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Bersani I, Ronci S, Savarese I, Piersigilli F, Micalizzi A, Maddaloni C, Dotta A, Braguglia A, Longo D, Campi F. COL4A1 gene mutations and perinatal intracranial hemorrhage in neonates: case reports and literature review. Front Pediatr 2024; 12:1417873. [PMID: 38978838 PMCID: PMC11228817 DOI: 10.3389/fped.2024.1417873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/27/2024] [Indexed: 07/10/2024] Open
Abstract
Intracranial hemorrhage may represent a complication of the perinatal period that affects neonatal morbidity and mortality. Very poor data exist about a possible association between mutations of the type IV collagen a1 chain (COL4A1) gene and the development of intracranial hemorrhage, and only sporadic reports focus on intracerebral bleedings already developing in utero or in the neonatal period in infants with such a mutation. This study presents a case series of term neonates affected by intracranial hemorrhage, with no apparent risk factors for the development of this condition, who were carriers of COL4A1 gene variants. This study also provides a review of the most recent scientific literature on this topic, specifically focusing on the available scientific data dealing with the perinatal period.
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Affiliation(s)
- Iliana Bersani
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Ronci
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fiammetta Piersigilli
- Neonatal Intensive Care Unit, Department of Pediatrics, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Alessia Micalizzi
- Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Maddaloni
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annabella Braguglia
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive and Sub-Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sherwani AS, Parry AH, Bhat MH, Gojwari TA, Charoo BA, Choh NA. Assessment of role of cranial ultrasound (CUS) in the evaluation of high-risk preterm and term neonates. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [DOI: 10.1186/s43054-023-00158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Abstract
Background
Cranial ultrasonography (CUS) has become an important tool to depict normal brain anatomy and to detect the ischemic and hemorrhagic brain injury patterns in high-risk neonates. The present study aimed to assess the utility of CUS to diagnose the spectrum of brain injury patterns in high-risk preterm and term neonates admitted to the neonatal intensive care unit (NICU) and to find the association of CUS findings in various adverse antenatal and perinatal feto-maternal factors.
Results
Out of the 200 neonates, 76 (38%) neonates had abnormal CUS findings and 124 (62%) had a normal CUS. Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) (28/76; 36.8 %) was the commonest abnormality with GMH (grade 1) in 14/76 (18.4%), grade 2 in 7 (9.2%), grade 3 in 5 (6.5%), and grade 4 in 2 (2.63%). The other findings observed were cerebral edema (14/76; 18.4%), thalamic hyperechogenicity (10/76; 13.1%), periventricular leukomalacia (PVL) (4/76; 5.2%), and congenital anomalies (8; 10.5%). Abnormal CUS findings had a statistically significant association with birth weight <2000 g, prematurity, Apgar score <7, and adverse peri-natal fetal and maternal factors (all p-values <0.05). Abnormal CUS findings had a statistically significant association with poor cry, poor activity, abnormal tone, and presence of cyanosis (all p-values <0.05).
Conclusion
In this cohort study of high-risk preterm and term infants GMH-IVH, cerebral edema, thalamic hyperechogenicity, PVL, and congenital malformations were the commonest lesions detected on CUS. Abnormal CUS findings were found to have a statistically significant association with various adverse peri-natal fetal and maternal factors.
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Gallo D, Bresesti I, Bossi A, Lissoni D, Cromi A, Tataranno ML, Bertù L, Ghezzi F, Agosti M. Cranial ultrasound screening in term and late preterm neonates born by vacuum-assisted delivery: Is it worthwhile? Pediatr Neonatol 2023; 64:75-80. [PMID: 36182569 DOI: 10.1016/j.pedneo.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Vacuum extraction is the most common choice to assist vaginal delivery, but there are still concerns regarding the neonatal injuries it may cause. This study aimed to evaluate the rate of intracranial injuries assessed by cranial ultrasound (cUS) among infants born by vacuum extraction, and the relationship with maternal and perinatal factors. METHODS This was a single-center retrospective study carried out in a level-3 neonatal unit. A total of 593 term and late preterm infants born by vacuum-assisted delivery were examined with a cUS scan within 3 days after birth. RESULTS Major head injuries were clinically silent and occurred in 2% of the infants, with a rate of intracranial haemorrhage of 1.7%. Regardless of obstetric factors, the risk of cranial injury was increased in infants requiring resuscitation at birth (p = 0.04, OR 4.1), admitted to NICU (p = 0.01, OR 5.5) or with perinatal asphyxia (p < 0.01, OR 21.3). Maternal age ≥40 years correlated both with adverse perinatal outcomes (p < 0.05) and the occurrence of major injury (p = 0.02, OR 4.6). CONCLUSION Overall, vacuum extraction is a safe procedure for neonates. Head injuries are usually mild and asymptomatic, and with spontaneous recovery. However, the rate of major cranial injuries in our cohort warrants further investigation to support a cUS screening, particularly for infants requiring respiratory support at birth. Also, maternal age might be taken into account when evaluating the risk for neonatal complications after vacuum application.
