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de Jager J, Brouwer F, Reijman J, van der Palen RLF, Steggerda SJ, Visser R, Te Pas AB, Dekker J. Occurrence of hyperoxia during iNO treatment for persistent pulmonary hypertension of the newborn: a cohort study. Eur J Pediatr 2024; 183:2455-2461. [PMID: 38470520 PMCID: PMC11035448 DOI: 10.1007/s00431-024-05506-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/16/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024]
Abstract
High concentrations of oxygen are often needed to optimize oxygenation in infants with persistent pulmonary hypertension (PPHN), but this can also increase the risk of hyperoxemia. We determined the occurrence of hyperoxemia in infants treated for PPHN. Medical records of infants ≥ 34 + 0 weeks gestational age (GA) who received inhaled nitric oxide (iNO) were retrospectively reviewed for oxygenation parameters during iNO therapy. Oxygen was manually titrated to target arterial oxygen tension (PaO2) 10-13 kPa and peripheral oxygen saturation (SpO2) 92-98%. The main study outcomes were the incidence and duration of hyperoxemia and hypoxemia and the fraction of inspired oxygen (FiO2). A total of 181 infants were included. The median FiO2 was 0.43 (IQR 0.34-0.56) and the maximum FiO2 was 1.0 in 156/181 (86%) infants, resulting in at least one PaO2 > 13 kPa in 149/181 (82%) infants, of which 46/149 (31%) infants had minimal one PaO2 > 30 kPa. SpO2 was > 98% in 179/181 (99%) infants for 17.7% (8.2-35.6%) of the iNO time. PaO2 < 10 kPa occurred in 160/181 (88%) infants, of which 81/160 (51%) infants had minimal one PaO2 < 6.7 kPa. SpO2 was < 92% in 169/181 (93%) infants for 1.6% (0.5-4.3%) of the iNO time. Conclusion: While treatment of PPHN is focused on preventing and reversing hypoxemia, hyperoxemia occurs inadvertently in most patients. What is Known: • High concentrations of oxygen are often needed to prevent hypoxemia-induced deterioration of PPHN, but this can also increase the risk of hyperoxemia. • Infants with persistent pulmonary hypertension may be particularly vulnerable to the toxic effects of oxygen, and hyperoxemia could further induce pulmonary vasoconstriction, potentially worsening the condition. What is New: • Hyperoxemia occurs in the majority of infants with PPHN during treatment with iNO. • Infants with PPHN spent a considerably longer period with saturations above the target range compared to saturations below the target range.
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Affiliation(s)
- Justine de Jager
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Fleur Brouwer
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Reijman
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco Visser
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Janneke Dekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Everwijn SM, van Bohemen JF, Jansen FA, Steggerda SJ, Teunissen AK, Haak MC. Feasibility of neurosonography in CHD-fetuses and controls in a clinical tertiary setting. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100289. [PMID: 38384382 PMCID: PMC10879662 DOI: 10.1016/j.eurox.2024.100289] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Ultrasonographic examination is the first-tier test to detect abnormal development of central nervous system (CNS). In optimal conditions, neurosonography can detect all important hallmarks of CNS development. It is, however, not known how the performance of this modality is in a routine setting. We aimed to evaluate the feasibility of neurosonography in a time-limited routine setting. Study design We have performed a prospective study in which we have included a group of pregnant women carrying a fetus with an isolated congenital heart defect (CHD), and a control group of fetuses without structural anomalies. We have performed basic neurosonography examination according to the guideline 'how to perform a basic screening examination of the CNS', published by the international society of ultrasound in obstetrics and gynecology in both groups. In all these examinations, 9 brain structures were scored in 3 different planes, by researchers that were blinded for group allocation. A sufficient neurosonogram was performed when 7 or more out of 9 CNS structures were clearly visible during the off-line scoring of the examination. Results A total of 574 neurosonographic examinations were performed in 151 fetuses, 90 in the CHD-group and 61 in the control group. A sufficient neurosonogram could be performed in 79% (234/294) of cases in a clinical setting (CHD cases) and in 90% (253/280) of control pregnancies. Higher maternal BMI (>30), maternal age, fetal cephalic position, fetal gender and placental position did not significantly influence neurosonography scores. Conclusion In clinical setting, basic fetal neurosonography can be sufficiently performed in the majority of cases. This was not significantly influenced by maternal or fetal factors. The optimal gestational age for neurosonography is between 22 and 34 weeks.
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Affiliation(s)
- Sheila M. Everwijn
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, the Netherlands
| | - Jiska F. van Bohemen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, the Netherlands
| | - Fenna A. Jansen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, the Netherlands
| | - Sylke J. Steggerda
- Leiden University Medical Center, Willem Alexander Children's Hospital, Department of Neonatology, Leiden, the Netherlands
| | - Aalbertine K. Teunissen
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique C. Haak
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, the Netherlands
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Alarcón A, de Vries LS, Parodi A, Arnáez J, Cabañas F, Steggerda SJ, Rebollo M, Ramenghi L, Dorronsoro I, López-Azorín M, Schneider J, Noguera-Julian A, Ríos-Barnés M, Recio M, Bickle-Graz M, Martínez-Biarge M, Fortuny C, García-Alix A, Truttmann AC. Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities. Arch Dis Child Fetal Neonatal Ed 2024; 109:151-158. [PMID: 37739774 PMCID: PMC10894834 DOI: 10.1136/archdischild-2023-325790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs). METHODS Multicentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability. RESULTS Neuroimaging scoring was associated with outcome (p<0.001, area under the curve 0.89±0.03). Isolated WMAs (IWMAs) were present in 61 infants, and WMAs associated with other lesions in 30. Although TPWMAs and diffuse pattern often coexisted in infants with IWMAs (p<0.001), only TPWMAs were associated with adverse outcomes (OR 7.8; 95% CI 1.4 to 42.8), including severe hearing loss in 20% and hearing loss combined with other moderate/severe disabilities in 15%. Increased ADC values were associated with higher neuroimaging scores, WMAs based on visual assessment and IWMAs with TPWMAs. ADC values were not associated with outcome in infants with IWMAs. Findings suggestive of progression of WMAs on follow-up MRI included gliosis and malacia. CONCLUSIONS Categorisation of neuroimaging severity correlates with outcome in cCMV. In infants with IWMAs, TPWMAs provide a guide to prognosis.
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Affiliation(s)
- Ana Alarcón
- Department of Neonatology, Hospital Sant Joan de Déu and Neonatal Brain Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Linda S de Vries
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Juan Arnáez
- Neonatal Unit, Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology NeNe Foundation, Madrid, Spain
- Sociedad Iberoamericana de Neonatología (SIBEN), New Jersey, New Jersey, USA
| | - Fernando Cabañas
- Department of Neonatology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
- Biomedical Research Foundation, Hospital Universitario La Paz, Madrid, Spain
| | - Sylke J Steggerda
- Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mónica Rebollo
- Radiology Department, Paediatric Radiology Unit, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Diagnostic and Therapeutic Imaging Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Luca Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Università di Genova, Genoa, Italy
| | - Izaskun Dorronsoro
- Department of Neonatology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Manuela López-Azorín
- Department of Neonatology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Juliane Schneider
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
| | - Antoni Noguera-Julian
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Infectious and Imported Diseases Department, Hospital Sant Joan de Déu and Infectious Diseases and Microbiome Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - María Ríos-Barnés
- Infectious and Imported Diseases Department, Hospital Sant Joan de Déu and Infectious Diseases and Microbiome Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quirónsalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Myriam Bickle-Graz
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
| | | | - Clàudia Fortuny
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Infectious and Imported Diseases Department, Hospital Sant Joan de Déu and Infectious Diseases and Microbiome Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Alfredo García-Alix
- Neonatal Neurology NeNe Foundation, Madrid, Spain
- Sociedad Iberoamericana de Neonatología (SIBEN), New Jersey, New Jersey, USA
| | - Anita C Truttmann
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital Centre, Lausanne, Switzerland
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Skubisz A, de Vries LS, Jansen SJ, van der Staaij H, Lopriore E, Steggerda SJ. Early red blood cell transfusion and the occurrence of intraventricular hemorrhage in very preterm infants. Early Hum Dev 2024; 189:105926. [PMID: 38218082 DOI: 10.1016/j.earlhumdev.2023.105926] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Preterm infants are at risk of developing both intraventricular hemorrhage (IVH) and anemia of prematurity. Several studies reported an association between early postnatal red blood cell (RBC) transfusion and IVH, however the timing and causality between these two remains unclear. AIMS To describe the temporal sequence between administration of early RBC transfusion (within the first week of life) and diagnosis of IVH in very preterm infants. STUDY DESIGN Retrospective single center case-series. SUBJECTS 132 very preterm infants (<32 weeks' gestation), admitted to a level III neonatal intensive care unit, studied with serial cranial ultrasound (CUS), and diagnosed with any grade of IVH. OUTCOME MEASURES Number and timing of early RBC transfusions in relation to the timing of IVH. RESULTS Median time of IVH diagnosis was 20.5 h after birth (interquartile range [IQR], 6.25-49.00 h). Of those who received an early RBC transfusion (36 %, 47/132), only 15 % (20/132) received it before the IVH diagnosis. Infants with RBC transfusion before IVH more frequently had lower birth weight, received less fequently antenatal steroids, required more often invasive mechanical ventilation and surfactant administration, had more often hypo- and hypercapnia, and received more fluid boluses, NaHCO3, and inotropes compared to the rest. CONCLUSIONS In the majority of infants, IVH was already present at the time of the first RBC transfusion. Studies including pre- and post RBC transfusion CUS are needed to assess the effect of early RBC transfusions on the development of IVH in preterm neonates.
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Affiliation(s)
- Aleksandra Skubisz
- Student Scientific Association of Neonatology, Institute of Medical Sciences, Medical College of Rzeszów University, University of Rzeszów, Rzeszów, Poland; Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Linda S de Vries
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sophie J Jansen
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hilde van der Staaij
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands; Sanquin Research & LAB Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sylke J Steggerda
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands.
