751
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Beani E, Maselli M, Sicola E, Perazza S, Cecchi F, Dario P, Braito I, Boyd R, Cioni G, Sgandurra G. Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy. J Neuroeng Rehabil 2019; 16:30. [PMID: 30795810 PMCID: PMC6387534 DOI: 10.1186/s12984-019-0499-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical environment, and in particular the use of wearable sensors, can provide quantitative measurement to overcome this issue. This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3-25 years compared to age-matched typically developing (TD) subjects. METHODS Fifty children with UCP and 50 TD subjects were assessed with AHA while wearing ActiGraphs GT3X+ on both wrists. The mean activity of each hand (dominant and non-dominant, MADH and MANDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MANDH and AI) varied by group (TD vs UCP) and among levels of manual ability based on Manual Ability Classification System (MACS). In both models age, sex, side of hemiplegia, presence/absence of mirror movements were specified as random effects. RESULTS The MANDH was significantly lower in UCP compared to TD, while the AI was significantly higher in UCP compared to TD. Moreover, in UCP group there were significant differences related to MACS levels, both for MANDH and AI. None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MANDH and AI. CONCLUSIONS These results confirm that actigraphy could provide, in a standardized setting, a quantitative description of differences between upper limbs activity. TRIAL REGISTRATION ClincalTrials.gov, NCT03054441 . Registered 15 February 2017.
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Affiliation(s)
- Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Martina Maselli
- The BioRobotics Institute, Scuola Superiore Sant’ Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Silvia Perazza
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Francesca Cecchi
- The BioRobotics Institute, Scuola Superiore Sant’ Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’ Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| | - Irene Braito
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
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752
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Graham D, Paget SP, Wimalasundera N. Current thinking in the health care management of children with cerebral palsy. Med J Aust 2019; 210:129-135. [DOI: 10.5694/mja2.12106] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- David Graham
- Concord Centre for Mental Health Sydney NSW
- Kids Neuroscience CentreKids Research Sydney NSW
| | - Simon P Paget
- Kids RehabChildren's Hospital at Westmead Sydney NSW
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753
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Marques FJP, Teixeira MCS, Barra RR, de Lima FM, Dias BLS, Pupe C, Nascimento OJM, Leyser M. Children Born With Congenital Zika Syndrome Display Atypical Gross Motor Development and a Higher Risk for Cerebral Palsy. J Child Neurol 2019; 34:81-85. [PMID: 30421639 DOI: 10.1177/0883073818811234] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Congenital Zika syndrome virus infection is said to interfere in children's development. OBJECTIVE evaluate gross motor trajectories and the frequency of cerebral palsy in children with congenital Zika syndrome. DESIGN Cohort study applying the Alberta Infant Motor Scale (AIMS) and the Bayley III Scales in infants from 6 to 18 months of age. SETTING The SARAH network, Rio de Janeiro. PARTICIPANTS Thirty-nine infants whose diagnoses were established through clinical history, serology tests, and neuroimaging findings. Main outcomes and measures: Congenital Zika syndrome is associated with severe motor delays and is a risk factor to the diagnosis of cerebral palsy. RESULTS The Alberta Infant Motor Scale mean raw score at 6 months was 9.74 (SD 4.80) or equivalent to 2 to 3 months of motor developmental age. At the age of 12 months, 14.13 (SD 11.90), corresponding to 3 to 4 months of motor development age; the Bayley III Scales results correlated to the Alberta Infant Motor Scale ( P < .001) at this age. At 18 months, 15.77 (SD 13.80) or a motor development equivalent to 4 to 5 months of age. Thirty-five of 39 children (89.7%) met criteria for the diagnosis of cerebral palsy. Conclusions and relevance: Gross motor development marginally progresses from 6 to 18 months of age. These individuals also displayed a high frequency of cerebral palsy.
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Affiliation(s)
- Fernanda J P Marques
- 1 SARAH Network of Rehabilitation Hospitals, Rio de Janeiro, Brazil.,2 Federal Fluminense University, Niterói, Brazil
| | | | - Rafael R Barra
- 1 SARAH Network of Rehabilitation Hospitals, Rio de Janeiro, Brazil
| | | | | | - Camila Pupe
- 2 Federal Fluminense University, Niterói, Brazil
| | | | - Marcio Leyser
- 3 University of Iowa Stead Family Department of Pediatrics, Iowa City, IA, USA
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754
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"STEP", an early developmental screening tool that predicts one-year outcomes. J Perinatol 2019; 39:153-155. [PMID: 30546059 DOI: 10.1038/s41372-018-0293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 11/08/2022]
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755
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Stetson BT, Buhimschi CS, Kellert BA, Hay K, Buhimschi IA, Maitre NL. Comparison of Cerebral Palsy Severity Between 2 Eras of Antenatal Magnesium Use. JAMA Pediatr 2019; 173:188-190. [PMID: 30508016 PMCID: PMC6439606 DOI: 10.1001/jamapediatrics.2018.3827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This before-and-after cohort analysis assesses whether implementing a recommendation of antenatal magnesium use at an institutional level in 2009 resulted in fewer subsequent cases of moderate or severe cerebral palsy.
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Affiliation(s)
- Bethany T. Stetson
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Catalin S. Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Brian A. Kellert
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Krystal Hay
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Irina A. Buhimschi
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nathalie L. Maitre
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
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756
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Galea C, Mcintyre S, Smithers-Sheedy H, Reid SM, Gibson C, Delacy M, Watson L, Goldsmith S, Badawi N, Blair E. Cerebral palsy trends in Australia (1995-2009): a population-based observational study. Dev Med Child Neurol 2019; 61:186-193. [PMID: 30187914 DOI: 10.1111/dmcn.14011] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate trends in birth prevalence of cerebral palsy (CP) overall and by gestational age, and examine the distribution of motor type, spastic topography, and severity using Australian CP Register data from 1995 to 2009. METHOD Prenatal and perinatal CP data were collated from state/territory CP registers. Birth prevalence estimates per 1000 live births and per 1000 neonatal survivors (NNS) were calculated in five epochs. Data from three state registers with population-level ascertainment were used to investigate birth prevalence trends by gestational age using Poisson regression. Distribution of motor type, spastic topography, and moderate to severe disability (IQ≤50 and/or Gross Motor Function Classification System levels III-V) were evaluated within birthweight categories. RESULTS Birth prevalence of CP varied across population-level states but within each state declined significantly over time (p<0.05). Birth prevalence per 1000 neonatal survivors declined amongst children born before 28 weeks (South Australia, Victoria p<0.001) and those born at or after 37 weeks (Victoria p<0.001, Western Australia p<0.002). Across Australia the percentage of children with bilateral spastic CP declined amongst those born less than 1000g. The percentage of children with moderate to severe disability decreased (48%-34%, p<0.001). INTERPRETATION Birth prevalence of CP declined. Encouragingly, the percentage of children with CP whose disability was moderate to severe also decreased. WHAT THIS PAPER ADDS Birth prevalence of cerebral palsy (CP) differed but declined across Australian states (1995-2009). Australian CP birth prevalence declined significantly amongst children born before 28 weeks and those born at or after 37 weeks. The percentage of children with moderate to severe disability decreased.
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Affiliation(s)
- Claire Galea
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Susan M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Gibson
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
| | | | - Linda Watson
- Department of Health Western Australia, Perth, WA, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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757
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Finch-Edmondson M, Morgan C, Hunt RW, Novak I. Emergent Prophylactic, Reparative and Restorative Brain Interventions for Infants Born Preterm With Cerebral Palsy. Front Physiol 2019; 10:15. [PMID: 30745876 PMCID: PMC6360173 DOI: 10.3389/fphys.2019.00015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Worldwide, an estimated 15 million babies are born preterm (<37 weeks' gestation) every year. Despite significant improvements in survival rates, preterm infants often face a lifetime of neurodevelopmental disability including cognitive, behavioral, and motor impairments. Indeed, prematurity remains the largest risk factor for the development of cerebral palsy. The developing brain of the preterm infant is particularly fragile; preterm babies exhibit varying severities of cerebral palsy arising from reductions in both cerebral white and gray matter volumes, as well as altered brain microstructure and connectivity. Current intensive care therapies aim to optimize cardiovascular and respiratory function to protect the brain from injury by preserving oxygenation and blood flow. If a brain injury does occur, definitive diagnosis of cerebral palsy in the first few hours and weeks of life is difficult, especially when the lesions are subtle and not apparent on cranial ultrasound. However, early diagnosis of mildly affected infants is critical, because these are the patients most likely to respond to emergent treatments inducing neuroplasticity via high-intensity motor training programs and regenerative therapies involving stem cells. A current controversy is whether to test universal treatment in all infants at risk of brain injury, accepting that some patients never required treatment, because the perceived potential benefits outweigh the risk of harm. Versus, waiting for a diagnosis before commencing targeted treatment for infants with a brain injury, and potentially missing the therapeutic window. In this review, we discuss the emerging prophylactic, reparative, and restorative brain interventions for infants born preterm, who are at high risk of developing cerebral palsy. We examine the current evidence, considering the timing of the intervention with relation to the proposed mechanism/s of action. Finally, we consider the development of novel markers of preterm brain injury, which will undoubtedly lead to improved diagnostic and prognostic capability, and more accurate instruments to assess the efficacy of emerging interventions for this most vulnerable group of infants.
