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Biomedical subjects

C L Fawer

Publications and source records attributed to C L Fawer.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Extremely premature infants: what is their future? Lausanne experience 1982-1992].

This study describes neonatal mortality and morbidity as well as the neuropsychological outcome of extremely-low-birth-weight infants (less than 1000 grams) born between 1/1/1982 and 12/31/1992. The number of preterm infants admitted to the neonatal unit has increased over the last ten years. If neonatal mortality remains high, the prognosis of these immature children is favourable and depends on close collaboration between obstetricians and neonatologists and on the quality of perinatal care.

Brain Damage, Chronic↗
PubMed1991

Significance of ultrasound appearances in the neurological development and cognitive abilities of preterm infants at 5 years.

The developmental outcome at 5 years of age was studied in 93 preterm infants who had been prospectively examined for peri-ventricular leucomalacia (PVL). Standardised neurological examination and developmental assessment, including tests of cognitive function, were carried out. Major sequelae (n = 10) could be ascribed in most cases to the presence of large PVL lesions. Children with normal scans (n = 51), with isolated haemorrhage (n = 15) and with post-haemorrhagic ventricular dilatation (n = 3) had a favourable prognosis. Patients with small focal PVL changes (n = 16) had lower cognitive abilities on the McCarthy scale and presented more abnormal neuromotor signs and more attention deficits when compared to children with normal scans and isolated haemorrhage. Small focal PVL changes seem therefore to interfere with development at 5 years of age and might represent a morphological marker of a more diffuse brain injury. This study demonstrated also the effect of socioeconomic status on outcome at the age of 5 years.

Cerebral Hemorrhage↗
PubMed1991

Cytomegalovirus fetal infection: prenatal diagnosis.

We report the results of prenatal diagnosis in 15 cases of primary cytomegalovirus infection during pregnancy. Sixteen fetuses (one twin pregnancy) were examined by ultrasonography, amniocentesis, and fetal blood sampling. Prenatal diagnosis was positive in eight cases as evidenced by positive amniotic fluid cultures in eight, positive immunoglobulin M (IgM) in six, and abnormal ultrasound in two. Among infected fetuses, abnormal laboratory findings included anemia, thrombocytopenia, and elevated liver function tests. Three pregnancies were terminated because of ultrasound abnormality or abnormal laboratory indices. In cases of fetal infection with normal ultrasound and normal laboratory findings, the pregnancies were allowed to proceed, leading to the birth of four infants (three with subclinical infections, one with bilateral hearing loss). The relation between anemia, thrombocytopenia, altered liver function tests, and subsequent handicap remains unknown, but the abnormalities observed in utero correspond to those described at birth in cases of cytomegalic inclusion disease. Amniocentesis alone allowed the diagnosis of infection in all cases, but fetal blood sampling provided additional information about the fetal condition.

Cytomegalovirus Infections↗
PubMed1989

Risk factors associated with the development of peri-intraventricular haemorrhage and periventricular leukomalacia.

81 preterm infants of 34 weeks' gestation or less were prospectively and sequentially examined by means of real-time ultrasound in order to identify which clinical risk factors might be associated with the development of peri-intraventricular haemorrhage (PVH) and periventricular leukomalacia (PVL). Infants were allocated in three groups: group A (n = 44): with normal scans; group B (n = 24): with isolated PVH, and group C (n = 13): with PVL. 28 obstetrical and neonatal factors were compared within the three groups using two methods of statistical analysis (2 x 2 chi 2 analysis and multivariate logistic regression analysis). Hyaline membrane disease, acidosis, pneumothorax and Apgar score at 10 min were statistically associated with PVH. The multivariate logistic regression analysis showed that need for resuscitation, hyaline membrane disease, acidosis and gestational age were the most important factors. Gestational age, seizures, hyaline membrane disease, apnoea with hypoxaemia and bradycardia were strongly associated with PVL. These results suggest that a low gestational age, the need for resuscitation and a respiratory distress syndrome with its consequences might lead to PVH, whereas a low gestational age, hypoxaemia and cardiocirculatory disturbances might decrease cerebral perfusion and result into PVL.

