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PubMed2006

Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.

BACKGROUND: Respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability. OBJECTIVES: To assess the effects on fetal and neonatal morbidity and mortality, on maternal mortality and morbidity, and on the child in later life of administering corticosteroids to the mother before anticipated preterm birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 October 2005). SELECTION CRITERIA: Randomised controlled comparisons of antenatal corticosteroid administration (betamethasone, dexamethasone, or hydrocortisone) with placebo or with no treatment given to women with a singleton or multiple pregnancy, expected to deliver preterm as a result of either spontaneous preterm labour, preterm prelabour rupture of the membranes or elective preterm delivery. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality and extracted data independently. MAIN RESULTS: Twenty-one studies (3885 women and 4269 infants) are included. Treatment with antenatal corticosteroids does not increase risk to the mother of death, chorioamnionitis or puerperal sepsis. Treatment with antenatal corticosteroids is associated with an overall reduction in neonatal death (relative risk (RR) 0.69, 95% confidence interval (CI) 0.58 to 0.81, 18 studies, 3956 infants), RDS (RR 0.66, 95% CI 0.59 to 0.73, 21 studies, 4038 infants), cerebroventricular haemorrhage (RR 0.54, 95% CI 0.43 to 0.69, 13 studies, 2872 infants), necrotising enterocolitis (RR 0.46, 95% CI 0.29 to 0.74, eight studies, 1675 infants), respiratory support, intensive care admissions (RR 0.80, 95% CI 0.65 to 0.99, two studies, 277 infants) and systemic infections in the first 48 hours of life (RR 0.56, 95% CI 0.38 to 0.85, five studies, 1319 infants). Antenatal corticosteroid use is effective in women with premature rupture of membranes and pregnancy related hypertension syndromes. AUTHORS' CONCLUSIONS: The evidence from this new review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids should be considered routine for preterm delivery with few exceptions. Further information is required concerning optimal dose to delivery interval, optimal corticosteroid to use, effects in multiple pregnancies, and to confirm the long-term effects into adulthood.

Adrenal Cortex Hormones↗
PubMed2006

Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more).

BACKGROUND: Prelabour rupture of membranes at term is managed expectantly or by elective birth, but it is not clear if waiting for birth to occur spontaneously is better than intervening. OBJECTIVES: To assess the effects of planned early birth versus expectant management for women with term prelabour rupture of membranes on fetal, infant and maternal wellbeing. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2004), MEDLINE (1966 to November 2004) and EMBASE (1974 to November 2004). SELECTION CRITERIA: Randomised or quasi-randomised trials of planned early birth compared with expectant management in women with prelabour rupture of membranes at 37 weeks' gestation or more. DATA COLLECTION AND ANALYSIS: Two review authors independently applied eligibility criteria, assessed trial quality and extracted data. A random-effects model was used. MAIN RESULTS: Twelve trials (total of 6814 women) were included. Planned management was generally induction with oxytocin or prostaglandin, with one trial using homoeopathic caulophyllum. Overall, no differences were detected for mode of birth between planned and expectant groups: relative risk (RR) of caesarean section 0.94, 95% confidence interval (CI) 0.82 to 1.08 (12 trials, 6814 women); RR of operative vaginal birth 0.98, 95% 0.84 to 1.16 (7 trials, 5511 women). Significantly fewer women in the planned compared with expectant management groups had chorioamnionitis (RR 0.74, 95% CI 0.56 to 0.97; 9 trials, 6611 women) or endometritis (RR 0.30, 95% CI 0.12 to 0.74; 4 trials, 445 women). No difference was seen for neonatal infection (RR 0.83, 95% CI 0.61 to 1.12; 9 trials, 6406 infants). However, fewer infants under planned management went to neonatal intensive or special care compared with expectant management (RR 0.72, 95% CI 0.57 to 0.92, number needed to treat 20; 5 trials, 5679 infants). In a single trial, significantly more women with planned management viewed their care more positively than those expectantly managed (RR of "nothing liked" 0.45, 95% CI 0.37 to 0.54; 5031 women). AUTHORS' CONCLUSIONS: Planned management (with methods such as oxytocin or prostaglandin) reduces the risk of some maternal infectious morbidity without increasing caesarean sections and operative vaginal births. Fewer infants went to neonatal intensive care under planned management although no differences were seen in neonatal infection rates. Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices.

