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Echocardiography plays a role in assessing cardiac health and detecting heart conditions, with various types providing critical insights for diagnosis and treatment.
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Routine Echocardiography is not Required in Neonates with Arterial Ischemic Stroke.

Indira Bhagat1, Rohan Sarkar2, Jayapalli R Bapuraj3

  • 1Division of Neonatal-Perinatal Medicine, Central Michigan University, Mount Pleasant, Michigan.

American Journal of Perinatology
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Summary

Routine postnatal echocardiography may not be necessary for all infants with neonatal arterial ischemic stroke (NAIS). Cardiac anomalies potentially causing NAIS are often detected prenatally, making postnatal echocardiography redundant in most cases.

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Area of Science:

  • Neonatal neurology
  • Pediatric cardiology
  • Medical imaging

Background:

  • Current guidelines recommend routine echocardiography (ECHO) in the acute phase to identify cardiac sources of neonatal arterial ischemic stroke (NAIS).
  • The assumption of a cardiac embolic origin for NAIS is increasingly challenged.
  • The necessity of postnatal ECHO for NAIS is questionable, particularly with widespread prenatal anomaly screening.

Purpose of the Study:

  • To determine the prevalence of significant cardiac risk factors in infants with NAIS.
  • To evaluate the necessity of routine postnatal ECHO in NAIS cases during the era of routine fetal anomaly scanning.

Main Methods:

  • Retrospective review of 54 infants diagnosed with NAIS via brain MRI.
  • All infants underwent echocardiography (ECHO) during the acute phase to exclude cardiac origins.

Main Results:

  • Postnatal ECHO identified no intracardiac thrombus or vegetation.
  • Only 5% of infants had structural heart anomalies, all previously diagnosed prenatally due to syndromic or chromosomal conditions.
  • Prenatal and postnatal detection rates for complex cardiac anomalies were statistically similar (p=0.617).

Conclusions:

  • Routine postnatal ECHO may not be necessary for all infants with NAIS.
  • ECHO has a low probability of excluding cardiac sources for NAIS in infants with normal fetal scans.
  • Postnatal ECHO is only recommended for NAIS infants with detected chromosomal malformations.