Cerebral Hemorrhage↗
PubMed1989

Auditory brainstem responses and ultrasound changes in a high-risk infants population.

50 neonates were selected in a high perinatal risk population and examined by means of cerebral ultrasound (US) and auditory brainstem responses (ABR). They were allocated in 5 groups according to their US diagnosis (normal scans, isolated peri-intraventricular haemorrhage, large haemorrhage with associated lesions, hypoxic-ischaemic lesions in term neonates, miscellaneous disorders). ABR abnormalities were found in 40% of the infants. They were more frequent in neonates with cerebral lesions. Furthermore, the more extensive the cerebral lesions, the more severe the ABR abnormalities. Most of the ABR changes were of audiological type (severe: threshold greater than 80 dB [14%]; moderate: threshold less than or equal to 80 dB [20%]), whereas neurological abnormalities were rare (6%). The prognostic value of ABR appears in this study to depend on the possible recovery in the neonatal period. Severe hearing loss was associated either with an early death or with major handicaps. ABR represent the method of first choice for the detection of hearing loss in the Neonatal Unit, while they seemed to be of limited value in assessing brainstem function.

Brain Damage, Chronic↗
PubMed1987

Periventricular leucomalacia and neurodevelopmental outcome in preterm infants.

During an 18 month period, 120 preterm infants of 34 weeks' gestation or less were prospectively examined for periventricular leucomalacia (PVL) by cerebral ultrasound. Neurological and developmental assessment was carried out at 18 months of age corrected for prematurity in 82 surviving neonates. The developmental outcome (Griffiths development quotient) was above 80 and similar in infants with normal scans (n = 41), isolated periventricular-intraventricular haemorrhage (n = 13), and post-haemorrhagic hydrocephalus (n = 4), and no major handicap was diagnosed in these groups. By contrast, the prognosis was variable and poorer in infants with PVL (n = 24) and depended on the extent and site of the lesion. Infants with frontal PVL (n = 13) developed normally. Major sequelae (n = 8) were closely related to frontal-parietal PVL and frontal-parietal-occipital PVL and could be ascribed to the presence of cysts as well as to a persistent hyperechogenic ultrasonographic PVL appearance. A relation between size and site of the lesion and type and severity of the handicap was established.

Developmental Disabilities↗
PubMed1986

Neurodevelopmental outcome and school performance of very-low-birth-weight infants at 8 years of age.

The neurodevelopmental outcome and school performance of 50 appropriate for gestational age (AGA) and 33 small for gestational age (SGA) very-low-birth-weight (VLBW) infants, compared to a control group (41 Term infants) were assessed at 8 years of age. The incidence of major handicaps among AGA and SGA/VLBW infants respectively, was 16% and 6%. No major handicap was found in the control group. The incidence of neurodevelopmental abnormalities (NDA) among AGA's (40%) and SGA's (57.6%) compared with the control group (31.7%) was found to be significantly higher. School failure occurred more frequently among VLBW infants (22.9%) and was related in children with NDA--and more particularly among AGA's--to the presence of language disorders or associated NDA. Evaluation of the consequences of NDA and school problems for later academic and professional achievement now requires further follow-up studies.

Achievement↗
PubMed1985

Primary thalamic haemorrhage in the newborn: a new clinical entity.

4 healthy full-term babies presented between 11 and 14 days of age with neurological abnormalities. Eye signs in 3 suggested involvement of tracts closely related to the thalamus. Spontaneous intrathalamic haemorrhage was confirmed with computed tomography and real-time ultrasound scans. Ventricular dilatation occurred in 3 babies and 2 of these needed ventriculoperitoneal shunts. The short-term neurodevelopmental outcome was fairly good.

Cerebral Hemorrhage↗
PubMed1985

Periventricular leukomalacia: a correlation study between real-time ultrasound and autopsy findings. Periventricular leukomalacia in the neonate.

