1
|
Nour Eldine M, Alhousseini M, Nour-Eldine W, Noureldine H, Vakharia KV, Krafft PR, Noureldine MHA. The Role of Oxidative Stress in the Progression of Secondary Brain Injury Following Germinal Matrix Hemorrhage. Transl Stroke Res 2024; 15:647-658. [PMID: 36930383 DOI: 10.1007/s12975-023-01147-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
Germinal matrix hemorrhage (GMH) can be a fatal condition responsible for the death of 1.7% of all neonates in the USA. The majority of GMH survivors develop long-term sequalae with debilitating comorbidities. Higher grade GMH is associated with higher mortality rates and higher prevalence of comorbidities. The pathophysiology of GMH can be broken down into two main titles: faulty hemodynamic autoregulation and structural weakness at the level of tissues and cells. Prematurity is the most significant risk factor for GMH, and it predisposes to both major pathophysiological mechanisms of the condition. Secondary brain injury is an important determinant of survival and comorbidities following GMH. Mechanisms of brain injury secondary to GMH include apoptosis, necrosis, neuroinflammation, and oxidative stress. This review will have a special focus on the mechanisms of oxidative stress following GMH, including but not limited to inflammation, mitochondrial reactive oxygen species, glutamate toxicity, and hemoglobin metabolic products. In addition, this review will explore treatment options of GMH, especially targeted therapy.
Collapse
Affiliation(s)
- Mariam Nour Eldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | | | - Wared Nour-Eldine
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Hussein Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Kunal V Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Paul R Krafft
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA.
| |
Collapse
|
2
|
Loth C, Treluyer L, Pierrat V, Ego A, Aubert AM, Debillon T, Zeitlin J, Torchin H, Chevallier M. Variations in neonatal mortality of preterm infants with intraparenchymal haemorrhage in Europe: the EPICE cohort. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326038. [PMID: 38272659 DOI: 10.1136/archdischild-2023-326038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The aim of this study was to investigate variations in mortality before neonatal intensive care unit (NICU) discharge of infants born preterm with intraparenchymal haemorrhage (IPH) in Europe with a special interest for withdrawing life-sustaining therapy (WLST). DESIGN Secondary analysis of the Effective Perinatal Intensive Care in Europe (EPICE) cohort, 2011-2012. SETTING Nineteen regions in 11 European countries. PATIENTS All infants born between 24+0 and 31+6 weeks' gestational age (GA) with a diagnosis of IPH. MAIN OUTCOME MEASURES Mortality rate with multivariable analysis after adjustment for GA, antenatal steroids and gender. WLST policies were described among NICUs and within countries. RESULTS Among 6828 infants born alive between 24+0 and 31+6 weeks' GA and without congenital anomalies admitted to NICUs, IPH was diagnosed in 234 infants (3.4%, 95% CI 3.3% to 3.9%) and 138 of them (59%) died. The median age at death was 6 days (3-13). Mortality rates varied significantly between countries (extremes: 30%-81%; p<0.004) and most infants (69%) died after WLST. After adjustment and with reference to the UK, mortality rates were significantly higher for France, Denmark and the Netherlands, with ORs of 8.8 (95% CI 3.3 to 23.6), 5.9 (95% CI 1.6 to 21.4) and 4.8 (95% CI 1.1 to 8.9). There were variations in WLST between European regions and countries. CONCLUSION In infants with IPH, rates of death before discharge and death after WLST varied between European countries. These variations in mortality impede studying reliable outcomes in infants with IPH across European countries and encourage reflection of clinical practices of WLST across European units.
Collapse
Affiliation(s)
- Charline Loth
- University Grenoble Alpes, Neonatology Department, CHU Grenoble-Alpes, Grenoble, France
| | - Ludovic Treluyer
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Véronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Anne Ego
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
- Grenoble Alpes, Inserm CIC1406, CHU Grenoble, Grenoble, France
| | - Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Thierry Debillon
- University Grenoble Alpes, Neonatology Department, CHU Grenoble-Alpes, Grenoble, France
- University Grenoble Alpes, CNRS, Public Health Department CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Institute of Engineering, University Grenoble Alpes, Grenoble, France
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Heloise Torchin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
- Neonatal Intensive Care Unit, Port-Royal Maternity, Paris, Île-de-France, France
| | - Marie Chevallier
- University Grenoble Alpes, Neonatology Department, CHU Grenoble-Alpes, Grenoble, France
- University Grenoble Alpes, CNRS, Public Health Department CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Institute of Engineering, University Grenoble Alpes, Grenoble, France
| |
Collapse
|
3
|
Pande GS, Vagha JD. A Review of the Occurrence of Intraventricular Hemorrhage in Preterm Newborns and its Future Neurodevelopmental Consequences. Cureus 2023; 15:e48968. [PMID: 38111458 PMCID: PMC10726079 DOI: 10.7759/cureus.48968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Intraventricular hemorrhage (IVH) is a type of bleeding that occurs through the germinal matrix and comes through the ependymal cells into the ventricular cavity. It is mostly seen in preterm neonates but can also be seen sometimes in term neonates. Various factors predispose to preterm delivery; it can be spontaneous or medically induced. Spontaneous IVH occurs in cases of intrauterine infections in the mother, and it can be induced in cases of medical emergencies such as preeclampsia and eclampsia. The brain of a preterm newborn is not fully developed as it does not have pericytes and proteins, so it can bleed very quickly, which can cause IVH. Also, the vessels supplying the germinal matrix are immature and highly vascularized. IVH has four grades based on findings detected on cranial ultrasound and MRI. Management includes medical and surgical management; medical management includes phenobarbitone used for seizures and prophylaxis. Surgical management includes drainage, irrigation, and fibrinolytic therapy (DRIFT), and neuro-endoscopic lavage. IVH causes various short-term and long-term neurodevelopmental consequences. Long-term complications include cerebral palsy and intellectual disability, which hamper the life of the child. It mainly presents with seizures, flaccidity, decerebrate posture, etc. Various preventive measures can be taken to tackle IVH in newborns. First of all, preterm delivery should be avoided, and intrauterine infections in mothers should be treated. The administration of corticosteroids should be done for all preterm deliveries as it helps in the maturation of organs. The administration of magnesium sulfate should be done as it is neuroprotective and reduces cerebral palsy in the future. Delayed cord clamping is to be done to reduce recurrent blood transfusions and decrease the risk of IVH. This article explains the pathogenesis, management, prevention, and future outcomes of IVH.
Collapse
Affiliation(s)
- Gauri S Pande
- Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
McLean G, Ditchfield M, Paul E, Malhotra A, Lombardo P. Evaluation of a Cranial Ultrasound Screening Protocol for Very Preterm Infants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1081-1091. [PMID: 36321412 DOI: 10.1002/jum.16121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Cranial ultrasound (cUS) screening is recommended for preterm neonates born before 32 weeks' gestational age (GA). The primary aim of this study was to determine if both a day 3 and day 8 cUS screening examination is necessary for all neonates. METHODS A retrospective observational study was performed at a tertiary-level Australian hospital. Frequencies of cranial ultrasound abnormality (CUA) were compared between routine screening performed at postnatal days 3, 8, and 42. Univariate and multivariate analyses of risk factors for intraventricular hemorrhage (IVH) was performed using logistic regression. RESULTS cUS examinations on 712 neonates born before 32 weeks' GA were included. Neonates were divided into 2 groups: 99 neonates in the 23-25 weeks 6 days GA (group A) and 613 neonates in the 26-31 weeks 6 days GA (group B). All CUA occurred more frequently in group A neonates and in the subset of group B neonates who had defined risk factors. Low-risk group B neonates had lower incidence of CUAs demonstrated on day 8 cUS than high-risk group B neonates, with no significant differences between day 3 and day 8. Logistic regression analysis identified a number of risk factors (vaginal delivery, small for GA, Apgar score <7 at 5 minutes, intubation, patent ductus arteriosus and infection) that were associated with increased frequency of IVH on day 8. In neonates born between 30 and 31 weeks 6 days GA, 35% had a CUA identified. CONCLUSIONS Low-risk preterm neonates born between 26 and 31 weeks 6 days GA, without complications, could be screened with a single early cUS examination around day 8 without missing substantial abnormality.
Collapse
Affiliation(s)
- Glenda McLean
- Diagnostic Imaging Department, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
| | - Michael Ditchfield
- Diagnostic Imaging Department, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Imaging, Monash University, Clayton, VIC, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, VIC, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
| |
Collapse
|
5
|
Valverde E, Ybarra M, Benito AV, Bravo MC, Pellicer A. Posthemorrhagic ventricular dilatation late intervention threshold and associated brain injury. PLoS One 2022; 17:e0276446. [PMID: 36301835 PMCID: PMC9612444 DOI: 10.1371/journal.pone.0276446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To systematically assess white matter injury (WMI) in preterm infants with posthemorrhagic ventricular dilatation (PHVD) using a high-threshold intervention strategy. STUDY DESIGN This retrospective analysis included 85 preterm infants (≤34 weeks of gestation) with grade 2-3 germinal matrix-intraventricular hemorrhage. Cranial ultrasound (cUS) scans were assessed for WMI and ventricular width and shape. Forty-eight infants developed PHVD, 21 of whom (intervention group) underwent cerebrospinal fluid drainage according to a predefined threshold (ventricular index ≥p97+4 mm or anterior horn width >10 mm, and the presence of frontal horn ballooning). The other 27 infants underwent a conservative approach (non-intervention group). The two PHVD groups were compared regarding ventricular width at two stages: the worst cUS for the non-intervention group (scans showing the largest ventricular measurements) versus pre-intervention cUS in the intervention group, and at term equivalent age. WMI was classified as normal/mild, moderate and severe. RESULTS The intervention group showed significantly larger ventricular index, anterior horn width and thalamo-occipital diameter than the non-intervention group at the two timepoints. Moderate and severe WMI were more frequent in the infants with PHVD (p<0.001), regardless of management (intervention or conservative management). There was a linear relationship between the severity of PHVD and WMI (p<0.001). CONCLUSIONS Preterm infants with PHVD who undergo a high-threshold intervention strategy associate an increased risk of WMI.
