Risk Factors For Cerebral Lesions Research Articles

Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome

To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery. A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in "high-risk survivors," defined as those delivered at <32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts. For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 "high-risk survivors" (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery <32 weeks' (odds ratio, 4.95; P < .001) and <28 weeks' (odds ratio, 6.25; P < .001) gestation were associated with increased likelihood of any cerebral lesion. This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.

Cerebral Injury in Twin–Twin Transfusion Syndrome Treated With Fetoscopic Laser Surgery

To estimate the incidence and risk factors for cerebral lesions in monochorionic twins with twin-twin transfusion syndrome treated with fetoscopic laser surgery compared with dichorionic twins. We performed a case-control study on cerebral injury detected by postnatal cranial ultrasonography in monochorionic twin neonates with twin-twin transfusion syndrome treated with a laser compared with a control group of dichorionic twin neonates matched for gestational age at birth. Severe cerebral lesions were defined as the presence of at least one of the following: intraventricular hemorrhage grade III, periventricular hemorrhagic infarction, periventricular leukomalacia grade II or greater, porencephalic cysts, arterial stroke, ventricular dilatation, or a combination of these. From 2004 until 2011, 267 twin neonates with twin-twin transfusion syndrome could be included and matched with 267 dichorionic twin neonates. Incidence of severe cerebral lesions in the twin-twin transfusion syndrome group and control group was 8.6% (23 of 267) and 6.7% (18 of 267), respectively (P=.44). Multivariable analysis revealed that only gestational age at birth was independently associated with increased risk for severe cerebral lesions (odds ratio [OR] 1.35 for each week, 95% confidence interval [CI] 1.14-1.59, P<.01). In 52.2% (12 of 23), the cerebral lesions in the twin-twin transfusion syndrome group were of antenatal origin compared with 16.7% (3 of 18) in the control group (OR 8.00, 95% CI 1.42-45.06, P=.02). Incidence of severe cerebral lesions in twin-twin transfusion syndrome treated with laser is similar to a matched control group and is independently associated with prematurity. In contrast to dichorionic twins, cerebral injury in twins with twin-twin transfusion syndrome most often occurs antenatally.

M10.4 Preeclampsia, a risk factor for cerebral lesions?

M10.4 Preeclampsia, a risk factor for cerebral lesions?

87: Which factor affect the occurrence of cerebral lesions in neonates born with intrauterine infection?

BORN WITH INTRAUTERINE INFECTION? ANNA LOCATELLI, MARIANNA ANDREANI, FRANCESCA ASSI, AGNESE PIZZARDI, SILVIA MALGUZZI, ALESSANDRO GHIDINI, University of Milano-Bicocca, Obstetrics and Gynecology, Monza, Italy, University of Milano-Bicocca, Neonatology, Monza, Italy OBJECTIVE: Intrauterine infection (II) is a risk factor for cerebral lesions (CL), and part of the damage seems to be attributed to the immune fetal response. We have evaluated which factor have an effect on neonatal ultrasonographic (US) evidence of CL in the presence of histological or clinical evidence of II. STUDY DESIGN: From a cohort of 567 consecutive singleton neonates born after preterm delivery at 24.0-31.6 weeks from 1/1993 to 12/2006 we selected 180 infants with histological and/or clinical evidence of II. Obstetric (gestational age, pregnancy complications, use of steroids and antibiotic, fetal distress, mode of delivery) and neonatal (sex, weight, Apgar score, pH, neonatal complications) were evaluated in reference to evidence of neonatal severe US CL, defined as IVH grade 3-4 and/or PVL. Excluded were stillbirths and congenital anomalies. Logistic regression analysis was used to control for confounders with P 0.05 considered significant. RESULTS: Table 1 Logistic regression analysis demonstrated that evidence of neonatal severe US CL is independently associated with antenatal administration of corticosteroids (OR 0.3, 95% CI 0.11, 0.88, P 0.03) and occurrence of abruptio placentae (OR 5.4, 95% CI 1.4, 20.7, P 0.02)