P.116 Cerebral Sinovenous Thrombosis in Preterm Infants

Background: Neonatal cerebral sinovenous thrombosis (CSVT) can lead to severe brain injury and long-term neurodevelopmental impairments. Previous studies of neonatal CSVT have mainly included term infants. In this study, we examined the clinical and radiological features, treatment and outcome of CSVT in preterm infants. Methods: This was a retrospective cohort study of preterm infants born <37 weeks with radiologically confirmed CSVT. All MRI/MRV and CT/CTV scans were re-reviewed. Clinical and radiological data were analysed using descriptive statistics, ANOVA and chi-square tests. Results: A total of 26 preterm infants with CSVT were included. Of these, 65% were late preterm, 27% very preterm and 8% extreme preterm. Most were symptomatic (seizures 50%, abnormal exam 50%). Radiological features included transverse sinus (85%) and sagittal sinus thrombosis (42%), intraventricular hemorrhage (42%) and venous infarction (19%). Most preterm infants with CSVT (69%) were treated with anticoagulation. Anticoagulation was not associated with new or worsening intracranial hemorrhage. Outcome at follow-up ranged from no impairment (39%), mild impairment (19%), severe impairment (19%) and death (23%). Conclusions: Preterm infants with CSVT are often symptomatic and present with a distinct pattern of brain injury. Anticoagulation treatment of preterm CSVT appeared to be safe. Further studies and treatment guidelines for preterm CSVT are needed.

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Epidemiology and pathogenesis of stroke in preterm infants: A systematic review

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200597 ◽

2021 ◽

pp. 1-8

Author(s):

B. Roy ◽

K. Walker ◽

C. Morgan ◽

M. Finch-Edmondson ◽

C. Galea ◽

...

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Meta Analysis ◽

Transverse Sinus ◽

Brain Maturation ◽

Left Middle Cerebral Artery ◽

Arterial Ischemic Stroke ◽

Term Infants ◽

Cerebral Sinovenous Thrombosis ◽

Causal Pathway

BACKGROUND: Perinatal stroke is one of the principal causes of cerebral palsy (CP) in preterm infants. Stroke in preterm infants is different from stroke in term infants, given the differences in brain maturation and the mechanisms of injury exclusive to the immature brain. We conducted a systematic review to explore the epidemiology and pathogenesis of periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT) in preterm infants. METHODS: Studies were identified based on predefined study criteria from MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE electronic databases from 2000 –2019. Results were combined using descriptive statistics. RESULTS: Fourteen studies encompassed 546 stroke cases in preterm infants between 23 –36 weeks gestational ages and birth weights between 450 –3500 grams. Eighty percent (436/546) of the stroke cases were PVHI, 17%(93/546) were PAIS and 3%(17/546) were CSVT. Parietal PVHI was more common than temporal and frontal lobe PVHI. For PAIS, left middle cerebral artery (MCA) was more common than right MCA or cerebellar stroke. For CSVT partial or complete thrombosis in the transverse sinus was universal. All cases included multiple possible risk factors, but the data were discordant precluding aggregation within a meta-analysis. CONCLUSION: This systematic review confirms paucity of data regarding the etiology and the precise causal pathway of stroke in preterm infants. Moreover, the preterm infants unlike the term infants do not typically present with seizures. Hence high index of clinical suspicion and routine cUS will assist in the timely diagnosis and understanding of stroke in this population.

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Abstract W MP109: Childhood Cerebral Sinovenous Thrombosis (CSVT): Long-Term Neuropsychological Outcomes

Stroke ◽

10.1161/str.45.suppl_1.wmp109 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Aly Aziz ◽

Robyn Westmacott ◽

Ann-Marie Pontigon ◽

Gabrielle deVeber ◽

Daune MacGregor ◽

...