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Spruijt MS, van Klink JMM, de Vries LS, Slaghekke F, Middeldorp JM, Lopriore E, Tan RNGB, Toirkens JP, Steggerda SJ. Fetal and neonatal neuroimaging in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2024. [PMID: 38214436 DOI: 10.1002/uog.27583] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/17/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To describe the types of brain injury and subsequent neurodevelopmental outcome, to determine risk factors for brain injury and to review the use of neuroimaging modalities in fetuses and neonates with twin-twin transfusion syndrome (TTTS). METHODS Retrospective cohort study of consecutive TTTS pregnancies treated with laser surgery in a single fetal therapy center between January 2010 and January 2020. Primary outcome was the incidence of brain injury, divided into predefined groups. Secondary outcomes included adverse outcome (perinatal mortality or neurodevelopmental impairment (NDI)), risk factors for brain injury and the numbers of magnetic resonance imaging (MRI) scans. RESULTS Fetal and neonatal brain ultrasound was performed in all 466 TTTS pregnancies and 685/749 (91%) liveborn neonates. MRI was performed in 3% of pregnancies and 4% of neonates. Brain injury was diagnosed in 16/935 (2%) fetuses and 37/685 (5%) neonates and all predefined injury groups were represented. Four fetal and four neonatal cases of cerebellar hemorrhage were detected. In the group with brain injury, perinatal mortality occurred in 11/16 (69%) fetuses and 8/37 (22%) neonates. Follow-up was available for 29/34 (85%) long-term survivors with brain injury and mean age at follow-up was 46 months. NDI was present in 9/29 (31%) survivors with brain injury. Adverse outcome occurred in 28/53 (53%) TTTS individuals with brain injury. The risk of brain injury was increased after recurrent TTTS/post-laser twin anemia polycythemia sequence (TAPS) (OR 3.095, 95%-CI 1.581 - 6.059, p = .001) and lower gestational age (GA) at birth (OR 1.381 for each week less, 95%-CI 1.238 - 1.541, p < .001). CONCLUSIONS Based on dedicated neurosonography and limited use of MRI, brain injury was diagnosed in 2% of fetuses and 5% of neonates with TTTS. Adverse outcome was seen in over half of cases with brain injury. Brain injury was related to recurrent TTTS/post-laser TAPS and a lower GA at birth. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- M S Spruijt
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatrics, Division of Perinatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M M van Klink
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - L S de Vries
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Slaghekke
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - J M Middeldorp
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - E Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R N G B Tan
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J P Toirkens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - S J Steggerda
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Rondagh M, De Vries LS, Peeters-Scholte CM, Tromp SC, Steggerda SJ. Efficacy of Levetiracetam as Add-On Therapy in the Treatment of Seizures in Neonates. Neonatology 2023; 121:233-243. [PMID: 38113859 PMCID: PMC10994567 DOI: 10.1159/000535499] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION There is no consensus regarding the efficacy of add-on therapy with levetiracetam (LEV) in the treatment of seizures in neonates. The aim of this study was to evaluate the efficacy of add-on therapy with LEV for achieving >80% seizure reduction after phenobarbital (PB) treatment. METHODS Retrospective cohort study of near term neonates admitted to the neonatal intensive care unit with EEG-confirmed seizures despite treatment with PB as first-line therapy and using LEV as 2nd-, 3rd- or 4th-line treatment. Antiseizure medication was administered according to national guidelines. All neonates were monitored with 2-channel amplitude-integrated electroencephalography. The total seizure burden in minutes, 2 h before and 4 h after administration of LEV, was calculated using raw EEG. Primary outcome was the efficacy of LEV in achieving >80% seizure reduction. The efficacy of additional midazolam (MDZ) and lidocaine (LDC) was also calculated. RESULTS A total of 47 full-term neonates were included. The mean total loading dose of LEV was 40 mg/kg (36-44 mg/kg). Seizure etiology consisted of hypoxic-ischemic encephalopathy (n = 11), hemorrhagic or ischemic stroke (n = 16), central nervous system infection (n = 8), genetic (n = 8), metabolic disorders (n = 3), and unknown (n = 1). Following LEV administration, >80% seizure reduction was observed in 17% (8/47) of neonates, whereas it was 23% (6/26) after MDZ and 92% (23/25) after LDC administration. DISCUSSION Although the cumulative loading dose of LEV was low and the group of infants studied was heterogeneous, the efficacy of LEV as add-on therapy for the treatment of seizures in neonates was limited. The highest seizure reduction rate was seen after LDC administration.
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Affiliation(s)
- Mathies Rondagh
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda S. De Vries
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Selma C. Tromp
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J. Steggerda
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
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Rondagh M, Groene SG, de Vries LS, Lopriore E, Steggerda SJ. Congenital Bilateral Perisylvian Polymicrogyria in Twin-Twin Transfusion Syndrome and Selective Fetal Growth Restriction. Neurology 2023; 101:970-971. [PMID: 37648524 PMCID: PMC10663019 DOI: 10.1212/wnl.0000000000207801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Mathies Rondagh
- From the Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center the Netherlands.
| | - Sophie G Groene
- From the Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center the Netherlands
| | - Linda S de Vries
- From the Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center the Netherlands
| | - Enrico Lopriore
- From the Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center the Netherlands
| | - Sylke J Steggerda
- From the Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center the Netherlands
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Benavente-Fernández I, Steggerda SJ, Liem KD, Lubián-López S, de Vries LS. Ultrasonographic Estimation of Ventricular Volume in Infants Born Preterm with Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled Early Versus Late Ventricular Intervention Study (ELVIS) Trial. J Pediatr 2023; 261:113578. [PMID: 37353143 DOI: 10.1016/j.jpeds.2023.113578] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To study the potential role of ventricular volume (VV) estimation in the management of posthemorrhagic ventricular dilatation related to the need for ventriculoperitoneal (VP)-shunt insertion and 2-year neurodevelopmental outcome in infants born preterm. STUDY DESIGN We included 59 patients from the Early vs Late Ventricular Intervention Study from 4 participating centers. VV was manually segmented in 209 3-dimensional ultrasound scans and estimated from 2-dimensional ultrasound linear measurements in a total of 1226 ultrasounds. We studied the association of both linear measurements and VV to the need for VP shunt and 2-year neurodevelopmental outcome in the overall cohort and in the 29 infants who needed insertion of a reservoir. We used general estimating equations to account for repeated measures per individual. RESULTS Maximum pre-reservoir VV (β coefficient = 0.185, P = .0001) and gestational age at birth (β = -0.338; P = .0001) were related to the need for VP shunt. The estimated optimal single VV measurement cut point of 17 cm3 correctly classified 79.31% with an area under the curve of 0.76 (CI 95% 0.74-0.79). Maximum VV (β = 0.027; P = .012) together with VP shunt insertion (β = 3.773; P = .007) and gestational age (β = -0.273; P = .0001) were related to cognitive outcome at 2 years. Maximum ventricular index and anterior horn width before reservoir insertion were independently associated with the need of VP shunt and the proposed threshold groups in the Early vs Late Ventricular Intervention Study trial were associated with long-term outcome. CONCLUSIONS Pre-reservoir VV measurements were associated with the need for VP-shunt insertion and 2-year cognitive outcome among infants born preterm with posthemorrhagic ventricular dilatation. TRIAL REGISTRATION ISRCTN43171322.
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Affiliation(s)
- Isabel Benavente-Fernández
- Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain; Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, Cádiz, Spain.
| | - Sylke J Steggerda
- Division of Neonatology, Department of pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Kian D Liem
- Division of Neonatology, Department of Paediatrics, Radboud University Medical Centre Nijmegen, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Simón Lubián-López
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, Cádiz, Spain
| | - Linda S de Vries
- Division of Neonatology, Department of pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, Leiden, The Netherlands; Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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de Vos TW, van Zagten M, de Haas M, Oepkes D, Tan RNGB, van der Schoot CE, Steggerda SJ, de Vries LS, Lopriore E, van Klink JMM. Children Newly Diagnosed with Fetal and Neonatal Alloimmune Thrombocytopenia: Neurodevelopmental Outcome at School Age. J Pediatr 2023; 258:113385. [PMID: 36933767 DOI: 10.1016/j.jpeds.2023.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To evaluate the neurodevelopmental outcome at school age in children newly diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT). STUDY DESIGN This observational cohort study included children diagnosed with FNAIT between 2002 and 2014. Children were invited for cognitive and neurological testing. Behavioral questionnaires and school performance results were obtained. A composite outcome of neurodevelopmental impairment (NDI) was used, defined, and subdivided into mild-to-moderate and severe NDI. Primary outcome was severe NDI, defined as IQ <70, cerebral palsy with Gross Motor Functioning Classification System level ≥ III, or severe visual/hearing impairment. Mild-to-moderate NDI was defined as IQ 70-85, minor neurological dysfunction or cerebral palsy with Gross Motor Functioning Classification System level ≤ II, or mild visual/hearing impairment. RESULTS In total, 44 children were included at a median age of 12 years (range: 6-17 years). Neuroimaging at diagnosis was available in 82% (36/44) of children. High-grade intracranial hemorrhage (ICH) was detected in 14% (5/36). Severe NDI was detected in 7% (3/44); two children had high-grade ICH, and one had low-grade ICH and perinatal asphyxia. Mild-to-moderate NDI was detected in 25% (11/44); one child had high-grade ICH, and eight children were without ICH, yet for two children, neuroimaging was not performed. Adverse outcome (perinatal death or NDI) was 39% (19/49). Four children (9%) attended special needs education, three of whom had severe NDI and one had mild-to-moderate NDI. Total behavioral problems within the clinical range were reported in 12%, which is comparable with 10% in the general Dutch population. CONCLUSION Children who are newly diagnosed with FNAIT are at increased risk for long-term neurodevelopmental problems, even those without ICH. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (Identifier: NCT04529382).
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Affiliation(s)
- Thijs W de Vos
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands; Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department of Experimental Immunohematology, Sanquin Research, Amsterdam.
| | - Maud van Zagten
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands
| | - Masja de Haas
- Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam; Department of Hematology, Leiden University Medical Center, Leiden
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden
| | - Ratna N G B Tan
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands
| | | | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands
| | - Linda S de Vries
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands
| | - Jeanine M M van Klink
- Division of Child and Adolescent Psychology, Department of Pediatrics, Leiden University Medical Center, Willem-Alexander Children's Hospital, The Netherlands
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Warmerdam LA, van Wezel-Meijler G, de Vries LS, Groenendaal F, Steggerda SJ. The Association of Dexamethasone and Hydrocortisone with Cerebellar Growth in Premature Infants. Neonatology 2023; 120:615-623. [PMID: 37379806 DOI: 10.1159/000531075] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/28/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This study aimed to compare cerebellar growth in premature infants who received dexamethasone or hydrocortisone to premature infants who did not receive postnatal corticosteroids. STUDY DESIGN Retrospective case-control study in infants born at a gestational age of <29 weeks and admitted to two level 3 neonatal intensive care units. Exclusion criteria were severe congenital anomalies and cerebellar or severe supratentorial lesions. Infants were treated with dexamethasone (unit 1) or hydrocortisone (unit 2) for chronic lung disease. Controls (unit 1) did not receive postnatal corticosteroids. Sequential head circumference (HC) and ultrasound measurements of transcerebellar diameter (TCD), biparietal diameter (BPD), and corpus callosum-fastigium length (CCFL) were performed until 40 weeks' postmenstrual age (PMA). Growth was assessed using linear mixed models correcting for PMA at measurement, sex, HC z-score at birth, and a propensity score indicating illness severity. Group differences before treatment were assessed using linear regression. RESULTS 346 infants were included (68 dexamethasone, 37 hydrocortisone, 241 controls). Before starting corticosteroids, TCD, BPD, and HC measurements did not differ between patients and controls at a comparable PMA. After starting treatment, both types of corticosteroid had a negative association with TCD growth. BPD, CCFL, and HC growth were not negatively affected. CONCLUSION Administration of dexamethasone and hydrocortisone are both associated with impaired cerebellar growth in premature infants without evident negative associations with cerebral growth.
