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The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
Early prediction of neurological outcome may be assessed by cerebral function monitoring (CFM) or an electroencephalogram (EEG). Early cranial ultrasound may show diagnoses other than HIE, cerebral injury established before birth and the evolution of acute cerebral damage.
Methods and Procedures
Published in Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin, Brain Injury and Pediatric Cardiac Surgery, 2019
Jane W. Newburger, Wypij David
Early in the study, cranial ultrasound examinations were performed on the day before surgery and again one week postoperatively to provide information about brain structural injury in the perioperative period. On September 17, 1990, investigators and members of the Safety and Data Monitoring Committee appointed by the National Heart, Lung, and Blood Institute (NHLBI) agreed that the scarcity of abnormalities detected at this time (halfway through the enrollment period) suggested that cranial ultrasound findings could not significantly contribute to the inferences from the study. Therefore, this test was discontinued.
Hematological problems in the neonate
Published in Prem Puri, Newborn Surgery, 2017
Andrea M. Malone, Owen P. Smith
Neonatal alloimmune thrombocytopenia (NAIT) is characterized by marked thrombocytopenia in the fetus and neonate. It occurs following maternal sensitization to a paternally inherited fetal platelet antigen that is lacking in the mother. The mother forms an IgG antibody that crosses the placenta and destroys fetal platelets. In contrast to hemolytic disease of the newborn (the red blood cell analog of NAIT), NAIT may occur during the first pregnancy. It complicates between 1 in 100 and 1 in 2000 births.9 NAIT typically presents as an isolated severe thrombocytopenia in an otherwise healthy child at birth. The most serious complication is intracranial hemorrhage, which occurs in 10%–20% of affected newborns.10 The risk of severe thrombocytopenia and intracranial hemorrhage is greater in alloimmune than in autoimmune thrombocytopenia. For testing to confirm NAIT, it must reveal both a platelet antigen incompatibility between the parents and a maternal antibody derived against that antigen. The most commonly involved antigen is HPA-1a. The mainstay of treatment is transfusion of donor-matched, antigen negative platelets with neonatal specification, and IVIG. Initial evaluation should include a cranial ultrasound to detect hemorrhage. The thrombocytopenia typically resolves over 3–6 weeks. NAIT is very likely to recur in subsequent pregnancies, and the thrombocytopenia is often more severe in the next child.
Fetal anemia in monochorionic twins: a review on diagnosis, management, and outcome
Published in Expert Review of Hematology, 2023
L.S.A. Tollenaar, F. Slaghekke, J.M. Middeldorp, E. Lopriore
Although outcome in TTTS has improved, neonatal morbidity still remains twice as high compared to the outcome of uncomplicated MC twins (26% vs. 13%, respectively) [36]. Neonatal morbidity in TTTS treated with laser is mostly related to the degree of prematurity and includes respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, and retinopathy of prematurity. Severe cerebral injury is detected in 5–10% of the treated TTTS survivors and can be a consequence of the TTTS itself or can be related to prematurity [36,37]. We therefore recommend routine cranial ultrasound examinations in all TTTS survivors at birth to rule out a severe cerebral injury. Neonatal mortality still occurs in approximately 5–8% of liveborn infants treated with laser, mostly as the result of extreme prematurity [6,36]. Severe long-term neurodevelopmental impairment is seen in 12% of TTTS survivors treated with laser surgery, with no difference between donor and recipients [38,39].
Re: Severe skull deformity in a child with shunted hydrocephalus
Published in British Journal of Neurosurgery, 2021
Ezequiel Garcia-Ballestas, Rafael Martinez-Perez, Amit Agrawal, Luis Rafael Moscote-Salazar
The use of ultrasound has been gaining ground in neurosurgery and it is used in the resection of brain tumors and even in the resection of spinal lesions as well.7 Similarly ultrasound can be used as an alternative to CT scan as it is non-invasive, portable and cost-effective tool to monitor the size of the ventricles, development of the brain8 and size of the sutures9 without the risk of radiation exposure. Suture obliteration can be detected early by ultrasound in children <12 months of age10,11 We think that the ultrasonographic evaluation of the cranial sutures can be an adjunct in region with limited resources. Short targeted training can make neurosurgeons comfortable with this technique in countries where other resources are not readily available. As the authors discuss2, this complication occurs mainly in patients who had a delay in shunt placement. Cranial ultrasound is a widely available, simple technique that can allow cranial evaluation (free of radiation particularly in resource limited regions of the world. This can help in early detection of symptomatic hydrocephalus, possible neurosurgical intervention as well as a follow-up measure of craniosynostosis and for the early detection of craniosynostosis associated with shunts.
Longitudinal Changes in the Sensorimotor Pathways of Very Preterm Infants During the First Year of Life With and Without Intervention: A Pilot Study
Published in Developmental Neurorehabilitation, 2021
Sonia Khurana, Megan E Evans, Claire E Kelly, Deanne K Thompson, Jennifer C. Burnsed, Amy D. Harper, Karen D. Hendricks-Muñoz, Mary S Shall, Richard D Stevenson, Ketaki Inamdar, Gregory Vorona, Stacey C Dusing
The emergence of new technology has allowed for advances in evaluation and diagnosis of brain injury. Structural MRI is a sensitive tool to identify subtle structural lesions and to provide further information regarding the volume and cortical morphology as compared to cranial ultrasound (cUS).1 Diffusion-weighted MRI (DWI) can evaluate the microstructural organization of the brain white matter, based on mapping of water diffusion in biological tissues.6 When combined with DWI analysis methods including Diffusion Tensor Imaging (DTI), parameters such as Fractional Anisotropy (FA), Mean Diffusivity (MD) and white matter volume can be extracted. These parameters provide an overall quantification of the underlying brain white matter structure, such as the axonal density and myelination.7 In addition, the availability of non-sedated MRI protocols has increased the safety of doing MRI in infants.