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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cocaine abuse has become one of America's leading public health problems. Its use throughout pregnancy is associated with an increased risk of abruptio placentae, stillbirth, and preterm labor. Cocaine-associated neonatal complications include congenital malformations, decreased fetal growth, seizures, cerebral infarction and hemorrhage, auditory system deficits, sudden infant death syndrome, cardiac arrhythmias, necrotizing enterocolitis, and behavioral changes. Children followed throughout the first year of life continue to show developmental delay. Infants and children growing up in cocaine-abusing families are at risk for drug-related injuries. Accidental and intentional intoxication has occurred in infants and children from the smoke of freebase cocaine. The drug has also caused intoxication in breast-feeding infants. Adolescents experimenting with cocaine are at risk, with an apparently high frequency of seizures and loss of consciousness, as well as behavioral changes and psychosocial dysfunction.
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PMID:Cocaine: its effects on maternal and child health. 154 34

Cocaine use has increased dramatically in the past several years, and multiple medical complications associated with its use have been reported in adults, including bowel infarction and colitis. Maternal use of cocaine during pregnancy has been associated with complications in the fetus and newborn infant, including spontaneous abortions, preterm labor, cerebral infarctions, seizures, renal anomalies, and neurobehavioral and neurophysiologic abnormalities. This paper presents a case of necrotizing enterocolitis at birth in a term newborn exposed to cocaine antenatally. Cultures of the bowel grew two types of Clostridia organisms, Escherichia coli and group B streptococcus. It is suggested that bowel ischemia was secondary to the vasoconstrictive properties of the maternally abused cocaine and that secondary invasion of the bowel by multiple bacteria ensued. This case presents another possible complication to the newborn of maternal cocaine exposure in utero, namely ischemic infarction of the bowel.
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PMID:Cocaine exposure in a term neonate. Necrotizing enterocolitis as a complication. 326 47

One hundred twenty-five infants underwent surgical intervention for necrotizing enterocolitis between 1972 and 1984. Sixty-three infants, who survived more than 30 days postoperatively, were evaluated for long-term complications. There were 28 girls and 35 boys (mean birth weight 1,725 +/- 890 g; gestational age 32 +/- 4 weeks). Associated problems included hyaline membrane disease (43), cardiac anomalies (25), and trisomy 21(2). Thirty-six survivors required long-term ventilatory support. Fifty-nine infants underwent bowel resection and enterostomy, 3 decompressing enterostomies without resection, and 1, exploratory laparotomy only. Enterostomies were closed at four months. Twenty four had short bowel syndrome. Fifteen infants subsequently died for a late mortality rate of 23%. Mortality was related to sepsis (3), respiratory failure (5), cardiac anomalies (3), cardio-respiratory arrest (2), and TPN related liver failure (2), and was common with gestational age less than 31 weeks and birth weight less than 1,000 g. Medical problems included cholestasis (17), TPN induced cirrhosis (3), meningitis (3), seizures (8), and nutritional rickets (6). Significant developmental and intellectual delays were observed.
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PMID:Long-term follow-up after surgical management of necrotizing enterocolitis: sixty-three cases. 372 6

We introduced a rapid rewarming technique as part of standard therapy in 16 newborn infants with effects of severe environmental hypothermia. On admission, mean rectal temperature was 31.0 +/- 2.7 degrees C, mean gestational age was 33.4 +/- 4.5 weeks, and mean birth weight was 1.76 +/- 0.71 kg. Thirteen infants were admitted within 30 hours of delivery, and the remainder at 2 to 3 weeks of age. Infants were rewarmed under a radiant warmer. The mean time required to reach a rectal temperature of 36.5 degrees C was 3.96 +/- 2.37 hours. Major medical entities encountered included thrombocytopenia (eight patients), metabolic acidosis (eight), respiratory distress (eight), renal failure (six), apnea (four), patent ductus arteriosus (four), seizures (four), intracranial hemorrhage (three), infection (three), and necrotizing enterocolitis (two). No complications could be attributed to the rapid rewarming technique. Of three infants who died, all weighed less than 1.25 kg at birth. This 81% survival is in contrast to the high mortality (25% to 50%) noted previously among infants treated by gradual rewarming.
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PMID:Improved prognosis in severely hypothermic newborn infants treated by rapid rewarming. 647 Aug 70