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Affiliation(s)
- Laura A Warmerdam
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, and Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Pijpers JA, Au PYB, Weeke LC, Vein AA, Smit LS, Vilan A, Jacobs E, de Vries LS, Steggerda SJ, Cilio MR, Carapancea E, Cornet MC, Appendino JP, Peeters-Scholte CMPCD. Early recognition of characteristic conventional and amplitude-integrated EEG patterns of seizures in SCN2A and KCNQ3-related epilepsy in neonates. Seizure 2023; 110:212-219. [PMID: 37429183 DOI: 10.1016/j.seizure.2023.06.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Early recognition of seizures in neonates secondary to pathogenic variants in potassium or sodium channel coding genes is crucial, as these seizures are often resistant to commonly used anti-seizure medications but respond well to sodium channel blockers. Recently, a characteristic ictal amplitude-integrated electroencephalogram (aEEG) pattern was described in neonates with KCNQ2-related epilepsy. We report a similar aEEG pattern in seizures caused by SCN2A- and KCNQ3-pathogenic variants, as well as conventional EEG (cEEG) descriptions. METHODS International multicentre descriptive study, reporting clinical characteristics, aEEG and cEEG findings of 13 neonates with seizures due to pathogenic SCN2A- and KCNQ3-variants. As a comparison group, aEEGs and cEEGs of neonates with seizures due to hypoxic-ischemic encephalopathy (n = 117) and other confirmed genetic causes affecting channel function (n = 55) were reviewed. RESULTS In 12 out of 13 patients, the aEEG showed a characteristic sequence of brief onset with a decrease, followed by a quick rise, and then postictal amplitude attenuation. This pattern correlated with bilateral EEG onset attenuation, followed by rhythmic discharges ending in several seconds of post-ictal amplitude suppression. Apart from patients with KCNQ2-related epilepsy, none of the patients in the comparison groups had a similar aEEG or cEEG pattern. DISCUSSION Seizures in SCN2A- and KCNQ3-related epilepsy in neonates can usually be recognized by a characteristic ictal aEEG pattern, previously reported only in KCNQ2-related epilepsy, extending this unique feature to other channelopathies. Awareness of this pattern facilitates the prompt initiation of precision treatment with sodium channel blockers even before genetic results are available.
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Affiliation(s)
- Judith A Pijpers
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands.
| | - Ping Yee Billie Au
- Departments of Medical Genetics, Cumming School of Medicine, University of Calgary, Canada
| | - Lauren C Weeke
- Departments of Neonatology, Erasmus Medical Center, the Netherlands
| | - Alla A Vein
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands
| | - Liesbeth S Smit
- Departments of Neonatology, Erasmus Medical Center, the Netherlands; Departments of Neurology, Erasmus Medical Center, the Netherlands
| | - Ana Vilan
- Department of Neonatology, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Portugal
| | - Elke Jacobs
- Departments of Neurology, Erasmus Medical Center, the Netherlands
| | - Linda S de Vries
- Departments of Neonatology, Leiden University Medical Center, the Netherlands
| | - Sylke J Steggerda
- Departments of Neonatology, Leiden University Medical Center, the Netherlands
| | - Maria Roberta Cilio
- Division of Pediatric Neurology, Department of Pediatrics, Catholic University of Louvain, Brussels, Belgium
| | - Evelina Carapancea
- Division of Pediatric Neurology, Department of Pediatrics, Catholic University of Louvain, Brussels, Belgium
| | - Marie-Coralie Cornet
- Division of Neonatology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Juan P Appendino
- Departments of Pediatric Neurology, Cumming School of Medicine, University of Calgary, Canada
| | - Cacha M P C D Peeters-Scholte
- Departments of Neurology and Clinical Neurophysiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands
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Groene SG, Jansen L, Tan RNGB, Steggerda SJ, Haak MC, Roest AAW, Lopriore E, van Klink JMM. Insecure attachment and internalizing behavior problems in growth discordant identical twins. Early Hum Dev 2022; 174:105679. [PMID: 36179588 DOI: 10.1016/j.earlhumdev.2022.105679] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and future relationships. AIMS To investigate psychosocial development, attachment and school functioning in MC twins with sFGR and compare outcomes with the general population and between smaller and larger twins. STUDY DESIGN Observational cohort study. SUBJECTS MC twins with sFGR (defined as a birth weight discordance ≥20 %) born between 2002 and 2017 and aged 3-17 years. OUTCOME MEASURES Multiple parent report questionnaires: the Child Behavior Checklist (social-emotional development and behavior), the (Early) Childhood Behavior Questionnaire Very Short Form (temperament), the Attachment Insecurity Screening Inventory (attachment) and a school functioning questionnaire. RESULTS Median age for the 48 twin pairs was 11 (interquartile range (IQR) 8-13) years. Attachment insecurity for both twins was higher than in the general population for ambivalence/resistance (34 % (21/62) vs. 16 %, p = 0.024) and total attachment insecurity (35 % (22/62) vs. 16 %, p = 0.016). Smaller twins had more internalizing behavioral problems, i.e. negative emotions and behaviors turned inwards (22 % (10/46) vs. 11 % (5/46), p = 0.021) and a higher negative affect, i.e. more likely to experience negative emotions (3.2 (2.9-3.7) vs. 2.9 (2.2-3.2), p = 0.009) than larger twins, as well as a lower secondary school level (p = 0.031). CONCLUSION MC twins with sFGR have more ambivalent/resistant attachment insecurity following the complicated pregnancy course. Smaller twins have a tendency towards negative emotions and internalizing behaviors compared to larger twins, indicating an increased sensitivity for depression and anxiety.
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Affiliation(s)
- Sophie G Groene
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands; Molecular Epidemiology, Dept. of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Lisette Jansen
- Dept. of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ratna N G B Tan
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sylke J Steggerda
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique C Haak
- Fetal Therapy, Dept. of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arno A W Roest
- Pediatric Cardiology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Lopriore
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanine M M van Klink
- Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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Jansen S, Berkhout RJM, Te Pas AB, Steggerda SJ, de Vries LS, Schalij-Delfos N, van der Hoeven A, Lopriore E, Bekker V. Comparison of neonatal morbidity and mortality between single-room and open-bay care: a retrospective cohort study. Arch Dis Child Fetal Neonatal Ed 2022; 107:611-616. [PMID: 35444004 DOI: 10.1136/archdischild-2021-323310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design remain a subject of debate. Our goal was to evaluate the impact of single-room versus open-bay care on the risk of neonatal morbidity and mortality in preterm neonates. DESIGN Retrospective cohort study. SETTING Level III NICU. PATIENTS Neonates born <32 weeks' gestation between 15 May 2015 and 15 May 2019. MAIN OUTCOME MEASURES Mortality and morbidities of a cohort of neonates admitted to a new, single-room unit (SRU) were compared with a historical cohort of neonates admitted to an open-bay unit (OBU). Group differences were evaluated and multivariable logistic regression analyses were performed. RESULTS Three-hundred and fifty-six and 343 neonates were admitted to the SRU and OBU, respectively. No difference in neonatal morbidities and mortality were observed between cohorts (bronchopulmonary dysplasia: OR 1.08, 95% CI 0.73 to 1.58, p=0.44; retinopathy of the prematurity stage ≥2: OR 1.36, 95% CI 0.84 to 2.22, p=0.10; intraventricular haemorrhage: OR 0.89, 95% CI 0.59 to 1.34, p=0.86; mortality: OR 1.55, 95% CI 0.75 to 3.20, p=0.28). In adjusted regression models, single-room care was independently associated with a decreased risk of symptomatic patent ductus arteriosus (adjusted OR 0.54, 95% CI 0.31 to 0.95). No independent association between single-room care and any of the other investigated outcomes was observed. CONCLUSIONS Implementation of single-rooms in our NICU did not lead to a significant reduction in neonatal morbidity and mortality outcomes.
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Affiliation(s)
- Sophie Jansen
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Romy J M Berkhout
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Linda S de Vries
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | - Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
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14
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Parmentier CEJ, Steggerda SJ, Weeke LC, Rijken M, De Vries LS, Groenendaal F. Outcome of non-cooled asphyxiated infants with under-recognised or delayed-onset encephalopathy. Arch Dis Child Fetal Neonatal Ed 2022; 107:364-370. [PMID: 34916259 DOI: 10.1136/archdischild-2020-321331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/15/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the clinical characteristics, MRI findings and neurodevelopmental outcome of infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who were not selected for therapeutic hypothermia (TH). DESIGN Retrospective cohort study. SETTING AND PATIENTS (Near-)term infants with documented perinatal asphyxia referred to two Dutch level III neonatal units with neonatal encephalopathy (NE) and seizures <24 hours after birth not treated with TH. Infants with a diagnosis other than NE following perinatal asphyxia causing the seizures were excluded. MAIN OUTCOME MEASURES Clinical characteristics, findings on cranial MRI performed within 8 days after birth and neurodevelopmental outcome assessed using the Griffiths Mental Development Scales at 18 months or Bayley Scales of Infant and Toddler Development-Third Edition at 2 years of age. RESULTS 39 infants were included. All had abnormalities on MRI. Predominant white matter/watershed injury was the most common pattern of injury, 23 (59%). 7 (18%) infants had predominant basal ganglia/thalamus injury, 3 (8%) near total brain injury, 5 (13%) arterial ischaemic stroke, 1 (3%) an intraventricular haemorrhage. Adverse outcome was seen in 51%: 6 died, 11 developed cerebral palsy (spastic n=8, dyskinetic n=3), 2 had neurodevelopmental delay, 1 had severe hearing impairment. CONCLUSIONS All infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who did not receive TH had abnormalities on MRI. 51% had an adverse outcome. Better methods for recognition of infants who might benefit from TH and careful neurodevelopmental follow-up are urgently needed.
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Affiliation(s)
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lauren C Weeke
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda S De Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Lequin MH, Steggerda SJ, Severino M, Tortora D, Parodi A, Ramenghi LA, Groenendaal F, Meys KME, Benders MJNL, de Vries LS, Vann SD. Mammillary body injury in neonatal encephalopathy: a multicentre, retrospective study. Pediatr Res 2022; 92:174-179. [PMID: 33654286 PMCID: PMC9411062 DOI: 10.1038/s41390-021-01436-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mammillary bodies (MBs) have repeatedly been shown to be critical for memory, yet little is known about their involvement in numerous neurological conditions linked to memory impairments, including neonatal encephalopathy. METHODS We implemented a multicentre retrospective study, assessing magnetic resonance scans of 219 infants with neonatal encephalopathy who had undergone hypothermia treatment in neonatal intensive care units located in the Netherlands and Italy. RESULTS Abnormal MB signal was observed in ~40% of infants scanned; in half of these cases, the brain appeared otherwise normal. MB involvement was not related to the severity of encephalopathy or the pattern/severity of hypoxic-ischaemic brain injury. Follow-up scans were available for 18 cases with abnormal MB signal; in eight of these cases, the MBs appeared severely atrophic. CONCLUSIONS This study highlights the importance of assessing the status of the MBs in neonatal encephalopathy; this may require changes to scanning protocols to ensure that the slices are sufficiently thin to capture the MBs. Furthermore, long-term follow-up of infants with abnormal MB signal is needed to determine the effects on cognition, which may enable the use of early intervention strategies. Further research is needed to assess the role of therapeutic hypothermia in MB involvement in neonatal encephalopathy. IMPACT The MBs are particularly sensitive to hypoxia in neonates. Current hypothermia treatment provides incomplete protection against MB injury. MB involvement is likely overlooked as it can often occur when the rest of the brain appears normal. Given the importance of the MBs for memory, it is necessary that this region is properly assessed in neonatal encephalopathy. This may require improvements in scanning protocols.
