Prevalence and factors affecting developmental delay among 0-6-year-old children attending immunization clinic

Background: Development in early childhood is an important determinant of health status in future life and any damage to brain in that period may affect quality of life. Reliable data regarding prevalence and predictors of developmental delay among under-5 children are required for combating this problem. Aim and Objective: Our study aimed at estimating proportion and determining predictors of developmental delay among 0–6-year-old children. Materials and Methods: An observational analytic study was conducted among 173 children (<6 years) attended in immunization clinic, medical college, Kolkata. Developmental status of children was assessed by Trivandrum Development Screening Chart. Sociodemographic parameters of children and their families were studied. Maternal morbidity and care during antenatal period as well as child morbidity and care during neonatal period were also assessed. Results: Proportion developmental delay among <6-year-old children was 26%. Maternal morbidity during antenatal period was revealed as significant predictor [AOR = 9.835 with 95% CI: 3.089–31.314]. Childhood morbidity and hospitalization during neonatal period were also found to be significant determinants of developmental delay [AOR = 28.041 with 95% CI: 8.826–89.089 and AOR = 28.286 with 95% CI: 8.790–91.023, respectively]. Conclusion: Improvement of neonatal care resulted in much reduction in neonatal mortality rate at the cost of increase in prevalence of developmental delay. Hence, more emphasis is now to be given on early detection and intervention of developmental abnormalities. It is mandatory to focus not only on care during newborn period for reducing mortality but also on “care beyond survival” which is the sixth pillar of India Newborn Action Plan.

Endtidal carbonmonoxide and carboxyhemoglobin for prediction of significant hyperbilirubinemia in healthy Indian neonates >35 weeks of gestation

Background: Endtidalcarbonmonoxide (ETCOc) and Carboxyhemoglobin (COHB) levels correlate well to bilirubin production and an availability of non-invasive point of care (POC) device in predicting significant hyperbilirubinemia is of great advantage when compared to measurement of serum bilirubin. Objective of the study is to measure a value of ETCOc and COHB in the early neonatal period for the prediction of significant hyperbilirubinemia.Methods: This was the descriptive Cross Sectional Study. ETCOc and COHB were measured 12th hourly for 72 hours followed by TSB in whom the TCB was >14mg/dl. Neonates were classified as jaundiced whose TSB values were in phototherapy range as per AAP Recommendations. Receiver Operative Curves (ROC) were created by appropriate statistical software for ETCOc and COHb to predict significant hyperbilirubinemia. The Sensitivity, Specificity, Positive predictive value, Negative predictive value and likelihood ratios of each was determined and the correlation between ETCOc and COHb levels, ETCOc and TCB, COHB and TCB at different hours of age was evaluated.Results: Among the total 320 infants, 156 of them developed significant hyperbilirubinemia. The ETCOc and COHB level at 60 hours of age was the most predictive of significant hyperbilirubinemia by ROC analysis. ETCOc cut-off of 1.65 ppm at 60 hours of age has a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 84.6%, 80.5%, 80.5% and 84.6%, 4.33 and 0.19. COHB cut-off of 1.32 ppm at 60 hours of age has a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 84.6%, 81%, 80% and 84.2%, 4.34 and 0.19.ETCOc had a maximum correlation with COHB at 48 hours of age.Conclusions: An increased level of Endtidalcarbonmonoxide and Carboxyhemoglobin in the early neonatal period is useful as a screening test for prediction of significant hyperbilirubinemia.

