Histopathologic Brain Changes in 1152 Cases of the Perinatal and Early Infancy Period

Terplan, Kornel

doi:10.1159/000240079

Cited by 35 publications

(7 citation statements)

References 12 publications

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“…Most investigators discuss these various lesions as though they occur separately, but in our study, as also in a study by Terplan (1967), they occurred in various combinations. The severity of the lesions appeared to depend on the length of time and severity of anoxia and acidosis.…”

Section: Discussionsupporting

confidence: 55%

Brain Changes in Newborns from an Intensive Care Unit

Grunnet

Curless

Bray

et al. 1974

Develop Med Child Neuro

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SUMMARY A study of the brains of 105 newborns (82 pre‐term and 23 term infants), who failed to survive after treatment for severe respiratory distress in an intensive care unit, revealed that 63 of the pre‐term infants died as a result of subependymal germinal plate hemorrhage. Additional lesions were found in the cerebral cortex, hippocampus, cerebral white matter and cranial nerve nuclei. The clinical course of 25 of the 105 infants was studied intensively. In these infants the severity of the lesions appeared to correlate roughly with the length of survival under anoxic and acidotic conditions. The data indicate the importance of determining the fundamental etiology of the germinal plate hemorrhage, of searching for new therapeutic approaches to attack this problem, and of planning follow‐up studies of those infants who survive. RÉSUMÉ L'étude des cerveaux de 105 nouveaux‐nés (82 prématurés et 23 nés a terme) n'ayant pas survécu à un traitement pour détresse respiratoire sévère dans une unité de soins intensifs, a montré que 63 des prématurés sont morts à la suite d'une hémorragie de la plaque germinatif dans la région sous‐ependymaire. Des lesions associées ont été trouvées dans le cortex cérébral, l'hippocampe, la substance blanche cérébrale et les noyaux des nerfs crâniens. L'évolution clinique de 25 des 105 nouveaux‐nés a étéétudiée très soigneusement. Chez ces nouveaux‐nés, la gravité des lésions est grossièrement corrélée avec la durée de la survie en état anoxique et acidosique. Ces données montrent l'importance de déterminer l'étiologie principale des hémorragies de la plaque germinatif dans la région sous‐ependymaire de rechercher de nouvelles approches thérapeutiques pour aborder ce problème et d'entreprendre des études longitudinales chez les suvivants. ZUSAMMENFASSUNG Eine Untersuchung an den Gehirnen von 105 Neugeborenen (82 Frühgeborene und 23 reife Neugeborene), die in einer Intensivstation wegen eines schweren RDS behandelt worden waren und nicht überlebt hatten, ergab, daβ 63 der Frühgeborenen an einer periventrikulären Hirnblutung gestorben waren. Weitere Läsionen fanden sich im Cortex, Hippocampus, in der weiβen Substanz und in den Hirnnervenkernen. Der klinische Verlauf wurde bei 25 der 105 Kinder sehr genau untersucht. Bei diesen Kindern schien das Ausrnaβ der Läsionen ungefähr in Korrelation mit der Dauer der Überlebenszeit unter anoxischen und azidotischen Bedingungen zu stehen. Die Befunde zeigen, daβ es sehr wichtig ist, die grundlegende Ursache für die periventrikuläre Hirnblutung zu finden, neue therapeutische Maβnahmen zur Bekämpfung dieses Problems zu suchen und Nachuntersuchungen der überlebenden Kinder zu planen.

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Section: Discussionsupporting

confidence: 55%

Brain Changes in Newborns from an Intensive Care Unit

Grunnet

Curless

Bray

et al. 1974

Develop Med Child Neuro

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“…term infant can also sustain hypoxic-ischemic injury with clear Both groups of infants were quiet before and during the study, evidence of neurodevelopmental sequelae related to a different breathing spontaneously without any respiratory assistance. Norunderlying pathophysiology (26,27,30). It has been shown that mal-term infants were studied before feeding.…”

Section: Summary Materials and Methodsmentioning

confidence: 99%

Estimated Cerebral Blood Flow in Term Infants with Hypoxic-Ischemic Encephalopathy

1981

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Summary MATERIALS AND METHODSEstimated cerebral blood flow (eCBF) was measured sequenSeven asphyxiated infants showing evidence of HIE and seven tially in seven term infants with evidence of hypoxic-ischemic normal-term infants were studied. ,411 infants in the control group encephalopathy (HIE) and compared with that of normal-term were selected from the normal newborn nurseries of the Royal infants. The eCBF was determined by a noninvasive method Alexandra Hospital and were found to be completely normal upon involving brief bilateral jugular venous occlusion with simultaneous general physical and detailed neurological examinations (21). All measurement of occipitofrontal circumference. There was a sig-infants in the asphyxia group were cared for in the Newborn nificant decrease in eCBF on day 2 (30 f 4 ml/min/100 g brain Intensive Care Nursery of the same hospital. Infants with evidence weight) and on day 4 (36 + 5 mJ/min/100 g brain weight) compared of infection, congential heart disease, congenital abnormalities of with control values (56 2 4 ml/min/100 g brain weight; 54 2 4 mJ/ the nervous system, or respiratory distress unrelated to asphyxia min/100 g brain weight) (P < 0.01). The alveolar CO2 was signifi-were not included in this study. Only those infants who fulfilled cantly lower on days 2 and 4 in the HIE group (P < 0.001), and the following criteria during an initial 24 hr period of observation these values increased to control values by day 6. There was no in the Newborn Intensive Care Nursery were selected: significant correlation between estimated cerebral blood flow and 1. Gestation >37 wk, both by maternal dates and clinical alveolar C 0 2 in infants with HIE. We conclude that term infants assessment, with a birth weight appropriate for gestational with evidence of hypoxic-ischemic encephalopathy demonstrate age. lowered eCBF in the first 4 days of life.2. A history suggestive of fetal disCress including meconium staining, fetal heart rate abnormalities, severe antepartum hemorrhage, or a complicated delivery including breech Speculation extraction, difficult forceps extraction, failed forceps, and/ Some of the treatment schedules used for infants with hypoxicor cesarean section for prolonged labor or fetal distress. ischemic encephalopathy may, in fact, alter brain blood flow.3. Immediate neonatal asphyxia as evidenced by the need for Therefore, consideration of low cerebral blood flow in these infants immediate intubation and resuscitation or Apgar scores of becomes very important when such therapy is contemplated.3 or less at 1 min or 5 or less at 5 min. 4. Neurologic dysfunction as evidenced by seizures, marked abnormalities of behavioral state, posture, tone, motility, Perinatal asphyxia or hypoxic-ischemic encephalopathy (HIE) and reflexes (3,25). Some infants had other system abnoris a significant cause of neonatal mortality and morbidity (1, 2, 6, malities related to asphyxia, i.e., renal, hepatic, and meta-15, 30). The majority of infants who demonstrate neurologic and bolic dysfuncti...

