scholarly journals LPA1/3 overactivation induces neonatal posthemorrhagic hydrocephalus through ependymal loss and ciliary dysfunction

2019 ◽  
Vol 5 (10) ◽  
pp. eaax2011 ◽  
Author(s):  
Nicole C. Lummis ◽  
Paloma Sánchez-Pavón ◽  
Grace Kennedy ◽  
Aaron J. Frantz ◽  
Yasuyuki Kihara ◽  
...  
Keyword(s):  
Premature Infants ◽  
Therapeutic Interventions ◽  
Ependymal Cells ◽  
High Risk Population ◽  
Csf Flow ◽  
Increased Intracranial Pressure ◽  
Posthemorrhagic Hydrocephalus ◽  
Lpa Receptor ◽  
Pharmacological Blockade ◽  
Chronic Comorbidities

Posthemorrhagic hydrocephalus (PHH) in premature infants is a common neurological disorder treated with invasive neurosurgical interventions. Patients with PHH lack effective therapeutic interventions and suffer chronic comorbidities. Here, we report a murine lysophosphatidic acid (LPA)–induced postnatal PHH model that maps neurodevelopmentally to premature infants, a clinically accessible high-risk population, and demonstrates ventriculomegaly with increased intracranial pressure. Administration of LPA, a blood-borne signaling lipid, acutely disrupted the ependymal cells that generate CSF flow, which was followed by cell death, phagocytosis, and ventricular surface denudation. This mechanism is distinct from a previously reported fetal model that induces PHH through developmental alterations. Analyses of LPA receptor–null mice identified LPA1 and LPA3 as key mediators of PHH. Pharmacological blockade of LPA1 prevented PHH in LPA-injected animals, supporting the medical tractability of LPA receptor antagonists in preventing PHH and negative CNS sequelae in premature infants.

Epidural Abscess and Vertebral Osteomyelitis Following Serial Lumbar Punctures

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 476-480 ◽  
Author(s):  
Ira Bergman ◽  
Ellen R. Wald ◽  
John D. Meyer ◽  
Michael J. Painter
Keyword(s):  
Premature Infants ◽  
Epidural Abscess ◽  
Vertebral Osteomyelitis ◽  
Infectious Complications ◽  
Causative Organism ◽  
Surgical Drainage ◽  
Csf Flow ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Intravenous Antibiotics

Lumbar epidural abscess and vertebral Osteomyelitis were diagnosed in a 3-month-old infant, born prematurely, who had had repeated lumbar punctures for the treatment of posthemorrhagic hydrocephalus. Staphylococcus aureus was the causative organism. Successful treatment was achieved with 6 weeks of intravenous antibiotics without surgical drainage. Infectious complications of lumbar punctures are rare, but may occur when multiple punctures are attempted in small premature infants whose subarachnoid space contains large amounts of blood. Infection can be introduced directly by a contaminated spinal needle, or trauma to the tissues with bleeding can create a favorable site for bacterial adherence and multiplication. Posthemorrhagic ventricular dilation often resolves spontaneously and serial lumbar punctures should be used to treat this condition only when CSF flow is easy to establish and maintain.

Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience

2009 ◽  
Vol 3 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Brian Willis ◽  
Vijayakumar Javalkar ◽  
Prasad Vannemreddy ◽  
Gloria Caldito ◽  
Junko Matsuyama ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Premature Infants ◽  
Preterm Neonates ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Group ◽  
Institutional Experience ◽  
Csf Diversion ◽  
The Mean

Object The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants. Methods From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions. Results The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity. Conclusions Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.

scholarly journals Premature Infants with Intraventricular Hemorrhage and Perioperative Management of Neonatal Posthemorrhagic Hydrocephalus

2013 ◽  
Vol 22 (4) ◽  
pp. 276-282
Author(s):  
Masakazu Miyajima ◽  
Takaoki Kimura ◽  
Akihide Kondo ◽  
Kazuaki Shimoji ◽  
Hajime Arai
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Perioperative Management ◽  
Posthemorrhagic Hydrocephalus

