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AlGoraini Y, AlJohani H, AlSaegh A, AlSadhan N. Post-traumatic cysts detected by ultrasound in infant presented with first-time seizures: Case report. Radiol Case Rep 2022; 17:4128-4131. [PMID: 36111183 PMCID: PMC9468497 DOI: 10.1016/j.radcr.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
In children at risk of neurological damage, such as those delivered prematurely or with history of birth asphyxia, cranial ultrasonography is frequently employed. Cranial ultrasonography also detects cysts, asymmetrical ventricles, periventricular white matter echogenicity, and hemorrhage, among other features. We report the case of an 8-month-old boy who was brought to the emergency department with a history of head trauma followed by seizures. Bedside cranial ultrasonography revealed multiple bilateral intracranial cysts, consistent with porencephalic cysts. Brain magnetic resonance imaging is the gold standard for identifying porencephaly and distinguishing it from other cysts. However, because of time restrictions in emergencies, cranial ultrasonography for a quick assessment in neonates and infants can be appropriate, as was the case in our encounter.
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Affiliation(s)
- Yara AlGoraini
- Pediatric Emergency Department, King Fahad Medical City, Riyadh, Saudi Arabia
- Corresponding author. Saudi Arabia, Riyadh
| | - Haya AlJohani
- Pediatric Emergency Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alaa AlSaegh
- Family Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nehal AlSadhan
- Pediatric Emergency Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Lin YJ, Chiu NC, Chen HJ, Huang JY, Ho CS. Cranial ultrasonographic screening findings among healthy neonates and their association with neurodevelopmental outcomes. Pediatr Neonatol 2021; 62:158-164. [PMID: 33214065 DOI: 10.1016/j.pedneo.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/17/2020] [Accepted: 10/30/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To analyze the findings of cranial ultrasonographic screening in asymptomatic neonates and to assess the association between abnormal results and neurodevelopment. METHODS We retrospectively reviewed the cranial ultrasonographic screening results of healthy neonates born between 35 and 42 weeks gestation at our hospital from October 2011 to October 2018. RESULTS In total, 11,681 neonates underwent cranial ultrasonographic screening during the study period, and 9666 (82.7%) had normal results. Of 2015 neonates with abnormal findings, 294 had more than two abnormalities. The most common minor findings were subependymal cysts (8.99%), choroid plexus cysts (2.43%), lenticulostriate vasculopathy (2.34%), frontal horn cysts (1.80%), and enlarged cisterna magna (1.04%). Then, 33 (0.28%) neonates had major abnormalities, including cerebral hemorrhage, periventricular heterotopia, focal cortical dysplasia, anomalies of the corpus callosum, and vascular malformation. Of 1334 neonates who underwent serial clinical evaluations, 76 (5.69%) had neurodevelopmental disorders, including developmental delay, attention-deficit/hyperactivity disorder, and autistic spectrum disorder. CONCLUSION The incidence rate of intracranial anomalies in healthy neonates was 17.3%, and about 5.69% had neurodevelopmental disorders. Cranial ultrasonographic screening has its own value in helping early detection of intracranial anomalies in healthy neonates, some of which have prognostic implications.
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Affiliation(s)
- Yi-Jie Lin
- Division of Pediatric Neurology, MacKay Children's Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Division of Pediatric Neurology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hui-Ju Chen
- Division of Pediatric Neurology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jia-Yun Huang
- Division of Pediatric Neurology, MacKay Children's Hospital, Taipei, Taiwan
| | - Che-Sheng Ho
- Division of Pediatric Neurology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
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Luciano R, Bersani I, Mancini G, Vento G, Mercuri E. Cranial ultrasound evaluation in term neonates. Early Hum Dev 2020; 143:104983. [PMID: 32113074 DOI: 10.1016/j.earlhumdev.2020.104983] [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: 10/14/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Term neonates (TN) are not routinely submitted to cranial ultrasound scan (CUS), since they are not considered at high risk for developing cerebral lesions. AIMS To investigate the prevalence of cerebral abnormal findings in term neonates (TN), to identify the associated clinical features and to better target neonatal CUS investigations. STUDY DESIGN Prospective observational study. SUBJECTS A total number of 1805 healthy TN underwent CUS. 1181 neonates had clinical features supposed to increase the risk for cerebral abnormal findings (study cohort), 624 were controls. OUTCOME MEASURES Prevalence of minimal, minor, and major cerebral abnormal findings was analyzed in six different categories of low-risk TN and compared to controls. RESULTS Variations from normality at the neonatal CUS were observed in 402 TN (22.27%). In half of the cases the ultrasound findings were minimal abnormal findings, while minor abnormal findings were found in 179 TN (9.92%). About 1% of the studied neonates showed major cerebral abnormal findings potentially compromising neurodevelopmental outcome. The prevalence of the observed abnormal findings varied significantly in the different low-risk categories. CONCLUSIONS The clinical features significantly increasing the risk for cerebral anomalies in healthy TN were microcrania, macrocrania, mild neurologic signs, and the detection of mild variations from normal cerebral aspect at the antenatal ultrasound evaluation.
