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Fontana C, Schiavolin P, Ardemani G, Amerotti DA, Pesenti N, Bonfanti C, Boggini T, Gangi S, Porro M, Squarza C, Giannì ML, Persico N, Mosca F, Fumagalli M. To be born twin: effects on long-term neurodevelopment of very preterm infants-a cohort study. Front Pediatr 2023; 11:1217650. [PMID: 37528875 PMCID: PMC10389041 DOI: 10.3389/fped.2023.1217650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Objective To examine the effect of twin birth on long-term neurodevelopmental outcomes in a cohort of Italian preterm infants with very low birth weight. Study design We performed a retrospective cohort study on children born in a tertiary care centre. We included children born between 1 January 2007 and 31 December 2013 with a gestational age (GA) of ≤32 weeks and birth weight of <1,500 g. The infants born from twin pregnancies complicated by twin-to-twin transfusion syndrome and from higher-order multiple pregnancies were excluded. The children were evaluated both at 2 years corrected age and 5 years chronological age with Griffiths mental development scales revised (GMDS-R). The linear mixed effects models were used to study the effect of being a twin vs. being a singleton on GMDS-R scores, adjusting for GA, being born small for gestational age, sex, length of NICU stay, socio-economic status, and comorbidity score (CS) calculated as the sum of the weights associated with each of the major morbidities of the infants. Results A total of 301 children were included in the study, of which 189 (62.8%) were singletons and 112 (37.2%) were twins; 23 out of 112 twins were monochorionic (MC). No statistically significant differences were observed between twins and singletons in terms of mean general quotient and subscales at both 2 and 5 years. No effect of chorionicity was found when comparing scores of MC and dichorionic twins vs. singletons; however, after adjusting for the CS, the MC twins showed lower scores in the hearing and language and performance subscales at 5 years. Conclusion Overall, in our cohort of children born very preterm, twin infants were not at higher risk of neurodevelopmental impairment compared with singletons at pre-school age.
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Affiliation(s)
- Camilla Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Paola Schiavolin
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Giulia Ardemani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Chiara Bonfanti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Tiziana Boggini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Silvana Gangi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Matteo Porro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine and Rehabilitation Service, Milan, Italy
| | - Chiara Squarza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Persico
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Prenatal Diagnosis and Fetal Surgery Unit, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Aoki Y, Dai H, Furuta F, Akamatsu T, Oshima T, Takahashi N, Goto YI, Oka A, Itoh M. LOX-1 mediates inflammatory activation of microglial cells through the p38-MAPK/NF-κB pathways under hypoxic-ischemic conditions. Cell Commun Signal 2023; 21:126. [PMID: 37268943 DOI: 10.1186/s12964-023-01048-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/14/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Microglial cells play an important role in the immune system in the brain. Activated microglial cells are not only injurious but also neuroprotective. We confirmed marked lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) expression in microglial cells in pathological lesions in the neonatal hypoxic-ischemic encephalopathy (nHIE) model brain. LOX-1 is known to be an activator of cytokines and chemokines through intracellular pathways. Here, we investigated a novel role of LOX-1 and the molecular mechanism of LOX-1 gene transcription microglial cells under hypoxic and ischemic conditions. METHODS We isolated primary rat microglial cells from 3-day-old rat brains and confirmed that the isolated cells showed more than 98% Iba-1 positivity with immunocytochemistry. We treated primary rat microglial cells with oxygen glucose deprivation (OGD) as an in vitro model of nHIE. Then, we evaluated the expression levels of LOX-1, cytokines and chemokines in cells treated with or without siRNA and inhibitors compared with those of cells that did not receive OGD-treatment. To confirm transcription factor binding to the OLR-1 gene promoter under the OGD conditions, we performed a luciferase reporter assay and chromatin immunoprecipitation assay. In addition, we analyzed reactive oxygen species and cell viability. RESULTS We found that defects in oxygen and nutrition induced LOX-1 expression and led to the production of inflammatory mediators, such as the cytokines IL-1β, IL-6 and TNF-α; the chemokines CCL2, CCL5 and CCL3; and reactive oxygen/nitrogen species. Then, the LOX-1 signal transduction pathway was blocked by inhibitors, LOX-1 siRNA, the p38-MAPK inhibitor SB203580 and the NF-κB inhibitor BAY11-7082 suppressed the production of inflammatory mediators. We found that NF-κB and HIF-1α bind to the promoter region of the OLR-1 gene. Based on the results of the luciferase reporter assay, NF-κB has strong transcriptional activity. Moreover, we demonstrated that LOX-1 in microglial cells was autonomously overexpressed by positive feedback of the intracellular LOX-1 pathway. CONCLUSION The hypoxic/ischemic conditions of microglial cells induced LOX-1 expression and activated the immune system. LOX-1 and its related molecules or chemicals may be major therapeutic candidates. Video abstract.
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Affiliation(s)
- Yoshinori Aoki
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Faculty of Medicine, University of Miyazaki, Kiyotake-cho Kihara 5200, Miyazaki, 889-1692, Japan
| | - Hongmei Dai
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Fumika Furuta
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tomohisa Akamatsu
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Takuya Oshima
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu-Ichi Goto
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Akira Oka
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Japan
| | - Masayuki Itoh
- Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
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53
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Liebowitz M, Kramer KP, Rogers EE. All Care is Brain Care: Neuro-Focused Quality Improvement in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:399-420. [PMID: 37201988 DOI: 10.1016/j.clp.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Neonates requiring intensive care are in a critical period of brain development that coincides with the neonatal intensive care unit (NICU) hospitalization, placing these infants at high risk of brain injury and long-term neurodevelopmental impairment. Care in the NICU has the potential to be both harmful and protective to the developing brain. Neuro-focused quality improvement efforts address 3 main pillars of neuroprotective care: prevention of acquired injury, protection of normal maturation, and promotion of a positive environment. Despite challenges in measurement, many centers have shown success with consistent implementation of best and potentially better practices that may improve markers of brain health and neurodevelopment.
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Affiliation(s)
- Melissa Liebowitz
- Envision Physician Services, St. Francis Hospital, 6001 East Woodmen Road, Colorado Springs, CO 80923, USA
| | - Katelin P Kramer
- Department of Pediatrics, University of California, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA; University of California, Benioff Children's Hospital, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA.
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA; University of California, Benioff Children's Hospital, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA. https://twitter.com/eerogersmd
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54
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Williams LZJ, Fitzgibbon SP, Bozek J, Winkler AM, Dimitrova R, Poppe T, Schuh A, Makropoulos A, Cupitt J, O'Muircheartaigh J, Duff EP, Cordero-Grande L, Price AN, Hajnal JV, Rueckert D, Smith SM, Edwards AD, Robinson EC. Structural and functional asymmetry of the neonatal cerebral cortex. Nat Hum Behav 2023; 7:942-955. [PMID: 36928781 DOI: 10.1038/s41562-023-01542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
Features of brain asymmetry have been implicated in a broad range of cognitive processes; however, their origins are still poorly understood. Here we investigated cortical asymmetries in 442 healthy term-born neonates using structural and functional magnetic resonance images from the Developing Human Connectome Project. Our results demonstrate that the neonatal cortex is markedly asymmetric in both structure and function. Cortical asymmetries observed in the term cohort were contextualized in two ways: by comparing them against cortical asymmetries observed in 103 preterm neonates scanned at term-equivalent age, and by comparing structural asymmetries against those observed in 1,110 healthy young adults from the Human Connectome Project. While associations with preterm birth and biological sex were minimal, significant differences exist between birth and adulthood.
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Affiliation(s)
- Logan Z J Williams
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK.
| | - Sean P Fitzgibbon
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Anderson M Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ralica Dimitrova
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Tanya Poppe
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andreas Schuh
- Department of Computing, Imperial College London, London, UK
| | - Antonios Makropoulos
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - John Cupitt
- Department of Computing, Imperial College London, London, UK
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Eugene P Duff
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- UK Dementia Research Institute, Department of Brain Sciences, Imperial College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, ISCIII, Madrid, Spain
| | - Anthony N Price
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephen M Smith
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Emma C Robinson
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK.
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Novitskiy N, Chan PHY, Chan M, Lai CM, Leung TY, Leung TF, Bornstein MH, Lam HS, Wong PCM. Deficits in neural encoding of speech in preterm infants. Dev Cogn Neurosci 2023; 61:101259. [PMID: 37257249 DOI: 10.1016/j.dcn.2023.101259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
Preterm children show developmental cognitive and language deficits that can be subtle and sometimes undetectable until later in life. Studies of brain development in children who are born preterm have largely focused on vascular and gross anatomical characteristics rather than pathophysiological processes that may contribute to these developmental deficits. Neural encoding of speech as reflected in EEG recordings is predictive of future language development and could provide insights into those pathophysiological processes. We recorded EEG from 45 preterm (≤ 34 weeks of gestation) and 45 term (≥ 38 weeks) Chinese-learning infants 0-12 months of (corrected) age during natural sleep. Each child listened to three speech stimuli that differed in lexically meaningful pitch (2 native and 1 non-native speech categories). EEG measures associated with synchronization and gross power of the frequency following response (FFR) were examined. ANCOVAs revealed no main effect of stimulus nativeness but main effects of age, consistent with earlier studies. A main effect of prematurity also emerged, with synchronization measures showing stronger group differences than power. By detailing differences in FFR measures related to synchronization and power, this study brings us closer to identifying the pathophysiological pathway to often subtle language problems experienced by preterm children.
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Affiliation(s)
- Nikolay Novitskiy
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Peggy H Y Chan
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China; Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Mavis Chan
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Chin Man Lai
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Tak Yeung Leung
- Department of Obsterics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA; UNICEF, USA; Institute for Fiscal Studies, UK
| | - Hugh S Lam
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China.
| | - Patrick C M Wong
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.
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Easson K, Khairy M, Rohlicek CV, Saint-Martin C, Gilbert G, Nguyen KA, Luu TM, Couture É, Nuyt AM, Wintermark P, Deoni SCL, Descoteaux M, Brossard-Racine M. A comparison of altered white matter microstructure in youth born with congenital heart disease or born preterm. Front Neurol 2023; 14:1167026. [PMID: 37251222 PMCID: PMC10213269 DOI: 10.3389/fneur.2023.1167026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Alterations to white matter microstructure as detected by diffusion tensor imaging have been documented in both individuals born with congenital heart disease (CHD) and individuals born preterm. However, it remains unclear if these disturbances are the consequence of similar underlying microstructural disruptions. This study used multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) and neurite orientation dispersion and density imaging (NODDI) to characterize and compare alterations to three specific microstructural elements of white matter - myelination, axon density, and axon orientation - in youth born with CHD or born preterm. Methods Participants aged 16 to 26 years with operated CHD or born ≤33 weeks gestational age and a group of healthy peers of the same age underwent a brain MRI including mcDESPOT and high angular resolution diffusion imaging acquisitions. Using tractometry, average values of myelin water fraction (MWF), neurite density index (NDI), and orientation dispersion index (ODI) were first calculated and compared between groups for 30 white matter bundles. Afterwards, bundle profiling was performed to further characterize the topology of the detected microstructural alterations. Results The CHD and preterm groups both presented with widespread bundles and bundle segments with lower MWF, accompanied by some occurrences of lower NDI, relative to controls. While there were no differences in ODI between the CHD and control groups, the preterm group presented with both higher and lower ODI compared to the control group and lower ODI compared to the CHD group. Discussion While youth born with CHD or born preterm both presented with apparent deficits in white matter myelination and axon density, youth born preterm presented with a unique profile of altered axonal organization. Future longitudinal studies should aim to better understand the emergence of these common and distinct microstructural alterations, which could orient the development of novel therapeutic approaches.