Collapse
Affiliation(s)
- Eva Valverde
- Department of Neonatology, La Paz University Hospital, Madrid, Spain,NeNe Foundation, Madrid, Spain,Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain,* E-mail:
| | - Marta Ybarra
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Andrea V. Benito
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - María Carmen Bravo
- Department of Neonatology, La Paz University Hospital, Madrid, Spain,Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain,Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| |
Collapse
|
6
|
Indrakanti S, Chavez W, Castro-Aragon I. Normal variant residual germinal matrix in extremely premature infants: radiographic features and imaging pitfalls. J Ultrasound 2022; 25:493-505. [PMID: 35092600 PMCID: PMC9402871 DOI: 10.1007/s40477-021-00612-9] [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: 03/07/2021] [Accepted: 07/12/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND As radiology volume from premature patients increases, previously undescribed imaging findings may be identified, posing diagnostic dilemma to the pediatric radiologist. OBJECTIVE The primary goal of our study is to characterize the previously undescribed imaging finding of subependymal echogenicity at the floor of the frontal horns, which we postulate represents normal variant embryologic remnant residual germinal matrix. Furthermore, we hope to equip the pediatric radiologist with diagnostic criteria to distinguish this normal variant from pathology. MATERIALS AND METHODS Retrospective review of neonates at our institution over a 10 year period was performed to identify extremely premature infants who received head ultrasounds during their hospital stay. Clinical data from EPIC was collected on these patients in addition to retrospective review of their head ultrasound images. RESULTS Literature review of neuroembryology and observed involution of the frontal horn subependymal echogenicity on sequential imaging inform our hypothesis that this imaging finding represents normal variant residual germinal matrix. Two-thirds of the 210 included extremely premature infants demonstrated this finding, which was frequently misinterpreted as grade 1 germinal matrix, intra-choroidal or intra-ventricular hemorrhage. Residual matrix was concomitantly present with additional pathology in 29.4% of the patients. CONCLUSION Previously undescribed subependymal echogenicity at the floor of the frontal horns is favored to represent normal variant embryologic remnant residual germinal matrix. Since this finding may be misinterpreted as germinal matrix, intra-choroidal or intra-ventricular hemorrhage, it is essential for the interpreting radiologist to be aware of this normal variant and not confuse it for pathology.
Collapse
Affiliation(s)
- Santoshi Indrakanti
- Department of Radiology, Massachusetts General Hospital, Boston Medical Center, 55 Fruit Street, White 427, Boston, MA, 02114, USA.
| | - Wilson Chavez
- Department of Radiology, Massachusetts General Hospital, Boston Medical Center, 55 Fruit Street, White 427, Boston, MA, 02114, USA
| | - Ilse Castro-Aragon
- Department of Radiology, Massachusetts General Hospital, Boston Medical Center, 55 Fruit Street, White 427, Boston, MA, 02114, USA
| |
Collapse
|
7
|
Song J, Nilsson G, Xu Y, Zelco A, Rocha-Ferreira E, Wang Y, Zhang X, Zhang S, Ek J, Hagberg H, Zhu C, Wang X. Temporal brain transcriptome analysis reveals key pathological events after germinal matrix hemorrhage in neonatal rats. J Cereb Blood Flow Metab 2022; 42:1632-1649. [PMID: 35491813 PMCID: PMC9441725 DOI: 10.1177/0271678x221098811] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Germinal matrix hemorrhage (GMH) is a common complication in preterm infants and is associated with high risk of adverse neurodevelopmental outcomes. We used a rat GMH model and performed RNA sequencing to investigate the signaling pathways and biological processes following hemorrhage. GMH induced brain injury characterized by early hematoma and subsequent tissue loss. At 6 hours after GMH, gene expression indicated an increase in mitochondrial activity such as ATP metabolism and oxidative phosphorylation along with upregulation of cytoprotective pathways and heme metabolism. At 24 hours after GMH, the expression pattern suggested an increase in cell cycle progression and downregulation of neurodevelopmental-related pathways. At 72 hours after GMH, there was an increase in genes related to inflammation and an upregulation of ferroptosis. Hemoglobin components and genes related to heme metabolism and ferroptosis such as Hmox1, Alox15, and Alas2 were among the most upregulated genes. We observed dysregulation of processes involved in development, mitochondrial function, cholesterol biosynthesis, and inflammation, all of which contribute to neurodevelopmental deterioration following GMH. This study is the first temporal transcriptome profile providing a comprehensive overview of the molecular mechanisms underlying brain injury following GMH, and it provides useful guidance in the search for therapeutic interventions.
Collapse
Affiliation(s)
- Juan Song
- Centre for Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Gisela Nilsson
- Centre for Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yiran Xu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Aura Zelco
- Centre for Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eridan Rocha-Ferreira
- Centre for Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Yafeng Wang
- Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Shan Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Joakim Ek
- Centre for Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Hagberg
- Centre for Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Xiaoyang Wang
- Centre for Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Centre for Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
8
|
Intraventricular Vancomycin Treatment for Shunt-related Ventriculitis Caused by Methicillin-resistant Staphylococcus Aureus in a Preterm Infant: A Case Report. Pediatr Infect Dis J 2022; 41:340-342. [PMID: 34845150 DOI: 10.1097/inf.0000000000003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posthemorragic hydrocephalus is a relatively common condition in prematures, often requiring ventriculoperitoneal shunts. We report a case of methicillin-resistant Staphylococcus aureus infection of a ventriculoperitoneal shunt in a premature neonate which failed conventional intravenous treatment. Despite the absence of published guidelines, we used available data and expert advice to treat the patient with intraventricular vancomycin. The treatment was successful in eradicating the infection without observed toxicity. This case highlights the need for international guidelines on intraventricular treatment for neonates.
Collapse
|
9
|
Siffel C, Kistler KD, Sarda SP. Global incidence of intraventricular hemorrhage among extremely preterm infants: a systematic literature review. J Perinat Med 2021; 49:1017-1026. [PMID: 33735943 DOI: 10.1515/jpm-2020-0331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To conduct a systematic literature review to evaluate the global incidence of intraventricular hemorrhage grade 2-4 among extremely preterm infants. METHODS We performed searches in MEDLINE and Embase for intraventricular hemorrhage and prematurity cited in English language observational studies published from May 2006 to October 2017. Included studies analyzed data from infants born at ≤28 weeks' gestational age and reported on intraventricular hemorrhage epidemiology. RESULTS Ninety-eight eligible studies encompassed 39 articles from Europe, 31 from North America, 25 from Asia, five from Oceania, and none from Africa or South America; both Europe and North America were included in two publications. The reported global incidence range of intraventricular hemorrhage grade 3-4 was 5-52% (Europe: 5-52%; North America: 8-22%; Asia: 5-36%; Oceania: 8-13%). When only population-based studies were included, the incidence range of intraventricular hemorrhage grade 3-4 was 6-22%. The incidence range of intraventricular hemorrhage grade 2 was infrequently documented and ranged from 5-19% (including population-based studies). The incidence of intraventricular hemorrhage was generally inversely related to gestational age. CONCLUSIONS Intraventricular hemorrhage is a frequent complication of extremely preterm birth. Intraventricular hemorrhage incidence range varies by region, and the global incidence of intraventricular hemorrhage grade 2 is not well documented.
Collapse
Affiliation(s)
- Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA.,College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Kristin D Kistler
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | - Sujata P Sarda
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA
| |
Collapse
|
10
|
Epstein KN, Kline-Fath BM, Zhang B, Venkatesan C, Habli M, Dowd D, Nagaraj UD. Prenatal Evaluation of Intracranial Hemorrhage on Fetal MRI: A Retrospective Review. AJNR Am J Neuroradiol 2021; 42:2222-2228. [PMID: 34711550 DOI: 10.3174/ajnr.a7320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The evaluation and characterization of germinal matrix hemorrhages have been predominantly described on postnatal head sonography in premature neonates. However, germinal matrix hemorrhages that are seen in premature neonates can be also seen in fetuses of the same postconceptual age and are now more frequently encountered in the era of fetal MR imaging. Our aim was to examine and describe the MR imaging findings of fetuses with intracranial hemorrhage. MATERIALS AND METHODS A retrospective review of diagnostic-quality fetal MRIs showing intracranial hemorrhage from January 2004 to May 2020 was performed. Images were reviewed by 2 radiologists, and imaging characteristics of fetal intracranial hemorrhages were documented. Corresponding postnatal imaging and clinical parameters were reviewed. RESULTS One hundred seventy-seven fetuses with a mean gestational age of 25.73 (SD, 5.01) weeks were included. Germinal matrix hemorrhage was identified in 60.5% (107/177) and nongerminal matrix hemorrhage in 39.5% (70/177) of patients. Significantly increased ventricular size correlated with higher germinal matrix hemorrhage grade (P < .001). Fetal growth restriction was present in 21.3% (20/94) of our population, and there was no significant correlation with germinal matrix grade or type of intracranial hemorrhage. An increased incidence of neonatal death with grade III germinal matrix hemorrhages (P = .069) compared with other grades was identified; 23.2% (16/69) of the neonates required ventriculoperitoneal shunts, with an increased incidence in the nongerminal matrix hemorrhage group (P = .026). CONCLUSIONS MR imaging has become a key tool in the diagnosis and characterization of intracranial hemorrhage in the fetus. Appropriate characterization is important for optimizing work-up, therapeutic approach, and prenatal counseling.
