Neonatal Hemorrhage Research Articles

Fundus Photography-Based Distribution of Retinal Hemorrhages in Newborns: Implications for Underlying Mechanisms.

Introduction: The aim of this study was to investigate the locational distribution and potential mechanisms of retinal hemorrhages in newborns using fundus photography. Methods: A retrospective analysis of 98 consecutive newborns with retinal hemorrhages in at least one eye and 30 control newborns without retinal hemorrhages after uneventful delivery was conducted. Retinal hemorrhages were diagnosed and characterized using fundus photography and indirect ophthalmoscopy. The location, grade, and features of the hemorrhages were analyzed, alongside their association with delivery mode. Visual function was assessed at a mean follow-up of 7.8 months to evaluate the long-term implications. Results: Retinal hemorrhages were significantly associated with normal spontaneous vaginal delivery (NSVD) compared to cesarean section (p = 0.004). Bilateral involvement was observed in 87.8% of cases, with hemorrhages predominantly located around the major vascular arcade (MVA) and near the optic disc. Higher grades of hemorrhages were linked to increased involvement of the macula and retinal capillary area (RCA) (p < 0.001). All hemorrhages resolved spontaneously within 45.6 ± 15.9 days. No significant differences in refractive errors or strabismus development were identified between the hemorrhage and control groups at follow-up. Conclusions: Neonatal retinal hemorrhages are commonly observed near the MVA and optic disc, with greater severity associated with macular and RCA involvement. These findings, along with the significant association with NSVD, support a mechanism related to elevated central venous pressure. Retinal hemorrhages resolve spontaneously without impacting refractive error or strabismus development in the short term follow-up.

Occurrence and Time of Onset of Intraventricular Hemorrhage in Preterm Neonates

Intraventricular hemorrhage (IVH) has been described to typically occur during the early hours of life (HOL); however, the exact time of onset is still unknown. To investigate the temporal distribution of IVH reported in very preterm neonates. PubMed, Embase, Cochrane Library, and Web of Science were searched on May 9, 2024. Articles were selected in which at least 2 cranial ultrasonographic examinations were performed in the first week of life to diagnose IVH. Studies with only outborn preterm neonates were excluded. Data were extracted independently by 3 reviewers. A random-effects model was applied. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality in Prognostic Studies 2 tool was used to assess the risk of bias. The overall occurrence of any grade IVH and severe IVH among preterm infants was calculated along with a 95% CI. The temporal distribution of the onset of IVH was analyzed by pooling the time windows 0 to 6, 0 to 12, 0 to 24, 0 to 48, and 0 to 72 HOL. A subgroup analysis was conducted using studies published before and after 2007 to allow comparison with the results of a previous meta-analysis. A total of 21 567 records were identified, of which 64 studies and data from 9633 preterm infants were eligible. The overall rate of IVH did not decrease significantly before vs after 2007 (36%; 95% CI, 30%-42% vs 31%; 95% CI, 25%-36%), nor did severe IVH (10%; 95% CI, 7%-13% vs 11%; 95% CI, 8%-14%). The proportion of very early IVH (up to 6 HOL) after 2007 was 9% (95% CI, 3%-23%), which was 4 times lower than before 2007 (35%; 95% CI, 24%-48%). IVH up to 24 HOL before and after 2007 was 44% (95% CI, 31%-58%) and 25% (95% CI, 15%-39%) and up to 48 HOL was 82% (95% CI, 65%-92%) and 50% (95% CI, 34%-66%), respectively. This systematic review and meta-analysis found that the overall prevalence of IVH in preterm infants has not changed significantly since 2007, but studies after 2007 showed a later onset as compared with earlier studies, with only a small proportion of IVHs occurring before 6 HOL.

Development of a machine learning model for prediction of intraventricular hemorrhage in premature neonates.

Intraventricular hemorrhage (IVH) is a common and severe complication in premature neonates, leading to long-term neurological impairments. Early prediction and identification of risk factors for IVH in premature neonates are crucial for improving clinical outcomes. This study aimed to predict IVH in premature neonates and determine risk factors using machine learning (ML) algorithms. This study investigated the medical records of premature neonates admitted to the neonatal intensive care unit. The patients were labeled as case (IVH) and control (No IVH). The independent variables included demographic, clinical, laboratory, and imaging data. Machine learning algorithms, including random Forest, support vector machine, logistic regression, and k-nearest neighbor, were used to train the models after data preprocessing and feature selection. The performance of the trained models was evaluated using various performance metrics. Data from 160 premature neonates were collected including 70 patients with IVH. The identified risk factors for IVH were the gestational age, birth weight, low Apgar scores at 1min and 5min, delivery method, head circumference, and various laboratory findings. The random forest algorithm demonstrated the highest sensitivity, specificity, accuracy, and F1 score in predicting IVH in premature neonates, with a great area under the receiver operating characteristic curve of 0.99. This study revealed that the random forest model effectively predicted IVH in premature neonates. The early identification of premature neonates at higher risk of IVH allows for preventive measures and interventions to reduce the incidence and morbidity of IVH in these patients.

