Neurovascular Pathology in Newborns: A Short Review
Alejandro Fuerte, MD
Newborn neurovascular diseases are common and are responsible for permanent disability. Early diagnosis and correct management are important to decrease the morbidity and mortality of these diseases. Studies are currently underway to advance this field and achieve more effective therapies.
Based on highlighted articles, below I present a short review of the most common perinatal neurovascular diseases.
- Germinal matrix hemorrhage (GMH): The germinal matrix is vascular tissue. It rarely persists in newborns to term because it disappears by around 33 weeks. GMH is, therefore, more common in pre-term infants. Although it typically originates in the periventricular region, blood can invade the ventricular system. Risk factors include weight < 1.5 kg and gestational age < 34 weeks. The findings of transcranial Doppler ultrasound determine the severity of the hemorrhage. A study of bleeding diathesis should be included in the diagnosis. There is no treatment protocol, although some studies confirm that the administration of corticosteroids to the mother in situations of threatened pre-term birth reduces the incidence and mortality of GMH. Currently, the best strategy to reduce the incidence of GMH is the prevention of pre-term birth. As far as surgical treatment is concerned, ventricular lavage or ventriculostomy is usually performed. The prognosis is usually related to the severity of the hemorrhage and the appearance of complications such as periventricular leukomalacia (25-75% of cases) and hydrocephalus (11-30% of cases). For the treatment of hydrocephalus, CSF ventriculoperitoneal shunting is, in many cases, the best option, and it has been shown to improve long-term psychomotor development.