Clinical LetterUse of Nimodipine in a Neonate With Cerebral Vasospasm With Delayed Ischemia From Subarachnoid Hemorrhage in the Posterior Fossa
Section snippets
Background
Subarachnoid hemorrhage (SAH) causing cerebral vasospasm and delayed cerebral ischemia is a significant source of morbidity and mortality in adults.1 Oral nimodipine is the standard of care for preventing delayed cerebral ischemia (DCI) in those with aneurysmal SAH.1,2 Although use of nimodipine has been described in older children,3 its use in the neonatal population has not yet been reported. We describe the use of nimodipine in a neonate with SAH resulting in vasospasm and DCI.
Patient Description
This neonate was born at 39 weeks' gestation to a 44-year-old primigravida mother with no significant past medical history. He was delivered via Caesarean section due to failed labor progression. Apgar scores were 8 and 9 at one and five minutes, respectively, and routine postnatal care was provided. At six hours of life, he developed respiratory distress, hypotonia, and lethargy requiring intubation and admission to the neonatal intensive care unit. Magnetic resonance imaging (MRI) showed a
Discussion
We describe a neonate with SAH who developed DCI secondary to vasospasm. He was treated with oral nimodipine without any adverse events. This is the first report of nimodipine use in a neonate with SAH and vasospasm-related DCI. Although the literature supports the use of nimodipine for prevention of vasospasm and DCI in adults, with impact on morbidity and mortality,4 there have been few pediatric studies, with only one prospective trial of 43 children not showing reduction in vasospasm.5 In a
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Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children
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Cited by (1)
Clinical improvement of a toddler with COVID-19 focal cerebral arteriopathy possibly due to intra-arterial nimodipine
2022, European Journal of Paediatric NeurologyCitation Excerpt :In a study of 2 pediatric cases, oral and intravenous administration of nimodipine was reported to be associated with a beneficial outcome with no hemodynamic concerns and no side effects. The first patient was a neonate with subarachnoid hemorrhage and the second was a 13-year-old child with hemiplegic migraine due to a de novo heterozygous ATP1A2 gene mutation [22,23]. A retrospective review of children with subarachnoid hemorrhage showed that oral nimodipine given to 12 children yielded favorable clinical outcomes relative to adults, but it was associated with mild hypotension [24].
Conflicts of interest: The authors declare no conflict of interest.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Financial disclosure: The authors have indicated they have no financial relationships relevant to this article to disclose.
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Equally responsible for the work described in this article.