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Affiliation(s)
- Kaitlyn Easson
- Advances in Brain and Child Development (ABCD) Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - May Khairy
- Division of Neonatology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Charles V. Rohlicek
- Division of Cardiology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Christine Saint-Martin
- Department of Medical Imaging, Division of Pediatric Radiology, Montreal Children’s Hospital, Montreal, QC, Canada
| | | | - Kim-Anh Nguyen
- Division of Neonatology, Department of Pediatrics, Jewish General Hospital, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Élise Couture
- Division of Neonatology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Anne-Monique Nuyt
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Pia Wintermark
- Division of Neonatology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Sean C. L. Deoni
- Advanced Baby Imaging Lab, Brown University, Providence, RI, United States
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie Brossard-Racine
- Advances in Brain and Child Development (ABCD) Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Division of Neonatology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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57
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Janson E, Willemsen MF, Van Beek PE, Dudink J, Van Elburg RM, Hortensius LM, Tam EWY, de Pipaon MS, Lapillonne A, de Theije CGM, Benders MJNL, van der Aa NE. The influence of nutrition on white matter development in preterm infants: a scoping review. Pediatr Res 2023:10.1038/s41390-023-02622-1. [PMID: 37147439 DOI: 10.1038/s41390-023-02622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/16/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
White matter (WM) injury is the most common type of brain injury in preterm infants and is associated with impaired neurodevelopmental outcome (NDO). Currently, there are no treatments for WM injury, but optimal nutrition during early preterm life may support WM development. The main aim of this scoping review was to assess the influence of early postnatal nutrition on WM development in preterm infants. Searches were performed in PubMed, EMBASE, and COCHRANE on September 2022. Inclusion criteria were assessment of preterm infants, nutritional intake before 1 month corrected age, and WM outcome. Methods were congruent with the PRISMA-ScR checklist. Thirty-two articles were included. Negative associations were found between longer parenteral feeding duration and WM development, although likely confounded by illness. Positive associations between macronutrient, energy, and human milk intake and WM development were common, especially when fed enterally. Results on fatty acid and glutamine supplementation remained inconclusive. Significant associations were most often detected at the microstructural level using diffusion magnetic resonance imaging. Optimizing postnatal nutrition can positively influence WM development and subsequent NDO in preterm infants, but more controlled intervention studies using quantitative neuroimaging are needed. IMPACT: White matter brain injury is common in preterm infants and associated with impaired neurodevelopmental outcome. Optimizing postnatal nutrition can positively influence white matter development and subsequent neurodevelopmental outcome in preterm infants. More studies are needed, using quantitative neuroimaging techniques and interventional designs controlling for confounders, to define optimal nutritional intakes in preterm infants.
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Affiliation(s)
- Els Janson
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marle F Willemsen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Pauline E Van Beek
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Ruurd M Van Elburg
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lisa M Hortensius
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Emily W Y Tam
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Miguel Saenz de Pipaon
- Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain
| | - Alexandre Lapillonne
- Department of Neonatology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Caroline G M de Theije
- Department for Developmental Origins of Disease, University Medical Center Utrecht Brain Center and Wilhelmina Children's Hospital, Utrecht University, 3508 AB, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
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58
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Gonzalez-Moreira E, Harmony T, Hinojosa-Rodríguez M, Carrillo-Prado C, Juárez-Colín ME, Gutiérrez-Hernández CC, Carlier MEM, Cubero-Rego L, Castro-Chavira SA, Fernández T. Prevention of Neurological Sequelae in Preterm Infants. Brain Sci 2023; 13:brainsci13050753. [PMID: 37239225 DOI: 10.3390/brainsci13050753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Preterm birth is one of the world's critical health problems, with an incidence of 5% to 18% of living newborns according to various countries. White matter injuries due to preoligodendrocytes deficits cause hypomyelination in children born preterm. Preterm infants also have multiple neurodevelopmental sequelae due to prenatal and perinatal risk factors for brain damage. The purpose of this work was to explore the effects of the brain risk factors and MRI volumes and abnormalities on the posterior motor and cognitive development at 3 years of age. METHODS A total of 166 preterm infants were examined before 4 months and clinical and MRI evaluations were performed. MRI showed abnormal findings in 89% of the infants. Parents of all infants were invited to receive the Katona neurohabilitation treatment. The parents of 128 infants accepted and received Katona's neurohabilitation treatment. The remaining 38 infants did not receive treatment for a variety of reasons. At the three-year follow-up, Bayley's II Mental Developmental Index (MDI) and the Psychomotor Developmental Index (PDI) were compared between treated and untreated subjects. RESULTS The treated children had higher values of both indices than the untreated. Linear regression showed that the antecedents of placenta disorders and sepsis as well as volumes of the corpus callosum and of the left lateral ventricle significantly predicted both MDI and PDI, while Apgar < 7 and volume of the right lateral ventricle predicted the PDI. CONCLUSIONS (1) The results indicate that preterm infants who received Katona's neurohabilitation procedure exhibited significantly better outcomes at 3 years of age compared to those who did not receive the treatment. (2) The presence of sepsis and the volumes of the corpus callosum and lateral ventricles at 3-4 months were significant predictors of the outcome at 3 years of age.
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Affiliation(s)
- Eduardo Gonzalez-Moreira
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - María Elena Juárez-Colín
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - Claudia Calipso Gutiérrez-Hernández
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - María Elizabeth Mónica Carlier
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - Lourdes Cubero-Rego
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - Susana A Castro-Chavira
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Querétaro 76230, Mexico
| | - Thalía Fernández
- Laboratorio de Psicofisiología, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro 76230, Mexico
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Conole ELS, Vaher K, Cabez MB, Sullivan G, Stevenson AJ, Hall J, Murphy L, Thrippleton MJ, Quigley AJ, Bastin ME, Miron VE, Whalley HC, Marioni RE, Boardman JP, Cox SR. Immuno-epigenetic signature derived in saliva associates with the encephalopathy of prematurity and perinatal inflammatory disorders. Brain Behav Immun 2023; 110:322-338. [PMID: 36948324 DOI: 10.1016/j.bbi.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/12/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Preterm birth is closely associated with a phenotype that includes brain dysmaturation and neurocognitive impairment, commonly termed Encephalopathy of Prematurity (EoP), of which systemic inflammation is considered a key driver. DNA methylation (DNAm) signatures of inflammation from peripheral blood associate with poor brain imaging outcomes in adult cohorts. However, the robustness of DNAm inflammatory scores in infancy, their relation to comorbidities of preterm birth characterised by inflammation, neonatal neuroimaging metrics of EoP, and saliva cross-tissue applicability are unknown. METHODS Using salivary DNAm from 258 neonates (n = 155 preterm, gestational age at birth 23.28 - 34.84 weeks, n = 103 term, gestational age at birth 37.00 - 42.14 weeks), we investigated the impact of a DNAm surrogate for C-reactive protein (DNAm CRP) on brain structure and other clinically defined inflammatory exposures. We assessed i) if DNAm CRP estimates varied between preterm infants at term equivalent age and term infants, ii) how DNAm CRP related to different types of inflammatory exposure (maternal, fetal and postnatal) and iii) whether elevated DNAm CRP associated with poorer measures of neonatal brain volume and white matter connectivity. RESULTS Higher DNAm CRP was linked to preterm status (-0.0107 ± 0.0008, compared with -0.0118 ± 0.0006 among term infants; p < 0.001), as well as perinatal inflammatory diseases, including histologic chorioamnionitis, sepsis, bronchopulmonary dysplasia, and necrotising enterocolitis (OR range |2.00 | to |4.71|, p < 0.01). Preterm infants with higher DNAm CRP scores had lower brain volume in deep grey matter, white matter, and hippocampi and amygdalae (β range |0.185| to |0.218|). No such associations were observed for term infants. Association magnitudes were largest for measures of white matter microstructure among preterms, where elevated epigenetic inflammation associated with poorer global measures of white matter integrity (β range |0.206| to |0.371|), independent of other confounding exposures. CONCLUSIONS Inflammatory-related DNAm captures the allostatic load of inflammatory burden in preterm infants. Such DNAm measures complement biological and clinical metrics when investigating the determinants of neurodevelopmental differences.
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Affiliation(s)
- Eleanor L S Conole
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK.
| | - Kadi Vaher
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Manuel Blesa Cabez
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Jill Hall
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Lee Murphy
- Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Alan J Quigley
- Imaging Department, Royal Hospital for Children and Young People, Edinburgh, EH16 4TJ, UK
| | - Mark E Bastin
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Veronique E Miron
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Heather C Whalley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - James P Boardman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Simon R Cox
- Lothian Birth Cohorts group, Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK.
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60
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Schmitz-Koep B, Menegaux A, Gaser C, Brandes E, Schinz D, Thalhammer M, Daamen M, Boecker H, Zimmer C, Priller J, Wolke D, Bartmann P, Sorg C, Hedderich DM. Altered Gray Matter Cortical and Subcortical T1-Weighted/T2-Weighted Ratio in Premature-Born Adults. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:495-504. [PMID: 35276405 DOI: 10.1016/j.bpsc.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Microscopic studies in newborns and animal models indicate impaired myelination after premature birth, particularly for cortical myelination; however, it remains unclear whether such myelination impairments last into adulthood and, if so, are relevant for impaired cognitive performance. It has been suggested that the ratio of T1-weighted (T1w) and T2-weighted (T2w) magnetic resonance imaging signal intensity (T1w/T2w ratio) is a proxy for myelin content. We hypothesized altered gray matter (GM) T1w/T2w ratio in premature-born adults, which is associated with lower cognitive performance after premature birth. METHODS We analyzed GM T1w/T2w ratio in 101 adults born very premature (VP) and/or at very low birth weight (VLBW) (<32 weeks of gestation and/or birth weight <1500 g) and 109 full-term control subjects at 26 years of age, controlled for voxelwise volume alterations. Cognitive performance was assessed by verbal, performance, and full scale IQ using the Wechsler Adult Intelligence Scale. RESULTS Significantly higher T1w/T2w ratio in VP/VLBW subjects was found bilaterally in widespread cortical areas, particularly in frontal, parietal, and temporal cortices, and in putamen and pallidum. In these areas, T1w/T2w ratio was not related to birth variables, such as gestational age, or IQ scores. In contrast, significantly lower T1w/T2w ratio in VP/VLBW subjects was found in bilateral clusters in superior temporal gyrus, which was associated with birth weight in the VP/VLBW group. Furthermore, lower T1w/T2w ratio in left superior temporal gyrus was associated with lower full scale and verbal IQ. CONCLUSIONS Results demonstrate GM T1w/T2w ratio alterations in premature-born adults and suggest altered GM myelination development after premature birth with lasting and functionally relevant effects into early adulthood.
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Affiliation(s)
- Benita Schmitz-Koep
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Aurore Menegaux
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Gaser
- Departments of Psychiatry, University Hospital Jena, Jena, Germany; Departments of Neurology, University Hospital Jena, Jena, Germany
| | - Elin Brandes
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - David Schinz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Melissa Thalhammer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcel Daamen
- Functional Neuroimaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany; Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany; Department of Neuropsychiatry, Charité - Universitätsmedizin Berlin and Deutsches Zentrum für Neurodegenerative Erkrankungen e.V., Berlin, Germany; UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dennis M Hedderich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany; Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
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61
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Kelly CE, Shaul M, Thompson DK, Mainzer RM, Yang JY, Dhollander T, Cheong JL, Inder TE, Doyle LW, Anderson PJ. Long-lasting effects of very preterm birth on brain structure in adulthood: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 147:105082. [PMID: 36775083 DOI: 10.1016/j.neubiorev.2023.105082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/01/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023]
Abstract
Early life experiences, such as very preterm (VP) birth, can affect brain and cognitive development. Several prior studies investigated brain structure in adults born VP; synthesising these studies may help to provide a clearer understanding of long-term effects of VP birth on the brain. We systematically searched Medline and Embase for articles that investigated brain structure using MRI in adulthood in individuals born VP (<32 weeks' gestation) or with very low birth weight (VLBW; <1500 g), and controls born at term or with normal birth weight. In total, 77 studies met the review inclusion criteria, of which 28 studies were eligible for meta-analyses, including data from up to 797 VP/VLBW participants and 518 controls, aged 18-33 years. VP/VLBW adults exhibited volumetric, morphologic and microstructural alterations in subcortical and temporal cortical regions compared with controls, with pooled standardised mean differences up to - 1.0 (95% confidence interval: -1.2, -0.8). This study suggests there is a persisting neurological impact of VP birth, which may provide developmental neurobiological insights for adult cognition in high-risk populations.