A Potential Mechanism of Pathogenesis for Early Posthemorrhagic Hydrocephalus in the Premature Newborn

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 19-21
Author(s):  
Alan Hill ◽  
Gary D. Shackelford ◽  
Joseph J. Volpe
Keyword(s):  
Particulate Matter ◽  
Posterior Fossa ◽  
Intraventricular Hemorrhage ◽  
Ventricular System ◽  
Potential Mechanism ◽  
Ultrasound Scanning ◽  
Csf Flow ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Expected Time

Ventricular dilation is common following intraventricular hemorrhage. Neuropathologic studies have demonstrated that chronic posthemorrhagic hydrocephalus most commonly is a result of an obliterative arachnoiditis in the posterior fossa or is due to obstruction of flow of CSF within the ventricular system. Recent use of ultrasound scanning has demonstrated the occurrence of ventricular dilation within days of intraventricular hemorrhage (prior to the expected time of development of arachnoiditis). In the case described, serial realtime ultrasound scans demonstrated small mobile particles within dilated ventricles seven days following intraventicular hemorrhage. There was no obstruction of CSF flow within the ventricular system. Thus, in this case, ventricular dilation may have been secondary to plugging of arachnoid villi by the small particulate matter and, as a consequence, decrease in CSF reabsorption.

scholarly journals 27 Determinants of referral to developmental resources among neonatal follow-up patients discharged from tertiary neonatal unit from 2005 UNTIL 2014

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e10-e10
Author(s):  
Maad Saleem ◽  
Lamia Hayawi ◽  
Nick Barrowman ◽  
Nadya BenFadel ◽  
Jana Feberova ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
High Risk ◽  
Premature Infants ◽  
Gestational Age ◽  
High Risk Population ◽  
Risk Population ◽  
Neurodevelopmental Impairment ◽  
Developmental Support

Abstract Background Lower gestational age or birth weight and higher rate of neurodevelopmental impairment have been commonly linked to higher need for developmental resources in premature infants. Existing evidence on need for developmental support in premature infants is limited in description of the needs, timing and method of assessment. Objectives To identify predictors for the needs for developmental resources among high-risk groups of infants born less than 29 weeks or with a birth weight (BW) less than 1250 grams. Secondarily, to compare the need of referrals to developmental resources and the rate of neurodevelopmental impairment defined as cerebral palsy, global developmental delay, blindness and deafness for this high risk population. Design/Methods We conducted a retrospective chart review of premature infants < 29+0 weeks GA or BW < 1250 grams born between January 2005 and December 31st 2014, who had at least one visit at the neonatal follow up clinic. Univariate and multivariate logistic regression analyses were conducted to examine potential predictors for referral to developmental resources. Results The study included 687 infants. Within this high risk population, 579 (85.0%) of infants were referred, of these 153 (26.4%) had one referral, 132 (22.8%) had 2 and 294 (50.8%) had 3 or more referral/s to developmental resources. Most frequent referrals were for speech therapy (339, 50.0%) physiotherapy (319, 46.8%) occupational therapy (262, 38.3%) and infant development program (232, 34.1%). The rates of referral to developmental resources decrease with increasing gestational age. Multivariate logistic regressions showed that gestational age (OR: 1.19, 95% CI: 1.05 - 1.35), birth weight (OR: 0.87, 95% CI: 0.77 - 0.99), female gender (OR: 0.70, 95% CI: 0.49 - 0.99), intraventricular hemorrhage grades III-IV (OR: 3.02, 95% CI: 1.28 - 7.16), and days on mechanical ventilator (OR:1.03, 95% CI: 1.01 - 1.05) were predictors for 2 or more referrals to developmental resources. Cerebral palsy was present in 4.4 % of the study population, deafness in 4% and blindness in 0.6%. The rate of referral to developmental resources was 54 (98.2%) among infants with neurodevelopmental impairment (NDI) compared to 522 (83.9%) in infants without NDI (p value= 0.01). Conclusion There is substantial need for developmental support among high-risk premature infants. Infants without neurodevelopmental impairments still need significant developmental resources to achieve their outcome.

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