Collapse
Affiliation(s)
- K N Epstein
- From the Departments of Radiology and Medical Imaging (K.N.E., B.M.K.-F., U.D.N.) .,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio
| | - B M Kline-Fath
- From the Departments of Radiology and Medical Imaging (K.N.E., B.M.K.-F., U.D.N.).,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio
| | - B Zhang
- Biostatistics (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio
| | - C Venkatesan
- Neurology (C.V., D.D.).,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio
| | - M Habli
- Maternal Fetal Medicine (M.H.).,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio.,Department of Obstetrics and Gynecology (M.H.), Good Samaritan Hospital, Cincinnati, Ohio
| | - D Dowd
- Neurology (C.V., D.D.).,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio
| | - U D Nagaraj
- From the Departments of Radiology and Medical Imaging (K.N.E., B.M.K.-F., U.D.N.).,University of Cincinnati College of Medicine (K.N.E., B.M.K.-F., B.Z., C.V., M.H., D.D., U.D.N.), Cincinnati, Ohio
| |
Collapse
|
11
|
Pinto C, Malik P, Desai R, Shelar V, Bekina-Sreenivasan D, Satnarine TA, Lavado LK, Singla R, Chavda D, Kaul S, Datta S, Shah S, Patel UK. Post-Hemorrhagic Hydrocephalus and Outcomes Amongst Neonates With Intraventricular Hemorrhage: A Systematic Review and Pooled Analysis. Cureus 2021; 13:e18877. [PMID: 34804726 PMCID: PMC8599435 DOI: 10.7759/cureus.18877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Intraventricular hemorrhage (IVH) is a common cause of morbidity and mortality in preterm neonates. IVH leads to complications such as posthemorrhagic hydrocephalus (PHH), which commonly occurs in neonates with a more severe degree of IVH. Hence, we aimed to evaluate the characteristics and outcomes of PHH in neonates with IVH. Methods We performed a systematic review of cases reported from January 1978 to December 2020 through the PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the keywords 'intraventricular hemorrhage,' 'cerebral intraventricular hemorrhage,' and 'newborn.' A total of 79 articles were considered for analysis, and data on neonatal and maternal characteristics and outcomes were collected. The analysis was performed by using the χ2 test, Wilcoxon rank-sum test, and multivariate logistic regression model. Results We analyzed a total of 101 IVH cases, 54.5% were male and 62.4% preterm. Thirteen point nine percent (13.9%) presented with grade I, 35.6% grade II, and grade III respectively, and 8% grade IV IVH. Among the 59 (58.4%) neonates with PHH, 33.6% had resolved PHH and 24.8% had unresolved. In adjusted regression analysis, we found that neonates with resolved PHH have lower odds of having neurodevelopmental delay (OR:0.15, 95%CI:0.03-0.74; p=0.02) and death (OR:0.9;95%CI:0.01-0.99; p=0.049) as compared to unresolved PHH. Conclusion Our study showed that neonates with resolved PHH have a statistically significant lower risk of neurodevelopmental delay (NDD) and mortality. Future studies should be planned to evaluate the role of treatment and its effect on outcomes in IVH neonates with PHH as a complication.
Collapse
Affiliation(s)
- Candida Pinto
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Preeti Malik
- Pathology, Montefiore Medical Center, Wakefield Campus, Bronx, USA
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rutikbhai Desai
- Internal Medicine, University of North Carolina Cardiology at Nash, Rocky Mount, USA
| | - Vrushali Shelar
- Internal Medicine, Saratov State Medical University, Saratov, RUS
| | | | - Travis A Satnarine
- Neonatal Intensive Care Unit, Port of Spain General Hospital, Port of Spain, TTO
| | | | - Ramit Singla
- Pediatric Neurology, Children's Hospital of Michigan, Detroit, USA
| | - Devraj Chavda
- Pediatric Neurology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Surabhi Kaul
- Pediatric Neurology, Mercyone North Iowa, Mason City, USA
| | - Shae Datta
- Neurology, NYU Langone Health, New York, USA
| | - Shamik Shah
- Neurology, Stormont Vail Health, Topeka, USA
| | - Urvish K Patel
- Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
12
|
Lai GY, Chu-Kwan W, Westcott AB, Kulkarni AV, Drake JM, Lam SK. Timing of Temporizing Neurosurgical Treatment in Relation to Shunting and Neurodevelopmental Outcomes in Posthemorrhagic Ventricular Dilatation of Prematurity: A Meta-analysis. J Pediatr 2021; 234:54-64.e20. [PMID: 33484696 DOI: 10.1016/j.jpeds.2021.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/11/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the relationship between timing of initiation of temporizing neurosurgical treatment and rates of ventriculoperitoneal shunt (VPS) and neurodevelopmental impairment in premature infants with post-hemorrhagic ventricular dilatation (PHVD). STUDY DESIGN We searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Database of Systematic Reviews, and the Cochrane Center Register of Controlled Trials for studies that reported on premature infants with PHVD who underwent a temporizing neurosurgical procedure. The timing of the temporizing neurosurgical procedure, gestational age, birth weight, outcomes of conversion to VPS, moderate-to-severe neurodevelopmental impairment, infection, temporizing neurosurgical procedure revision, and death at discharge were extracted. RESULTS Sixty-two full-length articles and 6 conference abstracts (n = 2533 patients) published through November 2020 were included. Pooled rate for conversion to VPS was 60.5% (95% CI, 54.9-65.8), moderate-severe neurodevelopmental impairment 34.8% (95% CI, 27.4-42.9), infection 8.2% (95% CI, 6.7-10.1), revision 14.6% (95% CI, 10.4-20.1), and death 12.9% (95% CI, 10.2-16.4). The average age at temporizing neurosurgical procedure was 24.2 ± 11.3 days. On meta-regression, older age at temporizing neurosurgical procedure was a predictor of conversion to VPS (P < .001) and neurodevelopmental impairment (P < .01). Later year of publication predicted increased survival (P < .01) and external ventricular drains were associated with more revisions (P = .001). Tests for heterogeneity reached significance for all outcomes and a qualitative review showed heterogeneity in the study inclusion and diagnosis criteria for PHVD and initiation of temporizing neurosurgical procedure. CONCLUSIONS Later timing of temporizing neurosurgical procedure predicted higher rates of conversion to VPS and moderate-severe neurodevelopmental impairment. Outcomes were often reported relative to the number of patients who underwent a temporizing neurosurgical procedure and the criteria for study inclusion and the initiation of temporizing neurosurgical procedure varied across institutions. There is need for more comprehensive outcome reporting that includes all infants with PHVD regardless of treatment.
Collapse
Affiliation(s)
- Grace Y Lai
- Department of Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, IL; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - William Chu-Kwan
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Surgery and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Annie B Westcott
- Galter Health Science Library, Northwestern University, Chicago, IL
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Surgery and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - James M Drake
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Surgery and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Sandi K Lam
- Department of Neurological Surgery, McGaw Medical Center of Northwestern University, Chicago, IL; Division of Neurosurgery, Ann & Robert Lurie Children's Hospital, Chicago, IL
| |
Collapse
|
13
|
Egesa WI, Odoch S, Odong RJ, Nakalema G, Asiimwe D, Ekuk E, Twesigemukama S, Turyasiima M, Lokengama RK, Waibi WM, Abdirashid S, Kajoba D, Kumbakulu PK. Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants. Int J Pediatr 2021; 2021:6622598. [PMID: 33815512 PMCID: PMC7987455 DOI: 10.1155/2021/6622598] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.
Collapse
Affiliation(s)
- Walufu Ivan Egesa
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Simon Odoch
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Richard Justin Odong
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Gloria Nakalema
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Eddymond Ekuk
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Sabinah Twesigemukama
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Munanura Turyasiima
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Rachel Kwambele Lokengama
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - William Mugowa Waibi
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Said Abdirashid
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Dickson Kajoba
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Patrick Kumbowi Kumbakulu
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| |
Collapse
|
14
|
Jashni Motlagh A, Elsagh A, Sedighipoor E, Qorbani M. Risk factors and short-term complications of high-grade intraventricular hemorrhages in preterm neonates in training hospitals of Alborz. IRANIAN JOURNAL OF CHILD NEUROLOGY 2021; 15:47-55. [PMID: 33558813 PMCID: PMC7856434 DOI: 10.22037/ijcn.v15i1.20346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 07/30/2019] [Indexed: 11/25/2022]
Abstract
Objectives The aim of this study is to determine risk factors and short-term complications of high-grade intraventricular hemorrhages (IVHs) in preterm neonates. Other topics of investigation include the increase in complications of IVH with its severity and the effect of IVH risk factors on the severity of IVH. Materials & Methods We conducted a retrospective case-control study of 436 consecutive preterm neonates with high-grade (3, 4) IVHs admitted in training hospitals of Alborz University in Karaj, Iran, from 2012 to 2017. The risk factors and short-term complications were assessed and analyzed in the subjects by SPSS 19. Results Out of 10 000 eligible neonates, we identified 1203 premature infants with IVH. A total of 436 infants with IVH grades 3 and 4 were allocated to the case group. The control group consisted of 767 infants with IVH grades 1 and 2. This study revealed that the most common risk factors of IVH include lack of corticosteroid use in 67.2%, low Apgar score in 10%, and surfactant use in 5.7% of the patients. Ten percent (31 cases) had short-term complications (18 hydrocephalus and 13 death cases). Male gender (P = .006) and lower gestational age (P = .0001) contributed to higher grades of IVH. Conclusion According to the results obtained in this study, it may be concluded that the lack of corticosteroid use is the most common risk factor for IVH, and short-term complications may be seen in one-tenth of the cases.
