Cases Of Intraventricular Hemorrhage Research Articles

Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis.

Our objective was to determine the optimal timing of delivery of growth restricted fetuses with gastroschisis in the setting of normal umbilical artery (UA) Dopplers. We designed a decision analytic model using TreeAge software for a hypothetical cohort of 2000 fetuses with isolated gastroschisis, fetal growth restriction (FGR), and normal UA Dopplers across 34-39weeks of gestation. This model accounted for costs and quality adjusted life years (QALYs) for the pregnant individual and the neonate. Model outcomes included stillbirth, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), short gut syndrome (SGS), neonatal sepsis, neonatal death, and neurodevelopmental disability (NDD). We found 38weeks to be the optimal timing of delivery for minimizing overall perinatal mortality and leading to the highest total QALYs. Compared to 37weeks, delivery at 38weeks resulted in 367.98 more QALYs, 2.22 more cases of stillbirth, 2.41 fewer cases of RDS, 0.02 fewer cases of NEC, 1.65 fewer cases of IVH, 0.5 fewer cases of SGS, 2.04 fewer cases of sepsis, 11.8 fewer neonatal deaths and 3.37 fewer cases of NDD. However, 39weeks were the most cost-effective strategy with a savings of $1,053,471 compared to 38weeks. Monte Carlo analysis demonstrated that 38weeks was the optimal gestational age for delivery 51.70% of the time, 39weeks were optimal 47.40% of the time, and 37weeks was optimal 0.90% of the time. Taking into consideration a range of adverse perinatal outcomes and cost effectiveness, 38-39weeks gestation is ideal for the delivery of fetuses with gastroschisis, FGR, and normal UA Dopplers. However, there are unique details to consider for each case, and the timing of delivery should be individualized using shared multidisciplinary decision making.

Short-Term Outcome of Preterm Infants with Intraventricular Hemorrhage

Background: Intra-ventricular hemorrhage (IVH) remains a severe complication of very preterm infants born before 32 weeks of gestation. IVH is strongly associated with post-hemorrhagic hydrocephalus and subsequent neurodevelopmental disabilities. Objectives: This study evaluated the short-term outcome of IVH in preterm infants concerning its occurrence time. Methods: This study enrolled preterm newborn infants with IVH visiting a teaching referral university hospital in the North West of Iran from September 2019 to October 2020. We followed 40 neonates with IVH and evaluated their neurodevelopment at 6 and 12 months. We defined delayed IVH as IVH detected the first time after the second week of life. The neurodevelopmental outcome was compared with respect to the time of IVH occurrence. Results: Forty cases of IVH were enrolled in this study, of whom 4 cases were excluded because of death before hospital discharge. The studied patients' mean gestation age and birth weight were 29.3 ± 2.3 weeks and 1361 ± 564 g, respectively. Intra-ventricular hemorrhage occurred in the first week of life in 31 neonates (86.1%) and delayed in 5 neonates (13.9%). The neurodevelopmental delay was detected at 6 months after birth in 14 infants (45.1%) with IVH in the first week of life and 2 (40%) cases with delayed IVH (P = 0.37). Neurodevelopmental delay was diagnosed at 12 months after birth in 8 infants (25.8%) with IVH in the first week of life and 1 infant (20%) with delayed IVH (P = 0.17). Conclusions: Intra-ventricular hemorrhage is an essential cause of neurodevelopmental delay in preterm infants, and there is no significant difference in IVH outcomes with respect to the time of IVH occurrence.

Navigating the Complexities of Intraventricular Hemorrhage in Preterm Infants: An Updated Review.

Intraventricular hemorrhage (IVH) is a type of bleeding that occurs in the ventricular cavity of the brain. In this comprehensive study, we providea summary of the pathogenesis, diagnosis, and treatment of intraventricular hemorrhage in premature infants. Preterm babies are at high risk of developing IVH because their germinal matrix is not fully developed, making their blood vessels more prone to rupture. However, that is not necessarily the case in all preterm babies as the inherent structure of the germinal matrixmakes it more susceptible to hemorrhage. Incidences of IVH are discussed based on recent data which states that around 12,000 premature infants in the United States experience IVH each year. Although grades I and II make up the majority of IVH cases and are frequently asymptomatic, IVH remains a significant issue for premature infants in neonatal intensive care facilities worldwide. Grades I and II have been linked to mutations in the type IV procollagen gene, COL4A1, as well as prothrombin G20210A and factor V Leiden mutations. Intraventricular hemorrhagecan be detected using brain imaging in the first seven to 14 days following delivery. This review also shines a light on reliable methods for identifying IVH in premature newborns like cranial ultrasound and magnetic resonance imaging along with the treatment of IVH which is primarily supportive and involves the management of intracranial pressure, the correction of coagulation abnormalities, and the prevention of seizures.