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Affiliation(s)
- Claire E Kelly
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Michelle Shaul
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Melbourne, Australia; Deakin University, Melbourne, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Rheanna M Mainzer
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Population Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Joseph Ym Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, The Royal Children's Hospital, Melbourne, Australia; Neuroscience Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie Ly Cheong
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Melbourne, Australia; The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Terrie E Inder
- Department of Pediatrics, Children's Hospital of Orange County, University of California Irvine, CA, USA
| | - Lex W Doyle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Melbourne, Australia
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62
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Loron G, Pansiot J, Olivier P, Charriaut-Marlangue C, Baud O. Inhaled Nitric Oxide Promotes Angiogenesis in the Rodent Developing Brain. Int J Mol Sci 2023; 24:ijms24065871. [PMID: 36982947 PMCID: PMC10054632 DOI: 10.3390/ijms24065871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Inhaled nitric oxide (iNO) is a therapy used in neonates with pulmonary hypertension. Some evidence of its neuroprotective properties has been reported in both mature and immature brains subjected to injury. NO is a key mediator of the VEGF pathway, and angiogenesis may be involved in the reduced vulnerability to injury of white matter and the cortex conferred by iNO. Here, we report the effect of iNO on angiogenesis in the developing brain and its potential effectors. We found that iNO promotes angiogenesis in the developing white matter and cortex during a critical window in P14 rat pups. This shift in the developmental program of brain angiogenesis was not related to a regulation of NO synthases by exogenous NO exposure, nor the VEGF pathway or other angiogenic factors. The effects of iNO on brain angiogenesis were found to be mimicked by circulating nitrate/nitrite, suggesting that these carriers may play a role in transporting NO to the brain. Finally, our data show that the soluble guanylate cyclase/cGMP signaling pathway is likely to be involved in the pro-angiogenetic effect of iNO through thrombospondin-1, a glycoprotein of the extracellular matrix, inhibiting soluble guanylate cyclase through CD42 and CD36. In conclusion, this study provides new insights into the biological basis of the effect of iNO in the developing brain.
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Affiliation(s)
- Gauthier Loron
- Service de Médecine Néonatale et de Réanimation Pédiatrique, Université de Reims Champagne-Ardenne, CReSTIC, CHU Reims, 51100 Reims, France
| | - Julien Pansiot
- Inserm, NeuroDiderot, Faculty of Medicine, Université Paris Cité, 75019 Paris, France
| | - Paul Olivier
- Inserm, NeuroDiderot, Faculty of Medicine, Université Paris Cité, 75019 Paris, France
| | | | - Olivier Baud
- Inserm, NeuroDiderot, Faculty of Medicine, Université Paris Cité, 75019 Paris, France
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital of Geneva, 1205 Geneva, Switzerland
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63
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Lear BA, Lear CA, Dhillon SK, Davidson JO, Gunn AJ, Bennet L. Evolution of grey matter injury over 21 days after hypoxia-ischaemia in preterm fetal sheep. Exp Neurol 2023; 363:114376. [PMID: 36889575 DOI: 10.1016/j.expneurol.2023.114376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/05/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
Reduced grey matter volume in preterm infants is associated with later disability, but its time course and relationship with white matter injury are not well understood. We recently showed that moderate-severe hypoxia-ischaemia (HI) in preterm fetal sheep led to severe cystic injury 2-3 weeks later. In the same cohort we now show profound hippocampal neuronal loss from 3 days after HI. By contrast, reduction in cortical area and perimeter developed much more slowly, with maximum reduction at day 21. There was transient upregulation of cleaved caspase-3-positive apoptosis in the cortex at day 3 but no change in neuronal density or macroscopic injury of the cortex. Both microglia and astrocytes were transiently upregulated in the grey matter. EEG power was initially profoundly suppressed but partially recovered by 21 days of recovery, and final power was correlated with white matter area (p < 0.001, r2 = 0.75, F = 24.19), cortical area (p = 0.004, r2 = 0.44, F = 11.90) and hippocampi area (p = 0.049, r2 = 0.23, F = 4.58). In conclusion, the present study suggests that in preterm fetal sheep, hippocampal injury is established within a few days of acute HI, but impaired cortical growth develops slowly, in a similar time course to severe white matter injury.
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Affiliation(s)
- Benjamin A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Christopher A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Simerdeep K Dhillon
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.
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64
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Sullivan G, Vaher K, Blesa M, Galdi P, Stoye DQ, Quigley AJ, Thrippleton MJ, Norrie J, Bastin ME, Boardman JP. Breast Milk Exposure is Associated With Cortical Maturation in Preterm Infants. Ann Neurol 2023; 93:591-603. [PMID: 36412221 DOI: 10.1002/ana.26559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Breast milk exposure is associated with improved neurocognitive outcomes following preterm birth but the neural substrates linking breast milk with outcome are uncertain. We tested the hypothesis that high versus low breast milk exposure in preterm infants results in cortical morphology that more closely resembles that of term-born infants. METHODS We studied 135 preterm (<32 weeks' gestation) and 77 term infants. Feeding data were collected from birth until hospital discharge and brain magnetic resonance imaging (MRI) was performed at term-equivalent age. Cortical indices (volume, thickness, surface area, gyrification index, sulcal depth, and curvature) and diffusion parameters (fractional anisotropy [FA], mean diffusivity [MD], radial diffusivity [RD], axial diffusivity [AD], neurite density index [NDI], and orientation dispersion index [ODI]) were compared between preterm infants who received exclusive breast milk for <75% of inpatient days, preterm infants who received exclusive breast milk for ≥75% of inpatient days and term-born controls. To investigate a dose response effect, we performed linear regression using breast milk exposure quartile weighted by propensity scores. RESULTS In preterm infants, high breast milk exposure was associated with reduced cortical gray matter volume (d = 0.47, 95% confidence interval [CI] = 0.14 to 0.94, p = 0.014), thickness (d = 0.42, 95% CI = 0.08 to 0.84, p = 0.039), and RD (d = 0.38, 95% CI = 0.002 to 0.77, p = 0.039), and increased FA (d = -0.38, 95% CI = -0.74 to -0.01, p = 0.037) after adjustment for age at MRI, which was similar to the cortical phenotype observed in term-born controls. Breast milk exposure quartile was associated with cortical volume (ß = -0.192, 95% CI = -0.342 to -0.042, p = 0.017), FA (ß = 0.223, 95% CI = 0.075 to 0.372, p = 0.007), and RD (ß = -0.225, 95% CI = -0.373 to -0.076, p = 0.007) following adjustment for age at birth, age at MRI, and weighted by propensity scores, suggesting a dose effect. INTERPRETATION High breast milk exposure following preterm birth is associated with a cortical imaging phenotype that more closely resembles the brain morphology of term-born infants and effects appear to be dose-dependent. ANN NEUROL 2023;93:591-603.
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Affiliation(s)
- Gemma Sullivan
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kadi Vaher
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Manuel Blesa
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Paola Galdi
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David Q Stoye
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alan J Quigley
- Department of Radiology, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Michael J Thrippleton
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
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65
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Wang X, Bik A, de Groot ER, Tataranno ML, Benders MJNL, Dudink J. Feasibility of automated early postnatal sleep staging in extremely and very preterm neonates using dual-channel EEG. Clin Neurophysiol 2023; 146:55-64. [PMID: 36535092 DOI: 10.1016/j.clinph.2022.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/25/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the feasibility of automated sleep staging based on quantitative analysis of dual-channel electroencephalography (EEG) for extremely and very preterm infants during their first postnatal days. METHODS We enrolled 17 preterm neonates born between 25 and 30 weeks of gestational age. Three-hour behavioral sleep observations and simultaneous dual-channel EEG monitoring were conducted for each infant within their first 72 hours after birth. Four kinds of representative and complementary quantitative EEG (qEEG) metrics (i.e., bursting, synchrony, spectral power, and complexity) were calculated and compared between active sleep, quiet sleep, and wakefulness. All analyses were performed in offline mode. RESULTS In separate comparison analyses, significant differences between sleep-wake states were found for bursting, spectral power and complexity features. The automated sleep-wake state classifier based on the combination of all qEEG features achieved a macro-averaged area under the curve of receiver operating characteristic of 74.8%. The complexity features contributed the most to sleep-wake state classification. CONCLUSIONS It is feasible to distinguish between sleep-wake states within the first 72 postnatal hours for extremely and very preterm infants using qEEG metrics. SIGNIFICANCE Our findings offer the possibility of starting personalized care dependent on preterm infants' sleep-wake states directly after birth, potentially yielding long-run benefits for their developmental outcomes.
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Affiliation(s)
- Xiaowan Wang
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne Bik
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eline R de Groot
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Luisa Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
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Gilchrist CP, Thompson DK, Alexander B, Kelly CE, Treyvaud K, Matthews LG, Pascoe L, Zannino D, Yates R, Adamson C, Tolcos M, Cheong JLY, Inder TE, Doyle LW, Cumberland A, Anderson PJ. Growth of prefrontal and limbic brain regions and anxiety disorders in children born very preterm. Psychol Med 2023; 53:759-770. [PMID: 34105450 DOI: 10.1017/s0033291721002105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children born very preterm (VP) display altered growth in corticolimbic structures compared with full-term peers. Given the association between the cortiocolimbic system and anxiety, this study aimed to compare developmental trajectories of corticolimbic regions in VP children with and without anxiety diagnosis at 13 years. METHODS MRI data from 124 VP children were used to calculate whole brain and corticolimbic region volumes at term-equivalent age (TEA), 7 and 13 years. The presence of an anxiety disorder was assessed at 13 years using a structured clinical interview. RESULTS VP children who met criteria for an anxiety disorder at 13 years (n = 16) displayed altered trajectories for intracranial volume (ICV, p < 0.0001), total brain volume (TBV, p = 0.029), the right amygdala (p = 0.0009) and left hippocampus (p = 0.029) compared with VP children without anxiety (n = 108), with trends in the right hippocampus (p = 0.062) and left medial orbitofrontal cortex (p = 0.079). Altered trajectories predominantly reflected slower growth in early childhood (0-7 years) for ICV (β = -0.461, p = 0.020), TBV (β = -0.503, p = 0.021), left (β = -0.518, p = 0.020) and right hippocampi (β = -0.469, p = 0.020) and left medial orbitofrontal cortex (β = -0.761, p = 0.020) and did not persist after adjusting for TBV and social risk. CONCLUSIONS Region- and time-specific alterations in the development of the corticolimbic system in children born VP may help to explain an increase in anxiety disorders observed in this population.
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Affiliation(s)
- Courtney P Gilchrist
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Bonnie Alexander
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia
| | - Claire E Kelly
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- La Trobe University, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lillian G Matthews
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Leona Pascoe
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rosemary Yates
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Chris Adamson
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mary Tolcos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Terrie E Inder
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Angela Cumberland
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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Keshishyan ES, Ziborova MI, Sakharova ES. Premature children and assessment of their capability for school education by 7 years of age (the role of interdisciplinary approach. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-7-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent decades, there has been a distinct increase in the number of deeply and extremely preterm children without structural organic lesions of the nervous system. A comprehensive study and clinical observations of these children reveal their differences from full-term peers, becoming the most obvious by the beginning of schooling. In this article, we consider the cognitive, behavioral, and socializing features of these children, paying attention to key biosocial factors of their development, such as the long-term influence of the early neonatal period on the formation of brain structures and connections and the «resetting» of the neurohumoral system, the role of genomic polymorphism, the special importance of a favorable environment for the emotional well-being and success of these children among their peers. Knowledge and understanding of extremely preterm infants’ specific development, typical risks of behavioral disorders and social disfavor is of great practical importance for prolonged interdisciplinary follow-up — in the form of appropriate medical, educational, and psychological programs.