Cesarean Section↗
PubMed1979

Pathology of the placenta and cord in ascending and in haematogenous infection.

The two main patterns of inflammatory response in the placenta and its adnexae are: (1) amniotic infection, usually bacterial ascending, with acute chorioamnionitis and funisitis; (2) haematogenous villitis, usually viral, with early necrotizing lesions and vasculitis and, later, chronic infiltrates and obliterative vasculitis. In amniotic infection most cells in the exudate are maternal. These leucocytes participate in antibacterial defence of the amniotic cavity in conjunction with substances such as zinc polypeptide and lysozyme and may contribute directly to fetal defence. Immunoglobulins may be produced in the cord of placenta only in protracted lesions such as 'healed' funisitis. Individual variations in the resistance of the membranes to bacterial penetration are possible. In viral infections a massive multifocal production by plasmacytes of immunoglobulins M, G and A is seen in affected villi. The secretion of non-specific antiviral substances in the infected placenta is possible. In all affected villi there is an activation of fixed macrophages (Hofbauer cells) that remain partly 'immature', i.e. are lysozyme-negative. Multifocal lymphoplasmacytic villitis is uncommon and has helped to focus the diagnosis on prenatal infection. In contrast, non-specific lymphocytic villitis is common; since there is no morphological difference between cases known to be associated with an infection, e.g. varicella, and the others, many cases may well be due to silent infection, although a graft-versus-host reactions remains a distinct possibility.

Amnion↗
PubMed1981

Developmental changes in the fine structure of the chorion laeve (smooth chorion) of the rhesus monkey placenta.

Developmental changes in the fine structure of the chorion laeve (smooth chorion) of the rhesus monkey were studied at two time periods during gestation: 1) Early (19-60 days of gestation), before the chorionic epithelium fuses with the parietal decidua, and 2) near term, when the fused chorioamnion has also fused with the parietal decidua. Early in gestation the chorionic epithelium consisted of columnar and cuboidal cells one or two layers thick. The apical border of the cells had microvilli and coated pits, and adjacent cells were joined by tight junctions and desmosomes. The chorionic epithelial cells during this early period contained numerous large vesicles and vacuoles of varying electron-density. The apical cytoplasm contained various small coated vesicles and tubules. Taken together these observations were interpreted as indicating a possible role for these cells in endocytosis or phagocytosis of substances from the uterine lumen; i.e., a potential role in histiotrophic nutrition during this early period. Late in gestation the trophoblastic cells were more irregular in shape. The cells contained abundant granular endoplasmic reticulum (ER) and mitochondria, and a well-developed Golgi complex, suggesting the cells were actively synthetic late in gestation. The numerous cytoplasmic vacuoles characteristic of the trophoblastic cells of early gestation were absent near term. Glycogen deposits and lipid droplets were moderately well-developed near term. Most of the cells were joined by desmosomes but wide intercellular spaces, unobstructed by any cell junctions, were frequently observed. This observation provides at least one explanation for the increase in permeability of the chorion laeve later in gestation. Cells of the parietal decidua associated with the chorion laeve were also examined. These cells generally had a well-developed granular ER and Golgi apparatus, and numerous mitochondria. Limited numbers of membrane-bounded secretory bodies, similar to those in human decidual cells, were also present.

Animals↗
PubMed1992

Amnion cell biosynthesis of interleukin-8: regulation by inflammatory cytokines.

The cellular constituents of the placenta are important participants in the recruitment and trafficking of inflammatory cells within the placenta. In infection-induced labor, gestational tissues synthesize and release a variety of inflammatory cytokines whose effects include increased prostaglandin biosynthesis and the initiation of uterine contractions. Interleukin-8 (IL-8), a potent neutrophil chemoattractant, has been recently described as being elevated in the amniotic fluid of mothers with chorioamnionitis. We investigated the biosynthesis of IL-8 by human amnion cells and its regulation by other inflammatory cytokines. Cultured amnion cells obtained from normal term placentae were found to produce IL-8 in response to pathophysiologic concentrations of interleukin 1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF-alpha). Treatment of amnion cells stimulated by IL-1 beta with cycloheximide resulted in increased IL-8 production, while incubation of IL-1 beta treated amnion cells with actinomycin D resulted in a concentration-dependent decrease in detectable amounts of IL-8. Northern blot analysis of cultured amnion cells stimulated with IL-1 beta demonstrated a rapid increase in IL-8 mRNA which peaked at 2-4 hr. These in vitro results suggest inflammation of gestational tissues in vivo may result in locally produced IL-8 and, in association with other inflammatory mediators, may be important in the pathophysiology of infection-induced labor.

