My daughter just born, 28 days old (7th May 2012) was premature born (8 months 1 day) through C section. Did not cry from 4 to 5 min after comming out, was required to be on oxygen for 3 days. Her weight was 1400 grms when born.Today she is 1750 grams, however as her head size a little large (now measures 33 cm) trigred some querisity in Dr's mind, he referd for Cranial Sonography.The result is - The falx cerebri is in the mid line, The lateral ventricle are modererately dialted. The third ventricle is mildly dilated. The forth venricle is not dilated, Choroid plexus is normal in size & shape, no evidence of sybependymal, intraventriculer/choroid plexus haemorrhage. Small 6 to 7 mm & lagre 19mm cysts seen in right and left brain parenchyma, no posterior fossa abnomality is noted
Person's Gender: Male
Person's Age: 44
Have gone for MRI today, reports awaited
With the history you have given your child may not be a sign of brain hypoxia . However, when a child is born the oxygen in the blood comes through the umbilical cord an even not breathing . Not crying is not a specific sign of brain hypoxia. The color of the baby and other signs are more prognostic. This is the APGAR scale 10 is perfect-8-10 average normal. Ask the OB or the Pediatrican what the apgar was at birth.
All parents worry about weight and growth. This link gives your more information
It is all relative. So if you have a 5 % weight baby but a large 95% head, that is significant. According to the CDC growth chart for american females your daughter is at the 1-2% range for growth and head circumference. This would be expected with low birth weight and prematurity. Most babies catch up by 3 months.
The ultrasound may just be a normal variant seen with prematurity. The ventricles are normal, but I do not know what the cysts are. You should had a PEDiatric Neuro see her and seen if further tests such as the MRI may be needed.
From my standpoint, I see these finds as indicative of mild growth delay associated with the premature birth. Here are the World health Organization (WHO)Standard birth charts Which you can use to follow her growth. the automatic calculators on line do not appear to be as accurate..
Relist: Answer quality.
Hello, I'm a pediatrician on JA. Congratulations on the birth of your new baby. I am sorry she has some possible health issues. Your infant needs to be evaluated in person by a pediatric neurologist who sees premature infants. The mild dilatation of the ventricles and the cysts of course must be followed and the MRI is an appropriate next step. This will give some information as to the relative age of the cysts (when during gestation did they form) and the integrity of the brain parenchyma (tissue). UNfortunately, scans do not give us all the information about how will your child develop. I've seen infants with terrible looking scans who are essentially neurologically normal and develop fine ; I've seen fairly normal looking scans in infants who do not develop on track. The key is to discuss with your baby's treating doctors what her progress is daily, weekly, and monthly. Please post back if you have more questions. I am seeing patients all day but will check back as I am able. All best to your daughter and your family.
Relist: Incomplete answer.Pls get me answer from Pediatric Neurologist who is expert in pre mature infantsMean while pls find below the MRI report also for better inputsMRI - BRAINTechnique:MRI of brain was performed using T1, T2, FLAIR, axial 3D SWI and Diffusion weighted sequences in various planes.Imaging Findings:Evidence of areas of T1 hypersensitivity, isointense on T2 and showing blooming on SWI sequences noted in the right caudothalamic groove, lateral ventricle (extending in frontal, temporal and occipital horns), IIIrd and IVth ventricle with moderate to severe communicating hydrocephalus, periventricular ooze and represent sequelae to grade III germinal matrix hemorrhage.Evidence of multiple well circumscribed discrete cystic lesions, homogeneously hyperintense on T2, hypointense on T1, in the parietooccipital white matter, periventricular region and along the inferior cerebellar hemispheres and consistent with cystic periventricular leukomalacia.Rest of the brain parenchyma of hemispheres including thalami and basal ganglia appear normal in signal intensity and morphology.Rest of the brain parenchyma including brainstem and cerebellum appear normal.There is no evidence of midline shift.There is no evidence of mass lesion.Impressions:MRI brain study reveals, imaging evidence of Grade III Germinal Matrix hemorrhage with cystic periventricular leukomalacia as described.
Sorry about this illness with your newborn, and that there would be no pediatric neurologist available for opinion.
You have not described about her clinical state, feeding, sleep, other symptoms like cry, fits, bowel and urine, or whether her eyes show 'setting sun' sign commonly seen in hydrocephalus. Also about state of soft spot called anterior fontanel, whether bulged or pulsatile.
As stated above, there is no accurate clinico-investigation (MRI, Ultrasound) correlation. One has to just observe and watch for early mile stones like recognition of elders' face with smile, holding head erect (both by 8-10 weeks age).