The added value of third trimester fetal brain MRI in cases of isolated ventriculomegaly

Objectives To assess the added value of third trimester fetal brain MRI, performed in one tertiary referral center, in cases of isolated ventriculomegaly as established by a dedicated multiplanar neurosonography. Methods Fetal brain MRI scans performed in a single tertiary center during a 3-year period were assessed for possible inclusion. Only cases diagnosed with ventriculomegaly without additional findings in a neurosonography preceding the MRI were included. Fetal MRI was performed at a median gestational of 32 weeks (IQR 31–34 weeks). Results A total of 68 cases met the inclusion criteria. Of them, in four cases MRI identified additional findings including three cases of intraventricular hemorrhage and one case of cortical infarction. The overall rate of MRI-findings in the study population was (5.9%, 95% CI 2.3–14.2%). No additional findings were detected in cases of mild ventriculomegaly, 6.1% in moderate and 25% in severe ventriculomegaly. The combined rate of additional findings in mild to moderate ventriculomegaly was 3.3% (95%CI 0.9–11.4%). Conclusions MRI was able to detect additional findings in 5.9% of cases with seemingly isolated ventriculomegaly after a dedicated neurosonography. The severity of ventriculomegaly is associated with a higher chance of detecting abnormalities in fetal brain MRI.

Fetal Intraventricular Hemorrhage in Open Neural Tube Defects: Prenatal Imaging Evaluation and Perinatal Outcomes.

Fetal imaging is crucial in the evaluation of open neural tube defects. The identification of intraventricular hemorrhage prenatally has unclear clinical implications. We aimed to explore fetal imaging findings in open neural tube defects and evaluate associations between intraventricular hemorrhage with prenatal and postnatal hindbrain herniation, postnatal intraventricular hemorrhage, and ventricular shunt placement. After institutional review board approval, open neural tube defect cases evaluated by prenatal sonography between January 1, 2013 and April 24, 2018 were enrolled (n = 504). The presence of intraventricular hemorrhage and gray matter heterotopia by both prenatal sonography and MR imaging studies was used for classification. Cases of intraventricular hemorrhage had intraventricular hemorrhage without gray matter heterotopia (n = 33) and controls had neither intraventricular hemorrhage nor gray matter heterotopia (n = 229). A total of 135 subjects with findings of gray matter heterotopia were excluded. Outcomes were compared with regression analyses. Prenatal and postnatal hindbrain herniation and postnatal intraventricular hemorrhage were more frequent in cases of prenatal intraventricular hemorrhage compared with controls (97% versus 79%, 50% versus 25%, and 63% versus 12%, respectively). Increased third ventricular diameter, specifically >1 mm, predicted hindbrain herniation (OR = 3.7 [95% CI, 1.5-11]) independent of lateral ventricular size and prenatal intraventricular hemorrhage. Fetal closure (n = 86) was independently protective against postnatal hindbrain herniation (OR = 0.04 [95% CI, 0.01-0.15]) and postnatal intraventricular hemorrhage (OR = 0.2 [95% CI, 0.02-0.98]). Prenatal intraventricular hemorrhage was not associated with ventricular shunt placement. Intraventricular hemorrhage is relatively common in the prenatal evaluation of open neural tube defects. Hindbrain herniation is more common in cases of intraventricular hemorrhage, but in association with increased third ventricular size. Fetal closure reverses hindbrain herniation and decreases the rate of intraventricular hemorrhage postnatally, regardless of the presence of prenatal intraventricular hemorrhage.

Successful use of an artificial placenta–based life support system to treat extremely preterm ovine fetuses compromised by intrauterine inflammation