Amnion↗
PubMed2002

Detection of cytomegalovirus DNA in human placenta.

Although human cytomegalovirus (CMV) is one of the most common causes of viral intrauterine and perinatal infection, its distribution in the placenta is poorly understood. The purpose of this study was to determine the frequency of CMV DNA positivity in placentas, to demonstrate the localization of the viral genome, and to identify the clinical features related to placental CMV. A total of 254 placentas from 231 mothers were investigated, and the maternal serum CMV immunoglobulin antibodies were measured. Specimens from both the placental parenchyma and the placental membrane close to the ruptured site in each placenta were examined for the presence of CMV DNA using dot blot hybridization after PCR amplification. None of 57 placentas from seronegative mothers was positive for CMV DNA. Of 197 placentas from seropositive mothers, 60 (30.5%) had CMV DNA in either the parenchyma or the membrane by dot blot analysis. In situ hybridization was carried out on these 60 placentas, and the localization of the viral genome was established in 19; CMV DNA was localized mostly to the villi, including the mesenchyme and trophoblasts, extravillous trophoblasts, and decidual cells. The mean gestational age at delivery was significantly later in the CMV DNA-positive placentas than in the negative placentas (36.9 +/- 5.1 vs 34.7 +/- 6.2 weeks, P = 0.0059). CMV DNA was detected in only 6 of 33 placentas delivered in the second trimester, and all six were associated with either severe maternal nephritis or severe chorioamnionitis. These results suggest that the CMV genome is common in placentas at later gestational ages and in those of earlier gestational ages with certain maternal complications.

Antibodies, Viral↗
PubMed1992

Regulated temporal and spatial expression of the calcium-binding proteins calcyclin and OPN (osteopontin) in mouse tissues during pregnancy.

In situ hybridization and northern/slot blot analyses were used to quantify the expression of calcyclin (2A9, 5B10), osteopontin (opn, secreted phosphoprotein, 2ar) and calmodulin mRNAs in mouse tissues that support pregnancy. High-to-moderate levels of the mRNAs of all three genes were detected at discrete locations in the uterus, decidua and placenta as a function of gestation time. Calmodulin expression was constant in these tissues; calcyclin mRNA was high during early pregnancy and declined after day 8-9 of gestation; and opn mRNA was undetectable before day 7, with maximal levels on days 9-12 in each of these tissues. Calcyclin, but not opn, expression was also observed in the chorioamnion after day 12. Calcyclin was expressed throughout the decidua on day 8 but became restricted to the primary (antimesometrial) decidual zone and decidua lateralis on day 9, and the decidua capsularis after day 9. By contrast, opn mRNA was localized on day 9 to the mesometrial triangle, which contains a large population of granulated metrial gland cells, and to the decidua basalis. These two genes may serve as markers for the two types of decidual tissue. We suggest that one function of OPN, which may be an indicator of cells in the decidua that have a bone marrow genealogy, is to mediate the flux of calcium from the maternal circulation to the developing embryo.

Animals↗
PubMed1993

Bronchus-associated lymphoid tissue (BALT) in human fetal and infant lung.

Bronchus-associated lymphoid tissue (BALT) has been defined as the organized lymphoid tissue of the lung. Although well described in a variety of animal species, documentation of its presence and development in human lung is limited. Because the tissue to volume ratio in adult lungs is so low, a systematic search for BALT would involve so many sections as to be impractical. In this study, therefore, we have studied post-mortem specimens of fetal (n = 102) and infant (n = 17) lungs, which have a much higher tissue to volume ratio. Fetal death was due to various causes but all but two infants died from sudden infant death syndrome. In the fetal lungs, the presence of BALT was almost invariably associated with chorioamnionitis or intrauterine pneumonia, being present in 24 of 51 of these cases (47 per cent). The earliest ill-defined lymphoid aggregate was seen at 16 weeks' gestation, while lymphoepithelium, a hallmark of mucosa-associated lymphoid tissue, could be identified at 20 weeks. In 51 fetuses without infection, BALT was found in only five cases (10 per cent). BALT was identified in 13/17 (77 per cent) of infant lungs and well-developed lymphoepithelium was evident in four cases. This study shows that BALT may be present in the human fetal and infant lung, but that its appearance is probably dependent on antigenic stimulation.

