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

Moran Hausman-Kedem, Stephanie Libzon, Aviva Fattal Valevski, Gustavo Malinger, Nina Krajden Haratz, Itay Tokatly Latzer, Amit Blumovich, Jonathan Roth, Shlomi Constantini, Dror Mandel, Liat Ben-Sira, Shelly I Shiran
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Abstract

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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胎儿和足月新生儿围产期颅内出血的临床和神经影像学模式:一项前瞻性观察队列研究。
研究目的描述围产期颅内出血(pICH)的围产期、临床和神经影像学模式及病因,并评估产前诊断病例与产后诊断病例之间的潜在差异:方法:前瞻性、观察性、单中心研究,对 2014 年至 2023 年间在胎儿期或新生儿期发现的或诊断为推测 pICH 的 110 例连续 pICH 病例进行研究。早产相关病例除外。对产前和产后磁共振成像数据进行了分析,以了解出血的模式和机制及其潜在病因。此外,还探讨了 pICH 与围产期和临床风险因素之间的潜在关联:110例纳入病例中有59例(53.6%)在产前确诊(终止妊娠,22例),81/88例(92%)患儿的产后数据可用。脑室内出血(IVH)是最常见的出血类型(83/110 (75.5%)),在产前更常见(P=0.004)。皮下出血仅在产后确诊(p=0.004):产前和产后确诊病例以及出血类型的 pICH 模式和发病机制似乎有所不同。鉴于遗传因素在产前颅内出血中的重要作用,下一代测序适用于这些病例。
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来源期刊
CiteScore
9.00
自引率
4.50%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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