Collapse
Affiliation(s)
- Alireza Jashni Motlagh
- Neonatologist, Department of Neonatology, Alborz University of Medical Sciences, Karaj, Iran
| | - Azamolmolouk Elsagh
- MSN, Faculty of Nursing, Alborz University of Medical Sciences, Karaj, Iran.,Department of Nursing, Faculty of Nursing & Midwifery, Tehran Azad University of Medical Sciences,Tehran, Iran
| | - Elham Sedighipoor
- Department of Neonatal Intensive Care Unit, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mostafa Qorbani
- Non-Communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
15
|
MacLeod R, Paulson JN, Okalany N, Okello F, Acom L, Ikiror J, Cowan FM, Tann CJ, Dyet LE, Hagmann CF, Burgoine K. Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study. BMC Pediatr 2021; 21:12. [PMID: 33407279 PMCID: PMC7786968 DOI: 10.1186/s12887-020-02464-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda. Methods This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival. Results Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH. Conclusion In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-020-02464-4.
Collapse
Affiliation(s)
- R MacLeod
- Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda
| | - J N Paulson
- Department of Biostatistics, Product Development, Genentech, Inc., South San Francisco, California, USA
| | - N Okalany
- Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda
| | - F Okello
- Varimetrics Group Limited, P. O Box 2190, Mbale, Uganda
| | - L Acom
- Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda
| | - J Ikiror
- Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda
| | - F M Cowan
- Department of Paediatrics, Imperial College London, London, UK
| | - C J Tann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,MRC/UVRI & LSHTM Uganda Research Unit, PO Box 149, Entebbe, Uganda.,Neonatal Medicine, University College London Hospitals NHS Trust, 235 Euston Road, London, UK
| | - L E Dyet
- Neonatal Medicine, University College London Hospitals NHS Trust, 235 Euston Road, London, UK
| | - C F Hagmann
- Department of Neonatology and Pediatric Intensive Care, Children's University Hospital of Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - K Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda.
| |
Collapse
|
16
|
Wallau CAK, Costa-Nobre DT, Leslie ATFS, Guinsburg R. Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a pre-post interventional study. SAO PAULO MED J 2021; 139:251-258. [PMID: 33978129 PMCID: PMC9625011 DOI: 10.1590/1516-3180.2020.0412.r1.28012021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Peri/intraventricular hemorrhage (PIVH) is a frequent cause of death and morbidity among preterm infants. Few studies have addressed the use of bundles for preventing PIVH. OBJECTIVE To evaluate the efficacy of a bundle of interventions designed to decrease the incidence of intraventricular hemorrhage at hospital discharge among preterm infants. DESIGN AND SETTING Pre-post interventional study with retrospective and prospective data collection performed before and after bundle implementation in the neonatal intensive care unit of a university hospital. METHODS Infants with gestational age < 32 weeks without malformations, who survived > 6 days were included. The bundle consisted of the following actions during the first 72 hours of life: maintenance of head in neutral position with the body in supine position, minimal handling, including delay of lumbar puncture until after 72 hours and absence of respiratory therapy maneuvers. Cranial ultrasound was performed on days 3, 7 and 28, or later if needed. The effect of the bundle was analyzed through logistic regression and results were adjusted for confounding variables. RESULTS 167 infants met the inclusion criteria; 146 (87%) were analyzed. Bundle implementation was associated with decreased chances of PIVH at hospital discharge (odds ratio 0.29; 95% confidence interval 0.13-0.65). Cerebrospinal fluid collection within the first 72 hours increased the odds of PIVH of any grade during the hospital stay fourfold, after adjustment for all variables included in the model. CONCLUSION Implementation of a bundle of interventions to avoid intraventricular hemorrhage was effective for decreasing the incidence of all grades of PIVH in preterm infants.
Collapse
Affiliation(s)
- Cristiane Akemi Koyama Wallau
- MSc. Postgraduate Student. Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Daniela Testoni Costa-Nobre
- MD, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Ana Teresa Figueiredo Stochero Leslie
- MD, MSc, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Ruth Guinsburg
- MD, PhD. Full Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| |
Collapse
|
17
|
Hollebrandse NL, Spittle AJ, Burnett AC, Anderson PJ, Roberts G, Doyle LW, Cheong JLY. School-age outcomes following intraventricular haemorrhage in infants born extremely preterm. Arch Dis Child Fetal Neonatal Ed 2021; 106:4-8. [PMID: 32732377 DOI: 10.1136/archdischild-2020-318989] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/02/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the associations of different grades of intraventricular haemorrhage (IVH), particularly grades 1 and 2, with neurodevelopmental outcomes at 8 years of age in children born extremely preterm. DESIGN Population-based cohort study. SETTING State of Victoria, Australia. PATIENTS Survivors born at <28 weeks' gestational age (n=546) and matched term-born controls (n=679) from three distinct eras, namely, those born in 1991-1992, 1997 and 2005. EXPOSURE Worst grade of IVH detected on serial neonatal cranial ultrasound. OUTCOME MEASURES Intellectual ability, executive function, academic skills, cerebral palsy and motor function at 8 years. RESULTS There was a trend for increased motor dysfunction with increasing severity of all grades of IVH, from 24% with no IVH, rising to 92% with grade 4 IVH. Children with grade 1 or 2 IVH were at higher risk of developing cerebral palsy than those without IVH (OR 2.24, 95% CI 1.21 to 4.16). Increased rates of impairment in intellectual ability and academic skills were observed with higher grades of IVH, but not for grade 1 and 2 IVH. Parent-rated executive functioning was not related to IVH. CONCLUSION While low-grade IVH is generally considered benign, it was associated with higher rates of cerebral palsy in school-aged children born EP, but not with intellectual ability, executive function, academic skills or overall motor function. Higher grades of IVH were associated with higher rates and risks of impairment in motor function, intellectual ability and some academic skills, but not parental ratings of executive function.
Collapse
Affiliation(s)
| | - Alicia J Spittle
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | - Alice C Burnett
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Premature Infant Follow-Up Program, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neonatal Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Gehan Roberts
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Premature Infant Follow-Up Program, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jeanie Ling Yoong Cheong
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia .,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
18
|
Jinnai M, Koning G, Singh-Mallah G, Jonsdotter A, Leverin AL, Svedin P, Nair S, Takeda S, Wang X, Mallard C, Ek CJ, Rocha-Ferreira E, Hagberg H. A Model of Germinal Matrix Hemorrhage in Preterm Rat Pups. Front Cell Neurosci 2020; 14:535320. [PMID: 33343300 PMCID: PMC7744792 DOI: 10.3389/fncel.2020.535320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023] Open
Abstract
Germinal matrix hemorrhage (GMH) is a serious complication in extremely preterm infants associated with neurological deficits and mortality. The purpose of the present study was to develop and characterize a grade III and IV GMH model in postnatal day 5 (P5) rats, the equivalent of preterm human brain maturation. P5 Wistar rats were exposed to unilateral GMH through intracranial injection into the striatum close to the germinal matrix with 0.1, 0.2, or 0.3 U of collagenase VII. During 10 days following GMH induction, motor functions and body weight were assessed and brain tissue collected at P16. Animals were tested for anxiety, motor coordination and motor asymmetry on P22–26 and P36–40. Using immunohistochemical staining and neuropathological scoring we found that a collagenase dose of 0.3 U induced GMH. Neuropathological assessment revealed that the brain injury in the collagenase group was characterized by dilation of the ipsilateral ventricle combined with mild to severe cellular necrosis as well as mild to moderate atrophy at the levels of striatum and subcortical white matter, and to a lesser extent, hippocampus and cortex. Within 0.5 h post-collagenase injection there was clear bleeding at the site of injury, with progressive increase in iron and infiltration of neutrophils in the first 24 h, together with focal microglia activation. By P16, blood was no longer observed, although significant gray and white matter brain infarction persisted. Astrogliosis was also detected at this time-point. Animals exposed to GMH performed worse than controls in the negative geotaxis test and also opened their eyes with latency compared to control animals. At P40, GMH rats spent more time in the center of open field box and moved at higher speed compared to the controls, and continued to show ipsilateral injury in striatum and subcortical white matter. We have established a P5 rat model of collagenase-induced GMH for the study of preterm brain injury. Our results show that P5 rat pups exposed to GMH develop moderate brain injury affecting both gray and white matter associated with delayed eye opening and abnormal motor functions. These animals develop hyperactivity and show reduced anxiety in the juvenile stage.
