1672 Neonatal Neurosonography Predictors of Cerebral Palsy Preterm Infants

Abstract

was made e i t h e r d i d n o t s u r v i v e g e s t a t i o n or t h e i n i t-i a l neonatal p e r i o d due t o i n t e r r u p t i o n of t h e pregnancy or i n t r a p a r t u m demise. GA a t d i a g n o s i s v a r i e d f r o m 2 6 t o 3 8 w k s w i t h a m e a n of 3 1 wks. Age a t d e l i v e r y v a r i e d from 32 t o 4 0 wks with a mean of 36 wks. Four of t h e s e c h i l d r e n had myelomeningocoele, 6 had hydrocephalus without o t h e r anomalies, t h r e e had i n t r a c r a n i a l c y s t s , and one had an encephalocoele. A l l of them underwent v e n t r i c u l o-p e r i t o n e a 1 shunting. Five had shunt r e l a t e d i n f e c t i o n s. S i x had Bayley mental or Stanford-Binet s c o r e s >80 (4 3 %) , 2 had s c o r e s between 65 and 80 (1 4 %) , and 6 had s c o r e s <65 (4 3 %). The poorer outcome of t h i s group i n com-p a r i s o n t o o t h e r s e r i e s of such hydrocephalus may r e l a t e both t o t h e e a r l y s t a g e a t which t h e d i a g n o s i s was made such t h a t c h i l d r e n with more s e v e r e con-d i t i o n s have survived and t h e high r a t e of i n f e c t i o n. EIOGENIC AMINE METABOLISM IN RETT'S SYNDROME, Huda. P e d i a t r i c s & Neurology, Houston, Texas. R e t t ' s Syndrome i s a progressive d i s o r d e r i n females charac-t e r i z e d by a u t i s t i c behavior, dementia, a t a x i a , l o s s of purpose-f u l use of t h e hands and s e i z u r e s. Extensive laboratory i n v e s t i-g a t i o n s a r e usually normal with t h e exception of electroenceph-alography. To d a t e no biochemical abnormalities have been reported. In an attempt t o f i n d a lead t o t h e pathogenesis of t h i s syndrome we assayed biogenic amine metabolites i n t h e cerebrospinal f l u i d (CSF) of s i x p a t i e n t s , age 2-15 y e a r s , with R e t t ' s Syndrome. The following metabolites were assayed and compared t o age matched controls: 3-methoxy-4-hydroxyphenyl-ethyleneglycol (MHPG) , homovani 11 i c acid (HVA) and 5-hydroxy-indole a c e t i c a c i d (5-HIAA). Results a r e a s follows: Mean + S.D. (nglml). MHPG HVA 5-HIAA P a t i e n t s 7.81t1.49 64.70i26.5 23.83t6.25 Controls 12.35t0.64 110.23+25.83 32.07+8.26 p-val ue 0.0005 0.0008 0.004 Thus, norepinephrine, dopamine, and serotonin metabolites a r e s i g n i f i c a n t l y reduced i n t h e CSF of p a t i e n t s with R e t t ' s Syndrome. This may provide new i n s i g h t i n t o t h e pathogenesis and f u t u r e t h e r a p e u t i c i n t e r v e n t i o n i n t h e s e p a t i e n t s. DIAcs.IOSIS OF GSEBRAL ATROPHY I N WFANTS BY THE NEAR-F I m. MErHOD: A m TECHNIQUE IN CRPNIAZl SONOC,RAPIN ' 671 by Asma Q. fischer, Medical College of Georgia, Dept. of Neurolcqy, Augusta, Georgia Cerebral atrophy in infants has been difficult to assess by cranial sonogram (CS) because the subarachnoid space has been a "blind spot" by ultrasound, yet CS is an ideal imaging methcd for infants as it is portable, non-radiative and unlike c q u t e d cranial tam-qraphy (CCT), requires no intra...

The evolution and outcome of cavitating periventricular leukomalacia in infancy. A study of 46 cases

“…Cyst size has been previously shown to be an accurate predictor of the extent of the neurological damage [8,10] and we have confirmed this finding. In 11 infants the largest cyst was less than 1 cm in diameter and eight (73%) of these infants had no evidence of cerebral palsy.…”

Neonatal risk factors for cerebral palsy in very preterm babies: case-control study

“…In earlier studies, hypotension, transfusion, and patent ductus arteriosus have been associated with periventricular leukomalacia,16 17 18 19 an ultrasound finding which predicts later handicap (especially cerebral palsy) more accurately than any other antecedent 20 21 22 23 24 25 26 27 28 29. Pneumothorax and prolonged ventilation have been associated with both periventricular leukomalacia17 19 30 and cerebral palsy 31 32.…”

Neurosonographic and Biochemical Correlates of Periventricular Leukomalacia in Low-Birth-Weight Infants

“…However, it is essentially impossi ble to distinguish clinically between PVL and other se vere neonatal anoxic encephalopathic processes [28,29], Besides, the clinical features of PVL in the neonatal period and during early infancy are in no way distinc tive: lethargy, hypotonia, feeding difficulties and con vulsions are the most frequent symptoms [30]. In recent years, largely owing to a great interest in neonatal intracranial hemorrhage, cranial sonography has become a routine tool in the evaluation of high-risk newborns and permits the early detection of PVL in liv ing infants [31,32]. In these cases ultrasound scans re veal in a first stage a dense echogenic area in the periven tricular region on the side of hemorrhagic infarction followed by cystic degeneration of the lesion [33].…”