Identification of CSPG4 as a Biomarker and Therapeutic Target for Infantile Post-Hemorrhagic Hydrocephalus via Multi-Omics Analysis.

Intraventricular hemorrhage in preterm neonates has become a major global health problem and is associated with a high risk of post-hemorrhagic hydrocephalus (PHH). Identifying diagnostic markers and therapeutic targets is a focal challenge in the PHH prevention and control. Here, this study applies multi-omics analyses to characterize the biochemical, proteomic, and metabolomic profiles of the cerebrospinal fluid (CSF) in clinical human cohorts to investigate disease development and recovery processes occurring due to PHH. Integrative multiomics analysis suggests that the over-representation of ferroptosis, calcium, calcium ion binding, and cell adhesion signaling pathways is associated with PHH. Bioinformatic analysis indicates that chondroitin sulfate proteoglycan 4 (CSPG4) is discovered as a CSF biomarker and positively correlated with the ventricular size and the rate of periventricular leukomalacia. Next, it is further demonstrated that these signaling pathways are dysregulated in the choroid plexus (ChP) in PHH by using in vitro cellular experiments and rat models of PHH, whereas CSPG4 silencing can suppress ferroptosis, cell adhesion function, and the intracellular flow of Ca2+. These findings broaden the understanding of the pathophysiological mechanisms of PHH and suggest that CSPG4 may be an effective therapeutic target for PHH.

Prevalence, type, and risk factors of intracranial hemorrhage in term neonates: a systematic review and meta-analysis.

Intracranial hemorrhage in the newborn poses a significant challenge to their well-being and subsequent development. In pre-term neonates, germinal matrix hemorrhage is the most common cause of intracranial hemorrhage with the prevalence varying from 20 to 59%. However, in term neonates, the prevalence and type of intracranial hemorrhage have not been well elucidated. The type of hemorrhage occurring in term neonates differs from those occurring in pre-term neonates. We conducted a systematic review to assess the prevalence, type, and risk factors of intracranial hemorrhage occurring in term neonates. We conducted a systematic review and meta-analysis by searching the PubMed and Embase databases. Inclusion criteria were studies reporting intracranial hemorrhage in term neonates (37weeks or more gestational age at the time of birth). Exclusion criteria were as follows: (1) studies which examined only a specific type of hemorrhage, (2) studies which examined only a single risk factor, (3) sample size < 20, (4) not in English language, and (5) full text not accessible/available. The studies which met the eligibility criteria were assessed and evaluated by two authors, and data was extracted using a predesigned template. The risk of bias in the included studies was assessed using the Joanna Briggs Institute bias assessment tool. The meta-analysis for prevalence, type of hemorrhage, and risk factor was conducted using MetaXL extension for Microsoft Excel. A total of 1226 records were identified in a database search of PubMed and Embase. After screening, 20 studies were included in the final analysis. The overall prevalence of intracranial hemorrhage in term neonates was 9.3% (95% CI, 4.9-14.9%). The prevalence of intracranial hemorrhage in asymptomatic patients was 5.8% (95% CI, 2.5-10.2%) and in symptomatic patients was 29.3% (95% CI, 15.3-44.8%). Sub-group analysis of the modality of detection shows that the prevalence of hemorrhage detection was higher with computed tomography/magnetic resonance imaging (CT/MRI) than with ultrasonography (USG). Extra-axial hemorrhage was the most common type of hemorrhage detected, comprising about 32.4% of the overall. The odds of having an intracranial hemorrhage was significantly higher with an instrumental delivery (OR = 3.75, 95% CI, 1.4-10.02). The present study shows that the prevalence of intracranial hemorrhage is relatively high in symptomatic and asymptomatic patients with extra-axial hemorrhage being the most common type of hemorrhage. The prevalence of hemorrhage varied according to the type of imaging used for detection and ideal imaging modality for evaluation, and the consequences of intracranial hemorrhage in term infants on development remain to be determined.

