ABSTRACT
Chronic lung disease is associated with several poorly defined risk factors for impaired cerebral development. Late neonatal onset of subependymal hyperechogenic areas in the caudothalamic groove has been reported in association with dexamethasone treatment and postnatal cytomegalovirus infection. We reviewed charts of 18 patients who developed subependymal hyperechogenicity beyond the first week of life, as well as charts of 79 patients belonging to a prospective surfactant study group. Thirteen of the 18 patients with subependymal hyperdensities had been treated with surfactant and were all found in the subgroup with chronic lung disease. In the surfactant-treated patients who did not develop chronic lung disease, we could not find any patient with subependymal hyperdensities. From the remaining five patients with ultrasound lesions, but who were not treated with surfactant, three had developed chronic lung disease. There was no evident association with dexamethasone treatment or cytomegalovirus infection. Our results support the idea of an association between chronic lung disease and the described echographic lesions in the caudothalamic groove, but the nature of the link between them is still unclear.
Subject(s)
Bronchopulmonary Dysplasia/complications , Cerebral Hemorrhage/diagnostic imaging , Cytomegalovirus Infections/complications , Ependyma/diagnostic imaging , Infant, Premature , Thalamus/diagnostic imaging , Betamethasone/administration & dosage , Betamethasone/adverse effects , Bronchopulmonary Dysplasia/drug therapy , Bronchopulmonary Dysplasia/mortality , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/mortality , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/mortality , Ependyma/pathology , Female , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Hyaline Membrane Disease/complications , Hyaline Membrane Disease/drug therapy , Hyaline Membrane Disease/mortality , Infant, Newborn , Male , Retrospective Studies , Survival Rate , Thalamus/pathology , UltrasonographyABSTRACT
Unilateral thalamic bleeding with associated intraventricular hemorrhage is reported in three full-term neonates. The first presented within 48 hours from birth with early onset streptococcal meningitis, persistent pulmonary hypertension, tonic seizures and a tense fontanelle. The second presented 6 days after birth with irritability, opisthotonus, a tense fontanelle and tonic seizures. The third was admitted three days after birth with seizures and a tense fontanelle. In the latter two infants NMR and CT imaging documented thrombosed superficial and deep cerebral veins. The etiopathogenesis of intracranial venous thrombosis in the neonate is diverse: asphyxia, dehydration, polycythemia, sepsis-meningitis and difficult delivery are the main causes. In one of our patients jugular vein compression by the collar of a negative-pressure ventilation chamber probably initiated the intracranial events. More than half of the survivors sustain severe neurological impairment.