Profissionais de saúde e comunicação de más notícias: experiências de uma unidade neonatal / Health professionals and communication of bad news: experiences of a neonatal unit / Profesionales de salud y comunicación de malas noticias: experiencias de una unidad neonatal

Este é um estudo descritivo, de abordagem qualitativa, que teve por objetivo investigar as experiências e formas de enfrentamento de profissionais de saúde diante da comunicação de más notícias em uma Unidade Neonatal. Utilizou-se para a coleta dos dados uma ficha de caracterização dos participantes e entrevista semiestruturada. Foram entrevistadas nove profissionais de saúde que trabalham em uma Unidade Neonatal. Foram encontradas duas categorias de análise: Experiências em relação ao preparo profissional e Experiências em relação a protocolos de comunicação de más notícias. Os resultados apresentaram que a maioria dos profissionais de saúde não sente preparada para comunicar más notícias e baseiam-se em experiências pessoais ou profissionais. Destaca-se também a não utilização de protocolos/embasamento teórico, porém existe reconhecimento dessa importância. Conclui-se que é essencial proporcionar espaço para refletir e analisar as práticas profissionais e agregar subsídios para a comunicação de más notícias, assim como destaca-se a importância da educação continuada.

Descriptive study, with a qualitative approach, that aimed to investigate the experiences and ways of coping that professionals of health use when reporting bad news in a Neonatal Unit. The data collecting used a data sheet for the characterization of the participants and a semi-structured interview. Were interviewed nine professionals of health. Two categories were found: the experiences in the professional preparation and the experiences of bad news communication protocols. The results showed that the most professionals of health do not feel prepared to communicate bad news and theirs performances are based on personal or professional experiences. It's also important highlight that protocols / theoretical basis are not used, but there are recognition of theirs importance. It's conclusive the need to provide space to reflect and analyze professional practices, and add subsidies for the communication of bad news, as well as the importance of continuing education for the professionals.

Estudio descriptivo, de abordaje cualitativo, que tuvo por objetivo investigar las experiencias y formas de enfrentamiento de profesionales de salud ante la comunicación de malas noticias en una Unidad Neonatal. Se utilizó una ficha de caracterización de los participantes y entrevista semiestructurada. Fueron entrevistados nueve profesionales de la salud. Categorías de análisis: Experiencias en relación a la preparación profesional y Experiencias en relación a protocolos de comunicación de malas noticias. Los resultados mostraron que la mayoría de los profesionales de la salud no se lo sienten preparados para comunicar malas noticias y se basan en experiencias personales o profesionales. Se destaca también la no utilización de protocolos/basamento teórico, pero existe reconocimiento de su importancia. Se concluye que es esencial proporcionar espacio para reflexionar y analizar las prácticas profesionales y agregar subsidios para la comunicación de malas noticias, así como, se destaca la importancia de la educación continuada.

Morbidity and mortality pattern among babies admitted in special newborn care unit, Nellore, Andhra Pradesh, India

Background: India contributes to 25% of neonatal mortality around the world. In developing countries neonatal mortality is quite high despite of advances in perinatal and neonatal care. The establishment of Special Newborn Care Units (SNCU) has been quite essential in reducing the neonatal morbidity and mortality. This study was conducted to assess the outcome of SNCU at a newly commissioned tertiary care teaching hospital at Nellore District, Andhra Pradesh. Aim of this study the morbidity and mortality patterns in an SNCU at tertiary care teaching hospital.Methods: It was a Retrospective, Hospital based, Descriptive study which was done among neonates admitted to SNCU, Nellore District, Andhra Pradesh for a period of 1 year (January 2015-December 2015). All the neonates admitted to SNCU, Nellore District, Andhra Pradesh during the study period were included in the study. Data was recorded in a predesigned semi-structured proforma. the data was entered into excel-sheet and analyzed using SPSS software version 21.Results: A total of 1015 babies were included in the study. Almost half 592(58.32%) were born in this hospital(inborn) and 423(41.67%) babies were referred from peripheral hospitals and nursing homes (out born). about 3/4th 767(75.5%) of babies were admitted in the first 24 hours of life. Almost half (53.4%) of the study group were male and 46.6% were female. The chief causes of admission in SNCU were Respiratory Distress Syndrome (40.2%) followed by birth asphyxia (19.1%), sepsis (13.3%), Neonatal Jaundice (9.9%) and prematurity (6.6%). In our study 63.0% patients were discharged, 19.3% had left hospital against medical advice, 10.1% died and 7.6% were referred to other institutions for specialized treatment.Conclusion: Respiratory Distress Syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and HIE as the major causes of morbidity. Low Birth Weight and prematurity were the commonest contributors of death, therefore, attempts to prolong the pregnancy each week might improve the neonatal outcome considerably.