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Affiliation(s)
- Megan Finch-Edmondson
- The Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, The University of Sydney Medical School, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Morgan
- The Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, The University of Sydney Medical School, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rod W. Hunt
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Iona Novak
- The Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, The University of Sydney Medical School, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
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758
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Einspieler C, Utsch F, Brasil P, Panvequio Aizawa CY, Peyton C, Hydee Hasue R, Françoso Genovesi F, Damasceno L, Moreira ME, Adachi K, Marschik PB, Nielsen-Saines K. Association of Infants Exposed to Prenatal Zika Virus Infection With Their Clinical, Neurologic, and Developmental Status Evaluated via the General Movement Assessment Tool. JAMA Netw Open 2019; 2:e187235. [PMID: 30657537 PMCID: PMC6431234 DOI: 10.1001/jamanetworkopen.2018.7235] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE There is an urgent need to assess neurodevelopment in Zika virus (ZIKV)-exposed infants. OBJECTIVES To perform general movement assessment (GMA) at 9 to 20 weeks' postterm age and to evaluate whether the findings are associated with neurodevelopmental outcomes at age 12 months in infants prenatally exposed to acute maternal illness with rash in Brazil during the ZIKV outbreak and in age-matched controls. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, infants prenatally exposed to acute maternal illness with rash were recruited at medical institutions in Rio de Janeiro and Belo Horizonte, Brazil, from February 1, 2016, to April 30, 2017, while infants without any exposure to maternal illness originated from the Graz University Audiovisual Research Database for the Interdisciplinary Analysis of Neurodevelopment. Participants were 444 infants, including 76 infants without congenital microcephaly, 35 infants with microcephaly, and 333 neurotypical children matched for sex, gestational age at birth, and age at GMA. MAIN OUTCOMES AND MEASURES General movement assessment performed at 9 to 20 weeks' postterm age, with negative predictive value, positive predictive value, sensitivity, and specificity generated, as well as clinical, neurologic, and developmental status (Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] scores) at age 12 months. Motor Optimality Scores were generated based on the overall quality of the motor repertoire. Adverse outcomes were defined as a Bayley-III score less than 2 SD in at least 1 domain, a score less than 1 SD in at least 2 domains, and/or atypical neurologic findings. RESULTS A total of 444 infants were enrolled, including 111 children prenatally exposed to a maternal illness with rash and 333 children without any prenatal exposure to maternal illness (57.7% male and mean [SD] age, 14 [2] weeks for both groups); 82.1% (46 of 56) of ZIKV-exposed infants without congenital microcephaly were healthy at age 12 months. Forty-four of 46 infants were correctly identified by GMA at 3 months, with a negative predictive value of 94% (95% CI, 85%-97%). Seven of 10 ZIKV-exposed children without microcephaly with adverse neurodevelopmental outcomes were identified by GMA. The GMA positive predictive value was 78% (95% CI, 46%-94%), sensitivity was 70% (95% CI, 35%-93%), specificity was 96% (95% CI, 85%-99%), and accuracy was 91% (95% CI, 80%-97%). Children with microcephaly had bilateral spastic cerebral palsy; none had normal movements. The Motor Optimality Score differentiated outcomes: the median Motor Optimality Score was 23 (interquartile range [IQR], 21-26) in children with normal development, 12 (IQR, 8-19) in children with adverse outcomes, and 5 (IQR, 5-6) in children with microcephaly, a significant difference (P = .001). CONCLUSIONS AND RELEVANCE This study suggests that although a large proportion of ZIKV-exposed infants without microcephaly develop normally, many do not. The GMA should be incorporated into routine infant assessments to enable early entry into targeted treatment programs.
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Affiliation(s)
- Christa Einspieler
- Interdisciplinary Developmental Neuroscience–iDN, Medical University of Graz, Graz, Austria
| | - Fabiana Utsch
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, Belo Horizonte, Brazil
| | - Patricia Brasil
- Laboratorio de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Carolina Y. Panvequio Aizawa
- Department of Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Science, Northwestern University, Chicago, Illinois
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Renata Hydee Hasue
- Department of Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fernanda Françoso Genovesi
- Department of Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luana Damasceno
- Laboratorio de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Kristina Adachi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Peter B. Marschik
- Interdisciplinary Developmental Neuroscience–iDN, Medical University of Graz, Graz, Austria
- Interdisciplinary Developmental Neuroscience–iDN, Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
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759
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Gunn AJ, Thoresen M. Neonatal encephalopathy and hypoxic-ischemic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:217-237. [PMID: 31324312 DOI: 10.1016/b978-0-444-64029-1.00010-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Acute hypoxic-ischemic encephalopathy around the time of birth remains a major cause of death and life-long disability. The key insight that led to the modern revival of studies of neuroprotection was that, after profound asphyxia, many brain cells show initial recovery from the insult during a short "latent" phase, typically lasting approximately 6h, only to die hours to days later after a "secondary" deterioration characterized by seizures, cytotoxic edema, and progressive failure of cerebral oxidative metabolism. Studies designed around this framework showed that mild hypothermia initiated as early as possible before the onset of secondary deterioration and continued for a sufficient duration to allow the secondary deterioration to resolve is associated with potent, long-lasting neuroprotection. There is now compelling evidence from randomized controlled trials that mild to moderate induced hypothermia significantly improves survival and neurodevelopmental outcomes in infancy and mid-childhood.
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Affiliation(s)
- Alistair J Gunn
- Departments of Physiology and Paediatrics, University of Auckland, Auckland, New Zealand.
| | - Marianne Thoresen
- Department of Physiology University of Oslo, Oslo, Norway; Neonatal Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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760
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Kuint J, Lerner-Geva L, Chodick G, Boyko V, Shalev V, Reichman B. Type of Re-Hospitalization and Association with Neonatal Morbidities in Infants of Very Low Birth Weight. Neonatology 2019; 115:292-300. [PMID: 30808837 DOI: 10.1159/000495702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at high risk for long-term morbidities and an increased rate of re-hospitalization. OBJECTIVE The aim of this study was to evaluate the type of re-hospitalization of very low birth weight (VLBW) infants, from infancy through adolescence, and to assess the association of neonatal morbidities with specific types of re-hospitalization. STUDY DESIGN The study cohort comprised 6,385 VLBW infants who were registered with the Maccabi Healthcare Services (MHS) from their birth hospitalization. Data were collected for up to 18 years (median 10.7 years) following neonatal intensive care unit discharge. Hospitalization types were determined from the MHS coding. Neonatal morbidities included necrotizing enterocolitis (NEC), grades 3-4 intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazards model. RESULTS Overall, 3,956 infants were re-hospitalized at least once and a total of 11,595 hospitalization types were identified. NEC, IVH, PVL, and BPD were associated with significantly higher aHRs for general pediatric (aHR 1.28-1.55), general surgical (aHR 1.18-1.46), and pediatric intensive care unit (aHR 1.57-2.04) hospitalizations. IVH and PVL were associated with significantly higher aHRs for orthopedic (aHR 2.12 and 4.88, respectively) and ophthalmology (1.76 and 4.02, respectively) hospitalizations. IVH was associated with a 14.2-fold higher aHR for neurosurgical admissions, and ROP with a 1.62-fold higher aHR for ophthalmology hospitalizations. CONCLUSION Among VLBW infants, specific patterns of re-hospitalization types associated with major neonatal morbidities were identified as particularly high risks for orthopedic and ophthalmology hospitalizations in infants with IVH and PVL, and for intensive care admissions in infants with NEC and BPD.
