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Lavongtheung A, Jedraszak G, Naepels P, Tourneux P, Gondry-Jouet C, Le Moing AG, Gondry J, Chevreau J. Should isolated fetal ventriculomegaly measured below 12 mm be viewed as a variant of the norm? Results of a 5-year experience in a prenatal referral center. J Matern Fetal Neonatal Med 2017; 31:2325-2331. [DOI: 10.1080/14767058.2017.1342801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anaïs Lavongtheung
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Guillaume Jedraszak
- Department of Genetics, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Philippe Naepels
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Pierre Tourneux
- Department of Neonatology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Catherine Gondry-Jouet
- Department of Radiology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Anne-Gaëlle Le Moing
- Department of Pediatric Neurology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
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Oudgenoeg-Paz O, Mulder H, Jongmans MJ, van der Ham IJM, Van der Stigchel S. The link between motor and cognitive development in children born preterm and/or with low birth weight: A review of current evidence. Neurosci Biobehav Rev 2017. [PMID: 28642071 DOI: 10.1016/j.neubiorev.2017.06.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The current review focuses on evidence for a link between early motor development and later cognitive skills in children born preterm or with Low Birth Weight (LBW). Studies with term born children consistently show such a link. Motor and cognitive impairments or delays are often seen in children born preterm or with LBW throughout childhood and studies have established a cross-sectional association between the two. However, it is not yet clear if, and if so, how, motor and cognitive skills are longitudinally interrelated in these children. Longitudinal studies with this population including measures of motor development during the first year of life and cognitive measures at later measurement points were included. The 17 studies included usually show a link between level and/or quality of motor development during the first year of life and later cognitive skills in children born preterm and/or with LBW. However, given the small number of studies, and a possible effect of early interaction between motor and cognitive skills affecting this relation, more work is clearly needed.
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Affiliation(s)
- Ora Oudgenoeg-Paz
- Department of Pedagogical and Educational Sciences, Utrecht University, The Netherlands.
| | - Hanna Mulder
- Department of Pedagogical and Educational Sciences, Utrecht University, The Netherlands
| | - Marian J Jongmans
- Department of Pedagogical and Educational Sciences, Utrecht University, The Netherlands
| | - Ineke J M van der Ham
- Department of Health, Medical, and Neuropsychology, Leiden University, The Netherlands
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Olusanya BO, Osibanjo FB, Ajiboye AA, Ayodele OE, Odunsi AA, Olaifa SM, Emokpae AA. A neurologic dysfunction scoring protocol for jaundiced neonates requiring exchange transfusion. J Matern Fetal Neonatal Med 2017; 31:888-894. [PMID: 28320216 DOI: 10.1080/14767058.2017.1300650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the performance of a neurologic assessment protocol among jaundiced infants requiring exchange transfusion (ET). METHODS We identified infants in a referral children's hospital who received ET and those who met the American Academy of Pediatrics (AAP) criteria for ET based on total serum bilirubin (TSB) levels. The performance of a bilirubin-induced neurologic dysfunction (BIND-M) scoring protocol for acute bilirubin encephalopathy (ABE) in detecting infants treated with ET in both groups was investigated by logistic regression analysis and c-statistic. RESULTS A total of 438 late-preterm and term infants were enrolled, out of which 141 (32.2%) received ET, and 155 (35.4%) met AAP criteria for ET. Infants with BIND-M scores of 3-6 (intermediate ABE) or 7-12 (advanced ABE) were significantly associated with ET in both groups, but not scores of 1-2 (mild ABE), with or without adjustment for confounding neurotoxicity risk factors. However, the discriminatory ability of BIND-M regression models was modestly satisfactory (c-statistic range: 0.693-0.791). CONCLUSIONS Our findings suggest that BIND-M is a potentially useful decision-making tool for ET and support current recommendation for immediate ET for infants with intermediate-to-advanced stages of ABE regardless of the TSB levels.