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Affiliation(s)
- Dario Gallo
- Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy
| | - Ilia Bresesti
- Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Angela Bossi
- Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy
| | - Donatella Lissoni
- Division of Obstetrics and Gynaecology, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Division of Obstetrics and Gynaecology, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Luisa Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht 3584, the Netherlands
| | - Lorenza Bertù
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Division of Obstetrics and Gynaecology, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy
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Boswinkel V, Krüse-Ruijter MF, Nijboer-Oosterveld J, Nijholt IM, Edens MA, Mulder-de Tollenaer SM, Smit-Wu MN, Boomsma MF, de Vries LS, van Wezel-Meijler G. Incidence of brain lesions in moderate-late preterm infants assessed by cranial ultrasound and MRI: The BIMP-study. Eur J Radiol 2020; 136:109500. [PMID: 33429207 DOI: 10.1016/j.ejrad.2020.109500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the incidence and characteristics of brain lesions in moderate-late preterm (MLPT) infants, born at 32-36 weeks' gestation using cranial ultrasound (cUS) and magnetic resonance imaging (MRI). METHODS Prospective cohort study carried out at Isala Women and Children's Hospital between August 2017 and November 2019. cUS was performed at postnatal day 3-4 (early-cUS), before discharge and repeated at term equivalent age (TEA) in MLPT infants born between 32+0 and 35+6 weeks' gestation. At TEA, MRI was also performed. Several brain lesions were assessed e.g. hemorrhages, white matter and deep gray matter injury. Brain maturation was visually evaluated. Lesions were classified as mild or moderate-severe. Incidences and confidence intervals were calculated. RESULTS 166 MLPT infants were included of whom 127 underwent MRI. One or more mild lesions were present in 119/166 (71.7 %) and moderate-severe lesions in 6/166 (3.6 %) infants on cUS and/or MRI. The most frequent lesions were signs suggestive of white matter injury: inhomogeneous echogenicity in 50/164 infants (30.5 %) at early-cUS, in 12/148 infants (8.1 %) at TEA-cUS and diffuse white matter signal changes (MRI) in 27/127 (23.5 %) infants. Cerebellar hemorrhage (MRI) was observed in 16/127 infants (12.6 %). Delayed maturation (MRI) was seen in 17/117 (13.4 %) infants. Small hemorrhages and punctate white matter lesions were more frequently detected on MRI than on cUS. CONCLUSIONS In MLPT infants mild brain lesions were frequently encountered, especially signs suggestive of white matter injury and small hemorrhages. Moderate-severe lesions were less frequently seen.
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Affiliation(s)
- Vivian Boswinkel
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | | | | | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, the Netherlands
| | | | - Mei-Nga Smit-Wu
- Department of Pediatrics, Isala Women and Children's Hospital, Zwolle, the Netherlands
| | | | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Boswinkel V, Nijboer-Oosterveld J, Nijholt IM, Edens MA, Mulder-de Tollenaer SM, Boomsma MF, de Vries LS, van Wezel-Meijler G. A systematic review on brain injury and altered brain development in moderate-late preterm infants. Early Hum Dev 2020; 148:105094. [PMID: 32711341 DOI: 10.1016/j.earlhumdev.2020.105094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To provide a systematic review of brain injury and altered brain development in moderate-late preterm (MLPT) infants as compared to very preterm and term infants. STUDY DESIGN A systematic search in five databases was performed in January 2020. Original research papers on incidence of brain injury and papers using quantitative data on brain development in MLPT infants were selected. The Johanna Briggs Institute 'Critical Appraisal Checklist for Studies Reporting Prevalence Data' was used for quality appraisal. Data extraction included: imaging modality, incidences of brain injury, brain volumes, 2D-measurements and diffusivity values. RESULTS In total, 24 studies were eligible. Most studies had a moderate quality. Twenty studies reported on the incidence of brain injury in MLPT infants. The incidence of intraventricular hemorrhage (IVH) ranged from 0.0% to 23.5% and of white matter injury (WMI) from 0.5% to 10.8%. One study reported the incidence of arterial infarction (0.3%) and none of cerebellar hemorrhage. Eleven studies compared incidences of brain injury between MLPT infants and very preterm or term infants. Five studies reported signs of altered brain development in MLPT infants. CONCLUSIONS The incidences of IVH and WMI in MLPT infants varied widely between studies. Other abnormalities were sparsely reported. Evidence regarding a higher or lower incidence of brain injury in MLPT infants compared to very preterm or term infants is weak due to moderate methodological quality of reported studies. There is limited evidence suggesting a difference in brain development between MLPT and term infants.
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Affiliation(s)
- Vivian Boswinkel
- Department of Neonatology, Isala Women and Children's hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | | | - Ingrid M Nijholt
- Department of Radiology, Isala hospital, Zwolle, the Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala hospital, Zwolle, the Netherlands
| | | | | | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Meyer S, Zimmer A, Hamza A, Poryo M. Is there a role for cerebral ultrasonography in near-term/term neonates following assisted vaginal delivery? A prospective, single-center study. Early Hum Dev 2020; 147:105101. [PMID: 32518027 DOI: 10.1016/j.earlhumdev.2020.105101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Meyer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany.
| | - A Zimmer
- Medical School, Saarland University Medical Center, Homburg, Germany
| | - A Hamza
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - M Poryo
- Department of Gynecology and Obstetrics, Saarland University Medical Center, Homburg, Germany
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