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Dunbar M, Norris A, Craig BT, Chaput K, Mohammad K, Cole L, Esser MJ, Caughey A, Carlson H, Kirton A. Relationship Between Neonatal Brain Injury and Objective Measures of Head Trauma: A Case-Control Study. Neurology 2023; 101:e2401-e2410. [PMID: 37848334 PMCID: PMC10752635 DOI: 10.1212/wnl.0000000000207766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal brain injury is a common and devastating diagnosis conferring lifelong challenges for children and families. The role of mechanical forces applied to the head, often referred to as "birth trauma," are often considered although evidence for this association is lacking. The objective of this study was to investigate the association between common types of neonatal brain injury and scalp swelling using a novel method to quantify scalp swelling as an unbiased proxy for mechanical forces applied to the head. METHODS Case-control study using population-based, prospectively collected tertiary care center databases and healthy controls from the Human Connectome Development Project. Included were infants born 32-42 weeks gestational age and MRI in the first 9 days. Outcomes categories included healthy neonates, hypoxic ischemic encephalopathy (HIE) with or without brain injury, or stroke (ischemic or hemorrhagic). Volume of scalp swelling was objectively quantified by a novel imaging method blinded to brain injury. Variables included mode of delivery and use of instrumentation. Statistical tests included Kruskal-Wallis test, chi square, and multivariable and multinomial logistic regression. RESULTS There were 309 infants included (55% male): 72 healthy controls, 77 HIE without brain injury on MRI, 78 HIE with brain injury, and 82 with stroke (60 ischemic, 22 hemorrhagic). Scalp swelling was present in 126 (40.8%, 95% confidence interval [CI] 35.2%-46.5%) with no difference in proportions between outcome groups. Compared to healthy controls, median volume was higher in those with HIE without brain injury (17.5 mL, 95% CI 6.8-28.2), HIE with brain injury (12.1 mL, 95% CI 5.5-18.6), but not ischemic stroke (4.7 mL, 95% CI -1.2-10.6) nor hemorrhagic stroke (8.3 mL, 95% CI -2.2-18.8). Scalp swelling was associated with instrumented delivery (OR 2.1, 95% CI 1.0-4.1), but not associated with increased odds of brain injury in those with HIE (OR 1.5, 95% CI 0.76-3.30). Scalp swelling measures were highly reliable (ICC = 0.97). DISCUSSION "Birth trauma" quantified by scalp swelling volume was more common in infants with difficult deliveries, but not associated with greater odds of brain injury due to hypoxia or stroke. These results may help parents and practitioners to dissociate the appearance of trauma with the risk of brain injury.
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Affiliation(s)
- Mary Dunbar
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Abbey Norris
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Brandon T Craig
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Kathleen Chaput
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Khorshid Mohammad
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Lauran Cole
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Michael J Esser
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Aaron Caughey
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Helen Carlson
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada
| | - Adam Kirton
- From the Department of Pediatrics (M.D., B.T.C., H.C., A.K.), University of Calgary; Calgary Pediatric Stroke Program (M.D., B.T.C., H.C., A.K.); Alberta Children's Hospital Research Institute (M.D., B.T.C., H.C., A.K.); Hotchkiss Brain Institute (M.D., B.T.C., H.C., A.K.); Pediatric Stroke Program (A.N.); Department of Obstetrics and Gynecology (K.C.); Department of Pediatrics (K.M., M.J.E.), University of Calgary; Department of Pediatrics (L.C.), University of Alberta, Edmonton, Canada; Department of Obstetrics and Gynecology (A.C.), Oregon Health & Science University, Portland, OR; and Department of Clinical Neurosciences and Radiology (A.K.), University of Calgary, Alberta, Canada.
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Giraud A, Stephens CM, Fluss J, Kossorotoff M, Walsh BH, Chabrier S. Long-term developmental condition following neonatal arterial ischemic stroke: A systematic review. Arch Pediatr 2023; 30:600-606. [PMID: 37805299 DOI: 10.1016/j.arcped.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Neonatal arterial ischemic stroke (NAIS) is the most frequent subtype of perinatal stroke. Its elusive pathophysiology, its abrupt and unexpected occurrence, and the uncertainty of the post-NAIS developmental condition may lead to parental emotional distress and psychological difficulties. The aim of this study was to summarize the current data on long-term developmental conditions following NAIS to support parental information given within the neonatal unit. METHODS This systematic review included clinical studies of term infants with NAIS, who had a developmental assessment at ≥5 years of age. Studies were identified from the Medline and Embase databases on June 1, 2022. The Joanna Briggs Institute (JBI) appraisal tool was used to assess the risk of bias. Results were synthesized using a narrative approach. The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to report this work. RESULTS Three cohort studies enrolling 205 children assessed from 5 to 7 years after NAIS were included. Most of the children presented long-term developmental conditions allowing them to be integrated into a regular school program, to participate in physical activities, and to have a good quality of life. Global intellectual deficiency and moderate-to-severe cerebral palsy occurred in less than 10% of the children. CONCLUSION Physicians should not overestimate the incidence of moderate-to-severe developmental outcome following NAIS when discussing the prognosis with parents. A parental information sheet about NAIS and its long-term developmental conditions is provided.
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Affiliation(s)
- Antoine Giraud
- Service de Réanimation Néonatale, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France; INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France; Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.
| | - Carol M Stephens
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Joel Fluss
- Paediatric Neurology Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Manoëlle Kossorotoff
- Centre National de Référence de l'AVC de l'Enfant, Service de Neurologie Pédiatrique, APHP - Hôpital Necker Enfants Malades, Paris, France
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Stéphane Chabrier
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France; Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
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