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Affiliation(s)
- Maarten H Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luca A 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
| | - Floris Groenendaal
- Department of Neonatology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Karlijn M E Meys
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neonatology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Seralynne D Vann
- School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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De Vos TW, De Haas M, Oepkes D, Tan RRNGB, Van der Schoot CE, Steggerda SJ, de Vries LS, Lopriore E, Van Klink JMM. Long-term neurodevelopmental outcome in children after antenatal intravenous immune globulin treatment in fetal and neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol 2022; 227:637.e1-637.e9. [PMID: 35671780 DOI: 10.1016/j.ajog.2022.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with fetal and neonatal alloimmune thrombocytopenia (FNAIT) face increased risk of intracranial hemorrhage (ICH) potentially leading to developmental impairment. To prevent ICH, pregnant women with alloantibodies against fetal platelets are often treated with intravenous immunoglobulin (IVIg). IVIg appears effective in vastly reducing the risk of fetal or neonatal bleeding complications. However, information on long-term neurodevelopment of these children is lacking. OBJECTIVE To evaluate long-term neurodevelopmental outcome in children with FNAIT who were treated with IVIg antenatally. STUDY DESIGN An observational cohort study was performed including children of mothers who were treated with IVIg during pregnancy because a previous child was diagnosed with FNAIT. Children, were invited for a follow-up assessment including standardized cognitive and neurologic tests. The parents were asked to complete a behavioral questionnaire and school performance reports. The primary outcome was severe neurodevelopmental impairment (NDI), defined as severe cognitive impairment (IQ < 70), cerebral palsy with Gross Motor Function Classification System (GMFCS) Level ≥ 3, bilateral blindness, and/or bilateral deafness (requiring amplification). The secondary outcome was mild to moderate NDI, defined as either mild to moderate cognitive impairment (IQ < 85), cerebral palsy with GMFCS Level ≤ 2, minor neurologic dysfunction, vision loss, and/or hearing loss. RESULTS Between 2003 and 2017, 51 children were liveborn after antenatal IVIg treatment. One family moved abroad and was therefore not eligible for inclusion. In total, 82% (41/50) of the eligible cases were included for neurodevelopmental assessment at a median age of 9 years and 8 months. Severe NDI was not detected. The incidence of mild to moderate NDI was 14% (6/41, 95% confidence interval: 6%-29%). The children's mean cognitive score, behavioral scores, and academic achievement were not different from the Dutch norm groups. Neuroimaging was performed in 90% (37/41) of cases. Severe ICH had been diagnosed in two cases (5%), one antenatally before the start of IVIg and the other case 1 day after birth. Both cases had a normal neurodevelopmental outcome. CONCLUSION The risk of NDI in children whose mothers were treated for FNAIT with antenatal IVIg is comparable to that in the general population.
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Affiliation(s)
- Thijs W De Vos
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands; Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department of Experimental Immunohematology, Sanquin Research, Amsterdam.
| | - Masja De Haas
- Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam; Department of Hematology, Leiden University Medical Center, Leiden
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden
| | - Ratna R N G B Tan
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | | | - Sylke J Steggerda
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Linda S de Vries
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Jeanine M M Van Klink
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Child and Adolescent Psychology, Leiden University Medical Center, the Netherlands
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Baak LM, Wagenaar N, van der Aa NE, Groenendaal F, Dudink J, Tataranno ML, Mahamuud U, Verhage CH, Eijsermans RMJC, Smit LS, Jellema RK, de Haan TR, ter Horst HJ, de Boode WP, Steggerda SJ, Prins HJ, de Haar CG, de Vries LS, van Bel F, Heijnen CJ, Nijboer CH, Benders MJNL. Feasibility and safety of intranasally administered mesenchymal stromal cells after perinatal arterial ischaemic stroke in the Netherlands (PASSIoN): a first-in-human, open-label intervention study. Lancet Neurol 2022; 21:528-536. [DOI: 10.1016/s1474-4422(22)00117-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/22/2022]
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18
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van 't Westende C, Steggerda SJ, Jansen L, van den Berg-Huysmans AA, van de Pol LA, Wiggers-de Bruine FT, Stam CJ, Peeters-Scholte CMPCD. Combining advanced MRI and EEG techniques better explains long-term motor outcome after very preterm birth. Pediatr Res 2022; 91:1874-1881. [PMID: 34031571 DOI: 10.1038/s41390-021-01571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm born children are at high risk for adverse motor neurodevelopment. The aim of this study was to establish the relationship between motor outcome and advanced magnetic resonance imaging (MRI) and electroencephalography (EEG) measures. METHODS In a prospective cohort study of 64 very preterm born children, the motor outcome was assessed at 9.83 (SD 0.70) years. Volumetric MRI, diffusion tensor imaging (DTI), and EEG were acquired at 10.85 (SD 0.49) years. We investigated associations between motor outcome and brain volumes (white matter, deep gray matter, cerebellum, and ventricles), white matter integrity (fractional anisotropy and mean, axial and radial diffusivity), and brain activity (upper alpha (A2) functional connectivity and relative A2 power). The independence of associations with motor outcome was investigated with a final model. For each technique, the measure with the strongest association was selected to avoid multicollinearity. RESULTS Ventricular volume, radial diffusivity, mean diffusivity, relative A2 power, and A2 functional connectivity were significantly correlated to motor outcome. The final model showed that ventricular volume and relative A2 power were independently associated with motor outcome (B = -9.42 × 10-5, p = 0.027 and B = 28.9, p = 0.007, respectively). CONCLUSIONS This study suggests that a lasting interplay exists between brain structure and function that might underlie motor outcome at school age. IMPACT This is the first study that investigates the relationships between motor outcome and brain volumes, DTI, and brain function in preterm born children at school age. Ventricular volume and relative upper alpha power on EEG have an independent relation with motor outcome in preterm born children at school age. This suggests that there is a lasting interplay between structure and function that underlies adverse motor outcome.
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Affiliation(s)
- Charlotte van 't Westende
- Department of Child Neurology, Amsterdam University Medical Centers, AMC Site, Amsterdam, The Netherlands. .,Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette Jansen
- Department of Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Laura A van de Pol
- Department of Child Neurology, Amsterdam University Medical Centers, AMC Site, Amsterdam, The Netherlands
| | | | - Cornelis J Stam
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, VUmc Site, Amsterdam, The Netherlands
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19
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de Vries LS, Steggerda SJ, Groenendaal F, Cowan FM. Comment on 'value of cranial ultrasound at initiation of therapeutic hypothermia for neonatal encephalopathy'. J Perinatol 2022; 42:418-419. [PMID: 35017677 DOI: 10.1038/s41372-021-01307-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/25/2021] [Accepted: 12/23/2021] [Indexed: 02/08/2023]
Affiliation(s)
- L S de Vries
- Department of Neonatology, University medical Center Utrecht, Utrecht, the Netherlands. .,Department of Neonatology, Leiden University medical Center, Leiden, the Netherlands.
| | - S J Steggerda
- Department of Neonatology, Leiden University medical Center, Leiden, the Netherlands
| | - F Groenendaal
- Department of Neonatology, University medical Center Utrecht, Utrecht, the Netherlands
| | - F M Cowan
- Department of Paediatrics, Imperial College London, London, UK
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20
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van der Hoeven A, van der Beek MT, Lopriore E, Steggerda SJ, Bekker V. Predicting Neonatal Early Onset Sepsis: A 14-Year Cohort Study. Pediatr Infect Dis J 2022; 41:72-77. [PMID: 34292266 DOI: 10.1097/inf.0000000000003266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In many infants, treatment is started for suspicion of early onset sepsis (EOS), of whom the majority do not have an infection. Early prediction of the absence of a culture-proven sepsis (CPS) would significantly reduce the time of antibiotic treatment and hospitalization. Our objective was to analyze 3 criteria in infants with CPS: positive blood culture (BC) at 24 hours after the onset of suspicion of EOS (OSEOS), C-reactive protein (CRP) ≥10 mg/L and clinical signs of infection, so we can consequently consider to stop antibiotic treatment in infants without these criteria. METHODS We included all infants with suspicion of EOS from 2007 until 2020. The proportion was calculated of (1) infants with CPS with, at 24 hours, a positive BC and/or CRP ≥10 mg/L and/or clinical signs of infection and (2) infants without CPS with CRP <10 mg/L between 12 and 24 hours after OSEOS. RESULTS The BC showed growth of a pathogenic microorganism in 50 of 4120 included infants (1.2%). Time to positivity was ≥24 hours in 8 (16%) infants, of whom 7 infants had a raised CRP and/or clinical symptoms of infection within 24 hours. In 1095 (74%) of infants without CPS in whom CRP was measured between 12 and 24 hours after OSEOS, CRP was <10 mg/L. CONCLUSION A combination of BC, CRP, and clinical signs of infection can diagnose 98% (49/50) of infants with CPS 24 hours after OSEOS. Based on normal CRP and the absence of a positive BC, the decision to stop antibiotics could have been brought forward to 24 hours in 74% of infants.
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Affiliation(s)
| | | | - Enrico Lopriore
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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21
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Jansen SJ, Lopriore E, Beek MT, Veldkamp KE, Steggerda SJ, Bekker V. The road to zero nosocomial infections in neonates-a narrative review. Acta Paediatr 2021; 110:2326-2335. [PMID: 33955065 PMCID: PMC8359829 DOI: 10.1111/apa.15886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
Aim Nosocomial infections (NI) in neonates are associated with prolonged hospitalisation, adverse neurodevelopmental outcome and high mortality. Over the past decade, numerous prevention strategies have resulted in significant reductions in NI rates. In this review, we aim to provide an overview of current NI rates from large, geographically defined cohorts. Methods PubMed, Web of Science, EMBASE and Cochrane Library were searched for evidence regarding epidemiology and prevention of NI in neonates. Extracted studies were synthesised in a narrative form with experiential reflection. Results Despite the abundance of geographically defined incidence proportions, an epidemiological overview of NI is difficult to provide, given the lack of consensus definition for neonatal NI and different baseline populations being compared. Successful prevention efforts have focused on implementing evidence‐based practices while eliminating outdated strategies. The most promising model for reduction in infection rates is based on quality improvement (QI) collaboratives and benchmarking, involving identification and implementation of best practices, selection of measurable outcomes and fostering a sense of community and transparency. Conclusion The preventative rather than curative approach forms the new paradigm for reducing the burden of neonatal infections. Despite progress achieved, continued work towards improved prevention practices is required in the strive towards zero NIs.
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Affiliation(s)
- Sophie J. Jansen
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Enrico Lopriore
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Martha T. Beek
- Department of Medical Microbiology Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Sylke J. Steggerda
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Vincent Bekker
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
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22
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Jansen L, van Steenis A, van den Berg-Huysmans AA, Wiggers-de Bruine ST, Rijken M, de Vries LS, Vermeiren RRJM, Peeters-Scholte CMPCD, Steggerda SJ. Associations between Neonatal Magnetic Resonance Imaging and Short- and Long-Term Neurodevelopmental Outcomes in a Longitudinal Cohort of Very Preterm Children. J Pediatr 2021; 234:46-53.e2. [PMID: 33577803 DOI: 10.1016/j.jpeds.2021.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess associations between neonatal brain injury assessed by magnetic resonance imaging and cognitive, motor, and behavioral outcomes at 2 and 10 years of age, in a longitudinal cohort of children born very preterm. STUDY DESIGN There were 112 children born at <32 weeks of gestation who participated in a longitudinal prospective study on brain injury and neurodevelopmental outcome. Using the Kidokoro score, neonatal brain injury and altered brain growth in white matter, cortical and deep gray matter, and the cerebellum were assessed. Cognitive, motor, and behavioral outcomes were assessed during follow-up visits at both 2 (corrected) and 10 years of age. RESULTS After adjusting for perinatal factors and level of maternal education, the global brain abnormality score was associated with cognition (B = -1.306; P = .005), motor skills (B = -3.176; P < .001), and behavior (B = 0.666; P = .005) at 2 years of age, but was not associated with cognition at 10 years of age. In the subgroup of children with a moderate-severe global brain abnormality score, magnetic resonance imaging was independently associated with cognitive impairment at 10 years of age. For children with milder forms of brain injury, only birth weight and level of maternal education were associated with cognitive outcomes. CONCLUSIONS Neonatal brain injury, assessed by a standardized scoring system, was associated with short-term neurodevelopmental outcomes, but only with motor skills and behavior in childhood. Environmental factors, such as level of maternal education, become more important for cognitive development as children grow older, especially for children with relatively mild neonatal brain injury.