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Affiliation(s)
- E. S. Keshishyan
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| | - M. I. Ziborova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| | - E. S. Sakharova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
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68
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Kallankari H, Taskila HL, Heikkinen M, Hallman M, Saunavaara V, Kaukola T. Microstructural alterations in association tracts and language abilities in schoolchildren born very preterm and with poor fetal growth. Pediatr Radiol 2023; 53:94-103. [PMID: 35773359 PMCID: PMC9816217 DOI: 10.1007/s00247-022-05418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/07/2022] [Accepted: 06/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prematurity and perinatal risk factors may influence white matter microstructure. In turn, these maturational changes may influence language development in this high-risk population of children. OBJECTIVE To evaluate differences in the microstructure of association tracts between preterm and term children and between preterm children with appropriate growth and those with fetal growth restriction and to study whether the diffusion tensor metrics of these tracts correlate with language abilities in schoolchildren with no severe neurological impairment. MATERIALS AND METHODS This study prospectively followed 56 very preterm children (mean gestational age: 28.7 weeks) and 21 age- and gender-matched term children who underwent diffusion tensor imaging at a mean age of 9 years. We used automated probabilistic tractography and measured fractional anisotropy in seven bilateral association tracts known to belong to the white matter language network. Both groups participated in language assessment using five standardised tests at the same age. RESULTS Preterm children had lower fractional anisotropy in the right superior longitudinal fasciculus 1 compared to term children (P < 0.05). Preterm children with fetal growth restriction had lower fractional anisotropy in the left inferior longitudinal fasciculus compared to preterm children with appropriate fetal growth (P < 0.05). Fractional anisotropy in three dorsal tracts and in two dorsal and one ventral tract had a positive correlation with language assessments among preterm children and preterm children with fetal growth restriction, respectively (P < 0.05). CONCLUSION There were some microstructural differences in language-related tracts between preterm and term children and between preterm children with appropriate and those with restricted fetal growth. Children with better language abilities had a higher fractional anisotropy in distinct white matter tracts.
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Affiliation(s)
- Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,Department of Child Neurology, Oulu University Hospital, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland.
| | - Hanna-Leena Taskila
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Department of Neonatology, Oulu University Hospital, Oulu, Finland
| | - Minna Heikkinen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Child Language Research Center, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Virva Saunavaara
- PET Center, Turku University Hospital, Turku, Finland ,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Department of Neonatology, Oulu University Hospital, Oulu, Finland
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Neubauer A, Menegaux A, Wendt J, Li HB, Schmitz-Koep B, Ruzok T, Thalhammer M, Schinz D, Bartmann P, Wolke D, Priller J, Zimmer C, Rueckert D, Hedderich DM, Sorg C. Aberrant claustrum structure in preterm-born neonates: an MRI study. Neuroimage Clin 2023; 37:103286. [PMID: 36516730 PMCID: PMC9755238 DOI: 10.1016/j.nicl.2022.103286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
The human claustrum is a gray matter structure in the white matter between insula and striatum. Previous analysis found altered claustrum microstructure in very preterm-born adults associated with lower cognitive performance. As the claustrum development is related to hypoxia-ischemia sensitive transient cell populations being at-risk in premature birth, we hypothesized that claustrum structure is already altered in preterm-born neonates. We studied anatomical and diffusion-weighted MRIs of 83 preterm- and 83 term-born neonates at term-equivalent age. Additionally, claustrum development was analyzed both in a spectrum of 377 term-born neonates and longitudinally in 53 preterm-born subjects. Data was provided by the developing Human Connectome Project. Claustrum development showed increasing volume, increasing fractional anisotropy (FA), and decreasing mean diffusivity (MD) around term both across term- and preterm-born neonates. Relative to term-born ones, preterm-born neonates had (i) increased absolute and relative claustrum volumes, both indicating increased cellular and/or extracellular matter and being in contrast to other subcortical gray matter regions of decreased volumes such as thalamus; (ii) lower claustrum FA and higher claustrum MD, pointing at increased extracellular matrix and impaired axonal integrity; and (iii) aberrant covariance between claustrum FA and MD, respectively, and that of distributed gray matter regions, hinting at relatively altered claustrum microstructure. Results together demonstrate specifically aberrant claustrum structure in preterm-born neonates, suggesting altered claustrum development in prematurity, potentially relevant for later cognitive performance.
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Affiliation(s)
- Antonia Neubauer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany.
| | - Aurore Menegaux
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Jil Wendt
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Hongwei Bran Li
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Tobias Ruzok
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Melissa Thalhammer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - David Schinz
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Germany; Neuropsychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany; University of Edinburgh and UK DRI, Edinburgh, UK
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Daniel Rueckert
- School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; Department of Informatics, Technical University of Munich, Germany; Department of Computing, Imperial College London, UK
| | - Dennis M Hedderich
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Germany
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Song W, Hoppe G, Hanna D, DeSilva TM, Sears JE. Hyperoxia Induced Hypomyelination. Biomedicines 2022; 11:37. [PMID: 36672545 PMCID: PMC9855863 DOI: 10.3390/biomedicines11010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
We asked whether hyperoxia might induce hypomyelination of the corpus callosum, clinically described as periventricular leukomalacia (PVL) of the severely preterm infant. Mouse pups and their nursing dams were placed in 80% oxygen from P4-P8, then removed to room air until P11. Corpus callosal sections were probed myelin immunofluorescence, tested for myelin basic protein concentration by Western blot, and both glial fibrillary acidic protein levels and apoptosis quantified. Density of corpus callosal capillaries were measured after lectin staining and hypoxia measured by Hypoxyprobe. Numbers of oligodendrocytes were quantified by immunohistochemistry. We next used hypoxiamimesis as a surrogate to hypoxia by comparing cerebral hypoxia inducible factor (HIF) stabilization to hepatic HIF stabilization. Hyperoxia induced hypomyelination and a reduction of corpus callosal capillaries. Hyperoxia decreased numbers of oligodendrocytes with an increase in corpus callosal fibrosis and apoptosis. Cerebral hypoxiamimesis induced hypomyelination whereas hepatic hypoxiamimesis alone increased myelination, oligodendrocyte numbers, and corpus callosal capillary density. Hepatic HIF-1 dependence on myelination was confirmed using the cre/lox hepatic HIF-1 knockout. These findings suggest that hyperoxia can induce hypomyelination through vasoobliteration and subsequent ischemia, adding a potential oxygen induced mechanism to the diverse causes of periventricular leukomalacia of the severely preterm infant. Targeting hepatic HIF-1 alone led to increased myelination.
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Affiliation(s)
- Weilin Song
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - George Hoppe
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Demiana Hanna
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Tara M. DeSilva
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jonathan E. Sears
- Department of Ophthalmic Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Scher MS. A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities. Biomedicines 2022; 10:3290. [PMID: 36552046 PMCID: PMC9775202 DOI: 10.3390/biomedicines10123290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.
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Affiliation(s)
- Mark S. Scher
- Pediatrics and Neurology, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Department of Pediatrics, Division of Pediatric Neurology Fetal/Neonatal Neurology Program, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Legouez L, Le Dieu-Lugon B, Feillet S, Riou G, Yeddou M, Plouchart T, Dourmap N, Le Ray MA, Marret S, Gonzalez BJ, Cleren C. Effects of MgSO 4 Alone or Associated with 4-PBA on Behavior and White Matter Integrity in a Mouse Model of Cerebral Palsy: A Sex- and Time-Dependent Study. Int J Mol Sci 2022; 23:ijms232415947. [PMID: 36555591 PMCID: PMC9788405 DOI: 10.3390/ijms232415947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Cerebral palsy (CP) is defined as permanent disorders of movement and posture. Prematurity and hypoxia-ischemia (HI) are risk factors of CP, and boys display a greater vulnerability to develop CP. Magnesium sulfate (MgSO4) is administered to mothers at risk of preterm delivery as a neuroprotective agent. However, its effectiveness is only partial at long term. To prolong MgSO4 effects, it was combined with 4-phenylbutyrate (4-PBA). A mouse model of neonatal HI, generating lesions similar to those reported in preterms, was realized. At short term, at the behavioral and cellular levels, and in both sexes, the MgSO4/4-PBA association did not alter the total prevention induced by MgSO4 alone. At long term, the association extended the MgSO4 preventive effects on HI-induced motor and cognitive deficits. This might be sustained by the promotion of oligodendrocyte precursor differentiation after HI at short term, which led to improvement of white matter integrity at long term. Interestingly, at long term, at a behavioral level, sex-dependent responses to HI were observed. This might partly be explained by early sex-dependent pathological processes that occur after HI. Indeed, at short term, apoptosis through mitochondrial pathways seemed to be activated in females but not in males, and only the MgSO4/4-PBA association seemed to counter this apoptotic process.
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Affiliation(s)
- Lou Legouez
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Bérénice Le Dieu-Lugon
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Shérine Feillet
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Gaëtan Riou
- INSERM U1234 “Pan’Ther”, Flow Cytometry Core—IRIB, 76000 Rouen, France
| | - Melissa Yeddou
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Thibault Plouchart
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Nathalie Dourmap
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Marie-Anne Le Ray
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Stéphane Marret
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
- Department of Neonatal Paediatrics and Intensive Care-Neuropediatric, CHU, Rouen Hospital, 76000 Rouen, France
| | - Bruno J. Gonzalez
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
| | - Carine Cleren
- INSERM U1245 “Cancer and Brain Genomics”—Team “Genetics and Pathophysiology of Neurodevelopmental Disorders”, IRIB, 76000 Rouen, France
- Correspondence:
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73
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Kramer BW, Niklas V, Abman S. Bronchopulmonary Dysplasia and Impaired Neurodevelopment-What May Be the Missing Link? Am J Perinatol 2022; 39:S14-S17. [PMID: 36318942 DOI: 10.1055/s-0042-1756677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Bronchopulmonary dysplasia (BPD) and poor neurodevelopmental outcome after preterm birth are closely associated. However, mechanistic links are uncertain. We are exploring the hypothesis that decreased circulating insulin-like growth factor (IGF)-1 after preterm birth due to the abrupt end of supply by the placenta impairs growth during critical windows of development in most organs, including the lung and brain. Throughout gestation, the fetus uses glycolysis as its main source of energy. Metabolism is mainly stopped at pyruvate, which serves as a "metabolic crossroad", allowing for the production of amino acids and other "building blocks" for new cells. Metabolic pathways are differentially regulated in the nucleus and the cytoplasm. The ratio between pyruvate dehydrogenase (PDH) and pyruvate dehydrogenase kinase (PDK) determines the biochemical activity which irreversibly metabolizes pyruvate to acetyl-co-A. Metabolites in the nucleus modulate epigenetic remodeling, an essential mechanism of normal growth and maturation during development. IGF-1 has been shown to contribute significantly to the development of virtually all organs, especially related to the regulation of microvascular growth, based on extensive studies of the brain, retina, lung, and intestine. With a preterm birth, the abrupt withdrawal of the placental supply of IGF-1 and its local production directly affects metabolism and microvascular development, which may contribute to a high risk for organ maldevelopment and injury after birth. We speculate that reduced bioavailability of IGF-1 is a possible link between lung and brain development disruption and increases susceptibility for major pulmonary and neurocognitive morbidities in preterm babies. KEY POINTS: · Metabolic changes inherent to prterm birth may cause epigenetic changes which cause "dysmaturational" development.. · IGF-1 may be the potential link between BPD and brain development.. · The ratio between pyruvate dehydrogenase and pyruvate dehydrogenase kinase determines the biochemical activity..