Exvivo uterine environment therapy is an experimental intensive care strategy for extremely preterm infants born between 21 and 24 weeks of gestation. Gas exchange is performed by membranous oxygenators connected by catheters to the umbilical vessels. The fetus is submerged in a bath of synthetic amniotic fluid. The lungs remain fluid filled, and pulmonary respiration does not occur. Intrauterine inflammation is strongly associated with extremely preterm birth and fetal injury. At present, there are no data that we are aware of to show that artificial placenta-based systems can be used to support extremely preterm fetuses compromised by exposure to intrauterine inflammation. To evaluate the ability of our exvivo uterine environment therapy platform to support extremely preterm ovine fetuses (95-day gestational age; approximately equivalent to 24 weeks of human gestation) exposed to intrauterine inflammation for a period of 120 hours, the following primary endpoints were chosen: (1) maintenance of key physiological variables within normal ranges, (2) absence of infection and inflammation, (3) absence of brain injury, and (4) gross fetal growth and cardiovascular function matching that of age-matched in utero controls. Ten ewes with singleton pregnancies were each given a single intraamniotic injection of 10-mg Escherichia coli lipopolysaccharides under ultrasound guidance 48 hours before undergoing surgical delivery for adaptation to exvivo uterine environment therapy at 95-day gestation (term=150 days). Fetuses were adapted to exvivo uterine environment therapy and maintained for 120 hours with constant monitoring of key vital parameters (exvivo uterine environment group) before being killed at 100-day equivalent gestational age. Umbilical artery blood samples were regularly collected to assess blood gas data, differential counts, biochemical parameters, inflammatory markers, and microbial load to exclude infection. Ultrasound was conducted at 48 hours after intraamniotic lipopolysaccharides (before surgery) to confirm fetal viability and at the conclusion of the experiments (before euthanasia) to evaluate cardiac function. Brain injury was evaluated by gross anatomic and histopathologic investigations. Eight singleton pregnant control animals were similarly exposed to intraamniotic lipopolysaccharides at 93-day gestation and were killed at 100-day gestation to allow comparative postmortem analyses (control group). Biobanked samples from age-matched saline-treated animals served as an additional comparison group. Successful instillation of lipopolysaccharides into the amniotic fluid exposure was confirmed by amniotic fluid analysis at the time of administration and by analyzing cytokine levels in fetal plasma and amniotic fluid. Data were tested for mean differences using analysis of variance. Six of 8 lipopolysaccharide control group (75%) and 8 of 10 exvivo uterine environment group fetuses (80%) successfully completed their protocols. Six of 8 exvivo uterine environment group fetuses required dexamethasone phosphate treatment to manage profound refractory hypotension. Weight and crown-rump length were reduced in exvivo uterine environment group fetuses at euthanasia than those in lipopolysaccharide control group fetuses (P<.05). There were no biologically significant differences in cardiac ultrasound measurement, differential leukocyte counts (P>.05), plasma tumor necrosis factor α, monocyte chemoattractant protein-1 concentrations (P>.05), or liver function tests between groups. Daily blood cultures were negative for aerobic and anaerobic growth in all exvivo uterine environment group animals. No cases of intraventricular hemorrhage were observed. White matter injury was identified in 3 of 6 lipopolysaccharide control group fetuses and 3 of 8 vivo uterine environment group fetuses. We report the use of an artificial placenta-based system to support extremely preterm lambs compromised by exposure to intrauterine inflammation. Our data highlight key challenges (refractory hypotension, growth restriction, and white matter injury) to be overcome in the development and use of artificial placenta technology for extremely preterm infants. As such challenges seem largely absent from studies based on healthy pregnancies, additional experiments of this nature using clinically relevant model systems are essential for further development of this technology and its eventual clinical application.

Reducing Germinal Matrix-Intraventricular Hemorrhage: Perinatal and Delivery Room Factors.

Germinal matrix hemorrhage-intraventricular hemorrhage (IVH) is the most common form of brain injury in preterm infants. Although severe IVH has declined over the years, it still affects approximately 6% of infants born before 32 weeks of gestation. Most IVH cases are detectable by the first 24 hours after birth; therefore interventions to prevent IVH should focus on antenatal management for pregnant women and delivery room management. Obstetrical interventions, including antenatal corticosteroids, maternal rather than infant transport, and possibly elective cesarean delivery have been associated with a decreased risk of IVH. Neonatal interventions in the delivery room, including delayed cord clamping or umbilical cord milking, maintaining normothermia, avoiding fluctuations in cerebral blood flow, and optimal ventilation management are associated with a decreased risk of IVH. Multiple clinical trials are under way to further identify IVH risk factors, ability to monitor or predict IVH, and ideally prevent IVH altogether. This discussion will focus on reviewing current obstetric and neonatal management practices and their associations with germinal matrix hemorrhage-IVH.