Study of cases with perinatal mortality

Background: Perinatal loss is one of the most traumatic life events. It is indeed a great psychological and emotional shock to not only the mother and father but the entire family and society as a whole. The perinatal mortality rate (PMR) is an important indicator of the quality of obstetric care during pregnancy. Perinatal deaths result largely from obstetric complications that can be prevented with proper antenatal care and quality neonatal services. The study was aims to study the factors related with perinatal loss and its prevention in future pregnancy.Methods: It was a prospective analytical study. All patients with IUFD, stillbirths and early neonatal loss were studied. Postpartum both mother and father were counselled. Detailed history and thorough physical examination were conducted. Data was recorded and tabulated, observation made and compared with results of various studies.Results: The results showed that the incidence of IUFD was 3.7% and early neonatal death was 10.8% per total admissions. The perinatal mortality rate was 63.62 per 1000 live births. Perinatal mortality rate was inversely related to the number of antenatal visits taken by the patient. Lack of antenatal care results in perinatal deaths probably due to failure of early identification and management of maternal problems that impact negatively on perinatal outcome. Even in advanced economies with sophisticated diagnostic and monitoring equipment, lack of antenatal care categorizes a pregnant woman as a high-risk pregnancy.Conclusions: There is a need for awareness regarding importance of antenatal care and institutional delivery. Perinatal mortality is an important indicator of maternal care, health and nutrition. It also reflects the quality of Obstetric and Pediatric care available. Every effort must be made to reduce perinatal mortality.

A study to assess the newborn care practices among mothers at a tertiary care hospital in Hyderabad, Telangana

Background: Early neonatal period (<1 week) is the crucial period in the life of an infant as the risk of death is greatest during the first 24- 48 hours after birth. In India, around 61.3% of all infant deaths occur during neonatal period (<28 days) and more than half of these deaths occur during early neonatal period. Most of these deaths can be attributed to harmful newborn care practices in relation to bathing, feeding, cord care etc. The aims and objectives of the study were to assess the newborn care practices among women who delivered in Gandhi Hospital; to assess the relationship between maternal education and newborn care practices among study population.Methods: A cross sectional study was carried out among 200 women who delivered in Gandhi Hospital, Hyderabad, Telangana from March to June 2017 and a predesigned, pre tested questionnaire was used to obtain information.Results: The mean age of study population was 21.5±2.3 years. Around 61.9% of mother’s breastfed within first hour of life and 93.5% fed colostrum. Around 17% were given pre lacteal feeds like cow milk, honey, water etc. No harmful cord care practices like application of cow dung etc. were not followed.Conclusions: Majority of the study population had correct knowledge regarding newborn care practices. Although some of the traditional practices were still observed like giving pre lacteal feeds, discarding colostrum and avoidance of certain foods like pulses, meat, curd etc. by mother.

Effect of unilateral basal ganglia hemorrhage on long-term behavioral development of neonatal rats / 中华实用儿科临床杂志

