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Gestational hypertension and pre-eclampsia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Patients with severe pre-eclampsia at a gestational age of < 27 weeks should receive extensive counseling regarding the risks and benefits of expectant management (Table 10). Sibai (86) reported a perinatal survival rate in conservative management of severe pre-eclampsia between 25 and 27 weeks of gestation of 76% compared with 35.5% in the group that had immediate delivery. In addition, the infants in the conservative management group had a lower incidence of intraventricular hemorrhage (41% vs. 71%) and a shorter length of stay in the neonatal intensive care unit (70 vs. 15 days). In the same study, a perinatal survival rate of 6.7% and a 27% incidence of maternal morbidity were reported in conservative management of severe pre-eclampsia at £ 24 weeks of gestation. Therefore, expectant management of patients between 25 and 27 weeks of gestation had a significantly higher perinatal survival and a lower acute and long-term neonatal morbidity compared with aggressive management. Maternal complications were infrequent in both groups. Perinatal survival was low, morbidity was high, and maternal complications were also elevated. Therefore, for patients between 24 and 25 weeks of gestation, a gain of 1 or 2 weeks will markedly improve perinatal survival and reduce neonatal morbidity.
Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
White matter injury is commonly seen in premature babies due to peri-natal hypoxic-ischaemic events resulting in symmetrical peri-ventricular gliosis. This may be seen as small punctate hyperintense peri-ventricular lesions on T1-weighted imaging and where the injury leads to cavitation, this is indicated by high signal on T2-weighted imaging and low signal on T1-weighted imaging. In term babies, hypoxic events affect specific regions of both the grey and white matter. Severe, total hypoxia may result in increased signal intensity on T1-weighted images in the basal ganglia, the thalamus and the posterior limb of the internal capsule and restricted diffusion affecting these areas can be seen on DWI. Partial, prolonged hypoxia caused by a difficult and protracted delivery, tends to result in necrosis of the cortex and underlying white matter. In the acute phase lesions are low signal on T1- and high signal on T2-weighted imaging, lesions become more conspicuous with increased signal intensity on T1-weighted imaging after 3 days and T2-weighted imaging after 6–10 days. Abnormalities on DWI are best seen at 3–5 days after which they start to return to normal. Intraventricular haemorrhage (IVH) may be seen in premature rather than full-term babies. Blood may be normal or increased signal intensity on T1-weighted imaging and low signal on T2-weighted imaging but SWI or T2*-weighted gradient echo imaging is the most sensitive sequence for detecting haemorrhage [65].
Brain Monitoring Using Optical Imaging and Optical Spectroscopy
Published in Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin, Brain Injury and Pediatric Cardiac Surgery, 2019
In critically ill infants, illnesses producing maldistributions of heme in the brain have been studied for detectability. After Human Studies Commission approval and parental informed consent were obtained, we studied infants with intraventricular hemorrhage, measuring at multiple skull locations, to see if the presence of bleeding can be detected. Using a comparison of path length on one side of the head versus that on the contralateral side, we found that superficial bleeding (subdural hematomas, cephalohe-matomas) could be easily identified, and some instances of intraventricular bleeding are detectable as well.19 Chance, using a path-dependent method in the frequency-domain, found that as little as 50 mL of blood in brain can be detected using his phase system33 and that by using absorbance alone, with no additional path measurement, hemorrhage in adults can be reliably detected postoperatively.63
Clinical Features, Autoantibodies, and Outcome of Neonatal Lupus Erythematosus
Published in Fetal and Pediatric Pathology, 2022
Age at onset of cutaneous lesions ranged from birth to 20 days. Eleven infants (36.7%) had cutaneous lesions. Of these 11 infants, 10 presented with characteristic annular erythema, three presented with papulosquamous rashes. The most frequent lesions were isolated to the face and scalp, with all cases (100%). The trunk and extremities were also commonly affected, with six cases (54.5%) and five cases (45.5%), respectively. Petechiae and ecchymoses induced by thrombocytopenia were not considered cutaneous lesions. All four infants with CHB were detected by routine examination during gestation on account of maternal connective tissue diseases. One patient (3.3%) showed a second-degree AV block and three patients (10.0%) showed a third-degree AV block. Among the nine patients with transaminase elevations, one child had cholestatic hepatitis. Seizures occurred on one patient who suffered grade one intraventricular hemorrhage while hospitalized.
Platelet count and function in umbilical cord blood versus peripheral blood in term neonates
Published in Platelets, 2021
Alexander K. Grevsen, Claus V. B. Hviid, Anne K. Hansen, Anne-Mette Hvas
Notably, only few studies have investigated whether platelet function in UC blood in fact reflects that of peripheral blood in neonates. Saxonhouse et al. [20] found shorter closure times in UC blood than in peripheral blood of term and preterm neonates, whereas Sitaru et al. [21] investigated term neonatal platelets with flow cytometry and failed to demonstrate a difference in the expression of platelet surface glycoproteins (GP) or platelet activation. No further reports compare platelet function in neonatal UC blood with peripheral blood. The comparability of UC blood platelets with peripheral blood platelets would be of great interest when assessing previous studies on neonatal UC blood platelets. Furthermore, only sparse knowledge exists on platelet function in preterm neonates[2], most likely because of the relatively large blood volume needed for such tests. However, this would be of great clinical interest as preterm neonates have increased risk of intraventricular hemorrhage especially the very preterm neonates[22]. Future studies aiming to investigate platelet function in preterm neonates could gain feasibility if UC blood platelets reflect peripheral blood platelets.
Etiological factors of spontaneous primary intraventricular hemorrhage
Published in British Journal of Neurosurgery, 2020
Zhongzhong Jiang, Yong Peng, Mingming Zhang, Mengqiang Yu
MMD is a unique disease, occurring mainly in east Asia, especially in Japan, and is characterized by progressive occlusion of the Willis artery rings. MMD has two peak periods, one in children and the other in adults aged 30–40. In addition, the clinical manifestations in children are mainly cerebral ischemic symptoms, while in adults the clinical manifestations are mainly cerebral hemorrhagic symptoms.15 In our study, out of 13 patients with intraventricular hemorrhage caused by MMD, 12 were adults aged 20–60. MMD is an important vascular cause of spontaneous ventricular hemorrhage, accounting for 2.9 ∼ 22.4% of SIVH cases.7,10 In our study, MMD accounted for 14.8% of SPIVH cases (13/88). The major cause of intraventricular hemorrhage is the compensatory formation of the pericallosal branch of the anterior cerebral artery or its aneurysm.7,16