Endoscopic management of intraventricular shunt-related cystic compartment in paediatric patients

Background. Intraventricular uniloculated compartments are relatively seen frequently in children previously treated with ventriculoperitoneal shunts for hydrocephalus. These compartments may present before shunt insertion and even as an end result to the shunt gliosis. Although the availability of different surgical modalities for the management of such loculations but till now there is no consensus about a single therapeutic approach for its management. Objective. The aim of this study is to assess the role of neuroendoscopy in management of uniloculated compartments, in pediatric cases who underwent shunting for hydrocephalus, to avoid multiple shunt insertion and even to eliminate the need for the preexisting shunt system.Patients and Methods. We retrospectively studied 44 consecutive previously shunted patients with isolated intraventricular compartment who underwent 58 endoscopic procedures by a single surgeon during the period between February 2015 and February 2018. These procedures included endoscopic cyst fenestration, intraventricular septum pellucidotomy, foraminoplasty and additionally third ventriculostomy in some cases was added to the previous procedures. Multiloculated hydrocephalus and cysts related to the tumours were excluded. Clinical, radiological and surgical data were assessed.Results. The most common cause of a single loculation in those patients was neuroepithelial cyst (20 cases) followed by post shunt isolated compartment (12 cases), meningitis (8 cases) and four cases of intraventricular haemorrhage. The patient's age varied from two months up to seven years (mean = 3.2 years). The follow-up period was ranged from (2-49 months) with the mean of 12.3 months. The overall success of restoration of communication between the uniloculated compartment and the ventricular system was achieved in 36 patients (81.8%), with 28 (63.6%) patient needed only one shunt and eight (18.2%) patients became independent of their previous shunts. Fourteen repeated endoscopic procedures were considered necessary in ten patients for either reopening of a closed stoma and/or shunt revision and finally, eight patient (18%) required additional shunt insertion during follow up period. The complications encountered were minor and reversible (CSF leak in two cases, infection in two cases, subdural fluid collection in four cases) with no mortality.Conclusion. Minimal invasive endoscopic technique is a useful operative alternative to control uniloculated compartments in patients with previous ventriculoperitoneal shunts. It does not only simplify the existing shunt system by restoration of the communication between the loculated compartment and the draining shunt but it may eliminate the need for external shunt in some cases as well.

Successful use of an artificial placenta to support extremely preterm ovine fetuses at the border of viability

Exvivo uterine environment therapy is an experimental life support platform designed to reduce the risk of morbidity and mortality for extremely preterm infants born at the border of viability (21-24 weeks' gestation). To spare the functionally immature lung, this platform performs gas exchange via a membranous oxygenator connected to the umbilical vessels, and the fetus is submerged in a protective bath of artificial amniotic fluid. We and others have demonstrated the feasibility of extended survival with exvivo uterine environment therapy therapy in late preterm fetuses; however, there is presently no evidence to show that the use of such a platform can support extremely preterm fetuses, the eventual translational target for therapy of this nature. The objective of the study was to use our exvivo uterine environment therapy platform to support the healthy maintenance of 600-700 g/95 days gestational age (equivalent to 24 weeks of human gestation) sheep fetuses. Primary outcome measures were as follows: (1) maintenance of key physiological variables; (2) absence of infection; (3) absence of brain injury; and (4) growth and cardiovascular function patterns matching that of noninstrumented, age-matched in utero controls. Singleton fetuses from 8 ewes underwent surgical delivery at 95 days' gestation (term, 150 days). Fetuses were adapted to exvivo uterine environment therapy and maintained for 120 hours with real-time monitoring of key physiological variables. Umbilical artery blood samples were regularly collected to assess blood gas data, differential counts, inflammation, and microbial load to exclude infection. Brain injury was evaluated by gross anatomical and histopathological approaches after euthanasia. Nine pregnant control animals were euthanized at 100 days' gestation to allow comparative postmortem analyses. Data were tested for mean differences with an analysis of variance. Seven of 8 exvivo uterine environment group fetuses (87.5%) completed 120 hours of therapy with key parameters maintained in a normal physiological range. There were no significant intergroup differences (P > .05) in final weight, crown-rump length, and body weight-normalized lung and brain weights at euthanasia compared with controls. There were no biologically significant differences in hematological parameters (total or differential leucocyte counts and plasma concentration of tumor necrosis factor-α and monocyte chemoattractant protein 1) (P > .05). Daily blood cultures were negative for aerobic and anaerobic growth in all exvivo uterine environment animals. There was no difference in airspace consolidation between control and exvivo uterine environment animals, and there was no increase in the number of lung cells staining positive for the T-cell marker CD3. There were no increases in interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-α, and monocyte chemoattractant protein 1 mRNA expression in lung tissues compared with the control group. No cases of intraventricular hemorrhage were observed, and white matter injury was identified in only 1 exvivo uterine environment fetus. For several decades, there has been little improvement in outcomes of extremely preterm infants born at the border of viability. In the present study, we report the use of artificial placenta technology to support, for the first time, extremely preterm ovine fetuses (equivalent to 24 weeks of human gestation) in a stable, growth-normal state for 120 hours. With additional refinement, the data generated by this study may inform a treatment option to improve outcomes for extremely preterm infants.

