Abstract 1122 Poster Session II, Sunday, 5/2 (poster 75)

Thalamostriate vessels of increased echo-density are occasionally observed during screening cranial sonography in neonates. This 'thalamostriate vasculopathy' (TSV) has been observed in case studies in neonates with perinatal infection or with chromosomal disorders; however, the clinical relevance, causes, and outcomes remain unclear. As a short-term neurologic endpoint, serial cranial sonography of neonates was performed in a prospective, randomized trial of intrapartum magnesium sulfate (MgSO4) in which the long-term objective was to reduce cerebral palsy (Magnesium and Neurologic Endpoint Trial, MAGnet). Entry criteria: <34 wks gestation and preterm labor; exclusions: pre-eclampsia. In the MAGnet trial, mothers were randomized in two arms to receive either IV MgSO4 (4gm bolus, 2 gm/hr) vs another tocolytic (tocolytic arm, <4cm cervical dilatation) or MgSO4 (4gm bolus) vs NS (preventive arm, >4 cm dilatation). Placentas were examined by a blinded investigator and prospectively cultured (aerobic, anaerobic, mycoplasmas, and chlamydia) after the amnion was split from the chorion. In the period 10/95-1/97, 159 neonates remained in the trial and 148 had cranial sonography; of these, 15 (10%) revealed TSV. Epidemiologic, intrapartum, and neonatal variables were compared: (Table) The groups did not differ in: GA, gender, race, route of delivery, survival, or incidence of RDS; in cord blood pH, total or ionized [Mg++] or [Ca++]; or in neonatal [Mg++] or [Ca++] over the first 3 days. TSV is associated with both the risk factor of placental funisitis and the adverse outcome of intraventricular hemorrhage (IVH). Funisitis has been shown by us and others to be associated with neonatal brain injury. Based on these relationships, we conclude that TSV (1) is likely a pathological finding with clinical relevance, and not just incidental, (2) may be another form of brain injury related to perinatal infection, and (3) may share common pathogenesis with IVH.

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