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Affiliation(s)
- R Luciano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Division of Neonatology; Catholic University of Sacred Heart, Rome, Italy.
| | - I Bersani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Division of Neonatology.
| | - G Mancini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Division of Neonatology.
| | - G Vento
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Division of Neonatology; Catholic University of Sacred Heart, Rome, Italy.
| | - E Mercuri
- Catholic University of Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS Rome, Italy, Department of Pediatric Neurology, Catholic University, Rome, Italy.
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Ballardini E, Tarocco A, Rosignoli C, Baldan A, Borgna-Pignatti C, Garani G. Universal Head Ultrasound Screening in Full-term Neonates: A Retrospective Analysis of 6771 Infants. Pediatr Neurol 2017; 71:14-17. [PMID: 28449983 DOI: 10.1016/j.pediatrneurol.2017.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Full-term neonates may have asymptomatic cranial injuries at birth and head ultrasound screening could be useful for early diagnosis. The aim of this study was to assess the prevalence and type of intracranial abnormalities and the usefulness of head ultrasound screening in these infants. METHODS Head ultrasound screening was performed on all full-term neonates (gestational age between 37 and 42 weeks), born at Sant'Anna University Hospital of Ferrara, Italy, from June 1, 2008 through May 31, 2013. Ultrasound findings were categorized into three groups: normal, minor, and major anomalies. RESULTS All full-term neonates (6771) born at our hospital underwent head ultrasound screening. One hundred fourteen of 6771 (1.7%) presented ultrasound abnormalities, whereas 6657 were normal or exhibited insignificant findings. In 101 of 114 (88.6%), abnormalities were minor, and only 13 infants had major abnormalities (0.19% of all full-term newborns). All neonates with major abnormalities presented with either microcephaly or abnormal neurological evaluations. Only one individual with major abnormalities was detected exclusively by ultrasound. CONCLUSIONS The number of significant anomalies detected by head ultrasound screening in asymptomatic full-term neonates born during the study period was low. Therefore, there is no indication for routine general head ultrasound screening in these patients. However, even if low, in neonates who have neurological abnormalities, risk factors or suspected brain malformations, head ultrasound screening may play an important role in the early diagnosis of intracranial anomalies.
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Affiliation(s)
- Elisa Ballardini
- Pediatric Unit, Department of Medical Sciences, University Hospital of Ferrara, Ferrara, Italy
| | - Anna Tarocco
- Pediatric Unit, Department of Medical Sciences, University Hospital of Ferrara, Ferrara, Italy.