Risk factors and adverse outcomes of initial non-invasive ventilation failure in very low birth weight infants: a multicenter retrospective cohort study

Objective: To investigate the risk factors of initial non-invasive ventilation(NIV) failure and its association with adverse outcomes in very low birth weight infants (VLBWI). Methods: A retrospective cohort study was conducted, collecting clinical data of 2 102 VLBWI who received NIV within 30 minutes after birth, admitted to 18 NICU of Suxinyun Neonatal Perinatal Collaboration Network (SNPN) from January 1st, 2019 to December 31st, 2022. According to the outcome of NIV within the first 72 hours, the study cohort was divided into success group and failure group. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for NIV failure and its association with adverse outcome. Results: A total of 2 102 VLBWI were included, consisting of 1 078 males (51.3%). The gestational age was 29 (28, 31) weeks, and the birth weight was 1 250 (1 090, 1 380) g. The initial NIV failure rate was 15.3%(321/2 102). Multivariate Logistic regression analysis showed that smaller gestational age (OR=0.67, 95%CI 0.61-0.74, P<0.001), maternal hypertensive disorders during pregnancy (OR=10.31, 95%CI 7.48-14.21, P<0.001), Apgar score at the first minute ≤7 (OR=1.40, 95%CI 1.01-1.93, P=0.042), grade 3-4 respiratory distress syndrome (RDS)(OR=2.85, 95%CI 1.69-4.81, P<0.001), ≥2 times pulmonary surfactant (PS) treatment (OR=3.78, 95%CI 2.09-6.83, P<0.001), fraction of inspired oxygen (FiO2)>0.30 (OR=2.21, 95%CI 1.64-2.98, P<0.001) were all independent risk factors for initial NIV failure. The failure group had higher risks of mortality (OR=10.19, 95%CI 6.50-15.97, P<0.001), pneumothorax (OR=4.33, 95%CI 1.59-11.79, P=0.004), neonatal pulmonary hemorrhage (OR=8.48, 95%CI 4.08-17.64, P<0.001), moderate to severe bronchopulmonary dysplasia (BPD)(OR=1.75, 95%CI 1.19-2.56, P=0.004), and intraventricular hemorrhage (IVH) ≥grade Ⅲ (OR=2.18, 95%CI 1.27-3.73, P=0.004) compared to the success group. Conclusions: Small gestational age, maternal hyertensive disorders during pregnancy, Apgar score at the first minute ≤7, grade 3-4 RDS, PS treatment ≥2 times and FiO2 >0.30 are risk factors for initial NIV failure in VLBWI. Initial NIV failure is associated with increased risk of mortality, pneumothorax, pulmonary hemorrhage, moderate to severe BPD, and IVH ≥grade Ⅲ.

Contemporary mortality of neonatal germinal matrix hemorrhage and incidence of hydrocephalus requiring cerebrospinal fluid diversion in a substantially rural patient population.

Germinal matrix hemorrhage/intraventricular hemorrhage (GMH-IVH) affects primarily preterm infants and causes significant morbidity and mortality. Health disparities are a reality for underserved populations, such as those rural patients. As our institution serves a substantial portion of rural patients, we examined mortality rates and rates of permanent cerebrospinal fluid (CSF) diversion in newborns with GMH-IVH. In this retrospective cohort study of patients with GMH-IVH admitted to our neonatal intensive care unit in 2014-2019, the primary outcomes were rates of mortality and permanent CSF diversion. We examined if demographic, socioeconomic, and disease-specific factors were associated with these outcomes. Analysis was conducted with two definitions of rurality. A total of 162 patients met study criteria, and there were 26 (15.6%) in-hospital mortalities. Mortality was associated with younger gestational age at birth as quantified by a modified World Health Organization prematurity subcategory (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.2-0.9, p = .04) and with higher grade GMH-IVH (OR 1.8, 95% CI 1.2-2.7, p = .007). Permanent CSF diversion was associated with higher grade GMH-IVH (OR 8.7, 95% CI 3.2-40.4, p < .001). Rurality did not meet univariable screening criteria for logistic regression and was considered non-significant. The mortality rates of this substantially rural cohort mirrored published rates, and rurality was not associated with increased mortality or hydrocephalus. However, further research with differing definitions of rurality and more patients may reveal healthcare disparities for which actionable interventions can be designed.

