Outcome of Neonates Presenting With Severe Cardiac Failure due to Cerebral Arteriovenous Fistula.

Arteriovenous Fistula / complications Critical Illness / therapy Embolization, Therapeutic / methods Heart Failure / complications Humans Infant, Newborn Retrospective Studies
Central nervous system vascular malformation EEG Electroencephalogram Infant Interventional radiology Neonatal Seizures Neurocritical Care Newborn

Journal

Pediatric neurology
ISSN: 1873-5150
Titre abrégé: Pediatr Neurol
Pays: United States
ID NLM: 8508183

Informations de publication

Date de publication:
06 2022
Historique:
received: 06 12 2021
revised: 25 03 2022
accepted: 06 04 2022
pubmed: 25 4 2022
medline: 26 5 2022
entrez: 24 4 2022
Statut: ppublish

Résumé

Congenital cerebral arteriovenous fistulas (AVFs), including vein of Galen malformations, presenting in infancy carry variable mortality and morbidity. This study aimed to describe the outcome of neonates with cerebral AVFs who present with refractory cardiac failure. Retrospective chart review of neonates with refractory cardiac failure due to cerebral AVFs presenting before 28 days of age in a single-center neuro-intensive care nursery over a 12-year period (2008-2020) was conducted. Seventeen neonates were included. Twelve had a vein of Galen malformation, four a non-galenic pial AVF, and one a dural AVF. Seven neonates (41%) died without receiving an embolization procedure. The remaining ten were critically ill. Seven (70%) were mechanically ventilated and on nitric oxide, 5 (50%) were on pressors, and 6 (60%) had renal and/or hepatic dysfunction. Seven (70%) had pre-existing brain injury on imaging. The first embolization procedure occurred at a median age of 4 days (range: 0-8 d). Complications included intracranial hemorrhage in 8 of 10 (80%) and seizures in 5 of 8 (62%). Five (50%) neonates who underwent embolization died. Among the 5 neonates who survived, all have motor impairment. Four (80%) developed hydrocephalus requiring a ventriculoperitoneal shunt, and 2 (40%) developed epilepsy and are nonverbal. In this cohort of critically ill neonates with cerebral AVF, all seven who did not receive embolization and half of ten who were treated died. The five survivors all have neurodevelopmental impairment. This information may be helpful to parents and providers who make decisions regarding life-sustaining treatments for neonates with cerebral AVFs and refractory cardiac failure.

Sections du résumé

BACKGROUND
Congenital cerebral arteriovenous fistulas (AVFs), including vein of Galen malformations, presenting in infancy carry variable mortality and morbidity. This study aimed to describe the outcome of neonates with cerebral AVFs who present with refractory cardiac failure.
METHODS
Retrospective chart review of neonates with refractory cardiac failure due to cerebral AVFs presenting before 28 days of age in a single-center neuro-intensive care nursery over a 12-year period (2008-2020) was conducted.
RESULTS
Seventeen neonates were included. Twelve had a vein of Galen malformation, four a non-galenic pial AVF, and one a dural AVF. Seven neonates (41%) died without receiving an embolization procedure. The remaining ten were critically ill. Seven (70%) were mechanically ventilated and on nitric oxide, 5 (50%) were on pressors, and 6 (60%) had renal and/or hepatic dysfunction. Seven (70%) had pre-existing brain injury on imaging. The first embolization procedure occurred at a median age of 4 days (range: 0-8 d). Complications included intracranial hemorrhage in 8 of 10 (80%) and seizures in 5 of 8 (62%). Five (50%) neonates who underwent embolization died. Among the 5 neonates who survived, all have motor impairment. Four (80%) developed hydrocephalus requiring a ventriculoperitoneal shunt, and 2 (40%) developed epilepsy and are nonverbal.
CONCLUSION
In this cohort of critically ill neonates with cerebral AVF, all seven who did not receive embolization and half of ten who were treated died. The five survivors all have neurodevelopmental impairment. This information may be helpful to parents and providers who make decisions regarding life-sustaining treatments for neonates with cerebral AVFs and refractory cardiac failure.

Identifiants

DOI: 10.1016/j.pediatrneurol.2022.04.006 PMID: 35462109
pubmed: 35462109
pii: S0887-8994(22)00056-X
doi: 10.1016/j.pediatrneurol.2022.04.006
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

25-29

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Marie-Coralie Cornet (MC)

Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California.

Yi Li (Y)

Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.

Roxanne L Simmons (RL)

Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.

Amanda Baker (A)

Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.

Heather J Fullerton (HJ)

Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.

Steven W Hetts (SW)

Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.

Hannah C Glass (HC)

Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California. Electronic address: Hannah.Glass@ucsf.edu.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Fistule › Fistule vasculaire › Fistule artérioveineuse › Outcome of Neonates Presenting With Severe...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Outcome of Neonates Presenting With Severe...
questionsmedicales.fr › Thérapeutique › Occlusion thérapeutique › Embolisation thérapeutique › Outcome of Neonates Presenting With Severe...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Outcome of Neonates Presenting With Severe...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcome of Neonates Presenting With Severe...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Outcome of Neonates Presenting With Severe...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Outcome of Neonates Presenting With Severe...