Collapse
Affiliation(s)
- Masako Jinnai
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Gabriella Koning
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gagandeep Singh-Mallah
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Andrea Jonsdotter
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna-Lena Leverin
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Pernilla Svedin
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Syam Nair
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Xiaoyang Wang
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Carina Mallard
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Carl Joakim Ek
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Eridan Rocha-Ferreira
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Henrik Hagberg
- Department of Obstetrics and Gynecology, Centre of Perinatal Medicine, Health, Institute of Clinical Sciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
19
|
Abstract
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity and inversely associated with gestational age and birth weight. The hemorrhage originates from the germinal matrix with an immature capillary bed where vascularization is intense and active cell proliferation is high. It occurs in around 20% of very low-birth-weight preterm neonates. Germinal matrix-intraventricular hemorrhage is less common in females, the black race, and with antenatal steroid use, but is more common in the presence of mechanical ventilation, respiratory distress, pulmonary bleeding, pneumothorax, chorioamnionitis, asphyxia, and sepsis. Ultrasonography is the diagnostic tool of choice for intraventricular hemorrhage and its complications. Approximately 25-50% of the germinal matrix-intraventricular hemorrhage cases are asymptomatic and diagnosed during routine screening. These cases are usually patients with low-grade hemorrhage. Neurologic findings are prominent in severe intraventricular hemorrhage cases. The major complications of the germinal matrix-intraventricular hemorrhage in preterm babies are periventricular hemorrhagic infarction, posthemorrhagic ventricular dilatation, periventricular leukomalacia, and cerebellar hemorrhage. It is an important cause of mortality and morbidity. The management of hemodynamics and ventilation of patients, appropriate follow-up, and early diagnosis and treatment can minimize morbidity. Prognosis in intraventricular hemorrhage is related to the severity of bleeding, parenchymal damage, and the presence of seizures and shunt surgery. The main determinant of prognosis is periventricular hemorrhagic infarction and its severity. Moderate-severe intraventricular hemorrhage can cause posthemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Even mild germinal matrix-intraventricular hemorrhage can result in developmental disorders. Long-term problems such as neurodevelopmental disorders and cerebral palsy are as important as short-term problems. Improving the quality of life of these babies should be aimed through appropriate treatment and follow-up. In this review, intraventricular hemorrhage and complications are discussed.
Collapse
|
20
|
Chen Z, Morales JE, Avci N, Guerrero PA, Rao G, Seo JH, McCarty JH. The vascular endothelial cell-expressed prion protein doppel promotes angiogenesis and blood-brain barrier development. Development 2020; 147:dev.193094. [PMID: 32895288 DOI: 10.1242/dev.193094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
The central nervous system (CNS) contains a complex network of blood vessels that promote normal tissue development and physiology. Abnormal control of blood vessel morphogenesis and maturation is linked to the pathogenesis of various neurodevelopmental diseases. The CNS-specific genes that regulate blood vessel morphogenesis in development and disease remain largely unknown. Here, we have characterized functions for the gene encoding prion protein 2 (Prnd) in CNS blood vessel development and physiology. Prnd encodes the glycosylphosphatidylinositol (GPI)-linked protein doppel, which is expressed on the surface of angiogenic vascular endothelial cells, but is absent in quiescent endothelial cells of the adult CNS. During CNS vascular development, doppel interacts with receptor tyrosine kinases and activates cytoplasmic signaling pathways involved in endothelial cell survival, metabolism and migration. Analysis of mice genetically null for Prnd revealed impaired CNS blood vessel morphogenesis and associated endothelial cell sprouting defects. Prnd-/- mice also displayed defects in endothelial barrier integrity. Collectively, these data reveal novel mechanisms underlying doppel control of angiogenesis in the developing CNS, and may provide new insights about dysfunctional pathways that cause vascular-related CNS disorders.
Collapse
Affiliation(s)
- Zhihua Chen
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - John E Morales
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Naze Avci
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Paola A Guerrero
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Je Hoon Seo
- Department of Anatomy, Chungbuk National University College of Medicine, Chungbuk 28644, Republic of Korea
| | - Joseph H McCarty
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
21
|
Hierro-Bujalance C, Infante-Garcia C, Sanchez-Sotano D, del Marco A, Casado-Revuelta A, Mengual-Gonzalez CM, Lucena-Porras C, Bernal-Martin M, Benavente-Fernandez I, Lubian-Lopez S, Garcia-Alloza M. Erythropoietin Improves Atrophy, Bleeding and Cognition in the Newborn Intraventricular Hemorrhage. Front Cell Dev Biol 2020; 8:571258. [PMID: 33043002 PMCID: PMC7525073 DOI: 10.3389/fcell.2020.571258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/22/2022] Open
Abstract
The germinal matrix-intraventricular hemorrhage (GM-IVH) is one of the most devastating complications of prematurity. The short- and long-term neurodevelopmental consequences after severe GM-IVH are a major concern for neonatologists. These kids are at high risk of psychomotor alterations and cerebral palsy; however, therapeutic approaches are limited. Erythropoietin (EPO) has been previously used to treat several central nervous system complications due to its role in angiogenesis, neurogenesis and as growth factor. In addition, EPO is regularly used to reduce the number of transfusions in the preterm infant. Moreover, EPO crosses the blood-brain barrier and EPO receptors are expressed in the human brain throughout development. To analyze the role of EPO in the GM-IVH, we have administered intraventricular collagenase (Col) to P7 mice, as a model of GM-IVH of the preterm infant. After EPO treatment, we have characterized our animals in the short (14 days) and the long (70 days) term. In our hands, EPO treatment significantly limited brain atrophy and ventricle enlargement. EPO also restored neuronal density and ameliorated dendritic spine loss. Likewise, inflammation and small vessel bleeding were also reduced, resulting in the preservation of learning and memory abilities. Moreover, plasma gelsolin levels, as a feasible peripheral marker of GM-IVH-induced damage, recovered after EPO treatment. Altogether, our data support the positive effect of EPO treatment in our preclinical model of GM-IVH, both in the short and the long term.
Collapse
Affiliation(s)
- Carmen Hierro-Bujalance
- Division of Physiology, School of Medicine, Universidadde Cádiz, Cádiz, Spain
- Instituto de Investigacion e Innovacion en Ciencias Biomedicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain
| | - Carmen Infante-Garcia
- Division of Physiology, School of Medicine, Universidadde Cádiz, Cádiz, Spain
- Instituto de Investigacion e Innovacion en Ciencias Biomedicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain
| | | | - Angel del Marco
- Division of Physiology, School of Medicine, Universidadde Cádiz, Cádiz, Spain
- Instituto de Investigacion e Innovacion en Ciencias Biomedicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain
| | - Ana Casado-Revuelta
- Division of Physiology, School of Medicine, Universidadde Cádiz, Cádiz, Spain
| | | | | | | | - Isabel Benavente-Fernandez
- Instituto de Investigacion e Innovacion en Ciencias Biomedicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain
- Division of Paediatrics, Section of Neonatology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Simon Lubian-Lopez
- Instituto de Investigacion e Innovacion en Ciencias Biomedicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain
- Division of Paediatrics, Section of Neonatology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Monica Garcia-Alloza
- Division of Physiology, School of Medicine, Universidadde Cádiz, Cádiz, Spain
- Instituto de Investigacion e Innovacion en Ciencias Biomedicas de la Provincia de Cádiz (INiBICA), Cádiz, Spain
| |
Collapse
|
22
|
Parodi A, De Angelis LC, Re M, Raffa S, Malova M, Rossi A, Severino M, Tortora D, Morana G, Calevo MG, Brisigotti MP, Buffelli F, Fulcheri E, Ramenghi LA. Placental Pathology Findings and the Risk of Intraventricular and Cerebellar Hemorrhage in Preterm Neonates. Front Neurol 2020; 11:761. [PMID: 32922347 PMCID: PMC7456995 DOI: 10.3389/fneur.2020.00761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement. Of the 286 neonates included, 68 (23.8%) had intraventricular hemorrhage (all grades) and 48 (16.8%) had a cerebellar hemorrhage (all grades). After correction for gestational age, chorioamnionitis involving the maternal side of the placenta was found to be an independent risk factor for developing intraventricular hemorrhage, whereas there was no association between maternal and fetal inflammatory response and cerebellar hemorrhage. Among perinatal factors, we found that intraventricular hemorrhage was significantly associated with cerebellar hemorrhage (odds ratio [OR], 8.14), mechanical ventilation within the first 72 h (OR, 2.67), and patent ductus arteriosus requiring treatment (OR, 2.6), whereas cesarean section emerged as a protective factor (OR, 0.26). Inotropic support within 72 h after birth (OR, 5.24) and intraventricular hemorrhage (OR, 6.38) were independent risk factors for cerebellar hemorrhage, whereas higher gestational age was a protective factor (OR, 0.76). Assessing placental pathology may help in understanding mechanisms leading to intraventricular hemorrhage, although its possible role in predicting cerebellar bleeding needs further evaluation.