Time trends in antithrombotic therapy during pregnancy and maternal and perinatal outcomes in the Netherlands (2013–19): a nationwide cohort study

Considering the paucity of data, we aimed to describe nationwide time trends in antithrombotic therapy during pregnancy and risks of maternal and perinatal outcomes in the Netherlands. In this nationwide cohort study, all female individuals aged 16-45 years with delivery records in the Dutch perinatal registry between Jan 1, 2013, and Dec 31, 2019, and their infants, were included. Individually linked data from Statistics Netherlands on outpatient medication prescriptions, in-hospital diagnoses, and mortality were used to evaluate time trends in antithrombotic therapy during pregnancy, and risks of maternal and perinatal outcomes (including thromboembolism, bleeding, preeclampsia and eclampsia, and low birthweight). A total of 1 122 711 pregnancies and 1 139 116 infants were included (median maternal age 30·5 years [IQR 27·3-33·7]; 886 085 [78·9%] White; median gravidity 2 (IQR 1-3); and median gestational age at delivery 39 weeks [IQR 38-40]). Low-molecular-weight heparin (LMWH) was the most commonly (more than 99%) prescribed anticoagulants during pregnancy, which slightly increased from 0·7% (1063 of 163 479) in 2013 to 0·9% (1352 of 158 654) in 2019. LMWH was generally started at 5-8 weeks' gestation when oral anticoagulant prescriptions dropped. Antiplatelet drug prescriptions increased from 0·7% (1129 of 163 479) to 4·8% (7671 of 158 654), which primarily initiated around week 12. Maternal risks of venous and arterial thromboembolism and bleeding remained constant from 2013 to 2019; the risk of preeclampsia and eclampsia gradually increased from 1·70% (95% CI 1·63-1·76) in 2013 to 2·05% (1·98-2·13) in 2017, after which it decreased to 1·83% (1·77-1·90) in 2019. There was a significant decrease (2019 vs 2013) in low birthweight (adjusted odds ratio 0·92 [0·90-0·94]; p<0·0001), whereas 28-day neonatal bleeding risk remained unchanged. Exposure to anticoagulants during pregnancy is not uncommon, and health-care providers and female individuals of reproductive age should be mindful of this to avoid unintended oral anticoagulant exposure. Adhering to guidelines for aspirin use to prevent preeclampsia might lead to a population-level reduction in disease burden and potential improvement in neonatal prognosis. None. For the Dutch translation of the abstract see Supplementary Materials section.

Advancing the management of neonatal hemorrhages: clinical evaluation of external ventricular drainage efficacy.

To evaluate the clinical efficacy of external ventricular drainage (EVD) in the treatment of neonatal intraventricular hemorrhage (IVH). A retrospective analysis was conducted on the clinical data of neonates with IVH admitted to the Department of Neurosurgery at Qingdao Women and Children's Hospital from January 2018 to February 2024. All patients received a definitive diagnosis followed by EVD treatment. Regular follow-ups were conducted, and patients who developed posthemorrhagic hydrocephalus (PHH) underwent ventriculoperitoneal shunt (VPS) procedures. Among the 44 neonates with IVH, 28 were male and 16 were female. The median gestational age at birth was 36weeks (range: 24-40weeks), and the median birth weight was 2.9kg (range: 0.78-4.33kg). There were 3 cases of grade II IVH, 34 cases of grade III IVH, and 7 cases of grade IV IVH. The average duration of EVD was 12.2 ± 5.6days. All patients were followed up for at least 1year. Twelve patients (27%) developed hydrocephalus, of which 8 cases (18%) with progressive ventricular enlargement underwent VPS, and 4 cases (9%) had arrested hydrocephalus and remained stable without VPS. During the follow-up period, 39 patients exhibited normal development, 3 patients (6.8%) developed epilepsy, and 2 patients (4.5%) developed cerebral palsy. EVD is an effective treatment for intraventricular hemorrhage. It improves survival rates and outcomes for patients while effectively reducing the incidence of hydrocephalus.

