Targeted neonatal echocardiography-guided management of high flow cerebral vascular malformations: Impact of a multidisciplinary neurohemodynamics team

N A Aleem; A H Stanford; S S Lee; S Ortega-Gutierrez; P J McNamara

doi:10.1038/s41372-026-02787-7

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Targeted neonatal echocardiography-guided management of high flow cerebral vascular malformations: Impact of a multidisciplinary neurohemodynamics team

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Targeted neonatal echocardiography-guided management of high flow cerebral vascular malformations: Impact of a multidisciplinary neurohemodynamics team

N A Aleem, A H Stanford, S S Lee, S Ortega-Gutierrez and P J McNamara

Journal of perinatology

07/20/2026

DOI: 10.1038/s41372-026-02787-7

PMID: 42477111

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Abstract

High-flow cerebral vascular malformations (HFCVM) are rare, life-threatening anomalies causing severe neonatal cardiorespiratory compromise. Targeted neonatal echocardiography (TNE) enables detailed hemodynamic assessment to guide stabilization and embolization timing. We evaluated a multidisciplinary, TNE-guided protocol to optimize individualized care and shorten shunting duration. Single-center case series of five neonates with HFCVM admitted to a Level IV NICU (June 2022-June 2025). The protocol incorporated serial TNE for prenatal diagnosis, pre-/post-embolization care, and intra-procedural monitoring. TNE categorized cardiovascular phenotypes, guided embolization timing, and monitored cardiac function. Five neonates with HFCVM were managed using this protocol. Median number of embolizations per neonate were 2 (2.0-2.5). Four patients exhibited flow-mediated physiology with high cardiac output and ductal-dependent systemic perfusion. Four patients survived to discharge. One patient experienced a fatal intracranial hemorrhage. A physiology-driven, TNE-guided approach for neonatal HFCVM is feasible and supports tailored hemodynamic management and staged embolization. Prospective multicenter validation is warranted.

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Title: Subtitle: Targeted neonatal echocardiography-guided management of high flow cerebral vascular malformations: Impact of a multidisciplinary neurohemodynamics team
Creators: N A Aleem - University of Iowa
A H Stanford - University of Iowa Health Care
S S Lee - University of Iowa Health Care
S Ortega-Gutierrez - University of Iowa, Iowa Neuroscience Institute
P J McNamara - University of Iowa Health Care
Resource Type: Journal article
Publication Details: Journal of perinatology
DOI: 10.1038/s41372-026-02787-7
PMID: 42477111
NLM abbreviation: J Perinatol
ISSN: 1476-5543
eISSN: 1476-5543
Publisher: Springer Nature
Language: English
Electronic publication date: 07/20/2026
Academic Unit: Neurology; Radiology; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neonatology; Neurosurgery
Record Identifier: 9985183677002771

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