Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Via Giustiniani 3, 35128, Padua, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Eur J Pediatr. 2024 Aug;183(8):3461-3470. doi: 10.1007/s00431-024-05602-7. Epub 2024 May 23.
Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT.
Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol.
Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8 days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up. Conclusion: DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.
脑静脉血栓形成（CVT）是一种脑血管疾病，占围产期卒中的 20%。CVT 的发病率为每 10 万新生儿 0.67 至 1.12 例，而“深部脑髓静脉血栓形成”（DMVT）的发病率则无法准确估计，DMVT 是 CVT 的一个亚型。本研究旨在分析新生儿期 CVT 的病例，重点关注 DMVT。
使用意大利婴儿血栓形成登记处（RITI）收集 2002 年 1 月至 2023 年 4 月期间诊断为 CVT 的新生儿病例，包括有或无 DMVT 的患儿。由一名神经放射学专家按照标准化方案对脑 MRI 进行评估。
共发现 42 例 CVT 新生儿，其中 27/42（64%）为 CVT，15/42（36%）为 DMVT（孤立性 DMVT 9/15）。症状发作于生后第一周（中位数 8 天，IQR 4-14），男性占 59%。CVT 的最常见危险因素为复杂分娩（38%）、早产（40%）、先天性心脏病（48%）和感染（40%）。所有病例中，抽搐是最常见的首发症状，占 52%。孤立性 DMVT 患者的出血性梗死发生率更高（77%），而无 DMVT 的 CVT 患者则较低（p=0.013）。36%的患者接受了抗凝治疗。出院时，48%的患儿存在神经功能障碍，31 例中有 18 例（58%）在长期随访中出现 1 种或多种神经功能缺陷。
DMVT 见于超过三分之一的 CVT 新生儿。需要开展多中心研究，以制定这些患者的治疗、神经影像学和随访标准化方案。
