A poor long-term neurological prognosis is associated with abnormal cord insertion in severe growth-restricted fetuses

2018 ◽  
Vol 46 (9) ◽  
pp. 1040-1047 ◽  
Author(s):  
Masamitsu Nakamura ◽  
Nagayoshi Umehara ◽  
Keisuke Ishii ◽  
Jun Sasahara ◽  
Kenji Kiyoshi ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Confidence Intervals ◽  
Developmental Disorders ◽  
Neurological Complications ◽  
Impaired Hearing ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Neurological Prognosis

Abstract Objective: To clarify and compare if the neurological outcomes of fetal growth restriction (FGR) cases with abnormal cord insertion (CI) are associated with a higher risk of a poor neurological outcome in subjects aged 3 years or less versus those with normal CI. Methods: A multicenter retrospective cohort study was conducted among patients with a birth weight lower than the 3rd percentile, based on the standard reference values for Japanese subjects after 22 weeks’ gestation, who were treated at a consortium of nine perinatal centers in Japan between June 2005 and March 2011. Patients whose birth weights were less than the 3rd percentile and whose neurological outcomes from birth to 3 years of age could be checked from their medical records were analyzed. The relationship between abnormal CI and neurological outcomes was analyzed. Univariate and multivariate models of multivariate logistic regression were employed to estimate the raw and odds ratio (OR) with 95% confidence intervals comparing marginal (MCI) and velamentous cord insertion (VCI) to normal CI. Results: Among 365 neonates, 63 cases of MCI and 14 cases of VCI were observed. After excluding 24 cases with neonatal or infant death from the total FGR population, the assessment of the outcomes of the infants aged 3 years or younger showed the following rates of neurological complications: 7.3% (n=25) for cerebral palsy, 8.8% (n=30) for developmental disorders, 16.7% (n=57) for small-for-gestational-age short stature (SGA), 0.6% (n=2) for impaired hearing, 0.9% (n=3) for epilepsy, 1.2% (n=4). The ORs (95% confidence intervals) based on multivariate analysis were as follows: cerebral palsy=10.1 (2.4–41.5) in the VCI group and 4.3 (1.6–11.9) in the MCI group, developmental disorders=6.7 (1.7–26) in the VCI group and 3.9 (1.1–14.2) in the single umbilical artery (SUA) group, 5.1 (1.4–18.7) for birth weight <1000 g and 2.8 (1.2–6.7) for placental weight <200 g. Conclusions: The present results indicate that growth-restricted fetuses diagnosed with a birth weight below the 3rd percentile exhibiting abnormal umbilical CI are at a high risk for poor neurological outcomes, including cerebral palsy and/or developmental disorders.

Brain Natriuretic Peptide as a Marker of Adverse Neurological Outcomes Among Survivors of Cardiac Arrest

2021 ◽  
pp. 088506662110347
Author(s):  
Abhishek Dutta ◽  
Zaid Alirhayim ◽  
Youssef Masmoudi ◽  
John Azizian ◽  
Lawson McDonald ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Neurological Status ◽  
Modified Rankin Scale ◽  
Neurological Disability ◽  
Neurological Outcomes ◽  
All Cause Mortality ◽  
Neurological Prognosis