Diagnosis and treatment of five neonatal cerebral venous sinus thrombosis

Objective: To summarize the clinical presentations and imaging features of cerebral venous sinus thrombosis (CVST) in 5 newborns. Methods: The clinical data of 5 newborns with CVST admitted to Department of Neonatology of Maternal and Children Hospital of Hubei Province from February 2017 to April 2018 were analyzed retrospectively. The risk factors, clinical presentations, imaging manifestations and treatment of CVST were investigated. Results: Of the 5 full term neonates, 4 were males and 1 female, with 4 aged less than 7 days and 1 more than 7 days; one with the history of maternal gestational diabetes mellitus, one with maternal gestational hypertension. The clinical presentations included seizures (3 cases), fever (3 cases), dehydration (1 cases), lethargy (2 cases), hypoglycemia (2 cases), thrombocytopenia (2 cases). Electroencephalogram (EEG) showed electrical seizures in 3 cases. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) showed 4 cases of intracranial hemorrhage, 3 cases of cerebral parenchymal infarction. For the sites of the thrombi, 4 were in the superior sagittal sinus, 3 in straight sinus, 2 in transverse sinus and 1 in sinus confluence. CT showed intracranial hemorrhage in 2 cases and venous sinus dilatation in 2 cases. Doppler ultrasound showed 2 cases of intraventricular hemorrhage and 2 cases of changes of venous sinus blood flow. Three neonates were treated with anticoagulant and thrombolytic therapy, followed by recanalization of the veins and discontinuing of seizures. Conclusions: Seizure is the main clinical presentation of CVST. The main radiologic manifestations are cerebral infarction and hemorrhage. Timely brain MRI and MRV are helpful in the early diagnosis and treatment of CVST.

The Utility of Head Computed Tomography in the Evaluation of Apparent Life-Threatening Event.

This study aimed to evaluate the diagnostic utility of empiric head computed tomography (CT) in apparent life threatening event (ALTE). This was a retrospective chart review of children younger than 12 months presenting to an urban pediatric hospital and its suburban satellite for an ALTE from October 2009 to December 2012. The ALTE cases were identified as having had a diagnosis of ALTE (International Classification of Diseases, 9th Revision 799.82) or as having had a constellation of studies performed consistent with our institutional protocol for ALTE evaluation. Exclusion criteria were known trauma and cases lacking an identifiable ALTE feature on review. There were 631 cases identified, of which 617 met inclusion and exclusion criteria. Of those, 537 had a head CT performed. Five patients were identified with clinically important head CT findings: a case of congenital toxoplasmosis, a case of intraventricular hemorrhage, and 3 cases of nonaccidental trauma (NAT). One of the NAT patients had a bruise on his forehead; the other patients had no historical, physical examination, and other laboratory or radiologic findings to raise concern for significant finding on head CT. The rate of clinically significant findings and occult clinically significant findings was 5/537 (0.93%) (95% confidence interval, 0.30%-2.16%; number needed to treat = 108) and 4/537 (0.75%) (95% confidence interval, 0.20%-1.90%; number needed to treat = 135), respectively. The rate of clinically important head CT findings in ALTE evaluation was relatively rare, at 0.93%. Given the severe consequences of missing these cases, these data establish a role for empiric head CT in the evaluation of ALTE.

Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: a case series and review of the literature.

Tumors within the pineal region represent 1.5 to 8.5% of the pediatric brain tumors and 1.2% of all brain tumors. A management algorithm has been proposed in several publications. The algorithm includes endoscopic third ventriculostomy (ETV) and biopsy in cases presenting with hydrocephalus. In this series, we are presenting the efficacy of a single-trajectory approach for both ETV and biopsy. Eleven cases were admitted to Alexandria main university hospital from 2013 to 2016 presenting with pineal region tumors and hydrocephalus. Mean age at diagnosis was 11years (1-27years). All cases had ETV and biopsy using rigid ventriculoscope through a single trajectory from a burr hole planned on preoperative imaging. Follow-up period was 7-48months. All 11 cases presented with hydrocephalus and increased intracranial pressure manifestations. Histopathological diagnosis was successful in 9 out of 11 cases (81.8%). Three cases were germ-cell tumors, two cases were pineoblastomas, two cases were pilocytic astrocytomas, and two cases were grade 2 tectal gliomas. Five of the ETV cases (45.5%) failed and required VPS later on. Other complications of ETV included one case of intraventricular hemorrhage and a case with tumor disseminated to the basal cisterns. In our series, we were able to achieve ETV and biopsy through a single trajectory and a rigid endoscope with results comparable to other studies in the literature.