Vascular insult in neonatal retinal hemorrhage: computational analysis of a fundus-segmented blood vessel network

Common hypotheses for the biomechanical cause underlying neonatal retinal hemorrhage include elevated intracranial pressure (ICP) inducing venous outflow obstruction and retinal deformation. A finite element computational model of the eye, optic nerve, and orbit was simulated with particular attention to the retinal vessels to analyze stress and strain on these structures during external head compression associated with normal vaginal delivery. Pressure from maternal contractions displaced the eye backward into the orbit, and the stiff optic nerve sheath provided localized resistance to this posterior displacement at its insertion point, resulting in tensile strain of 2.5% in the peripapillary (central) retina. Correspondingly, retinal vessels experienced tensile stress of up to 2.3 kPa near the optic nerve insertion point and opposing compressive stress of up to 3.2 kPa further away. The optic nerve was longitudinally compressed and experienced a mean radial tensile strain of 2.0%. Overall, forces associated with maternal labor resulted in a pattern of eye deformation that stretched the central retina in this simulation, mirroring the classical posterior localization of neonatal retinal hemorrhage. The optic nerve increased modestly in diameter despite rising ICP, suggesting retinal deformation is a more likely mechanism for retinal hemorrhage than occlusion of the central retinal vein.

Diagnostic Accuracy of Cranial Ultrasound for the Detection of Intracranial Hemorrhage in Preterm Neonates Using Magnetic Resonance Imaging As the Gold Standard.

Background and objective Intracranial hemorrhage (ICH) and white-matter damage are the main brain injuries in preterm infants. Magnetic resonance imaging (MRI) is the best way to examine cerebral bleeding. The evidence on cranial ultrasounddiagnostic accuracy in neonates is limited in Pakistani publications, which show variability in evidence, necessitating the present study. The aim is to find out the diagnostic accuracy of cranial ultrasound for detecting ICH in preterm neonates, taking MRI as the gold standard. Methodology A cross-sectional study was carried out in the Department of Radiology, The Children's Hospital, Lahore, Pakistan, from June 19, 2018 to December 18, 2018. The study involved 103 preterm neonates of both genders aged between 1 and 27 days and presenting with suspicion of ICH. The cranial ultrasound with MRI (gold standard) was used to diagnose ICH, and the results of the cranial ultrasound were assessed accordingly. The diagnostic performance of ultrasound was estimated using parameters, e.g., sensitivity, specificity, accuracy, and positive and negative predictive values. The p < 0.05 was taken as statistically significant. Results The neonateshad a mean age of 9.9 ± 6.6 days. There were 53 (51.5%) male and 50 (48.5%) female neonates. The cranial ultrasound diagnosed ICH in 39 (37.9%) neonates, which is confirmed by MRI as the gold standard. Cranial ultrasound had 100.0% sensitivity, 90.62% specificity, 94.17% accuracy, 86.67% positive predictive value, and 100.0% negative predictive value for detecting ICH in preterm neonates. Similar diagnostic performance was seen across age and gender groups (p > 0.05). Conclusion Cranial ultrasound was 100% sensitive, 90.6% specific, and 94.2% accurate in identifying cerebral bleeding in preterm neonates. The noninvasive, ionizing radiation-free nature and availability at the bedside of cranial ultrasound make it a promising future modality.

Clinical and neuroimaging patterns of perinatal intracranial haemorrhage in fetuses and term-born neonates: a prospective observational cohort study.

To characterise perinatal, clinical and neuroimaging patterns and aetiology of perinatal intracranial haemorrhage (pICH), and to assess potential differences between cases diagnosed antenatally and postnatally. Prospective, observational, single-centre study of 110 consecutive cases of pICH identified in the fetal or neonatal period or diagnosed with presumed pICH between 2014 and 2023. Prematurity-related cases were excluded. Antenatal and postnatal MRI data were analysed for patterns and mechanisms of haemorrhage and their potential aetiology. Potential associations between pICH with perinatal and clinical risk factors were also explored. Fifty-nine of the 110 included cases (53.6%) were diagnosed antenatally (termination of pregnancy, n=22), and postnatal data on 81/88 (92%) children were available. Intraventricular haemorrhage (IVH) was the most common haemorrhage type (83/110 (75.5%)) and was more common prenatally (p=0.004). Subpial haemorrhage was exclusively diagnosed postnatally (p<0.001), and it was more commonly detected in primigravida women (p=0.013). The germinal matrix was the most common origin of IVH (n=56, 50.9%) occuring more frequently prenatally (p<0.001), whereas sinus venous thrombosis-related IVH was more commonly detected postnatally (p=0.002). Subdural haemorrhage was associated with haematological abnormalities (p=0.023). Genetic disorders caused 31.9% of the cases (15 of 47 tested cases). Genetic disorders and associated congenital anomalies were more common in the prenatally diagnosed group (p=0.038 and p=0.04, respectively). The patterns and pathogenesis of pICH appear to be different for prenatally and postnatally diagnosed cases and for types of haemorrhages. Given the important role of genetic factors in prenatal intracranial haemorrhage, next-generation sequencing is indicated in these cases.