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Affiliation(s)
- Jacob Kuint
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Liat Lerner-Geva
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valentina Boyko
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Varda Shalev
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brian Reichman
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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761
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Jiang H, Li X, Jin C, Wang M, Liu C, Chan KC, Yang J. Early Diagnosis of Spastic Cerebral Palsy in Infants with Periventricular White Matter Injury Using Diffusion Tensor Imaging. AJNR Am J Neuroradiol 2019; 40:162-168. [PMID: 30545838 PMCID: PMC7048607 DOI: 10.3174/ajnr.a5914] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Periventricular white matter injury is the common cause of spastic cerebral palsy. However, the early diagnosis of spastic cerebral palsy still remains a challenge. Our aim was to investigate whether infants with periventricular white matter injury with bilateral spastic cerebral palsy have unique lesions different from those in infants without cerebral palsy and to evaluate the efficiency of DTI in the early diagnosis of spastic cerebral palsy. MATERIALS AND METHODS Infants with periventricular white matter injury and controls underwent MR imaging at 6-18 months of age. Fractional anisotropy was calculated from DTI. Cerebral palsy was diagnosed by 24-30 months of age. Subjects were divided into 3 groups: infants with periventricular white matter injury with bilateral spastic cerebral palsy, infants with periventricular white matter injury without cerebral palsy, and controls. Tract-Based Spatial Statistics and Automated Fiber Quantification were used to investigate intergroup differences. Receiver operating characteristic curves were used to assess the diagnostic accuracy of spastic cerebral palsy. Correlations between motor function scores and fractional anisotropy were evaluated along white matter tracts. RESULTS There were 20, 19, and 33 subjects in periventricular white matter injury with spastic cerebral palsy, periventricular white matter injury without cerebral palsy, and control groups, respectively. Decreased fractional anisotropy in the corticospinal tract was only observed in infants with periventricular white matter injury with spastic cerebral palsy, whereas decreased fractional anisotropy in the posterior thalamic radiation and genu and splenium of the corpus callosum was seen in both periventricular white matter injury subgroups. Fractional anisotropy in the corticospinal tract at the internal capsule level was effective in differentiating infants with periventricular white matter injury with spastic cerebral palsy from those without cerebral palsy by a threshold of 0.53, and it had strong correlations with motor function scores. CONCLUSIONS Corticospinal tract lesions play a crucial role in motor impairment related to spastic cerebral palsy in infants with periventricular white matter injury. Fractional anisotropy in the corticospinal tract at the internal capsule level could aid in the early diagnosis of spastic cerebral palsy with high diagnostic accuracy.
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Affiliation(s)
- H Jiang
- From the Department of Radiology (H.J., X.L., C.J., M.W., C.L., J.Y.), First Affiliated Hospital
- Department of Biomedical Engineering (H.J., J.Y.), Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - X Li
- From the Department of Radiology (H.J., X.L., C.J., M.W., C.L., J.Y.), First Affiliated Hospital
| | - C Jin
- From the Department of Radiology (H.J., X.L., C.J., M.W., C.L., J.Y.), First Affiliated Hospital
| | - M Wang
- From the Department of Radiology (H.J., X.L., C.J., M.W., C.L., J.Y.), First Affiliated Hospital
| | - C Liu
- From the Department of Radiology (H.J., X.L., C.J., M.W., C.L., J.Y.), First Affiliated Hospital
| | - K C Chan
- Department of Ophthalmology and Radiology (K.C.C.), School of Medicine, New York University, New York, New York
| | - J Yang
- From the Department of Radiology (H.J., X.L., C.J., M.W., C.L., J.Y.), First Affiliated Hospital
- Department of Biomedical Engineering (H.J., J.Y.), Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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762
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Marcroft C, Tsutsumi A, Pearse J, Dulson P, Embleton ND, Basu AP. Current Therapeutic Management of Perinatal Stroke with a Focus on the Upper Limb: A Cross-Sectional Survey of UK Physiotherapists and Occupational Therapists. Phys Occup Ther Pediatr 2019; 39:151-167. [PMID: 30211625 DOI: 10.1080/01942638.2018.1503212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. DESIGN Web-based cross-sectional survey. METHODS Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. RESULTS 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. CONCLUSIONS Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.
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Affiliation(s)
- Claire Marcroft
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK
| | | | - Janice Pearse
- c Newcastle upon Tyne Hospitals NHS Foundation Trust , Paediatric Occupational Therapy Services , Newcastle upon Tyne , UK
| | - Pat Dulson
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK
| | - Nicholas D Embleton
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK.,d Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Anna P Basu
- e Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK.,f Department of Paediatric Neurology , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
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763
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Early developmental assessment with a short screening test, the STEP, predicts one-year outcomes. J Perinatol 2019; 39:184-192. [PMID: 30301940 PMCID: PMC6349683 DOI: 10.1038/s41372-018-0234-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/09/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the Specific Test of Early Infant Motor Performance (STEP), a rapid screening test of preterm infants at risk for developmental delay. STUDY DESIGN We prospectively studied 23 preterm infants' performance on the STEP and the Test of Infant Motor Performance (TIMP) at term and 3 months, and on the Bayley-III at 12 months. We investigated the psychometric qualities of the STEP and determined STEP cutoff scores for low and high-performing infants. RESULTS STEP scores at term and 3 months strongly correlate with 12-month Bayley-III gross motor and cognitive scaled scores, while TIMP scores did not. The STEP showed excellent reliability and required 6-10 min to administer. CONCLUSION STEP is a short, easy to administer, early developmental assessment with unique scoring that emphasizes qualitative and quantitative aspects of muscle tone in movements and predicts 12-month Bayley gross motor and cognitive scaled scores.
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764
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Nurturing the preterm infant brain: leveraging neuroplasticity to improve neurobehavioral outcomes. Pediatr Res 2019; 85:166-175. [PMID: 30531968 DOI: 10.1038/s41390-018-0203-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
An intrinsic feature of the developing brain is high susceptibility to environmental influence-known as plasticity. Research indicates cascading disruption to neurological development following preterm (PT) birth; yet, the interactive effects of PT birth and plasticity remain unclear. It is possible that, with regard to neuropsychological outcomes in the PT population, plasticity is a double-edged sword. On one side, high plasticity of rapidly developing neural tissue makes the PT brain more vulnerable to injury resulting from events, including inflammation, hypoxia, and ischemia. On the other side, plasticity may be a mechanism through which positive experience can normalize neurological development for PT children. Much of the available literature on PT neurological development is clinically weighted and focused on diagnostic utility for predicting long-term outcomes. Although diagnostic utility is valuable, research establishing neuroprotective factors is equally beneficial. This review will: (1) detail specific mechanisms through which plasticity is adaptive or maladaptive depending on the experience; (2) integrate research from neuroimaging, intervention, and clinical science fields in a summary of findings suggesting inherent plasticity of the PT brain as a mechanism to improve child outcomes; and (3) summarize how responsive caregiving experiences situate parents as agents of change in normalizing PT infant brain development.
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765
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Novak I, Morgan C. High-risk follow-up: Early intervention and rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:483-510. [PMID: 31324326 DOI: 10.1016/b978-0-444-64029-1.00023-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
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766
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Guttmann K, Flibotte J, DeMauro SB. Parental Perspectives on Diagnosis and Prognosis of Neonatal Intensive Care Unit Graduates with Cerebral Palsy. J Pediatr 2018; 203:156-162. [PMID: 30244983 DOI: 10.1016/j.jpeds.2018.07.089] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe how parents of neonatal intensive care unit (NICU) graduates with cerebral palsy (CP) perceive both the accuracy of prognoses provided in the NICU and the timing of their child's diagnosis of CP, and to assess the influence of functional outcome on these perceptions. STUDY DESIGN We surveyed parents of NICU graduates with CP about timing and benefit of diagnosis, accuracy of prognosis, and functional abilities of their children. After piloting and validation, CP parent support groups circulated the survey on social media, websites, and email lists. Bivariate relationships between categorical responses to survey questions were assessed with the χ2 test, and multivariable logistic regression was performed to identify independent factors associated with perceptions about the timing of diagnosis. RESULTS Parents of 463 children were included. Two-thirds (67%) of the children were diagnosed with CP before age 2 years, yet 40% of the respondents felt that diagnosis was made late, and only 11% categorized diagnosis as early. More than one-half (59%) perceived a benefit to diagnosis. There was a significant association between earlier age at diagnosis and greater functional limitations; 24% of parents who recalled being given a prognosis reported that their child functioned as predicted, and 46% reported that their child exceeded expectations. Parents were more likely to believe that children with fewer functional limitations had exceeded expectations. CONCLUSION Parents remember prognostic discussions about children who develop CP as underestimating functional outcome. Diagnosis is rarely seen as early and is associated with benefits. These observations suggest that clinicians should aim to diagnose CP early and to maintain guarded optimism about future outcomes. Tools for improved communication are urgently needed.