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Affiliation(s)
- Boris W Kramer
- University of Western Australia, Subiaco, Western Australia, Australia.,Neuroplast BV, Maastricht, The Netherlands
| | - Victoria Niklas
- Oak Hill Bio Ltd., 1 Ashley Road, Altrincham, Cheshire, United Kingdom
| | - Steven Abman
- Department of Pediatrics and Division of Pulmonology, University of Colorado Anschutz Medical Center, Aurora, Colorado
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74
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Renz P, Schoeberlein A, Haesler V, Maragkou T, Surbek D, Brosius Lutz A. A Novel Murine Multi-Hit Model of Perinatal Acute Diffuse White Matter Injury Recapitulates Major Features of Human Disease. Biomedicines 2022; 10:biomedicines10112810. [PMID: 36359331 PMCID: PMC9687579 DOI: 10.3390/biomedicines10112810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
The selection of an appropriate animal model is key to the production of results with optimal relevance to human disease. Particularly in the case of perinatal brain injury, a dearth of affected human neonatal tissue available for research purposes increases the reliance on animal models for insight into disease mechanisms. Improvements in obstetric and neonatal care in the past 20 years have caused the pathologic hallmarks of perinatal white matter injury (WMI) to evolve away from cystic necrotic lesions and toward diffuse regions of reactive gliosis and persistent myelin disruption. Therefore, updated animal models are needed that recapitulate the key features of contemporary disease. Here, we report a murine model of acute diffuse perinatal WMI induced through a two-hit inflammatory–hypoxic injury paradigm. Consistent with diffuse human perinatal white matter injury (dWMI), our model did not show the formation of cystic lesions. Corresponding to cellular outcomes of dWMI, our injury protocol produced reactive microgliosis and astrogliosis, disrupted oligodendrocyte maturation, and disrupted myelination.. Functionally, we observed sensorimotor and cognitive deficits in affected mice. In conclusion, we report a novel murine model of dWMI that induces a pattern of brain injury mirroring multiple key aspects of the contemporary human clinical disease scenario.
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Affiliation(s)
- Patricia Renz
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Andreina Schoeberlein
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Valérie Haesler
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Theoni Maragkou
- Institute of Pathology, University of Bern, 3010 Bern, Switzerland
| | - Daniel Surbek
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Amanda Brosius Lutz
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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75
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Neurodevelopmental Outcomes in Preterm Children with Sickle Cell Disease. J Int Neuropsychol Soc 2022; 28:1039-1049. [PMID: 34839840 PMCID: PMC9148381 DOI: 10.1017/s1355617721001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the combined effect of pediatric sickle cell disease (SCD) and preterm birth on cognitive functioning. METHODS Cognitive functioning was examined in children ages 6-8 with high risk SCD genotypes born preterm (n = 20) and full-term (n = 59) and lower risk SCD genotypes/no SCD born preterm (n = 11) and full-term (n = 99) using tests previously shown to be sensitive to SCD-related neurocognitive deficits. Factorial ANOVAs and log linear analyses were conducted to examine the relationship between SCD risk, preterm birth status, and cognitive outcomes. Continuous scores were examined for specific tests. Children were categorized as having an abnormal screening outcome if at least one cognitive score was ≥1.5 standard deviations below the population mean. RESULTS Children with elevated risk due to high risk SCD and preterm birth performed worse than other groups on a test of expressive language but not on tests that emphasize processing speed and working memory. There was a three-way interaction between preterm status, SCD risk, and abnormal screening outcome, which was largely driven by the increased likelihood of abnormal cognitive scores for children with high risk SCD born preterm. CONCLUSIONS The combination of SCD and preterm birth may confer increased risk for language deficits and elevated rates of abnormal cognitive screenings. This suggests that neurodevelopmental risk imparted by comorbid SCD and preterm birth may manifest as heterogenous, rather than specific, patterns of cognitive deficits. Future studies are needed to clarify the domains of cognitive functioning most susceptible to disease-related effects of comorbid SCD and preterm birth.
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76
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Øberg GK, Handegård BH, Campbell SK, Ustad T, Fjørtoft T, Kaaresen PI, Girolami GL. Two-year motor outcomes associated with the dose of NICU based physical therapy: The Noppi RCT. Early Hum Dev 2022; 174:105680. [PMID: 36183567 DOI: 10.1016/j.earlhumdev.2022.105680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Interventions involving both the parent and the preterm infant have demonstrated lasting effects on cognitive outcomes, but motor effects are less salient. It remains unclear when to commence early intervention and if dosages have impact on motor outcomes. AIMS To examine the effect on motor performance at 24-months corrected age following a parent-administered intervention performed with infants born preterm in the NICU. Intervention dosing and longitudinal motor performance were also analyzed. STUDY DESIGN Single-blinded randomized multicenter clinical trial. SUBJECTS 153 infants born, gestational age ≤ 32 weeks at birth, were randomized into intervention or control group. OUTCOME MEASURES Infant Motor Performance Screening Test, Test of Infant Motor Performance, Peabody Developmental Motor Scales-2. RESULTS No significant difference was found between the intervention and the control group assessed with the PDMS-2 at 24-months CA. However, a significant positive association was found between dosing and the Gross Motor and Total Motor PDMS-2 scores. Analysis of longitudinal motor performance showed a decreasing motor performance between 6- and 24-months corrected age in both groups. CONCLUSIONS There was no difference in motor performance between groups at 24-months corrected age. However, increased intervention dosage was positively associated with improved motor outcome.
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Affiliation(s)
- Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway.
| | - Bjørn Helge Handegård
- Regional Center for Child and Youth Mental Health and Child Welfare, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Suzann K Campbell
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Tordis Ustad
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Toril Fjørtoft
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Per Ivar Kaaresen
- Pediatric and Adolescent Department, University Hospital North Norway HF, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Gay L Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
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77
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Yates AG, Kislitsyna E, Alfonso Martin C, Zhang J, Sewell AL, Goikolea-Vives A, Cai V, Alkhader LF, Skaland A, Hammond B, Dimitrova R, Batalle D, Fernandes C, Edwards AD, Gressens P, Thornton C, Stolp HB. Montelukast reduces grey matter abnormalities and functional deficits in a mouse model of inflammation-induced encephalopathy of prematurity. J Neuroinflammation 2022; 19:265. [PMID: 36309753 PMCID: PMC9617353 DOI: 10.1186/s12974-022-02625-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
Encephalopathy of prematurity (EoP) affects approximately 30% of infants born < 32 weeks gestation and is highly associated with inflammation in the foetus. Here we evaluated the efficacy of montelukast, a cysteinyl leukotriene receptor antagonist widely used to treat asthma in children, to ameliorate peripheral and central inflammation, and subsequent grey matter neuropathology and behaviour deficits in a mouse model of EoP. Male CD-1 mice were treated with intraperitoneal (i.p.) saline or interleukin-1beta (IL-1β, 40 μg/kg, 5 μL/g body weight) from postnatal day (P)1-5 ± concomitant montelukast (1-30 mg/kg). Saline or montelukast treatment was continued for a further 5 days post-injury. Assessment of systemic and central inflammation and short-term neuropathology was performed from 4 h following treatment through to P10. Behavioural testing, MRI and neuropathological assessments were made on a second cohort of animals from P36 to 54. Montelukast was found to attenuate both peripheral and central inflammation, reducing the expression of pro-inflammatory molecules (IL-1β, IL-6, TNF) in the brain. Inflammation induced a reduction in parvalbumin-positive interneuron density in the cortex, which was normalised with high-dose montelukast. The lowest effective dose, 3 mg/kg, was able to improve anxiety and spatial learning deficits in this model of inflammatory injury, and alterations in cortical mean diffusivity were not present in animals that received this dose of montelukast. Repurposed montelukast administered early after preterm birth may, therefore, improve grey matter development and outcome in EoP.
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Affiliation(s)
- Abi G Yates
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elena Kislitsyna
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Carla Alfonso Martin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jiaying Zhang
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Amy L Sewell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ane Goikolea-Vives
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - Valerie Cai
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - Lama F Alkhader
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Aleksander Skaland
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Basil Hammond
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cathy Fernandes
- SGDP Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopment Disorders, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Claire Thornton
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - Helen B Stolp
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK.
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78
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Zhao Y, Liu G, Liang L, Yu Z, Zhang J, Zheng H, Dai L. Relationship of plasma MBP and 8-oxo-dG with brain damage in preterm. Open Med (Wars) 2022; 17:1674-1681. [PMID: 36349194 PMCID: PMC9587527 DOI: 10.1515/med-2022-0566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
Abstract
Preterm infants face a significant risk of brain injury in the perinatal period, as well as potential long-term neurodevelopmental disabilities. However, preterm children with brain injury lack specific clinical manifestations in the early days. Therefore, timely and accurate diagnosis of brain injury is of vital importance. This study was to explore the diagnostic efficiency of myelin basic protein (MBP) and 8-oxo-deoxyguanosine (8-oxo-dG) serum levels in brain injury of premature infants. A total of 75 preterm infants with gestational age between 28 and 32 weeks and birth weight higher than 1,000 g were prospectively included. MBP serum levels were significantly higher in premature infants with white matter injury (WMI). 8-oxo-dG serum levels were significantly increased in both WMI and periventricular–intraventricular hemorrhages (PIVH). MBP and 8-oxo-dG were significantly correlated. The area under the curve was 0.811 [95% confidence interval (CI) 0.667–0.955; p = 0.002] in MBP and 0.729 (95% CI 0.562–0.897; p = 0.020) in 8-oxo-dG. Therefore, the results showed that high MBP levels indicated a possibility of WMI in the premature brain during the early postnatal period, while high 8-oxo-dG levels were closely related to both WMI and PIVH, thus suggesting that MBP and 8-oxo-dG could be used as potential neuro-markers of preterm brain injury.
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Affiliation(s)
- Yuwei Zhao
- Neonatology Department, Anhui Provincial Children Hospital , Hefei , China
| | - Guanghui Liu
- Neonatology Department, Anhui Provincial Children Hospital , Hefei , China
| | - Lei Liang
- Pulmonary Department, Anhui Provincial Children Hospital , Hefei , China
| | - Zaiwei Yu
- Neonatology Department, Fuyang First People’s Hospital , Fuyang , China
| | - Jian Zhang
- Neonatology Department, Anhui Provincial Children Hospital , Hefei , China
| | - Hong Zheng
- Neonatology Department, Anhui Provincial Children Hospital , Hefei , China
| | - Liying Dai
- Neonatology Department, Anhui Provincial Children Hospital , Hefei , China
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79
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Yrjölä P, Myers MM, Welch MG, Stevenson NJ, Tokariev A, Vanhatalo S. Facilitating early parent-infant emotional connection improves cortical networks in preterm infants. Sci Transl Med 2022; 14:eabq4786. [PMID: 36170448 DOI: 10.1126/scitranslmed.abq4786] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Exposure to environmental adversities during early brain development, such as preterm birth, can affect early brain organization. Here, we studied whether development of cortical activity networks in preterm infants may be improved by a multimodal environmental enrichment via bedside facilitation of mother-infant emotional connection. We examined functional cortico-cortical connectivity at term age using high-density electroencephalography recordings in infants participating in a randomized controlled trial of Family Nurture Intervention (FNI). Our results identify several large-scale, frequency-specific network effects of FNI, most extensively in the alpha frequency in fronto-central cortical regions. The connectivity strength in this network was correlated to later neurocognitive performance, and it was comparable to healthy term-born infants rather than the infants receiving standard care. These findings suggest that preterm neurodevelopmental care can be improved by a biologically driven environmental enrichment, such as early facilitation of direct human connection.