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Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands; Curium-LUMC Department of Child and Adolescent Psychiatry, Leiden, the Netherlands.
| | - Andrea van Steenis
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
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23
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van Steenis A, Fumagalli M, Kruit MC, Peeters-Scholte CMPCD, de Vries LS, Steggerda SJ. Cranial Ultrasound Is an Important Tool in the Recognition of Life-Threatening Infratentorial Hemorrhage in Newborns. Neuropediatrics 2021; 52:170-178. [PMID: 33316833 DOI: 10.1055/s-0040-1716899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Timely detection of severe infratentorial hemorrhage in neonates is crucial, especially in case of life-threatening brain stem compression and/or acute obstructive hydrocephalus, which need lifesaving neurosurgical intervention. Although the detection of infratentorial hemorrhage by ultrasound scanning is often considered as difficult, the use of additional acoustic windows and recognition of characteristic ultrasound features facilitate early diagnosis. In this case series, we report on newborns with severe, symptomatic infratentorial hemorrhage detected primarily by cranial ultrasound. We demonstrate the characteristic ultrasound features present in all cases and discuss how ultrasound diagnosis contributed to early diagnosis and treatment.
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Affiliation(s)
- A van Steenis
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Fumagalli
- Dipartimento Donna-Bambino-Neonato, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - M C Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - L S de Vries
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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24
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Joanna R G V, Lopriore E, Te Pas AB, Rijken M, van Zwet EW, de Bruine FT, Steggerda SJ. Persistent pulmonary hypertension in neonates with perinatal asphyxia and therapeutic hypothermia: a frequent and perilous combination. J Matern Fetal Neonatal Med 2021; 35:4969-4975. [PMID: 33615985 DOI: 10.1080/14767058.2021.1873941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES (1) To investigate whether neonates with perinatal asphyxia and therapeutic hypothermia more often developed PPHN compared to a control group with perinatal asphyxia not treated with hypothermia; (2) To identify risk factors for severe PPHN during hypothermia and evaluate short-term outcome. METHODS This single-center retrospective cohort study included (near-)term neonates with perinatal asphyxia admitted between 2004 and 2016. Neonates with perinatal asphyxia and hypothermia were compared to a historical control group without hypothermia. Primary outcome was PPHN, defined as severe hypoxemia requiring mechanical ventilation and inhaled nitric oxide, confirmed by echocardiography. Short-term adverse outcome was defined as mortality within one month and/or severe brain injury on MRI. RESULTS Incidence of PPHN was 23% (26/114) in the hypothermia group and 11% (8/70) in controls. In multivariate analysis, PPHN was 2.5 times more common among neonates with hypothermia. Neonates developing PPHN during hypothermia often had higher fraction of inspired oxygen at baseline. PPHN was not associated with a higher risk of severe brain injury. However, early mortality was higher and three infants died due to severe refractory PPHN during hypothermia. CONCLUSIONS In this study PPHN occurred more often since the introduction of therapeutic hypothermia. This was usually reversible and did not lead to overall increased adverse outcome. However, in individual cases with PPHN deterioration occurred rapidly. In such cases the benefits of hypothermia should be weighed against the risk of a complicated, fatal course.
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Affiliation(s)
- Vijverberg Joanna R G
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik W van Zwet
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisca T de Bruine
- Department of Neuroradiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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25
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Jansen L, Peeters-Scholte CMPCD, van den Berg-Huysmans AA, van Klink JMM, Rijken M, van Egmond-van Dam JC, Vermeiren RRJM, Steggerda SJ. Longitudinal Follow-Up of Children Born Preterm: Neurodevelopment From 2 to 10 Years of Age. Front Pediatr 2021; 9:674221. [PMID: 34235124 PMCID: PMC8257021 DOI: 10.3389/fped.2021.674221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/28/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the rate and stability of impairments in children born preterm by assessing (1) early and school-age outcome in four developmental domains and (2) individual changes in outcome at both timepoints. Design: Prospective, longitudinal cohort study in children born in 2006-2007, <32 weeks' gestation. Follow-up at 2 and 10 years of age included standardized neurological, motor, cognitive and behavioral assessments. Children were categorized as having no, mild or moderate-severe impairment in these four domains. A composite impairment score was composed and the number of domains with impairments counted. For each child, individual outcomes at both timepoints were compared. Results: Follow-up at both time-points was available in 71/113(63%) children. At group level, there were no significant changes in the severity of impairments per domain. However, at individual level, there were less children with a mild abnormal composite score at 10 years of age (44 vs. 20%; p = 0.006), and more with a moderate-severe abnormal composite score (12 vs. 35%; p = 0.001). Especially children with normal/mild outcome at 2 years were likely to shift to other outcome categories over time. Conclusions: Children with early severe impairment are likely experiencing impairments later on, but early normal/mild abnormal outcomes should be interpreted with care, considering the large individual shifts over time. Long-term follow-up in all children born very preterm should therefore be continued to at least school-age.
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Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands.,Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands
| | | | | | - Jeanine M M van Klink
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
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26
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Koene S, Peeters-Scholte CMPCD, Knijnenburg J, de Vries LS, van Scheltema PNA, Meuwissen ME, Steggerda SJ, Santen GWE. Intracerebral hemorrhage in a neonate with an intragenic COL4A2 duplication. Am J Med Genet A 2020; 185:571-574. [PMID: 33247988 PMCID: PMC7839436 DOI: 10.1002/ajmg.a.61988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 11/10/2022]
Abstract
Intracerebral hemorrhage is rare in term born neonates. Besides several non‐genetic risk factors, pathogenic variants in COL4A1 and COL4A2 have been described to play a role in the pathophysiology of neonatal intracerebral hemorrhage. To the best of our knowledge, no intragenic COL4A2 duplications have been reported in humans to date. We report a neonate with intracerebral hemorrhage and a de novo intragenic COL4A2 duplication. Although it is not clear yet whether this genetic factor fully explains the clinical phenotype, it may have contributed at least as a risk factor for cerebral hemorrhage. Screening for intragenic COL4A1 and COL4A2 duplications as part of collagen IV diagnostics should be considered as part of the fetal and neonatal work‐up for unexplained cerebral hemorrhages and to collect more evidence of the pathogenicity of this genetic mechanism.
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Affiliation(s)
- Saskia Koene
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen Knijnenburg
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marije E Meuwissen
- Center of Medical Genetics, Antwerp University Hospital/University of Antwerp, Edegem, Belgium
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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27
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Steggerda SJ, Tan RNGB, de Laat PCJ. PHACE syndrome in a preterm infant. Neurology 2020; 95:751-752. [PMID: 32913025 DOI: 10.1212/wnl.0000000000010800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sylke J Steggerda
- From the Department of Paediatrics (S.J.S., R.N.G.B.T.), Division of Neonatology, Leiden University Medical Centre; and Department of Paediatrics (P.C.J.d.L.), Vascular Anomaly Center, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Ratna N G B Tan
- From the Department of Paediatrics (S.J.S., R.N.G.B.T.), Division of Neonatology, Leiden University Medical Centre; and Department of Paediatrics (P.C.J.d.L.), Vascular Anomaly Center, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Peter C J de Laat
- From the Department of Paediatrics (S.J.S., R.N.G.B.T.), Division of Neonatology, Leiden University Medical Centre; and Department of Paediatrics (P.C.J.d.L.), Vascular Anomaly Center, Erasmus Medical Centre, Rotterdam, the Netherlands
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28
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van 't Westende C, Peeters-Scholte CMPCD, Jansen L, van Egmond-van Dam JC, Tannemaat MR, de Bruïne FT, van den Berg-Huysmans AA, Geraedts VJ, Gouw AA, Steggerda SJ, Stam CJ, van de Pol LA. The degree of prematurity affects functional brain activity in preterm born children at school-age: An EEG study. Early Hum Dev 2020; 148:105096. [PMID: 32534406 DOI: 10.1016/j.earlhumdev.2020.105096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
Prematurely born children are at higher risk for long-term adverse motor and cognitive outcomes. The aim of this paper was to compare quantitative measures derived from electroencephalography (EEG) between extremely (EP) and very prematurely (VP) born children at 9-10 years of age. Fifty-five children born <32 weeks' of gestation underwent EEG at 9-10 years of age and were assessed for motor development and cognitive outcome. Relative frequency power and functional connectivity, as measured by the Phase Lag Index (PLI), were calculated for all frequency bands. Per subject, power spectrum and functional connectivity results were averaged over all channels and pairwise PLI values to explore differences in global frequency power and functional connectivity between EP and VP children. Brain networks were constructed for the upper alpha frequency band using the Minimum Spanning Tree method and were compared between EP and VP children. In addition, the relationships between upper alpha quantitative EEG results and cognitive and motor outcomes were investigated. Relative power and functional connectivity were significantly higher in VP than EP children in the upper alpha frequency band, and VP children had more integrated networks. A strong positive correlation was found between relative upper alpha power and motor outcome whilst controlling for gestational age, age during EEG recording, and gender (ρ = 0.493, p = 0.004). These results suggest that 9-10 years after birth, the effects of the degree of prematurity can be observed in terms of alterations in functional brain activity and that motor deficits are associated with decreases in relative upper alpha power.
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Affiliation(s)
- Charlotte van 't Westende
- Department of Child Neurology, Amsterdam University Medical Centers, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of Neonatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | | | - Lisette Jansen
- Department of Psychology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | | | - Martijn R Tannemaat
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Francisca T de Bruïne
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | | | - Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; Department of Clinical Neurophysiology, Amsterdam University Medical Centers, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Alida A Gouw
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Laura A van de Pol
- Department of Child Neurology, Amsterdam University Medical Centers, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands.
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29
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Boswinkel V, Steggerda SJ, Fumagalli M, Parodi A, Ramenghi LA, Groenendaal F, Dudink J, Benders MN, Knol R, de Vries LS, van Wezel-Meijler G. The CHOPIn Study: a Multicenter Study on Cerebellar Hemorrhage and Outcome in Preterm Infants. Cerebellum 2020; 18:989-998. [PMID: 31250213 DOI: 10.1007/s12311-019-01053-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cerebellar hemorrhage (CBH) is a frequent complication of preterm birth and may play an important and under-recognized role in neurodevelopment outcome. Association between CBH size, location, and neurodevelopment is still unknown. The main objective of this study was to investigate neurodevelopmental outcome at 2 years of age in a large number of infants with different patterns of CBH. Of preterm infants (≤ 34 weeks) with known CBH, perinatal factors, neuro-imaging findings, and follow-up at 2 years of age were retrospectively collected. MRI scans were reassessed to determine the exact size, number, and location of CBH. CBH was divided into three groups: punctate (≤ 4 mm), limited (> 4 mm but < 1/3 of the cerebellar hemisphere), or massive (≥ 1/3 of the cerebellar hemisphere). Associations between pattern of CBH, perinatal factors, and (composite) neurodevelopmental outcome were assessed. Data of 218 preterm infants with CBH were analyzed. Of 177 infants, the composite outcome score could be obtained. Forty-eight out of 119 infants (40%) with punctate CBH, 18 out of 35 infants (51%) with limited CBH, and 18 out of 23 infants (78%) with massive CBH had an abnormal composite outcome score. No significant differences were found for the composite outcome between punctate and limited CBH (P = 0.42). The risk of an abnormal outcome increased with increasing size of CBH. Infants with limited CBH have a more favorable outcome than infants with massive CBH. It is therefore important to distinguish between limited and massive CBH.
