1
|
Campi F, De Rose DU, Pugnaloni F, Ronci S, Calì M, Pro S, Longo D, Lucignani G, Raho L, Pisaneschi E, Digilio MC, Savarese I, Bersani I, Amante PG, Conti M, De Liso P, Capolupo I, Braguglia A, Gandolfo C, Dotta A. Neurodevelopmental and genetic findings in neonates with intracranial arteriovenous shunts: A case series. Front Pediatr 2023; 11:1111527. [PMID: 37063679 PMCID: PMC10090511 DOI: 10.3389/fped.2023.1111527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023] Open
Abstract
Background Despite the latest advances in prenatal diagnosis and postnatal embolization procedures, intracranial arteriovenous shunts (AVSs) are still associated with high mortality and morbidity rates. Our aim was to evaluate the presentation and clinical course, the neurodevelopmental outcome, and the genetic findings of neonates with AVSs. Methods In this retrospective observational study, medical records of neonates with cerebral AVSs admitted to our hospital from January 2020 to July 2022 were revised. In particular, we evaluated neuroimaging characteristics, endovascular treatment, neurophysiological features, neurodevelopmental outcomes, and genetic findings. Results We described the characteristics of 11 patients with AVSs. Ten infants (90.9%) required embolization during the first three months of life. In 5/9 infants, pathological electroencephalography findings were observed; of them, two patients presented seizures. Eight patients performed Median Nerve Somatosensory Evoked Potentials (MN-SEPs): of them, six had an impaired response. We found normal responses at Visual Evoked Potentials and Brainstem Auditory Evoked Potentials. Eight patients survived (72.7%) and were enrolled in our multidisciplinary follow-up program. Of them, 7/8 completed the Bayley-III Scales at 6 months of corrected age: none of them had cognitive and language delays; conversely, a patient had a moderate delay on the Motor scale. The remaining survivor patient developed cerebral palsy and could not undergo Bayley-III evaluation because of the severe psychomotor delay. From the genetic point of view, we found a novel pathogenic variant in the NOTCH3 gene and three additional genomic defects of uncertain pathogenicity. Conclusion We propose SEPs as an ancillary test to discern the most vulnerable infants at the bedside, particularly to identify possible future motor impairment in follow-up. The early identification of a cognitive or motor delay is critical to intervene with personalized rehabilitation treatment and minimize future impairment promptly. Furthermore, the correct interpretation of identified genetic variants could provide useful information, but further studies are needed to investigate the role of these variants in the pathogenesis of AVSs.
Collapse
Affiliation(s)
- Francesca Campi
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
- Correspondence: Francesca Campi
| | | | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Sara Ronci
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Monica Calì
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Pro
- Development Neurology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Lucignani
- Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Laura Raho
- Clinical Psychology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Elisa Pisaneschi
- Translational Cytogenomics Research Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | | | - Marta Conti
- Clinical and Experimental Neurology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Paola De Liso
- Clinical and Experimental Neurology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Annabella Braguglia
- Neonatal Sub-Intensive Care Unit and Follow-up, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Carlo Gandolfo
- Neuroradiology Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| |
Collapse
|
2
|
Campi F, Longo D, Bersani I, Savarese I, Lucignani G, Haass C, Paolino MC, Vadalà S, De Liso P, Di Capua M, Luciani M, Esposito G, Amante PG, Vigevano F, Dotta A. Neonatal Cerebral Venous Thrombosis following Maternal SARS-CoV-2 Infection in Pregnancy. Neonatology 2022; 119:268-272. [PMID: 35220305 PMCID: PMC9059005 DOI: 10.1159/000520537] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022]
Abstract
A possible consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the development of an exacerbated thrombophilic status, and cerebral venous thrombosis (CVT) is a rare but possible complication of SARS-CoV-2 infection reported both in adults and in children. The present case report describes the clinical course of a term neonate showing extended CVT of unclear origin, whose mother had developed SARS-CoV-2 infection during the third trimester of pregnancy. We speculate that the prothrombotic status induced by maternal SARS-CoV-2 infection may have played a pathophysiological role in the development of such severe neonatal complication. Further investigations are required to confirm such hypothesis.
Collapse
Affiliation(s)
- Francesca Campi
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Savarese
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giulia Lucignani
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Care Unit, S. Pietro FBF Hospital, Rome, Italy
| | | | - Sarah Vadalà
- Neonatal Intensive Care Unit, S. Pietro FBF Hospital, Rome, Italy
| | - Paola De Liso
- Division of Neurology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Matteo Di Capua
- Division of Neurology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Matteo Luciani
- Department of Pediatric Hematology Oncology, Bambino Gesù Children Hospital IRCSS, Rome, Italy
| | - Giacomo Esposito
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolina Giuseppina Amante
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federico Vigevano
- Division of Neurology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| |
Collapse
|
3
|
Auriti C, Piersigilli F, Bersani I, Cairoli S, Amante PG, Longo D, Goffredo BM. Staphylococcal meningitis therapy with linezolid in a young infant: efficacy, CSF levels and side effects. Ital J Pediatr 2020; 46:90. [PMID: 32600437 PMCID: PMC7325046 DOI: 10.1186/s13052-020-00854-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Linezolid is a synthetic antibiotic which is active against most Gram-positive bacteria, especially on Staphylococcus aureus. Its administration can be required when the infection is due to staphylococcus strains, which are resistant to vancomycin. Although mostly well tolerated, some mild to moderate side effects have been reported. Case presentation This case report describes an infant with multiloculated hydrocephalus, staphylococcal meningitis and prolonged linezolid therapy, in which we observed the association between linezolid administration and a lengthened QTc interval at the electrocardiogram (ECG). To rule out toxic levels during the therapy, plasma and cerebro-spinal fluid concentrations of linezolid were measured and reported. Conclusions Although generally well tolerated in neonates and infants, linezolid prolonged administration seems be able to cause QTc interval prolongation. Therefore, its administration in such patients should be limited to cases of bacterial resistance to other antibiotics. In addition to well-known close monitoring of the platelet level, we suggest serial ECG controls before and during linezolid administration. In the case we report, linezolid plasma concentrations resulted within the therapeutic range during therapy, while cerebrospinal fluid (CSF) concentrations appeared lower than those considered effective.
Collapse
Affiliation(s)
- Cinzia Auriti
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Fiammetta Piersigilli
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Iliana Bersani
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Sara Cairoli
- Department of Pediatric Medicine, Laboratory of Metabolic Biochemistry Unit, Bambino Gesù Children's Hospital, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Daniela Longo
- Department of Imaging, Bambino Gesù Childrens' Hospital, IRCCS, Rome, Italy
| | - Bianca Maria Goffredo
- Department of Pediatric Medicine, Laboratory of Metabolic Biochemistry Unit, Bambino Gesù Children's Hospital, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
4
|
Auriti C, Piersigilli F, Ronchetti MP, Campi F, Amante PG, Falcone M, Goffredo BM. Shunt lock therapy with micafungin to treat shunt-associated Candida albicans meningitis in an infant. J Antimicrob Chemother 2016; 71:2060-1. [PMID: 27009029 DOI: 10.1093/jac/dkw072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Fiammetta Piersigilli
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | | | - Marco Falcone
- Infectious Diseases Section, Department of Public Health and Infectious Diseases, 'La Sapienza' University, Rome, Italy
| | - Bianca Maria Goffredo
- Laboratory of Biochemistry, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| |
Collapse
|