| | - Chiara Rosignoli
- Pediatric Unit, Department of Medical Sciences, University Hospital of Ferrara, Ferrara, Italy
| | - Alessandro Baldan
- Pediatric Unit, Department of Medical Sciences, University Hospital of Ferrara, Ferrara, Italy
| | | | - Giampaolo Garani
- Neonatal Intensive Care Unit, Department of Reproduction and Growth, University Hospital of Ferrara, Ferrara, Italy
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Martinez-Biarge M, Cheong JLY, Diez-Sebastian J, Mercuri E, Dubowitz LMS, Cowan FM. Risk Factors for Neonatal Arterial Ischemic Stroke: The Importance of the Intrapartum Period. J Pediatr 2016; 173:62-68.e1. [PMID: 27049002 DOI: 10.1016/j.jpeds.2016.02.064] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/22/2016] [Accepted: 02/25/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate risk factors for neonatal arterial ischemic stroke (NAIS), and compare them with those present in term controls and infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN Antepartum and intrapartum data were collected at presentation from 79 infants with NAIS and compared with 239 controls and 405 infants with HIE. The relationships between risk factors and NAIS were explored using univariable and multivariable regression. RESULTS Compared with controls, infants with NAIS more frequently had a family history of seizures/neurologic diseases, primiparous mothers, and male sex. Mothers of infants with NAIS experienced more intrapartum complications: prolonged rupture of membranes (21% vs 2%), fever (14% vs 3%), thick meconium (25% vs 7%), prolonged second stage (31% vs 13%), tight nuchal cord (15% vs 6%), and abnorm8al cardiotocography (67% vs 21%). Male sex (OR 2.8), family history of seizures (OR 6.5) or neurologic diseases (OR 4.9), and ≥1 (OR 5.8) and ≥2 (OR 21.8) intrapartum complications were independently associated with NAIS. Infants with NAIS and HIE experienced similar rates though different patterns of intrapartum complications. Maternal fever, prolonged rupture of membranes, prolonged second stage, tight nuchal cord, and failed ventouse delivery were more common in NAIS; thick meconium, sentinel events, and shoulder dystocia were more frequent in HIE. Abnormal cardiotocography occurred in 67% of NAIS and 77.5% of infants with HIE. One infant with NAIS and no infant with HIE was delivered by elective cesarean (10% of controls). CONCLUSIONS NAIS is multifactorial in origin and shares risk factors in common with HIE. Intrapartum events may play a more significant role in the pathogenesis of NAIS than previously recognized.
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Affiliation(s)
| | - Jeanie L Y Cheong
- Department of Pediatrics, Imperial College London, London, United Kingdom; Departments of Newborn Research and Neonatal Services, Royal Women's Hospital, Melbourne, Australia
| | | | - Eugenio Mercuri
- Department of Pediatrics, Imperial College London, London, United Kingdom; Pediatric Neurology Unit, Catholic University, Rome, Italy
| | - Lilly M S Dubowitz
- Department of Pediatrics, Imperial College London, London, United Kingdom
| | - Frances M Cowan
- Department of Pediatrics, Imperial College London, London, United Kingdom
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6
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Romeo DM, Ricci D, Brogna C, Mercuri E. Use of the Hammersmith Infant Neurological Examination in infants with cerebral palsy: a critical review of the literature. Dev Med Child Neurol 2016; 58:240-5. [PMID: 26306473 DOI: 10.1111/dmcn.12876] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 11/30/2022]
Abstract
The Hammersmith Infant Neurological Examination (HINE) has been proposed as one of the early neurological examination tools for the diagnosis of cerebral palsy (CP). The aim of the present study was to critically review the existing literature and our experience with the use of the HINE in infants at risk of CP. The published papers confirm that the HINE can play an important role in the diagnosis and prognosis of infants at risk of developing CP, and provide information on aspects of neurological findings impaired in different forms of CP and brain lesions.
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Affiliation(s)
| | - Daniela Ricci
- Paediatric Neurology Unit, Catholic University, Rome, Italy
| | - Claudia Brogna
- Paediatric Neurology Unit, Catholic University, Rome, Italy
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Hagmann CF, Chan D, Robertson NJ, Acolet D, Nyombi N, Nakakeeto M, Cowan FM. Neonatal neurological examination in well newborn term Ugandan infants. Early Hum Dev 2015; 91:739-49. [PMID: 26386608 DOI: 10.1016/j.earlhumdev.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/20/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Newborn neurological examinations have mostly been developed in high-resource settings with cohorts comprising predominantly white Caucasian infants. No comparison has been made with different populations. AIMS To (i) establish the range of neurological findings in apparently well newborn term Ugandan infants, (ii) compare these findings to published data for equivalent term UK infants and (iii) correlate the neurological findings with perinatal characteristics and cranial ultrasound (cUS) imaging. METHODS Low-risk term Ugandan infants were recruited from the postnatal ward at Mulago Hospital, Kampala, Uganda. Neurological examination (1) and cUS were performed. The raw data and neurological optimality scores were compared to published data from UK infants (1). Gestational age, postnatal age, sex, maternal parity and HIV status, mode of delivery, birth weight and head circumference were correlated with raw scores. RESULTS Ugandan infants showed significantly stronger palmar grasp, better auditory and visual orientation, less irritability and less need for consoling but had poorer tone, poorer quality of spontaneous movements and more abnormal signs than UK infants. No correlation was found between raw scores and cUS findings, gestational age, sex, birth weight and head circumference. Significantly fewer Ugandan infants had optimal scores based on the UK data. CONCLUSION The neurological status of low-risk hospital-born term Ugandan infants differs from that of low-risk UK infants. The study findings have implications for assessing normality in Ugandan infants and raise concerns about the use of this UK "optimality" score in other research settings. Further work is needed to understand fully the reasons for the differences.