Bronchi↗
PubMedDate not supplied

Clinical significance of persistent amniotic fluid leakage after genetic amniocentesis.

Chronic amniotic fluid leakage is a rare complication of genetic amniocentesis. Pregnancy outcomes in two such patients are presented and six previous cases reviewed. Although chorioamnionitis has not been reported, potentially serious complications may occur including an increased risk for pre-term delivery and fetal skeletal deformity. While conservative management of post-amniocentesis amniotic fluid leakage is advocated, patients should be advised of these risks.

Adult↗
PubMed2004

CC chemokine concentrations increase in respiratory distress syndrome and correlate with development of bronchopulmonary dysplasia.

Inflammation is one of the primary processes underlying respiratory distress syndrome (RDS) and its evolution into bronchopulmonary dysplasia (BPD). Recruitment and subsequent activation of macrophages in the lung are mediated by CC chemokines. The role of CC chemokines has not been extensively studied in the course of RDS. Serial tracheal aspirates (TA) were obtained from 56 mechanically ventilated infants with birth weights less than 1,500 g during intervals in the first 21 days of life. Tracheal aspirate concentrations of monocyte chemoattractant proteins-1,2,3 (MCP-1,2,3) and macrophage inflammatory proteins-1alpha and -1beta (MIP-1alpha, MIP-1beta) were determined by enzyme-linked immunosorbent assay (ELISA). Tracheal aspirate concentrations of MCP-1, MCP-2, MCP-3, and MIP-1beta increased during the first week of life in infants with RDS, whereas MIP-1alpha concentrations did not increase appreciably. Increased TA cytokine concentrations were associated with the development of BPD. Maximal TA concentrations of MCP-1, MCP-2, MCP-3, MIP-1alpha, and MIP-1beta were significantly higher in infants who were oxygen-dependent at 28 postnatal days compared to infant who were not. Similarly, maximal TA MCP-1, MCP-2, and MCP-3 but not MIP-1alpha and MIP-1beta concentrations were significantly higher in infants who were oxygen-dependent at 36 weeks of postconceptional age (PCA) than those who were not oxygen-dependent at 36 weeks PCA. Histologic chorioamnionitis and isolation of Ureaplasma urealyticum from the airways were associated with higher maximal TA concentrations of MIP-1alpha and MIP-1beta. Pulmonary hemorrhage was associated with increased maximal concentrations of MCP-1, MCP-2, and MCP-3. These data suggest a role for CC chemokines in the development of BPD in the newborn infant.

Bronchopulmonary Dysplasia↗
PubMed2004

Procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios.

OBJECTIVE: To investigate the procedure-related complications of rapid amniodrainage in the treatment of polyhydramnios. METHODS: We followed prospectively all patients with polyhydramnios treated with rapid amniodrainage under continuous ultrasound guidance using a vacuum wound-drainage system from 1995 to 2002 in the fetal medicine unit of a university teaching hospital. We recorded: maternal age, type of pregnancy (singleton/twin), cause of polyhydramnios, gestational age at amniocentesis, volume of amniotic fluid drained, duration of the procedure, other intrauterine procedures in addition to the amniodrainage, and procedure-related complications including placental abruption, premature rupture of membranes (PROM), chorioamnionitis, fetal bradycardia and preterm delivery within 48 h of amniodrainage. RESULTS: Seventy-four consecutive women had 134 rapid amniodrainage procedures during the study period. Four procedures were excluded because the women were already in labor at the time of amniodrainage and they delivered within 48 h of the procedure. The final database therefore consisted of 70 patients with 130 procedures. Sixty-two percent (80/130) of the procedures were performed for the treatment of twin-twin transfusion syndrome (TTTS). There were altogether four procedure-related complications (3.1%; 95% CI, 1.0-8.0%). Three of them occurred in the TTTS group (3/80 procedures, 3.8%; 95% CI, 1.0-11.0%): one case each of placental abruption, PROM and fetal bradycardia. One PROM occurred in the non-TTTS group (1/50 procedures, 2.0%; 95% CI, 0-11.0%). In both cases of PROM the women presented in labor. CONCLUSIONS: Rapid amniodrainage using a vacuum wound-drainage system is safe and efficient to treat severe polyhydramnios, with a 3.1% complication rate.

