J Korean Pediatr Soc.  1994 Oct;37(10):1364-1375.

Clinical and Ultrasonographic Study on Prenatal Brain Damage inNewborn Infants

• Park KI
• Han DG
• Namgung R
• Lee C

Abstract

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 periventricularintraventricular 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 amniotic 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 ll 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 janudice 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 doctor's advices and died. This study confirms that some drain 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 possible 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 an ultrasound scan, since detection of prenatal brain damage would be of little benefit to the patients and enormous cost of routinely examining all pregnancies would be required.

MeSH Terms

Amnion
Asphyxia
Brain*
Cerebral Palsy
Early Intervention (Education)
Electroencephalography
Encephalomalacia
Evoked Potentials, Auditory, Brain Stem
Female
Follow-Up Studies
Hemorrhage
Humans
Hydrocephalus
Incidence
Infant*
Infant, Newborn
Influenza, Human
Intellectual Disability
Leukomalacia, Periventricular
Male
Malpractice
Medical Records
Neurologic Manifestations
Obstetric Labor, Premature
Parents
Pre-Eclampsia
Pregnancy
Pregnancy Trimester, Third
Prospective Studies
Respiratory Tract Infections
Rupture
Ultrasonography