The objective of the study was to evaluate neonatal survival and subsequent disabilities in infants with extremely low gestational age in relation to perinatal events and neonatal treatment. A retrospective follow-up study was performed based on medical records, questionnaires to parents and recordings of contact with health authorities. All infants with a gestational age 28 completed weeks or less, who were admitted to the Department of Neonatology, Rigshospitalet, within 24 hours of age during the period January 1, 1987 - December 31, 1990 were included. During this period the basic therapeutic approach was a combination of minimal handling and early nasal-continuous positive airway pressure (CPAP) ("minitouch"). Main outcome measures were: mortality, healthy survival and disabled survival. Variables related to outcome were: risk factors present at birth (gestational age, birth weight, gender, place of birth (Rigshospitalet/other hospital), mode of delivery, Apgar score at five minutes; interventions in the neonatal period (intermittent positive pressure ventilation and treatment of hypotension); complications in the neonatal period (intracranial haemorrhage grade II-IV, periventricular leucomalacia, pneumothorax, seizures and septicaemia). One hundred and ninety-seven infants without major malformations were included. The mortality rate was 29%. Among infants with gestational age 24-25 weeks 49% died versus 24% of infants born after 26-28 weeks (p = 0.004). Mean gestational age was 26.7 weeks (range 24-28) and mean birth weight 994 g (range 525-1630). Fifty-five infants (28%) were small-for-gestational age. One hundred and fifty-five infants (79%) were born in our hospital and 115 (58%) were delivered by caesarean section. A total of 140 infants (71%) survived until discharge and none died between discharge and follow-up. At follow-up at a mean uncorrected age of 48 months information was obtained about all infants, except two (1%) who had emigrated; 75 (54%) had no impairments, 31 (22%) had minor impairments, 17 (12%) were moderately disabled, and 15 (11%) were severely disabled. Of the 197 infants 121 (61%) were treated with intermittent positive pressure ventilation, 83 (42%) with dopamine for hypotension, and 92 (47%) received parenteral nutrition. In 64 infants (33%) the course was complicated with intracranial haemorrhage (ICH) grade II-IV, in 17 (9%) with seizures, in 23 (12%) with pneumothorax, in 21 (11%) with septicaemia, and in 10 (5%) with necrotizing enterocolitis. Sixty infants (31%) needed medical or surgical closure of a persistent ductus arteriosus. In 11 infants (6%) cystic periventricular leucomalacia occurred, 10 infants (5%) developed retinopathy of prematurity stage 3-4, and 35 infants (24%) received supplementary oxygen at 28 days of age. Risk factors present at birth for adverse outcome were: Apgar score <7 at five minutes, birth weight <1000 g, male sex and birth in another hospital than Rigshospitalet, For adverse outcome in surviving infants only, ICH grade II-IV was the only significant risk factor.
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PMID:Infants with gestational age 28 weeks or less. 890 83

The absence of fetal pulmonary maturity in patients with preterm premature rupture of the membranes (PPROM) is often considered an indication for conservative management. The purpose of this study was to examine the value of biochemical pulmonary maturity assessment for the prediction of neonatal outcome in patients with PPROM between 32 and 34 weeks' gestation. Pregnancies complicated by PPROM at 32 to 34 weeks' gestation that delivered from January 1995 to May 2000 and had biochemical pulmonary maturity assessment were reviewed. Patients with medical disorders, multiple gestations, fetal growth restriction or structural anomalies, or evidence of intra-amniotic infection were excluded. Neonatal outcome measures were compared between patients with mature and immature pulmonary indices. During this time period, 244 patients with PPROM at 32-34 weeks' gestation were delivered; 78 patients met inclusion criteria (n = 41 patients with mature indices and n = 37 patients with immature indices). There were no cases of perinatal death or sepsis. There was no difference in major neonatal morbidities including need for mechanical ventilation, grade 2 or 3 necrotizing enterocolitis, grade 3 or 4 intraventricular hemorrhage, or seizures. After controlling for confounding factors including gestational age at PPROM and delivery, latency period, group B streptococcus (GBS) vaginal colonization, corticosteroid therapy, neonatal sex, mode of delivery, fetal indications for delivery, and umbilical cord pH, biochemical pulmonary maturity was not predictive of major neonatal morbidity. In our population, biochemical pulmonary maturity status does not appear to be predictive of neonatal morbidity in pregnancies complicated by PPROM at 32-34 weeks' gestation.
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PMID:Relationship between fetal pulmonary maturity assessment and neonatal outcome in premature rupture of the membranes at 32-34 weeks' gestation. 1173 61

