Fetal Intraparenchymal Hemorrhage Imaging Patterns, Etiology, and Outcomes: A Single Center Cohort Study.
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
31 Aug 2024
31 Aug 2024
Historique:
revised:
10
08
2024
received:
26
04
2024
accepted:
15
08
2024
medline:
1
9
2024
pubmed:
1
9
2024
entrez:
31
8
2024
Statut:
aheadofprint
Résumé
This study examines associations among fetal brain magnetic resonance imaging (MRI) injury patterns, etiologies, and outcomes in fetal intraparenchymal hemorrhage (IPH). This is a retrospective, single-center cohort study of IPH diagnosed on fetal MRI (1996-2022). IPH and associated abnormalities were categorized by 2 pediatric neuroradiologists; electronic medical records were reviewed by 2 pediatric neurologists to classify etiology and outcomes including cerebral palsy, epilepsy, developmental delay, and death. Forty-four fetuses with IPH were identified (34 singleton and 10 twin gestations) with MRI at median 24 weeks gestation (interquartile range [IQR] = 22-28 weeks). IPH was commonly supratentorial (84%) and focal (50%) or focal with diffuse injury (43%) and was often associated with germinal matrix hemorrhage (GMH; 75%) and/or intraventricular hemorrhage (IVH; 52%). An etiology was identified in 75%, including twin-twin transfusion syndrome (TTTS, n = 10), COL4A1/2 variants (n = 8), or other fetal/maternal conditions (n = 15). COL4A1/2 variants were associated with focal IPH and the presence of hemorrhagic porencephaly, and intrauterine transfusion was associated with infratentorial hemorrhage. Twenty-two fetuses were liveborn, and 18 pregnancies were terminated. Among those with follow-up ≥ 12 months (median = 7 years), 12 of 13 had cerebral palsy, 6 of 13 had developmental delay, and 5 of 13 had epilepsy. An etiology for fetal IPH with or without GMH-IVH is identified in most cases in our cohort and is commonly TTTS, COL4A1/2 variants, or other maternal/fetal comorbidities. Pattern of fetal IPH on MRI is associated with etiology. Cerebral palsy and neurodevelopmental impairment were common in liveborn infants. Genetic studies should be considered in cases of fetal IPH without an otherwise apparent cause. ANN NEUROL 2024.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Brain Vascular Malformation Consortium
ID : U54NS065705
Informations de copyright
© 2024 The Author(s). Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
Références
Agrawal N, Johnston SC, Wu YW, et al. Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Stroke 2009;40:3415–3421.
Ferriero DM, Fullerton HJ, Bernard TJ, et al. Management of Stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019;50:e51–e96.
Raju TNK, Nelson KB, Ferriero D, et al. Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics 2007;120:609–616.
Sileo FG, Zöllner J, D'Antonio F, et al. Perinatal and long‐term outcome of fetal intracranial hemorrhage: systematic review and meta‐analysis. Ultrasound Obstet Gynecol 2022;59:585–595.
Golomb MR, Saha C, Garg BP, et al. Association of cerebral palsy with other disabilities in children with perinatal arterial ischemic stroke. Pediatr Neurol 2007;37:245–249.
Ozduman K, Pober BR, Barnes P, et al. Fetal stroke. Pediatr Neurol 2004;30:151–162.
Practice Bulletin No. 175: Ultrasound in pregnancy. Obstet Gynecol 2016;128:e241–e256.
Kutuk MS, Yikilmaz A, Ozgun MT, et al. Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage. Childs Nerv Syst 2014;30:411–418.
Dunbar MJ, Woodward K, Leijser LM, Kirton A. Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis. Dev Med Child Neurol 2021;63:144–155.
Adiego B, Martínez‐Ten P, Bermejo C, et al. Fetal intracranial hemorrhage. Prenatal diagnosis and postnatal outcomes. J Matern‐Fetal Neonat Med 2019;32:21–30.
Elchalal U, Yagel S, Gomori JM, et al. Fetal intracranial hemorrhage (fetal stroke): does grade matter?: fetal intracranial hemorrhage. Ultrasound Obstet Gynecol 2005;26:233–243.
Gano D, Cowan FM, De Vries LS. Cerebral palsy after very preterm birth—an imaging perspective. Semin Fetal Neonatal Med 2020;25:101106.
IBM Corp. IBM SPSS Statistics for Windows. IBM Press; 2020.
George E, Vassar R, Mogga A, et al. Spectrum of fetal Intraparenchymal hemorrhage in COL4A1/A2‐related disorders. Pediatr Neurol 2023;147:63–67.
Fraser S, Levy SM, Talebi Y, et al. A national, electronic health Record–based study of perinatal hemorrhagic and ischemic stroke. J Child Neurol 2023;38:206–215.
Srivastava R, Mailo J, Dunbar M. Perinatal stroke in fetuses, preterm and term infants. Semin Pediatr Neurol 2022;43:100988.