Background Neurological prognosis after cardiac arrest remains ill-defined. Plasma brain natriuretic peptide (BNP) may relate to poor neurological prognosis in brain-injury patients, though it has not been well studied in survivors of cardiac arrest. Methods We performed a retrospective review and examined the association of BNP with mortality and neurological outcomes at discharge in a cohort of cardiac arrest survivors enrolled from January 2012 to December 2016 at the Wake Forest Baptist Hospital, in North Carolina. Cerebral performance category (CPC) and modified Rankin scales were calculated from the chart based on neurological evaluation performed at the time of discharge. The cohort was subdivided into quartiles based on their BNP levels after which multivariable adjusted logistic regression models were applied to assess for an association between BNP and poor neurological outcomes as defined by a CPC of 3 to 4 and a modified Rankin scale of 4 to 5. Results Of the 657 patients included in the study, 254 patients survived until discharge. Among these, poor neurological status was observed in 101 (39.8%) patients that had a CPC score of 3 to 4 and 97 patients (38.2%) that had a modified Rankin scale of 4 to 5. Mean BNP levels were higher in patients with poor neurological status compared to those with good neurological status at discharge ( P = .03 for CPC 3-4 and P = .02 for modified Rankin score 4-5). BNP levels however, did not vary significantly between patients that survived and those that expired ( P = .22). BNP did emerge as a significant discriminator between patients with severe neurological disability at discharge when compared to those without. The area under the curve for BNP predicting a modified Rankin score of 4 to 5 was 0.800 (95% confidence interval [CI] 0.756-0.844, P < .001) and for predicting CPC 3 to 4 was 0.797 (95% CI 0.756-0.838, P < .001). BNP was able to significantly improve the net reclassification index and integrated discriminatory increment ( P < .05). BNP was not associated with long-term all-cause mortality ( P > .05). Conclusions In survivors of either inpatient or out-of-hospital cardiac arrest, increased BNP levels measured at the time of arrest predicted severe neurological disability at discharge. We did not observe an independent association between BNP levels and long-term all-cause mortality. BNP may be a useful biomarker for predicting adverse neurological outcomes in survivors of cardiac arrest.

Routine Indomethacin Prophylaxis: Has the Time Come?

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 784-785
Author(s):  
Henrietta S. Bada
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Intraventricular Hemorrhage ◽  
Maternal Education ◽  
Severe Form ◽  
Term Outcome ◽  
Intelligence Scale ◽  
Long Term Outcome ◽  
Iq Scores

Periventricular-intraventricular hemorrhage (IVH) remains a significant cause of long-term morbidity among premature infants1. Clinical trials2-4 have shown that prophylactic indomethacin is associated with a decreased incidence of IVH, including the severe form. In this issue of Pediatrics, Ment et al5 report on the long-term outcome of children who received indomethacin prophylaxis for IVH. Incidence of cerebral palsy (8%) was similar between the indomethacin-and placebo-treated groups; mean IQ scores determined from the Stanford-Binet Intelligence Scale (Form L-M, 1972) did not differ. IQ scores were significantly related to IVH, birth weight, and maternal education; ie, lower IQ scores with IVH and higher scores with higher birth weight and years of education.

scholarly journals Delayed severe median nerve palsy due to undiagnosed brachial pseudoaneurysm

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 418-421
Author(s):  
Jean-Eudes Trihan ◽  
Iris Lebuhotel ◽  
Mathieu Desvergnes ◽  
Fabrice Schneider
Keyword(s):  
Median Nerve ◽  
Endovascular Procedures ◽  
Diagnostic Delay ◽  
Neurological Complications ◽  
Nerve Compression ◽  
Autologous Vein ◽  
Median Nerve Palsy ◽  
Vein Bypass ◽  
Neurological Prognosis

Summary. Post-catheterization pseudoaneurysms are a well-known complication of many endovascular procedures at the site of arterial puncture. However, long-term neurological complications due to undiagnosed compression are rare. A 60-year-old man presented to our unit for round, non-pulsatile, painless swelling in the inner side of his upper arm. Clinical examination showed finger paralysis, associated with amyotrophy of the forearm. Large brachial pseudoaneurysm with median nerve compression was diagnosed. The patient underwent autologous vein bypass, with poor 6-month neurological recovery. Early diagnosis of pseudoaneurysms is paramount because, when associated with nerve compression, the longer the diagnostic delay, the poorer the neurological prognosis.