Objective To investigate the effect of unilateral basal ganglia hemorrhage on long -term behavio-ral development of neonatal SD rats.Methods Forty -eight neonatal SD rats (1 0 days after birth)were equally divided into cerebral hemorrhage (CH)group,sham operation (SH)group and normal control (NC)group randomly, 1 6 cases for each group.Stereotaxic apparatus was used to inject autologous blood 25 μL into rats′brain caudate nu-cleus to establish basal ganglia hemorrhage model,while SH group was injected with nothing,and NC group received no treatment.Berderson scoring method was used to test rats′neurological functions on the first day,the third day,the seventh day,and the fourteenth day after operation,respectively.The open -field environment test and the Lat maze were used to assess behavior of the rats on the fourteenth day after operation,lasting for 3 days continuously.Results (1 )After being modeled rats appeared with different degrees of neurological function damage.SH group rats′neurologi-cal function damage was slight,which was completely restored in the 72 hours after surgery.CH group rats appeared hemiplegia and muscle tension change.CH rats neurological scores′on the first and third day after modeling scores were separate (3.40 ±0.83)scores and (1 .1 3 ±0.92)scores respectively,and the scores were statistically higher than SH group [(0.73 ±0.59)scores and (0.1 3 ±0.35)scores]and NC group (all P 0.05).(2)On the fourteenth day after modeling,in open -field test and the Lat maze,the number of passed panels,straightening(times)and grooming(times)in CH group were more than those in SH group and NC group respectively (all P 0.05 ). Conclusions Neonatal rats focal hemorrhage in unilateral basal ganglia is strongly repairable and compensatory,which leaves no severe neurological dysfunction.The neurological function damage which is caused by unilateral basal ganglia hemorrhage can lead to the increase of autonomic activities,the decrease of non -selective attention level,attention defi-cit and other long -term behavioral abnormalities.

Analysis of risk factors of children with cerebral palsy in Xinxiang area / 中华实用儿科临床杂志

Objective To explore the risk factors of children with cerebral palsy during pregnancy and neonatal period in Xinxiang area.Methods A retrospective analysis of the relevant research data of cerebral palsy children in Xinxiang area was performed.The research objects were children with cerebral palsy born from May 1,2005 to April 30,2010.At the same time,3 healthy children were selected as the control group to analyze the related risk factors causing cerebral palsy in children.Results The risk factors of children with cerebral palsy in Xinxiang city were as follows : maternal nutritional status, vaginal bleeding during pregnancy, pregnancy-induced hypertension syndrome, and abnormal production history were associated with cerebral palsy (x2 =2.313,13.296,5.034,7.434, all P ＜ 0.05)during the perinatal period;related factors during neonatal period were premature birth,severe asphyxia, severe jaundice, and intracranial infection(x2 =4.637,29.50,4.633,5.107, all P ＜ 0.05).Multivariate Logistic regression analysis showed the history of severe asphyxia (OR =2.340,95 ％ CI: 1.250-4.440), severe jaundice (OR =4.110, 95％ CI:2.430-6.740) ,premature birth(OR =2.570,95％ CI: 1.410-4.770) ,pregnancy-induced hypertension syndrome (OR =2.350,95 ％ CI:I.020-5.440), vaginal bleeding during pregnancy (OR =73.600,95 ％ C1:3.060-17.750) and abnormal production history(OR =5.710,95％ CI: 1.250-26.310) were independent risk factors causing children with cerebral palsy.Conclusions The history of severe asphyxia, severe jaundice, premature birth, pregnancy-induced hypertension syndrome, vaginal bleeding during pregnancy and congenital dysplasia are independent risk factors of children with cerebral palsy in Xinxiang area.It should be strengthened to screen and standardize the management of high-risk newborn infants with cerebral palsy, and do well management for perinatal high-risk pregnant women management.Early prevention can help to reduce the incidences of cerebral palsy in local area.

Molecular regulation mechanism of pancreatic islet β-cell remodeling in neonatal stage / 中华内分泌代谢杂志

The neonatal period is important for the dramatic increment as well as function improvement of islet β-cell.β-cell mass augmentation is primarily regulated by neogenesis,replication,and apoptosis.The mechanisms involve cell cycle related proteins and mitosis-promoting signaling pathways.This remodeling period has far-reaching effects on the body in adapting to the metabolic needs and regulating glucose homeostasis later in life.