Sanapo L, Whitehead MT, Bulas DI, et al. Fetal intracranial hemorrhage: role of fetal MRI: fetal intracranial hemorrhage and fetal MRI. Prenat Diagn 2017;37:827–836.
Gano D, Agarwal S, Khakoo Y. Pediatric neurology in the post‐roe era. Pediatr Neurol 2023;149:182–183.
Russ JB, Brown JEH, Gano D. The next frontier in neurology is in utero. JAMA Neurol 2023;80:1015–1016.
Tarui T, Venkatesan C, Gano D, et al. Fetal neurology practice survey: current practice and the future directions. Pediatr Neurol 2023;145:74–79.
Griffiths PD, Bradburn M, Campbell MJ, et al. Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): a multicentre, prospective cohort study. Lancet 2017;389:538–546.
Epstein KN, Kline‐Fath BM, Zhang B, et al. Prenatal evaluation of intracranial hemorrhage on fetal MRI: a retrospective review. Am J Neuroradiol 2021;42:2222–2228.
Berezowsky A, Hochberg A, Regev N, et al. Intrauterine blood transfusion for Parvo B19‐induced fetal anemia: neuroimaging findings and long‐term neurological outcomes. Fetal Diagn Ther 2023;50:206–214.
Glenn OA, Bianco K, Barkovich AJ, et al. Fetal cerebellar hemorrhage in parvovirus‐associated non‐immune hydrops fetalis. J Matern Fetal Neonatal Med 2007;20:769–772.
Simonazzi G, Bernabini D, Curti A, et al. Fetal cerebellar damage in fetuses with severe anemia undergoing intrauterine transfusions. J Matern Fetal Neonatal Med 2016;29:389–392.
Gano D, Barkovich AJ. Cerebellar hypoplasia of prematurity: causes and consequences. Handb Clin Neurol 2019;162:201–216.
Cole L, Dewey D, Letourneau N, et al. Clinical characteristics, risk factors, and outcomes associated with neonatal hemorrhagic stroke: a population‐based case‐control study. JAMA Pediatr 2017;171:230–238.
Tiller H, Kamphuis MM, Flodmark O, et al. Fetal intracranial haemorrhages caused by fetal and neonatal alloimmune thrombocytopenia: an observational cohort study of 43 cases from an international multicentre registry. BMJ Open 2013;3:e002490.
Coste T, Vincent‐Delorme C, Stichelbout M, et al. COL4A1/COL4A2 and inherited platelet disorder gene variants in fetuses showing intracranial hemorrhage. Prenat Diagn 2022;42:601–610.
Maurice P, Guilbaud L, Garel J, et al. Prevalence of COL4A1 and COL4A2 mutations in severe fetal multifocal hemorrhagic and/or ischemic cerebral lesions. Ultrasound Obstet Gynecol 2021;57:783–789.
Agarwal S, Venkatesan C, Tarui T, Gano D. Advancing the field of fetal neurology: a call for global collaborations. Indian Pediatr 2023;60:795–799.
Ilves N, Pajusalu S, Kahre T, et al. High prevalence of Collagenopathies in preterm‐ and term‐born children with periventricular venous hemorrhagic infarction. J Child Neurol 2023;38:373–388.
Bamberg C, Hecher K. Update on twin‐to‐twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol 2019;58:55–65.
Jelin AC, Norton ME, Bartha AI, et al. Intracranial magnetic resonance imaging findings in the surviving fetus after spontaneous monochorionic cotwin demise. Am J Obstet Gynecol 2008;199:398.e1–398.e5.
Shinar S, Harris K, Van Mieghem T, et al. Early imaging predictors of fetal cerebral ischemic injury in monochorionic twin pregnancy complicated by spontaneous single intrauterine death. Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet Gynecol 2022;59:497–505.
Merhar SL, Kline‐Fath BM, Meinzen‐Derr J, et al. Fetal and postnatal brain MRI in premature infants with twin‐twin transfusion syndrome. J Perinatol 2013;33:112–118.
Quarello E, Molho M, Ville Y. Incidence, mechanisms, and patterns of fetal cerebral lesions in twin‐to‐twin transfusion syndrome. J Matern Fetal Neonatal Med 2007;20:589–597.
Kocaoglu M, Kline‐Fath BM, Calvo‐Garcia MA, et al. Magnetic resonance imaging of the fetal brain in monochorionic diamniotic twin gestation: correlation of cerebral injury with ultrasound staging and survival outcomes. Pediatr Radiol 2020;50:1131–1138.
Vanholder IM, Ecury‐Goossen GM, Admiraal J, et al. Congenital amegakaryocytic thrombocytopenia presenting with a new thrombopoietin receptor (MPL) pathogenic variant: an instructive neonatal case. J Paediatr Child Health 2022;58:2319–2321.