Deep Medullary Vein Thrombosis in Newborns: A Systematic Literature Review.

IF 2.6 3区 医学 Q1 PEDIATRICS Neonatology Pub Date : 2023-01-01 Epub Date: 2023-06-28 DOI:10.1159/000530647
Jacopo Norberto Pin, Letizia Leonardi, Margherita Nosadini, Maria Federica Pelizza, Luca Capato, Luca Piretti, Maria Elena Cavicchiolo, Paolo Simioni, Eugenio Baraldi, Giorgio Perilongo, Matteo Luciani, Stefano Sartori
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Abstract

Background: Deep medullary vein (DMV) thrombosis is a rare cause of brain damage in both preterm and full-term neonates. In this study, we aimed to collect data on clinical and radiological presentation, treatment, and outcome of neonatal DMV thrombosis.

Methods: Systematic literature review on neonatal DMV thrombosis was carried out in PubMed, ClinicalTrial.gov, Scopus, and Web of Science up to December 2022.

Results: Seventy-five published cases of DMV thrombosis were identified and analysed (preterm newborns were 46%). Neonatal distress, respiratory resuscitation, or need for inotropes were present in 34/75 (45%) of patients. Signs and symptoms at presentation included seizures (38/75, 48%), apnoea (27/75, 36%), lethargy or irritability (26/75, 35%). At magnetic resonance imaging (MRI), fan-shaped linear T2 hypointense lesions were documented in all cases. All had ischaemic injuries, most often involving the frontal (62/74, 84%) and parietal lobes (56/74, 76%). Signs of haemorrhagic infarction were present in 53/54 (98%). Antithrombotic treatment was not mentioned in any of the studies included. Although mortality was low (2/75, 2.6%), a large proportion of patients developed neurological sequelae (intellectual disability in 19/51 [37%] and epilepsy in 9/51 [18%] cases).

Conclusions: DMV thrombosis is rarely identified in the literature, even if it is possibly under-recognized or under-reported. Presentation in neonatal age is with seizures and non-specific systemic signs/symptoms that often cause diagnostic delay, despite the pathognomonic MRI picture. The high rate of morbidity, which determines significant social and health costs, requires further in-depth studies aimed at earlier diagnosis and evidence-based prevention and therapeutic strategies.

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新生儿延髓深静脉血栓形成:系统文献综述。
背景:髓深静脉血栓形成是早产儿和足月新生儿脑损伤的罕见原因。在这项研究中,我们旨在收集新生儿DMV血栓形成的临床和放射学表现、治疗和结果的数据。方法:截至2022年12月,在PubMed、ClinicalTrial.gov、Scopus和Web of Science上对新生儿DMV血栓形成进行了系统的文献综述。结果:确定并分析了75例已发表的DMV血栓病例(早产儿占46%)。34/75(45%)的患者出现新生儿窘迫、呼吸复苏或需要止痛药。发作时的体征和症状包括癫痫发作(38/75,48%)、呼吸暂停(27/75,36%)、嗜睡或易怒(26/75,35%)。在磁共振成像(MRI)中,所有病例都记录了扇形线性T2低强度病变。所有患者都有缺血性损伤,最常见的是额叶(62/74,84%)和顶叶(56/74,76%)。出血性梗死的症状出现在53/54(98%)。在纳入的任何研究中均未提及抗血栓治疗。尽管死亡率很低(2/75,2.6%),但很大一部分患者出现了神经后遗症(19/51例为智力残疾[37%],9/51例为癫痫[18%])。结论:DMV血栓形成在文献中很少被发现,即使它可能被低估或报道不足。新生儿年龄段的表现是癫痫发作和非特异性全身体征/症状,尽管有病理性MRI图像,但通常会导致诊断延迟。高发病率决定了巨大的社会和健康成本,需要进一步深入研究,以早期诊断和循证预防和治疗策略。
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来源期刊
Neonatology
Neonatology 医学-小儿科
CiteScore
0.60
自引率
4.00%
发文量
91
审稿时长
6-12 weeks
期刊介绍: This highly respected and frequently cited journal is a prime source of information in the area of fetal and neonatal research. Original papers present research on all aspects of neonatology, fetal medicine and developmental biology. These papers encompass both basic science and clinical research including randomized trials, observational studies and epidemiology. Basic science research covers molecular biology, molecular genetics, physiology, biochemistry and pharmacology in fetal and neonatal life. In addition to the classic features the journal accepts papers for the sections Research Briefings and Sources of Neonatal Medicine (historical pieces). Papers reporting results of animal studies should be based upon hypotheses that relate to developmental processes or disorders in the human fetus or neonate.
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