Malformación adenomatoidea quística pulmonar: importancia del diagnóstico prenatal / Cystic adenomatoid malformation of the lung: importance of prenatal diagnosis

La malformación adenomatoidea quística pulmonar (MAQP)es una anomalía de la vía aérea pulmonar poco frecuente cuyodiagnóstico suele realizarse en el período prenatal medianteecografía. Durante el embarazo, debe realizarse seguimiento ecográfico para valorar el desarrollo pulmonar. Presentamos el caso clínico de una paciente de 4 años con diagnóstico prenatal de MAQP, no confirmado mediante radiografía de tóraxrealizada al nacimiento, lo cual retrasó el diagnóstico definitivo; fue intervenida con 4 años de edad tras haber presentado varias neumonías a repetición. Una radiografía de tórax normal realizada al nacimiento no descarta la presencia de estamalformación, por lo que es necesario realizar una tomografía computarizada a las 4 semanas del nacimiento para confirmar o descartar la MAQP. Una vez diagnosticada, el tratamiento quirúrgico debe ser precoz para evitar complicaciones.

Cystic adenomatoid malformation of the lung is a rare malformation of the lung airway which often performed diagnosed in the prenatal period by ultrasound. Ultrasound monitoring should be performed during pregnancy to assess lung development. We report the case of a 4-year-old patient with prenatal diagnosis of cystic adenomatoid malformation of the lung, not confirmed by chest radiograph at birth. The patient underwent surgery at 4 years of age after diagnosis was made for presenting recurrent pneumonia. A normal chest radiograph at birth does not exclude this malformation and a computerized tomography at 4 weeks of birth must be done to confirm or rule out this anomaly. Once the diagnosis is made, surgical treatment should be prompted to avoid complications.

Quiste broncogénico: presentación de un caso en el período neonatal / Bronchogenic cyst: report of a case in the neonatal period

El quiste broncogénico es una malformación de la pared ventral del intestino primitivo que genera alteraciones en el desarrollo del árbol traqueobronquial. Presentamos el caso de un varón recién nacido con un quiste broncogénico en el lóbulo superior derecho, remitido a la unidad de cuidados intensivos neonatales del Hospital Universitario San Vicente de Paúl, de Medellín, por dificultad respiratoria progresiva y quiste torácico congénito. El tratamiento quirúrgico –lobectomía- fue exitoso. Los quistes brocogénicos son un grupo heterogéneo; pueden ser únicos o múltiples y generalmente están confinados a un segmento o lóbulo pulmonar; su sintomatología se debe a compresión o sobreinfección y depende del lugar y el tamaño del quiste; el tratamiento de elección es el quirúrgico aun en pacientes asintomáticos.

Bronchogenic cysts are malformations of the ventral wall of the primitive gut that disturb the development of the tracheo-bronchial tree. We report the case of a newborn male with a bronchogenic cyst in the right upper lobe, referred to the neonatal intensive care unit at Hospital Universitario San Vicente de Paul, in Medellín, Colombia, because of progressive respiratory distress. Surgical treatment by lobectomy was successful. Bronchogenic cysts are a heterogeneous group of abnormalities. They may be single or multiple and are usually confined to a pulmonary segment or lobe. Symptomatology is due to compression or superinfection, and depends on the location and size of the cyst. Treatment of choice is surgery even in asymptomatic patients.

Monitoring of physiological and blood parameters during perinatal and neonatal period in calves / Monitoramento de parâmetros fisiológicos e sanguíneos de bezerros durante os períodos perinatal e neonatal

Rectal temperature, heart and respiratory rates, and the course of some blood parameters were monitored in calves during perinatal and neonatal periods. The study was carried out on eight Limousine calves. From all subjects, rectal temperature, heart rate, and respiratory rate were measured. Blood samples were taken at the same hour (9am) from the external jugular vein, and then centrifuged and stored until analyses. By means of an UV spectrophotometer, the following blood parameters were assessed for each subject: total protein, total cholesterol, triglycerides, glucose, non-esterified fatty acids (NEFA), urea, creatinine, cholinesterase, lactate dehydrogenase (LDH), hydroxybutirate, glutamate pyruvate transaminases (GPT), glutamate oxalacetate transaminases (GOT), direct and total bilirubin, magnesium, iron, potassium, phosphorus, chloride and sodium. The results showed a significant effect of days of life (P<0.05) only on total cholesterol, creatinine and GOT during the first week of life and a significant effect of days of life on rectal temperature, heart rate, respiratory rate, total cholesterol, NEFA, creatinina, and GOT during the first month of life. A correlation among individual values for postnatal age (days of life) and heart rate in calves during the first month of life was observed. In conclusion, modifications of studied parameters could be attributed to functional development of calves in neonatal period and contribute to the knowledge of adaptation processes in calf during the first week and the first month of life resulting useful for the diagnosis and treatment of any neonatal diseases.