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Affiliation(s)
- C F Hagmann
- EGA UCL Institute for Women's Health, UCL, UK; SBCU Mulago Hospital, Kampala, Uganda.
| | - D Chan
- Department of Paediatrics, Hammersmith and Queen Charlotte's Hospitals, Imperial College, London, UK
| | | | - D Acolet
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - N Nyombi
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - M Nakakeeto
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - F M Cowan
- Department of Paediatrics, Hammersmith and Queen Charlotte's Hospitals, Imperial College, London, UK
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Bilavsky E, Schwarz M, Pardo J, Attias J, Levy I, Haimi-Cohen Y, Amir J. Lenticulostriated vasculopathy is a high-risk marker for hearing loss in congenital cytomegalovirus infections. Acta Paediatr 2015; 104:e388-94. [PMID: 26018986 DOI: 10.1111/apa.13053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 03/17/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022]
Abstract
AIM This study investigated the relationship between lenticulostriated vasculopathy (LSV) and hearing loss in 141 infants with congenital cytomegalovirus (cCMV) infection. METHODS We included all infants with cCMV infection who were followed in our clinic for more than a year with only LSV signs of brain involvement on initial brain ultrasound. Group one comprised 13 infants with no hearing impairment at birth who were not treated with gan/valganciclovir during 2006-2009. Group two was 51 infants with LSV and no hearing impairment who had been treated since mid-2009. Group three was 25 infants born with LSV and hearing loss, who had been treated from birth. Group four was 52 control infants born during the same period with asymptomatic cCMV. Hearing tests were performed during the neonatal period and every four to six months until four years of age. RESULTS Hearing deterioration was more extensive in group one (85%) than in group two (0%, p < 0.001) and the asymptomatic group (10%, p < 0.001) and occurred more often in group four (10%) than in group two (0%, p = 0.008). CONCLUSION Lenticulostriated vasculopathy was common in infants with cCMV infection and may serve as a sign of central nervous system involvement and further hearing deterioration. Antiviral treatment may be prudent in such infants.
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Affiliation(s)
- Efraim Bilavsky
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Schwarz
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Pediatric Radiology; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Joseph Pardo
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Gynecology and Obstetrics; Rabin Medical Center; Beilinson Hospital; Petah Tiqva Israel
| | - Joseph Attias
- Institute of Audiology and Clinical Neurophysiology; Schneider Children's Medical Center; Petah Tiqva Israel
- Department of Communication Sciences and Disorders; University of Haifa; Haifa Israel
| | - Itzhak Levy
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Infectious Diseases Unit; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Yishai Haimi-Cohen
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Day Hospitalization Unit; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Jacob Amir
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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9
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Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM. Antepartum and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy. Pediatrics 2013; 132:e952-9. [PMID: 24019409 DOI: 10.1542/peds.2013-0511] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether antepartum factors alone, intrapartum factors alone, or both in combination, are associated with term neonatal hypoxic-ischemic encephalopathy (HIE). METHODS A total of 405 infants ≥ 35 weeks' gestation with early encephalopathy, born between 1992 and 2007, were compared with 239 neurologically normal infants born between 1996 and 1997. All cases met criteria for perinatal asphyxia, had neuroimaging findings consistent with acute hypoxia-ischemia, and had no evidence for a non-hypoxic-ischemic cause of their encephalopathy. RESULTS Both antepartum and intrapartum factors were associated with the development of HIE on univariate analysis. Case infants were more often delivered by emergency cesarean delivery (CD; 50% vs 11%, P < .001) and none was delivered by elective CD (vs 10% of controls). On logistic regression analysis only 1 antepartum factor (gestation ≥ 41 weeks) and 7 intrapartum factors (prolonged membrane rupture, abnormal cardiotocography, thick meconium, sentinel event, shoulder dystocia, tight nuchal cord, failed vacuum) remained independently associated with HIE (area under the curve 0.88; confidence interval 0.85-0.91; P < .001). Overall, 6.7% of cases and 43.5% of controls had only antepartum factors; 20% of cases and 5.8% of controls had only intrapartum factors; 69.5% of cases and 31% of controls had antepartum and intrapartum factors; and 3.7% of cases and 19.7% of controls had no identifiable risk factors (P < .001). CONCLUSIONS Our results do not support the hypothesis that HIE is attributable to antepartum factors alone, but they strongly point to the intrapartum period as the necessary factor in the development of this condition.
