echography.

[Oral administration of doxapram in preterm neonates with aminophylline-resistant idiopathic apnea crisis]

Doxapram is an analeptic capable of stimulating both central and periferal areas of the respiratory system. During the last few years, intravenous infusion of doxapram has been carried out, with success, for the treatment of idiopathic apnea in preterm infants otherwise unresponsive to methylxantine. Since doxapram has a tendency to precipitate into various solution containing amino acids and calcium gluconate, oral administration has been suggested. The Authors in this study have seen that in 18 preterm infants suffering from idiopathic apnea unresponsive to amynofillina, an oral administration of doxapram at 12 mg/kg/6h resulted in a complete recovery from apnea spells in 66.7% of cases, while 22.2% gave a partial positive response and only 11.1% a negative result. Furthermore the Authors would like to stress that doxapram showed a good tolerance level when administered orally. In fact, no side effects which were previously reported in other publications were presented in the infants studied.

[Oral administration of itraconazole in a case of neonatal hepatic candidiasis]

Systemic Candida A. infections are increasing in Neonatal Intensive Care Units. For many years, Amphotericin B, alone or in combination with 5-fluorocytosine, have been used. Recently a search for new and less toxic drugs has been started. In this study we report the case of hepatic candidosis in a preterm newborn. The patient has been treated with itraconazole, an oral antifungal agent with broad spectrum activity. Its tolerance has been good. No severe side effects were observed and biochemical parameters showed no consistent drug induced effects.