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“…Brand and Bignami (1969) have reviewed the recent literature on the acute effects of hypoxia on the neonatal brain. The neuropathological lesions in infants dying with severe respiratory failure in the first few days of life include selective neuronal necrosis involving the cerebral cortex (Banker and Larroche 1962, Schneck and Neubuerger 1962, Terplan 1967, the thalamus (Riggs 1963), and the Purkinje cells (Schneck and Neubuerger 19621, the dorsal motor nucleus of the vagus nerve (Bucking-ham et al. 1967) and the dorsal cochlear nucleus (Hall 1962).…”

Section: Discussionmentioning

confidence: 99%

“…but in the sole report to date concerning the histological findings incident to hypoglycaemia, Anderson er 01. ( I 967) described changes differing from those reported after hypoxia (Banker and Larroche 1962, Hall 1962, Buckingham et al 1967, Terplan 1967.…”

Section: Introductionmentioning

confidence: 90%

The Effect of Hypoxia and Hypoglycaemia on the Brain of the Newborn Human Infant

Griffiths

Laurence

1974

Develop Med Child Neuro

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SUMMARY Brain sections were studied from 34 infants who died following an episode of clinical hypoxia in the perinatal period. They were divided into two groups of 17 each depending on the additional presence or absence of a recorded episode of hypoglycaemia. Attention was confined mainly to alterations of the neurones in the grey matter. Histologically, both groups of infants, who had been exposed to essentially similar degrees of hypoxia, were characterised by the presence of ‘ischaemic’ nerve‐cell change, the cells involved being shrunken with hyperchromatic cytoplasm and pyknotic nuclei. The distribution of these changes was similar, with predominant involvement of the brain‐stem nuclei, dentate nucleus, thalamus and Ammon's horn. Involvement of the cerebral cortex was less common. The frequency and severity of these changes at the various sites differed slightly but not significantly between the two groups. It appears that in infants who suffer hypoxia in the newborn period, exposure to a limited degree of hypoglycaemia produces no histological evidence of central nervous system damage over and above that produced by the hypoxia. RÉSUMÉ Des coupes cérébrales ont étéétudiées chez 34 nouveaux‐nés morts à la suite d'un épisode d'hypoxie clinique durant la période néo‐natale. Us ont été divisés en deux groupes de 17, selon la présence ou l'absence d'un épisode associé et mis en évidence d'hypoglycémie. L'étude a été concentrée sur les altérations des neurones de la substance grise. Histologiquement, chez les deux groupes d'enfants, exposés au même degré d'hypoxie, on a observé des modifications des cellules nerveuses de type ‘ischémique’, les cellules altérées étant rétrécies avec un cytoplasme hyperchromatique et des noyaux pycnotiques. La répartition de ces modifications était identique, prédominant dans les noyaux du tronc cérébral, le noyau dentelé, le thalamus et la come d'Ammon. L'atteinte du cortex cérébral était moins fréquente. La fréquence et la gravité de ces modifications dans les différents sièges lésionnels présentaient des différences légères mais non significatives entre les deux groupes. II semble done que l'exposition à un degré léger d'hypoglycémie pendant la période néo‐natale n'ajoute pas de lésions du système nerveux central à celles qui sont produites par une hypoxie concomittante. ZUSAMMENFASSUNG Es wurden Hirnschnitte von 34 Kindern untersucht, die in der Perinatalperiode nach einer Episode klinischer Hypoxie gestorben waren. In Abhängigkeit vom zusätzlichen Vorhandensein oder Fehlen einer registrierten Hypoglykämie wurden sie in zwei Gruppen von je 17 Kindern geteilt. In der Hauptsache lag das Interesse bei den Veränderungen der Neurone der grauen Hirnsubstanz. Beide Gruppen der Kinder, die einem grundsätzlich gleichen Ausmaβ von Hypoxie ausgestezt waren, waren histologisch charakterisiert durch eine ‘ischämische’ Nervenzellveränderung, bei der die Zellen geschrumpft sind und ein hyperchromatisches Zytoplasma und einen pyknotischen Kern aufweisen. Die Verteilung dieser Veränderungen war...

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Histopathologic Brain Changes in 1152 Cases of the Perinatal and Early Infancy Period

Cited by 35 publications

References 12 publications

Brain Changes in Newborns from an Intensive Care Unit

Brain Changes in Newborns from an Intensive Care Unit

Estimated Cerebral Blood Flow in Term Infants with Hypoxic-Ischemic Encephalopathy

The Effect of Hypoxia and Hypoglycaemia on the Brain of the Newborn Human Infant

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