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Affiliation(s)
- Katherine Guttmann
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John Flibotte
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sara B DeMauro
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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767
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Ibrahim J, Mir I, Chalak L. Brain imaging in preterm infants <32 weeks gestation: a clinical review and algorithm for the use of cranial ultrasound and qualitative brain MRI. Pediatr Res 2018; 84:799-806. [PMID: 30315272 DOI: 10.1038/s41390-018-0194-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 02/07/2023]
Abstract
The aim is to review the evidence about the utility of term-equivalent age (TEA) magnetic resonance imaging (MRI) in predicting neurodevelopmental outcomes for preterm neonates. Preterm birth accounts for ~12% of all deliveries in the United States and is the leading cause of neurologic disabilities in children. From the neonatologist perspective, it is critically important to identify preterm infants at risk of subsequent neurodevelopmental disability who may benefit from early intervention services. However "the choose wisely campaign" also emphasizes the need to have ongoing cost/benefit discussions regarding care of preterm newborns to avoid waste that comes from subjecting infants to procedures that do not help. We performed a MEDLINE EMBASE database review from 2000 to 2018 to account for the technical evolution in the cranial ultrasound machines and introduction of MRI imaging in the NICU. Studies were graded based on the strength of their design using the GRADE guidelines and summarized with respect to brain MRI vs. cranial US (1) detection of white matter injury; (2) cerebellar hemorrhage; (3) long-term neurodevelopmental outcomes and impact on parental anxiety. We conclude with a hospital-specific guideline algorithm for performing TEA MRI based on risk evaluations ≤32 weeks.
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Affiliation(s)
- John Ibrahim
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Imran Mir
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Lina Chalak
- University of Texas Southwestern Medical Center Dallas, Dallas, TX, USA.
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768
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Mebius MJ, Bos AF. Clinical assessment of early brain function in infants with congenital heart disease. Dev Med Child Neurol 2018; 60:1192-1193. [PMID: 29905374 DOI: 10.1111/dmcn.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mirthe J Mebius
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Arend F Bos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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769
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Kurz MJ, Willett S. Clinical biomarkers for assessing neurodevelopmental outcome of infants born preterm. Dev Med Child Neurol 2018; 60:1193-1194. [PMID: 29984463 DOI: 10.1111/dmcn.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sandra Willett
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
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770
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Kwong AKL, Olsen JE, FitzGerald TL, Doyle LW, Cheong JLY, Spittle AJ. Spontaneous infant movements that predict later cerebral palsy: reply to Hadders-Algra and Philippi. Dev Med Child Neurol 2018; 60:1289. [PMID: 30393857 DOI: 10.1111/dmcn.14036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Amanda K L Kwong
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Service, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Tara L FitzGerald
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, The Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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771
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
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772
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Wright JL, Chu HX, Kagan BJ, Ermine CM, Kauhausen JA, Parish CL, Sobey CG, Thompson LH. Local Injection of Endothelin-1 in the Early Neonatal Rat Brain Models Ischemic Damage Associated with Motor Impairment and Diffuse Loss in Brain Volume. Neuroscience 2018; 393:110-122. [PMID: 30300704 DOI: 10.1016/j.neuroscience.2018.09.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/23/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022]
Abstract
Cerebral palsy is an irreversible movement disorder resulting from cerebral damage sustained during prenatal or neonatal brain development. As survival outcomes for preterm injury improve, there is increasing need to model ischemic injury at earlier neonatal time-points to better understand the subsequent pathological consequences. Here we demonstrate a novel neonatal ischemic model using focal administration of the potent vasoconstrictor peptide, endothelin-1 (ET-1), in newborn rats. The functional and histopathological outcomes compare favourably to those reported following the widely used hypoxic ischemia (HI) model. These include a robust motor deficit sustained into adulthood and recapitulation of hallmark features of preterm human brain injury, including atrophy of subcortical white matter and periventricular fiber bundles. Compared to procedures involving carotid artery manipulation and periods of hypoxia, the ET-1 ischemia model represents a rapid and technically simplified model more amenable to larger cohorts and with the potential to direct the locus of ischemic damage to specific brain areas.
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Affiliation(s)
- Jordan L Wright
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
| | - Hannah X Chu
- Biomedicine Discovery Institute and Department of Pharmocology, Monash University, Melbourne, VIC, Australia
| | - Brett J Kagan
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Charlotte M Ermine
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Jessica A Kauhausen
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Clare L Parish
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Christopher G Sobey
- Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Lachlan H Thompson
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
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773
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Prediction of long-term neurodevelopmental outcome in preterm infants using trajectories of general movement assessments. J Perinatol 2018; 38:1398-1406. [PMID: 30054588 DOI: 10.1038/s41372-018-0173-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the predictive value of trajectories and individual assessment of quality of general movements (AQGM) for identification of neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA) in infants <30 weeks gestational age and/or birth weight <1500 g. METHODS In this retrospective cohort study, AQGM at 6 weeks and 3 months CA were scored and categorized as normal (N) or abnormal (A). AQGM measures were compared with degree of NDI and Bayley Scales of Infant Development, Third Edition (BSID-III) composite motor and cognitive scores. 'Persistently abnormal' AQGM included both mildly abnormal (MA) and definitely abnormal (DA) assessments. A "modified AQGM" where MA assessments were considered normal variant/transient injury was used to conduct post-hoc analysis. RESULTS Across 244 cases, persistently abnormal AQGM trajectory predicted the level of NDI (OR 2.5, 95% CI 1.2, 5.1) compared to AQGM trajectory that normalized. However, using the "modified AQGM", persistently DA trajectories were associated with significantly lower BSID-III composite motor and cognitive scores (p < 0.001 and p = 0.039, respectively). CONCLUSION Categorizing MA assessments as transient injury increased the predictive value of AQGM trajectories and significantly predicted lower cognitive and motor scores at 18-24 months CA.
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774
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Schiariti V, Fowler E, Brandenburg JE, Levey E, Mcintyre S, Sukal-Moulton T, Ramey SL, Rose J, Sienko S, Stashinko E, Vogtle L, Feldman RS, Koenig JI. A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations. Dev Med Child Neurol 2018. [PMID: 29542813 DOI: 10.1111/dmcn.13723] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED To increase the efficiency and effectiveness of clinical research studies, cerebral palsy (CP) specific Common Data Elements (CDEs) were developed through a partnership between the National Institute of Neurological Disorders and Stroke (NINDS) and the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). International experts reviewed existing NINDS CDEs and tools used in studies of children and young people with CP. CDEs were compiled, subjected to internal review, and posted online for external public comment in September 2016. Guided by the International Classification of Functioning, Disability and Health framework, CDEs were categorized into six domains: (1) participant characteristics; (2) health, growth, and genetics; (3) neuroimaging; (4) neuromotor skills and functional assessments; (5) neurocognitive, social, and emotional assessments; and (6) engagement and quality of life. Version 1.0 of the NINDS/AACPDM CDEs for CP is publicly available on the NINDS CDE and AACPDM websites. Global use of CDEs for CP will standardize data collection, improve data quality, and facilitate comparisons across studies. Ongoing collaboration with international colleagues, industry, and people with CP and their families will provide meaningful feedback and updates as additional evidence is obtained. These CDEs are recommended for NINDS-funded research for CP. WHAT THIS PAPER ADDS This is the first comprehensive Common Data Elements (CDEs) for children and young people with CP for clinical research. The CDEs for children and young people with CP include common definitions, the standardization of case report forms, and measures. The CDE guides the standardization for data collection and outcome evaluation in all types of studies with children and young people with CP. The CDE ultimately improves data quality and data sharing.
