Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC.
Department of Cardiology, Children's National Hospital, Washington, DC.
J Pediatr. 2022 Sep;248:59-65.e3. doi: 10.1016/j.jpeds.2022.05.056. Epub 2022 Jun 3.
To determine the prevalence of and risk factors for cerebral sinus venous thrombosis (CSVT) in neonates undergoing congenital heart disease (CHD) repair.
Neonates who had CHD repair with cardiopulmonary bypass and postoperative brain magnetic resonance imaging (MRI) between 2013 and 2019 at a single tertiary care center were identified from institutional databases. Demographic, clinical, and surgical data were abstracted from these databases and from the medical record; 278 neonates with CHD had cardiopulmonary bypass, 184 of whom had a postoperative brain MRI.
Eight patients (4.3%) had a CSVT. Transposition of the great arteries with an intact ventricular septum (P < .01) and interrupted aortic arch (P = .02) were associated with an increased risk for CSVT. Other risk factors for CSVT included cross-clamp time (98 [IQR, 77.5-120] minutes vs 67 [IQR, 44-102] minutes; P = .03), units of platelets (3.63 [IQR, 3-4] vs 2.17 [IQR, 1-4]; P < .01) and packed red blood cells (0.81 [IQR, 0.25-1] vs 1.21 [IQR, 1-1]; P = .03) transfused intraoperatively, and time between surgery and MRI (10 [IQR, 7-12.5] days vs 20 [IQR, 12-35] days; P < .01). Five patients (62.5%) were treated with anticoagulation. All patients had complete or partial resolution of their CSVT, regardless of treatment.
Brain MRI after cardiopulmonary bypass in neonates revealed a low prevalence of CSVT (4.3%). Further studies are needed to establish best practices for surveillance, prevention, and treatment of CSVT in this population.
确定行体外循环先天性心脏病（CHD）修复术的新生儿中脑静脉窦血栓形成（CSVT）的发生率和危险因素。
从机构数据库中确定了 2013 年至 2019 年期间在一家三级医疗中心行 CHD 修复术并在术后行脑磁共振成像（MRI）的新生儿。从这些数据库和病历中提取人口统计学、临床和手术数据；278 例 CHD 患儿行体外循环，其中 184 例行术后脑 MRI。
8 例（4.3%）患儿发生 CSVT。室间隔完整的大动脉转位（P<.01）和主动脉弓中断（P=.02）与 CSVT 的风险增加相关。CSVT 的其他危险因素包括体外循环夹闭时间（98 [IQR，77.5-120] 分钟 vs 67 [IQR，44-102] 分钟；P=.03）、血小板单位数（3.63 [IQR，3-4] vs 2.17 [IQR，1-4]；P<.01）和浓缩红细胞单位数（0.81 [IQR，0.25-1] vs 1.21 [IQR，1-1]；P=.03）术中输注量以及手术与 MRI 之间的时间（10 [IQR，7-12.5] 天 vs 20 [IQR，12-35] 天；P<.01）。5 例（62.5%）患儿接受抗凝治疗。所有患儿的 CSVT 均完全或部分缓解，无论是否接受治疗。
体外循环后新生儿行脑 MRI 显示 CSVT 的发生率较低（4.3%）。需要进一步的研究来确定该人群 CSVT 的监测、预防和治疗的最佳实践。
