Volume 168 Number I, Part 2

39 NEONATAL COMPLICATIONS AFTER ANTENATAL INDOMETHACIN FOR PRETERM LABOR. M Norton J. Merrillx, J. Kuller, R. Clymanx. Dept. Pediatrics and Ob'Gyn and Reproductive Sciences, UCSF, San Francisco CA. OBJECTIVE: The complications associated with indomethacin (indo) are controversial. Oligohydramnios and constriction of the fetal ductus have been reported frequently. In contrast, neonatal bleeding disorders, intracranial bleeds (ICH), and necrotizing enterocolitis (NEC) have been found only in isolated cases. However, most controlled studies have examined neonatal morbidity in infants with mean birth age > 32 wk. Because most neonatal complications occur in much more immature infants, we performed a blinded, case­controlled study to examine neonatal complications in infants exposed to indo and delivered ~ 30 wk. STUDY DESIGN: Fifty-seven infants exposed to indo antenatally were each matched with 57 control, unexposed infants. Infants were matched for sex, gestational age at delivery (27 ± 2 wk), prenatal betamethasone, ruptured membranes (> 24 h), and multiple gestation. RESULTS: As expected, both groups had similar birth weights, Apgar scores, cord gases, and incidence of respiratory distress syndrome. The need for exogenous surfactant, ventilator settings at 24 h, development of chronic lung disease, and sepsis also were similar. Indo-exosed infants had a lower urine output and elevated creatinine for the first 3 d after delivery (p < 0.05). Significantly more indo infants had confirmed NEC (19% indo; 2% control), ICH (grade II-IV: 29% indo; 10% control), and patent ductus arteriosus requiring ligation (37% indo; 13% control). CONCLUSIONS: Antenatal indo may increase the risk of serious neonatal complications, especially in infants delivered ~ 30 wk gestation.

40 A COMPARISON OF GESTATIONAL AGE-SPECIFIC NEONATAL MORBIDITIES BETWEEN TWIN AND SINGLETON PREGNANCIES. R. Ramus, J. Yankowitz, P. Robertson. Dept. Ob/Gyn and Reproductive Sciences, Univ. of California, San Francisco; San Francisco, CA. OBJECTIVE: This study details the incidence, by gestational age and birth weight, of specific neonatal morbidities in twin pregnancies without major congenital anomalies. This was done in order to compare the incidence of gestational age-specific morbidities in twin and singleton pregnancies without maternal complications. STUDY DESIGN: Data were collected prospectively on all deliveries at five tertiary care centers in the United States during the years 1983 through 1986. Pregnancies were meticulously dated and the gestational ages of the neonates at delivery were confirmed by Dubowitz score. RESULTS: From the study popUlation of 25,481 neonates there were 695 live·born twins. The incidence of respiratory distress syndrome (RDS) in twins decreased from 79% at 30 weeks to 23% at 31-32 weeks, and then remained stable until a decrease at 36 weeks. Intraventricular hemorrhage (Grade III and IV), sepsis, patent ductus arteriosus, and necrotizing enterocolitis were markedly decreased beyond 32 completed weeks. A group of 426 twins were compared to 20,680 singletons with identical exclusion criteria and found to have an increased incidence of RDS at 29-30 weeks and again between 36 and 40 weeks (P<0.05). This late increased incidence of RDS in twins compared to singletons was almost exclusively found in white neonates. There were no significant differences detectable in the other morbidity outcomes, including mean number of days on the ventilator. CONCLUSIONS: The incidence of RDS in twins differs significantly from singletons at 29-30 weeks and again after 36 weeks, with etlmicity being an important consideration between 36 and 38 weeks. The incidence of other neonatal morbidities in twins is similar to singletons. These data permit prediction of the neonatal course in twins by gestational age, a parameter better quantified antepartum than birth weight.

SPO Abstracts 303

41 ELEVATION OF UMBILICAL ARTERY CREATINE KINASE BRAIN BAND ISOENZ'fME AT BIRTH PREDICTS NEURO­LOGIC DEFICIT. U. Verma, N. Tejani, S. Nigam!, P. Towle!, S. Kleinx, R. Figueroa, J. Dietrich. New York l1edical College, Valhalla, NY. OBJECTIVE: In a previous study we described the association of umbilical artery (UA) creatine kinase brain band (CKBB) isoenzyme % level of ~15 with major intraventricular hemorrhage (IVH) in neonates with birth weights (BW) ~ 1750 gms. This study evaluates the long term neurologic significance of elevated CKBB% in the absence of major IVH and periventricular leucomalacia (PVL) . STUDY DESIGN: 18 babies had elevated UA CKBB%. Of them 8 were excluded because of major IVH (6) and PVL (2). The remaining 10 cases were individually matched for BW with babies who had UA CKBB of <15%. All babies had a detailed neurologic evaluation at 1 - 2 years of age by an examiner unaware of the UA CKBB% values. Fisher's exact test ~Ias used. RESULTS: Six of 8 study infants showed deficit in the form of hypertonus (5) and hydrocephalus ( 1) compared to 0 out of 8 in birth weight­matched controls (p<0.005). CONCLUSION: In the absence of major IVH and PVL, UA CKBB % elevation at birth predicts neurologic deficit.

42 CONTINUOUS FETAL COCAINE INFUSION INCREASES CEREBRAL BLOOD FLOW AND GLUCOSE CONSUMPTION IN THE LAMB. C. R. Chao", H. O. Morishimax• M. Matsuo", Y. Abex, K. E. Jackx, Depts. of ObiGyn and Anesthesiology, Columbia University, New Yorl<, NY. OBJECTIVE: Cocaine use during pregnancy has been related to CNS abnormalities in the offspring. Because cocaine is a potent vasoconstrictor, we sought to determine if cocaine infusions would exert a vasoconstrictive effect on the fetal cerebral circulation. We also examined the effect of cocaine on cerebral glucose metabolism and fetal blood gases and blood pressures. STUDY DESIGN: Nine chronically catheterized near-term fetal sheep were given a one-hour continuous fetar intravenous infusion of cocaine (loading dose 2 mglkg, infusion 1 mg/kg/min). Fetal blood gases and blood pressures, regional brain blood flow (microspheres), and cerebral glucose metabolism (Fick principle) were measured. Statistical significance was determined by Friedman's ANOVA for repeated measures. RESULTS: Fetal cocaine infusion decreased arterial p02from 20.9 ± 0.7 mm Hg (control) to 16.5 ± 0.9 at 60 minutes of the infusion (mean ±

SEM, p<.OOO1). Cerebral blood flow (CBF) increased by 62, 70, and 72% at 15. 30 and 60 minutes of the infusion (p<.OOO1). Cerebral glucose consumption (CMRGlu) was increased by 113, 168, and 182% at these times respectively (p<.01). Despite a 10 mm Hg increase in mean arterial blood pressure, cerebral vascular resistance decreased from 0.39 ± 0.04 mm Hg/mVminl100g (control) to 0.27 ± 0.04 at 60 minutes (p<.01). CONCLUSIONS: Continuous fetal cocaine infusion decreased fetal oxygen tension. This suggests that cocaine-induced fetal hypoxia may be secondary to a fetal mechanism in addition to the previously described uterine artery vasoconstriction. Cocaine marl<edly stimUlated CMRGlu. The increase in CBF may be due to a combination of the hypoxia and the augmented production of a metabolic vasodilator (secondary to the increase in CMRGlu). Supported by NIDA (DA07588).