morphine and Nervous-System-Diseases

Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH less than 7.00 and base deficit greater or equal to 12 mmol/l. Neonatal complications of intrapartum asphyxia include multiorgan failure and neonatal encephalopathy. Most severe consequences are death and neurological or sensorial impairment. Cause of permanent neurological impairment can be attributed to intrapartum asphyxia if three criteria are met: intrapartum history of a threatening event with acute fetal heart rate deterioration, biological markers of asphyxia, neonatal encephalopathy. Moderate to severe neonatal encephalopathy in asphyxiated term infants is associated with a high risk of cerebral palsy (especially quadriplegic or dyskinetic type) and/or cognitive disorders. Prognosis of neonatal encephalopathy can be accurately assessed by MR imaging.

Topics: Acidosis; Apgar Score; Biomarkers; Brain Diseases; Cerebral Palsy; Female; Fetal Blood; Fetal Hypoxia; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lactic Acid; Magnetic Resonance Imaging; Meconium; Multiple Organ Failure; Nervous System Diseases; Pregnancy; Ultrasonography

Exposure to organochlorine compounds (OCs) has been a subject of interest in recent years, given their potential neurotoxicity. Meconium is easily available and accumulates neurotoxicants and/or metabolites from the 12th week of gestation.. To determine whether neurotoxicants, specifically OCs, could be detected in serially collected meconium, and to compare the results with those obtained in cord blood samples.. A sample of cord blood and three serial stool samples were analysed in 10 newborns. Pentachlorobenzene (PeCB), hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), dichlorodiphenyl trichloroethane (p,p'-DDT) and its metabolite dichlorodiphenyl dichloroethylene (p,p'-DDE), and hexachlorocyclohexane isomers (alpha-, beta-, gamma-, and delta-HCH) were analysed by gas chromatography.. From serial stool collection and analysis in newborns, there was an increase in the concentrations of HCB, p,p'-DDE, PCBs, and beta-HCH between the first and last stools of the newborn. Levels of DDT diminished as pregnancy progressed. Concentrations in cord blood were positively associated with concentrations in meconium for p,p'-DDE and beta-HCH.. Meconium is a very useful instrument for the investigation of fetal exposure to neurotoxicants; serial collection and analysis of meconium should estimate the timing and degree of in utero exposure of the fetus to neurotoxicants. Analysis and interpretation of neurotoxicants in meconium results is a complex process. Measurement in meconium of a wide range of neurotoxic substances should facilitate early identification of harmful exposures, and enable rehabilitation and instigation of preventive measures.

Topics: Adult; Female; Fetal Blood; Hazardous Substances; Humans; Hydrocarbons, Chlorinated; Infant, Newborn; Meconium; Nervous System Diseases; Pregnancy; Prenatal Exposure Delayed Effects

Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables.. Healthy newborns with birth weights > or =2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at approximately 6 weeks of age by an examiner blinded to history.. At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine-unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04-8.25), if the maternal urine cotinine level was >200 ng/mL.. Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine-exposed infants.

Topics: Cocaine; Confounding Factors, Epidemiologic; Cotinine; Female; Humans; Infant; Infant, Newborn; Logistic Models; Male; Meconium; Muscle Hypertonia; Nervous System Diseases; Neurologic Examination; Nicotine; Pregnancy; Prenatal Exposure Delayed Effects; Prospective Studies; Smoking

Neonatal neurological morbidity was studied in relation to Apgar score, meconium stained amniotic fluid and acidaemia at birth in 247 small-for-gestational age (SGA) maturely born infants. SGA infants, and especially the severely SGA infants and those born abdominally, showed higher rates of neurological morbidity, acidaemia and meconium stained amniotic fluid than appropriate-for-gestational age (AGA) controls. The examined indicators of asphyxia at birth showed slightly higher correlation coefficients with the 'neonatal neurological optimality score' (NNOS) in SGA, than in AGA term infants, but the percentage of explained variance was low, except in the 23 infants born abdominally. In this group poor neurological outcome was restricted to the 14 infants who showed signs of fetal hypoxaemia diagnosed by decelerative fetal heart rate (FHR) patterns. In 11 of them, FHR decelerations occurred antepartum. These FHR abnormalities appear to be better predictors for the neonatal neurological outcome than indicators of asphyxia at birth.

Topics: Apgar Score; Asphyxia Neonatorum; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Small for Gestational Age; Meconium; Nervous System Diseases

The relation between Apgar score, meconium and acidaemia at birth and neonatal neurological morbidity was investigated in 805 vaginally born term infants whose birthweight was appropriate-for-dates (AFD). Presence or absence of meconium stained amniotic fluid was not related to the neonatal neurological condition. The 1-min and 3-min Apgar scores and the umbilical artery pH were related, but the variances explained in neonatal neurological optimality score were very low (0.9 and 0.5% respectively). Combination of Apgar score and pH slightly increased these percentages to 1.5. The highest frequency of neurologically deviant infants was, on the other hand, found in the group with a normal pH but low Apgar score. It is concluded that in AFD term infants nowadays the predictive value of a low Apgar score, acidaemia at birth and/or presence of meconium for the neonatal neurological morbidity is poor. Most neonatal neurological abnormalities must be due to other factors.

Topics: Acidosis; Amniotic Fluid; Apgar Score; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Nervous System Diseases; Risk

Seventy five pregnancies where the presence of antepartum meconium was detected by transabdominal amniocentesis, were compared with 224 cases showing clear amniotic fluid (A.F.). The statistical differences were analized in terms of data of anamnesis, diseases complicating pregnancy, gestational age, fetal maturity diagnosis from the A.F. study, oxytocin test, labor characteristics, perinatal mortality and neurologic morbidity during the first nine months of life. The results suggest that the presence of antepartum meconium implies an increase in fetal risk, demanding an adequate analysis of the obstetric solutions, which is discussed.

Topics: Adult; Amniotic Fluid; Apgar Score; Female; Fetal Distress; Follow-Up Studies; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Menstruation; Nervous System Diseases; Obstetric Labor Complications; Parity; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Prognosis