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Affiliation(s)
- Miriam Martinez-Biarge
- MRCPCH, Department of Paediatrics, 5 Floor, Hammersmith House, Hammersmith Hospital, DuCane Rd, London W12 OHS, United Kingdom.
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van Huis M, van Kempen AAMW, Peelen M, Timmers M, Boer K, Smit BJ, Van Rijn RR. Brain ultrasonography findings in neonates with exposure to cocaine during pregnancy. Pediatr Radiol 2009; 39:232-8. [PMID: 19099298 DOI: 10.1007/s00247-008-1079-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/29/2008] [Accepted: 11/08/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cocaine exposure during pregnancy has been reported to have detrimental effects on the fetus. OBJECTIVE To describe the findings on cranial ultrasonography (CUS) as part of a neonatal screening programme for exposed neonates. MATERIALS AND METHODS The study was a semiprospective analysis of a 12-year cohort of neonates born to mothers who had used cocaine during their pregnancy and who had follow-up according to a strict clinical protocol. RESULTS In total, 154 neonates (78 boys, 76 girls) were included, of whom 29 (19%) were born preterm, and 125 (81%) were born full-term. Abnormalities on CUS were seen in 37 neonates (24%; 95% CI 18-31%). The abnormalities were classified as minor in 20 (13%; 95% CI 9-19%) and mildly abnormal in 17 (11%; 95% CI 7-17%). None of the infants showed severe abnormalities. The abnormalities were not associated with the duration or maximum amount of cocaine use during pregnancy. CONCLUSION None of the infants had severe abnormalities. Detected abnormalities were not correlated with the duration or maximum amount of cocaine use. Given these findings, we feel that routine cranial ultrasonography in this population is not warranted.
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Affiliation(s)
- Marian van Huis
- Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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11
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Okereafor A, Allsop J, Counsell SJ, Fitzpatrick J, Azzopardi D, Rutherford MA, Cowan FM. Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 2008; 121:906-14. [PMID: 18450893 DOI: 10.1542/peds.2007-0770] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We studied (1) the pattern of brain injury in term neonates with encephalopathy with evidence of a preceding hypoxic sentinel event, (2) prenatal and perinatal risk factors, and (3) the correlation between neuroimaging findings and developmental outcomes. METHODS We identified, among 500 term neonates with encephalopathy who were studied with MRI between 1992 and 2005, 48 infants with evidence of a preceding acute hypoxic event, and we reviewed their MRI scans retrospectively. Prenatal and perinatal data were compared with those for term normal low-risk infants. Neurodevelopmental outcomes were assessed at a minimum of 12 months. RESULTS Five patterns of brain injury were identified, as follows: pattern I, basal ganglia and thalami lesions associated with severe white matter damage (n = 6; 14%); pattern II, basal ganglia and thalami lesions with mild or moderate white matter changes (n = 24; 56%); pattern III, isolated thalamic injury (n = 2; 5%); pattern IV, moderate white matter damage only (n = 1; 2%); pattern V, mild white matter changes or normal findings (n = 10; 23%). No scan showed evidence of long-standing injury. The internal capsule was abnormal in 93% of infants with patterns I and II, and 86% of those infants died or developed cerebral palsy. Infants with patterns III and IV had developmental delay and diplegic cerebral palsy, respectively. Pattern V was associated with normal outcomes. Case infants were significantly more often of African descent, born to pluriparous or hypertensive mothers. Uterine rupture followed previous cesarean section in 8 of 11 cases. Cord prolapse accompanied undiagnosed breech presentation in 4 of 9 cases. CONCLUSIONS Basal ganglia and thalami lesions are the imaging signature in term neonates exposed to hypoxic-ischemic sentinel events. Patterns of central gray matter and secondary white matter injury were associated with higher risks of severe morbidity and death. Affected infants did not seem intrinsically different from our low-risk population. These data support the need for anticipating sentinel events and expediting delivery.