Isolated oligohydramnios and long-term neurological morbidity of the offspring

2019 ◽  
Vol 11 (6) ◽  
pp. 648-652
Author(s):  
Avital Dorot ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Asnat Walfisch ◽  
Daniella Landau ◽  
...  
Keyword(s):  
Developmental Disorders ◽  
Medical Center ◽  
Survival Curve ◽  
Neurological Complications ◽  
Population Based ◽  
Exposed Group ◽  
Kaplan Meier ◽  
Neurological Morbidity ◽  
Independent Association

AbstractThis study aimed to assess the association between maternal-isolated oligohydramnios (IO) and offspring long-term neurological complications. A population-based retrospective cohort study was conducted, including all births at a single tertiary medical center in Israel between the years 1991 and 2014. Multiple pregnancies and potential pregnancy complications associated with oligohydramnios were excluded. The computerized obstetrical database was linked with the computerized dataset of all pediatric hospitalizations of the same medical center. Evaluation of cumulative neurological-associated hospitalizations rate over time was compared using a Kaplan–Meier survival curve. The Weibull survival parametric model was conducted to assess the neurological-associated hospitalization risk in the presence of IO, while accounting for potential confounders. A total of 190,259 pregnancies were included in the study, of which 4063 (2.13%) pregnancies were complicated with IO. Total neurological-related hospitalizations were significantly more common in the IO group (3.7% in the IO group and 3.0% in the comparison group, p = 0.005). Pervasive developmental disorder, movement disorders, developmental disorders, and degenerative and demyelization disorders were all specific neurological diagnoses significantly more common in the exposed group. The survival curve demonstrated a significantly higher cumulative hospitalization rate in the exposed group (log-rank p = 0.001). Using a multivariate model adjusting for gestational age, maternal age, and labor induction, an independent association between IO and long-term neurological morbidity of the offspring was observed (adjusted hazard ratio 1.203; 95% CI 1.02–1.42). In summary, a significant association was found between pregnancies complicated by IO and long-term neurological morbidity of the offspring.

scholarly journals Neurological Complications of Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Case-Control Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yinan Luo ◽  
Qiao Gu ◽  
Xin Wen ◽  
Yiwei Li ◽  
Weihua Peng ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Troponin I ◽  
Multiple Logistic Regression Analysis ◽  
Cerebral Performance Category ◽  
Neurological Complications ◽  
Ecmo Support ◽  
Risk Indicators ◽  
Neurological Outcomes ◽  
Membrane Oxygenation

Background: To explore the epidemiology, clinical features, risk indicators, and long-term outcomes of neurological complications caused by veno-arterial extracorporeal membrane oxygenation (V-A ECMO).Methods: We retrospectively analyzed 60 adult patients who underwent V-A ECMO support in our unit from February 2012 to August 2020. These patients were separated into the neurological complications group (NC group) and the non-neurological complications group (nNC group). The differences in basic data and ECMO data between the two groups were compared. The data of long-term neurological prognosis were collected by telephone follow-up.Results: Thirty-nine patients (65.0%) had neurological complications. There were significant differences between the two groups in terms of median age, hypertension, median blood urea nitrogen, median troponin I (TNI), median lactic acid, pre-ECMO percutaneous coronary intervention, continuous renal replacement therapy (CRRT), median Sequential Organ Failure Assessment score, median Acute Physiology and Chronic Health Evaluation II score, median peak inspiratory pressure, median positive end expiratory pressure, and median fresh frozen plasma (P &lt; 0.05). The median Intensive Care Unit length of stay (ICU LOS), 28-day mortality, median post-ECMO vasoactive inotropic score, non-pulsate perfusion (NP), and median ECMO duration of the NC group were significantly higher than those of the nNC group (P &lt; 0.05). Furthermore, multiple logistic regression analysis revealed that TNI (P = 0.043), CRRT (P = 0.047), and continuous NP &gt; 12 h (P = 0.043) were independent risk indicators for neurological complications in patients undergoing ECMO. Forty-four patients (73.3%) survived after discharge, and 38 patients (63.3%) had Cerebral Performance Category score of 1–2. And there were significant differences between the two groups in long-term neurological outcomes after discharge for 6 months (P &lt; 0.05).Conclusion: The incidence of neurological complications was higher in patients undergoing V-A ECMO and was closely related to adverse outcomes (including ICU LOS and 28-day mortality). TNI, CRRT, and continuous NP &gt; 12 h were independent risk indicators for predicting neurological complications in ECMO supporting patients. And the neurological complications of patients during ECMO support had significant adverse effect on long-term surviving and neurological outcomes of patients after discharge for 6 months.

