Low birth weight and intrauterine growth retardation are well-recognized risk factors for increased mortality, morbidity and poor neurologic outcome. Risk assessment is different considering true preterm (appropriate-for-gestational-age, AGA) or growth-retarded (small-for-gestational-age, SGA) infants. Therefore, we carried out a study on the incidence of hemorrhagic (peri-intraven-tricular hemorrhage, PIVH) and ischemic (periventricular leukomalacia) brain lesions in two groups of AGA and SGA very-low-birth-weight (VLBW) infants. In the study period (1987-1990), 111 VLBW babies (< 1,500 g body weight) were serially studied at days 1, 3 and 7 and weekly until discharge by cerebral ultrasonography (ATL, MK 4, 7.5 MHz). 57 were VLBW-AGA babies (mean gestational age 28 weeks, mean body weight 1,106 g). 54 were VLBW-SGA babies (mean gestational age 31 weeks, mean body weight 990 g). PIVH was graded according to the system of Papile et al. Periventricular leukomalacia was defined as an echodensity (>3 mm) adjacent to the lateral border of the ventricular body. We noted a higher incidence of PIVH in the AGA group (36.8%) than in SGA babies (18.5%; p < 0.01, Fisher test). The AGA subgroup < 1,000 g body weight had 72.2% PIVH compared to AGA babies > 1,000 g (20.5%; p < 0.01). The same relationship was observed in SGA babies (34.8% in < 1,000 g and 6.4% in > 1,000 g babies). Ischemic brain lesions (periventricular leukomalacia) were equally distributed between AGA and SGA babies (10.5 vs. 3.7%, p > 0.5) independently of body weight category. We conclude that VLBW infants are a heterogeneous group of babies with different distribution of hemorrhagic and ischemic brain lesions, extremely low birth weight being a risk factor for PIVH.

In the last years new diagnostic technologies were developed to assess brain development and to identify early brain injury. Some of them are very attractive methods but invasive, expensive, and time-consuming. The availability of clinically useful serum markers of risk for perinatal brain damage will easily permit the development of rational strategies for prevention of cerebral insults in neonates and more accurate prognostic counseling. In this study, protein S-100 (PS-100), a cytosolic constituent of neuroglial cells, was measured serially, during the neonatal period, in a group of preterm infants suffering perinatal asphyxia. Protein S-100 was measured at 1, 7, and 21 days of life by radioimmunoassay. Cerebral ultrasound confirmed cerebral white matter insult. The results of this study show significantly higher protein S-100 serum levels in asphyxiated preterm babies with periventricular white matter lesions, with a peak at 24 hours of life (5.7 +/- 2.9 microg/L) compared with healthy preterm babies (0.6 +/- 0.3 microg/L) ( p <0.05) and progressively lower values at seven (3.3 +/- 2.4 microg/L) and 21 days (2.2 +/- 1.3 microg/L) of life ( p <0.05). These data suggest that elevated protein S-100 serum levels can be considered an indicator of regional brain damage in preterm infants, allowing noninvasive, superior scrutiny of perinatal asphyxia and potential early preventive strategies.

Improvements in the management of respiratory distress syndrome (RDS) include pre- and postnatal stimulation of pulmonary maturity, and triiodothyronine (T3) is believed to influence directly surfactant production. Its circulating levels are low in premature infants with RDS probably due to a low thyroxine T4-T3 hepatic conversion mechanism. While a state of hypotriiodothyroninemia exists at birth, we studied the influence of postnatal intravenous T3 administration on the course of RDS in preterm infants of less than 32 weeks’ gestation. Fifty preterm infants with RDS were studied (mean gestational age 30.4 ± 1.2 weeks and birth weight 1,180 ± 220 g). They were at random assigned to treatment with 50 µg L-T3 (Thyrotardin) or to the control group. Mortality rate, peak oxygen concentrations, duration of artificial ventilation and development of major complications of RDS were the criteria to estimate the influence of T3 treatment on RDS. We failed to detect a statistically significant difference between the two groups in all of the mentioned criteria except for Fio₂ concentrations required to maintain Pao₂ between 50 and 60 mm Hg (p < 0.05). These observations suggest a relative beneficial effect of T3 replacement on the course of RDS in preterm infants of less than 32 weeks of gestation.

Peri-intraventricular hemorrhage (PIVH) is an important complication of the brain in immature newborn infants. In a real-time ultrasound study with frequent scanning of 78 preterm infants (50 with birth-weight less than 1,500 g and 28 weighing more than 1,500 g), we examined the influence of sex on the occurrence of PIVH. A significant difference between sexes was only found in the group with birth-weight below 1,500 g. PIVH occurred in 72% of male infants and in 28% of females (p < 0.001). This effect is probably due to a difference in the timing of cerebral vascular maturation in males leading to a difference in the risk of developing PIVH between the sexes before 34 weeks of gestation.

Background Pregnancy counselling is an important aspect of the care of women of childbearing age who have multiple sclerosis (MS). The issue of cessation of interferon therapy for conception and pregnancy still provokes debate within the MS community, given conflicting study findings. Here we present a review of the literature. Methods A literature search was performed for studies examining the effect of interferon-β therapy on pregnancy outcomes in women with MS. This returned 12 eligible studies, reviewed by two independent reviewers. Results In six studies data was collected retrospectively, prospectively in five studies and by both methods in one study and included a total of 1105 pregnancies 'exposed' to interferon. In 10 studies, there was no increase in the rate of spontaneous abortion or birth defects. Interpretation of studies finding a higher than expected rate of spontaneous abortion was limited by inadequate sample sizes.Conclusions We found 1105 pregnancies in which the effect of interferon exposure was examined in women with MS. There is no evidence of unfavourable pregnancy outcomes in the majority of studies. Given the lack of proven adverse effects with interferon therapy in early pregnancy, neurologists could safely advise females with MS to continue treatment when planning conception.