Collapse
Affiliation(s)
- Alessandro Parodi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Costanza De Angelis
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martina Re
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sarah Raffa
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Pia Brisigotti
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Buffelli
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ezio Fulcheri
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Division of Pathology, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| |
Collapse
|
23
|
Tortora D, Lo Russo FM, Severino M, Parodi A, Massirio P, Ramenghi LA, Rossi A. Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: an ASL study. Neuroradiology 2020; 62:1689-1699. [DOI: 10.1007/s00234-020-02514-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
|
24
|
Young JM, Vandewouw MM, Whyte HEA, Leijser LM, Taylor MJ. Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age. Front Hum Neurosci 2020. [PMID: 32760258 DOI: 10.3389/fnhum.2020.00219.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children born very preterm (VPT) are at high-risk for altered brain development and impaired neurodevelopmental outcomes but are not well-studied before school-age. We investigated 64 four-year-olds: 37 VPT children [<32 weeks gestational age [GA]; 22 males; mean GA: 28.8 weeks ± 1.6], 25 full-term (FT) children (12 males), plus two VPT cases with ventriculomegaly and exceptionally resilient outcomes. All children underwent high-resolution structural magnetic resonance imaging and developmental assessments. Measures of brain volume, cortical thickness, and surface area were obtained. Children born VPT demonstrated reduced cerebral and cerebellar white matter volumes yet increased cerebral gray matter, temporal lobe, occipital lobe and ventricle volumes after adjusting for total brain volume. Cortical thickness was greater in the VPT children compared to FT children across all lobes. On developmental assessments, the VPT children scored lower on average than FT children while the two cases had intact cognitive abilities. In addition to larger ventricle volumes, the two cases had white matter and gray matter volumes within the ranges of the FT children. The VPT children displayed distinct differences in structural brain volumes at 4 years of age, consistent with delayed maturation. The cases with persistent ventriculomegaly and good cognitive outcomes displayed typical gray matter and increased white matter volumes, indicating a potential protective developmental phenomenon contributing to their intact cognitive abilities.
Collapse
Affiliation(s)
- Julia M Young
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Marlee M Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Hilary E A Whyte
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.,Department of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Lara M Leijser
- Department of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.,Section of Neonatology, Department of Pediatrics, Cumming School of Medicine and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Margot J Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
25
|
Young JM, Vandewouw MM, Whyte HEA, Leijser LM, Taylor MJ. Resilience and Vulnerability: Neurodevelopment of Very Preterm Children at Four Years of Age. Front Hum Neurosci 2020; 14:219. [PMID: 32760258 PMCID: PMC7372104 DOI: 10.3389/fnhum.2020.00219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/14/2020] [Indexed: 12/22/2022] Open
Abstract
Children born very preterm (VPT) are at high-risk for altered brain development and impaired neurodevelopmental outcomes but are not well-studied before school-age. We investigated 64 four-year-olds: 37 VPT children [<32 weeks gestational age [GA]; 22 males; mean GA: 28.8 weeks ± 1.6], 25 full-term (FT) children (12 males), plus two VPT cases with ventriculomegaly and exceptionally resilient outcomes. All children underwent high-resolution structural magnetic resonance imaging and developmental assessments. Measures of brain volume, cortical thickness, and surface area were obtained. Children born VPT demonstrated reduced cerebral and cerebellar white matter volumes yet increased cerebral gray matter, temporal lobe, occipital lobe and ventricle volumes after adjusting for total brain volume. Cortical thickness was greater in the VPT children compared to FT children across all lobes. On developmental assessments, the VPT children scored lower on average than FT children while the two cases had intact cognitive abilities. In addition to larger ventricle volumes, the two cases had white matter and gray matter volumes within the ranges of the FT children. The VPT children displayed distinct differences in structural brain volumes at 4 years of age, consistent with delayed maturation. The cases with persistent ventriculomegaly and good cognitive outcomes displayed typical gray matter and increased white matter volumes, indicating a potential protective developmental phenomenon contributing to their intact cognitive abilities.
Collapse
Affiliation(s)
- Julia M Young
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Marlee M Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Hilary E A Whyte
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.,Department of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Lara M Leijser
- Department of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.,Section of Neonatology, Department of Pediatrics, Cumming School of Medicine and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Margot J Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.,Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
26
|
Parodi A, Govaert P, Horsch S, Bravo MC, Ramenghi LA. Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome. Pediatr Res 2020; 87:13-24. [PMID: 32218535 PMCID: PMC7098890 DOI: 10.1038/s41390-020-0780-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.
Collapse
Affiliation(s)
- Alessandro Parodi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy
| | - Paul Govaert
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
- Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium
| | - Sandra Horsch
- Department of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Luca A Ramenghi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy.
| |
Collapse
|
27
|
Kaur A, Luu TM, Shah PS, Ayoub A, Auger N. Neonatal Intraventricular Hemorrhage and Hospitalization in Childhood. Pediatr Neurol 2020; 103:35-42. [PMID: 31753542 DOI: 10.1016/j.pediatrneurol.2019.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraventricular hemorrhage is a serious neonatal complication associated with neurodevelopmental disorders, but the relationship with other childhood morbidities is unclear. We sought to assess the association of neonatal intraventricular hemorrhage with the risk of morbidity up to 12 years of age. METHODS We analyzed a cohort of 794,384 infants born between 2006 and 2016 in Quebec, Canada, with 4,269,579 person-years of follow-up. The exposure was grade I to IV intraventricular hemorrhage in the neonatal period. The main outcome measure was childhood hospitalization by cause of admission. In adjusted Cox regression models, we estimated hazard ratios and 95% confidence intervals for the association of intraventricular hemorrhage with future childhood hospitalization. RESULTS Infants with intraventricular hemorrhage had a higher incidence of childhood hospitalization than infants without hemorrhage (23.8 vs. 5.7 per 100 person-years). Compared with those with no hemorrhage, infants with intraventricular hemorrhage had 1.56 times the risk of hospitalization (95% confidence interval, 1.43-1.70). The risk was 2.81 times higher for grade III/IV hemorrhage (95% confidence interval, 2.23-3.53). Intraventricular hemorrhage at term was associated with 3.19 times the risk of hospitalization (95% confidence interval, 2.55-4.00), whereas preterm intraventricular hemorrhage was associated with 2.06 times the risk before 28 weeks (95% confidence interval, 1.75-2.42) and 1.87 times the risk between 28 and 36 weeks (95% confidence interval, 1.68-2.08), compared with no hemorrhage at term. Primary reasons for hospitalizations included central nervous system, ophthalmologic, musculoskeletal, and cardiovascular disorders. CONCLUSIONS Intraventricular hemorrhage, especially of higher grades and in term neonates, is a predictor of future risk of hospitalization in childhood.
Collapse
Affiliation(s)
- Amarpreet Kaur
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine University Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
| |
Collapse
|
28
|
Weise J, Heckmann M, Bahlmann H, Ittermann T, Allenberg H, Domanski G, Lange AE. Analyses of pathological cranial ultrasound findings in neonates that fall outside recent indication guidelines: results of a population-based birth cohort: survey of neonates in Pommerania (SNiP-study). BMC Pediatr 2019; 19:476. [PMID: 31805885 PMCID: PMC6894314 DOI: 10.1186/s12887-019-1843-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. Here, we addressed the need to extend these recommendations. Methods We retrospectively reviewed 5107 CUs acquired in the population-based Survey of Neonates in Pomerania, conducted in 2002 to 2008. Neonates with conspicuous CUs that were ≥ 30 weeks gestation without recent indications for CU were identified and assigned to the following groups: with (I) or without (II) admission to neonatal care. We designated CU conspicuities as mild (MC) or significant (SC), and we investigated related neurodevelopment during follow-up. Results Of 5107 neonates, 5064 were born at ≥30 weeks gestation and of those, 4306 received CUs without any indication for this examination. We found conspicuities in 7.7% (n = 47/610) of group I (n = 30 MC, n = 17 SC), and 3.2% (n = 117/3696) of group II (n = 100 MC, n = 17 SC). In group II, SC comprised, e.g., bilateral cysts, partial agenesis of the corpus callosum, and periventricular leukomalacia. Follow-up was available in 75% of infants in group II with MCs and SCs; of these, 12.8% had an abnormal neurological follow-up. Conclusions We detected a high number of conspicuities in neonates without a CU indication. However, we could not demonstrate that ultrasound findings were associated with the neurological follow-up or any advantage to an earlier diagnosis. Our data did not support extending current guidelines or a general CU screening policy for all neonates.