Keyword(s):

Executive Function ◽

Sinus Thrombosis ◽

Neuropsychological Testing ◽

Cerebral Sinovenous Thrombosis ◽

Cognitive Behaviour ◽

Significant Difference ◽

Sinovenous Thrombosis ◽

Neuropsychological Outcomes ◽

Perceptual Reasoning

Background: Outcome from childhood CSVT particularly in infants is poor. Most studies report “general” neurological outcomes; few describe neuropsychological outcomes specifically. Objectives: To study the spectrum of neuropsychological deficits following childhood CSVT. Methods: Retrospective review of clinical data [incl pediatric stroke outcome measure (PSOM)] & neuropsychological testing (NPT) from 1995-2011 was conducted. NPT included IQ [Wechsler Intelligence Score for Children (WISC-IV), Wechsler Preschool & Primary Scale of intelligence (WPPSI-III)], executive function [Behaviour Rating Inventory of Executive Function (BRIEF)] & attention [Test of everyday attention for children (Tea-Ch)]. Full scale IQ (FSIQ) included verbal comprehension (VCI), perceptual reasoning (PRI), working memory (WMI) & processing speed (PSI) index. Results: NPT was performed in 48/206 subjects. 41 (34 males) were analyzed [excl: cavernous sinus thrombosis (5), prematurity (1), concurrent arterial stroke (1)]. Mean age at NPT: 5.4-y (neonatal CSVT) and 8.5-y (non-neonatal CSVT; mean time from CSVT to NPT 2.4-y). NPT was abnormal (atleast 1SD below mean) in 87% patients in one (29%) or multiple (58%) tests. FSIQ was abnormal in 64% [VCI-69%, PRI-80%, WMI-71%, PSI-79%). Compared to normative population, patients scored significantly lower on FSIQ (p=0.026), VCI (p=0.608), PRI (p= 0.032), WMI (0.124) and PSI (p=0.007). No significant difference was seen in FSIQ between groups [neonates/non-neonates (p=0.827), single/multiple sinus (p=0.2), present/absent parenchymal lesions (p=0.991)]. However males scored significantly lower on FSIQ (p=0.006), PRI (p=0.004), WMI (p=0.002)& PSI (p=0.002)] but not on VCI (0.69)]. BRIEF [metacognition (p=0.061) & executive composite (p=0.095)] & Tea-Ch (p=0.046) scores were also poorer in males. Mean cognitive/behaviour sphere score (max 2.0) of PSOM (assessed closest to NPT) was worse in males (0.41) than females (0.14). Conclusions: Majority of childhood CSVT survivors (males > females) have detectable cognitive deficits on detailed NPT on long term follow-up. NPT is useful in accurate assessment of CSVT outcome & could guide academic interventions. Larger studies are needed to replicate these findings.

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Serial Cranial US for Detection of Cerebral Sinovenous Thrombosis in Preterm Infants

Radiology ◽

10.1148/radiol.13130401 ◽

2013 ◽

Vol 269 (3) ◽

pp. 879-886 ◽

Cited By ~ 23

Author(s):

Marlou M. A. Raets ◽

Jeanine J. Sol ◽

Paul Govaert ◽

Maarten H. Lequin ◽

Irwin K. M. Reiss ◽

...

Keyword(s):

Preterm Infants ◽

Cerebral Sinovenous Thrombosis ◽

Sinovenous Thrombosis

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Paediatric stroke

Hämostaseologie ◽

10.1055/s-0037-1616948 ◽

2009 ◽

Vol 29 (01) ◽

pp. 88-90 ◽

Cited By ~ 6

Author(s):

G. deVeber

Keyword(s):