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Affiliation(s)
- Pauliina Yrjölä
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital and HUS Imaging, Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland.,Department of Physiology, University of Helsinki, 00014 University of Helsinki, Helsinki, Finland
| | - Michael M Myers
- Departments of Psychiatry and Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Martha G Welch
- Departments of Psychiatry and Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Nathan J Stevenson
- Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Anton Tokariev
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital and HUS Imaging, Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland.,Department of Physiology, University of Helsinki, 00014 University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital and HUS Imaging, Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland.,Department of Physiology, University of Helsinki, 00014 University of Helsinki, Helsinki, Finland
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80
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Ortueta-Olartecoechea A, Torres-Peña JL, Muñoz-Gallego A, López-López C, Vázquez Román S, Tejada-Palacios P. Prematurity: A medical history of obligatory consideration when assessing the retinal ganglion cell complex. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:S2173-5794(22)00123-2. [PMID: 36075825 DOI: 10.1016/j.oftale.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Premature children birth and survival is becoming more frequent due to the improvement in obstetric and neonatal care. This makes it increasingly common to find patients with history of preterm birth in ophthalmology clinics, both in pediatric and adult ages. Premature birth can lead to ocular structural changes, being possible to affect the ganglion cell complex (GCC), among other structures, which can be studied using optical coherence tomography. MATERIALS AND METHODS To carry out a bibliographic review of the studies that analyze GCC in patients with a history of prematurity compared with patients born at term. RESULTS Several studies that analyze GCC in patients with a history of prematurity are referenced and their results are studied. CONCLUSIONS In our clinical practice, knowing the history of prematurity is fundamental in the assessment of GCC measured by optical coherence tomography, since this layer is different in the patients with a history of prematurity compared to patients born at term.
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Affiliation(s)
- A Ortueta-Olartecoechea
- Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
| | - J L Torres-Peña
- Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - A Muñoz-Gallego
- Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - C López-López
- Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - S Vázquez Román
- Neonatología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - P Tejada-Palacios
- Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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81
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Abstract
According to the World Health Organization (WHO), 15 million babies are born preterm each year. Preterm infants are those born at less than 37 weeks, while extremely and very preterm neonates include those born at 22 to less than 32 weeks gestational age. Infants that fail to make it to term are missing a key part in neurodevelopment, as weeks 24 to 40 are a critical period of brain development. Neonatal brain injury is a crucial predictor for mortality and morbidity in premature and low birth weight (<1500 g) infants. Although the complications associated with preterm birth continue to be the number one cause of death in children under 5, the survival rates are increasing (Volpe, 2019). Despite this, the incidence of comorbidities, such as learning disabilities and visual and hearing problems, is still high. The functional deficits seen in these infants can be contributed to the white matter abnormalities (WMA) that have been found in 50% to 80% of extremely and very preterm neonates. While numerous, the etiology of the neonatal brain injury is essential for determining the mortality and morbidities of the infant, as there is an increased risk for both intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), which can be attributed to their lack of cerebrovascular autoregulation and hypoxic events. Neuroimaging plays a key role in detecting and assessing these neurologic injuries that preterm infants are at risk for. It is essential to diagnose these events early on to assess neurologic damage, minimize disease progression, and provide supportive care. Brain MRI and cranial ultrasound (CUS) are both extensively used neuroimaging techniques to assess WMA, and it has become ever more important to determine the best imaging techniques and modalities with the increasing survival rates and high incidence of comorbidities among these infants.
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Affiliation(s)
- Abigail Locke
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA.
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82
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McNaughton R, Pieper C, Sakai O, Rollins JV, Zhang X, Kennedy DN, Frazier JA, Douglass L, Heeren T, Fry RC, O'Shea TM, Kuban KK, Jara H. Quantitative MRI Characterization of the Extremely Preterm Brain at Adolescence: Atypical versus Neurotypical Developmental Pathways. Radiology 2022; 304:419-428. [PMID: 35471112 PMCID: PMC9340244 DOI: 10.1148/radiol.210385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 12/16/2022]
Abstract
Background Extremely preterm (EP) birth is associated with higher risks of perinatal white matter (WM) injury, potentially causing abnormal neurologic and neurocognitive outcomes. MRI biomarkers distinguishing individuals with and without neurologic disorder guide research on EP birth antecedents, clinical correlates, and prognoses. Purpose To compare multiparametric quantitative MRI (qMRI) parameters of EP-born adolescents with autism spectrum disorder, cerebral palsy, epilepsy, or cognitive impairment (ie, atypically developing) with those without (ie, neurotypically developing), characterizing sex-stratified brain development. Materials and Methods This prospective multicenter study included individuals aged 14-16 years born EP (Extremely Low Gestational Age Newborns-Environmental Influences on Child Health Outcomes Study, or ELGAN-ECHO). Participants underwent 3.0-T MRI evaluation from 2017 to 2019. qMRI outcomes were compared for atypically versus neurotypically developing adolescents and for girls versus boys. Sex-stratified multiple regression models were used to examine associations between spatial entropy density (SEd) and T1, T2, and cerebrospinal fluid (CSF)-normalized proton density (nPD), and between CSF volume and T2. Interaction terms modeled differences in slopes between atypically versus neurotypically developing adolescents. Results A total of 368 adolescents were classified as 116 atypically (66 boys) and 252 neurotypically developing (125 boys) participants. Atypically versus neurotypically developing girls had lower nPD (mean, 557 10 × percent unit [pu] ± 46 [SD] vs 573 10 × pu ± 43; P = .04), while atypically versus neurotypically developing boys had longer T1 (814 msec ± 57 vs 789 msec ± 82; P = .01). Atypically developing girls versus boys had lower nPD and shorter T2 (eg, in WM, 557 10 × pu ± 46 vs 580 10 × pu ± 39 for nPD [P = .006] and 86 msec ± 3 vs 88 msec ± 4 for T2 [P = .003]). Atypically versus neurotypically developing boys had a more moderate negative association between T1 and SEd (slope, -32.0 msec per kB/cm3 [95% CI: -49.8, -14.2] vs -62.3 msec per kB/cm3 [95% CI: -79.7, -45.0]; P = .03). Conclusion Atypically developing participants showed sexual dimorphisms in the cerebrospinal fluid-normalized proton density (nPD) and T2 of both white matter (WM) and gray matter. Atypically versus neurotypically developing girls had lower WM nPD, while atypically versus neurotypically developing boys had longer WM T1 and more moderate T1 associations with microstructural organization in WM. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Ryan McNaughton
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Chris Pieper
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Osamu Sakai
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Julie V. Rollins
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Xin Zhang
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - David N. Kennedy
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Jean A. Frazier
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Laurie Douglass
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Timothy Heeren
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Rebecca C. Fry
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - T. Michael O'Shea
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Karl K. Kuban
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
| | - Hernán Jara
- From the Departments of Mechanical Engineering (R.M., X.Z.) and
Biomedical Engineering (H.J.), Boston University College of Engineering, Boston,
Mass; Department of Radiology, Boston University School of Medicine, 670 Albany
St, Boston, MA 02118 (C.P., O.S., H.J.); Department of Pediatrics, University of
North Carolina School of Medicine, Chapel Hill, NC (J.V.R., T.M.O.); Department
of Psychiatry, University of Massachusetts Medical School, Worcester, Mass
(D.N.K., J.A.F.); Department of Pediatrics, Boston University School of
Medicine, Boston, Mass (L.D.); Department of Biostatistics, Boston University
School of Public Health, Boston, Mass (T.H.); and Department of Environmental
Sciences & Engineering, University of North Carolina Gillings School of
Global Public Health, Chapel Hill, NC (R.C.F.)
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83
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Kasirer Y, David EB, Hammerman C, Shchors I, Nun AB. Hypercapnia: An Added Culprit in Gray Matter Injury in Preterm Neonates. Neuropediatrics 2022; 53:251-256. [PMID: 34983072 DOI: 10.1055/a-1730-7878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Over the last decade, there has been increased recognition of diverse forms of primary gray matter injury (GMI) in postpreterm neonates. In this study, we aimed to assess whether early neonatal hypercapnia in the preterm infant was associated with GMI on magnetic resonance imaging (MRI) at term equivalent age (TEA). All blood gases taken during the first 2 weeks of life were analyzed for hypercapnia. MRI was performed at TEA postpreterm infants using a unique neonatal MRI 1T scanner. The neonatal MRI scans were assessed using a standardized scoring system, the Kidokoro scoring system, a method used to assess abnormal brain metrics and the presence and severity of brain abnormalities. Subscores are assigned for different regions of the brain. Twenty-nine infants were studied, about half of whom had evidence of some gray matter abnormality. Fifteen of the infants were hypercapnic. The hypercapnic infants had significantly higher deep gray matter abnormality readings as compared with the nonhypercapnic infants (12 [11; 12] vs. 10 [8; 11], respectively; p = 0.0106). Correlations were observed between peak pCO2 over the first 2 weeks of life and the overall gray matter abnormality score (GMAS) at TEA, and between the percentage of hypercapnic blood gases during the first 2 weeks of life and the GMAS. All of the infants in our population who had severe GMI at TEA were hypercapnic in the first 2 weeks of life. In conclusion, our data show a correlation between early hypercapnia in preterm neonates and GMI at TEA.
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Affiliation(s)
- Yair Kasirer
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eliel Ben David
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Irina Shchors
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Alona Bin Nun
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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84
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Howe CC, Rose KP, Ferrick J, Pines R, Pardo A. Improving Developmental Positioning in a Level III NICU Using Evidence-Based Teaching and a Standardized Tool: An Evidence-Based Quality Improvement Project. Neonatal Netw 2022; 41:273-280. [PMID: 36002275 DOI: 10.1891/nn-2021-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
Abstract
Positioning and handling is a core measure of developmental care that has been universally difficult to implement in the technical NICU environment. Appropriate positioning has been shown to not only improve postural and musculoskeletal outcomes, but enhance sensory development, physiologic stability, thermal regulation, behavioral organization, sleep facilitation, and brain development. In order to improve the developmental positioning practices of bedside nurses in a level III neonatal intensive care unit, a quality improvement project was initiated. Guided by the Iowa Model for Evidence-Based Practice, this project included an evidence-based educational intervention and a standardized positioning assessment tool. After the intervention, there was improvement in knowledge scores, and positioning scores increased from an average of 8.81 +/- 0.19 to 10.93 +/- 0.15.
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85
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Caporali C, Longo S, Tritto G, Perotti G, Pisoni C, Naboni C, Gardella B, Spinillo A, Manzoni F, Ghirardello S, Borgatti R, Orcesi S. Neurodevelopmental outcome of Italian preterm ELBW infants: an eleven years single center cohort. Ital J Pediatr 2022; 48:117. [PMID: 35854369 PMCID: PMC9297614 DOI: 10.1186/s13052-022-01303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm extremely low birth weight infants (ELBWi) are known to be at greater risk of developing neuropsychiatric diseases. Identifying early predictors of outcome is essential to refer patients for early intervention. Few studies have investigated neurodevelopmental outcomes in Italian ELBWi. This study aims to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year single-center cohort of Italian ELBWi and to identify early risk factors for adverse neurodevelopmental outcomes. METHODS All infants born with birth weight < 1000 g and admitted to the Neonatal Intensive Care Unit of the "Fondazione IRCCS Policlinico San Matteo" hospital in Pavia, Italy, from Jan 1, 2005 to Dec 31, 2015 were eligible for inclusion. At 24 months, Griffiths' Mental Developmental Scales Extended Revised (GMDS-ER) were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). Univariate and multivariate multinomial logistic regression models were performed to analyze the correlation between neonatal variables and neurodevelopmental outcome. RESULTS 176 ELBWi were enrolled (mean gestational age 26.52 weeks sd2.23; mean birthweight 777.45 g sd142.89). 67% showed a normal outcome at 24 months, 17% minor sequelae and 16% major sequelae (4.6% cerebral palsy on overall sample). The most frequent major sequela was cognitive impairment (8.52%). In the entire sample the median score on the Hearing-Speech subscale was lower than the median scores recorded on the other subscales and showed a significantly weaker correlation to each of the other subscales of the GMDS-ER. Severely abnormal cUS findings (RRR 10.22 p 0.043) and bronchopulmonary dysplasia (RRR 4.36 p 0.008) were independent risk factors for major sequelae and bronchopulmonary dysplasia for minor sequelae (RRR 3.00 p 0.018) on multivariate multinomial logistic regression. CONCLUSIONS This study showed an improvement in ELBWI survival rate without neurodevelopmental impairment at 24 months compared to previously reported international cohorts. Cognitive impairment was the most frequent major sequela. Median scores on GMDS-ER showed a peculiar developmental profile characterized by a selective deficit in the language domain. Severely abnormal cUS findings and bronchopulmonary dysplasia were confirmed as independent risk factors for major sequelae.