Amniocentesis↗
PubMed1993

Perinatal AIDS: drugs of abuse and transplacental infection.

The number of children infected by the human immunodeficiency virus type-1 (HIV-1) who develop the acquired immunodeficiency syndrome (AIDS) continues to increase. While some children become infected after birth and others at the time of parturition, a significant percentage are infected during gestation and there is a positive correlation between maternal illicit intravenous drug use and fetal HIV-1 infection. Drugs can contribute in, at least, four ways to vertical transmission of HIV-1. These four ways are divisible into 2 main categories that are comprised of both direct and indirect mechanisms. For example, drugs of abuse can have a direct effect on the maternal-fetal interface. Cocaine is associated with vasculitis. If this occurs as a placentitis or chorioamnionitis, it can alter the permeability of these barriers to maternal blood and increase the number of potentially infected inflammatory cells in this tissue and as a result in the fetus. Another direct mechanism wherein drugs of abuse can increase the probability that a fetus will become infected is via an inflammatory reaction such as a vasculitis in the fetus rendering it more susceptible to viral infection. Drugs can also affect the course of HIV-1 infection via indirect mechanisms. An example of this may be by modulating the female immune system. This effect can exacerbate the woman's immunodeficiency and accelerate opportunistic infections. For example, cytomegalovirus infection resulting in placentitis might facilitate fetal HIV-1 infection. Lastly, a similar type of indirect mechanism can be postulated for the fetus wherein its developing immune system can be adversely effected.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1993

Evaluation of a rapid latex test for direct detection of Streptococcus agalactiae in various obstetrical and gynaecological disorders.

Cervical samples collected during speculum examination in 413 women were tested for the presence of Streptococcus agalactiae by Gram staining, a new latex agglutination test and standard cultures. The results of each method are reported in correlation with the clinical circumstances of isolation. Gram stain and the latex agglutination test had a sensitivity of 30% and 78%, and a specificity of 89% and 98% respectively compared with culture. The sensitivity of the latex agglutination test was higher in cases of premature rupture of membranes (90%), presumed chorioamnionitis (86%), presumed post-partum endometritis (86%) and presumed salpingitis (87%). This latex agglutination test appears to be useful for identifying patients who are heavily colonized with Streptococcus agalactiae and are at a high risk of infection.

Evaluation Studies as Topic↗
PubMed1997

A report on 158 cases of transcervical chorionic villus sampling.

Between 1989 and 1994 first trimester transcervical chorionic villus sampling was offered to 158 patients after proper counselling. The gestational age range was 9-12 weeks. The most important indication was advanced maternal age (75.4%). Adequate sampling after two, and a maximum of three attempts, was achieved in 98% and 99.3% of patients respectively. After the first year of the study karyotyping using the direct method alone was successful in 96% of cases. The success of karyotyping cultures was 98%. Excluding one false positive result the rate of fetal karyotypic abnormalities was 4.8%. 5 spontaneous abortions occurred (3.2%), all in patients of advanced maternal age. Moderate or severe vaginal bleeding occurred in 6.7% of the patients. There was no case of chorioamnionitis.

Abortion, Spontaneous↗
PubMed2004

Perforated acute appendicitis in a term neonate.

Acute appendicitis is rare in term neonates. In most of the reported cases, it is seen as a complication of necrotizing enterocolitis, Hirschsprung's disease, cystic fibrosis, meconium plug, inguinal hernia, umbilical hernia, Group B Streptococcal septicemia and chorioamnionitis. A surviving term male newborn with isolated acute appendicitis with perforation is reported. A high index of suspicion of acute appendicitis, early surgery and the importance of a thorough search for a perforation in cases of neonatal acute abdominal distention is stressed. Literature of this rare condition is reviewed briefly.