Clinical analysis of 30 cases of neonatal group B streptococcus sepsis

Objective To explore the clinical characteristics, treatment and prognosis of neonatal group B streptococcus (GBS) sepsis. Methods According to the onset time and clinical features of the patients, 30 cases of neonatal GBS sepsis in Department of Neonatology, Zhuhai People′s Hospital and ICU of Newborn of Maternity and Child Care Health Hospital of Guangxi from January 2013 to February 2015 were divided into the early-onset group (onset day of the patients ≤7 days) and late-onset group (onset day of the patients >7 days). The clinical manifestations, the examination results of laboratory, imaging examination, treatment and prognosis were retrospectively analyzed. Results Among the newborns diagnosed as neonatal GBS sepsis, there were 19 cases of early-onset sepsis and 11 cases of late-onset sepsis, including 17 males and 13 females, consisting of 24 term infants and 6 premature infants.The early-onset newborns were mainly diagnosed with respiratory symptoms like anhelation, groaning (73.7%, 14/19 cases), late-onset GBS sepsis with high fever (81.8%, 9/11 cases), high frequency of early-onset intraute-rine infection pneumonia (89.5%, 17/19 cases) and late-onset intracranial infection (63.6%, 7/11 cases). The differences between the 2 groups were statistically significant(all P<0.05). Laboratory tests of GBS sepsis showed that the early value of procalcitonin (PCT) increased, while the number of white blood cells, platelet decreased and C-reactive protein (CRP) increased relatively late.Chest X-ray examination showed 16 cases of pneumonia in children, 1 case of pulmonary hemorrhage, 1 case of bilateral pneumothorax. Head CT, B ultrasound, and magnetic resonance imaging discover 1 case of ventricular perivascular hemorrhage, 2 cases of intraventricular hemorrhage with ventricular dilatation and 1 case of subdural effusion.Drug sensitivity test showed that 30 cases of children were sensitive to Penicillin, Vancomycin among which 17 cases (56.66%) were cured, 4 cases (23.33%) were improved, 9 cases died, 6 cases died of abandoning treatment, and the total mortality was 30.00% (9/30 cases). The 6-month follow-up of 9 cases of purulent meningitis newborns showed that there were 2 cases of mild mental retardation and motor dysfunction, 1 case of mild ventricular dilatation with no progressive increase, and 6 cases with no significant sequelae. Conclusion The clinical manifestations of neonatal GBS sepsis are typical.Dynamically monitoring the changes of PCT, CRP, white blood cells and platelet helps to early identify GBS sepsis infection and use sensitive antibiotics to cure the newborns. Key words: Group B streptococcal; Infant, neonatal; Sepsis

Long-term outcomes of extremely preterm infants and extremely low birth weight infants with low one-minute Apgar score

Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score (≤7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11% (4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation. Key words: Infant, extremely low birth weight; Apgar score; Survival rate; Treatment outcome

Ventricular Zone Disruption in Human Neonates With Intraventricular Hemorrhage.

To determine if ventricular zone (VZ) and subventricular zone (SVZ) alterations are associated with intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus, we compared postmortem frontal and subcortical brain samples from 12 infants with IVH and 3 nonneurological disease controls without hemorrhages or ventriculomegaly. Birth and expiration estimated gestational ages were 23.0-39.1 and 23.7-44.1 weeks, respectively; survival ranges were 0-42 days (median, 2.0 days). Routine histology and immunohistochemistry for neural stem cells (NSCs), neural progenitors (NPs), multiciliated ependymal cells (ECs), astrocytes (AS), and cell adhesion molecules were performed. Controls exhibited monociliated NSCs and multiciliated ECs lining the ventricles, abundant NPs in the SVZ, and medial vs. lateral wall differences with a complex mosaic organization in the latter. In IVH cases, normal VZ/SVZ areas were mixed with foci of NSC and EC loss, eruption of cells into the ventricle, cytoplasmic transposition of N-cadherin, subependymal rosettes, and periventricular heterotopia. Mature AS populated areas believed to be sites of VZ disruption. The cytopathology and extension of the VZ disruption correlated with developmental age but not with brain hemorrhage grade or location. These results corroborate similar findings in congenital hydrocephalus in animals and humans and indicate that VZ disruption occurs consistently in premature neonates with IVH.