Inputs on feeding, sleep, other symptoms like cry, fits, bowel and urine, as follows,
She is taking spoon feed (35 ml of milk - Pre Nan by nestle, per two hrs), bowel and urine is normal (Avg two times a day potty) she crys when feeling hungry or if she do not see some one in her room, during massage or giving bath she crys. she sleeps for more than 20 hrs (mostly through out day time).
She also smile some time in her sleep also. she reacts to sound, she tries to catch up voice on mobile speaker phone (as to where its coming from), other physical inputs may help you is her head size which was 31.7 cm has grown to 33 cm in last 10 days, where as her weight which was 1500 gms has grown to 1750 gms in last 10 days (she was born underweight)
Pls let me know if you need any other inputs
Head growth is fast in first year, from normal 14" to almost 17" at one year. Her size seems to grow faster though and needs monthly watch. If forehead appears bulging and if you can see the white of eye (sclera) above the cornea when she is looking in front, that is 'setting sun' sigh indicating hydrocephalus.
Her higher functions appear normal, as also sight, hearing etc. Sleeping 20+ hours also good sign. Please feed (one measure powder per ounce) every 2 hours sufficient quantity such that she stops feeding herself.
Serial MRI or ultrasound scans would tell about need for intervention like putting an internal shunt.
Pls find Ultrasound as well as MRI reports for your further inputs and advise (my queries are listed at the end of the report)
Cranial Sonography ReportThe falx cerebri is in the mid line, The lateral ventricle are modererately dialted. The third ventricle is mildly dilated. The forth venricle is not dilated, Choroid plexus is normal in size & shape, no evidence of sybependymal, intraventriculer/choroid plexus haemorrhage. Small 6 to 7 mm & lagre 19mm cysts seen in right and left brain parenchyma, no posterior fossa abnomality is noted
MRI - BRAIN Report
MRI of brain was performed using T1, T2, FLAIR, axial 3D SWI and Diffusion weighted sequences in various planes.
Evidence of areas of T1 hypersensitivity, isointense on T2 and showing blooming on SWI sequences noted in the right caudothalamic groove, lateral ventricle (extending in frontal, temporal and occipital horns), IIIrd and IVth ventricle with moderate to severe communicating hydrocephalus, periventricular ooze and represent sequelae to grade III germinal matrix hemorrhage.
Evidence of multiple well circumscribed discrete cystic lesions, homogeneously hyperintense on T2, hypointense on T1, in the parietooccipital white matter, periventricular region and along the inferior cerebellar hemispheres and consistent with cystic periventricular leukomalacia.
Rest of the brain parenchyma of hemispheres including thalami and basal ganglia appear normal in signal intensity and morphology.
Rest of the brain parenchyma including brainstem and cerebellum appear normal.
There is no evidence of midline shift.
There is no evidence of mass lesion.
MRI brain study reveals, imaging evidence of Grade III Germinal Matrix hemorrhage with cystic periventricular leukomalacia as described.
1. What can we expect due to this scenario (limitations in leading normal life)
2. Will this gets taken care as she grows (on its own) & what are the changes of this.
3. If not then what would be due course of action require
4. When will we require to put an internal shunt. (can this be suggested basis the above two reports)
5. What will be effects of this process on leading a normal life (it is permenent solution without any side effect)
6. We are based in Chandigarh (India), which Hospital or Dr would you suggest for us to get this done (I need best for my child)
1) It is too early to predict about limitations in leading normal life. One has to observe for early mile-stones.
2) There are 50 % chances that as she grows, on its own she will normalize in head size. Early increase in size of lateral ventricles may become normal as rest of head grows.
3) She should be weekly or fortnightly assessed for neurological development and other growth parameters like weight, head measurement.
4) When serial tests show that the gray matter of brain gets thinned out due to distending ventricles, a shunt is put before she develops neurological embarrassment due to fluid pressure.
5)Procedure has good prognosis for normal life only occasionally needing revision after teen age.
6) Please consider PGIMER pediatric neurology dept. of your city.
One last question Dr, is there any thing required to be done right now, I mean any medicine can be started which helps open the blockage or reduce pressure or helps dilute the cysts.RgdsManoj Roy
If your neonatologist considers any cause related to mother having some infection which is passed on to baby during pregnancy, that can be treated with medicine. Most probably there is some developmental block that can not be treated with any medicines.
Wish her all the best.
could not understand last reply...?
There are some maternal infections by viruses, bacilli or protozoa which cross placenta and damage newly forming brain and other structures. One of such effect could cause blockage in brain resulting in hydrocephalus.
Mother's serology tests are done to find out exact diagnosis (Common test is called TORCH test) and accordingly, if baby is suspected to harbor such germs (like Toxoplasma), treatment could be given to baby.
Link : http://www.merckmanuals.com/professional/pediatrics/infections_in_neonates/congenital_toxoplasmosis.html