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Ahmann PA, Lazzara A, Dykes FD, Brann AW, Schwartz JF. Intraventricular hemorrhage in the high-risk preterm infant: incidence and outcome. Ann Neurol 1980; 7:118-24. [PMID: 7369717 DOI: 10.1002/ana.410070205] [Citation(s) in RCA: 168] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To determine the incidence of subependymal (SEH) or intraventricular hemorrhage (IVH) and its short-term outcome, infants of less than 35 weeks' gestation who required intensive care were evaluated and computerized tomographic scans obtained. If the scans showed blood, serial scans were followed until the hemorrhage had resolved and ventricle size was stable. Hemorrhage was quantitated; Seventy-seven of 191 (40.3%) infants were shown to have SEH, IVH, or both; 22 of them (28%) died, and hemorrhage was thought to be the primary cause of death in 17. Fifty-five survivors (71%) with SEH, IVH, or a combination of the two had serial follow-up scans. Six had SEH alone; 49 had IVH. Severe progressive hydrocephalus developed in 12 (22%) infants. Thirty-seven (75.5%) die not show progressive hydrocephalus. The degree of hemorrhage in these 37 was mild in 14, moderate in 13, and marked in 10. Of those with progressive hydrocephalus, hemorrhage was marked in 8 and moderate in 4. Hydrocephalus resolved spontaneously in 4 of the 12. Medical treatment (repeated lumbar punctures) was successful in 3, but failed in 4. Hydrocephalus was managed by shunt surgery in 5. This study revealed that the quantity of blood is prognostically important with regard to both survival (p less than 0.001) and development of progressive hydrocephalus (p less than 0.05). Furthermore, hydrocephalus, even if progressive, may not necessitate surgical management;
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Abstract
All neonates with necrotizing enterocoltis cared for at Grady Memorial Hospital from July, 1977, through February, 1979, were compared with controls matched for birth weight and time of admission to the nursery, to examine risk factors which have been implicated in the etiology of the disease. Data on maternal history, birth history, and hospital course were uniformly collected and contrasted for 35 cases and 98 controls. Low birth weight was associated with an increased incidence of NEC and an increased case fatality rate. All babies 36 weeks or more at birth were diagnosed by seven days. More immature infants developed the disease later in their hospital course. In addition, preterm babies who developed NEC after 2 weeks of age appear to be smaller and sicker. Factors previously thought to predispose an infant to the development of the disease, such as prolonged rupture of membranes, infectious complications of pregnancy, low Apgar scores, patent ductus arteriosus, and use of umbilical catheters, were found with equal frequency in cases and controls and may simply represent the descriptive characteristics of a population of sick premature infants. Feeding history and antibiotic use were examined in depth and were not correlated with the development of NEC.
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Brann AW, Myers RE. Central nervous system findings in the newborn monkey following severe in utero partial asphyxia. Neurology 1975; 25:327-38. [PMID: 235749 DOI: 10.1212/wnl.25.4.327] [Citation(s) in RCA: 102] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Seizures, brain swelling, and cortical necrosis have been observed in the newborn rhesus monkey following a 2 to 4-hour period of intrauterine partial asphyxia produced by halothane-induced maternal hypotension. These clinical and neuropathologic findings are similar to those seen in human newborn infants who have experienced an episode of intrauterine asphyxia from such a cause as premature placental separation. The present study strongly indicates that fetal partial asphyxia, from any cause, in the absence of fetal circulatory collapse or fetal head compression, may be the primary event that sets in motion a vicious cycle of brain swelling and impaired cerebral blood flow, leading finally to cerebral necrosis.
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Biermann J, Dunlop AL, Brady C, Dubin C, Brann A. Promising practices in preconception care for women at risk for poor health and pregnancy outcomes. Matern Child Health J 2007; 10:S21-8. [PMID: 16927159 PMCID: PMC1592161 DOI: 10.1007/s10995-006-0097-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: Two programs targeting urban African-American women are presented as promising models for preconception care, which includes interconception care. Methods: The Grady Memorial Hospital Interpregnancy Care (IPC) Program in Atlanta, Georgia, and the Magnolia Project in Jacksonville, Florida, are described. The IPC program aims to investigate whether IPC can improve the health status, pregnancy planning and child spacing of women at risk of recurrent very low birthweight (VLBW). The Magnolia Project aims to reduce key risks in women of childbearing age, such as lack of family planning and repeat sexually transmitted diseases (STDs), through its case management activities. Results: Seven out of 21 women in the IPC were identified as having a previously unrecognized or poorly managed chronic disease. 21/21 women developed a reproductive plan for themselves, and none of the 21 women became pregnant within nine months following the birth of their VLBW baby. The Magnolia Project had a success rate of greater than 70% in resolving the key risks (lack of family planning, repeat STDs) among case management participants. The black to white infant mortality (IM) ratio was better for the babies born to women managed in the Magnolia Project compared to the same ration for the United States. Conclusions: Preconception care targeted to African-American women at risk for poor birth outcomes appears to be effective when specific risk factors are identified and interventions are appropriate. Outreach to women at risk and case management can be effective in optimizing the woman's health and subsequent reproductive health outcomes.
