Ischemic Stroke in Children with Critical Illness: A Poor Prognostic Sign

Jordan, Lori C.; Beek, Jackelien G M van; Gottesman, Rebecca F.; Kossoff, Eric H.; Johnston, Michael V.

doi:10.1016/j.pediatrneurol.2006.12.014

“…The importance of severity of illness at the time of stroke onset is supported by studies of children with stroke from all causes: The presence of critical illness prior to stroke onset is associated with increased mortality, and the need for intensive care unit care after stroke is associated with higher mortality. 17,18 Neither severity of stroke nor decision making following stroke can be compared between IDE and non-IDE sites, given the available data, although there is no reason to suspect a difference between IDE and non-IDE sites in this regard. Non-IDE sites were provided with the anticoagulation protocol, but adherence was not required or tracked, so it is possible that this played a role in modulating outcome after a neurological injury.…”

Section: Discussionmentioning

confidence: 99%

Neurological Complications and Outcomes in the Berlin Heart EXCOR ^® Pediatric Investigational Device Exemption Trial

Jordan

¹

,

Ichord

²

,

Reinhartz

³

et al. 2015

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundThe Berlin Heart EXCOR® ventricular assist device has been approved for use in the United States as a bridge to heart transplantation in children. We sought to characterize neurological events in children supported with the Berlin Heart EXCOR® device.Methods and ResultsThe multicenter prospective cohort consisted of all 204 children implanted with the Berlin Heart EXCOR® device at 47 centers in North America between May 2007 and December 2010. There were 73 neurological events in 59 patients, with 29% of the cohort experiencing ≥1 neurological event. Events included 52 strokes in 43 patients (21% of the cohort). The neurological event rate was 0.51 events per 100 patient‐days. Many of the neurological events occurred early in the course of support, with 30 events recorded during the first 14 days of support. The mortality rate in participants with at least 1 neurological event was 42% (25 of 59), significantly higher than the 18% mortality rate (26 of 145) for those who did not have a neurological event (P=0.0006). Risk‐factor analysis did not identify significant preimplantation predictors of neurological injury.ConclusionsOf children treated with the Berlin Heart EXCOR® device as a bridge to transplant, 29% experienced at least 1 neurological event. The majority of neurological events were ischemic strokes, and many of those occurred early in the course of support. Neurological injury was the leading cause of death after implantation of the Berlin Heart EXCOR® device. Risk stratification for stroke or neurological injury is not possible based on baseline preimplantation characteristics.Clinical Trial RegistrationURL: www.clinicaltrials.gov. Unique Identifier: NCT00583661.

show abstract

“…Crianças criticamente doentes foram estudadas por Jordan et al 54 . Nessa análise retrospectiva, 93% dos pacientes internados na unidade de terapia intensiva pediátrica tinham pelo menos um fator de risco para AVC isquêmico agudo.…”

Section: Outras Causas De Ave Em Criançasunclassified

Stroke in children

Filho¹,

Carvalho²

2009

View full text Add to dashboard Cite

Objectives: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children.Sources: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. Summary of the findings:Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. Conclusions:Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.J Pediatr (Rio J). 2009;85(6):469-479: Stroke, pediatrics, neonatology, intensive care, anticoagulants. ResumoObjetivos: Listar 1) as definições e características epidemiológicas de acidentes vasculares encefálicos (AVE) em crianças; 2) os principais fatores de risco para a ocorrência de AVE em pediatria e neonatologia; 3) as principais características fisiopatológicas para a ocorrência de lesão cerebral no AVE; 4) as manifestações clínicas e o diagnóstico por imagem; e 5) as recomendações atualizadas para as medidas de suporte, tratamento e profilaxia dos AVE em pediatria. Fontes dos dados:Realizou-se revisão da literatura nas bases de dados PubMed, EMBASE e SciELO utilizando-se como palavras-chave stroke, pediatrics e neonatology, além da utilização de referências bibliográficas importantes dos textos escolhidos. Síntese dos dados:A ocorrência de AVE em pediatria é incomum, com a incidência variando entre duas e oito por 100.000 crianças abaixo de 14 anos, tendo a maioria como denominador comum a ocorrência de doenças de base como cardiopatias congênitas, anemia falciforme e malformações vasculares. Não há padronização nas recomendações de tratamento para o AVE em crianças, embora as medidas fundamentais incluam monitoração, tratamento de suporte e anticoagulação em casos selecionados. O prognóstico depende da extensão de área cerebral acometida e da doença de base, mas as taxas de recorrência são altas na maioria dos casos. Conclusões:O diagnóstico precoce dos AVE em pediatria é fundamental, e é importante que os pediatras estejam atentos à falta de especificidade...

show abstract

“…52 A large retrospective cohort study published by Donahue et al 53 Critically ill children were studied by Jordan et al 54 In this retrospective analysis, 93% of the patients admitted in the pediatric intensive care unit had at least one risk factor for AIS. In addition, critically ill children with stroke had 60 times more chances to die than non-critically ill children.…”

Section: Hemorrhagic Strokementioning

confidence: 99%

Acidentes vasculares encefálicos em pediatria

Filho¹,

Carvalho²

2009

J. Pediatr. (Rio J.)

View full text Add to dashboard Cite

Objectives: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children.Sources: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. Summary of the findings:Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. Conclusions:Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.

show abstract

Ischemic Stroke in Children with Critical Illness: A Poor Prognostic Sign

Cited by 16 publications

References 10 publications

Neurological Complications and Outcomes in the Berlin Heart EXCOR ^® Pediatric Investigational Device Exemption Trial

Neurological Complications and Outcomes in the Berlin Heart EXCOR ^® Pediatric Investigational Device Exemption Trial

Stroke in children

Acidentes vasculares encefálicos em pediatria

Contact Info

Product

Resources

About

Ischemic Stroke in Children with Critical Illness: A Poor Prognostic Sign

Cited by 16 publications

References 10 publications

Neurological Complications and Outcomes in the Berlin Heart EXCOR ® Pediatric Investigational Device Exemption Trial

Neurological Complications and Outcomes in the Berlin Heart EXCOR ® Pediatric Investigational Device Exemption Trial

Stroke in children

Acidentes vasculares encefálicos em pediatria

Contact Info

Product

Resources

About

Neurological Complications and Outcomes in the Berlin Heart EXCOR ^® Pediatric Investigational Device Exemption Trial

Neurological Complications and Outcomes in the Berlin Heart EXCOR ^® Pediatric Investigational Device Exemption Trial