scholarly journals Prognostic Value of Early Intermittent Electroencephalography in Patients After Extracorporeal Cardiopulmonary Resuscitation

2020 ◽  
Author(s):  
Yong Oh Kim ◽  
Ryoung-Eun Ko ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
Taek Kyu Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Neurological Status ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Neurological Prognosis ◽  
Favorable Neurological Outcome

Abstract Background The aim of this study was to investigate whether intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods This was a retrospective, single center, and observational study of adult patients who were evaluated by EEG scan within 96 hours after ECPR between February 2012 and December 2018. The primary endpoint was neurological status upon discharge from the hospital assessed with Cerebral Performance Categories (CPC) scale. Results Among 69 adult cardiac arrest patients who underwent ECPR, 32 (46.4%) patients survived until discharge from the hospital. Of these 32 survivors, 17 (24.6%) patients had favorable neurological outcomes (CPC score: 1 or 2). Sedatives or analgesics were used in 41 (59.4%) patients. Malignant EEG patterns were more common in patients with poor neurological outcome than in patients with favorable neurological outcome (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcome. Moderately malignant EEG patterns were reported in 8 (11.6%) patients with poor neurological outcome and one (1.4%) patient with favorable neurological outcome. Benign EEG patterns were more common in patients with favorable neurological outcome than in patients with poor neurological outcome (94.1% vs. 26.9%, p < 0.001). In multivariable analysis, malignant EEG patterns (adjusted odd ratio [OR]: 53.26, 95% confidence interval [CI]: 5.956 – 476.249) and duration of cardiopulmonary resuscitation (adjusted OR: 1.07, 95% CI: 1.011 – 1.130) were significantly associated with poor neurological outcomes in patients who underwent ECPR (Hosmer-Lemeshow Chi-squared = 7.84, df = 7, p = 0.347). Conclusions In this study, malignant EEG patterns within 96 hr after cardiac arrest were significantly associated with poor neurological outcomes in patients who underwent ECPR. Therefore, early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals Neurodevelopmental outcome of preterm very low birth weight infants admitted to an Italian tertiary center over an 11-year period

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stefania Longo ◽  
Camilla Caporali ◽  
Camilla Pisoni ◽  
Alessandro Borghesi ◽  
Gianfranco Perotti ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Neurodevelopmental Outcome ◽  
International Studies ◽  
Perinatal Complications ◽  
Neurological Assessment ◽  
Low Birth Weight Infants ◽  
Tertiary Center

AbstractPreterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome. Identifying early factors associated with outcome is essential in order to refer patients for early intervention. Few studies have investigated neurodevelopmental outcome in Italian VLBWi. The aim of our longitudinal study is to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year cohort of 502 Italian preterm VLBWi and to identify associations with outcome. At 24 months, Griffiths’ Mental Developmental Scales were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). 75.3% showed a normal outcome, 13.9% minor sequelae and 10.8% major sequelae (3.8% cerebral palsy). Male gender, bronchopulmonary dysplasia, abnormal neonatal neurological assessment and severe brain ultrasound abnormalities were independently associated with poor outcome on multivariate ordered logistic regression. Rates of major sequelae are in line with international studies, as is the prevalence of developmental delay over cerebral palsy. Analysis of perinatal complications and the combination of close cUS monitoring and neurological assessment are still essential for early identification of infants with adverse outcome.

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