Treatment Guidelines ◽

Recurrence Risk ◽

Current Treatment ◽

Antithrombotic Treatment ◽

The Past ◽

Stroke Research ◽

Cerebral Sinovenous Thrombosis ◽

Sinovenous Thrombosis ◽

Arterial Ischaemic Stroke ◽

Paediatric Stroke

SummaryThe past decade has seen a dramatic increase in pediatric stroke research. However few studies have addressed anti-thrombotic safety or effectiveness. Three paediatric stroke guidelines combining research data with expert consensus have been published in the past five years. For most patients treatment recommendations are consistent. Newborns with arterial ischaemic stroke (AIS) rarely require antithrombotic treatment given their extremely low risk of recurrence. In children with AIS a substantial recurrence risk means that antithrombotic treatment is required unless contraindicated. Anticoagulation (heparins, warfarin) is recommended for possible or established dissection and cardiogenic embolism. Antiplatelet treatment is recommended for other children with AIS. For neonatal cerebral sinovenous thrombosis (CSVT) most centers provide initial anticoagulation in the absence of haemorrhagic contra indications, and otherwise, monitor for propagation. Children with CSVT, even with haemorrhagic infarction, more consistently receive anticoagulation, as in adults. While more studies are necessary, current treatment guidelines offer an interim option for guiding the treatment of paediatric stroke.

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Concurrent and Predictive Validity of the Infant Motor Profile in Infants at Risk of Neurodevelopmental Disorders

10.21203/rs.3.rs-105167/v1 ◽

2020 ◽

Author(s):

Riccardo Rizzi ◽

Valentina Menici ◽

Maria Luce Cioni ◽

Alessandra Cecchi ◽

Veronica Barzacchi ◽

...

Keyword(s):

At Risk ◽

Brain Injury ◽

Preterm Infants ◽

Neurodevelopmental Disorders ◽

Concurrent Validity ◽

Brain Lesion ◽

Neurodevelopmental Outcome ◽

Motor Behaviour ◽

Perinatal Brain Injury ◽

Term Infants

Abstract Background: Preterm infants and infants with perinatal brain injury show higher incidence of neurodevelopmental disorders (NDD). The Infant Motor Profile (IMP) is a clinical assessment which evaluates the complexity of early motor behaviour. More data are needed to confirm its predictive ability and concurrent validity with other common and valid assessments such as the Alberta Infant Motor Profile (AIMS) and the Prechtl’s General Movement Assessment (GMA). The present study aims to evaluate the concurrent validity of IMP with AIMS, to assess its association with GMA, to evaluate how IMP reflects the severity of the brain injury and to compare the ability of IMP and AIMS to predict abnormal outcome in 5-months infants at risk of NDD.Methods: 86 infants at risk of NDD were retrospectively recruited among the participants of two clinical trials. Preterm infants with or without perinatal brain injury and term infants with brain injury were assessed at 3 months corrected age (CA) using GMA and at 5 months CA using IMP and AIMS. Neurodevelopmental outcome was established at 18 months.Results: Results confirm a solid concurrent validity between IMP and AIMS (Spearman’s ρ 0.76; p<.001) and significant association between IMP and GMA. Unlike AIMS, IMP Total score accurately reflects the severity of neonatal brain injury (p<.001) and results to be the strongest predictor of NDD (p<.001). Confrontation of areas under receiver operating characteristic curves (AUC) confirms that IMP Total score has the highest diagnostic accuracy at 5 months (AUC 0.92). For an optimal IMP cut-off value of 70, the assessment shows high sensitivity (93%) and specificity (81%) (PPV 84%; NPV 90%).Conclusions: Early motor behaviour assessed with IMP is strongly associated with middle-term neurodevelopmental outcome. The present study confirms the concurrent validity of IMP with AIMS, its association with GMA and its ability to reflect brain lesion load contributing to the construct validity of the assessment.Trial registration: NCT01990183 and NCT03234959 (clinicaltrials.gov)

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Early Diagnosis of Brain Injury in Premature Infants Based on Amplitude-Integrated EEG Scoring System

Journal of Healthcare Engineering ◽

10.1155/2021/6684818 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Xinyuan Guo ◽