Acute Disease↗
PubMed2005

Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes.

OBJECTIVE: To compare case-mix, health care practices, and outcome in obstetric ICU admissions in inner-city teaching hospitals in economically developed and developing countries. DESIGN: Retrospective study. SETTING: Ben Taub General Hospital (BTGH), Houston, Texas, and King Edward Memorial Hospital (KEMH), Mumbai, India. PATIENTS: Women admitted during pregnancy or 6 weeks postpartum between 1992 and 2001. MEASUREMENTS AND RESULTS: Patients from BTGH (n=174) and KEMH (n=754) had comparable age, number of organs affected, incidence of medical disorders (30%), liver dysfunction, and thrombocytopenia. Fewer KEMH patients received prenatal care (27 vs 86%) and came to hospital within 24 h of onset of symptoms (60 vs 90%). They had higher APACHE II scores (median 16 vs 10), greater incidence of neurological (63 vs 36%), renal (50 vs 37%), and cardiovascular dysfunction (39 vs 29%). Severe malaria, viral hepatitis, cerebral venous thrombosis, and poisoning were common medical disorders. The BTGH group had higher incidence of respiratory dysfunction (59 vs 46%) and disseminated intravascular coagulation (40 vs 23%), placental anomalies, HELLP syndrome, chorioamnionitis, peripartum cardiomyopathy, puerperal sepsis, urinary infection, bacteremia, substance abuse, and asthma. More BTGH patients required mechanical ventilation and blood component therapy, whereas more KEMH patients needed dialysis. Of BTGH patients, 78.2% were delivered by cesarean section (vs 15.4%). Maternal (2.3 vs 25%) and fetal (13 vs 51%) mortality were lower in BTGH patients. CONCLUSIONS: There were marked differences in medical diseases, organ failure, and intensive care needs. Higher mortality in the Indian ICU may be due to difference in case mix, inadequate prenatal care, delay in reaching hospital, and greater severity of illness.

Adult↗
PubMed2003

Screening for infectious diseases.

INTRODUCTION: Fetal brain injury is an essential cause of lifelong morbidity. Infection appears as a cause of brain damage. Apart from chorioamnionitis, screening for infectious diseases must be considered in pregnancies with a risk of congenital infection or cases with abnormal cerebral ultrasound findings. DISCUSSION: Congenital infections include most of the major components of the TORCH complex: toxoplasmosis, rubella, cytomegalovirus, herpes, and varicella. Seronegative mothers can develop primary infection, which carries a risk of vertical transmission. The timing of the infection is a critical point, because fetal damage often depends on the gestational age at which acute maternal infection took place and occurs more likely in the first half of pregnancy. Antenatal ultrasound can detect brain abnormalities, like hydrocephalus, periventricular leukomalacia, calcifications or hemorrhage. Maternal serologic tests must be performed to look for an infectious etiology; the most frequent agents are the components of the TORCH complex. But additional serology must include parvovirus B19, HIV, and coxsackieviruses.

Brain Injuries↗
PubMed2005

Short-term dexamethasone treatment for symptomatic slit ventricle syndrome.

OBJECTIVE: The objective was to report our positive experience of using dexamethasone to treat 13 patients with symptomatic slit ventricle syndrome (SVS). METHODS: Thirteen SVS patients who received dexamethasone during acute episodes were studied. The etiology for hydrocephalus was prematurity and intraventricular hemorrhage in 9 patients and neonatal meningitis, chorioamnionitis, Dandy-Walker variant, and congenital in 1 case each. The shunt was inserted at 1.8+/-1.0 months of age and SVS was diagnosed at 4.9+/-3.2 years of age. RESULTS: All patients reported relief and shorter duration of symptoms with dexamethasone. Surgical intervention was decided upon and carried out within 11+/-8 months of SVS diagnosis in 9 out of 13 patients. The other 4 are being monitored and continue to receive dexamethasone when needed. CONCLUSIONS: Dexamethasone appears to be a useful treatment in acutely increased intracranial pressure caused by SVS. It can provide temporary relief during the decision-making process of whether and when to perform surgery.

Acute Disease↗