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Affiliation(s)
- Verónica Schiariti
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eileen Fowler
- University of California Los Angeles, Los Angeles, CA, USA
| | - Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Levey
- Health Services for Children with Special Needs, Inc., Washington, DC, USA
| | - Sarah Mcintyre
- Cerebral Palsy Alliance, University of Sydney, Sydney, NSW, Australia
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sharon L Ramey
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute, Roanoke, VA, USA
| | - Jessica Rose
- Stanford University School of Medicine, Stanford, CA, USA
| | - Susan Sienko
- Shriners Hospitals for Children, Portland, OR, USA
| | | | - Laura Vogtle
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - James I Koenig
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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775
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Morgan C, Fahey M, Roy B, Novak I. Diagnosing cerebral palsy in full-term infants. J Paediatr Child Health 2018; 54:1159-1164. [PMID: 30294991 DOI: 10.1111/jpc.14177] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022]
Abstract
More than 50% of infants with cerebral palsy (CP) are born at or near term, with the vast majority having pre- or perinatally acquired CP. While some have a clinical history predictive of CP, such as neonatal encephalopathy or neonatal stroke, others have no readily identifiable risk factors. Paediatricians are often required to discriminate generalised motor delay from a variety of other diagnoses, including CP. This paper outlines known causal pathways to CP in term-born infants with a focus on differential diagnosis. Early and accurate diagnosis is important as it allows prompt access to early intervention during the critical periods of brain development. A combination of clinical history taking, standard clinical examination, neuroimaging and genetic testing should be started at the time of referral. Attention to the investigation of common comorbidities of CP, including feeding and sleep difficulties, and referral to early intervention are recommended.
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Affiliation(s)
- Catherine Morgan
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance, School of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Bithi Roy
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
- Special Care Nursery, Mater Hospital Sydney, Sydney, New South Wales, Australia
| | - Iona Novak
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance, School of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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776
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Rodby-Bousquet E. The gap between current knowledge and clinical practice in childhood disability. Dev Med Child Neurol 2018; 60:969-970. [PMID: 29998559 DOI: 10.1111/dmcn.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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777
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Hay K, Nelin M, Carey H, Chorna O, Moore-Clingenpeel M, Maitre N. Hammersmith Infant Neurological Examination Asymmetry Score Distinguishes Hemiplegic Cerebral Palsy From Typical Development. Pediatr Neurol 2018; 87:70-74. [PMID: 30190180 PMCID: PMC6320694 DOI: 10.1016/j.pediatrneurol.2018.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Hammersmith Infant Neurological Examination is one of several useful tools for early identification of cerebral palsy; however, cut-off scores for cerebral palsy do not consistently distinguish infants with hemiplegia from those typically developing. We hypothesized that use of an asymmetry score, in addition to the assessment's standard total cutoff score, could remedy this problem in a clinical setting. METHODS This retrospective study of a neonatal intensive care follow-up program with consistent clinical use of the Hammersmith Infant Neurological Examination matched infants with a diagnosis of cerebral palsy to infants without motor delays or evidence of neurodevelopmental impairments. Groups had same corrected and gestational ages at Hammersmith Infant Neurological Examination assessment. Asymmetry presence was recorded. RESULTS Of 74 infants with cerebral palsy, 28 had quadriplegia, 11 had diplegia, and 35 had hemiplegia. Median total Hammersmith Infant Neurological Examination and asymmetry scores for hemiplegia were 57.5 and 10 versus 76 and 0 for those without cerebral palsy. Sensitivity and specificity to distinguish hemiplegia from typical development by combining a total Hammersmith Infant Neurological Examination score less than 63 and an asymmetry score greater than 5 were 91.8% and 100%, respectively. CONCLUSIONS In a clinical setting, combining total Hammersmith Infant Neurological Examination and asymmetry scores can help providers differentiate infants with hemiplegia from those typically developing.
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Affiliation(s)
- Krystal Hay
- Center for Perinatal Research and Department of Pediatrics at Nationwide Children’s Hospital, Columbus, OH
| | - MaryAnn Nelin
- Center for Perinatal Research and Department of Pediatrics at Nationwide Children’s Hospital, Columbus, OH
| | - Helen Carey
- Center for Perinatal Research and Department of Pediatrics at Nationwide Children’s Hospital, Columbus, OH
| | - Olena Chorna
- Center for Perinatal Research and Department of Pediatrics at Nationwide Children’s Hospital, Columbus, OH
| | - Melissa Moore-Clingenpeel
- Center for Perinatal Research and Department of Pediatrics at Nationwide Children’s Hospital, Columbus, OH
| | - Nathalie Maitre
- Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital, Columbus, Ohio; Department of Hearing and Speech Sciences, Vanderbilt Kennedy Center, Nashville, Tennessee.
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778
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Sgandurra G, Beani E, Giampietri M, Rizzi R, Cioni G. Early intervention at home in infants with congenital brain lesion with CareToy revised: a RCT protocol. BMC Pediatr 2018; 18:295. [PMID: 30185165 PMCID: PMC6126039 DOI: 10.1186/s12887-018-1264-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Congenital brain lesions expose infants to be at high-risk for being affected by neurodevelopmental disorders such as cerebral palsy (CP). Early interventions programs can significantly impact and improve their neurodevelopment. Recently, in the framework of the European CareToy (CT) Project ( www.caretoy.eu ), a new medical device has been created to deliver an early, intensive, customized, intervention program, carried out at home by parents but remotely managed by expert and trained clinicians. Reviewing results of previous studies on preterm infants without congenital brain lesion, the CT platform has been revised and a new system created (CT-R). This study describes the protocol of a randomised controlled trial (RCT) aimed to evaluate, in a sample of infants at high-risk for CP, the efficacy of CT-R intervention compared to the Infant Massage (IM) intervention. METHODS/DESIGN This RCT will be multi-centre, paired and evaluator-blinded. Eligible subjects will be preterm or full-term infants with brain lesions, in first year of age with predefined specific gross motor abilities. Recruited infants will be randomized into CT-R and IM groups at baseline (T0). Based on allocation, infants will perform an 8-week programme of personalized CareToy activities or Infant Massage. The primary outcome measure will be the Infant Motor Profile. On the basis of power calculation, it will require a sample size of 42 infants. Moreover, Peabody Developmental Motor Scales-Second Edition, Teller Acuity Cards, standardized video-recordings of parent-infant interaction and wearable sensors (Actigraphs) will be included as secondary outcome measures. Finally, parents will fill out questionnaires (Bayley Social-Emotional, Parents Stress Index). All outcome measures will be carried out at the beginning (T0) and at end of 8-weeks intervention period, primary endpoint (T1). Primary outcome and some secondary outcomes will be carried out also after 2 months from T1 and at 18 months of age (T2 and T3, respectively). The Bayley Cognitive subscale will be used as additional assessment at T3. DISCUSSION This study protocol paper is the first study aimed to test CT-R system in infants at high-risk for CP. This paper will present the scientific background and trial methodology. TRIAL REGISTRATION NCT03211533 and NCT03234959 ( www.clinicaltrials.gov ).
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Affiliation(s)
- Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital “Santa Chiara”, Via Roma 67, 56126 Pisa, Italy
| | - Riccardo Rizzi
- Neuroscience Center of Excellence and Neonatal Intensive Care Unit, “A. Meyer” University Children’s Hospital, Florence, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
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779
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Wagenaar N, Martinez-Biarge M, van der Aa NE, van Haastert IC, Groenendaal F, Benders MJNL, Cowan FM, de Vries LS. Neurodevelopment After Perinatal Arterial Ischemic Stroke. Pediatrics 2018; 142:peds.2017-4164. [PMID: 30072575 DOI: 10.1542/peds.2017-4164] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perinatal arterial ischemic stroke (PAIS) leads to cerebral palsy in ∼30% of affected children and has other neurologic sequelae. Authors of most outcome studies focus on middle cerebral artery (MCA) stroke without differentiating between site and extent of affected tissue. Our aim with this study was to report outcomes after different PAIS subtypes. METHODS Between 1990 and 2015, 188 term infants from 2 centers (London [n = 79] and Utrecht [n = 109]) had PAIS on their neonatal MRI. Scans were reevaluated to classify stroke territory and determine specific tissue involvement. At 18 to 93 (median 41.7) months, adverse neurodevelopmental outcomes were recorded as 1 or more of cerebral palsy, cognitive deficit, language delay, epilepsy, behavioral problems, or visual field defect. RESULTS The MCA territory was most often involved (90%), with posterior or anterior cerebral artery territory strokes occurring in 9% and 1%, respectively. Three infants died, and 24 had scans unavailable for reevaluation or were lost to follow-up. Of 161 infants seen, 54% had an adverse outcome. Outcomes were the same between centers. Main branch MCA stroke resulted in 100% adverse outcome, whereas other stroke subtypes had adverse outcomes in only 29% to 57%. The most important outcome predictors were involvement of the corticospinal tracts and basal ganglia. CONCLUSIONS Although neurodevelopmental outcome was adverse in at least 1 domain with main branch MCA stroke, in other PAIS subtypes outcome was favorable in 43% to 71% of children. Site and tissue involvement is most important in determining the outcome in PAIS.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | | | - Niek E van der Aa
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Ingrid C van Haastert
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; and
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780
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Korzeniewski SJ, Slaughter J, Lenski M, Haak P, Paneth N. The complex aetiology of cerebral palsy. Nat Rev Neurol 2018; 14:528-543. [PMID: 30104744 DOI: 10.1038/s41582-018-0043-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.