Realizou-se o monitoramento da temperatura retal das frequências cardíaca e respiratória e de alguns parâmetros sanguíneos em oito bezerros da raça Limousine, durante o período perinatal e neonatal. Paralelamente às mensurações da temperatura retal e das frequências cardíaca e respiratória (9h), foram pesquisados, por meio de espectrofotômetro de UV, proteína total, colesterol total, triglicérides, glicose, ácidos graxos não esterificados (NEFA), ureia, creatinina, colinesterose, lactato desidrogenase (LDH), hidroxibutirato, glutamato piruvato transaminases (GOT), direta e total bilirrubina, magnésio, fósforo, cloretos e sódio. Os resultados mostraram efeito significativo dos dias de vida (P<0,05) somente sobre o colesterol total, creatinina e GOT, durante a primeira semana e um significante efeito de dias de vida sobre a temperatura retal, as frequências cardíaca e respiratória, colesterol total, NEFA, creatina e GOT durante o primeiro mês de vida. Observou-se correlação entre os valores individuais para dias de vida e frequência cardíaca durante o primeiro mês de vida. Conclui-se que as modificações desses parâmetros podem ser atribuídas ao desenvolvimento dos bezerros no período neonatal, contribuindo para o conhecimento do processo de adaptação, em bezerros, durante a primeira semana e o primeiro mês de vida.

Readmission in Neonatal Period among the Normal Full-term Neonates / 대한주산의학회잡지

PURPOSE:This study was conducted to analyse the characteristics of the full-term neonates admitted in neonatal period and to evaluate the relationship between readmission and perinatal, maternal factors. METHODS:We studied retrospectively the neonatal readmissions who were born in Il Sin Christian Hospital during the 18-months period (January 1, 2007 to June 30, 2008). RESULTS:After discharge, 415 neonates were readmitted during the first month of life. The most common cause for readmission was jaundice (82.7%). Among them, 211 (61.5%) neonates were fully breast feeding and 119 (34.7%) were mixed feeding infants. The second cause was rota enteritis (6.3%). Others included dehydration (4.1%), suspected sepsis (3.1%), other enteritis (1.7%), pneumonia (0.7%), cardiac problem (0.5%), meningitis (0.5%), urinary tract infection (0.2%), and other urinary problem (0.2%). There were no significant relationships between readmission and neonatal, maternal factors. CONCLUSION:While newborns discharged from hospital are at risk for readmission, but relationship among neonatal, maternal, and other factors are not proven. Education of risk factors for jaundice to parents should be done and prevention of hospital acquired infection is important. Further research should include relationships between neonatal, maternal factors and the other factors influencing neonatal readmission.

