Challenges in acute management of cerebral sinovenous thrombosis among neonates with acute kidney injury: A retrospective cohort study

Manish Parakh^1,2*Marilyn Tan³Ankit Kumar Meena⁴

• ¹Dr S N Medical College, Jodhpur, Jodhpur, India
• ²Dr Sampurnanand Medical College, Jodhpur, India
• ³University of the Philippines Manila, Manila, Philippines
• ⁴All India Institute of Medical Sciences Jodhpur, Jodhpur, India

Introduction: Cerebral sinovenous thrombosis (CSVT) in neonates with acute kidney injury (AKI) is a rare neurologic condition with potential serious consequences. Rapid diagnosis is key to good outcomes. This study aims to identify challenges in acute care and to evaluate outcomes of these patients in a resource-limited setting. Materials and Methods: This retrospective cohort study included term neonates with AKI and CSVT admitted at a tertiary center in Western India (January 2021–January 2023). Clinical profile, timing of consult with healthcare providers, diagnosis, neuroimaging, management strategies and outcomes at discharge and at 2 years were analyzed. Results: 31 neonates (19 male) with mean age 18.5 ± 6.6 days at diagnosis were included. Dehydration was the most common risk factor in 80.6%, while seizures were the most common clinical presentation (80.6% patients). Almost 84% patients had thrombosis in multiple sinuses. Venous infarcts were identified in 20 (64.5%) patients, with concomitant hemorrhage in 13 (42%). Only 10 patients received anticoagulation therapy. Median time from symptom onset to consult in first healthcare facility was 48 hours (IQR: 44-72 hours). Eighteen patients (58.06%) were subsequently referred to a second facility after a median stay of 48 hours (IQR: 28-72 hours). At the secondary or tertiary referral center, diagnostic neuroimaging was performed after a median of 48 hours (IQR: 36–108 hours). Anticoagulation was initiated within a median of 2 hours (IQR: 2–2.75 hours) following the diagnosis of CSVT. Although all patients survived, 32% had neurologic sequelae at discharge which persisted at the 2-year follow-up. Complete vessel recanalization on follow-up neuroimaging was achieved in all anticoagulated patients, compared with 66.7% of those who were not anticoagulated. However, statistical analysis showed no significant association between anticoagulation therapy and either clinical outcome or vessel recanalization. Conclusion: Neonatal CSVT associated with AKI can lead to persistent neurologic deficits at 2 years. Timely diagnosis and management remain a significant challenge in resource-limited settings due to delays both before and during hospitalization. Although anticoagulation treatment was not associated with outcomes in our cohort, further research is needed to develop acute care guidelines, applicable across diverse clinical settings, particularly in resource limited situations.