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Affiliation(s)
- V Boswinkel
- Department of Neonatology, Isala Women and Children's hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
| | - S J Steggerda
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Parodi
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - L A Ramenghi
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - F Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Dudink
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M N Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Knol
- Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G van Wezel-Meijler
- Department of Neonatology, Isala Women and Children's hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
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30
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Hopmans EM, van der Heide A, Chung PK, Brinkman D, Feltkamp MCW, van Dijk JG, Steggerda SJ, Niks EH. Rotavirus-Induced Neonatal Epileptic Encephalopathy-A Disease Spectrum Illustrated by Monochorionic Twins. Neuropediatrics 2020; 51:62-67. [PMID: 31541999 DOI: 10.1055/s-0039-1695712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rotavirus has been associated with neonatal seizures and specific white matter magnetic resonance imaging (MRI) abnormalities. We describe monochorionic twins who not only tested positive for rotavirus with these white matter MRI abnormalities but who also showed an electroencephalogram (EEG) pattern characteristic of early infantile epileptic encephalopathy (EIEE), which has so far solely been described in epileptic encephalopathies with a poor prognosis. This report suggests that rotavirus infection must be added to the list of causes of EIEE EEG, and that the outcome then is likely more favorable. As MRI and EEG signs of rotavirus encephalopathy were present in one twin with only subtle neurologic symptoms, rotavirus may well cause insidious central nervous system complications more often. We suggest considering rotavirus infection in neonates presenting with seizures, and to add rotavirus infection to the differential diagnosis of EIEE.
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Affiliation(s)
- Esther M Hopmans
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Astrid van der Heide
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pui Khi Chung
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniëlle Brinkman
- Department of Paediatrics, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Mariet C W Feltkamp
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Gert van Dijk
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik H Niks
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands
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31
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Spruijt MS, Lopriore E, J Steggerda S, Slaghekke F, Van Klink JMM. Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond. Expert Rev Hematol 2020; 13:259-267. [PMID: 31971028 DOI: 10.1080/17474086.2020.1720643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Twin-twin transfusion syndrome (TTTS) is a devastating complication of monochorionic twin pregnancy and remains a major challenge for worldwide fetal medicine specialists. In TTTS, intertwin transfusion through vascular anastomoses in the shared placenta leads to severe hemodynamic imbalance. This review summarizes the current knowledge of TTTS.Areas covered: The most recent insights concerning the management of TTTS, as well as fetal and neonatal complications are described. Relevant articles were selected based on a Pubmed search using the keywords below. Understanding of the underlying pathophysiology has improved greatly as a result of placental injection studies. Advancements in antenatal management have led to increased perinatal survival and a decreased incidence of neonatal complications, including brain injury and neurodevelopmental impairment.Expert opinion: Further opportunities for improvement comprise technological innovations in laser procedures and the prevention of preterm rupture of membranes with subsequent prematurity. A noninvasive treatment such as high-intensity focused ultrasound (HIFU) seems to hold promise for the future treatment of TTTS. Fetal MRI studies are important to improve our understanding of fetal brain injury and should relate their findings to long-term neurodevelopment. International collaboration and centralization of care are of paramount importance to ensure the best care for our patients.
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Affiliation(s)
- Marjolijn S Spruijt
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke Slaghekke
- Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanine M M Van Klink
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
BACKGROUND: Hyponatremia is a common laboratory finding in premature and ill neonates. When the degree of hyponatremia is more severe, the likelihood of a pathologic entity increases. In this case report we describe a premature neonate with severe hyponatremia due to the idiopathic syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE DESCRIPTION: The patient is a male neonate, born prematurely. He was admitted to the neonatal intensive care unit and received non-invasive respiratory support. After 48 hours of life serum sodium (Na+) decreased to 115 mmol/l. Hyponatremia progressively worsened despite aggressive Na+ supplementation. The clinical and laboratory data were most consistent with severe SIADH. Fluid restriction was initiated which resulted in a gradual normalization of Na+. A causal factor for development of SIADH could not be identified. CONCLUSION: When a neonate presents with significant hyponatremia that is not responsive to conventional therapy, it is important to perform a diagnostic work-up for SIADH, even in the absence of overt triggering factors.
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Affiliation(s)
- D van der Lee
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - C de Bruin
- Division of Pediatric Endocrinology, Department of Pediatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - S J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - H Vlaardingerbroek
- Division of Pediatric Endocrinology, Department of Pediatrics, Leiden University Medical Centre, Leiden, Netherlands
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van der Sluijs PJ, Aten E, Barge-Schaapveld DQ, Bijlsma EK, Bökenkamp-Gramann R, Kaat LD, van Doorn R, van de Putte DF, van Haeringen A, ten Harkel AD, Hilhorst-Hofstee Y, Hoffer MJ, den Hollander NS, van Ierland Y, Koopmans M, Kriek M, Moghadasi S, Nibbeling EA, Peeters-Scholte CM, Potjer TP, van Rij M, Ruivenkamp CA, Rutten JW, Steggerda SJ, Suerink M, Tan RN, van der Tuin K, Visser R, van der Werf –’t Lam AS, Williams M, Witlox R, Santen GW. Correction: Putting genome-wide sequencing in neonates into perspective. Genet Med 2019; 21:2159-2164. [DOI: 10.1038/s41436-018-0363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Peeters-Scholte CMPCD, Adama van Scheltema PN, Klumper FJCM, Everwijn SMP, Koopmans M, Hoffer MJV, Koopmann TT, Ruivenkamp CAL, Steggerda SJ, van der Knaap MS, Santen GWE. Genotype-phenotype correlation in ATAD3A deletions: not just of scientific relevance. Brain 2019; 140:e66. [PMID: 29053797 DOI: 10.1093/brain/awx239] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Frans J C M Klumper
- Department of Obstetrics and Fetal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Sheila M P Everwijn
- Department of Obstetrics and Fetal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Marije Koopmans
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariette J V Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Tamara T Koopmann
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Claudia A L Ruivenkamp
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjo S van der Knaap
- Department of Pediatrics/Child Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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35
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Cizmeci MN, Khalili N, Claessens NHP, Groenendaal F, Liem KD, Heep A, Benavente-Fernández I, van Straaten HLM, van Wezel-Meijler G, Steggerda SJ, Dudink J, Išgum I, Whitelaw A, Benders MJNL, de Vries LS, Woerdeman P, ter Horst H, Dijkman K, Ley D, Fellman V, de Haan T, Brouwer A, van ‘t Verlaat E, Govaert P, Smit B, Agut Quijano T, Barcik U, Mathur A, Graca A. Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled ELVIS Trial. J Pediatr 2019; 208:191-197.e2. [PMID: 30878207 DOI: 10.1016/j.jpeds.2018.12.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI. STUDY DESIGN In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis. RESULTS The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P < .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03). CONCLUSIONS More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation. TRIAL REGISTRATION ISRCTN43171322.
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Affiliation(s)
- Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nadieh Khalili
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kian D Liem
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel Heep
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, United Kingdom
| | | | | | - Gerda van Wezel-Meijler
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, The Netherlands; Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew Whitelaw
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, United Kingdom
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
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36
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Hortensius LM, Dijkshoorn ABC, Ecury-Goossen GM, Steggerda SJ, Hoebeek FE, Benders MJNL, Dudink J. Neurodevelopmental Consequences of Preterm Isolated Cerebellar Hemorrhage: A Systematic Review. Pediatrics 2018; 142:peds.2018-0609. [PMID: 30341153 DOI: 10.1542/peds.2018-0609] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The effect of neonatal cerebellar hemorrhage on neurodevelopmental outcome (NDO) in the absence of supratentorial injury is still largely unknown. OBJECTIVE To evaluate the influence of isolated neonatal cerebellar hemorrhage on cognitive, motor, language, and behavioral NDOs and assess the effect of location and size on outcome. DATA SOURCES Embase, Medline, and Scopus were searched from inception to September 30, 2017. STUDY SELECTION Studies in which a diagnosis of isolated cerebellar hemorrhage was reported in preterm infants (<32 weeks' gestation) with a standardized NDO at ≥12 months of age were included. DATA EXTRACTION Patient characteristics, location, and size of bleeding and NDO (defined as severe [yes or no] on the basis of given cutoff points) in 4 domains were extracted. RESULTS Of the 1519 studies identified, 8 were included in final analyses. Of infants with isolated cerebellar hemorrhage, 128 were described (cumulative incidence: 2.3%). The incidence of severe delay in cognition, motor, language, and behavioral development was 38%, 39%, 41%, and 38%, respectively. The overall incidence of severe neurodevelopmental delay in ≥1 domain ranged from 43% to 75% and was most seen in infants with vermis involvement (87%-93%) and with large bleeds (46%-82%). LIMITATIONS Different neurodevelopmental scales lead to data heterogeneity, and reporting of data on a group level limited possibilities for an outcome description on an individual level. CONCLUSIONS Of infants with isolated cerebellar hemorrhage, 43% to 75% were severely delayed in cognition, motor, language, and/or behavioral development, with the highest incidence with vermis involvement and with large bleeds.
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Affiliation(s)
| | | | | | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands; and
| | - Freek E Hoebeek
- Laboratory of Neuroimmunology and Developmental Origins of Disease, Wilhelmina Children's Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
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37
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Gijtenbeek M, Lopriore E, Steggerda SJ, Te Pas AB, Oepkes D, Haak MC. Persistent pulmonary hypertension of the newborn after fetomaternal hemorrhage. Transfusion 2018; 58:2819-2824. [PMID: 30315664 DOI: 10.1111/trf.14932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Newborns with anemia are at increased risk of persistent pulmonary hypertension of the newborn (PPHN), yet reports on the association between fetomaternal hemorrhage (FMH) and PPHN are rare. To optimize care for pregnancies complicated by FMH, clinicians should be aware of the risks of FMH and the possible diagnostic and therapeutic options. To increase the current knowledge, the incidence of PPHN and short-term neurologic injury in FMH cases were studied. STUDY DESIGN AND METHODS We included all FMH cases (≥30 mL fetal blood transfused into the maternal circulation) admitted to our neonatal unit between 2006 and 2018. First, we evaluated the incidence of PPHN and short-term neurologic injury. Second, we studied the potential effect of intrauterine transfusion (IUT). RESULTS PPHN occurred in 37.9% of newborns (11 of 29), respectively, 14.3% (one of seven) and 45.5% (10 of 22) in the IUT group and no-IUT group (p = 0.20). The mortality rate was 13.8% (4 of 29). Severe brain injury occurred in 34.5% (10 of 29), respectively, and 14.3% (one of seven) and 40.9% (nine of 22) in the IUT group and no-IUT group (p = 0.37). CONCLUSION Awareness should be raised among perinatologists and neonatologists about the possible life-threatening consequences of FMH, as more than one-third of neonates with anemia due to FMH experience PPHN and suffer from severe brain injury. Antenatal treatment with IUT seems to reduce these risks. Specialists should therefore always consider fetal anemia in FMH cases and refer patients to a fetal therapy center. If anemia is present at birth, it should be corrected promptly and neonatologists should be aware of signs of PPHN.