Neonatal Outcomes of Near-term Infants / 대한주산의학회잡지

OBJECTIVE: To document the common medical problems and clinical outcomes of near-term infants who were delivered between 35(+0) and 36(+6) weeks of gestation, in order to promote optimal health outcomes for these infants. METHODS: We performed a retrospective review of medical records of 113 near-term infants and 138 term infants as control, who were born at Chungbuk national university hospital in 2003~2004. RESULTS: When compared with term infants, near-term infants had a significantly lower Apgar scores (7.7 vs. 8.7 at 1 minute) and higher frequency of prolonged rupture of membrane (19.8% vs. 6.7%), preeclampsia (20.9% vs. 4.4%), jaundice (46.0% vs. 11.6%), respiratory distress (20.4% vs. 10.9%), feeding problems (19.5% vs. 5.8%), intravenous fluid infusion (63.7% vs. 24.6%), diagnostic work-up for possible sepsis (68.1% vs. 26.1%), and use of antibiotics (58.4% vs. 22.5%). There were no differences in frequency of cesarean section, hypoglycemia, hypothermia and clinical sepsis. More near-term infants were admitted to the neonatal intensive care unit (68% vs. 28%) and delayed in discharge home (60% vs. 27%) with longer hospital stay (7.77+/-5.63 days vs. 4.67+/-3.17 days). CONCLUSION: Near-term infants showed significantly more neonatal problems and longer and repeated hospital stays than full-term infants. Optimal care guidelines for near-term infants including scrupulous monitoring for the development of early complications and meticulous follow-up after discharge need to be developed.

Clinical Significance of MRI in Hypoxic-Ischemic Encephalopathy During Neonatal Period

PURPOSE: Hypoxic-ischemic encephalopathy is a major neurologic problem and one of the most important perinatal causes of neurological morbidity. Evaluation of the presence, extent, and subsequent evolution of hypoxic-ischemic lesions may be very important. We studied the significance of imaging modality through the analysis of brain MRI findings of hypoxic-ischemic encephalopathy during neonatal period and comparison with findings of brain ultrasonography. METHODS: We analysed the forty-seven infants retrospectively who were diagnosed as hypoxic-ischemic encephalopathy and underwent brain MRI and ultrasonography from Jan. 1992 to May 1996. RESULTS: 1) The mean gestational age and birth weight of the twenty-seven infants who were premature were 32.8+/-2.08weeks and 1.97+/-0.44kg respectively. The mean gestational age and birth weight of twenty infants who were fullterm were 39.3+/-1.04weeks and 2.98+/- 0.93kg respectively. The primary hypoxic-ischemic insults occurred during antenatal, intrapartum and postnatal period. 2) The findings of brain MRI were classified into periventricular leukomalacia, encephalomalacia, basal ganglia lesion, focal parenchymal hemorrhage, ventriculomegaly without other lesion and normal finding. 3) Three infants among twenty-five infants with periventricular leukomalacia, four infants among seven infants with basal ganglia lesion and six infants among seven infants with focal parenchymal hemorrhage were not diagnosed by brain ultrasonography. 4) All of ten infants with encephalomalacia and four infants with ventriculomegaly without other lesion were diagnosed by brain ultrasonography. CONCLUSIONS: MRI can diagnose the hypoxic-ischemic lesions which would not be possible by brain ultrasonography. Therefore MRI is the imaging modality of choice for diagnosis in infants with hypoxic-ischemic encephalopathy. We believe that the benefits of MRI outweigh its somewhat higher cost, lack of portability and monitoring difficulties.

Clinical Significance of MRI in Hypoxic-Ischemic Encephalopathy During Neonatal Period

PURPOSE: Hypoxic-ischemic encephalopathy is a major neurologic problem and one of the most important perinatal causes of neurological morbidity. Evaluation of the presence, extent, and subsequent evolution of hypoxic-ischemic lesions may be very important. We studied the significance of imaging modality through the analysis of brain MRI findings of hypoxic-ischemic encephalopathy during neonatal period and comparison with findings of brain ultrasonography. METHODS: We analysed the forty-seven infants retrospectively who were diagnosed as hypoxic-ischemic encephalopathy and underwent brain MRI and ultrasonography from Jan. 1992 to May 1996. RESULTS: 1) The mean gestational age and birth weight of the twenty-seven infants who were premature were 32.8+/-2.08weeks and 1.97+/-0.44kg respectively. The mean gestational age and birth weight of twenty infants who were fullterm were 39.3+/-1.04weeks and 2.98+/- 0.93kg respectively. The primary hypoxic-ischemic insults occurred during antenatal, intrapartum and postnatal period. 2) The findings of brain MRI were classified into periventricular leukomalacia, encephalomalacia, basal ganglia lesion, focal parenchymal hemorrhage, ventriculomegaly without other lesion and normal finding. 3) Three infants among twenty-five infants with periventricular leukomalacia, four infants among seven infants with basal ganglia lesion and six infants among seven infants with focal parenchymal hemorrhage were not diagnosed by brain ultrasonography. 4) All of ten infants with encephalomalacia and four infants with ventriculomegaly without other lesion were diagnosed by brain ultrasonography. CONCLUSIONS: MRI can diagnose the hypoxic-ischemic lesions which would not be possible by brain ultrasonography. Therefore MRI is the imaging modality of choice for diagnosis in infants with hypoxic-ischemic encephalopathy. We believe that the benefits of MRI outweigh its somewhat higher cost, lack of portability and monitoring difficulties.