Demographic Risk Factors for Vascular Lesions as Etiology of Intraventricular Hemorrhage in Prospectively Screened Cases

Background: Spontaneous intraventricular hemorrhage (IVH) is associated with high rates of morbidity and mortality despite critical care and other advances. An important step in clinical management is to confirm/rule out an underlying vascular lesion, which influences further treatment, potential for further bleeding, and prognosis. Our aim is to compare demographic and clinical characteristics between IVH patients with and without an underlying vascular lesion, and among cohorts with different vascular lesions. Methods: We analyzed prospectively collected data of IVH patients screened for eligibility as part of the Clot Lysis: Evaluation Accelerated Resolution of IVH Phase III (CLEAR III) clinical trial. The trial adopted a structured screening process to systematically exclude patients with an underlying vascular lesion as the etiology of IVH. We collected age, sex, ethnicity, and primary diagnosis on these cases and vascular lesions were categorized prospectively as aneurysm, vascular malformation (arteriovenous malformation, dural arteriovenous fistula, and cavernoma), Moyamoya disease, or other vascular lesion. We excluded cases <18 or >80 years of age. Baseline characteristics were compared between the CLEAR group (IVH screened without vascular lesion) and the group of IVH patients screened and excluded from CLEAR because of an identified vascular lesion. We further analyzed the differential demographic and clinical characteristics among subcohorts with different vascular lesions. Results: A total of 10,538 consecutive IVH cases were prospectively screened for the trial between 2011 and 2015. Out of these, 496 cases (4.7%) screened negative for underlying vascular lesion, met the inclusion criteria, and were enrolled in the trial (no vascular etiology group); and 1,205 cases (11.4%) were concurrently screened and excluded from the trial because of a demonstrated underlying vascular lesion (vascular etiology group). Cases with vascular lesion were less likely to be >45 years of age (OR 0.28, 95% CI 0.20-0.40), African-American (OR 0.23, 95% CI 0.18-0.31), or male gender (OR 0.48, 95% CI 0.38-0.60), and more likely to present with primary IVH (OR 1.85, 95% CI 1.37-2.51) compared to those with no vascular etiology (p < 0.001). Other demographic factors were associated with specific vascular lesion etiologies. A combination of demographic features increases the association with the absence of vascular lesion, but not with absolute reliability (OR 0.1, 95% CI 0.06-0.17, p < 0.001). Conclusion: An underlying vascular lesion as etiology of IVH cannot be excluded solely by demographic parameters in any patient. Some form of vascular imaging is necessary in screening patients before contemplating interventions like intraventricular fibrinolysis, where safety may be impacted by the presence of vascular lesion.

Measurement of interleukin-6 (IL-6) and erythropoietin (EPO) in umbilical cords of preterm infants with intraventricular hemorrhage in two hospitals in Tehran

Background: Intraventricular hemorrhage (IVH) is an important cause of death in premature infants. This study aimed to assess the association of the umbilical cord plasma levels of interleukin-6 (IL-6) and erythropoietin (EPO) with the occurrence and severity of IVH in premature infants.Methods: Fifty premature newborns of mothers with chorioamnionitis risk factor were selected via nonprobability sampling. The concentration of the cord plasma’s IL-6 and erythropoietin were measured by enzyme-linked immunosorbent assay (ELISA) for 3 days. Finally, all samples underwent sonography for the diagnosis of IVH. Results analyzed statistically.Results: Among the samples, 68.98% of them were diagnosed with IVH grade 1. The most severe IVH cases were detected on the second day. The mean and standard deviation of IL-6 level was 74.71 ± 50.53 in the case group and 24.10 ± 46.10 in the control group. There was a correlation between IL-6 levels and IVH (p = 0.0005). The mean and standard deviation of EPO level was 18.38 ± 15.23 in the IVH group and 6.45 ± 13.48 in samples without IVH. A correlation was detected between EPO level and IVH (p = 0.005).Conclusion: The concentration of IL-6 and EPO levels of the cord plasma was higher in the premature newborns with IVH.

