Intracraniële bloedingen bij preterm geborenen: een echografische studie

In de afgelopen decennia heeft de medische zorg voor de zieke pasgeborene zich ontwikkeld tot een zeer gespecialiseerd vakgebied (Cockburn en Drillien 1974, Avery 1981, Avery en Taeusch 1984, Fanaroff en Martin 1983). Door een explosieve toename van de kennis van de foetale en neonatale fysiologie (Dawes 1968, Smith en Nelson 1976) en door ontwikkelingen in de medische technologie verbeterde het inzicht in de adaptatieproblematiek van de pasgeborene en werd het mogelijk stoornissen tijdig te herkennen en te behandelen. Dankzij de ontwikkeling van methoden ter bewaking en ondersteuning van vitale functies bleken ernstige ventilatoire en circulatoire problemen in vele gevallen adequaat te kunnen worden opgevangen (Gregory et al. 1971, Reynolds 1971, Reynolds en Taghizadeh 1974, Heicher et al. 1981). Door nieuw verworven kennis over immuniteit en bacteriële kolonisatie en de ontwikkeling van bruikbare antibiotica werd een effectieve bestrijding van levensbedreigende infecties meestal mogelijk. Dankzij nieuwe kennis over stofwisseling en lichaamssamenstelling konden een toenemend aantal stoornissen in het interne milieu tijdig worden gesignaleerd en verholpen. Ook de obstetrische zorg maakte in de afgelopen jaren belangrijke ontwikkelingen door. Het werd mogelijk meer dan 100 verschillende hereditaire ziekten in een vroeg stadium van de zwangerschap door middel van vruchtwateronderzoek bij de foetus vast te stellen. In geval van therapeutisch niet-beinvloedbare ziekte kan dan de geboorte van een kind met ernstige defecten worden voorkomen. De toestand van de foetus in utero bleek met behulp van echografische technieken en de cardiotocografie beter te kunnen worden beoordeeld (Donald et al. 1958, Hon 1958, Taylor et al. 1967, Campbellen Dewhurst 1971, Dunne en Johnson 1979). Het bleek mogelijk de longrijping van het ongeboren kind door toediening van corticosteroiden aan de moeder te bevorderen (Liggins en Howie 1972). Met behulp van medicamenteuze weeënremming en weeënstimulatie werd het mogelijk het tijdstip van een bevalling in hoge mate te beïnvloeden. Bovenstaande en andere pediatrische en obstetrische verworvenheden hadden een belangrijke invloed op de mortaliteit en morbiditeit van de pasgeborene. Tussen 1960 en 1980 daalde de perinatale sterfte in Nederland van 27 per 1000 levendgeborenen tot 11 per 1000. In Finland daalde de perinatale sterfte plaatselijk zelfs tot minder dan 10 per 1000, een getal dat de geschatte minimaal mogelijke mortaliteit van 8.5 per 1000 dicht nadert. De invloed van de neonatale intensieve zorg op de daling van de perinatale mortaliteit is met name gelegen in de verbeterde overlevingskansen van neonaten met een geboortegewicht onder de 1500 gram. Deze minder dan 1% van alle pasgeborenen tellende groep omvat 30 tot 50% van de opnamen op een afdeling voor neonatale intensieve zorg. Dankzij de geavanceerde medische techniek steeg de overlevingskans van deze groep patiënten van ongeveer 30% in 1960 tot ongeveer 70% in 1980 (Stewart et al. 1981). De sterk verbeterde mortaliteitscijfers gingen gepaard met een geringe daling van het percentage ernstig gehandicapte overlevenden. Tien tot 15% van de overlevenden lijden echter aan min of meer ernstige motorische, zintuiglijke, of intellectuele stoornissen

Long-Term Neurodevelopmental Outcome of Monochorionic and Matched Dichorionic Twins