Yanfang Geng ◽

Lei Zhang ◽

Shiping Niu ◽

Jiang Xue

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Premature Infants ◽

Low Voltage ◽

Background Activity ◽

Epileptic Activity ◽

Control Group ◽

Term Infants ◽

Continuous Eeg ◽

Long Term Prognosis

Analyzing and discussing the relationship between brain injury in preterm infants and related risk factors can provide evidence for perinatal prevention and early intervention of brain injury in preterm infants, thereby improving the quality of life of preterm infants. This paper selects term preterm infants diagnosed with preterm infant asphyxia in the NICU of a university’s First Affiliated Hospital from January 2018 to February 2019 as the research object. In addition, healthy term infants born at the same time in the obstetric department of this hospital are selected as the control group. Both groups of premature infants were monitored for brain function within 6 hours after birth. The aEEG results range from background activity (continuous normal voltage, discontinuous normal voltage, burst suppression, continuous low voltage, and plateau) and sleep-wake cycle (no sleep-wake cycle, immature, and mature sleep-wake cycle) to epileptic activity (single seizures, recurrent seizures, and status epilepticus), three aspects to judge. Statistical analysis uses SPSS 17.0 software. Amplitude-integrated EEG is a simplified form of continuous EEG recording. The trace of the trace represents the voltage change signal of the entire EEG background activity, which can reflect the EEG amplitude, frequency, burst-inhibition, and other pieces of information. aEEG can reflect the degree of HIE lesions in premature infants and the long-term prognosis. It is easy to operate and effective in diagnosis and can be continuously monitored. It is worthy of clinical popularization. There is a good correlation between the expression of EEG and biomarkers. Combining multiple methods can diagnose HIE earlier and evaluate the prognosis.

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Cerebral Oxygen Metabolism in Newborns

PEDIATRICS ◽

10.1542/peds.92.1.99 ◽

1993 ◽

Vol 92 (1) ◽

pp. 99-104

Author(s):

Denis I. Altman ◽

Jeffrey M. Perlman ◽

Joseph J. Volpe ◽

William J. Powers

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Treatment Strategies ◽

Oxygen Metabolism ◽

Therapeutic Interventions ◽

Term Infants ◽

Newborn Brain ◽

Positron Emission ◽

The Brain ◽

Human Neonates

Objective. A better understanding of the developmental changes in brain energy metabolism that occur in human neonates is critically important for designing rational treatment strategies that ensure an adequate supply of nutrients to the brain and minimize deleterious side effects of therapeutic interventions in sick newborns. Methods. Cerebral metabolic rate for oxygen (CMRO2) was measured with positron emission tomography in 11 sick newborns of different gestational ages. Results. In five preterm infants, mean hemispheric CMRO2 was 0.06 to 0.54 mL 100 g-1 min-1. Two of these preterm infants with virtually absent CMRO2 (0.06 mL 100 g-1 min-1) had minimal or no evidence of parenchymal brain injury detected in the newborn period. In six term infants, mean hemispheric CMRO2 was 0.0 to 1.3 mL 100 g-1 min-1. Two with no neurological disease had mean hemispheric CMRO2 of 0.4 and 0.7 mL 100 g-1 min-1 and were normal at 6 and 7 months, respectively. Conclusions. CMRO2 in four newborns who had minimal or no detectable brain injury was considerably below the threshold for brain viability in adults of 1.3 mL 100 g-1 min-1. This indicates that energy requirements in fetal and newborn brain are minimal or can be met by nonoxidative metabolism.

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Cerebral sinovenous thrombosis during asparaginase treatment

Hämostaseologie ◽

10.1055/s-0037-1619586 ◽

2003 ◽

Vol 23 (03) ◽

pp. 109-112

Author(s):

A. Hirt ◽

C. Zwicky ◽

W.A. Wuillemin ◽

K. Leibundgut

Keyword(s):

Acute Lymphoblastic Leukaemia ◽

Lymphoblastic Leukaemia ◽

Induction Treatment ◽

Pathogenic Mechanisms ◽

Cerebral Sinovenous Thrombosis ◽

Haemorrhagic Infarction ◽

Sinovenous Thrombosis

SummaryA boy (age: 71/12 years) with acute lymphoblastic leukaemia developed thrombosis of the sinus sagitalis superior with secondary haemorrhagic infarction while on induction treatment with vincristine, prednisone, and asparaginase. Based on this report, the potential pathogenic mechanisms are discussed with respect to congenital prothrombotic defects as well as to the role of antileukaemic treatment. Current hypotheses on mechanisms for thromboembolism in children and proposed prophylactic strategies are briefly summarized.

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