CSF Removal in Infantile Posthemorrhagic Hydrocephalus Results in Significant Improvement in Cerebral Hemodynamics

Soul, Janet S.; Eichenwald, Eric C.; Walter, Gene; Volpe, Joseph J.; Plessis, Adré J. du

doi:10.1203/01.pdr.0000119370.21770.ac

Cited by 60 publications

(32 citation statements)

References 25 publications

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“…In this 1998 review, an unpublished observation of Synder and du Plessis was noted that cerebral perfusion and oxygenation are clearly improved on near infrared spectroscopy (NIRS) when pressure is relieved by removing CSF. This work has subsequently been published; interestingly although removing CSF did improve cerebral hemodynamic indices on NIRS, these changes did not correlate with intracranial pressure [53] . Others have observed that measuring pressure during obtaining CSF is fraught with diffi culties and may not be a reliable predictor of pressure on the cortical mantle [54][55][56][57] .…”

Section: Discussionmentioning

confidence: 92%

Accumulation of Transforming Growth Factor-β<sub>2</sub> and Nitrated Chondroitin Sulfate Proteoglycans in Cerebrospinal Fluid Correlates with Poor Neurologic Outcome in Preterm Hydrocephalus

et al. 2005

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Background: Progressive post-hemorrhagic hydrocephalus in preterm infants strongly predicts abnormal neurologic development, and often accompanies cystic periventricular leukomalacia (cPVL). Transforming growth factor-β₁ (TGF-β₁), associated with hydrocephalus, can upregulate the chondroitin sulfate proteoglycan (CSPG) synthesis. To date, CSPG and their nitrated metabolites (NT-CSPG) have not been evaluated in hydrocephalus. Objectives: We hypothesized that TGF-β₁, TGF-β₂, CSPG, and NT-CSPG would accumulate in cerebrospinal fluid (CSF) in preterm hydrocephalus, and their concentrations would correlate with poor long-term outcomes. Methods: TGF-β₁, TGF-β₂, CSPG, and NT-CSPG concentrations in CSF were measured prospectively by ELISA in 29 preterm newborns with (n = 22) or without (n = 34) progressive post-hemorrhagic hydrocephalus, and correlated with progressive neonatal hydrocephalus and neurologic outcome. Only concentrations from each patient’s initial CSF sample were used for statistical analysis. Results: Compared to neonates without hydrocephalus, CSF [TGF-β₁], [TGF-β₂], [CSPG] and [NT-CSPG] were significantly greater by >3-, >35-, >8-, and >3-fold, respectively. Unlike CSF [TGF-β₂] and [CSPG], [TGF-β₁] correlated with CSF [total protein]. Only CSF [NT-CSPG] correlated with cPVL. Unlike [TGF-β₂] or [CSPG], [NT-CSPG] correlation with preterm progressive post-hemorrhagic hydrocephalus (PPHH) was explained entirely by the presence of cPVL among these patients. [TGF-β₂] was >20-fold greater in preterm survivors who required a ventriculoperitoneal shunt for PPHH (n = 9), as compared to survivors who did not require a shunt (n = 2), or those without hydrocephalus (n = 12). [TGF-β₂] and [NT-CSPG] correlated inversely with Bayley Index Scores (15.0 months median adjusted age). Conclusions: This is the first report that [TGF-β₂], [CSPG], and [NT-CSPG], measured well before term, accumulate abnormally in preterm progressive post-hemorrhagic hydrocephalus CSF, and correlate with adverse neurologic outcome.

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Section: Discussionmentioning

confidence: 92%

Accumulation of Transforming Growth Factor-β<sub>2</sub> and Nitrated Chondroitin Sulfate Proteoglycans in Cerebrospinal Fluid Correlates with Poor Neurologic Outcome in Preterm Hydrocephalus

et al. 2005

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“…It is important to differentiate communicating hydrocephalus from ex-vacuo ventricular dilation as the prior may pose damage to the developing brain. The decision for therapeutic intervention is often based on the demonstration of progressive increase in ventricular dimensions on serial imaging [39]. One must be aware that there is often a small progressive increase in size of the anterior horn width in both term and preterm neonates in the first week and life and this physiological change should not be interpreted as progressive ventriculomegaly [40,41,42,43].…”

Section: Ventriculomegaly: Is It Benign External Hydrocephalus Ex-vamentioning

confidence: 99%

Pediatric MRI Brain: Normal or abnormal, that is the question.

Tan¹

2017

Radiol Diagn Imaging

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“…Observational studies [33,34] have shown low regional cerebral oxygenation (rSO 2 ) values in infants with PHVD with recovery following intervention. Further research is needed to prove that near-infrared spectroscopy can be used as an aid for optimising timing of intervention.…”

Section: Low-grade Gmh-ivhmentioning

confidence: 99%

Early and Late Complications of Germinal Matrix-Intraventricular Haemorrhage in the Preterm Infant: What Is New?

Brouwer

Groenendaal²,

Benders³

et al. 2014

Neonatology

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Germinal matrix-intraventricular haemorrhage (GMH-IVH) remains a serious problem in the very and extremely preterm infant. This article reviews current methods of diagnosis, treatment and neurodevelopmental outcome in preterm infants with low-grade and severe GMH-IVH. We conclude that there is still no consensus on timing of intervention and treatment of infants with GMH-IVH, whether or not complicated by post-haemorrhagic ventricular dilatation. The discrepancies between the studies underline the need for international collaboration to define the optimal strategy for these infants.

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CSF Removal in Infantile Posthemorrhagic Hydrocephalus Results in Significant Improvement in Cerebral Hemodynamics

Cited by 60 publications

References 25 publications

Accumulation of Transforming Growth Factor-β<sub>2</sub> and Nitrated Chondroitin Sulfate Proteoglycans in Cerebrospinal Fluid Correlates with Poor Neurologic Outcome in Preterm Hydrocephalus

Accumulation of Transforming Growth Factor-β<sub>2</sub> and Nitrated Chondroitin Sulfate Proteoglycans in Cerebrospinal Fluid Correlates with Poor Neurologic Outcome in Preterm Hydrocephalus

Pediatric MRI Brain: Normal or abnormal, that is the question.

Early and Late Complications of Germinal Matrix-Intraventricular Haemorrhage in the Preterm Infant: What Is New?

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