morphine and Cerebral-Hemorrhage

Topics: Acidosis; Animals; Animals, Newborn; Asphyxia Neonatorum; Bacterial Infections; Cerebral Hemorrhage; Erythroblastosis, Fetal; Female; Fetal Diseases; Hepatitis, Animal; Horse Diseases; Horses; Humans; Hypoglycemia; Hypoxia; Infant, Newborn; Meconium; Nephritis; Pregnancy; Respiratory Insufficiency; Seizures; Syndrome; Virus Diseases

The incidence of preterm meconium staining of the amniotic fluid (MSAF) is uncertain. It may be an indicator of possible listeriosis. It is unclear how great this risk is or whether preterm MSAF is a risk factor for adverse neonatal outcome.. To investigate the incidence of preterm MSAF, the incidence of associated maternal and neonatal infection, and the outcomes of the infants at discharge.. Retrospective case-control study.. Infants < 33 weeks gestation with preterm MSAF born in the Simpson Memorial Maternity Pavilion, Edinburgh between 1 January 1994 and 2 January 2001 were matched with the next infant of the same sex and gestation with clear liquor. Maternal and infant characteristics, culture results, placental histology, and clinical outcomes were compared.. Preterm MSAF was observed in 45/1054 (4.3%) infants below 33 weeks gestation. No maternal or infant listeriosis was identified in cases or controls. There was no significant difference in birth weight, Apgar score, or first pH between cases and controls. Preterm MSAF was associated with prolonged rupture of the membranes (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.07 to 10.49), but not maternal hypertension, sepsis, or chorioamnionitis. Severe (grade 3/4) intraventricular haemorrhage was significantly more common in infants with preterm MSAF (OR 2.03, 95% CI 1.62 to 2.53). There was no significant difference in mortality. Early onset sepsis was observed in two cases and three controls.. Preterm meconium staining of the amniotic fluid may be associated with increased risk of intraventricular haemorrhage. It does not appear to be a useful indicator of listeriosis.

Topics: Amniotic Fluid; Birth Weight; Cerebral Hemorrhage; Chronic Disease; Epidemiologic Methods; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Leukomalacia, Periventricular; Lung Diseases; Male; Meconium; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Scotland; Twins

To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants.. A cohort study of preterm singleton infants born between 25 and 33 weeks gestation.. Pavia, Italy.. Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia.. The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders.. The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98).. This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.

Topics: Acidosis; Adult; Cerebral Hemorrhage; Cerebral Palsy; Cohort Studies; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Leukomalacia, Periventricular; Meconium; Obstetric Labor, Premature; Pregnancy; Risk Factors; Ritodrine; Tocolytic Agents; Urinary Tract Infections

Major advances have been made in the identification and prevention of perinatal factors that lead to long-term handicap or neurologic deficits. When the infant or child exhibits a major handicap, scrutiny of the pregnancy management often occurs in an attempt to define the causal factors. The medical goal of this inquiry is to prevent injuries and, when possible, to eliminate these factors. In the litigious sense, any deviation from optimal, ideal care or any unusual observations, such as unusual or atypical fetal heart rate patterns, are often causally linked to the adverse outcome. There are at least four categories of major fetal injury that probably occur prior to labor. An awareness of, and a diligent search for, details will no doubt clarify the legitimate origins of many so-called birth injuries. Hence the common tendency to fixate on minor deviations and/or deficiencies of labor and delivery management as causing catastrophic injuries will be successfully challenged.

