Perinatal arterial ischemic stroke diagnosed in infants receiving therapeutic hypothermia for hypoxic-ischemic encephalopathy.

IF 3.1 3区医学 Q1 PEDIATRICS

Pediatric Research Pub Date : 2024-08-27 DOI:10.1038/s41390-024-03531-7

Fernando F Gonzalez, Sarah E Monsell, Marie-Coralie Cornet, Hannah Glass, Jessica Wisnowski, Amit Mathur, Robert McKinstry, Yi Li, Tai-Wei Wu, Dennis E Mayock, Patrick J Heagerty, Sandra E Juul, Yvonne W Wu

{"title":"Perinatal arterial ischemic stroke diagnosed in infants receiving therapeutic hypothermia for hypoxic-ischemic encephalopathy.","authors":"Fernando F Gonzalez, Sarah E Monsell, Marie-Coralie Cornet, Hannah Glass, Jessica Wisnowski, Amit Mathur, Robert McKinstry, Yi Li, Tai-Wei Wu, Dennis E Mayock, Patrick J Heagerty, Sandra E Juul, Yvonne W Wu","doi":"10.1038/s41390-024-03531-7","DOIUrl":null,"url":null,"abstract":"Background: Both perinatal arterial ischemic stroke (PAIS) and hypoxic-ischemic encephalopathy (HIE) can present with neonatal encephalopathy. We hypothesized that among infants undergoing therapeutic hypothermia, presence of PAIS is associated with a higher risk of seizures and a lower risk of persistent encephalopathy after rewarming.Methods: We studied 473 infants with moderate or severe HIE enrolled in the HEAL Trial who received a brain MRI. We defined PAIS as focal ischemic infarct(s) within an arterial distribution, and HIE pattern of brain injury as central gray, peripheral watershed, or global injury. We compared the risk of seizures (clinically suspected or electrographic), and of an abnormal 5-day Sarnat exam, in infants with and without PAIS.Results: PAIS was diagnosed in 21(4%) infants, most of whom (16/21, 76%) also had concurrent HIE pattern of brain injury. Infants with PAIS were more likely to have seizures (RR 2.4, CI 2.8-3.3) and persistent moderate or severe encephalopathy on 5-day Sarnat exam (RR 2.5, 95% CI 1.9-3.4).Conclusion: Among infants undergoing therapeutic hypothermia, PAIS typically occurs with concurrent HIE pattern brain injury. The higher rate of encephalopathy after rewarming in infants with PAIS may be due to the frequent co-existence of PAIS and HIE patterns of injury.","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":null,"pages":null},"PeriodicalIF":3.1000,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41390-024-03531-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Both perinatal arterial ischemic stroke (PAIS) and hypoxic-ischemic encephalopathy (HIE) can present with neonatal encephalopathy. We hypothesized that among infants undergoing therapeutic hypothermia, presence of PAIS is associated with a higher risk of seizures and a lower risk of persistent encephalopathy after rewarming.

Methods: We studied 473 infants with moderate or severe HIE enrolled in the HEAL Trial who received a brain MRI. We defined PAIS as focal ischemic infarct(s) within an arterial distribution, and HIE pattern of brain injury as central gray, peripheral watershed, or global injury. We compared the risk of seizures (clinically suspected or electrographic), and of an abnormal 5-day Sarnat exam, in infants with and without PAIS.

Results: PAIS was diagnosed in 21(4%) infants, most of whom (16/21, 76%) also had concurrent HIE pattern of brain injury. Infants with PAIS were more likely to have seizures (RR 2.4, CI 2.8-3.3) and persistent moderate or severe encephalopathy on 5-day Sarnat exam (RR 2.5, 95% CI 1.9-3.4).

Conclusion: Among infants undergoing therapeutic hypothermia, PAIS typically occurs with concurrent HIE pattern brain injury. The higher rate of encephalopathy after rewarming in infants with PAIS may be due to the frequent co-existence of PAIS and HIE patterns of injury.

Abstract Image

查看原文本刊更多论文

接受治疗性低温治疗缺氧缺血性脑病的婴儿被诊断为围产期动脉缺血性中风。

背景：围产期动脉缺血性卒中（PAIS）和缺氧缺血性脑病（HIE）都可能出现新生儿脑病。我们假设，在接受治疗性低温的婴儿中，PAIS 的存在与较高的癫痫发作风险和较低的复温后持续脑病风险相关：我们对参加 HEAL 试验并接受脑磁共振成像的 473 名中度或重度 HIE 婴儿进行了研究。我们将 PAIS 定义为动脉分布的局灶性缺血性梗死，将 HIE 脑损伤模式定义为中央灰质、外周分水岭或整体损伤。我们比较了有 PAIS 和没有 PAIS 的婴儿癫痫发作（临床怀疑或电图）和 5 天 Sarnat 检查异常的风险：结果：21 名婴儿（4%）被诊断出 PAIS，其中大多数（16/21，76%）同时伴有 HIE 脑损伤模式。患有 PAIS 的婴儿更有可能出现癫痫发作（RR 2.4，CI 2.8-3.3）以及在 5 天 Sarnat 检查中出现持续性中度或重度脑病（RR 2.5，95% CI 1.9-3.4）：结论：在接受治疗性低温的婴儿中，PAIS通常与HIE模式脑损伤同时发生。结论：在接受治疗性低温的婴儿中，PAIS 通常与 HIE 型脑损伤同时发生。PAIS 患儿在复温后发生脑病的比例较高，这可能是因为 PAIS 和 HIE 型损伤经常同时存在。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pediatric Research 医学-小儿科

CiteScore

6.80

自引率

5.60%

发文量

473

审稿时长

3-8 weeks

期刊介绍： Pediatric Research publishes original papers, invited reviews, and commentaries on the etiologies of children''s diseases and disorders of development, extending from molecular biology to epidemiology. Use of model organisms and in vitro techniques relevant to developmental biology and medicine are acceptable, as are translational human studies