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Journal Article |
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Reivich M, Brann AW, Shapiro H, Rawson J, Sano N. Reactivity of cerebral vessels to CO 2 in the newborn rhesus monkey. Eur Neurol 1971; 6:132-6. [PMID: 5005112 DOI: 10.1159/000114481] [Citation(s) in RCA: 41] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Watson DG, Smith RR, Brann AW. Arteriovenous malformation of the vein of Galen: treatment in a neonate. AMERICAN JOURNAL OF DISEASES OF CHILDREN (1960) 1976; 130:520-5. [PMID: 1274903 DOI: 10.1001/archpedi.1976.02120060066013] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Heart failure in a 2-day-old infant was not readily explained by clinical examination. Cardiac catheterization suggested an intracranial arteriovenous (AV) fistula, and cerebral arteriography showed a malformation of the vein of Galen. The major feeding arteries were surgically obliterated. At age 27 months, the boy has normal mentation but moderate left hemiparesis. Review of the literature disclosed 39 other infants with AV malformations of the vein of Galen producing heart failure before age 3 months. Most of them were boys, and had cyanosis, a systolic murmer, cranial bruit, cardiomegaly, and right bentricular hypertrophy. Only three of the 13 who had surgery for their malformation survived. Removal of the malformation is difficult; obliteration of the nutrient vessels, using the operating microscope, is the currently accepted treatment.
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Case Reports |
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Dunlop AL, Dubin C, Raynor BD, Bugg GW, Schmotzer B, Brann AW. Interpregnancy primary care and social support for African-American women at risk for recurrent very-low-birthweight delivery: a pilot evaluation. Matern Child Health J 2007; 12:461-8. [PMID: 17712612 PMCID: PMC4118143 DOI: 10.1007/s10995-007-0279-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Very-low-birthweight (VLBW) delivery accounts for the majority of neonatal mortality and the black-white disparity in infant mortality. The risk of recurrent VLBW is highest for African-Americans of lower socioeconomic status. This study explores whether the provision of primary health care and social support following a VLBW delivery improves subsequent child spacing and pregnancy outcomes for low-income, African-American women. METHODS This pilot study of mixed prospective-retrospective cohort design enrolled African-American women who qualified for indigent care and delivered a VLBW infant at a public hospital in Atlanta from November 2003 through March 2004 into the intervention cohort (n (1) = 29). The intervention consisted of coordinated primary health care and social support for 24 months following the VLBW delivery. A retrospective cohort was assembled from consecutive women meeting the same eligibility criteria who delivered a VLBW infant during July 2001 through June 2002 (n (2) = 58). The number of pregnancies conceived within 18 months of the index VLBW delivery and the number of adverse pregnancy outcomes for each cohort was compared with Poisson regression. RESULTS Women in the control cohort had, on average, 2.6 (95% CI: 1.1-5.8) times as many pregnancies within 18 months of the index VLBW delivery and 3.5 (95% CI: 1.0-11.7) times as many adverse pregnancy outcomes as women in the intervention cohort. CONCLUSIONS This small, pilot study suggests that primary health care and social support for low-income, African-American women following a VLBW delivery may enhance achievement of a subsequent 18-month interpregnancy interval and reduce adverse pregnancy outcomes.
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Research Support, Non-U.S. Gov't |
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Stoll BJ, Nahmias AJ, Wickliffe C, Brann AW, Dowell VR, Whaley DN. Bacterial toxin and neonatal necrotizing enterocolitis. J Pediatr 1980; 96:114-5. [PMID: 7350290 DOI: 10.1016/s0022-3476(80)80345-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
This article concerns itself with the effects of HIE on the brain of the full-term infant. Several treatment options are available, with phenobarbital being the drug of choice, but the course remains observation and careful monitoring of the at-risk infant.