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Affiliation(s)
- Steven J Korzeniewski
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jaime Slaughter
- Department of Health Systems and Sciences Research and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Madeleine Lenski
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Peterson Haak
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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781
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Abstract
Technological advances in neonatal-perinatal medicine have led to a steady increase in the survival of preterm infants. Although the increase in survival is a remarkable success, children born preterm remain at high risk for brain injury and long-term neurodevelopmental deficits. Children born preterm may have abnormal muscle tone or movements, cognitive deficits, language impairments, and behavioral problems. This article reviews neurodevelopmental outcomes and factors that influence outcomes in preterm children during early childhood.
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782
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Schiariti V, Longo E, Shoshmin A, Kozhushko L, Besstrashnova Y, Król M, Neri Correia Campos T, Náryma Confessor Ferreira H, Verissimo C, Shaba D, Mwale M, Amado S. Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091899. [PMID: 30200412 PMCID: PMC6163506 DOI: 10.3390/ijerph15091899] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/11/2018] [Accepted: 08/16/2018] [Indexed: 12/21/2022]
Abstract
Background: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy (CP) offer service providers and stakeholders a specific framework to explore functioning and disability for assessment, treatment, evaluation, and policy purposes in a global context. Objective: Describe global initiatives applying the ICF Core Sets for children and youth with CP, with a focus on contributions to clinical practice and challenges in their implementation. Methods: This is a descriptive cross-sectional study. Ongoing initiatives applying the ICF Core Sets for CP in Russia, Poland, Malawi, and Brazil are included. Results: The main contributions of applying the ICF Core Sets for children and youth with CP include: (1) an objective description of abilities and limitations in everyday activities; (2) a consistent identification of facilitators and barriers influencing functioning; (3) a practical communication tool promoting client-centered care and multidisciplinary teamwork; and, (4) a useful guideline for measurement selection. The main challenges of adopting the ICF Core Sets are related to lack of ICF knowledge requiring intense training and translating results from standardized measures into the ICF qualifiers in a consistent way. Conclusions: Global initiatives include research and clinical applications at the program, service and system levels. The ICF Core Sets for CP are useful tools to guide service provision and build profiles of functioning and disability. Global interprofessional collaboration, capacity training, and informatics (e-records) will maximize their applications and accelerate adoption.
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Affiliation(s)
- Verónica Schiariti
- Division of Medical Sciences, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Egmar Longo
- Postgraduate Program in Collective Health, Faculty of Health Sciences of Trairi (UFRN-FACISA), Federal University of Rio Grande do Norte, Santa Cruz 59200-000, Brazil.
| | - Alexander Shoshmin
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Saint Petersburg 195067, Russia.
| | - Ludmila Kozhushko
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Saint Petersburg 195067, Russia.
| | - Yanina Besstrashnova
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Saint Petersburg 195067, Russia.
| | - Maria Król
- The Step by Step Association for Help of Disabled Children, Zamość 22-400, Poland.
| | - Taynah Neri Correia Campos
- Postgraduate Program in Collective Health, Faculty of Health Sciences of Trairi (UFRN-FACISA), Federal University of Rio Grande do Norte, Santa Cruz 59200-000, Brazil.
| | - Haryelle Náryma Confessor Ferreira
- Postgraduate Program in Collective Health, Faculty of Health Sciences of Trairi (UFRN-FACISA), Federal University of Rio Grande do Norte, Santa Cruz 59200-000, Brazil.
| | - Cláudia Verissimo
- Health School Science, Polytechnic Institute of Leiria, Leiria 2411-901, Portugal.
| | | | - Matilda Mwale
- RIPPLE Africa, Limbe 431136, Malawi, Africa.
- Department of Education, Catholic University of Malawi, Limbe 431136, Malawi, Africa.
| | - Sandra Amado
- Health School Science, Polytechnic Institute of Leiria, Leiria 2411-901, Portugal.
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783
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Spittle AJ, Morgan C, Olsen JE, Novak I, Cheong JLY. Early Diagnosis and Treatment of Cerebral Palsy in Children with a History of Preterm Birth. Clin Perinatol 2018; 45:409-420. [PMID: 30144846 DOI: 10.1016/j.clp.2018.05.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infants born preterm are at increased risk of cerebral palsy (CP), with the risk increasing with decreasing gestational age. Although preterm children are at increased risk of CP compared with their term-born peers, most preterm children do not have CP and thus, it is important to have a standardized process for detecting those children at high risk of CP early. A combination of clinical history, neuroimaging, and physical examination is recommended to ensure early, accurate diagnosis. Early detection of CP is essential for timely early intervention to optimize outcomes for children and their families.
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Affiliation(s)
- Alicia J Spittle
- Physiotherapy, University of Melbourne, 161 Barry Street, Parkville 3052, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Neonatal Services, The Royal Women's Hospitals, Cnr Flemington Road and Grattan Street, Parkville 3052, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Neonatal Services, The Royal Women's Hospitals, Cnr Flemington Road and Grattan Street, Parkville 3052, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Jeanie L Y Cheong
- Physiotherapy, University of Melbourne, 161 Barry Street, Parkville 3052, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Neonatal Services, The Royal Women's Hospitals, Cnr Flemington Road and Grattan Street, Parkville 3052, Australia
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784
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Abstract
The rate of bronchopulmonary dysplasia (BPD) in preterm infants is increasing; this trend reflects, in part, improved survival among extremely premature infants. BPD is associated with adverse developmental and medical outcomes in early childhood and at least through school age. Therefore, BPD imposes a significant burden on infants and children, their families, and society. Many interventions to decrease BPD and the sequelae of BPD have been studied; few to date have been proved to decrease both BPD and later disability.
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Affiliation(s)
- Sara B DeMauro
- Division of Neonatology, The Children's Hospital of Philadelphia, 2nd Floor Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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785
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Apkon S, Noritz G. The primary care pediatrician: key to improving neuromotor outcomes. Dev Med Child Neurol 2018; 60:851. [PMID: 30133721 DOI: 10.1111/dmcn.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Apkon
- Seattle Children's Hospital - Rehabilitation Medicine, Seattle, WA, USA
| | - Garey Noritz
- Nationwide Children's Hospital - Complex Care, Columbus, OH, USA
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786
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Ricci E, Einspieler C, Craig AK. Feasibility of Using the General Movements Assessment of Infants in the United States. Phys Occup Ther Pediatr 2018; 38:269-279. [PMID: 29144840 DOI: 10.1080/01942638.2017.1395380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To pilot the practicality of administering the Prechtl General Movements Assessment of infants (GMA) in the Neonatal Intensive Care Unit (NICU) setting and at home to infants at risk for developing cerebral palsy (CP). Additional aims included assessing inter-rater reliability and comparing GMA predictions to AIMS motor assessment at 12 months. METHODS 12 "at risk" infants were recruited by convenience sample. Video recordings were obtained in the NICU and provided by parents after discharge. These recordings were analyzed by two trained examiners to assess infants in the writhing and fidgety movement periods (birth to 16 weeks). Infants were assessed at 12 months corrected age using the Alberta Infant Motor Scale (AIMS) with scores lower than 5th centile considered a motor delay. RESULTS 33 of 42 videos (79%) were of sufficient quality to permit interpretation and there was 97% inter-examiner subcategory agreement and 100% overall developmental trajectory (abnormal/normal) agreement. The GMA demonstrated a sensitivity of 60% and a specificity of 100% in predicting AIMS score (age appropriate or delayed). CONCLUSIONS Clinical feasibility of GMA obtained in the NICU was demonstrated however feasibility of parents providing video samples after discharge was not demonstrated, indicating a need for a parent-friendly method.