A Study on the differences in Blood Pictures of Premature Babies and Term Babies

The author has studied on the differences in blood pictures, especially the differences of blood pictures in capillary blood and venous blood, in 25 premature babies and 50 term babies from birth to 7 days of age sequentially during the period of 6 monts from April 1980 to Sept. 1980. The results are summarized as follws; 1. As comparing blood pictures with term babies, premature babies showed somewhat lower values in erythrocyte, hemoglobin, hematocrit. MCV, MCH, leucocyte and platelet but somewhat higher values in reticulocyte and MCHC. 2. As comparing blood pictures with the venous blood, the capillary blood showed significantly higher values in erythrocyte, hemoglobin and hematocrit during the neonatal period in both premature babies and term babies, but showed somewhat lower values in MCV, MCH, MCHC, and platelet. 3. According to the time of clamping the umbilical cord after birth, there were significant differences of blood pictures between early and late clamping of the umbilical cord. 4. The highest mean erythrocyte counts in both term babies and premaature babies were 5,896,000/cub.mm and 5,542,000/cub.mm at 3-6 hours after birth. Those values were gradually decreased to 5,104,000/cub.mm and 4,753,000/cub.mm on the 6th-7the day of life. 5. The highest average hemoglobin levels in both term babies and premature babies were 21.1gm/dl and 19.5gm/dl at 3-6 hours after birth. Those values were gradually decreased to 18.1gm/dl and 17.1gm/dl on the 6th-7th day of life. 6. The mean values of hematocrit in both term babies and premature babies were higest, 64.5% and 59.9% at 3-6 hours after birth. Those values were gradually decreased to 54.8% and 50.2% on the 6th-7the of life. 7. The average total serum protein levels in both term babies and premature babies were 5.76gm/dl and 5.22gm/dl at birth. Those values were increased to 6.45gm/dl and 5.74gm/dl at 3- hours after birth. 8. The average MCV in both term babies and premature babies showed highest values, 114.2fl and 110.1fl at birth. Those values were gradually decreased to 107.0fl and 103.4fl on the 6th-7th day of life. 9. The average MCH in both term babies and premature babies showed highest values, 36.8pg and 35.3pg at birth. Those values were gradually decreased to 107.0fl and 103.4fl on the 6th-7th day of life. 10. The average MCHC in both term babies and premature babies showed constant levels, 31.3-32.0% and 32.2-33.1% from birth to 7the day of life. 11. The average platelet counts in both term babies and premature babies were 243,000/cub.mm and 229,000/cub.mm during the first 4 days of life. Those values were gradually increased to 283,000/cub.mm and 253,000/cub.mm on the 6th-7the day of life. 12. The highest reticulocyte counts in both term babies and premature babies were 3.1% and 3.6% at the age of 3-6 hours. Those values were rapidly dropped down from 4th day to 7th day of life, decreasing from 1.7% and 1.9% to 1.0% and 1.3%. 13. The highest llecucyte counts in both term babies and premature babies were 25,794/cub.mm and 23,363/cub.mm at the age of 3-6 hours. Both values were gradually decreased to 13,213/cub.mm and 11,870/cub.mm on the 6th-7th day of life.