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Review |
39 |
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Bondareff W, Myers RE, Brann AW. Brain extracellular space in monkey fetuses subjected to prolonged partial asphyxia. Exp Neurol 1970; 28:167-78. [PMID: 4988465 DOI: 10.1016/0014-4886(70)90171-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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11
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Review |
55 |
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Macris MP, Nahmias AJ, Bailey PD, Lee FK, Visintine AM, Brann AW. Electron microscopy in the routine screening of newborns with congenital cytomegalovirus infection. J Virol Methods 1981; 2:315-20. [PMID: 6267091 DOI: 10.1016/0166-0934(81)90054-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The pseudoreplica method of electron microscopy (EM) was evaluated as a rapid screening technique for the detection of cytomegaloviruria in 3056 neonates in a predominantly lower socioeconomic population. Virus isolation methods detected 49 (1.6%) CMV-positive individuals. When pools of three to five urines were tested, 26 (54%) of the culture-positive neonates were identified by EM; however, testing of individual urines increased EM detection to 33 (67%). Almost all of these urines, as well as urine or oral specimens obtained on follow-up visits, which had infectivity titers greater than or equal to 10(4)/ml were EM-positive, whereas only half of the specimens with titers less than 10(4)/ml were EM-positive. All the symptomatic neonates were detected by EM, suggesting that electron microscopy would be most valuable as a diagnostic aid in this group of CMV-infected neonates.
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Dunlop AL, Salihu HM, Freymann GR, Smith CK, Brann AW. Very low birth weight births in Georgia, 1994-2005: trends and racial disparities. Matern Child Health J 2012; 15:890-8. [PMID: 20221848 DOI: 10.1007/s10995-010-0590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the nature of very low birth weight (VLBW) births in Georgia-a major contributor to the overall and the black-white disparity in infant mortality-as a step toward elucidating strategies for reducing VLBW births. METHODS This population-based retrospective cohort study utilized maternally linked vital records data from Georgia to examine the status of and contributors to the VLBW rate for non-Hispanic blacks and whites by comparing trends in the proportion represented by singleton versus multiple gestations, first versus recurrent events, and specific subtypes over three, consecutive 4-year periods (1994-1996 through 2003-2005); and logistic regression to model the risk of various subtypes of VLBW as a function of maternal and obstetrical characteristics. RESULTS Georgia's VLBW rate remained unchanged from 1994-1996 to 2003-2005, although there was a significant decrease in the rates of twin and first VLBW and a significant increase in recurrent VLBW. For both first and recurrent VLBW, there was a statistically significant increase for blacks and a decrease for whites. The strongest risk factor for a VLBW birth of any subtype for blacks and whites was a prior VLBW, with recurrent VLBW accounting for 4.8-16% of all VLBW depending upon the subtype. CONCLUSION From 1994-1996 to 2003-2005, the rate of recurrent VLBW increased while the rate of first VLBW decreased in Georgia. For both first and recurrent VLBW, the black-white disparity widened. Because the strongest risk factor for a VLBW birth is a previous one, there is a need to identify strategies to prevent a woman's first VLBW birth and to reduce recurrences.
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Journal Article |
13 |
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15
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Sexson WR, Cruze DK, Escobedo MB, Brann AW. Report of an international conference on the medical and ethical management of the neonate at the edge of viability: a review of approaches from five countries. HEC Forum 2011; 23:31-42. [PMID: 21424778 DOI: 10.1007/s10730-011-9149-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Current United States guidelines for neonatal resuscitation note that there is no mandate to resuscitate infants in all situations. For example, the fetus that at the time of delivery is determined to be so premature as to be non-viable need not be aggressively resuscitated. The hypothetical case of an extremely premature infant was presented to neonatologists from the United States and four other European countries at a September 2006 international meeting sponsored by the World Health Organization Collaborating Center in Reproductive Health of Atlanta (currently, the Global Collaborating Center in Reproductive Health). Responses to the case varied by country, due to differences in legal, ethical and related practice parameters, rather than differences in medical technology, as similar medical technology was available within each country. Variations in approach seemed to stem from physicians' perceptions of their ability to remove the neonate from life support if this appeared non-beneficial. There appears to be a desire for greater convergence in practice options and more open discussion regarding the practical problems underlying the variability. Specifically, the conference attendees identified four areas that need to be addressed: (1) lack of international consensus guidelines in viability and therapeutic options, (2) lack of bodies capable of generating these guidelines, (3) variation in laws between countries, and (4) the frequent failure of physicians and families to confront death at the beginning of life.