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Affiliation(s)
- Manon Gijtenbeek
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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38
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Winkelhorst D, Kamphuis MM, Steggerda SJ, Rijken M, Oepkes D, Lopriore E, van Klink JMM. Perinatal Outcome and Long-Term Neurodevelopment after Intracranial Haemorrhage due to Fetal and Neonatal Alloimmune Thrombocytopenia. Fetal Diagn Ther 2018; 45:184-191. [PMID: 29730660 DOI: 10.1159/000488280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the perinatal and long-term neurodevelopmental outcome in a cohort of children with intracranial haemorrhage (ICH) due to fetal and neonatal alloimmune thrombocytopenia (FNAIT) and to clearly outline the burden of this disease. SUBJECTS AND METHODS We performed an observational cohort study and included all consecutive cases of ICH caused by FNAIT from 1993 to 2015 at Leiden University Medical Centre. Neurological, motor, and cognitive development were assessed at a minimum age of 1 year. The primary outcome was adverse outcome, defined as perinatal death or severe neurodevelopmental impairment (NDI). Severe NDI was defined as any of the following: cerebral palsy (Gross Motor Function Classification System [GMFCS] level ≥II), bilateral deafness, blindness, or severe motor and/or cognitive developmental delay (<-2 SD). RESULTS In total, 21 cases of ICH due to FNAIT were included in the study. The perinatal mortality rate was 10/21 (48%). Long-term outcome was assessed in 10 children (n = 1 lost to follow-up). Severe and moderate NDI were diagnosed in 6/10 (60%) and 1/10 (10%) of the surviving children. The overall adverse outcome, including perinatal mortality or severe NDI, was 16/20 (80%). CONCLUSIONS The risk of perinatal death or severe NDI in children with ICH due to FNAIT is high. Only screening and effective preventive treatment can avoid this burden.
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Affiliation(s)
- Dian Winkelhorst
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The
| | - Marije M Kamphuis
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monique Rijken
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeanine M M van Klink
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
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39
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Mohseny AB, van Velze V, Steggerda SJ, Smits-Wintjens VEHJ, Bekker V, Lopriore E. Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon. Eur J Pediatr 2018; 177:33-38. [PMID: 29063210 PMCID: PMC5748400 DOI: 10.1007/s00431-017-3030-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Urinary tract infection (UTI) is a common cause of sepsis in infants. Premature infants hospitalized at a neonatal intensive care unit often have risk factors for infection. In this group, the risk of UTI is not clearly known, and guidelines for urine analysis are not unanimous. We aimed to identify the risk of UTI in premature infants with central lines, suspected of late-onset sepsis. We analyzed all 1402 infants admitted to our hospital between 2006 and 2014 with a gestational age less than 32 weeks. Six hundred sixty-two episodes of sepsis evaluations were found with an unknown source of infection based on clinical symptoms. In half of this group, urine analysis was performed identifying UTI in 11.3% (24/212). In 13 of these infants (54%) with a UTI, infection was due to Candida albicans. In at least four episodes, the diagnosis and treatment would have been delayed if urine analysis had not been performed. CONCLUSION Based on these findings, we conclude that in premature infants with central lines, urine analysis should be performed routinely when signs of infection occur beyond 72 h after birth. Urine collection should not be delayed and cultures should preferably be performed before the start of the antibiotic treatment. What is known: • In preterm infants, the presence of other risk factors for infection might make clinicians reluctant to obtain urine cultures during sepsis evaluation. • An internal survey demonstrated that there is no consensus within the NICUs in The Netherlands regarding urine analysis as part of LOS work-up. What is new: • The risk of UTI in the NICU population (11.3%) is comparable to term infants; therefore, urine analysis should be performed routinely when LOS is suspected. • Candida albicans was the most frequently (54%) detected pathogen causing UTI in this population.
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Affiliation(s)
- Alexander B. Mohseny
- Department of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Veerle van Velze
- Department of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J. Steggerda
- Department of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Vincent Bekker
- Department of Pediatric Infectious Diseases, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
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Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One 2017; 12:e0185581. [PMID: 28977011 PMCID: PMC5627935 DOI: 10.1371/journal.pone.0185581] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/15/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predictive, independent risk factors for sepsis-associated mortality. This study aims to clarify the occurrence, severity and duration of thrombocytopenia in neonatal sepsis. Study design A cohort study was carried out among all neonates with proven culture positive sepsis that were admitted to a tertiary NICU between 2006 and 2015 (n = 460). The occurrence, severity and duration of thrombocytopenia were recorded, as well as major bleedings and potential risk factors for mortality in neonatal sepsis. Results Sepsis was diagnosed in 460 of 6551 neonates (7%). Severe thrombocytopenia (platelets ≤50*109/L) occurred in 20% (92/460) of septic neonates. The median time for platelets to rise >100*109 was 6.0 days (interquartile range 4.0–7.0). On multivariate analysis, maternal hypertension, intravascular thrombosis and Gram negative (as opposed to Gram positive) sepsis were independently associated with thrombocytopenia in neonatal sepsis. In severe thrombocytopenia, 10% (9/92) suffered a severe IVH, compared to 5% (20/356) in neonates with platelets >50*109/L (p = 0.125). 10% (9/92) suffered a pulmonary hemorrhage, compared to 2% (9/368) in neonates with platelets >50*109/L (p = 0.001). On multivariate analysis, thrombocytopenia and Gram negative (as opposed to Gram positive) sepsis were independently associated with neonatal mortality. Conclusions Thrombocytopenia is independently associated with maternal hypertension, intravascular thrombosis and Gram negative sepsis. Thrombocytopenia in neonatal sepsis increases the risk of mortality nearly four-fold, with another six-fold increase in mortality in case of Gram negative sepsis.
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Affiliation(s)
- Isabelle M. C. Ree
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - Suzanne F. Fustolo-Gunnink
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam, The Netherlands
- Sanquin Blood Supply, Department of Clinical Transfusion Research, Leiden, The Netherlands
| | - Vincent Bekker
- Division of Hematology/Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Karin J. Fijnvandraat
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam, The Netherlands
- Sanquin Blood Supply, Department of Plasma Proteins, Amsterdam, the Netherlands
| | - Sylke J. Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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41
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de Jong EP, Holscher HC, Steggerda SJ, Van Klink JMM, van Elzakker EPM, Lopriore E, Walther FJ, Brus F. Cerebral imaging and neurodevelopmental outcome after entero- and human parechovirus sepsis in young infants. Eur J Pediatr 2017; 176:1595-1602. [PMID: 28891004 PMCID: PMC5682858 DOI: 10.1007/s00431-017-2981-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 05/02/2017] [Revised: 07/26/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Enterovirus (EV) and human parechovirus (HPeV) are major causes of sepsis-like illness in infants under 90 days of age and have been identified as neurotropic. Studies about acute and long-term neurodevelopment in infants with sepsis-like illness without the need for intensive care are few. This study investigates cerebral imaging and neurodevelopmental outcome following EV and HPeV infection in these infants. We studied infants under 90 days of age who were admitted to a medium care unit with proven EV- or HPeV-induced sepsis-like illness. In addition to standard care, we did a cerebral ultrasound and cerebral magnetic resonance imaging (MRI), as well as neurodevelopmental follow-up at 6 weeks and 6 months and Bayley Scale of Infant and Toddler Development 3rd edition (BSID-III) investigation at 1 year of age. Twenty-six infants, 22 with EV and 4 with HPeV, were analysed. No abnormalities were detected at cerebral imaging. At 1 year of age, two infants had a moderate delay on both the motor and cognitive scale, one on the cognitive scale only and three others on the gross motor scale only. CONCLUSION Although our study population, especially the number of HPeV positive infants is small, our study shows that these infants do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal Dutch population. Follow-up to school age allows for more reliable assessments of developmental outcome and is recommended for further studies to better assess outcome. What is known: • Enterovirus and Human Parechovirus infections are a major cause of sepsis-like illness in young infants. • After intensive care treatment for EV or HPeV infection, white matter abnormalities and neurodevelopmental delay have been described. What is new: • In our 'medium care' population, no abnormalities at cerebral imaging after EV- or HPeV-induced sepsis-like illness have been found. • At 1 year of age, infants who had EV- or HPeV-induced sepsis-like illness do not seem to develop severe neurodevelopmental delay and neurologic sequelae more often than the normal population.
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Affiliation(s)
- Eveline P. de Jong
- Department of Pediatrics, Leiden University Medical Center, J-6, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,Department of Paediatrics, HAGA hospital, location Juliana Children’s Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Herma C. Holscher
- Department of Radiology, HAGA hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Sylke J. Steggerda
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeanine M. M. Van Klink
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Erika P. M. van Elzakker
- Department of Medical Microbiology, HAGA hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Enrico Lopriore
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Frans J. Walther
- Department of Medical Microbiology, HAGA hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Frank Brus
- Department of Paediatrics, HAGA hospital, location Juliana Children’s Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
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42
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Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens VEHJ, Steggerda SJ, Te Pas AB, Lopriore E. Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study. Front Pediatr 2017; 5:142. [PMID: 28676849 PMCID: PMC5477168 DOI: 10.3389/fped.2017.00142] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 03/27/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan-Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25-5.41], male gender (HR 2.63, 95% CI 1.17-5.90), and higher birth weight (HR 1.04, 95% CI 1.002-1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12-0.52) was associated with a decreased risk. CONCLUSION In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI.
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Affiliation(s)
- Gerdina H Dubbink-Verheij
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Iris C M Pelsma
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Erik W van Zwet
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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43
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Abstract
Cranial ultrasonography (CUS) is a reliable and non-invasive tool to detect frequently occurring brain abnormalities and to monitor brain development and maturation in high risk neonates. Standard CUS views are obtained through the anterior fontanel. However, evaluation of the posterior fossa is often suboptimal with this approach. Cerebellar injury occurs frequently in preterm infants and has important prognostic consequences. Early detection is therefore important. This review focuses on techniques that optimize the performance of CUS when studying the preterm cerebellum, including the use of the mastoid fontanel and the adaptation of focus points and scan frequencies. For illustration, CUS images of the normal posterior fossa anatomy as well as examples of abnormalities that may be encountered in preterm infants are included. We also discuss the limitations of CUS and the role of magnetic resonance imaging.
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Affiliation(s)
- S J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
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44
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Aziz NA, Peeters-Scholte CM, de Bruine FT, Klumper FJ, Adama van Scheltema PN, Lopriore E, Steggerda SJ. Fetal cerebellar hemorrhage: three cases with postnatal follow-up. Ultrasound Obstet Gynecol 2016; 47:785-786. [PMID: 26426778 DOI: 10.1002/uog.15772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/14/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- N A Aziz
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - C M Peeters-Scholte
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F T de Bruine
- Department of Neuroradiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F J Klumper
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - P N Adama van Scheltema
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - E Lopriore
- Department of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 AZ, Leiden, The Netherlands
| | - S J Steggerda
- Department of Neonatology, Leiden University Medical Centre, Albinusdreef 2, 2333 AZ, Leiden, The Netherlands
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45
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van Rij MC, Jansen FAR, Hellebrekers DMEI, Onkenhout W, Smeets HJM, Hendrickx AT, Gottschalk RWH, Steggerda SJ, Peeters-Scholte CMPCD, Haak MC, Hilhorst-Hofstee Y. Polyhydramnios and cerebellar atrophy: a prenatal presentation of mitochondrial encephalomyopathy caused by mutations in the FBXL4 gene. Clin Case Rep 2016; 4:425-8. [PMID: 27099744 PMCID: PMC4831400 DOI: 10.1002/ccr3.511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/06/2015] [Accepted: 12/12/2015] [Indexed: 11/07/2022] Open
Abstract
Severe recessive mitochondrial myopathy caused by FBXL4 gene mutations may present prenatally with polyhydramnios and cerebellar hypoplasia. Characteristic dysmorphic features are: high and arched eyebrows, triangular face, a slight upslant of palpebral fissures, and a prominent pointed chin. Metabolic investigations invariably show increased serum lactate and pyruvate levels.
