Cerebral Sinovenous Thrombosis in the Asphyxiated Cooled Infants: A Prospective Observational Study.
Cerebral sinovenous thrombosis is unusual in the asphyxiated cooled infants, but reliable data regarding the incidence of this comorbidity are lacking. We assessed the incidence of sinovenous thrombosis in a population of asphyxiated cooled infants by performing routine brain magnetic resonance venography.



All asphyxiated infants who underwent therapeutic cooling at our institution completed brain magnetic resonance venography after rewarming. Assessing the incidence of cerebral sinovenous thrombosis was the primary goal. Secondary analyses included group comparisons for laboratory tests and monitored parameters, relationship between variables, logistic regression models, and receiver operating characteristic curve for cerebral sinovenous thrombosis prediction.



Cerebral sinovenous thrombosis was detected in 10 of 37 infants (27%), most commonly affecting the superior sagittal sinus (eight of ten). These infants manifested higher blanket (P < 0.001) and lower esophageal temperatures (P = 0.006), lower platelet counts (P = 0.045), and received more red blood cell transfusions (P = 0.038) than the cooled infants without thrombosis. Blanket temperature was independently associated with cerebral sinovenous thrombosis (P = 0.049), and 32°C/hour was the optimal cutoff value to predict the event (sensitivity, 90%; specificity, 88.5%).



High incidence or cerebral sinovenous thrombosis in neonates treated with therapeutic hypothermia suggests that magnetic resonance venography may be reasonable in many of these children. High blanket temperature may be one variable that helps identify patients at higher risk.
Neonatal Intensive Care Unit, S.M. della Misericordia Hospital of Perugia, Perugia, Italy. Electronic address: maurizio.radicioni@ospedale.perugia.it.
Maurizio
M
Radicioni
Department of Medicine, University of Perugia, Perugia, Italy.
Vittorio
V
Bini
Neuroradiology, S.M. della Misericordia Hospital of Perugia, Perugia, Italy.
Pietro
P
Chiarini
Neonatal Intensive Care Unit, S.M. della Misericordia Hospital of Perugia, Perugia, Italy.
Ambra
A
Fantauzzi
Neuroradiology, S.M. della Misericordia Hospital of Perugia, Perugia, Italy.
Francesca
F
Leone
Neonatal Intensive Care Unit, S.M. della Misericordia Hospital of Perugia, Perugia, Italy.
Raffaella
R
Scattoni
Neonatal Intensive Care Unit, S.M. della Misericordia Hospital of Perugia, Perugia, Italy.
Pier Giorgio
PG
Camerini
D019540:Area Under Curve; D001238:Asphyxia Neonatorum / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000000981:diagnostic imaging; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D010690:Phlebography; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D013696:Temperature; D014654:Vascular Patency
cerebral sinovenous thrombosis; magnetic resonance venography; neonatal hypoxic–ischemic encephalopathy; stroke; therapeutic hypothermia