RT Journal Article
SR Electronic
T1 Patterns of brain injury and outcome in term neonates presenting with postnatal collapse
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F168
OP F177
DO 10.1136/adc.2008.140301
VO 94
IS 3
A1 A Foran
A1 C Cinnante
A1 A Groves
A1 D V Azzopardi
A1 M A Rutherford
A1 F M Cowan
YR 2009
UL http://fn.bmj.com/content/94/3/F168.abstract
AB Objective: To document perinatal events, brain imaging, neurophysiology and clinical outcome in term infants with early postnatal collapse (PNC).Design: Tertiary referral centre, retrospective case review (1993–2006).Patients: Infants born at ⩾36 weeks’ gestation with early (<72 h) PNC. Peri-partum and post-collapse data were collated with clinical, electrophysiological, neuroimaging and autopsy data and neurodevelopmental outcome.Results: Twelve infants were studied; median gestation 39 weeks (36–41), birth weight 3150 g (1930–4010). Ten were born vaginally (including occipitoposterior (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 min; median cord pH was 7.29 (7.18–7.34). All were thought to be well after birth. The median age at PNC was 75 min (10 min to 55 h). All infants required extensive resuscitation. The median pH after PNC was 6.75 (6.39–7.05). Seven infants became severely encephalopathic, with severely abnormal EEG/aEEG recorded within 12 h. MRI showed acute severe hypoxic–ischaemic injury. All died. One infant showed rapid recovery, had mild encephalopathy, and good outcome. Four infants had severe respiratory illness, normal background EEG, and MRI showing slight white matter change (n = 3) or a small infarction (n = 1). All had a good 2-year outcome.Conclusions: In this term cohort, early PNC was generally followed by severe encephalopathy, acute central grey matter injury and poor outcome, or severe respiratory illness, slight white matter change and good outcome. Early EEG and MRI predicted outcome accurately. However, no antepartum, intrapartum or other aetiological factors were identified. Further investigation is needed in larger PNC cohorts.