A Case Report on Congenital Mesoblastic Nephroma

Aims: This study aims to provide a comprehensive review of the epidemiology, genetic underpinnings, clinical presentation, and management strategies of congenital mesoblastic nephroma (CMN), with a focus on the diagnostic and therapeutic challenges that distinguish it from other neonatal renal tumors such as Wilms’ tumor. By presenting a unique case of a neonate diagnosed with CMN and undergoing tumor resection, we seek to highlight the complexities of perinatal care in such cases and the potential for life-threatening complications despite early intervention. Furthermore, the study underscores the importance of early and accurate differentiation between CMN subtypes, as well as the role of histopathology in guiding treatment approaches. Presentation of Case: A female neonate was born at 34+2 weeks gestation, presenting with a retroperitoneal mass on the left kidney, identified prenatally via ultrasound. Delivered by cesarean section due to polyhydramnios and anemia, a palpable intraabdominal mass was noted during examination. Imaging confirmed a heterogeneous solid lesion suggestive of nephroblastoma. The patient underwent nephroureterectomy, with histopathology confirming congenital mesoblastic nephroma. Despite successful resection, the patient died at 9 days of age from refractory catecholamine septic shock, with complications including neonatal sepsis, gastrointestinal bleeding, and femoral artery thrombosis. Discussion: Congenital mesoblastic nephroma is the most common renal tumor in neonates, often misdiagnosed as Wilms’ tumor. It typically presents before 2 months of age and is associated with translocation (12;15)(p13;q25). The prognosis for classical CMN is excellent, while the cellular variant is more aggressive. Surgical excision is the primary treatment, but the neonate's age necessitates careful management to mitigate risks. In this case, multiple complications contributed to the poor outcome despite timely intervention. Conclusion: CMN is a rare renal tumor in neonates, requiring accurate diagnosis through histopathology. While prognosis is generally favorable, complications from prematurity can adversely affect survival.

Clinical Analysis of Inhaled Nitric Oxide Therapy in Preterm Infants at Different Gestational Ages: A National Retrospective Multicenter Study.

This study aimed to investigate clinical features of inhaled nitric oxide (iNO) in preterm infants with a gestational age (GA) < 34 weeks in China. The clinical data of 434 preterm infants with GA < 34 weeks, treated with iNO in the neonatology departments of eight Class A tertiary hospitals in China over a 10-year period from January 2013 to December 2022, were included in this retrospective multicenter investigation. The infants were divided into three groups based on GA: 24 to 27 weeks (extremely preterm infants), 28 to 31 weeks (very preterm infants), and 32 to 33 weeks (moderate preterm infants). The use of iNO, perinatal data, incidence and mortality of indication for iNO treatment, therapeutic effects of iNO, incidence of short-term complications for iNO treatment, and mortality were compared among these three groups. Over the past 10 years, the proportion of iNO use was highest in extremely preterm infants each year. The lower the GA, the higher the iNO use rate: 4.20% for GA 24 to 27 weeks, 1.54% for GA 28 to 31 weeks, and 0.85% for GA 32 to 33 weeks. There was no significant difference in the therapeutic effect of iNO among the three groups. The incidence of neonatal pulmonary hemorrhage, neonatal shock, late-onset diseases, retinopathy of prematurity requiring intervention, intracranial hemorrhage (grade 3 or 4), periventricular leukomalacia, neonatal necrotizing enterocolitis (≥stage II), and moderate to severe bronchopulmonary dysplasia was highest in extremely preterm infants and increased with decreasing GA. Mortality was negatively correlated with GA and birth weight. The highest rate of iNO treatment in 24 to 27 weeks' preterm infants was due to hypoxic respiratory failure (HRF), whereas the highest rate of iNO treatment in 32 to 33 weeks' preterm infants was due to documented persistent pulmonary hypertension of the newborn (PPHN). The rates of iNO treatment due to HRF and documented PPHN were 54.3 and 60.6%, respectively, in extremely preterm infants, significantly higher than in very preterm and moderate preterm infants (all p < 0.05). Within the same GA group, the proportion of preterm infants treated with iNO for HRF was lower than that for documented PPHN (all p < 0.05), but there was no statistically significant difference in mortality between HRF and documented PPHN treated with iNO (all p > 0.05). Among preterm infants with GA < 34 weeks, the rate of iNO usage was highest in extremely preterm infants. However, iNO failed to improve the clinical outcome of extremely preterm infants with refractory hypoxemia, and there was no significant difference in the therapeutic effect of iNO among preterm infants with different GAs.