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Affiliation(s)
- Akudo Okereafor
- Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Du Cane Rd, London, W12 OHS, United Kingdom
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12
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Breau LM, McGrath PJ, Stevens B, Beyene J, Camfield C, Finley GA, Franck L, Gibbins S, Howlett A, McKeever P, O'Brien K, Ohlsson A. Judgments of pain in the neonatal intensive care setting: a survey of direct care staffs' perceptions of pain in infants at risk for neurological impairment. Clin J Pain 2006; 22:122-9. [PMID: 16428945 DOI: 10.1097/01.ajp.0000154045.45402.ec] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether healthcare professionals believe the pain of infants at risk for neurologic impairment differs from that of typical infants. SETTING Neonatal intensive care units at 2 tertiary pediatric centers in Canada. PARTICIPANTS Ninety-nine healthcare professionals who practice in the neonatal intensive care unit (51 nurses, 19 physicians, 18 respiratory therapists, 11 other). MAJOR MEASURES: Participants completed the Pain Opinion Questionnaire. It elicits beliefs regarding the similarity of the pain experienced by infants at mild, moderate, and severe risk for neurologic impairment relative to those without risk for neurologic impairment along 5 pain facets (ie, sensation, emotional reaction, behavioral reaction, communication, incidence). RESULTS Pain Opinion Questionnaire scores varied by level of risk of neurologic impairment (mild, moderate, severe) and pain facet. Respondents believed infants with risk were overall less likely to experience pain similar to infants without risk as the level of risk increased [F(2,97) = 66.0, P < 0.001] and were more likely to have a reduced pain experience relative to infants without risk as the level of risk increased [F(2,97) = 62.2, P < 0.001]. Pain Opinion Questionnaire scores did not vary due to profession, experience, gender, or age. CONCLUSION Professionals expressed the belief that neurologically impaired infants' pain experience is reduced, relative to infants without impairment, as their level of risk for neurologic impairment increases. This belief did not vary due to professional experience or personal factors. Future studies should investigate the source of these beliefs and their impact on the pain management provided to infants with risk for neurologic impairment.
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Affiliation(s)
- Lynn M Breau
- Pediatric Pain Service, IWK Health Centre, Halifax, Nova Scotia, Canada.
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13
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Ilves P, Lintrop M, Metsvaht T, Vaher U, Talvik T. Cerebral blood-flow velocities in predicting outcome of asphyxiated newborn infants. Acta Paediatr 2004; 93:523-8. [PMID: 15188981 DOI: 10.1080/08035250410024745] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the role of early (up to 12 h) changes in cerebral blood-flow (CBF) velocity in predicting the severity of hypoxic-ischaemic encephalopathy (HIE) and long-term outcome in asphyxiated term infants. METHODS CBF velocities were investigated by colour Doppler ultrasonography in 81 healthy and 60 asphyxiated term infants at least three times during the first 5 d of life. The psychomotor development of infants was followed up to 18 mo. RESULTS No differences in CBF velocities were found at the age of 2-6 h between infants with severe and mild-moderate HIE, mean CBF velocity [mean (95% CI of mean CBF velocity)] in anterior cerebral artery [14.9 (1.4-28.4)cm/s] and [13.9 (11.1-16.7) cm/s], respectively, and between infants with poor outcome (death or severe disability) and with normal development/mild impairments. By the age of 12 h infants with mild-moderate HIE and infants with normal development/mild impairments had decreased CBF velocity in the anterior cerebral artery, and infants with severe HIE or poor outcome had increased mean CBF velocity in anterior, medial cerebral and basilar artery compared to the control group. CONCLUSION The value of CBF velocity changes to predict poor outcome in asphyxiated infants is low 2-6 h after asphyxia, but increases by the age of 12 ho.
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Affiliation(s)
- P Ilves
- Radiology Department, Tartu University Clinics, Tartu, Estonia.
