Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infa... more Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.
Developmental medicine and child neurology, Jan 10, 2014
To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging ... more To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging (DTI) measures relate to developmental outcome in encephalopathic newborn infants after therapeutic hypothermia. Encephalopathic newborn infants enrolled in a longitudinal study underwent DTI after hypothermia. Parametric maps were generated for fractional anisotropy, mean, radial, and axial diffusivity. CC and CST were segmented by DTI-based tractography. Multiple regression models were used to examine the association of DTI measures with Bayley-II Mental (MDI) and Psychomotor Developmental Index (PDI) at 15 months and 21Ā months of age. Fifty-two infants (males n=32, females n=20) underwent DTI at median age of 8Ā days. Two were excluded because of poor magnetic resonance imaging quality. Outcomes were assessed in 42/50 (84%) children at 15Ā months and 35/50 (70%) at 21Ā months. Lower CC and CST fractional anisotropy were associated with lower MDI and PDI respectively, even after controlli...
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its ... more Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its value in predicting neurodevelopmental outcome (NDO) is yet to be known. To examine the relationship between NDO and SWC evaluated by amplitude integrated electroencephalogram (aEEG) in very low birth weight (VLBW) infants. VLBW infants (<1500 grams and ā¤34 weeks gestational age) were enrolled in a prospective study. Two channel 12-hour aEEG recordings were completed at 34 weeks postmenstrual age (PMA) and SWC scores were assigned. NDO was measured by the Bayley's Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 9 and 18 months corrected age (CA). Eighty-four of the 103 enrolled infants had an aEEG completed at 34 weeks PMA. At 9 months CA, in linear regression models, MDI was significantly associated with severe intraventricular hemorrhage (IVH) and SWC score, while PDI was associated with GA and SWC score. At 18 months CA, these associations lost significance. At 34 weeks PMA, all VLBW premature infants demonstrate some degree of SWC on aEEG. Maturation of SWC at 34 weeks PMA is not associated with gestational age, however may relate to early NDO. Further studies are needed to evaluate this relationship.
Newborn infants, chronically exposed in utero to low doses of methadone with or without concomita... more Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.
... However, the extreme immaturity of the visual system at this age is signaled by the presence ... more ... However, the extreme immaturity of the visual system at this age is signaled by the presence of fused eyelids, cloudy optic media, and remnants of an embryonic tissue (tunica vasculosa lentis) in the eye ... Eye movement is usually conjugate during tracking, even if the ...
Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resur... more Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resurgence has been attributed to advances in medical care which have increased the survival of infants less than 1000 g. Retinal immaturity and exposure to supplementary oxygen are generally accepted as the principal factors associated with ROP, however precocious exposure of the immature retina to light may also contribute. The preterm infant is routinely exposed for the duration of hospital stay to bright continuous light at levels which produce retinal damage in animals. A recent study has provided evidence implicating light in ROP. Preterm infants for whom the light levels were reduced had a lower incidence of ROP, compared to a similar group of preterms exposed to standard levels of nursery light. Given the problems of a non-randomized design, the results must be considered preliminary; however the findings are substantiated by parallel results in both hospitals studied and by an effect of exposure to light within the treatment group. Speculations regarding the mechanisms of light as a contributor to ROP include: alterations of retinal metabolism, cellular damage by phototoxicity, and the generation of free radicals. Mechanisms of phototoxicity are compatible with theories of oxygen toxicity. Light may not be necessary for ROP to occur, but it may increase the risk.
Journal of Neurology Neurosurgery and Psychiatry, 1977
Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (me... more Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (methylprednisolone 200-2000 mg/day) for up to 151 days (mean 55 days). Neurological improvement occurred in eight patients on high doses after deterioration on concentional doses (methylprednisolone 80-120 mg/day). In two patients steroids could be completely discontinued for several months. Serious adverse effects included sepsis in three patients
Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infa... more Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.
Developmental medicine and child neurology, Jan 10, 2014
To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging ... more To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging (DTI) measures relate to developmental outcome in encephalopathic newborn infants after therapeutic hypothermia. Encephalopathic newborn infants enrolled in a longitudinal study underwent DTI after hypothermia. Parametric maps were generated for fractional anisotropy, mean, radial, and axial diffusivity. CC and CST were segmented by DTI-based tractography. Multiple regression models were used to examine the association of DTI measures with Bayley-II Mental (MDI) and Psychomotor Developmental Index (PDI) at 15 months and 21Ā months of age. Fifty-two infants (males n=32, females n=20) underwent DTI at median age of 8Ā days. Two were excluded because of poor magnetic resonance imaging quality. Outcomes were assessed in 42/50 (84%) children at 15Ā months and 35/50 (70%) at 21Ā months. Lower CC and CST fractional anisotropy were associated with lower MDI and PDI respectively, even after controlli...
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its ... more Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its value in predicting neurodevelopmental outcome (NDO) is yet to be known. To examine the relationship between NDO and SWC evaluated by amplitude integrated electroencephalogram (aEEG) in very low birth weight (VLBW) infants. VLBW infants (<1500 grams and ā¤34 weeks gestational age) were enrolled in a prospective study. Two channel 12-hour aEEG recordings were completed at 34 weeks postmenstrual age (PMA) and SWC scores were assigned. NDO was measured by the Bayley's Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 9 and 18 months corrected age (CA). Eighty-four of the 103 enrolled infants had an aEEG completed at 34 weeks PMA. At 9 months CA, in linear regression models, MDI was significantly associated with severe intraventricular hemorrhage (IVH) and SWC score, while PDI was associated with GA and SWC score. At 18 months CA, these associations lost significance. At 34 weeks PMA, all VLBW premature infants demonstrate some degree of SWC on aEEG. Maturation of SWC at 34 weeks PMA is not associated with gestational age, however may relate to early NDO. Further studies are needed to evaluate this relationship.
Newborn infants, chronically exposed in utero to low doses of methadone with or without concomita... more Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.
... However, the extreme immaturity of the visual system at this age is signaled by the presence ... more ... However, the extreme immaturity of the visual system at this age is signaled by the presence of fused eyelids, cloudy optic media, and remnants of an embryonic tissue (tunica vasculosa lentis) in the eye ... Eye movement is usually conjugate during tracking, even if the ...
Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resur... more Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resurgence has been attributed to advances in medical care which have increased the survival of infants less than 1000 g. Retinal immaturity and exposure to supplementary oxygen are generally accepted as the principal factors associated with ROP, however precocious exposure of the immature retina to light may also contribute. The preterm infant is routinely exposed for the duration of hospital stay to bright continuous light at levels which produce retinal damage in animals. A recent study has provided evidence implicating light in ROP. Preterm infants for whom the light levels were reduced had a lower incidence of ROP, compared to a similar group of preterms exposed to standard levels of nursery light. Given the problems of a non-randomized design, the results must be considered preliminary; however the findings are substantiated by parallel results in both hospitals studied and by an effect of exposure to light within the treatment group. Speculations regarding the mechanisms of light as a contributor to ROP include: alterations of retinal metabolism, cellular damage by phototoxicity, and the generation of free radicals. Mechanisms of phototoxicity are compatible with theories of oxygen toxicity. Light may not be necessary for ROP to occur, but it may increase the risk.
Journal of Neurology Neurosurgery and Psychiatry, 1977
Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (me... more Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (methylprednisolone 200-2000 mg/day) for up to 151 days (mean 55 days). Neurological improvement occurred in eight patients on high doses after deterioration on concentional doses (methylprednisolone 80-120 mg/day). In two patients steroids could be completely discontinued for several months. Serious adverse effects included sepsis in three patients
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