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Clinical and Ultrasonographic Study on Prenatal Brain Damage in Newborn Infants

Journal of the Korean Pediatric Society 1994;37(10):1364-1375.
Published online October 15, 1994.
Clinical and Ultrasonographic Study on Prenatal Brain Damage in Newborn Infants
Kook In Park, Dong Gwan Han, Ran Namgung, Chul Lee
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
출생전에 발생한 신생아 뇌손상에 관한 연구
박국인, 한동관, 남궁란, 이철
연세대학교 의과대학 소아과학교실
To determine the incidence of prenatal brain damage, and evaluate the clinical and neurosonographical characteristics, we prospectively examined 508 newborn infants with intracranial ultrasound within the first day of life who admitted to the NICU of Severance Hospital from June 1990 to January 1992 and reviewed maternal or neonatal medical records. We found 12 cases(2.4%) of fetal brain lesions and ten of which had antenatal periventricular intraventricular hemorrhage and posthemorrhagic hydrocephalus. One of 10 infants had focal parenchymal hemorrhage, 1 had diffuse parenchymal hemorrhage with a porencephalic cavity, 1 had multicystic periventricular leukomalacia with spongiform cerebromalacia, and 1 had multicystic periventricular leukomalacia. Another 2 infants showed multicystic periventricular leukomalcia and multicystic encephalomalacia with ventriculomegaly respectively. Of 12 infants with prenatal brain damage, 7 were full-term, 5 were preterm, 9 were appropriate-for gestational age, 2 were small-for gestational-age, 7 were male, and 9 were delivered vaginally. Ten of 12 infants had perinatal asphyxia and five of which showed severe asphxia. Ten of 12 cases had significant materanl histories(three of which had preterm labor, three had premature rupture of ammiotic membrane, one had preeclampsia, one had frequent upper respiratory tract infection and influenza, one had herb medication, and one had mental retardation). Only one infant with prenatal brain damage was asymptomatic and 11 infants exhibited a few clinical signs during the neonatal period(all 5 infants had respiratory distress symptom, 4 infants had multiple congenital anomalies, 2 infants showed janudic and one infant had seizure). Of 9 infants who were taken electroencephalogram, 7 infants showed abnormal findings and four of 9 infants taken brainstem auditory evoked potential test exhibited abnormal response. Cerebral palsy and mental retardation were documented in two infants, 5 infants were lost on follow-up examination, and 5 infants were discharged against doctor뭩 advices and died. This study confirms that some brain damage is prenatal and these lesions are associated with the development of cerebral palsy. Therefore, prenatal brain damage can not be attributed to obstetrical events and neonatal care. We recommend that a fetal neurosonographic examination should be done in the last trimester of all pregnancies, especially in the presence of significant obstetric history or suspected fetal malformations and neonatal brain sonogaraphy be done within the first week of life. These examination are justified because they would allow early intervention to help offset possibel neurologic deficits, would help prepare parents and pediatricians for possible limitations, and would prevent lawsuits and protect against malpractice allegations. But, it is not clear that every newborn infants need and ultrasound scan, sine detection of prenatal brain damage would be of little benefit to the patients and enormous cost of routinely examining all pregnancies would be required.
Key Words: Prenatal Brain Damage, Newborn infants, Ultrasonography

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