Long-term follow-up of premature infants treated with prophylactic, intratracheal recombinant human CuZn superoxide dismutase.

OBJECTIVE: To examine the long-term effects of treatment with recombinant human CuZn superoxide dismutase (rhSOD) in infants enrolled previously in two placebo-controlled trials. STUDY DESIGN: Records for 46 (88%) infants were examined, with 19 infants having received either single or multiple intratracheal (i.t.) doses of placebo, 12 having received a single i.t. dose of rhSOD, and 15 having received multiple i.t. doses of rhSOD. Mean age at follow-up was 28 months corrected age. Records were examined for neurologic dysfunction, developmental delay, and any significant medical disorders. RESULTS: Four placebo infants (21%) had evidence of neurodevelopmental abnormalities and four infants developed asthma. Four single-dose rhSOD infants (33%) had neurodevelopmental abnormalities and two infants developed asthma. One multiple-dose rhSOD infant had evidence of neurodevelopmental abnormalities and one developed asthma. No other differences were found between the placebo and rhSOD groups. CONCLUSION: Preliminary data suggest that rhSOD is safe and not associated with any long-term adverse effects. Further results will depend on the results of multicenter trials of rhSOD in preterm infants.

Infancy and early childhood follow-up of neonates with periventricular or intraventricular hemorrhage or isolated ventricular dilation: a case controlled study.

Survivors of periventricular or intraventricular hemorrhage and isolated ventricular dilation showed a higher incidence of major developmental problems in the motor areas than matched control subjects in infancy. This effect is still seen, but less evident in early childhood. Problems were mainly related to grades III and IV periventricular or intraventricular hemorrhage and isolated ventricular dilation. The outcome of newborns with grades I and II hemorrhage was benign.

Intrauterine chronic subdural hematoma with postoperative tension pneumocephalus.

A newborn infant demonstrated prenatal, bilateral chronic subdural hematomas with recent hemorrhage, internal hydrocephalus, and macrocephaly at birth. Serial cranial ultrasound and computed tomography evaluations revealed progressive hydrocephalus and subdural hematomas. Following surgical evacuation of subdural hematomas the child developed tension pneumocephalus with clinical deterioration. The pathogenesis of congenital subdural hematoma and rare postoperative complication of tension pneumocephalus are discussed.

Delayed traumatic intracerebral hemorrhage in children.

This report describes delayed traumatic intracerebral hemorrhage in five pediatric patients. The phenomenon has been considered extremely rare in children. Cranial computed tomography preceding and following the ictal hemorrhages provides the best documentation of this phenomenon and suggests some insights into the pathogenic mechanism.

Spontaneous intracerebral hematomas in juvenile diabetic ketoacidosis.

Ketoacidosis is one of the common complications of Type I insulin-dependent diabetes mellitus. Several neurologic (cerebral) deficiencies have been associated with diabetic ketoacidosis, including cerebral edema with increased intracranial pressure resulting in coma; partial and generalized seizures; and cerebrovascular occlusive disease resulting in motor and/or sensory dysfunction. Intracerebral hematomas have not been reported. A child is described who had insulin-dependent diabetes mellitus with hyperglycemic ketoacidosis who developed multiple spontaneous intracerebral hematomas. Possible mechanisms are discussed.

Childhood stroke and supraventricular tachycardia.

Acquired hemiplegia in childhood is uncommon. All causes of stroke in adults should be considered in children, including atherosclerotic cerebrovascular disease even though it is rare. In addition, children suffer from many conditions that may result in stroke. Unlike adults, a cardiac illness resulting in stroke is extremely unusual in an otherwise healthy child. We report a case of a four-year-old child; he presented with the sudden onset of a right hemiplegia associated with supraventricular tachycardia. Cerebral angiography indicated a left internal carotid artery occlusion. To our knowledge this is the first reported case of childhood stroke with supraventricular tachycardia (SVT).

Four- to seven-year evaluation in two groups of small-for-gestational age infants.

Fifty-five small-for-gestational age neonates were tested for intellectual and neurologic development at 4 to 7 years of age. When infants of mothers who had hypertensive disease (Group A) were compared with those who had no such disease (Group B), it was found that Group A scored generally better on developmental testing than Group B. Within Group B, it was found that heavier neonates of more advanced gestational ages tested higher unlike Group A where lighter neonates delivered earlier tested better, indicating terminal compromise in this group. Major neurologic problems were found more commonly in Group A than Group B, indicating a greater intrapartum vulnerability. It is concluded that in Group A, earlier delivery after the establishment of lung maturity followed by fully monitored delivery would result in better long-term outcome.