Abstract T P322: Risk Factors for Vascular Lesions as Etiology of Intraventricular Hemorrhage in Prospectively Screened Cases

Introduction: Previous studies have used inconsistent screening thresholds and modalities for detecting vascular lesions as the cause of intraventricular hemorrhage (IVH). We aimed to characterize demographic and ethnicity risks of harboring vascular lesions in a cohort of prospectively identified IVH cases with systematic screening for underlying vascular etiology. Methods: Patients with IVH were identified from the database of Clot Lysis: Evaluation Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR III) clinical trial. It included patients age 18-80 years with obstructive IVH with or without associated intracerebral hemorrhage (ICH) less than 30 ml in volume. This cohort study compared 447 patients enrolled in CLEAR, who were screened negative for underlying vascular lesion (no lesion), and 1276 patients with IVH concurrently screened and excluded from CLEAR because of underlying lesion (vascular lesion). Results: Mean age was lower in patients with vascular lesion (55 vs. 59; p&lt;.001), with a greater difference in patients with vascular malformations (47 versus 58, p&lt;.001) and Moyamoya disease (45 versus 58, p&lt;.001), and there was no difference in age of patients with aneurysms versus no lesion (mean age 59 in both groups). Male prevalence was lower (lesion: 42%, no lesion: 55%; p&lt;.001), with a higher prevalence in those with vascular malformations than those with aneurysm (56% versus 35%, p&lt;.001) and Moyamoya disease (56% versus 39%, p=0.074). The prevalence of Whites was higher (lesion: 60%, no lesion: 51%; p&lt;.001) and that of African-Americans lower (lesion: 11%, no lesion: 33%; p&lt;.001). The prevalence of patients with primary IVH as opposed to IVH with intracerebral hemorrhage (ICH) was higher among patients with lesions (lesion: 21%, no lesion: 15%; p=.003). Conclusion: IVH patients with an underlying vascular lesion tend to be significantly younger, more likely female, White, and harbor primary IVH. The younger age is attributed to vascular malformations or Moyamoya disease, rather than aneurysm. Patients with lesion may have exhibited other characteristic features of hemorrhage not addressed in this study.

Factors that predict hydrocephalus following intraventricular hemorrhage

Objective. To evaluate potential risk factors that can predict the development of hydrocephalus (HCP) in adult patients with intraventricular hemorrhage (IVH). Methods. Retrospective analysis of all adult patients presented to King Fahad Medical City between 2004 and 2011 with intraventricular hemorrhage to evaluate different variables and their association with HCP. Results. A total of 31 patients were included in the study, 14 patients (45.16%) developed HCP. Seventy-four percent of HCP patients (10 out of 14) had Graeb classification of ≥6 and/or had IVH affecting all ventricles, while 76% of the patients without HCP (13 out of 17) had a Graeb classification of < 6 and/or had IVH only in the lateral ventricles (8 out of 17) or lateral ventricles and either third or fourth ventricle (5 out of 17). Statistical analysis showed that HCP is significantly associated with both Graeb classification of 6 or greater number of IVH affecting all ventricles and 3 versus 1–2 affected ventricles; (OR (95% CI, p value), respectively, 19.3(2, > 20), p value < 0.05; 8.5 (1.6, > 30), p value < 0.05. Conclusion. HCP following IVH is present in approximately half of all IVH cases. In the present retrospective study, it was found that patients with higher grades of IVH and/or a greater number of affected ventricles had a greater risk of developing HCP.

Clinical analysis of 66 cases of intraventricular hemorrhage

Objective To explore treatment methods and prognosis of external ventricular drainage .Methods A retrospective analysis of 66 cases with severe intraventricular hemorrhage patients were selected ,36 cases underwent bilateral ventricle drainage and urokinase （ UK ） intraventricular fibrinolysis therapy ＋terminal cistern drainages , 30 cases with bilateral ventricle drainage and urokinase for intraventricular fibrinolysis .The prognosis of the patients with modified Rankin Scale score was assessed .After multiple cerebral CT examination hematoma imaging changes were observed.Results A group of intraventricular hemorrhage clearing time （5.3 ±1.5）d,B group of intraventricu-lar hemorrhage clearing time （8.2 ±2.5）d,there was significant difference （t=-5.820,P=0.000）.Rate in group A was 83.3%（30/36）,group B was 66.7%（20/30）, there was no significant difference （χ2 =2.475,P=0.116）. Conclusion This study suggests that intraventricular hemorrhage were given bilateral ventricle drainage and uroki -nase for intraventricular fibrinolysis therapy ＋terminal cistern drainages effect is better . Key words: Cerebral hemorrahage; Cerebral vertricle; Eextemal ventricular dralnage; Urokinas; Terminal cis-tern drainage