Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants

Borenstein-Levin, Liron; Koren, Ilana; Kugelman, Amir; Bader, David A.; Toropine, Arina; Riskin, Arieh

doi:10.1515/jpem-2014-0098

Cited by 11 publications

(6 citation statements)

References 3 publications

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“…[3,7] Two cases of central DI in preterm infants with post-hemorrhagic hydrocephalus have been reported, but both resolved with the hydrocephalus treatment. [9] DI has also been reported in preterm neonates with IVH without hydrocephalus; [7,8] however, to the best of our knowledge, there are no published cases of multiple hormone deficiencies.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Hypothalamic-pituitary axis dysfunction has been reported in children with intraventricular hemorrhage (IVH) and/or hydrocephalus. [1,2,[7][8][9][10] (US) evaluations at first and second trimesters showed no abnormalities; however, just before delivery it demonstrated hydrops fetalis. Maternal serological tests at the time of birth showed a rapid plasma reagin (RPR) titer of 1/64 and a positive T. pallidum hemagglutination test (TPHA); the remaining laboratory evaluation was normal.…”

Section: Introductionmentioning

confidence: 99%

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Hypopituitarism in a preterm infant with history of congenital syphilis and intraventricular hemorrhage

Castelbranco-Silva

Martins

Cunha

2023

JPED

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A baby girl was born at 29 weeks and 2 days gestation with a physical examination notable for petechial rash, hepatosplenomegaly, and hydrops. The baby was born before the mother could be rescreened for syphilis and non-treponemal tests were positive at birth. The first weeks of life were complicated by clinical instability and post-hemorrhagic hydrocephalus that probably resulted from a combination of prematurity and syphilis. During the 2nd month of life, she showed a failure to thrive, persistent hypoglycemia, and diabetes insipidus and was diagnosed with hypopituitarism. Hormonal substitution treatment was challenging and required multiple adjustments until satisfactory control was attained.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypopituitarism in a preterm infant with history of congenital syphilis and intraventricular hemorrhage

Castelbranco-Silva

Martins

Cunha

2023

JPED

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“…In this state, CSF osmolality might remain elevated even though the epithelium continues to transport water both transcellularly and paracellularly (if brain-CSF-barrier (BCSFB) is disrupted) (59) in an attempt to restore normal CSF osmolality. Another consideration is increased CSF osmolality should reasonably lead to cell shrinkage and activation of antidiuretic hormone (ADH); and some clinical observations show possible changes in ADH in hydrocephalus (64)(65)(66)(67)(68). However, in a state of dynamic equilibrium and restriction to water transport into the ventricles by the factors mentioned earlier, it is possible for serum and epithelial cell osmolality to be normal while CSF osmolality remains elevated.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Profile of Human Infant Cerebrospinal Fluid in Intraventricular Hemorrhage and Post-hemorrhagic Hydrocephalus of Prematurity

Otun¹,

Morales²,

García-Bonilla³

et al. 2021

Preprint

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BACKGROUND Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have complex pathophysiology involving inflammatory response, ventricular zone and cell-cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. METHODS CSF samples were obtained from lumbar punctures in control infants and infants with IVH prior to development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. RESULTS CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p=0.012 - <0.0001), LGIVH (p=0.023 - <0.0001), and HGIVH (p=0.015 - 0.0003), while magnesium and calcium levels were higher compared to control (p=0.031) and LGIVH (p=0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p=0.0009 and 0.0006 respectively) and LGIVH (p=0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r,p=0.55,0.0015), potassium (r,p=0.51,0.0041), chloride (r,p=0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p=0.012), total nucleated cells (p=0.0005), and percent monocyte (p=0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p=0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p=0.025-0.0008) in the whole cohort. CONCLUSIONS CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition.

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“…Chan et al reported 2 cases of central diabetes insipidus in premature neonates with brain injury (periventricular leukomalacia, bilateral grade 2 intraventricular hemorrhage) and speculated that diabetes insipidus following intra-ventricular hemorrhage or ischaemic damage is not necessarily transient in nature and its duration depends on the location of damage in the pituitary glands [6]. Interestingly, Borenstein-Levin et al reported the novel association between DI and hydrocephalus and the fact that such DI could be reversible with the reduction of ventricular size [7]. The presence of a hyper-intense signal of the posterior pituitary on a T1-weighted MRI scan reflects the functional integrity of neurohypophysis, although absence is not pathognomonic of CDI and its presence does not discard DI [4].…”

Section: Discussionmentioning

confidence: 99%

Coexistence of Central and Nephrogenic Diabetes Insipidus in a Preterm Infant

Carolina¹,

Cordero-González²

2017

JCR

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Background: Diabetes insipidus (DI) is a rare cause of hypernatremia in preterm newborns. Common causes of central DI include intra-ventricular hemorrhage, congenital infection and midline defects. Nephrogenic DI (NDI) is less frequent and can be caused by nephrocalcinosis. Case Report: We hereby report 665 gram female infant born at 27 weeks gestation with central DI and treated with desmopressin. The infant presented again with hypernatremia and showed a poor response to desmopressin. The finding of nephrocalcinosis oriented us to a nephrogenic component of DI. Conclusion: Although nephrogenic diabetes insipidus is the less frequent form of DI, preterm newborns present many risk factors for developing nephrocalcinosis (prolonged ventilation, diuretic therapy, dexamethasone, hypercalcemia) and NDI as a result. In a preterm newborn with CDI, a nephrogenic component must be suspected in the set of decreasing response to DDAVP.

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Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants

Cited by 11 publications

References 3 publications

Hypopituitarism in a preterm infant with history of congenital syphilis and intraventricular hemorrhage

Hypopituitarism in a preterm infant with history of congenital syphilis and intraventricular hemorrhage

Biochemical Profile of Human Infant Cerebrospinal Fluid in Intraventricular Hemorrhage and Post-hemorrhagic Hydrocephalus of Prematurity

Coexistence of Central and Nephrogenic Diabetes Insipidus in a Preterm Infant

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