Introduction: In the fetus, the right ventricle (RV) is the dominant ventricle, contributing more than 50% to the combined cardiac output. RV dysfunction results in severe fetal cardiac failure with sometimes unpredictable postnatal outcome.
Intraventricular haemorrhage (IVH) and periventricular leucomalacia (PVL) in premature infants presumably have many causes. It has been proposed that inflammatory processes in the fetomaternal unit play an important role in the pathogenesis of these lesions.To study the correlation of postpartum serum interleukin 6 (IL6) concentration as a marker of inflammation and neonatal cerebral morbidity in preterm infants < 28 weeks of gestational age.A total of 88 infants were grouped according to maximum serum IL6 levels within 12 hours post partum: group A (n = 50), < or = 100 pg/ml; group B (n = 38), > 100 pg/ml. Ultrasound studies and clinical assessment were performed routinely.IVH was noted significantly more often in group B (24/38; 63%) than in group A (19/50; 38%) (p = 0.02). In a multiple logistic regression model, raised serum IL6 independently predicted development of severe IVH (odds ratio 8.4; 95% confidence interval 2.85 to 24.9; p = 0.0001).Raised serum IL6 may serve as a marker for severe IVH in infants < 28 weeks of gestational age. Although cerebral morbidity in premature infants is determined by different variables, the identification of systemic inflammation can help to define the need for anti-inflammatory strategies to prevent cerebral morbidity.
Hintergrund: Nekrotisierende Enterokolitis (NEC) ist der wichtigste gastrointestinale Notfall, der mit einer hohen Morbität und Mortalität bei Frühgeborenen mit sehr niedrigem Geburtsgewicht (<1500g Geburtsgewicht) verbunden ist. Bekannte Risikofaktoren sind die Unreife des Darmes, enterale Ernährung, intestinale Minderperfusion und Immundefizienz. Weiterhin kann durch intestinale Besiedlung mit Bakterien eine Entzündungsreaktion getriggert werden, die die Mucosabarriere schädigt. Die genaue Pathophysiologie ist jedoch weiterhin nicht vollständig verstanden. Regelmäßig werden Cluster von NEC's auf den neonatologischen Intensivstationen beobachtet, so dass auch pathogene Erreger eine Schlüsselrolle spielen könnten. So wurden auch gastrointestinale Viren wie z.B. Rotaviren in Zusammenhang mit der Entwicklung einer NEC beschrieben. Das Ziel dieser Analyse war es, die Rolle von Astrovirus (HAstV) bei Frühgeborenen mit NEC zu untersuchen.
To assess the spectrum of underlying diseases in cases of fetal anemia in which the cause was unknown in the intrauterine period. All patients that underwent intrauterine transfusion were identified in the perinatal databases of two tertiary referral centers for prenatal medicine and fetal echocardiography between 2002 and 2007. All cases in which the cause of fetal anemia was unknown at the time of second transfusion or thereafter were considered as the primary study population. 78 fetuses received an intrauterine transfusion in the study period. A total of 356 transfusions were performed in these patients. The causes of fetal anemia in our cohort were alloimmunisation (32), parvovirus infection (23), feto-fetal transfusion syndrome (9), sacrococcygeal teratoma (2) and cytomegalovirus infection (1). In the remaining 11 cases the cause of fetal anemia was unknown at the time of second transfusion and could only be ascertained in the further course of pregnancy or in the postnatal period. In all cases markedly elevated maximum systolic velocities in the middle cerebral artery accurately predicted fetal anemia. The final diagnosis in these cases was fetomaternal hemorrhage (2), Blackfan-Diamond anemia (1), generalised neonatal hemangiomatosis (1), elliptocytosis (1), neonatal hemochromatosis (1), mucopolysaccharidosis type VII (1) and in 4 cases the cause of fetal anemia remained unexplained. The latter 4 cases had an uneventful postnatal course and did not require further transfusions, suggesting fetomaternal haemorrhage as the most probable cause. In cases of fetal anemia with negative indirect Coombs-test and TORCH-serology, rare causes of anemia have to be considered. Fetal studies should therefore include reticulocyte count, parameters of hemolysis, peripheral blood smear and fetal liver function tests. Maternal studies should include a search for fetal cells using flow cytometry rather than Kleihauer-Betke test.
The international normalized ratio (INR), a standardized method of reporting the prothrombin time, can be a surrogate marker of the vitamin K-dependent coagulation pathways.To evaluate the relationship between INR measurements in the first 48 hours of life and subsequent development of intraventricular hemorrhage (IVH) in extremely preterm infants.A single-center retrospective, observational cohort study of infants born at <28 weeks gestation. The main outcome measure was defined as the degree of IVH seen on cranial ultrasound examinations at day 7 postnatal age.Of 200 infants, 109 (mean gestational age, 25.2 wk [SD, 1.27]) had coagulation results available. Of 109, 26 developed IVH. Elevated INR was associated with increased risk of a severe IVH (odds ratio [OR] 6.50; 95% confidence interval [CI], 1.65-25.62; P=0.008) adjusted for gestation, birth weight, and sex. INR was significantly associated with severe IVH in infants who did not receive blood products (OR, 64.60; 95% CI, 1.35-3081.25; P=0.035), but not in those who did (OR, 2.93; 95% CI, 0.67-12.71; P=0.151) (Pinteraction=0.086).An elevated INR in the first 48 hours of life may be useful to identify preterm infants at risk of severe IVH and may guide strategies to prevent the development, or limit the extension, of IVH.
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