THROMBOCYTOPENIA IN NEONATES: INCIDENCE, PRESENTATION, AND STUDY OF CORRELATED FACTORS AT A LAHORE TEACHING HOSPITAL

Background: Patients with thrombocytopenia have been observed to experience changes in their coagulation profile and severity of disease. This study aims to see the incidence, presentation, and correlating factors of thrombocytopenia in newborns. Methods: From Jan 2023 to Jan 2024, 200 newborns in the Paediatric and Pathology Departments of Chaudhry Muhammad Akram Teaching and Research Hospital participated in a cross-sectional study. Utilizing SPSS-23, overall data was analysed. Results: In this study 138 (69%) of the 200 newborns were female, and 62 (31%), were male. Seventy-six (38%) neonates had thrombocytopenia, whereas 124 (62%), neonates had normal platelet counts. Of the 76 newborns, 42 (21%) had mild thrombocytopenia, 25 (12.5%) had moderate thrombocytopenia, and 9 (4.5%) had severe thrombocytopenia. Thirty-five percent early-onset neonatal thrombocytopenia (EOT) had early onset thrombocytopenia, while 46 (23%) had thrombocytopenia in the late onset (LOT) phase. There was a strong correlation discovered between thrombocytopenia and anaemia, jaundice asphyxia, low birth weight, preterm and full-term neonatal birth, and neonatal jaundice. The correlation of bleeding in neonates with thrombocytopenia was significant (p&gt;0.05). Conclusion: Moderate to severe thrombocytopenia in newborns often follows mild thrombocytopenia. Thrombocytopenia is highly correlated with bleeding, preterm birth, full-term birth (extensive monitoring during childbirth), anaemia, hypoxia, and sepsis. In sick newborns, severe thrombocytopenia is considered as a prognostic marker. Pak J Physiol 2024;20(3):37–9, DOI: https://doi.org/10.69656/pjp.v20i3.1703

A Care-bundle to Prevent Germinal Matrix–Intraventricular Hemorrhage in Neonates

A Care-bundle to Prevent Germinal Matrix–Intraventricular Hemorrhage in Neonates

Subgaleal hemorrhage in neonates: a comprehensive review and summary recommendations.

Subgaleal hemorrhages (SH) involve bleeding in the expansive compartment between the periosteum of the skull and the galea aponeurotica. The potentially rapid accumulation of blood in this space is responsible for the clinical severity, as neonates with SH can present with acute hypovolemia, shock and multiorgan failure. SH is associated with instrumented delivery, especially with use of vacuum extraction. Although infrequent, the incidence of SH has not decreased over the past several decades, despite improvements in obstetrical care. Management of severe SH is complex and requires cardiovascular support, management of co-existent encephalopathy, and most importantly correction of coagulopathy and anemia.

Neonatal cardiorespiratory failure caused by splenic hemorrhages: a case report on a fatal and a rescued case

Two cases of neonatal splenic hemorrhage with acute cardiorespiratory failure are described in this report. The first case involves a full-term neonate who was found unresponsive without any witnesses and could not be successfully resuscitated. A postmortem diagnosis revealed a splenic hemorrhage. Second case is an extremely premature neonate who experienced a witnessed cardiovascular collapse on the 14th day of life. Rapid cardiovascular support was administered, resulting in a positive outcome. While splenic hemorrhage is commonly associated with traumatic events, these cases highlight the need of considering spontaneous splenic hemorrhages as a potential cause of acute neonatal compromise, even in the absence of birth-related trauma (e.g., asphyxia, prolonged labor, clavicle fractures, brachial plexus injuries). This report emphasizes the importance of including splenic hemorrhage timely in the differential diagnosis of neonatal cardiorespiratory instability, especially in the absence of more common diagnoses, and discusses the challenges associated with its recognition and treatment.

Birth-related subdural hemorrhage in asymptomatic neonates: evolution over time and differentiation from traumatic subdural hemorrhage.