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Affiliation(s)
- Maartje C van Rij
- Department of Clinical Genetics Leiden University Medical Centre Leiden Netherlands
| | - Fenna A R Jansen
- Department of Obstetrics Leiden University Medical Centre Leiden Netherlands
| | | | - W Onkenhout
- Department of Metabolic Testing Leiden University Medical Centre Leiden Netherlands
| | - Hubert J M Smeets
- Department of Clinical Genetics Maastricht University Medical Centre Leiden Netherlands
| | - Alexandra T Hendrickx
- Department of Clinical Genetics Maastricht University Medical Centre Leiden Netherlands
| | - Ralph W H Gottschalk
- Department of Clinical Genetics Maastricht University Medical Centre Leiden Netherlands
| | - Sylke J Steggerda
- Department of Neonatology Leiden University Medical Centre Leiden Netherlands
| | | | - Monique C Haak
- Department of Obstetrics Leiden University Medical Centre Leiden Netherlands
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46
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Adama van Scheltema PN, Zhang A, Ball LM, Steggerda SJ, van Wijk R, Fransen van de Putte DE, van Kamp IL. Successful treatment of fetal hemolytic disease due to glucose phosphate isomerase deficiency (GPI) using repeated intrauterine transfusions: a case report. Clin Case Rep 2015; 3:862-5. [PMID: 26509025 PMCID: PMC4614658 DOI: 10.1002/ccr3.358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/29/2015] [Accepted: 07/25/2015] [Indexed: 11/08/2022] Open
Abstract
Hemolytic anemia due to GPI deficiency can be severe and life threatening during fetal life. When parents decline invasive testing, ultrasound monitoring of fetuses at risk is feasible. Intrauterine transfusion can be effective for the treatment of severe fetal anemia due to GPI deficiency.
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Affiliation(s)
| | - Ai Zhang
- Department of Prenatal Diagnosis and Therapy, Leiden University Medical Center Leiden, the Netherlands
| | - Lynne M Ball
- Department of Pediatric Hematology, Leiden University Medical Center Leiden, the Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center Leiden, the Netherlands
| | - Richard van Wijk
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht Utrecht, the Netherlands
| | | | - Inge L van Kamp
- Department of Prenatal Diagnosis and Therapy, Leiden University Medical Center Leiden, the Netherlands
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47
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van Steenis A, Zhao DP, Steggerda SJ, Kist WJ, Haak MC, Oepkes D, Lopriore E. Double fatal outcome after ruptured vasa previa in monochorionic twins: case report and review of the literature. J Matern Fetal Neonatal Med 2015; 29:2523-6. [PMID: 26366672 DOI: 10.3109/14767058.2015.1092957] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Vasa previa is a condition in which one or more fetal blood vessels run through the amniotic membranes and cross or run near the external orifice of the uterus. Rupture of membranes can lead to tearing of these vessels and cause acute fetal exsanguination. In monochorionic twin (MC) pregnancies, acute exsanguination in one twin can lead to severe complications in the co-twin due to the presence of inter-twin placental vascular connections. We report a MC pair with severe perinatal asphyxia due to acute exsanguination after prenatally undetected ruptured vasa previa. This resulted in severe hemorrhagic shock in both twins with double fatal outcome. Antenatal detection of vasa previa is of paramount importance to prevent severe morbidity and mortality, especially in MCs. A review of the literature is presented.
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Affiliation(s)
- A van Steenis
- a Division of Neonatology , Department of Pediatrics, Leiden University Medical Center , Leiden , the Netherlands and
| | - D P Zhao
- a Division of Neonatology , Department of Pediatrics, Leiden University Medical Center , Leiden , the Netherlands and
| | - S J Steggerda
- a Division of Neonatology , Department of Pediatrics, Leiden University Medical Center , Leiden , the Netherlands and
| | - W J Kist
- b Division of Fetal Medicine , Department of Obstetrics, Leiden University Medical Center , Leiden , the Netherlands
| | - M C Haak
- b Division of Fetal Medicine , Department of Obstetrics, Leiden University Medical Center , Leiden , the Netherlands
| | - D Oepkes
- b Division of Fetal Medicine , Department of Obstetrics, Leiden University Medical Center , Leiden , the Netherlands
| | - Enrico Lopriore
- a Division of Neonatology , Department of Pediatrics, Leiden University Medical Center , Leiden , the Netherlands and
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48
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Steggerda SJ, de Bruïne FT, Smits-Wintjens VEHJ, Verbon P, Walther FJ, van Wezel-Meijler G. Posterior fossa abnormalities in high-risk term infants: comparison of ultrasound and MRI. Eur Radiol 2015; 25:2575-83. [PMID: 25899415 PMCID: PMC4529447 DOI: 10.1007/s00330-015-3665-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/29/2015] [Accepted: 02/12/2015] [Indexed: 11/26/2022]
Abstract
Objectives We aimed to assess the characteristics of posterior fossa (PF) abnormalities in a cohort of high-risk term neonates, as well as the diagnostic performance of cranial ultrasound (CUS) with additional mastoid fontanelle (MF) views for the detection of these abnormalities, with magnetic resonance imaging (MRI) being the reference standard. Methods In this retrospective study, 113 term neonates with CUS and subsequent MRI were included. Sensitivity, specificity, and predictive values of routine CUS and CUS with MF views were calculated. Results Posterior fossa abnormalities were diagnosed on CUS in 46 of 113 infants. MRI confirmed these findings in 43 and showed additional abnormalities in 32 infants. The sensitivity and specificity of anterior fontanelle views for major PF abnormalities as seen on MRI were 16 % and 99 %. Adding MF views increased the sensitivity of US to 82 %. The sensitivity and specificity of MF views for the detection of any (major or minor) PF abnormality were 57 % and 95 %. Especially acute hypoxic-ischemic injury and small subdural and punctate cerebellar haemorrhage remained undetected by CUS. Conclusions PF abnormalities are frequent in high-risk term infants. MF-CUS enables early diagnosis of major PF abnormalities. We therefore advocate to perform MF-CUS in high-risk term neonates. Key Points • Posterior fossa abnormalities are a frequent finding in high-risk term infants. • Adding mastoid fontanelle views improves ultrasound detection of clinically relevant abnormalities. • Hypoxic-ischemic injury and small posterior fossa haemorrhages are better detected with MRI. • Cranial ultrasound examination should include mastoid fontanelle views in high-risk term neonates.
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Affiliation(s)
- S J Steggerda
- Department of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands,
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49
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van Klink JMM, van Steenis A, Steggerda SJ, Genova L, Sueters M, Oepkes D, Lopriore E. Single fetal demise in monochorionic pregnancies: incidence and patterns of cerebral injury. Ultrasound Obstet Gynecol 2015; 45:294-300. [PMID: 25377504 DOI: 10.1002/uog.14722] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/20/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the incidence, type and severity of cerebral injury in the surviving monochorionic (MC) cotwin after single fetal demise in twin pregnancies. METHODS All MC pregnancies with single fetal demise that were evaluated at the Leiden University Medical Center between 2002 and 2013 were included. Perinatal characteristics, neonatal outcome and the presence of cerebral injury, observed on neuroimaging, were recorded for all cotwin survivors. RESULTS A total of 49 MC pregnancies with single fetal demise, including one MC triplet, were included in the study (n = 50 cotwins). Median gestational age at occurrence of single fetal demise was 25 weeks and median interval between single fetal demise and live birth was 61 days, with a median gestational age at birth of 36 weeks. Severe cerebral injury was diagnosed in 13 (26%) of the 50 cotwins and was detected antenatally in 4/50 (8%) and postnatally in 9/50 (18%) cases. Cerebral injury was mostly due to hypoxic-ischemic injury resulting in cystic periventricular leukomalacia, middle cerebral artery infarction or injury to basal ganglia, thalamus and/or cortex. Risk factors associated with severe cerebral injury were advanced gestational age at the occurrence of single fetal demise (odds ratio (OR), 1.14 (95% CI, 1.01-1.29) for each week of gestation; P = 0.03), twin-twin transfusion syndrome developing prior to single fetal demise (OR, 5.0 (95% CI, 1.30-19.13); P = 0.02) and a lower gestational age at birth (OR, 0.83 (95% CI, 0.69-0.99) for each week of gestation; P = 0.04). CONCLUSIONS Single fetal demise in MC pregnancies is associated with severe cerebral injury occurring in 1 in 4 surviving cotwins. Routine antenatal and postnatal neuroimaging, followed by standardized long-term follow-up, is mandatory.
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MESH Headings
- Basal Ganglia/embryology
- Basal Ganglia/injuries
- Basal Ganglia/pathology
- Diagnostic Techniques, Neurological
- Female
- Fetal Death/etiology
- Fetofetal Transfusion/embryology
- Fetofetal Transfusion/mortality
- Fetofetal Transfusion/pathology
- Gestational Age
- Humans
- Hypoxia-Ischemia, Brain/complications
- Hypoxia-Ischemia, Brain/embryology
- Hypoxia-Ischemia, Brain/mortality
- Hypoxia-Ischemia, Brain/pathology
- Incidence
- Leukomalacia, Periventricular/embryology
- Leukomalacia, Periventricular/etiology
- Leukomalacia, Periventricular/mortality
- Leukomalacia, Periventricular/pathology
- Perinatal Mortality
- Pregnancy
- Pregnancy Outcome
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Twins, Monozygotic
- Ultrasonography, Prenatal
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Affiliation(s)
- J M M van Klink
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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50
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Boutaybi N, Steggerda SJ, Smits-Wintjens VEHJ, van Zwet EW, Walther FJ, Lopriore E. Early-onset thrombocytopenia in near-term and term infants with perinatal asphyxia. Vox Sang 2014; 106:361-7. [PMID: 24877222 DOI: 10.1111/vox.12105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neonates after perinatal asphyxia are at increased risk of thrombocytopenia. The correlation between perinatal asphyxia and the risk and severity of early-onset thrombocytopenia is not well known. OBJECTIVE To estimate the incidence, severity and risk factors for early-onset thrombocytopenia in neonates after perinatal asphyxia. METHODS We included all newborns (gestational age ≥ 36 weeks) admitted to our neonatal nursery due to perinatal asphyxia in this retrospective study. We collected platelet counts that were obtained within the first 48 h of life to estimate the incidence and severity of early-onset thrombocytopenia. RESULTS A total number of 171 neonates with perinatal asphyxia were included in the study. The incidence of early-onset thrombocytopenia (platelet count < 150 × 109/l) was 51% (87/171). Several factors were associated with increased risk of early-onset thrombocytopenia, including prolonged prothrombin time (PT) [odds ratio (OR) 1·18, 95% confidence interval (CI) 1·08–1·30, P < 0·01], prolonged activated partial thromboplastin time (APTT) (OR 1·07, 95% CI 1·03–1·11, P < 0·01), low Apgar score at 10 min (OR 1·25, 95% CI 1·08–1·45, P < 0·01) and high serum lactate (OR 1·12, 95% CI 1·06–1·19, P < 0·01). After multiple logistic regression analysis, we found an independent association between early-onset thrombocytopenia and prolonged PT (OR 1·15, 95% CI 1·00–1·33, P = 0·045) and higher lactate level (OR 1·15, 95% CI 1·03–1·28, P = 0·01). CONCLUSIONS Early-onset thrombocytopenia occurs frequently in neonates after perinatal asphyxia and is independently associated with PT and lactate level.
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