The incidence and spectrum of neurological injury after open fetal surgery

John F. Bealer; Jack Raisanen; Erik D. Skarsgard; Steven R. Long; Kondi Wong; Roy A. Filly; N. Scott Adzick; Michael R. Harrison

doi:10.1016/0022-3468(95)90009-8

The incidence and spectrum of neurological injury after open fetal surgery

John F. Bealer, Jack Raisanen, Erik D. Skarsgard, Steven R. Long, Kondi Wong, Roy A. Filly, N. Scott Adzick, Michael R. Harrison

Research output: Contribution to journal › Article › peer-review

40 Scopus citations

Abstract

A preterm infant's immature brain is susceptible to both anoxic and hemorrhagic injury during periods of physiological stress. The advent of in utero surgery has created a new population of premature patients at risk for central nervous system (CNS) injury. The aim of this study was to evaluate the frequency and nature of CNS injuries in fetal surgical patients. Of 33 fetuses with known neurological outcome after fetal surgery, CNS injuries were identified in seven (21%). Of the seven, four had significant episodes of fetal bradycardia (3) or neonatal hypotension (1), which suggests that asphyxia contributed to the neurological injury. The CNS injuries in the other three patients occurred unexpectedly and without associated signs of fetal distress. The authors speculate that these injuries may have been caused by sudden fluxes in cerebral blood flow, induced by maternal hypoxia (1) or by maternally administered tocolytic drugs (2) used to treat postoperative preterm labor.

Original language	English (US)
Pages (from-to)	1150-1154
Number of pages	5
Journal	Journal of Pediatric Surgery
Volume	30
Issue number	8
DOIs	https://doi.org/10.1016/0022-3468(95)90009-8
State	Published - Aug 1995

Keywords

Fetal surgery
intraventricular hemorrhage
periventricular leukomalacia

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health

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10.1016/0022-3468(95)90009-8

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title = "The incidence and spectrum of neurological injury after open fetal surgery",

abstract = "A preterm infant's immature brain is susceptible to both anoxic and hemorrhagic injury during periods of physiological stress. The advent of in utero surgery has created a new population of premature patients at risk for central nervous system (CNS) injury. The aim of this study was to evaluate the frequency and nature of CNS injuries in fetal surgical patients. Of 33 fetuses with known neurological outcome after fetal surgery, CNS injuries were identified in seven (21%). Of the seven, four had significant episodes of fetal bradycardia (3) or neonatal hypotension (1), which suggests that asphyxia contributed to the neurological injury. The CNS injuries in the other three patients occurred unexpectedly and without associated signs of fetal distress. The authors speculate that these injuries may have been caused by sudden fluxes in cerebral blood flow, induced by maternal hypoxia (1) or by maternally administered tocolytic drugs (2) used to treat postoperative preterm labor.",

keywords = "Fetal surgery, intraventricular hemorrhage, periventricular leukomalacia",

author = "Bealer, {John F.} and Jack Raisanen and Skarsgard, {Erik D.} and Long, {Steven R.} and Kondi Wong and Filly, {Roy A.} and Adzick, {N. Scott} and Harrison, {Michael R.}",

note = "Funding Information: From The Fetal Treatment Center, and the Departments of Surgery, Neuropathology, Pathology, and Radiology, The University of California, San Francisco, CA. Presented at the 26th Annual Meeting of the Canadian Association of Paediatric Surgeons, Toronto, Ontario, September 19-21, 1994. Supported by NIH Grants HD27308 and 5T32GM08258, L.A.B. Charities, and the Hospital for Sick Children Foundation, Toronto, Canada. Address reprint requests to Michael R. Harrison, MD, The Fetal Treatment Center, University of California--San Francisco, 3rd and Parnassus Aves, Room 1601-HSW,, San Francisco, CA 94143-0570. Copyright {\textcopyright} 1995 by W.B. Saunders Company 0022-3468/95/3008-0010503. 00/0",

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AU - Raisanen, Jack

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AU - Long, Steven R.

AU - Wong, Kondi

AU - Filly, Roy A.

AU - Adzick, N. Scott

AU - Harrison, Michael R.

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N2 - A preterm infant's immature brain is susceptible to both anoxic and hemorrhagic injury during periods of physiological stress. The advent of in utero surgery has created a new population of premature patients at risk for central nervous system (CNS) injury. The aim of this study was to evaluate the frequency and nature of CNS injuries in fetal surgical patients. Of 33 fetuses with known neurological outcome after fetal surgery, CNS injuries were identified in seven (21%). Of the seven, four had significant episodes of fetal bradycardia (3) or neonatal hypotension (1), which suggests that asphyxia contributed to the neurological injury. The CNS injuries in the other three patients occurred unexpectedly and without associated signs of fetal distress. The authors speculate that these injuries may have been caused by sudden fluxes in cerebral blood flow, induced by maternal hypoxia (1) or by maternally administered tocolytic drugs (2) used to treat postoperative preterm labor.

AB - A preterm infant's immature brain is susceptible to both anoxic and hemorrhagic injury during periods of physiological stress. The advent of in utero surgery has created a new population of premature patients at risk for central nervous system (CNS) injury. The aim of this study was to evaluate the frequency and nature of CNS injuries in fetal surgical patients. Of 33 fetuses with known neurological outcome after fetal surgery, CNS injuries were identified in seven (21%). Of the seven, four had significant episodes of fetal bradycardia (3) or neonatal hypotension (1), which suggests that asphyxia contributed to the neurological injury. The CNS injuries in the other three patients occurred unexpectedly and without associated signs of fetal distress. The authors speculate that these injuries may have been caused by sudden fluxes in cerebral blood flow, induced by maternal hypoxia (1) or by maternally administered tocolytic drugs (2) used to treat postoperative preterm labor.

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The incidence and spectrum of neurological injury after open fetal surgery

Abstract

Keywords

ASJC Scopus subject areas

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