We studied periventricular/intraventricular type intracranial hemorrhage (ICH) by cranial ultrasonography in 82 low-birth-weight (LBW) newborn infants with admission hypothermia against the gestational-age-matched 82 normothermic neonates. The incidence of ICH was higher in the hypothermic infants during the 1st week of life (34/82 vs 20/82, P less than 0.02). Although the distribution of individual grades of ICH was not significantly different between the groups, the first ultrasound scan showed higher incidence of major ICH (grades 3 and 4) in the hypothermic infants. Most of the minor ICH (grades 1 and 2) after the first ultrasound appeared in infants who were small for their gestational age. Our data do not support the contention that admission hypothermia can precipitate the development of IVH in LBW infants. However, the detection of admission hypothermia in a LBW neonate should make one suspect the possibility of ICH and regard it as a manifestation of the severity of ICH rather than the cause. Most likely, this close relationship between hypothermia and neonatal ICH originates from perinatal asphyxia and the cumulative adverse effects of asphyxia-related events.
In a comparative study of 93 small-for-gestational-age (SGA) infants against 93 weight-matched, appropriate-for-gestational-age (AGA) neonates, the SGA group exhibited a significantly lower incidence of periventricular-intraventricular type intracranial hemorrhage (ICH) at the first ultrasound scan than did the AGA neonates (9/93 vs 21/93; p less than 0.02). This apparent advantage was no longer maintained in later scans of the first week (16/93 vs 27/93; NS), despite the fact that the SGA group were 4 weeks advanced in gestational age and had fewer respiratory problems than the AGA controls. It is prudent, therefore, to follow SGA infants closely for ICH by repeat ultrasound examinations even if the first scan is negative. Evaluation of the subgroup of SGA infants with ICH against the total SGA population revealed lower admission body temperature and Apgar scores, and higher incidence of asphyxia, resuscitation, and mortality. The above observations in SGA infants with ICH and the lack of a similar trend between the AGA infants with ICH and the total AGA population suggest that SGA status, hypothermia, and ICH are interrelated. Hypothermia, therefore, can be used as a convenient marker for the possibility of ICH in low birth weight SGA infants. The authors' data is consistent with the view that hypothermia and ICH are both the consequences of perinatal asphyxia in SGA infants and probably reflect the magnitude of stormy perinatal events.
serum enzymes in the human fetus may originate from mother, placenta or the fetus. We studied paired samples of umbilical cord artery (A) and venous (V) serum enzyme activities, namely, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), amylase and alkaline phosphatase (Alk-P). The study group consisted of a total of 30 infants with a birth weight (mean±sD) of 304o±sol gm, and gestational age of 38.6±2.4 wks. The following is a comparison between venous and arterial serum levels of the remaining enzymes: CPK AST LDH AMYLASE Alk-P venous (U/L) i69'!"97 ini"1oo 3S"l3• 373!154 Arterial (U/ L) 311±115* 43±22* 313±124* 42±16 379±126 bV-A +/-<'> z/15(12lt 2/16(1llt6/20(23)ts;22(27lta;2o(29lt Paired t: *p< o.os, Wilcoxon signed rank test: fp<0.05 Serum CPK, LDH and amylase were higher in the serum of A than V and the direction o! changes were significantly upward from V to A. The negative V-A gradient of these enzymes in cord serum represents fetal contribution and/or placental uptake during each passage of feto-placental circulatory cycle. Intrapartum fetal and placental disorders are expected to produce more acute changes which may be instrumental for further understanding of this issue.
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