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14
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Abstract
The aetiology of twin-twin transfusion syndrome (TTTS), which affects 10-15% of monochorionic (MC) twin pregnancies, remains poorly understood. Although all MC twins have placental vascular anastomoses, unbalanced intertwin transfusion has been shown by ex vivo injection and in vivo Doppler studies of chorionic plate vasculature to be mediated by > or =1 arterio-venous anastomoses (AVA) in association with absent bi-directional arterio-arterial anastomoses (AAA). TTTS presents in the mid trimester with the oligo-polyhydramnios sequence, the donor may have a small or non-visible bladder and abnormal umbilical artery Doppler, while the recipient has a large bladder and may develop cardiac hypertrophy, triscupid regurgitation, and eventually hydrops. Recently, discordant renal renin angiotensin expression, endothelin and atrial natriuretic peptide have been implicated in the pathogenesis. Survival has increased from <20% to <60-70% with modern treatments, although survivors remain at increased risk of antenatally acquired cerebral white matter injury, and neurodevelopmental sequelae are documented in c.10% (range 5-23%). The recent introduction of a staging system for TTTS facilitates selection of therapy with less invasive amnioreduction and septostomy preferred for early stage disease, and more aggressive modalities such as laser ablation and cord occlusion with their attendant risk of procedure related fetal loss, reserved for advanced stage disease.
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Affiliation(s)
- Ling Y Wee
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College of Science, Technology and Medicine, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
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15
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Affiliation(s)
- I Blumenthal
- Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, UK.
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16
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Maalouf EF, Duggan PJ, Counsell SJ, Rutherford MA, Cowan F, Azzopardi D, Edwards AD. Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 2001; 107:719-27. [PMID: 11335750 DOI: 10.1542/peds.107.4.719] [Citation(s) in RCA: 242] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare findings on hard copies of cranial ultrasound (US) and magnetic resonance imaging (MRI) obtained between birth and term in a group of preterm infants. PARTICIPANTS AND METHODS Infants born at or below a gestational age of 30 weeks who underwent cranial US scan and MRI on the same day were eligible for this study. Infants underwent, whenever possible, 3 scans between birth and term. We calculated the predictive probability (PP) of US findings as a predictor of findings on MRI. RESULTS Sixty-two paired MRI and US studies were performed between birth and term in 32 infants born at a median gestational age of 27 (range: 23-30) weeks and a median birth weight of 918 (530-1710) grams. US predicted some MRI findings accurately: germinal layer hemorrhage (GLH) on US had a PP of 0.8 with a 95% confidence interval of (0.70-0.90) for the presence of GLH on MRI, intraventricular hemorrhage (IVH) on US had a PP of 0.85 (0.76-0.94) for the presence of IVH on MRI, and severe white matter (WM) echogenicity on US had a PP of 0.96 (0.92-1.0) for the presence of WM hemorrhagic parenchymal infarction on MRI. Other MRI changes were less well-predicted: mild or no WM echogenicity on US had a PP of 0.54 (0.41-0.66) for the presence of normal WM signal intensity on MRI, and moderate or severe WM echogenicity on US had a PP of 0.54 (0.42-0.66) for the presence of small petechial WM hemorrhage and/or diffuse excessive high-signal intensity (DEHSI) in the WM on T2-weighted images on MRI. However, mild/moderate or severe WM echogenicity on US scans performed at >/=7 days after birth had a PP of 0.72 (0.58-0.87) for the presence of WM hemorrhage and/or DEHSI on MRI. There were no cases of cystic periventricular leukomalacia. CONCLUSION US accurately predicted the presence of GLH, IVH, and hemorrhagic parenchymal infarction on MRI. However, its ability to predict the presence of DEHSI and small petechial hemorrhages in the WM on T2 weighted images is not as good, but improves on scans performed at >/=7 days after birth. In addition, normal WM echogenicity on US is not a good predictor of normal WM signal intensity on MRI.
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Affiliation(s)
- E F Maalouf
- Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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17
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Abstract
Investigatory techniques, particularly magnetic resonance (MR) imaging and spectroscopy, performed in the early neonatal period on infants suspected of intrapartum asphyxia i.e. abnormal fetal heart recording, poor cord gases, low Apgar scores and the need for resuscitation, or with neonatal encephalopathy or seizures, have allowed a much better understanding of the patterns of brain injury and the biochemical processes that follow these events. It is usually possible to distinguish these patterns from those seen in other, often confounding, diagnoses. This has allowed far more precision about the timing of insults and in the prediction of particularly motor, feeding and visual outcome and to some extent intellectual outcome. Long-term neurological and psychometric follow-up of infants in whom detailed perinatal clinical histories and examination, haematological and biochemical investigation and MR brain scans are obtained will allow even more accurate prediction of outcome in the future. Such studies also help to validate standardized neonatal and infant clinical neurological examinations, making them useful tools to predict outcome.
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Affiliation(s)
- F Cowan
- Department of Paediatrics and Neonatal Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
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