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Spittle AJ, Walsh JM, Potter C, Mcinnes E, Olsen JE, Lee KJ, Anderson PJ, Doyle LW, Cheong JLY. Neurobehaviour at term-equivalent age and neurodevelopmental outcomes at 2 years in infants born moderate-to-late preterm. Dev Med Child Neurol 2017; 59:207-215. [PMID: 27775148 DOI: 10.1111/dmcn.13297] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 11/26/2022]
Abstract
AIM To examine the association between newborn neurobehavioural assessments and neurodevelopmental outcomes at 2 years in infants born moderate-to-late preterm (MLPT). METHOD Two-hundred and one infants born MLPT (born 32-36+6 wks' gestation) were assessed with the Hammersmith Neonatal Neurological Examination (HNNE) and NICU Network Neurobehavioral Scale (NNNS), with suboptimal performance defined as scores lower than the 10th centile. Development was assessed at 2 years corrected age with the Bayley Scales of Infant and Toddler Development 3rd Edition, with delay defined as scores less than 1 standard deviation (SD) below the mean. The relationships between neurobehaviour at term and Bayley-III cognitive, language, and motor scales at 2 years were examined using linear regression. RESULTS Increased odds for cognitive delay were associated with suboptimal HNNE total scores (odds ratio [OR] 2.66; 95% confidence interval [CI] 1.14-6.23, p=0.020) and suboptimal NNNS excitability (OR 3.01; 95% CI 1.33-6.82, p=0.008) and lethargy (OR 4.05; 95% CI 1.75-9.31, p=0.001) scores. Suboptimal lethargy scores on the NNNS were associated with increased odds of language (OR 5.64; 95% CI 1.33-23.85, p=0.019) and motor delay (OR: 6.86; 95% CI 1.64-28.71, p=0.08). INTERPRETATION Suboptimal performance on specific aspects of newborn neurobehavioural assessments is associated with neurodevelopmental delay at 2 years in children born MLPT.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Vic, Australia.,Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Vic, Australia
| | - Jennifer M Walsh
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Vic, Australia.,Paediatric Infant Perinatal Emergency Retrieval (PIPER), The Royal Children's Hospital, Melbourne, Vic, Australia
| | - Cody Potter
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia
| | - Emma Mcinnes
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Vic, Australia
| | - Joy E Olsen
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Jeanie L Y Cheong
- Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
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55
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Eeles AL, Olsen JE, Walsh JM, McInnes EK, Molesworth CML, Cheong JLY, Doyle LW, Spittle AJ. Reliability of Neurobehavioral Assessments from Birth to Term Equivalent Age in Preterm and Term Born Infants. Phys Occup Ther Pediatr 2017; 37:108-119. [PMID: 27002541 DOI: 10.3109/01942638.2015.1135845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Neurobehavioral assessments provide insight into the functional integrity of the developing brain and help guide early intervention for preterm (<37 weeks' gestation) infants. In the context of shorter hospital stays, clinicians often need to assess preterm infants prior to term equivalent age. Few neurobehavioral assessments used in the preterm period have established interrater reliability. AIM To evaluate the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS), when used both preterm and at term (>36 weeks). METHODS Thirty-five preterm infants and 11 term controls were recruited. Five assessors double-scored the HNNE and NNNS administered either preterm or at term. A one-way random effects, absolute, single-measures interclass correlation coefficient (ICC) was calculated to determine interrater reliability. RESULTS Interrater reliability for the HNNE was excellent (ICC > 0.74) for optimality scores, and good (ICC 0.60-0.74) to excellent for subtotal scores, except for 'Tone Patterns' (ICC 0.54). On the NNNS, interrater reliability was predominantly excellent for all items. Interrater agreement was generally excellent at both time points. CONCLUSIONS Overall, the HNNE and NNNS neurobehavioral assessments demonstrated mostly excellent interrater reliability when used prior to term and at term.
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Affiliation(s)
- Abbey L Eeles
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Joy E Olsen
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Jennifer M Walsh
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Emma K McInnes
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Charlotte M L Molesworth
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Jeanie L Y Cheong
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Lex W Doyle
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
| | - Alicia J Spittle
- a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia
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56
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Donald KA, Ipser JC, Howells FM, Roos A, Fouche JP, Riley EP, Koen N, Woods RP, Biswal B, Zar HJ, Narr KL, Stein DJ. Interhemispheric Functional Brain Connectivity in Neonates with Prenatal Alcohol Exposure: Preliminary Findings. Alcohol Clin Exp Res 2016; 40:113-21. [PMID: 26727529 DOI: 10.1111/acer.12930] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children exposed to alcohol in utero demonstrate reduced white matter microstructural integrity. While early evidence suggests altered functional brain connectivity in the lateralization of motor networks in school-age children with prenatal alcohol exposure (PAE), the specific effects of alcohol exposure on the establishment of intrinsic connectivity in early infancy have not been explored. METHODS Sixty subjects received functional imaging at 2 to 4 weeks of age for 6 to 8 minutes during quiet natural sleep. Thirteen alcohol-exposed (PAE) and 14 age-matched control (CTRL) participants with usable data were included in a multivariate model of connectivity between sensorimotor intrinsic functional connectivity networks. Seed-based analyses of group differences in interhemispheric connectivity of intrinsic motor networks were also conducted. The Dubowitz neurological assessment was performed at the imaging visit. RESULTS Alcohol exposure was associated with significant increases in connectivity between somatosensory, motor networks, brainstem/thalamic, and striatal intrinsic networks. Reductions in interhemispheric connectivity of motor and somatosensory networks did not reach significance. CONCLUSIONS Although results are preliminary, findings suggest PAE may disrupt the temporal coherence in blood oxygenation utilization in intrinsic networks underlying motor performance in newborn infants. Studies that employ longitudinal designs to investigate the effects of in utero alcohol exposure on the evolving resting-state networks will be key in establishing the distribution and timing of connectivity disturbances already described in older children.