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Affiliation(s)
- Eileen Ricci
- a Department of Physical Therapy , University of New England , Portland , ME
| | | | - Alexa K Craig
- c Maine Medical Partners Pediatric Neurology , Scarborough , ME
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787
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Ryan JM, Allen E, Gormley J, Hurvitz EA, Peterson MD. The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review. Dev Med Child Neurol 2018; 60:753-764. [PMID: 29572812 DOI: 10.1111/dmcn.13737] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
AIM To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP). METHOD Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted. RESULTS Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females. INTERPRETATION The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University, London, UK.,Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gormley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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788
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Basu AP, Pearse J, Watson R, Dulson P, Baggaley J, Wright B, Howel D, Vale L, Mitra D, Embleton N, Rapley T. Feasibility trial of an early therapy in perinatal stroke (eTIPS). BMC Neurol 2018; 18:102. [PMID: 30037324 PMCID: PMC6055336 DOI: 10.1186/s12883-018-1106-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Perinatal stroke (PS) affects up to 1/2300 infants and frequently leads to unilateral cerebral palsy (UCP). Preterm-born infants affected by unilateral haemorrhagic parenchymal infarction (HPI) are also at risk of UCP. To date no standardised early therapy approach exists, yet early intervention could be highly effective, by positively influencing processes of activity-dependent plasticity within the developing nervous system including the corticospinal tract. Our aim was to test feasibility and acceptability of an "early Therapy In Perinatal Stroke" (eTIPS) intervention, aiming ultimately to improve motor outcome. METHODS Design: Feasibility trial, North-East England, August 2015-September 2017. Participants were infants with PS or HPI, their carers and therapists. The intervention consisted of a parent-delivered lateralised therapy approach starting from term equivalent age and continuing until 6 months corrected age. The outcome measures were feasibility (recruitment and retention rates) and acceptability of the intervention (parental questionnaires including the Warwick-Edinburgh Mental Wellbeing Scale (WEBWMS), qualitative observations and in-depth interviews with parents and therapists). We also reviewed clinical imaging data and undertook assessments of motor function, including the Hand Assessment for Infants (HAI). Assessments were also piloted in typically developing (TD) infants, to provide further information on their ease of use and acceptability. RESULTS Over a period of 18 months we screened 20 infants referred as PS/HPI: 14 met the inclusion criteria and 13 took part. At 6 months, 11 (85%) of those enrolled had completed the final assessment. Parents valued the intervention and found it acceptable and workable. There were no adverse events related to the intervention. We recruited 14 TD infants, one of whom died prior to undertaking any assessments and one of whom was subsequently found to have a condition affecting neurodevelopmental progress: thus, data for 12 TD infants was analysed to 6 months. The HAI was well tolerated by infants and highly valued by parents. Completion rates for the WEBWMS were high and did not suggest any adverse effect of engagement in eTIPS on parental mental wellbeing. CONCLUSION The eTIPS intervention was feasible to deliver and acceptable to families. We plan to investigate efficacy in a multicentre randomised controlled trial. TRIAL REGISTRATION ISRCTN12547427 (registration request submitted 28/05/2015; retrospectively registered, 30/09/2015).
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
- Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Janice Pearse
- Therapy Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Rose Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Pat Dulson
- Newcastle Neonatal Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jessica Baggaley
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
| | - Blythe Wright
- Human Biosciences, Northumbria University, Newcastle upon Tyne, NE1 8ST UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Dipayan Mitra
- Department of Neuroradiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN UK
| | - Nick Embleton
- Newcastle Neonatal Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA UK
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789
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Of pioneers and advancements related to general movement assessment. Eur J Paediatr Neurol 2018; 22:584-585. [PMID: 29887416 DOI: 10.1016/j.ejpn.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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790
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Dostanic T, Sustersic B, Paro-Panjan D. Developmental outcome in a group of twins: Relation to perinatal factors and general movements. Eur J Paediatr Neurol 2018; 22:682-689. [PMID: 29709428 DOI: 10.1016/j.ejpn.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The quality of general movements (GMs) has proven to have predictive value for the developmental outcome, but this has not yet been studied in twins. AIMS Our aim was to analyse the quality of GMs and neurological and developmental outcome in relation to the gestational age (GA), mode of conception and other perinatal risk factors in a group of twins. STUDY DESIGN The documentation of twins referred for follow-up in the period from 1998 to 2016 was studied retrospectively. Data concerning the quality of GMs, perinatal risk factors and developmental outcome were analysed. SUBJECTS Eighty-nine twin pairs, GA from 24 to 38 weeks (median 35.0; IQR 3), birth weight 670 g-3820 g (median 2323; IQR 645) were included. OUTCOME MEASURES Results of neurological, psychological and speech/language development and school outcome were analysed. RESULTS GMs at term age and at three to four months postterm age did not differ with regard to the mode of conception. Preterm birth was significantly related to GMs at three to four months postterm age. At term age, GMs were significantly related to neurological outcome, while at three to four months postterm age, GMs were related to both the neurological and psychological outcome. Difficulties in speech/language development were diagnosed in almost half of the children, more frequently in boys and children with lower Apgar scores. CONCLUSION The study highlights the value of GMs for predicting the developmental outcome in twins and indicates the importance of developmental, especially speech/language, follow-up in twins.
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Affiliation(s)
- Tamara Dostanic
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia
| | - Breda Sustersic
- Developmental Clinic, Health Centre Domzale, Mestni Trg 2, 1230, Domzale, Slovenia
| | - Darja Paro-Panjan
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia.
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791
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Benfer KA, Novak I, Morgan C, Whittingham K, Khan NZ, Ware RS, Bell KL, Bandaranayake S, Salt A, Ghosh AK, Bhattacharya A, Samanta S, Moula G, Bose D, Tripathi S, Boyd RN. Community-based parent-delivered early detection and intervention programme for infants at high risk of cerebral palsy in a low-resource country (Learning through Everyday Activities with Parents (LEAP-CP): protocol for a randomised controlled trial. BMJ Open 2018; 8:e021186. [PMID: 29934387 PMCID: PMC6020941 DOI: 10.1136/bmjopen-2017-021186] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability, with 80% estimated to be in low-middle-income countries. This study aims to (1) determine the accuracy of General Movements (GMs)/Hammersmith Infant Neurological Examination (HINE) for detecting CP at 18 months corrected age (CA); (2) determine the effectiveness of a community-based parent-delivered early intervention for infants at high risk of CP in West Bengal, India (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). METHODS This study comprises two substudies: (1) a study of the predictive validity of the GMs and HINE for detecting CP; (2) randomised, double-blinded controlled trial of a novel intervention delivered through peer trainers (Community Disability Workers, CDW) compared with health advice (15 fortnightly visits). 142 infants at high risk of CP ('absent fidgety' GMs; 'high risk score' on HINE) aged 12-40 weeks CA will be recruited to the intervention substudy, with infants randomised based on a computer-generated sequence. Researchers will be masked to group allocation, and caregivers and CDWs naïve to intervention status. Visits will include therapeutic modules (goal-directed active motor/cognitive strategies and LEAP-CP games) and parent education. Health advice is based on the Integrated Management of Childhood Illness, WHO. Infants will be evaluated at baseline, post intervention and 18 months CA. The primary hypothesis is that infants receiving LEAP-CP will have greater scaled scores on the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (mobility domain) at 18 months compared with health advice. Secondary outcomes include infant functional motor, cognitive, visual and communication development; infant growth; maternal mental health. ETHICS AND DISSEMINATION This study is approved through appropriate Australian and Indian ethics committees (see in text) with families providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations. TRIAL REGISTRATION NUMBER 12616000653460p; Pre-results.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Naila Zaman Khan
- Department of Paediatric Neurosciences, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Kristie L Bell
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sasaka Bandaranayake
- Queensland Paediatric Rehabilitation Service, Lady Cilento Hospital, Brisbane, Queensland, Australia
| | - Alison Salt
- Neurodisability Service (GOSH), Great Ormond Street Hospital, London, UK
| | | | - Anjan Bhattacharya
- Child Development Centre (AGH), Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Sandip Samanta
- Dr BC Roy Postgraduate Institute of Paediatric Science, Kolkata, West Bengal, India
| | - Golam Moula
- Asha Bhavan Centre, Kathilia, West Bengal, India
| | - Dilip Bose
- Child In Need Institute, Kolkata, West Bengal, India
| | - Santanu Tripathi
- School of Tropical Medicine, Calcutta Medical College, Kolkata, West Bengal, India
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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792
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Dhillon SK, Lear CA, Galinsky R, Wassink G, Davidson JO, Juul S, Robertson NJ, Gunn AJ, Bennet L. The fetus at the tipping point: modifying the outcome of fetal asphyxia. J Physiol 2018; 596:5571-5592. [PMID: 29774532 DOI: 10.1113/jp274949] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022] Open
Abstract
Brain injury around birth is associated with nearly half of all cases of cerebral palsy. Although brain injury is multifactorial, particularly after preterm birth, acute hypoxia-ischaemia is a major contributor to injury. It is now well established that the severity of injury after hypoxia-ischaemia is determined by a dynamic balance between injurious and protective processes. In addition, mothers who are at risk of premature delivery have high rates of diabetes and antepartum infection/inflammation and are almost universally given treatments such as antenatal glucocorticoids and magnesium sulphate to reduce the risk of death and complications after preterm birth. We review evidence that these common factors affect responses to fetal asphyxia, often in unexpected ways. For example, glucocorticoid exposure dramatically increases delayed cell loss after acute hypoxia-ischaemia, largely through secondary hyperglycaemia. This critical new information is important to understand the effects of clinical treatments of women whose fetuses are at risk of perinatal asphyxia.
