Intracranial Hemorrhage in Neonates with Unrecognized Hemophilia A: A Persisting Problem

Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

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“…4 Individuals with ICH caused by bleeding disorders may require prophylactic replacement of coagulation factors. 72 …”

Section: Acutementioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

870

377

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“…If normal vaginal delivery is the recommended routine mode of delivery for a pregnant haemophilia carrier, the screening for some potential hazards such as cephalo-pelvic disproportion may also be critical [12]. Moreover, it has been reported that extracranial haemorrhages frequently accompany ICH and a significant bleed in such a location should raise the suspicion of a concomitant ICH and underlying coagulopathy [43,44]. Even if somewhat non-specific (anaemia, pallor and apnea) and sometimes more unambiguous (seizures, lethargy and paresis), these recurrent symptoms must be recognized by caregivers in maternity hospitals as possibly because of ICH [12,33,39].…”

Section: Prevention and Treatment Of Neonatal Ichmentioning

confidence: 99%

Haemophilia in the first years of life

et al. 2008

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Summary. Surgery in infants and young children with haemophilia, when preceded by accurate diagnosis and accompanied by safe and effective factor prophylaxis, is not associated with a significant risk of haemorrhage. Haemophilic newborns undergoing circumcision or major surgery prior to diagnosis and in the absence of appropriate haemostatic prophylaxis remain as a concern. Inhibitor development has replaced haemorrhage as the major surgical complication in the developed world, largely because of the intensity of treatment used to secure haemostasis. For that reason only, essential surgery should be performed. Intracranial haemorrhage (ICH) during the neonatal period affects 3.5-4.0% of all haemophilia boys in countries with a good standard of health care, which is considerably (40-80 times) higher than expected in the normal population. Because of the high frequency of sporadic cases, ICH in the neonatal period can only be partially prevented by improved carrier diagnosis and counselling. Infections and thrombosis are the major serious complications of central venous lines. Large differences are seen in the frequency of these complications, the most plausible explanations are probably related to the protocol used for device care, the quality of education and the compliance of the users, an issue addressed in an on-going study.

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“…Rapid stanching of bleeding may prevent progression to sensory and motor nerve compromise [19]. In addition, repletion of the missing clotting factor may prevent later spinal deformities when such bleeds occur in young children [20].…”

Section: Spinal Hematomamentioning

confidence: 99%

Emergency Management of Hemophilia

Hoots¹

2014

Textbook of Hemophilia

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Intracranial Hemorrhage in Neonates with Unrecognized Hemophilia A: A Persisting Problem

Cited by 37 publications

References 10 publications

Management of Stroke in Infants and Children

Management of Stroke in Infants and Children

Haemophilia in the first years of life

Emergency Management of Hemophilia

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