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Affiliation(s)
- Kirsten A Donald
- Division of Developmental Paediatrics (KAD), Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Jonathan C Ipser
- Department of Psychiatry and Mental Health (JCI, FMH, J-PF, NK, DJS), University of Cape Town, Cape Town, South Africa
| | - Fleur M Howells
- Department of Psychiatry and Mental Health (JCI, FMH, J-PF, NK, DJS), University of Cape Town, Cape Town, South Africa
| | - Annerine Roos
- MRC Unit on Anxiety & Stress Disorders (AR), Stellenbosch University, Cape Town, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health (JCI, FMH, J-PF, NK, DJS), University of Cape Town, Cape Town, South Africa.,Department of Psychiatry (J-PF), Stellenbosch University, Cape Town, South Africa
| | - Edward P Riley
- Department of Psychology (EPR), San Diego State University, San Diego, California
| | - Nastassja Koen
- Department of Psychiatry and Mental Health (JCI, FMH, J-PF, NK, DJS), University of Cape Town, Cape Town, South Africa
| | - Roger P Woods
- Department of Neurology (RPW, KLN), University of California, Los Angeles, California
| | - Bharat Biswal
- Department of Biochemical Engineering (BB), New Jersey Institute of Technology, Newark, New Jersey
| | - Heather J Zar
- Department of Paediatrics and Child Health & MRC Unit on Child & Adolescent Health (HJZ), Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Katherine L Narr
- Department of Neurology (RPW, KLN), University of California, Los Angeles, California
| | - Dan J Stein
- Department of Psychiatry and Mental Health (JCI, FMH, J-PF, NK, DJS), University of Cape Town, Cape Town, South Africa.,MRC Unit on Anxiety & Stress Disorders (DJS), University of Cape Town, Cape Town, South Africa
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57
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Howells FM, Donald KA, Roos A, Woods RP, Zar HJ, Narr KL, Stein DJ. Reduced glutamate in white matter of male neonates exposed to alcohol in utero: a (1)H-magnetic resonance spectroscopy study. Metab Brain Dis 2016; 31:1105-12. [PMID: 27311608 PMCID: PMC6465962 DOI: 10.1007/s11011-016-9850-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
In utero exposure to alcohol leads to a spectrum of fetal alcohol related disorders (FASD). However, few studies used have used proton magnetic resonance spectroscopy ((1)H-MRS) to understand how neurochemical disturbances relate to the pathophysiology of FASD. Further, no studies to date have assessed brain metabolites in infants exposed to alcohol in utero. We hypothesize that neonates exposed to alcohol in utero will show decreased glutamatergic activity, pre-emptive of their clinical diagnosis or behavioural phenotype. Single voxel (1)H-MRS data, sampled in parietal white and gray matter, were acquired from 36 neonates exposed to alcohol in utero, and 31 control unexposed healthy neonates, in their 2nd-4th week of life. Metabolites relative to creatine with phosophocreatine and metabolites absolute concentrations using a water reference are reported. Male infants exposed to alcohol in utero were found to have reduced concentration of glutamate with glutamine (Glx) in their parietal white matter (PWM), compared to healthy male infants (p = 0.02). Further, male infants exposed to alcohol in utero had reduced concentration and ratio for glutamate (Glu) in their PWM (p = 0.02), compared to healthy male infants and female infants exposed to alcohol in utero. Female infants showed higher relative Glx and Glu ratios for parietal gray matter (PGM, p < 0.01), compared to male infants. We speculate that the decreased Glx and Glu concentrations in PWM are a result of delayed oligodendrocyte maturation, which may be a result of dysfunctional thyroid hormone activity in males exposed to alcohol in utero. Further study is required to elucidate the relationship between Glx and Glu, thyroid hormone activity, and oligodendrocyte maturation in infants exposure to alcohol in utero.
