Risk Of Cerebral Lesions Research Articles

Intraaortic Protection From Embolization in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) results in the dislodgement of debris with risk of cerebral lesions or stroke. The EMBOL-X protection device (Edwards Lifesciences, Irvine, CA) is positioned within the ascending aorta to capture such debris. Between July 2012 and April 2014 we randomly assigned 30 high-risk patientsto undergo transaortic TAVI with the SAPIEN XT prosthesis (Edwards Lifesciences) combined with either the EMBOL-X device (group-1, n= 14) or without (group-2, n= 16). Periprocedural cerebral lesions were assessed by diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline and within 7 days post-procedurally. New foci of restricted diffusion on cerebral DW-MRI were found in 69% in group-2 and 50% in group-1. Lesion size was smaller in patients treated with the EMBOL-X device than in those without (88 ± 60 vs 168 ± 217 mm(3), p= 0.27, t= 1.2, degrees of freedom= 10). Transaortic TAVI patients treated with the EMBOL-X device had significantly smaller lesion volumes in the supply region of the middle cerebral artery (33 ± 29 vs 76 ± 67 mm(3), p= 0.04). There were no neurologic events after transaortic TAVI. The intraaortic protection device seems to reduce both the incidence and the volume of new cerebral lesions (ClinicalTrials.gov number, NCT01735513).

Late-onset Sepsis: Epidemiology, Evaluation, and Outcome

Late-onset neonatal sepsis is a common serious problem in preterm infants in neonatal intensive care units. Diagnosis can be difficult because clinical manifestations are not specific and none of the available laboratory tests can be considered an ideal marker. For this reason, a combination of markers has been proposed. Complete blood count and acute-phase reactants evaluated together help in diagnosis. C-reactive protein is a specific but late marker, and procalcitonin has proven accurate, although it is little studied in newborns. Blood, cerebrospinal fluid, and urine cultures always should be obtained when late-onset sepsis is suspected. Blood culture, the gold standard in diagnosis, is highly sensitive but needs up to 48 hours to detect microbial growth. Various cytokines have been investigated as early markers of infection, but results are not uniform. Other diagnostic tests that offer promise include: neutrophil surface markers, granulocyte colony-stimulating factor, toll-like receptors, and nuclear factor kappa B. The greatest hope for quick and accurate diagnosis lies in molecular biology, using real-time polymerase chain reaction combined with DNA microarray. Sepsis and meningitis may affect both the short- and long-term prognosis for newborns. Mortality in neonatal meningitis has been reduced in recent years, but short-term complications and later neurocognitive sequelae remain. Late-onset sepsis significantly increases preterm infant mortality and the risk of cerebral lesions and neurosensory sequelae, including developmental difficulties and cerebral palsy. Early diagnosis of late-onset sepsis contributes to improved neonatal prognosis, but the outcome remains far from satisfactory.

Fetal Heart Rate Accelerations and the Risk of Cerebral Lesions and Poor Neurodevelopmental Outcome in Very Low Birthweight Neonates

Fetal Heart Rate Accelerations and the Risk of Cerebral Lesions and Poor Neurodevelopmental Outcome in Very Low Birthweight Neonates

Fetal Heart Rate Accelerations and the Risk of Cerebral Lesions and Poor Neurodevelopmental Outcome in Very Low Birthweight Neonates

The risk of intraventricular hemorrhage and periventricular leukomalacia correlates with fetal brain immaturity. Given that the appearance of fetal heart rate (FHR) accelerations is associated with brain maturation, we tested the hypothesis that neonatal cerebral lesions and developmental delay in very low birthweight newborns are associated with absent reactivity of the FHR tracing prior to delivery. We analyzed the FHR tracing of 97 fetuses with birthweight < 1200 g who underwent head ultrasound at day 3 and Bayley Scales of Infant Development testing at age 1 year. We used multivariate analysis to adjust for confounding variables. We found that the absence of two FHR accelerations of 10 beats per minute (bpm) for 10 seconds twice in a 20-minute window 1 hour before delivery was associated with intraventricular hemorrhage and/or periventricular leukomalacia ( P < 0.01) and a significant risk for mental and psychomotor delays by Bayley testing ( P < 0.001). The absence of accelerations of 15 bpm for 15 seconds was not associated with these abnormalities. The absence of FHR accelerations before delivery suggests a greater risk for cerebral injury and developmental delay in the very premature neonate.