Associations of Clinical Characteristics and Etiology With Death in Hospitalized Chinese Children After Spontaneous Intracerebral Hemorrhage: A Single-Center, Retrospective Cohort Study

Abstract

Objective: We retrospectively analyzed clinical characteristics, etiology, and mortality risk factors in pediatric cases of non-traumatic spontaneous intracerebral hemorrhage.Methods: This study involved children between 29 days and 18 years old with confirmed spontaneous intracerebral hemorrhage based on head CT or MRI at the Second Affiliated Hospital of Wenzhou Medical University and Yuying Children's Hospital from January 2008 to March 2020. Demographic and clinical characteristics, etiology, imaging, and treatment data were collected at baseline. Potential risk factors of in-hospital death were identified using univariate analysis and multivariate logistic regression.Result: A total of 200 children (126 males, median age 5 years) were included in the study. Clinical symptoms of spontaneous intracerebral hemorrhage were typically non-specific (79.5%). One third of patients (31.1%) had a Glasgow Coma Scale score (GCS) ≤ 8, and nearly two-thirds (60.5%) showed a combination of ventricular hemorrhage or subarachnoid hemorrhage. Supratentorial hemorrhage was more common. Cerebrovascular disease (37.0%) and hematological disease (33.5%) were the most frequent etiologies of spontaneous intracerebral hemorrhage. Most patients (74.5%) received non-surgical treatment, while 25.5% received surgical treatment. After an average of 12 days of treatment, 167 children (83.5%) survived and 33 (16.5%) died. Multivariate logistic regression showed herniation syndrome, and low GCS (≤ 8) to be associated with increased risk of mortality, while hemorrhage due to arteriovenous malformation was associated with lower risk of mortality.Conclusion: Our data suggest that cerebrovascular disease is the most common cause of spontaneous intracerebral hemorrhage among children, and that arteriovenous malformation is associated with lower risk of death in hospital. Conversely, the presence of herniation syndrome, low GCS (≤ 8) increase risk of in-hospital mortality. Our results underscore the importance of timely imaging and supplementary examinations in cases of suspected spontaneous intracerebral hemorrhage.

Causes and Risk Factors of Pediatric Spontaneous Intracranial Hemorrhage—A Systematic Review

“…One article [ 20 ] was a duplicate. Data from the remaining 40 articles were extracted for the final data analysis [ 1 , 3 , 4 , 8 , 11 , 12 , 13 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ] (see Table 1 and Table S1 ).…”

“…As visualized in Table 1 , in 29 of the 40 studies analyzed, the most common reported cause was vascular [ 3 , 4 , 8 , 13 , 20 , 21 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 38 , 39 , 40 , 41 , 43 , 44 , 46 , 47 , 49 , 50 , 51 ]; hematological disorders were the most common cause in nine studies [ 11 , 12 , 22 , 26 , 35 , 37 , 45 , 48 , 52 ]; brain tumor was encountered in most patients from one study [ 1 ], and systemic causes were most frequent in one study [ 42 ].…”

Development and Validation of an MGBP Nomogram for 3-month Unfavorable Functional Prognosis Prediction of Nontraumatic Pediatric Intracerebral Hemorrhage in Chinese Patients: 10-year Experience from a National Children’s Medical Center

“…36,37 Additionally, a single-center case-control study from China reported cerebrovascular disease (37.0%) and hematologic system disease (33.5%) were the most frequent categories of pICH, AVM (28.5%) and VKDB (20.5%) were the specific leading causes of pICH, these were quite consistent with our results. 14 A major driver of this regional disparity is the higher prevalence of vitamin K deficiency in Chinese infants than in western populations, as Chinese infants were usually breastfed only during their first year of life, and large proportion of whom without prophylactic vitamin K administration after birth, prior case-series reports from 8 China also advocated the prevalence of VKDB in pediatric HS or ICH up to over 50%. 10,11 Furthermore, 10% pICH remained idiopathic in this study, which was consistent with a recent review demonstrated 14% patients had pICH of unknown etiology, 36 indicating the importance of comprehensive assessment and long-term follow-up.…”

“…However, research regarding pICH in Chinese children remain scant, prior literature mainly focus on case-series reports, [10][11][12][13][14][15] whether the prognostic factors in Chinese pICH cohort are similar to those described for other ethnic is unknown, therefore, predicting the risk probability of unfavorable functional prognosis would be meaningful to support clinical decision making.…”

The Genetic Basis of Strokes in Pediatric Populations and Insight into New Therapeutic Options

“…Among these heritable disorders are those with autosomal dominant, autosomal recessive, and X-linked recessive inheritance [22]. In a study done by Huang and colleagues, for children aged between 7-14 years with spontaneous ICH, the most common cause of such an event were cerebrovascular disorders, while ICH presenting in infants and young children (29 days of life up to 3 years) were mostly associated with hematologic diseases [23].…”