Collapse
Affiliation(s)
- Judith Weise
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Matthias Heckmann
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Hagen Bahlmann
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Till Ittermann
- Institute of Community Medicine, Div. of Health Care Epidemiology and Community Health, University Greifswald, Greifswald, Germany
| | - Heike Allenberg
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Grzegorz Domanski
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany
| | - Anja Erika Lange
- Dept. of Neonatology & Paediatric Intensive Care Medicine, University Greifswald, F.-Sauerbruchstr, 17475, Greifswald, Germany.
| |
Collapse
|
29
|
Galderisi A, Zammataro L, Losiouk E, Lanzola G, Kraemer K, Facchinetti A, Galeazzo B, Favero V, Baraldi E, Cobelli C, Trevisanuto D, Steil GM. Continuous Glucose Monitoring Linked to an Artificial Intelligence Risk Index: Early Footprints of Intraventricular Hemorrhage in Preterm Neonates. Diabetes Technol Ther 2019; 21:146-153. [PMID: 30835533 DOI: 10.1089/dia.2018.0383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To develop and validate a new risk score for intraventricular hemorrhage (IVH) in preterm neonates based on continuous glucose monitoring (CGM). STUDY DESIGN We retrospectively analyzed CGM traces obtained from 50 very preterm neonates, grouped into two sub-cohorts started on CGM within 12 and 48 h of birth, respectively. A CGM linked to an Artificial Intelligence Risk (CLAIR) index was developed to quantify glucose variability during the first 72 h of life in neonates with and without IVH. Brain-US was performed at least twice a day for the first 5 days of birth. An integrated remote monitoring platform was developed to capture major clinical events in real time and gather data for the risk index. The new score performance was further compared with other measures of glucose variability (coefficient of variation [CV] and standard deviation [SD]) and with a clinical risk index for babies II (CRIB-II) as a predictor of IVH event. The two cohorts were analyzed separately for internal validation of the method. RESULTS The primary cohort consisted of 26 neonates (gestational age 30 [28, 31] weeks; BW1275 g[1090, 1750]). Controls (n = 23) exhibited higher CLAIR index than cases (P = 0.004). A cut-off of 0.69 for the new CLAIR index allowed a 100% sensitivity and an 83% specificity for IVH prediction. The CLAIR index was the sole significant predictor for IVH (P = 0.003) when compared with clinical variables, CV, SD, and CRIB-II. In a subgroup analysis in very low-birth-weight infants, the CLAIR index was the sole variable significantly associated with IVH (P = 0.009). Analysis on the secondary cohort (five cases and 16 controls) confirmed a higher CLAIR index in the controls (P = 0.008), in the absence of a difference for CV, SD, and CRIB-II between the two groups. CONCLUSION CGM, combined with the AI-algorithm, provides a high-sensitivity index for risk detection of IVH that reflects the glycemic impairment preceding IVH.
Collapse
Affiliation(s)
- Alfonso Galderisi
- 1 Department of Pediatrics, Yale University, New Haven, Connecticut
- 2 Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Luca Zammataro
- 3 School of Medicine, Yale University, New Haven, Connecticut
| | - Eleonora Losiouk
- 4 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giordano Lanzola
- 4 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Kristen Kraemer
- 1 Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Andrea Facchinetti
- 5 Department of Information Engineering, University of Padova, Padova, Italy
| | - Beatrice Galeazzo
- 2 Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Valentina Favero
- 2 Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Eugenio Baraldi
- 2 Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Claudio Cobelli
- 5 Department of Information Engineering, University of Padova, Padova, Italy
| | - Daniele Trevisanuto
- 2 Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Garry M Steil
- 6 Harvard Medical School and Boston Children's Hospital, Division of Medicine Critical Care, Boston, Massachusetts
| |
Collapse
|
30
|
Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:173-199. [PMID: 31324310 DOI: 10.1016/b978-0-444-64029-1.00008-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Germinal matrix hemorrhage and intraventricular hemorrhages (GMH-IVH) remain a common and clinically significant problem in preterm infants, particularly extremely preterm infants. A large GMH-IVH is often complicated by posthemorrhagic ventricular dilation (PHVD) or parenchymal hemorrhagic infarction and is associated with an increased risk of adverse neurologic sequelae. The widespread use of cranial ultrasonography since the early 1980s has shown a gradual decrease in the incidence of GMH-IVH and has helped with the identification of antenatal and perinatal risk factors and timing of the lesion. The increased use of magnetic resonance imaging (MRI) has contributed to more detailed visualization of the site and extent of the GMH-IVH. In addition, MRI has contributed to the awareness of associated white matter changes as well as associated cerebellar hemorrhages. Although GMH-IVH and PHVD still cannot be prevented, cerebrospinal fluid drainage initiated in the early stage of PHVD development seems to be associated with a better neurodevelopmental outcome. Further studies are underway to improve treatment strategies for PHVD and to potentially prevent and repair GMH-IVH and PHVD and associated brain injury. This chapter discusses the pathogenesis, incidence, risk factors, and management, including preventive measures, of GHM-IVH and PHVD.
Collapse
Affiliation(s)
- Lara M Leijser
- Department of Pediatrics, Section of Neonatology, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
31
|
Munakomi S. Reader response: Posthemorrhagic ventricular dilatation in preterm infants: When best to intervene? Neurology 2018; 91:487. [DOI: 10.1212/wnl.0000000000006112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
32
|
Gilard V, Chadie A, Ferracci FX, Brasseur-Daudruy M, Proust F, Marret S, Curey S. Post hemorrhagic hydrocephalus and neurodevelopmental outcomes in a context of neonatal intraventricular hemorrhage: an institutional experience in 122 preterm children. BMC Pediatr 2018; 18:288. [PMID: 30170570 PMCID: PMC6119335 DOI: 10.1186/s12887-018-1249-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births. Despite a high risk of death and impaired neurodevelopment, the precise prognosis of infants with IVH remains unclear. The objective of this study was to evaluate the rate and predictive factors of evolution to post hemorrhagic hydrocephalus (PHH) requiring a shunt, in newborns with IVH and to report their neurodevelopmental outcomes at 2 years of age. METHODS Among all preterm newborns admitted to the department of neonatalogy at Rouen University Hospital, France between January 2000 and December 2013, 122 had an IVH and were included in the study. Newborns with grade 1 IVH according to the Papile classification were excluded. RESULTS At 2-year, 18% (n = 22) of our IVH cohort required permanent cerebro spinal fluid (CSF) derivation. High IVH grade, low gestational age at birth and increased head circumference were risk factors for PHH. The rate of death of IVH was 36.9% (n = 45). The rate of cerebral palsy was 55.9% (n = 43) in the 77 surviving patients (49.4%). Risk factors for impaired neurodevelopment were high grade IVH and increased head circumference. CONCLUSION High IVH grade was strongly correlated with death and neurodevelopmental outcome. The impact of an increased head circumference highlights the need for early management. CSF biomarkers and new medical treatments such as antenatal magnesium sulfate have emerged and could predict and improve the prognosis of these newborns with PHH.
Collapse
Affiliation(s)
- Vianney Gilard
- Neurosurgery Department, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
| | - Alexandra Chadie
- Paediatrics Department, Rouen University Hospital, 76000, Rouen, France
| | | | | | - François Proust
- Neurosurgery Department, Strasbourg University Hospital, 67000, Strasbourg, France
| | - Stéphane Marret
- Paediatrics Department, Rouen University Hospital, 76000, Rouen, France
| | - Sophie Curey
- Neurosurgery Department, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| |
Collapse
|
33
|
Risk factors associated with intraventricular hemorrhage in extremely premature neonates. Blood Coagul Fibrinolysis 2018; 29:25-29. [PMID: 28901997 DOI: 10.1097/mbc.0000000000000661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Intraventricular hemorrhage (IVH) is a significant cause of morbidity in extremely premature infants despite many advances in neonatal intensive care. We conducted an institutional retrospective review aimed to correlate risk factors associated with IVH. Clinical variables reported to the Vermont-Oxford Network on less than 30 weeks gestational age infants over a 5-year period were evaluated with Pearson's chi-square and multivariate logistic regression. Of 618 infants born less than 30-week gestational age, 178 (28.8%) experienced IVH. Of those less than 1000 g, 105 (36.5%) of 288 infants experienced IVH. Multivariate analysis revealed that thrombocytopenia [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.30-3.19, P = 0.0020] and cardiopulmonary resuscitation (CPR) ± intubation at delivery (OR 1.84, 95% CI 1.12-3.02, P = 0.0162) were independently associated with IVH. Among infants less than 1000 g, thrombocytopenia (OR 2.09, 95% CI 1.22-3.60, P = 0.0077) and CPR ± intubation at delivery (OR 2.01, 95% CI 1.10-3.68, P = 0.0229) were also significantly associated with IVH. IVH is a complex phenomenon with many contributing risk factors. In our study, infants less than 30-week gestational age and less than 1000 g revealed thrombocytopenia and CPR ± intubation in delivery room were independently associated with IVH. These data should alert clinicians to those neonates most likely to suffer IVH.
Collapse
|
34
|
Segado-Arenas A, Infante-Garcia C, Benavente-Fernandez I, Sanchez-Sotano D, Ramos-Rodriguez JJ, Alonso-Ojembarrena A, Lubian-Lopez S, Garcia-Alloza M. Cognitive Impairment and Brain and Peripheral Alterations in a Murine Model of Intraventricular Hemorrhage in the Preterm Newborn. Mol Neurobiol 2017; 55:4896-4910. [DOI: 10.1007/s12035-017-0693-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/14/2017] [Indexed: 12/11/2022]
|
35
|
Guerra M, Blázquez JL, Rodríguez EM. Blood-brain barrier and foetal-onset hydrocephalus, with a view on potential novel treatments beyond managing CSF flow. Fluids Barriers CNS 2017; 14:19. [PMID: 28701191 PMCID: PMC5508761 DOI: 10.1186/s12987-017-0067-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/24/2017] [Indexed: 12/12/2022] Open
Abstract
Despite decades of research, no compelling non-surgical therapies have been developed for foetal hydrocephalus. So far, most efforts have pointed to repairing disturbances in the cerebrospinal fluid (CSF) flow and to avoid further brain damage. There are no reports trying to prevent or diminish abnormalities in brain development which are inseparably associated with hydrocephalus. A key problem in the treatment of hydrocephalus is the blood–brain barrier that restricts the access to the brain for therapeutic compounds or systemically grafted cells. Recent investigations have started to open an avenue for the development of a cell therapy for foetal-onset hydrocephalus. Potential cells to be used for brain grafting include: (1) pluripotential neural stem cells; (2) mesenchymal stem cells; (3) genetically-engineered stem cells; (4) choroid plexus cells and (5) subcommissural organ cells. Expected outcomes are a proper microenvironment for the embryonic neurogenic niche and, consequent normal brain development.