The aim of this study was to validate the accuracy of real-time ultrasound (US) in the diagnosis of periventricular leukomalacia (PVL). US changes of PVL were correlated with autopsy results. During a 12-month period, all premature infants of 34 weeks' gestation or less (group A) and all neonates of more than 34 weeks' gestation who presented with abnormal neurological signs (group B) were studied with an ATL mechanical sector scanner (5 and 7.5 MHz). The overall incidence of PVL was 13.3%. In group A (n = 83), 13 infants had PVL and 3 died. In group B (n = 36), three developed PVL and two died. Autopsy was performed in the five infants. US revealed the sequence of lesion: - the early stage with increased echogenicity in the periventricular white matter, - the late stage with area of reduced echogenicity appearing in the most echogenic zone and resulting in cystic cavitation. Autopsy confirmed PVL lesions in all five infants. The increased echogenicity corresponded to necrosis with either vascular congestion and/or secondary bleeding, the reduced echogenicity to cystic degeneration with gliosis. US scan be used for the detection of PVL.

Brain Diseases↗
PubMed1985

Neurodevelopmental outcome at 12 months of age related to cerebral ultrasound appearances of high risk preterm infants.

A prospective neurological and developmental assessment at 12 months of age corrected for prematurity was performed on 54 surviving preterm infants of 34 weeks' gestation or less. The babies were allocated into three groups according to their ultrasound (US) appearances: Group I (n = 29), normal scan; Group II (n = 10), isolated periventricular-intraventricular haemorrhage (PVH); Group III (n = 15), association of PVH, periventricular leukomalacia (PVL) and ventricular dilatation. The developmental outcome evaluated with the Griffiths' development quotient (DQ) was good and similar in Groups I and II, while it was worse and variable in Group III. There was also a higher incidence of neurological abnormalities in Group III, as 47% of children only were found to be normal compared to 86% and 80% in Groups I and II, respectively. A major handicap was diagnosed in 5 children of Group III. Infants with small lesions of PVH or PVL or with ventricular dilatation developed as well as children with normal US scan, whereas more diffuse or extensive US changes of PVL had a poorer prognosis. The outcome of a cerebral injury seems to depend on the type, the size and localisation of the lesion, and to some extent, on the neuroplasticity of the developing brain.

Cerebral Hemorrhage↗
PubMed1985

Interaction between perinatal brain damage and processes of normal brain development. Ultrasonographic and neurodevelopmental study in the first year of life.

A systematic ultrasonographic study and a prospective neurodevelopmental assessment were carried out in a population of high-risk neonates. In group A (82 preterm infants of 34 weeks gestation or less), periventricular-intraventricular hemorrhage (PVH) and periventricular leukomalacia (PVL) were the commonest lesions. The association of PVH, PVL and ventricular dilatation had a variable outcome and the prognosis was found to be poorer in the presence of diffuse or extensive PVL. In group B (115 neonates of more than 34 weeks gestation), miscellaneous ultrasound changes were observed (malformations, infections, hemorrhages and hypoxic-ischemic lesions). Malformations, hypoxic-ischemic damage and prenatal infections had a gloomy prognosis. The main targets of hypoxic-ischemic damage in the immature infant were the germinal layer and the periventricular white matter, while in the mature infant the cortex and basal ganglia were more vulnerable. A relation between the localization and the size of the lesion could be established. In conclusion, basic forms of cerebral damage should therefore be understood in terms of brain maturation, type and timing of the insult, extent and localization of the lesion.

Brain↗
PubMed1985

Agenesis of the corpus callosum: real-time ultrasonographic diagnosis and autopsy findings.

Ultrasonographic appearances of agenesis of corpus callosum and its associated abnormalities are described in four cases. Clinical data, ultrasonographic diagnostic criteria, and correlation with neuropathological findings are presented. Ultrasound is the method of first choice in the neonatal period for the detection of cerebral malformations and more particularly of agenesis of corpus callosum.

Agenesis of Corpus Callosum↗