When extremely preterm birth is anticipated, a reliable estimate of neonatal outcome is essential for the parents and health care providers who face difficult management decisions. Estimates of birth weight and gestational age are most commonly used for this purpose. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (NICHD MFMU) Network performed an observational study of data available before delivery of infants with birth weights < 1000 g. Ultrasonographic variables (estimated fetal weight, obstetrically estimated gestational age, femur length, and biparietal diameter) and clinical variables (maternal race, antenatal care, substance abuse, medical treatment, reason for delivery, fetal gender, and presentation) were studied as predictors of intrapartum stillbirth, neonatal death, survival to 120 days after birth or to discharge, and with markers of "serious" morbidity (high-grade intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, oxygen dependence at discharge or 120 days, and seizures). Survival without serious morbidity was considered "intact." Logistic regression was used to evaluate the influence of the obstetrician's opinion of viability and willingness to perform cesarean delivery for fetal distress, birth weight, growth, gender, presentation, and ethnicity on outcomes. Fetal femur length and estimated gestational age predicted survival better than did biparietal diameter or estimated fetal weight. Antenatal ultrasound and clinical data did not distinguish those infants who would suffer serious morbidity or be considered intact. Willingness to perform cesarean delivery was associated with increased likelihood of both survival and intact survival by virtually eliminating intrapartum stillbirth and reducing neonatal mortality. However, such practice was associated with an increased chance of serious morbidity among survivors below 800 g or 26 weeks'. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks', willingness to perform cesarean delivery was associated with twice the risk for serious morbidity in survivors at that gestational age.
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PMID:What we have learned about antenatal prediction of neonatal morbidity and mortality. 1288 92

The aim of the study was to compare a variety of neonatal outcome variables of growth concordant twin gestations (CT) to that of growth discordant twins (DT). Maternal and neonatal charts of live, non-anomalous twins > 25 weeks' gestation from 1984-2000 with no evidence of twin-twin transfusion syndrome were reviewed for several variables. DT occurred in (N = 81) 11.9% of all twin pregnancies. In 61.7% of DT, twin B was the smaller of the twins. There was no difference in maternal age, admission indications, or antepartum complications between both groups. DT had a significantly higher incidence of growth restriction compared to CT (88.9% vs 43.5%, p < 0.001). More mothers of DT required oxytocin (37.0% vs 26.3%, p = 0.024); however, cesarean delivery rate and indications were similar in both groups. A similar percentage of infants had AS < 4 at 1 min and AS < 7 at 5 min in both groups. There was no difference between the 2 groups in neonatal complications including: trauma, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, pneumonia, seizures, or neonatal mortality. However, DT had a significantly higher incidence of hyperbilirubinemia, need for mechanical ventilation and a longer nursery stay. The neonatal outcome of growth discordant twins is worse than that of concordant twins even in pregnancies uncomplicated by twin-twin transfusion syndrome or congenital anomalies.
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PMID:Neonatal outcome of growth discordant twin gestations. 1295 90

The developing brain has an increased susceptibility to seizure activity, and neonatal seizures can adversely affect neurodevelopmental outcome. This study aimed to determine the incidence of neonatal seizures in very low birthweight infants and to identify perinatal and postnatal factors associated with the occurrence of clinical seizures. A population-based cohort of 6525 very low birthweight infants born from 1995 through 1999 comprised the study group. Maternal, perinatal, or postnatal variables that showed a significant association with neonatal seizures in a univariate analysis were tested by a multiple logistic regression to assess the independent effect of each variable on the risk of seizures. The overall incidence of seizures was 5.6%. Significant independent predictors of neonatal seizures were decreasing gestational age, male gender, respiratory distress syndrome, pulmonary air leak (pneumothorax and pulmonary interstitial emphysema), intraventricular hemorrhage, periventricular leukomalacia, patent ductus arteriosus, surgical ligation of patent ductus arteriosus, necrotizing enterocolitis, and surgical treatment of necrotizing enterocolitis. Neonatal seizures appear to be associated with major morbidities and surgical interventions in very low birthweight infants. Continuous electroencephalographic monitoring could be warranted in infants following surgical treatment.
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PMID:Risk factors for neonatal seizures in very low birthweight infants: population-based survey. 1507 5

This population-based observational study aimed to determine the perinatal factors that were associated with the occurrence of seizures in very low birthweight infants with periventricular leukomalacia. The study sample consisted of 545 infants from the Israel National Very Low Birthweight Infant Database, gestational age 24 to 36 weeks, who survived beyond 28 days of age, in whom a late cranial ultrasonographic examination was performed and in whom periventricular leukomalacia was diagnosed. To evaluate the association between periventricular leukomalacia and confounding variables on the occurrence of seizures, the chi-square test, univariate analysis, and a logistic regression model were used. Of the 545 infants who developed periventricular leukomalacia, 102 (18.7%) had seizures. Significant independent predictors of seizures among these infants were decreasing gestational age, intraventricular hemorrhage, posthemorrhagic hydrocephalus, sepsis, and necrotizing enterocolitis. Infants with both sepsis and necrotizing enterocolitis had a 4.6-fold increased risk of seizures, further suggesting a possible role of infection in the pathogenesis of brain injury in preterm infants.
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PMID:Risk factors for seizures in very low birthweight infants with periventricular leukomalacia. 1709 63


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