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Myers RE, Brann AW. Abruptio placentae in rhesus monkey causing brain damage to the fetus. Am J Obstet Gynecol 1976; 126:1048-9. [PMID: 826158 DOI: 10.1016/0002-9378(76)90704-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Letter |
49 |
4 |
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Stiehm ER, DeVivo DC, Brann AW, Fisher DA, Hodson WA, New MI, Shearer WT, Sokol RJ, Sunshine P, Taeusch HW. Advances in perinatology from the clinical research centers. Pediatr Res 1984; 18:197-212. [PMID: 6366722 DOI: 10.1203/00006450-198402000-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Review |
41 |
2 |
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Rivera A, Brann AW, Martinez-de Jesus J, Myers RE. Glycogen content of vital organs of newborn monkeys recovering from asphyxia. BIOLOGY OF THE NEONATE 1972; 20:22-39. [PMID: 5067539 DOI: 10.1159/000240443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Brann AW. Giving Georgia's babies a healthy beginning. JOURNAL OF THE MEDICAL ASSOCIATION OF GEORGIA 2000; 89:26-9. [PMID: 10820973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Dykes FD, Lazzara A, Ahmann P, Blumenstein B, Schwartz J, Brann AW. Intraventricular hemorrhage: a prospective evaluation of etiopathogenesis. Pediatrics 1980; 66:42-9. [PMID: 7402791] [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: 01/25/2023] Open
Abstract
In a study population of 151 newborn infants less than 35 weeks gestation, who required intensive care for more than 24 hours, clinical and biochemical factors associated with the presence of intraventricular hemorrhage (IVH) were prospectively evaluated. The diagnosis of IVH was confirmed by computed tomography, ventricular tap, or autopsy. Alveolar rupture was highly correlated with the presence of IVH. Other factors associated with IVH were: hypoxemia, hypercarbia, mechanical ventilation, peak inflation presser > 25 cm H2O, inspiratory to expiratory ratio > 1:1, patent ductus arteriosus, bicarbonate administration after the first day of life, volume expansion in the first day of life, hypotension, stages III and IV hyaline membrane disease, and intrauterine growth retardation. Early bicarbonate administration (first day), sodium administration > 8 mEq/kg/day, acidosis and birth weight less than or equal to 1,200 gm were associated with IVH only in the infants who died with IVH. Factors not associated with IVH were Apgar less than or equal to 5 at one and five minutes, birth weight, gestational age, male sex, osmolality greater than or equal to 300, serum sodium greater than or equal to 150, hypothermia, continuous distending pressure > 6 cm H2O, positive end-expiratory pressure > 5 cm H2O, outborn birth, obstetric trauma, or coagulopathy. Certain therapeutic interventions may lead to an increase incidence of intracerebral hemorrhage in the high-risk preterm infant.
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Wright DI, Brann AW. Acute bacterial infections in the newborn. JOURNAL OF THE MISSISSIPPI STATE MEDICAL ASSOCIATION 1970; 11:493-500. [PMID: 5466148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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22
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Brann AW, Dykes FD. The effects of intrauterine asphyxia on the full-term neonate. Clin Perinatol 1977; 4:149-61. [PMID: 322912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Review |
48 |
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23
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Smith RE, Brann AW. Resuscitation of the newborn. JOURNAL OF THE MISSISSIPPI STATE MEDICAL ASSOCIATION 1970; 11:417-22. [PMID: 5465163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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24
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Patterson CA, Graves WL, Bugg G, Sasso SC, Brann AW. Antenatal and intrapartum factors associated with the occurrence of seizures in term infant. Obstet Gynecol 1989; 74:361-5. [PMID: 2761911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To identify antenatal and intrapartum risk factors associated with seizures in term newborns, 40 infants who had seizures within 72 hours of birth were compared with 400 controls using logistic regression analysis. The risk of seizure in the term newborn was approximately one per 1000 in the population studied. The logistic regression model identified a group of infants in whom the risk of seizure was approximately one per 100. The risk factors included in the model were antepartum anemia, antepartum bleeding, asthma, meconium-stained amniotic fluid, presentation other than occiput anterior, fetal distress, and shoulder dystocia. Consistent with other studies, our analysis confirmed a strong association between seizures and factors that increase the risk of fetal asphyxia.
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25
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Lazzara A, Ahmann P, Dykes F, Brann AW, Schwartz J. Clinical predictability of intraventricular hemorrhage in preterm infants. Pediatrics 1980; 65:30-4. [PMID: 7355032] [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: 01/24/2023] Open
Abstract
Ninety-eight infants of less than 35 weeks' gestation, consecutively admitted to a regional neonatal intensive care unit, were followed prior to computerized tomography (CT) scan for clinical signs of subependymal and/or intraventricular hemorrhage. The presence or absence of intracerebral hemorrhage was confirmed by CT scan in all patients, and the severity of hemorrhage was quantitated as mild, moderate, or marked. Thirty-seven out of 98 infants (38%) demonstrated intracerebral hemorrhage on CT scan; 20 of 37 (54%) were predicted clinically. Clinical predictability was related to severity of hemorrhage as quantitated by CT scan. Clinical signs that were found helpful in predicting subependymal and/or intraventricular hemorrhage were fall in hematocrit, failure of rise in hematocrit with transfusion of packed red blood cells, tight fontanel, decrease in spontaneous activity, decreased tone, abnormal eye signs, and seizures.
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