Collapse
Affiliation(s)
- M Guerra
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
| | - J L Blázquez
- Departamento de Anatomía e Histología Humana, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - E M Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| |
Collapse
|
36
|
Wang LW, Lin YC, Tu YF, Wang ST, Huang CC. Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants. Neonatology 2017; 111:86-92. [PMID: 27643988 DOI: 10.1159/000448615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cystic periventricular leukomalacia (cPVL) is the most severe white matter injury and is often associated with intraventricular hemorrhage (IVH) in preterm infants. OBJECTIVE The aim of this study was to investigate the prevalence, risk factors and neurodevelopmental outcomes of isolated cPVL and cPVL with low-grade and high-grade IVH in premature infants. METHODS From 2001 to 2012, 9,964 infants with <31 weeks' gestational age (GA) admitted to Taiwan hospitals were enrolled. cPVL was classified into three groups: isolated cPVL, cPVL with low-grade (I/II) IVH, and cPVL with high-grade (III) IVH. RESULTS Of 7,805 infants with complete ultrasound data, 286 (3.7%) had cPVL. Among the cPVL infants, 93 (32.5%) were isolated, 118 (41.3%) had low-grade IVH and 75 (26.2%) had high-grade IVH. The risk of cPVL with IVH was significantly higher among infants with <27 weeks' GA than those with ≥27 weeks' GA, in contrast to that of isolated cPVL. Using infants without cPVL and IVH as the reference group, the most significant predictor of isolated cPVL was neonatal sepsis (odds ratio 2.39; 95% confidence interval 1.52-3.77), while 5-min Apgar score <5 (2.50; 1.48-4.21) and prolonged mechanical ventilation (2.19; 1.42-3.42) were associated with cPVL with low-grade IVH, and GA <27 weeks (2.63; 1.56-4.42), pneumothorax (3.04; 1.40-6.65) and prolonged mechanical ventilation (3.36; 1.88-6.01) contributed to cPVL with high-grade IVH. cPVL infants with low-grade and high-grade IVH had a higher risk of abnormal neurodevelopmental outcomes than infants with isolated cPVL at the age of 24 months. CONCLUSIONS Isolated cPVL, cPVL with low-grade IVH and cPVL with high-grade IVH had different risk factors and neurodevelopmental outcomes, suggestive of different causal pathways.
Collapse
Affiliation(s)
- Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan, ROC
| | | | | | | | | | | |
Collapse
|
37
|
Risk factors associated with post-hemorrhagic hydrocephalus among very low birth weight infants of 24-28 weeks gestation. J Perinatol 2016; 36:557-63. [PMID: 26938917 DOI: 10.1038/jp.2016.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/26/2015] [Accepted: 12/17/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Post-hemorrhagic hydrocephalus (PHH) is associated with morbidity and mortality among very low birth weight (VLBW) infants. This study aimed to determine risk factors for PHH among VLBW infants with peri-intraventricular hemorrhage (PIVH). STUDY DESIGN This is a population-based cohort of VLBW infants of 24 to 28 weeks gestation, born in Israel from 1995 to 2012. Infants in whom a brain ultrasound was not performed before 28 days or with major congenital malformations were excluded. Univariate and multivariable analyses identified risk factors associated with PHH. RESULTS The final study cohort comprised 2811 infants with grade 2 or higher PIVH, of whom 610 (21.7%) developed PHH. PHH was independently associated with PIVH severity, with bilateral grade 3 PIVH and PIVH grade 3 and contralateral grade 4 having the highest risks (odds ratio (OR) 12.2, 95% confidence interval (CI) 8.56 to 17.4 and OR 13.7, 95% CI 9.4 to 20.1, respectively). Unilateral grade 3 or 4 PIVH's had moderately increased risks of PHH (OR 3.50, 95% CI 2.26 to 5.42 and OR 3.79, 95% CI 2.35 to 6.12, respectively). PHH was independently associated with increasing gestational age (GA) and with neonatal morbidities including patent ductus arteriosus (OR 1.47, 95% CI 1.15 to 1.88 if medically treated and OR 3.01, 95% CI 2.11 to 4.29 if surgically treated), sepsis (OR 1.79, 95% CI 1.44 to 2.22) and necrotizing enterocolitis (OR 1.60, 95% CI 1.18 to 2.17). CONCLUSIONS Among VLBW infants with PIVH, PHH was independently associated with PIVH severity group, increasing GA and acute neonatal morbidities. Unilateral grade 3 or 4 PIVH was associated with a moderate risk of developing PHH compared with bilateral severe hemorrhages.
Collapse
|
38
|
Del Bigio MR, Di Curzio DL. Nonsurgical therapy for hydrocephalus: a comprehensive and critical review. Fluids Barriers CNS 2016; 13:3. [PMID: 26846184 PMCID: PMC4743412 DOI: 10.1186/s12987-016-0025-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/15/2016] [Indexed: 12/13/2022] Open
Abstract
Pharmacological interventions have been tested experimentally and clinically to prevent hydrocephalus and avoid the need for shunting beginning in the 1950s. Clinical trials of varied quality have not demonstrated lasting and convincing protective effects through manipulation of cerebrospinal fluid production, diuresis, blood clot fibrinolysis, or manipulation of fibrosis in the subarachnoid compartment, although there remains some promise in the latter areas. Acetazolamide bolus seems to be useful for predicting shunt response in adults with hydrocephalus. Neuroprotection in the situation of established hydrocephalus has been tested experimentally beginning more recently. Therapies designed to modify blood flow or pulsation, reduce inflammation, reduce oxidative damage, or protect neurons are so far of limited success; more experimental work is needed in these areas. As has been recommended for preclinical studies in stroke and brain trauma, stringent conditions should be met for preclinical studies in hydrocephalus.
Collapse
Affiliation(s)
- Marc R Del Bigio
- Department of Pathology, University of Manitoba; Children's Hospital Research Institute of Manitoba, Diagnostic Services Manitoba, 401 Brodie Centre, 715 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
| | - Domenico L Di Curzio
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada.
| |
Collapse
|
39
|
Radic JAE, Vincer M, McNeely PD. Temporal trends of intraventricular hemorrhage of prematurity in Nova Scotia from 1993 to 2012. J Neurosurg Pediatr 2015; 15:573-9. [PMID: 26030328 DOI: 10.3171/2014.11.peds14363] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intraventicular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) are common in premature newborns. The epidemiology of these conditions has been described, but selection bias remains a significant concern in many studies. The goal of this study was to review temporal trends in the incidence of IVH, PHH, and shunt surgery in a population-based cohort of very preterm infants with no selection bias. METHODS All very preterm infants (gestational age ≥ 20 and ≤ 30 weeks) born from 1993 onward to residents of Nova Scotia were evaluated by the IWK Health Centre's Perinatal Follow-Up Program, and were entered in a database. Infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2012, were included in this study. The incidences of IVH, PHH, and shunt surgery were calculated, basic demographic information was described, and chi-square test for trends over time was determined. RESULTS Of 1334 successfully resuscitated very preterm infants who survived to their initial screening ultrasound, 407 (31%) had an IVH, and 149 (11%) had an IVH Grade 3 or 4. No patients with IVH Grade 1 or 2 developed PHH. The percentage of very preterm infants with IVH Grade 3 or 4 has significantly increased over time (p = 0.013), as have the incidence of PHH and shunt surgery (p = 0.001 and p = 0.011, respectively) in infants with Grade 3 or 4 IVH. The proportion of patients with PHH receiving a shunt has not changed over time (p = 0.813). CONCLUSIONS The increasing incidence of high-grade IVH-and PHH and shunt surgery in infants with high-grade IVH-over time is worrisome. This study identifies a number of associated factors, but further research to identify preventable and treatable causal factors is warranted.
Collapse
Affiliation(s)
| | - Michael Vincer
- 2Department of Pediatrics, Division of Neonatal Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | |
Collapse
|
40
|
Rüegger CM, Hagmann CF, Bührer C, Held L, Bucher HU, Wellmann S. Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair). Neonatology 2015; 108:198-204. [PMID: 26278911 DOI: 10.1159/000437248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/25/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Preterm infants suffering from intraventricular hemorrhage (IVH) are at increased risk for neurodevelopmental impairment. Observational data suggest that recombinant human erythropoietin (rEPO) improves long-term cognitive outcome in infants with IVH. Recent studies revealed a beneficial effect of early high-dose rEPO on white matter development in preterm infants determined by magnetic resonance imaging (MRI). OBJECTIVES To summarize the current evidence and to delineate the study protocol of the EpoRepair trial (Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants). METHODS The study involves a review of the literature and the design of a double-blind, placebo-controlled, multicenter trial of repetitive high-dose rEPO administration, enrolling 120 very preterm infants with moderate-to-severe IVH diagnosed by cranial ultrasound in the first days of life, qualitative and quantitative MRI at term-equivalent age and long-term neurodevelopmental follow-up until 5 years of age. RESULTS AND CONCLUSIONS The hypothesis generated by observational data that rEPO may improve long-term cognitive outcomes of preterm infants suffering from IVH are to be confirmed or refuted by the randomized controlled trial, EpoRepair.
Collapse
Affiliation(s)
- Christoph M Rüegger
- Division of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Germany
| | | | | | | | | | | | | |
Collapse
|