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Affiliation(s)
- Camilla Caporali
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Longo
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanna Tritto
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Fondazione Stella Maris Mediterraneo, Chiaromonte, Potenza, Italy
| | - Gianfranco Perotti
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Manzoni
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Health Promotion - Environmental Epidemiology Unit, Hygene and Health Prevention Department, Health Protection Agency, Pavia, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Renato Borgatti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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86
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Collins SE, Thompson DK, Kelly CE, Gilchrist CP, Matthews LG, Pascoe L, Lee KJ, Inder TE, Doyle LW, Cheong JL, Burnett AC, Anderson PJ. Development of regional brain gray matter volume across the first 13 years of life is associated with childhood math computation ability for children born very preterm and full term. Brain Cogn 2022; 160:105875. [DOI: 10.1016/j.bandc.2022.105875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 11/02/2022]
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Sensory-based interventions in the NICU: systematic review of effects on preterm brain development. Pediatr Res 2022; 92:47-60. [PMID: 34508227 DOI: 10.1038/s41390-021-01718-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infants born preterm are known to be at risk for abnormal brain development and adverse neurobehavioral outcomes. To improve early neurodevelopment, several non-pharmacological interventions have been developed and implemented in the neonatal intensive care unit (NICU). Sensory-based interventions seem to improve short-term neurodevelopmental outcomes in the inherently stressful NICU environment. However, how this type of intervention affects brain development in the preterm population remains unclear. METHODS A systematic review of the literature was conducted for published studies in the past 20 years reporting the effects of early, non-pharmacological, sensory-based interventions on the neonatal brain after preterm birth. RESULTS Twelve randomized controlled trials (RCT) reporting short-term effects of auditory, tactile, and multisensory interventions were included after the screening of 1202 articles. Large heterogeneity was identified among studies in relation to both types of intervention and outcomes. Three areas of focus for sensory interventions were identified: auditory-based, tactile-based, and multisensory interventions. CONCLUSIONS Diversity in interventions and outcome measures challenges the possibility to perform an integrative synthesis of results and to translate these for evidence-based clinical practice. This review identifies gaps in the literature and methodological challenges for the implementation of RCTs of sensory interventions in the NICU. IMPACT This paper represents the first systematic review to investigate the effect of non-pharmacological, sensory-based interventions in the NICU on neonatal brain development. Although reviewed RCTs present evidence on the impact of such interventions on the neonatal brain following preterm birth, it is not yet possible to formulate clear guidelines for clinical practice. This review integrates existing literature on the effect of sensory-based interventions on the brain after preterm birth and identifies methodological challenges for the conduction of high-quality RCTs.
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88
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Scher MS. Gene-Environment Interactions During the First Thousand Days Influence Childhood Neurological Diagnosis. Semin Pediatr Neurol 2022; 42:100970. [PMID: 35868730 DOI: 10.1016/j.spen.2022.100970] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
Gene-environment (G x E) interactions significantly influence neurologic outcomes. The maternal-placental-fetal (MPF) triad, neonate, or child less than 2 years may first exhibit significant brain disorders. Neuroplasticity during the first 1000 days will more likely result in life-long effects given critical periods of development. Developmental origins and life-course principles help recognize changing neurologic phenotypes across ages. Dual diagnostic approaches are discussed using representative case scenarios to highlight time-dependent G x E interactions that contribute to neurologic sequelae. Horizontal analyses identify clinically relevant phenotypic form and function at different ages. Vertical analyses integrate the approach using systems-biology from genetic through multi-organ system interactions during each developmental age to understand etiopathogenesis. The process of ontogenetic adaptation results in immediate or delayed positive and negative outcomes specific to the developmental niche, expressed either as a healthy child or one with neurologic sequelae. Maternal immune activation, ischemic placental disease, and fetal inflammatory response represent prenatal disease pathways that contribute to fetal brain injuries. These processes involve G x E interactions within the MPF triad, phenotypically expressed as fetal brain malformations or destructive injuries within the MPF triad. A neonatal minority express encephalopathy, seizures, stroke, and encephalopathy of prematurity as a continuum of trimester-specific G x E interactions. This group may later present with childhood sequelae. A healthy neonatal majority present at older ages with sequelae such as developmental disorders, epilepsy, mental health diseases, tumors, and neurodegenerative disease, often during the first 1000 days. Effective preventive, rescue, and reparative neuroprotective strategies require consideration of G x E interactions interplay over time. Addressing maternal and pediatric health disparities will maximize medical equity with positive global outcomes that reduce the burden of neurologic diseases across the lifespan.
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Affiliation(s)
- Mark S Scher
- Department of Pediatrics, Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
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89
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Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070969. [PMID: 35883953 PMCID: PMC9320519 DOI: 10.3390/children9070969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Point-of-care human milk analysis is now feasible in the neonatal intensive care unit (NICU) and allows accurate measurement of macronutrient delivery. Higher macronutrient intakes over this period may promote brain growth and development. In a prospective, observational study of 55 infants born at <32 weeks’ gestation, we used a mid-infrared spectroscopy-based human milk analyzer to measure the macronutrient content in repeated samples of human milk over the NICU hospitalization. We calculated daily nutrient intakes from unfortified milk and assigned infants to quintiles based on median intakes over the hospitalization. Infants underwent brain magnetic resonance imaging at term equivalent age to quantify total and regional brain volumes and fractional anisotropy of white matter tracts. Infants in the highest quintile of energy intake from milk, as compared with the lower four quintiles, had larger total brain volume (31 cc, 95% confidence interval [CI]: 5, 56), cortical gray matter (15 cc, 95%CI: 1, 30), and white matter volume (23 cc, 95%CI: 12, 33). Higher protein intake was associated with larger total brain (36 cc, 95%CI: 7, 65), cortical gray matter (22 cc, 95%CI: 6, 38) and deep gray matter (1 cc, 95%CI: 0.1, 3) volumes. These findings suggest innovative strategies to close nutrient delivery gaps in the NICU may promote brain growth for preterm infants.
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90
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Sentner T, Wang X, de Groot ER, van Schaijk L, Tataranno ML, Vijlbrief DC, Benders MJNL, Bartels R, Dudink J. The Sleep Well Baby project: an automated real-time sleep–wake state prediction algorithm in preterm infants. Sleep 2022; 45:6617657. [PMID: 35749799 PMCID: PMC9548667 DOI: 10.1093/sleep/zsac143] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
Study Objectives Sleep is an important driver of early brain development. However, sleep is often disturbed in preterm infants admitted to the neonatal intensive care unit (NICU). We aimed to develop an automated algorithm based on routinely measured vital parameters to classify sleep–wake states of preterm infants in real-time at the bedside. Methods In this study, sleep–wake state observations were obtained in 1-minute epochs using a behavioral scale developed in-house while vital signs were recorded simultaneously. Three types of vital parameter data, namely, heart rate, respiratory rate, and oxygen saturation, were collected at a low-frequency sampling rate of 0.4 Hz. A supervised machine learning workflow was used to train a classifier to predict sleep–wake states. Independent training (n = 37) and validation datasets were validation n = 9) datasets were used. Finally, a setup was designed for real-time implementation at the bedside. Results The macro-averaged area-under-the-receiver-operator-characteristic (AUROC) of the automated sleep staging algorithm ranged between 0.69 and 0.82 for the training data, and 0.61 and 0.78 for the validation data. The algorithm provided the most accurate prediction for wake states (AUROC = 0.80). These findings were well validated on an independent sample (AUROC = 0.77). Conclusions With this study, to the best of our knowledge, a reliable, nonobtrusive, and real-time sleep staging algorithm was developed for the first time for preterm infants. Deploying this algorithm in the NICU environment may assist and adapt bedside clinical work based on infants’ sleep–wake states, potentially promoting the early brain development and well-being of preterm infants.
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Affiliation(s)
- Thom Sentner
- Digital Health, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Xiaowan Wang
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Eline R de Groot
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Lieke van Schaijk
- Digital Health, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Maria Luisa Tataranno
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Daniel C Vijlbrief
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Richard Bartels
- Digital Health, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands
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91
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Lammertink F, van den Heuvel MP, Hermans EJ, Dudink J, Tataranno ML, Benders MJNL, Vinkers CH. Early-life stress exposure and large-scale covariance brain networks in extremely preterm-born infants. Transl Psychiatry 2022; 12:256. [PMID: 35717524 PMCID: PMC9206645 DOI: 10.1038/s41398-022-02019-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022] Open
Abstract
The stressful extrauterine environment following premature birth likely has far-reaching and persistent adverse consequences. The effects of early "third-trimester" ex utero stress on large-scale brain networks' covariance patterns may provide a potential avenue to understand how early-life stress following premature birth increases risk or resilience. We evaluated the impact of early-life stress exposure (e.g., quantification of invasive procedures) on maturational covariance networks (MCNs) between 30 and 40 weeks of gestational age in 180 extremely preterm-born infants (<28 weeks of gestation; 43.3% female). We constructed MCNs using covariance of gray matter volumes between key nodes of three large-scale brain networks: the default mode network (DMN), executive control network (ECN), and salience network (SN). Maturational coupling was quantified by summating the number of within- and between-network connections. Infants exposed to high stress showed significantly higher SN but lower DMN maturational coupling, accompanied by DMN-SN decoupling. Within the SN, the insula, amygdala, and subthalamic nucleus all showed higher maturational covariance at the nodal level. In contrast, within the DMN, the hippocampus, parahippocampal gyrus, and fusiform showed lower coupling following stress. The decoupling between DMN-SN was observed between the insula/anterior cingulate cortex and posterior parahippocampal gyrus. Early-life stress showed longitudinal network-specific maturational covariance patterns, leading to a reprioritization of developmental trajectories of the SN at the cost of the DMN. These alterations may enhance the ability to cope with adverse stimuli in the short term but simultaneously render preterm-born individuals at a higher risk for stress-related psychopathology later in life.
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Affiliation(s)
- Femke Lammertink
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn P van den Heuvel
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije University Amsterdam, Amsterdam, The Netherlands
- Department of Child Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
| | - Erno J Hermans
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maria L Tataranno
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Christiaan H Vinkers
- Department of Anatomy & Neurosciences, Amsterdam UMC (location Vrije University Amsterdam), Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC (location Vrije University Amsterdam), Amsterdam, The Netherlands
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92
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Berken JA, Chang J. Neurologic consequences of neonatal necrotizing enterocolitis. Dev Neurosci 2022; 44:295-308. [PMID: 35697005 DOI: 10.1159/000525378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease of the premature infant with high mortality and morbidity. Children who survive NEC have been shown to demonstrate neurodevelopmental delay, with significantly worse outcomes than from prematurity alone. The pathways leading to NEC-associated neurological impairments remain unclear, limiting the development of preventative and protective strategies. This review aims to summarize the existing clinical and experimental studies related to NEC-associated brain injury. We describe the current epidemiology of NEC, reported long-term neurodevelopmental outcomes among survivors, and proposed pathogenesis of brain injury in NEC. Highlighted are the potential connections between hypoxia-ischemia, nutrition, infection, gut inflammation, and the developing brain in NEC.
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Affiliation(s)
- Jonathan A Berken
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jill Chang
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA,
- Division of Neonatal-Perinatal Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA,
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Abstract
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.
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94
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He Y, Zhang Y, Li F, Shi Y. White Matter Injury in Preterm Infants: Pathogenesis and Potential Therapy From the Aspect of the Gut–Brain Axis. Front Neurosci 2022; 16:849372. [PMID: 35573292 PMCID: PMC9099073 DOI: 10.3389/fnins.2022.849372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022] Open
Abstract
Very preterm infants who survive are at high risk of white matter injury (WMI). With a greater understanding of the pathogenesis of WMI, the gut microbiota has recently drawn increasing attention in this field. This review tries to clarify the possible mechanisms behind the communication of the gut bacteria and the immature brain via the gut–brain axis. The gut microbiota releases signals, such as microbial metabolites. These metabolites regulate inflammatory and immune responses characterized by microglial activation, which ultimately impact the differentiation of pre-myelinating oligodendrocytes (pre-OLs) and lead to WMI. Moreover, probiotics and prebiotics emerge as a promising therapy to improve the neurodevelopmental outcome. However, future studies are required to clarify the function of these above products and the optimal time for their administration within a larger population. Based on the existing evidence, it is still too early to recommend probiotics and prebiotics as effective treatments for WMI.
