Cerebral ultrasound abnormalities in infants born to mothers with autoimmune disease.

OBJECTIVES: Cerebral abnormalities detected by cranial ultrasound (cUS) have been reported in infants born to mothers with autoimmune disease. However, the pathogenesis of the infants' brain injury remains unclear. The authors aimed to study the possible association between abnormalities on neonatal cUS and perinatal factors related to maternal autoimmune disease. METHODS: cUS evaluation was carried out at birth in 114 infants born to mothers with autoimmune disease, and repeated up to 8-9 months of life in those showing sonographic abnormalities at the first examination. The authors analysed the relationships among cerebral ultrasound abnormalities and antenatal exposure to maternal drug treatment, placental transfer of auto-antibodies and gestational complications. In addition, infants were investigated for neuromotor development from birth to 24 months of age. RESULTS: Cerebral ultrasound abnormalities, including subependymal pseudocyst, lenticulostriate vasculopathy and echogenic periventricular white matter, were detected in 41 of 114 infants (35.9%). No significant associations were found between abnormalities on cUS and the perinatal factors included in the study. No cases of persistent cerebral ultrasound abnormalities or neuromotor delay were observed during the follow-up period. CONCLUSIONS: A considerable number of cerebral ultrasound abnormalities were observed in a cohort of infants born to mothers with autoimmune disease. However, no perinatal factors were significantly associated with this finding, suggesting the fetal brain impairment had a multi-factorial aetiology. Although no case of neuromotor delay was observed, long term neurological assessment of these babies is recommended in view of the cognitive impairment reported in previous studies.

Nasal bilevel vs. continuous positive airway pressure in preterm infants.

Our aim was to compare the effects of nasal bilevel positive airway pressure (N-BiPAP) and nasal continuous positive airway pressure (N-CPAP) on gas exchange in preterm babies. Twenty preterm infants (mean gestational age, 26.3 weeks; mean weight at study, 1,033 g) were evaluated. Patients received two repeated cycles of N-CPAP alternated with N-BiPAP, for a total of four alternated phases, each phase lasting 1 hr. Transcutaneous PO2 (TcPO2), transcutaneous PCO2 (tcPCO2), pulsoximetry, and respiratory rate were recorded every 15 min. Arterial blood gases and acid-base balance were measured at the beginning of the first study period on baseline CPAP and at the end of the last study period on bilevel positive airway pressure. During the two N-BiPAP phases, a statistically significant (P < 0.001) increase of peripheral oxygen saturation and tcPO2, and a significant (P < 0.001) reduction of tcPCO2 and respiratory rate, were noted as compared to the two N-CPAP periods. In addition, a significant improvement of PO2 (P < 0.003) and a reduction of PCO2 were noted at the end of the test (P < 0.02). In conclusion, N-BiPAP, as compared to N-CPAP, improved gas exchange in preterm infants.

High-frequency partial liquid ventilation in two infants.

Two infants on high-frequency oscillatory ventilation for chronic lung disease and severe respiratory failure, received a bolus of warmed and oxygenated perfluorodecalin up to residual functional capacity, followed by a continuous infusion of 6 ml/kg/hour. Our aim was to improve gas exchange without increasing ventilatory-induced lung injury. Heart rate, oxygen saturation, blood pressure, and TcPO(2)/TcPCO(2) were continuously monitored during treatment. Arterial blood gas was evaluated every 3 hours. Both patients showed improvement of gas exchange with a 13.6 and 12.5% reduction of oxygenation index, respectively. High-frequency partial liquid ventilation is an experimental ventilation technique that could be considered as rescue treatment, to improve oxygenation in subjects with critical respiratory failure. This method could probably produce less damage, than other ventilation modes, to severely injured lungs.