Intracranial birth-related subdural hemorrhage frequently occurs in asymptomatic newborns and has no adverse long-term sequelae. It is medically and medicolegally important to differentiate birth-related subdural hemorrhage from other pathological causes of intracranial hemorrhage. There is limited literature available on the incidence of birth-related subdural hemorrhage, its imaging features, and evolution over time, mainly because asymptomatic infants do not routinely undergo cranial MRI. To establish the incidence and distribution of birth-related subdural hemorrhage and evaluate their association with various modes of delivery, identify associated features, and evaluate the sequential evolution of signal changes of the birth-related hemorrhages on MRI. A total of 200 healthy term neonates and young infants were included in this retrospective review study. All infants underwent MRI of the brain and cervical spine at postnatal age of 0-2 months with acquisition of a 3D T1-weighted (T1W), 3D or 2D T2-weighted (T2W), and axial diffusion-weighted imaging (DWI) sequences. The scans were evaluated for the presence and distribution of subdural hemorrhages, other intracranial hemorrhages, and associated injuries. Prevalence of intracranial hemorrhage in various modes of delivery was analyzed. Relationship between the signal intensities of the bleeds on T1W, T2W, and DWI scans and the age of the infants was analyzed. Appropriate tests were applied to test for statistical significance of the data. Out of 200 neonates, 66 (33%) had detectable intracranial hemorrhage on MRI with an age range of 11-25 days, including 31 (47%) males and 35 (53%) females. All of them had subdural hemorrhages, 54 (81.8%) of which were in the posterior fossa. Additional parenchymal hemorrhages were present in a few, but no subarachnoid hemorrhages, cervical spinal canal hemorrhages, cortical bridging vein injury, or cervical spinal ligamentous injury were identified within the limitations of the study. No detectable intracranial hemorrhage was found in subjects above 25 days of age. Overall incidence of subdural hemorrhage by mode of delivery was 8/68 (11.8%) in babies born by cesarean section and 58/132 (43.9%) in babies born by vaginal delivery. Among the vaginal deliveries, the highest incidence was observed in assisted vaginal delivery (19/30, 63.3%). Subjects with birth-related subdural hemorrhage were categorized into three age groups: <13 days, 13-21 days, and >21 days. All detected hemorrhages were T1W hyperintense. In the <13 days group, all bleeds were T2W hypointense. In the 13-21 days group, 73.1% were T2W hypointense, while 26.9% were T2W mixed. All bleeds in the >21 days group were T2W hypointense. All DWI hyperintense bleeds were found in the 13-21 days group. Birth-related subdural hemorrhage occurs in over a third of normal deliveries and has a characteristic distribution, predominantly in the posterior fossa. Associated cervical spinal subdural hemorrhages, cervical spinal ligamentous injury, or cortical bridging vein injury, which are concerning for traumatic etiology, were not identified. Birth-related subdural hemorrhages follow a characteristic pattern of signal changes on MRI. Although not completely reliable, this can help in differentiating them from traumatic intracranial hemorrhages which usually occur postnatally. No birth-related subdural hemorrhages were seen after 25 days of age in our cohort.

The Predictive Value of Trancranial Ultrasound Doppler Parameters for Intracerebral Hemorrhage in Preterm and Low Birth Weight Neonates

Abstract Background Premature and low birth neonates are liable for many medical problems including intracranial hemorrhage. Transcranial Ultrasound examination and using different Doppler parameters of both ACA and MCA is considered as a good tool that is non invasive, cost effective and convenient to neonates to detect any intracerebral hemorrhage that they are risk for. Aim of the Work The aim of the current study was the assessment of the transcranial ultrasound as a predictive value of intracereberal hemorrhage in the examined neonates. Patients and Methods The study was performed on 33 preterm and low birth weight neonates attending Ain Shams University neonate intensive care unit and Ultrasound examination by B-Mode followed by Doppler examination were performed. Three neonates were died before performing the second examination. Examination was done at one day of birth considered as the first read and after 4-8 days which were considered as the second read to the rest 30 preterm neonates. Results Upon examination of 30 preterm and low birth neonates in two settings, they were categorized into hemorrhagic and non hemorrhagic groups. And by detecting the different Doppler parameters of both ACA and MCA in the two groups, it was found that the PSV2, MV, RI and PI gave a statistically significant difference between hemorrhagic and non hemorrhagic group. While ACA compared to MCA being has less branches and smaller diameter, its parameters are more sensitive in detection and prediction of hemorrhage than that of MCA. EDV1 of the ACA more than 8.1 cm/sec. was the most sensitive predictor of intracerebral hemorrhage in the present study. Conclusion In the current study, where more details examined upon ACA and MCA separately, it was found that EDV1 of the ACA has more predictive value than that of the EDV1 of MCA which is still can also used as a predictive value for intracranial hemorrhage.