Contains fulltext : 79941.pdf (publisher's version ) (Open Access)BACKGROUND: Monochorionic (MC) twins are at increased risk for perinatal mortality and serious morbidity due to the presence of placental vascular anastomoses. Cerebral injury can be secondary to haemodynamic and hematological disorders during pregnancy (especially twin-to-twin transfusion syndrome (TTTS) or intrauterine co-twin death) or from postnatal injury associated with prematurity and low birth weight, common complications in twin pregnancies. We investigated neurodevelopmental outcome in MC and dichorionic (DC) twins at the age of two years. METHODS: This was a prospective cohort study. Cerebral palsy (CP) was studied in 182 MC infants and 189 DC infants matched for weight and age at delivery, gender, ethnicity of the mother and study center. After losses to follow-up, 282 of the 366 infants without CP were available to be tested with the Griffiths Mental Developmental Scales at 22 months corrected age, all born between January 2005 and January 2006 in nine perinatal centers in The Netherlands. Due to phenotypic (un)alikeness in mono-or dizygosity, the principal investigator was not blinded to chorionic status; perinatal outcome, with exception of co-twin death, was not known to the examiner. FINDINGS: Four out of 182 MC infants had CP (2.2%) - two of the four CP-cases were due to complications specific to MC twin pregnancies (TTTS and co-twin death) and the other two cases of CP were the result of cystic PVL after preterm birth - compared to one sibling of a DC twin (0.5%; OR 4.2, 95% CI 0.5-38.2) of unknown origin. Follow-up rate of neurodevelopmental outcome by Griffith's test was 76%. The majority of 2-year-old twins had normal developmental status. There were no significant differences between MC and DC twins. One MC infant (0.7%) had a developmental delay compared to 6 DC infants (4.2%; OR 0.2, 95% 0.0-1.4). Birth weight discordancy did not influence long-term outcome, though the smaller twin had slightly lower developmental scores than its larger co-twin. CONCLUSIONS: There were no significant differences in occurrence of cerebral palsy as well as neurodevelopmental outcome between MC and DC twins. Outcome of MC twins seems favourable in the absence of TTTS or co-twin death

Gender differences in respiratory symptoms in 19-year-old adults born preterm

Objective: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. Methods: Design: Prospective cohort study. Setting: Nation wide follow-up study, the Netherlands. Participants: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). Main outcome measures: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

Background:Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO 2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2-rScO2)/SaO2) for small adult and neonatal NIRS sensors.Methods:In this study, 999 infants born preterm (GA 2 was ∼65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ∼36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor.Conclusion:rScO2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

Background:Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO 2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2-rScO2)/SaO2) for small adult and neonatal NIRS sensors.Methods:In this study, 999 infants born preterm (GA 2 was ∼65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ∼36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor.Conclusion:rScO2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

Background:Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO 2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2-rScO2)/SaO2) for small adult and neonatal NIRS sensors.Methods:In this study, 999 infants born preterm (GA 2 was ∼65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ∼36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor.Conclusion:rScO2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care

Effects of Neonatal Dexamethasone Treatment on the Cardiovascular Stress Response of Children at School Age

OBJECTIVE. The goal was to investigate cardiovascular responses to a psychosocial stressor in school-aged, formerly premature boys and girls who had been treated neonatally with dexamethasone or hydrocortisone because of chronic lung disease. METHODS. We compared corticosteroid-treated, formerly preterm infants with formerly preterm infants who had not been treated neonatally with corticosteroids (reference group). Children performed the Trier Social Stress Test for Children, which includes a public speaking task and a mental arithmetic task. Blood pressure was recorded continuously before, during, and after the stress test. Plasma norepinephrine levels were determined before the test, directly after the stress task, and after recovery. RESULTS. Overall, in response to stress, girls had significantly larger changes in systolic blood pressure and mean arterial pressure and in stroke volume and cardiac output, compared with boys. Boys exhibited larger total peripheral resistance responses, compared with girls. The hydrocortisone group did not differ significantly from the reference group in any of the outcome measures. However, dexamethasone-treated children had smaller stress-induced increases in systolic and mean arterial blood pressure than did hydrocortisone-treated children. In addition, the dexamethasone group showed smaller increases in stroke volume and blunted norepinephrine responses to stress, compared with children in the reference group. Correction for gender did not affect these results. CONCLUSIONS. The differences in cardiovascular stress responses between girls and boys are consistent with known gender differences in adult cardiovascular stress responses. Our data demonstrate that neonatal treatment with dexamethasone has long-term consequences for the cardiovascular and noradrenergic stress responses; at school age, the cardiovascular stress response was blunted in dexamethasone-treated children. Hydrocortisone-treated children did not differ from the reference group, which suggests that hydrocortisone might be a safe alternative to dexamethasone for treating chronic lung disease of prematurity. Pediatrics 2008; 122: 978-98

Valores de referencia de la saturación de oxígeno cerebral regional durante los primeros 3 días de vida en neonatos prematuros

Background: Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2 ? rScO2)/SaO2) for small adult and neonatal NIRS sensors. Methods: In this study, 999 infants born preterm (GA <32?wk) were monitored with NIRS during the first 72?h of life. Mixed modeling was used to generate reference curves grouped per 2?wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. Results: Average rScO2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36?h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. Conclusion: rScO2 and cFTOE reference curves are provided for the first 72?h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care

Valores de referencia de la saturación de oxígeno cerebral regional durante los primeros 3 días de vida en neonatos prematuros

Background: Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2 ? rScO2)/SaO2) for small adult and neonatal NIRS sensors. Methods: In this study, 999 infants born preterm (GA <32?wk) were monitored with NIRS during the first 72?h of life. Mixed modeling was used to generate reference curves grouped per 2?wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. Results: Average rScO2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36?h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. Conclusion: rScO2 and cFTOE reference curves are provided for the first 72?h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care