Topics: Adult; Cerebral Hemorrhage; Female; Fetal Diseases; Fetal Heart; Fetal Monitoring; Humans; Infant Mortality; Infant, Newborn; Lung Diseases, Obstructive; Meconium; Myocardial Infarction; Perinatology; Pregnancy; Prenatal Diagnosis; Respiratory Tract Infections

The pattern of arginine vasopressin (AVP) secretion in the immediate neonatal period is unclear. Plasma concentrations of AVP are reflected by its urinary excretion, thus providing a noninvasive method for studying the pattern of AVP release in the neonate. In these studies, we determined the pattern of urinary AVP excretion (microU/mg creatinine) during the first 2-4 days after birth in 78 neonates, 53 of whom had various prenatal and/or neonatal complications. In well term (n = 12) and preterm (n = 13) infants mean urinary AVP excretion decreased gradually during the first 24-36 h after birth. Although term and preterm infants with perinatal asphyxia had highest initial levels of urinary AVP (greater than 200 microU/mg creatinine) and a significant negative correlation with the 1-min Apgar score was obtained, their pattern of excretion was similar to respective controls. After delivery, elevated values for urinary AVP excretion were found among infants with neonatal courses complicated by intracranial hemorrhage, hypoxic encephalopathy, and pneumothorax. Urine osmolality did not correlate linearly with urinary AVP levels, but rather attained a maximum value of approximately 400 mosmol/kg at urinary AVP levels less than 200 microU/mg creatinine and then plateaued. It is concluded that the decrease in urinary AVP excretion observed soon after birth generally reflects diminution of the hypersecretion of AVP during parturition; neonates with evidence of intrapartum asphyxia initially have increased urinary AVP excretion; however, the pattern of excretion is similar to normal infants. During the neonatal period insults such as pneumothorax and intracranial hemorrhage may cause hypersecretion of this hormone.

Topics: Amniotic Fluid; Apgar Score; Arginine Vasopressin; Asphyxia Neonatorum; Cerebral Hemorrhage; Creatinine; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Male; Meconium; Osmolar Concentration; Pneumothorax; Time Factors

The intracranial pressure was monitored via the anterior fontanel, using a noninvasive technique, in 78 acutely ill, 39 normal term, and 6 normal preterm infants. In normal term and preterm infants the anterior fontanel pressure (AFP) was 10.2 +/- 0.4 and 9.5 +/- 0.8 cm H2O, respectively. Infants with hyaline membrane disease had elevated pressure (13.3 +/- 0.6 cm H2O), which was higher than that of normal preterm infants. Following an episode of intracranial hemorrhage in four infants, the AFP increased to 26.2 +/- 2.5 cm H2O. Elevated pressure was noted in infants with meconium aspiration syndrome (24.1 +/- 1.8 cm H2O); the pressure decreased during the phase of recovery (15.6 +/- 3.5 cm H2O). Elevated pressure was noted in infants with meningitis and hydrocephalus. Repeated measurements helped to diagnose shunt obstruction in an infant with hydrocephalus.

Topics: Cerebral Hemorrhage; Cerebrospinal Fluid Shunts; Humans; Hyaline Membrane Disease; Hydrocephalus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intracranial Pressure; Meconium; Meningitis; Monitoring, Physiologic; Syndrome

Sixteen moribund newborn infants with respiratory failure were treated with extracorporeal membrane oxygenation (ECMO) for 1 to 8 days. Cannulation via the right jugular vein and carotid artery was used to establish venoarterial-cardiopulmonary bypass. High flow (80 percent of cardiac output) allowed decreasing FIO2 and airway pressure. Diagnoses and results were as follows: respiratory distress syndrome, four patients (two improved, one survived); meconium aspiration syndrome, eight patients (four improved, three survived); persistent fetal circulation (some with diaphragmatic hernia), four patients (three improved, two survived). Intracranial bleeding occurred in 43 percent, accounting for most of the deaths. In a parallel series of 21 infants treated with conventional ventilator therapy, the mortality rate was 90 percent and intracranial bleeding occurred in 57 percent. ECMO provided life support and gains time in newborn respiratory failure. In high mortality risk infants, the rate of survival is higher and intracranial bleeding lower with ECMO than with optimal ventilator management.

Topics: Cerebral Hemorrhage; Extracorporeal Circulation; Heart Defects, Congenital; Humans; Infant, Newborn; Meconium; Oxygenators, Membrane; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Thrombocytopenia