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Affiliation(s)
| | - Christopher A Lear
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Robert Galinsky
- The Department of Physiology, University of Auckland, Auckland, New Zealand.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Guido Wassink
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Sandra Juul
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Alistair J Gunn
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- The Department of Physiology, University of Auckland, Auckland, New Zealand
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793
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Hayat TTA, Rutherford MA. Neuroimaging perspectives on fetal motor behavior. Neurosci Biobehav Rev 2018; 92:390-401. [PMID: 29886176 DOI: 10.1016/j.neubiorev.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
We are entering a new era of understanding human development with the ability to perform studies at the earliest time points possible. There is a substantial body of evidence to support the concept that early motor behaviour originates from supraspinal motor centres, reflects neurological integrity, and that altered patterns of behaviour precede clinical manifestation of disease. Cine Magnetic Resonance Imaging (cineMRI) has established its value as a novel method to visualise motor behaviour in the human fetus, building on the wealth of knowledge gleaned from ultrasound based studies. This paper presents a state of the art review incorporating findings from human and preclinical models, the insights from which, we propose, can proceed a reconceptualisation of fetal motor behaviour using advanced imaging techniques. Foremost is the need to better understand the role of the intrauterine environment, and its inherent unique set of stimuli that activate sensorimotor pathways and shape early brain development. Finally, an improved model of early motor development, combined with multimodal imaging, will provide a novel source of in utero biomarkers predictive of neurodevelopmental disorders.
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Affiliation(s)
- Tayyib T A Hayat
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Mary A Rutherford
- Centre for the Developing Brain, Perinatal Imaging & Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, United Kingdom
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794
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D Chorna O, L Hamm E, Shrivastava H, Maitre NL. Feasibility of event-related potential (ERP) biomarker use to study effects of mother's voice exposure on speech sound differentiation of preterm infants. Dev Neuropsychol 2018; 43:123-134. [PMID: 29436854 DOI: 10.1080/87565641.2018.1433671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Atypical maturation of auditory neural processing contributes to preterm-born infants' language delays. Event-related potential (ERP) measurement of speech-sound differentiation might fill a gap in treatment-response biomarkers to auditory interventions. We evaluated whether these markers could measure treatment effects in a quasi-randomized prospective study. Hospitalized preterm infants in passive or active, suck-contingent mother's voice exposure groups were not different at baseline. Post-intervention, the active group had greater increases in/du/-/gu/differentiation in left frontal and temporal regions. Infants with brain injury had lower baseline/ba/-/ga/and/du/-/gu/differentiation than those without. ERP provides valid discriminative, responsive, and predictive biomarkers of infant speech-sound differentiation.
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Affiliation(s)
- Olena D Chorna
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA
| | - Ellyn L Hamm
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA
| | - Hemang Shrivastava
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA
| | - Nathalie L Maitre
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA.,b Department of Hearing and Speech Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
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795
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DeMauro SB, Schmidt B. Comparing Like with Like When Reporting Neurodevelopmental Outcomes after Preterm Birth. J Pediatr 2018; 197:10-12. [PMID: 29551315 DOI: 10.1016/j.jpeds.2018.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Sara B DeMauro
- The Children's Hospital of Philadelphia The University of Pennsylvania Perelman School of Medicine
| | - Barbara Schmidt
- The Children's Hospital of Philadelphia The University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania; Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton, Ontario, Canada.
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796
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Kwong AKL, Fitzgerald TL, Doyle LW, Cheong JLY, Spittle AJ. Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review. Dev Med Child Neurol 2018; 60:480-489. [PMID: 29468662 DOI: 10.1111/dmcn.13697] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
AIM To systematically review the predictive validity of spontaneous early infant movements for later cerebral palsy (CP). METHOD Cohort studies with published data to calculate predictive validity of early spontaneous movements for later CP were searched in four electronic databases: CINAHL, Embase, MEDLINE, and PsycINFO. RESULTS Forty-seven studies met inclusion criteria. The Prechtl General Movements Assessment (GMA) during the fidgety period (10-20wks corrected age) had the strongest sensitivity: 97 per cent (95% confidence interval [CI] 93-99) and specificity: 89% (95% CI 83-93). The sensitivity and specificity of the Prechtl GMA during the writhing period (birth-6wks) was 93% (95% CI 86-96) and 59% (95% CI 45-71) respectively. Cramped-synchronized movements in the writhing period according to Prechtl had the best specificity (sensitivity: 70% [95% CI 54-82]; specificity: 97% [95% CI 74-100]). Hadders-Algra's method of assessing general movements had a pooled sensitivity and specificity of 89% (95% CI 66-97) and 81% (95% CI 64-91) respectively. Presence of asymmetric postures and movement quality/quantity were reported under the Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination, and Movement Assessment of Infants but had weak associations with later CP. INTERPRETATION Fidgety movements assessed by the Prechtl GMA have the strongest predictive validity for later CP, but cannot be considered in isolation because of the presence of false positive results. WHAT THIS PAPER ADDS Fidgety general movements (Prechtl) are most predictive for later cerebral palsy compared with other spontaneous movements. False positive results are high among all spontaneous movement assessments.
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Affiliation(s)
- Amanda K L Kwong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Tara L Fitzgerald
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
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797
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Affiliation(s)
- Nathalie Maitre
- Department of Pediatrics, Nationwide Children's Hospital - Center for Perinatal Research, Columbus, OH, USA
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798
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Peyton C, Einspieler C. General Movements: A Behavioral Biomarker of Later Motor and Cognitive Dysfunction in NICU Graduates. Pediatr Ann 2018; 47:e159-e164. [PMID: 29668025 DOI: 10.3928/19382359-20180325-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Infants who have graduated from a neonatal intensive care unit require close follow-up because they have a greater chance of experiencing later motor and cognitive difficulties; however, these difficulties are often challenging to identify at an early age. The General Movement Assessment is a low-cost and highly reliable tool that can indicate abnormal neurological development in young high-risk infants, but it has not yet been widely implemented in the United States. In this review, we discuss the literature about the use of the General Movement Assessment in high-risk infants and how to implement the tool in a clinical setting. [Pediatr Ann. 2018;47(4):e159-e164.].
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799
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Abstract
PURPOSE Cerebral palsy (CP) is the most common motor disability of childhood. Less is known about its prevalence and associated factors in Switzerland, so we aimed to fill this knowledge gap in one Swiss canton, evaluating the feasibility to build up a CP registry. METHODS A retrospective review of medical records was undertaken. Children born during 1995 and 2009 in the canton of Saint Gallen diagnosed with CP were eligible for inclusion. RESULTS A total of 140 patients formed the study cohort. The prevalence of CP was 0.19%, with 85% of children affected by spastic CP. CONCLUSIONS The results of the present study were comparable with data of the Surveillance of Cerebral Palsy in Europe network. Moreover, this pilot study demonstrated the feasibility and usefulness of creating a registry of children affected by CP.
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800
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Abstract
Infants who graduate from the neonatal intensive care unit, including those infants born preterm and/or with brain injury, are at increased risk of long-term neurodevelopmental impairments. The developmental allied health team, consisting of physical therapy, occupational therapy, and speech pathology, is crucial in early evaluation of gross motor, fine motor, feeding, and language development. Surveillance of neurodevelopment in the first year of life is essential to ensure early detection of specific developmental delays and impairments, and to ensure timely referral for early intervention. Early intervention is not only important in optimizing long-term outcomes for the child, but it also plays an important role in enhancing the parent-child relationship and parental well-being. In this review, we discuss the role of the developmental allied health team in the follow-up of high-risk infants, identify key assessment tools used in early neurodevelopmental surveillance, and provide recommendations regarding referral to intervention programs to optimize child and family outcomes. [Pediatr Ann. 2018;47(4):e165-e171.].
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