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Affiliation(s)
- Yu He
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Yuni Zhang
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Fang Li
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- *Correspondence: Fang Li,
| | - Yuan Shi
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Yuan Shi,
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95
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Christensen R, Krishnan P, deVeber G, Dlamini N, MacGregor D, Pulcine E, Moharir M. Cerebral Venous Sinus Thrombosis in Preterm Infants. Stroke 2022; 53:2241-2248. [DOI: 10.1161/strokeaha.121.037621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Neonatal cerebral venous sinus thrombosis (CVST) can lead to brain injury and neurodevelopmental impairments. Previous studies of neonatal CVST have focused on term infants, and studies of preterm infants are lacking. In this study, we examined the clinical and radiological features, treatment and outcome of CVST in preterm infants.
METHODS:
This was a retrospective, consecutive cohort study of preterm infants (gestational age <37 weeks) with radiologically confirmed CVST. All magnetic resonance imaging/MRV and CT/CTV scans were re-reviewed to study thrombus characteristics and pattern of brain injury. Outcome was assessed by the validated pediatric stroke outcome measure at the most recent clinic visit.
RESULTS:
Twenty-six preterm infants with CVST were studied. Of these, 65% were moderate-late preterm (32–37 weeks), 27% very preterm (28–32 weeks), and 8% extreme preterm (<28 weeks). Most (73%) were symptomatic at presentation with seizures or abnormal exam. Transverse (85%) and superior sagittal (42%) sinuses were common sites of thrombosis. Parenchymal brain injury was predominantly periventricular (35%) and deep white matter (31%) in location. Intraventricular hemorrhage occurred in 46%. Most infants (69%) were treated with anticoagulation. No treated infant (including eleven with pretreatment hemorrhage) had new or worsening post-treatment hemorrhage. Outcomes ranged from no deficits (50%), mild-moderate (25%), and severe (25%) impairment.
CONCLUSIONS:
In our sample of preterm infants with CVST, more than one-quarter were asymptomatic. White matter brain lesions predominated and one-half had neurological deficits at follow-up. Anticoagulation of preterm CVST in this small cohort appeared to be safe. Larger studies of preterm CVST are needed.
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Affiliation(s)
- Rhandi Christensen
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (P.K.)
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
- Child Health Evaluative Sciences Program, Hospital for Sick Children Research Institute‚ Toronto‚ Ontario‚ Canada (G.d.)
| | - Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Daune MacGregor
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Elizabeth Pulcine
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Mahendranath Moharir
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
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96
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When Is Infantile Strabismus a Sign of Neurologic Disease? Am J Ophthalmol 2022; 240:xi-xiv. [PMID: 35381205 DOI: 10.1016/j.ajo.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
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Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The MagNUM Study. EBioMedicine 2022; 78:103923. [PMID: 35331677 PMCID: PMC9043972 DOI: 10.1016/j.ebiom.2022.103923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/23/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Magnesium sulphate given to women prior to very
preterm birth protects the perinatal brain, so fewer babies die or develop
cerebral palsy. How magnesium sulphate exerts these beneficial effects remains
uncertain. The MagNUM Study aimed to assess the effect of exposure to antenatal
magnesium sulphate on MRI measures of brain white matter microstructure at term
equivalent age. Methods Nested cohort study within the Magnesium sulphate at
30 to <34 weeks’ Gestational age Neuroprotection Trial (MAGENTA).
Australian New Zealand Clinical Trials Registry ACTRN12611000491965. Mothers at
risk of preterm birth at 30 to <34 weeks’ gestation were randomised to
receive either 4 g of magnesium sulphate heptahydrate [8 mmol magnesium ions],
or saline placebo, when preterm birth was planned or expected within 24 h.
Participating babies underwent diffusion tensor MRI at term equivalent age. The
main outcomes were fractional anisotropy across the white matter tract skeleton
compared using Tract-based Spatial Statistics (TBSS), with adjustment for
postmenstrual age at birth and at MRI, and MRI site. Researchers and families
were blind to treatment group allocation during data collection and
analyses. Findings Of the 109 babies the demographics of the 49 babies
exposed to magnesium sulphate were similar to the 60 babies exposed to placebo.
In babies whose mothers were allocated to magnesium sulphate, fractional
anisotropy was lower within the corticospinal tracts and corona radiata, the
superior and inferior longitudinal fasciculi, and the inferior fronto-occipital
fasciculi compared to babies whose mothers were allocated placebo
(P < 0·05). Interpretation In babies born preterm after 30 weeks’ gestation,
antenatal magnesium sulphate exposure did not promote development of white
matter microstructure in pathways affecting motor or cognitive function. This
suggests that if the neuroprotective effect of magnesium sulphate treatment
prior to preterm birth is confirmed at this gestation, the mechanisms are not
related to accelerated white matter maturation inferred from fractional
anisotropy. Funding This study was funded by a project grant from the
Health Research Council of New Zealand (HRC 14/153).
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98
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Siahanidou T, Spiliopoulou C. Pharmacological Neuroprotection of the Preterm Brain: Current Evidence and Perspectives. Am J Perinatol 2022; 39:479-491. [PMID: 32961562 DOI: 10.1055/s-0040-1716710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite improvements in viability, the long-term neurodevelopmental outcomes of preterm babies remain serious concern as a significant percentage of these infants develop neurological and/or intellectual impairment, and they are also at increased risk of psychiatric illnesses later in life. The current challenge is to develop neuroprotective approaches to improve adverse outcomes in preterm survivors. The purpose of this review was to provide an overview of the current evidence on pharmacological agents targeting the neuroprotection of the preterm brain. Among them, magnesium sulfate, given antenatally to pregnant women with imminent preterm birth before 30 to 34 weeks of gestation, as well as caffeine administered to preterm infants after birth, exhibited neuroprotective effects for human preterm brain. Erythropoietin treatment of preterm infants did not result in neuroprotection at 2 years of age in two out of three published large randomized controlled trials; however, long-term follow-up of these infants is needed to come to definite conclusions. Further studies are also required to assess whether melatonin, neurosteroids, inhaled nitric oxide, allopurinol, or dietary supplements (omega-3 fatty acids, choline, curcumin, etc.) could be implemented as neuroprotectants in clinical practice. Furthermore, other pharmacological agents showing promising signs of neuroprotective efficacy in preclinical studies (growth factors, hyaluronidase inhibitors or treatment, antidiabetic drugs, cannabidiol, histamine-H3 receptor antagonists, etc.), as well as stem cell- or exosomal-based therapies and nanomedicine, may prove useful in the future as potential neuroprotective approaches for human preterm brain. KEY POINTS: · Magnesium and caffeine have neuroprotective effects for the preterm brain.. · Follow-up of infants treated with erythropoietin is needed.. · Neuroprotective efficacy of several drugs in animals needs to be shown in humans..
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Affiliation(s)
- Tania Siahanidou
- Neonatal Unit of the First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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99
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Kelly C, Dhollander T, Harding IH, Khan W, Beare R, Cheong JL, Doyle LW, Seal M, Thompson DK, Inder TE, Anderson PJ. Brain tissue microstructural and free-water composition 13 years after very preterm birth. Neuroimage 2022; 254:119168. [PMID: 35367651 DOI: 10.1016/j.neuroimage.2022.119168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/27/2022] [Accepted: 03/30/2022] [Indexed: 12/20/2022] Open
Abstract
There have been many studies demonstrating children born very preterm exhibit brain white matter microstructural alterations, which have been related to neurodevelopmental difficulties. These prior studies have often been based on diffusion MRI modelling and analysis techniques, which commonly focussed on white matter microstructural properties in very preterm-born children. However, there have been relatively fewer studies investigating the free-water content of the white matter, and also the microstructure and free-water content of the cortical grey matter, in very preterm-born children. These biophysical properties of the brain change rapidly during fetal and neonatal brain development, and therefore such properties are likely also adversely affected by very preterm birth. In this study, we investigated the relationship of very preterm birth (<30 weeks' gestation) to both white matter and cortical grey matter microstructure and free-water content in childhood using advanced diffusion MRI analyses. A total of 130 very preterm participants and 45 full-term control participants underwent diffusion MRI at age 13 years. Diffusion tissue signal fractions derived by Single-Shell 3-Tissue Constrained Spherical Deconvolution were used to investigate brain tissue microstructural and free-water composition. The tissue microstructural and free-water composition metrics were analysed using a bespoke voxel-based analysis and cortical region-of-interest analysis approach. Very preterm 13-year-olds exhibited reduced white matter microstructural density and increased free-water content across widespread regions of the white matter compared with controls. Additionally, very preterm 13-year-olds exhibited reduced microstructural density and increased free-water content in specific temporal, sensorimotor, occipital and cingulate cortical regions. These brain tissue composition alterations were strongly associated with cerebral white matter abnormalities identified in the neonatal period, and concurrent adverse cognitive and motor outcomes in very preterm children. The findings demonstrate brain microstructural and free-water alterations up to thirteen years from neonatal brain abnormalities in very preterm children that relate to adverse neurodevelopmental outcomes.
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Affiliation(s)
- Claire Kelly
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Victorian Infant Brain Studies (VIBeS), Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Thijs Dhollander
- Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Wasim Khan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Richard Beare
- Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie Ly Cheong
- Victorian Infant Brain Studies (VIBeS), Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies (VIBeS), Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Marc Seal
- Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies (VIBeS), Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Victorian Infant Brain Studies (VIBeS), Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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100
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Belfort MB, Inder TE. Human Milk and Preterm Infant Brain Development: A Narrative Review. Clin Ther 2022; 44:612-621. [PMID: 35307209 PMCID: PMC9133155 DOI: 10.1016/j.clinthera.2022.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE To review and synthesize the literature on human milk and structural brain development and injury in preterm infants, focusing on the application of quantitative brain magnetic resonance imaging (MRI) in this field. METHODS For this narrative review, we searched PubMed for articles published from 1990 to 2021 that reported observational or interventional studies of maternal milk or donor milk in relation to brain development and/or injury in preterm infants assessed with quantitative MRI at term equivalent age. Studies were characterized with respect to key aspects of study design, milk exposure definition, and MRI outcomes. FINDINGS We identified 7 relevant studies, all of which were observational in design and published between 2013 and 2021. Included preterm infants were born at or below 33 weeks' gestation. Sample sizes ranged from 22 to 377 infants. Exposure to human milk included both maternal and donor milk. No study included a full-term comparison group. Main MRI outcome domains were white matter integrity (assessed with diffusion tensor imaging, resting state functional connectivity, or semiautomated segmentation of white matter abnormality) and total and regional brain volumes. Studies revealed that greater exposure to human milk versus formula was associated with favorable outcomes, including more mature and connected cerebral white matter with less injury and larger regional brain volumes, notably in the deep nuclear gray matter, amygdala-hippocampus, and cerebellum. No consistent signature effect of human milk exposure was found; instead, the beneficial associations were regional and tissue-specific neuroprotective effects on the areas of known vulnerability in the preterm infant. IMPLICATIONS Evidence to date suggests that human milk may protect the preterm infant from the white matter injury and dysmaturation to which this population is vulnerable. Brain MRI at term equivalent age is emerging as a useful tool to investigate the effects of human milk on the preterm brain. When grounded in neurobiological knowledge about preterm brain injury and development, this approach holds promise for allowing further insight into the mechanisms and pathways underlying beneficial associations of human milk with neurodevelopmental outcomes in this population and in the investigation of specific milk bioactive components with neuroprotective or neurorestorative potential.
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