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Patterns of brain injury and outcome in term neonates presenting with postnatal collapse
  1. Adrienne Foran (adrienneforan{at}hotmail.com)
  1. Dept. of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College, London, United Kingdom
    1. Claudia Cinnante (c.cinnante{at}libero.it)
    1. Neuroradiology, Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy
      1. Alan M Groves (alan.groves{at}imperial.ac.uk)
      1. Dept. of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College, London, United Kingdom
        1. Denis V Azzopardi (d.azzopardi{at}imperial.ac.uk)
        1. Dept. of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Imperial College, London, United Kingdom
          1. Mary A Rutherford (m.rutherford{at}imperial.ac.uk)
          1. Imaging Sciences Department, Imperial College, London, United Kingdom
            1. Frances M Cowan (f.cowan{at}imperial.ac.uk)
            1. Dept of Paediatrics and Imaging Sciences, Hammersmith Hospital, Imperial College, London, United Kingdom

              Abstract

              Objective: To document perinatal events, brain imaging, neurophysiology and clinical outcome in term infants with early post-natal collapse (PNC).

              Design: Tertiary referral centre, retrospective case review (1993-2006).

              Patients: Infants born at ≥36 weeks gestation with early (<72 hours) PNC. Peri-partum and post-collapse data were collated with clinical, electrophysiological, neuroimaging, autopsy data and neurodevelopmental outcome.

              Results: Twelve infants were studied; median gestation 39 (36-41) weeks, birthweight 3.15 (1.93-4.01) kg. Ten were born vaginally (including occipito-posterior(1), breech(2), water-birth(2), ventouse/forceps(3)); and two by emergency Caesarean section. Median Apgar scores were 9 (3-9) and 10 (8-10) at 1 and 5 minutes; median cord pH 7.29 (7.18-7.34). All were thought well after birth.

              Median age of PNC was 75 minutes (10 min–55 hrs). All infants required extensive resuscitation. Median pH post-collapse: 6.75 (6.39-7.05).

              Seven infants became severely encephalopathic with severely abnormal EEG/aEEG recorded within 12 hours; MRI showed acute severe hypoxic-ischemic injury; all died. One infant showed rapid recovery, had a mild encephalopathy, and good outcome. Four infants had severe respiratory illness, normal background EEG and MRI showing mild white matter change (n=3) or a small infarction (n=1). All had a good 2-year outcome.

              Conclusions: In our term cohort early PNC was generally followed either by severe encephalopathy, acute central grey matter injury and poor outcome; or severe respiratory illness, mild white matter change and good outcome. Early EEG and MRI predicted outcome accurately. However no ante- or intrapartum or other aetiological factors were identified; further investigation is needed in larger PNC cohorts.

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