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Affiliation(s)
- F M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - K A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - A Roos
- Medical Research Council Anxiety and Stress Disorders Unit, University of Stellenbosch, Stellenbosch, South Africa
| | - R P Woods
- Departments of Neurology and of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - K L Narr
- Departments of Neurology and of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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PREMM: preterm early massage by the mother: protocol of a randomised controlled trial of massage therapy in very preterm infants. BMC Pediatr 2016; 16:146. [PMID: 27568006 PMCID: PMC5002318 DOI: 10.1186/s12887-016-0678-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Preterm infants follow an altered neurodevelopmental trajectory compared to their term born peers as a result of the influence of early birth, and the altered environment. Infant massage in the preterm infant has shown positive effects on weight gain and reduced length of hospital stay. There is however, limited current evidence of improved neurodevelopment or improved attachment, maternal mood or anxiety. The aim of this study is to investigate the effects of infant massage performed by the mother in very preterm (VPT) infants. Effects on the infant will be assessed at the electrophysiological, neuroradiological and clinical levels. Effects on maternal mood, anxiety and mother-infant attachment will also be measured. Methods/Design A randomised controlled trial to investigate the effect of massage therapy in VPT infants. Sixty VPT infants, born at 28 to 32 weeks and 6 days gestational age, who are stable, off supplemental oxygen therapy and have normal cranial ultrasounds will be recruited and randomised to an intervention (infant massage) group or a control (standard care) group. Ten healthy term born infants will be recruited as a reference comparison group. The intervention group will receive standardised massage therapy administered by the mother from recruitment, until term equivalent age (TEA). The control group will receive care as usual (CAU). Infants and their mothers will be assessed at baseline, TEA, 12 months and 24 months corrected age (CA), with a battery of clinical, neuroimaging and electrophysiological measures, as well as structured questionnaires, psychoanalytic observations and neurodevelopmental assessments. Discussion Optimising preterm infant neurodevelopment is a key aim of neonatal research, which could substantially improve long-term outcomes and reduce the socio-economic impact of VPT birth. This study has the potential to give insights into the mother-baby relationship and any positive effects of infant massage on neurodevelopment. An early intervention such as massage that is relatively easy to administer and could alter the trajectory of preterm infant brain development, holds potential to improve neurodevelopmental outcomes in this vulnerable population. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000335897. Date registered: 22/3/2012.
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59
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Spittle AJ, Walsh J, Olsen JE, McInnes E, Eeles AL, Brown NC, Anderson PJ, Doyle LW, Cheong JLY. Neurobehaviour and neurological development in the first month after birth for infants born between 32-42 weeks' gestation. Early Hum Dev 2016; 96:7-14. [PMID: 26964011 DOI: 10.1016/j.earlhumdev.2016.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022]
Abstract
AIMS The objective of this study was to generate reference values for infants born moderate preterm (MPT), late preterm (LPT) and full term (FT) for three newborn neurobehavioural/neurological examinations in the first weeks after birth. STUDY DESIGN Prospective cohort study to examine the expected range of values for MPT (born 32(+0) to 33(+6)), LPT (34(+0) to 36(+6)) and FT (born 37 to 42weeks' gestation) infants' performance on the Hammersmith Neonatal Neurological Examination (HNNE), the Neonatal Intensive Care Unit Network Neurobehavioural Scale (NNNS) and Prechtl's General Movements Assessment (GMA) in the first weeks after birth. Further, to determine the effects of sex, gestational age at birth, and postmenstrual age at assessment on the 3 different assessments within the gestational age groups. SUBJECTS 80 MPT, 129 LPT and 201 FT infants were recruited shortly after birth from a tertiary hospital. RESULTS The means, standard deviations and 5th, 10th, 25th, 50th, 75th, 90th and 95th centiles are presented for the HNNE and NNNS for each of the three gestational age groups. Overall, FT infants performed better than MPT and LPT infants. The rate of normal GMA within the first few weeks after birth was 25% for MPT, 32% for LPT, and 90% for FT infants. The effects of sex, gestational age at birth, and postmenstrual age at assessment varied between test and gestational age groups. CONCLUSIONS This study provides normative data for the HNNE, NNNS, and GMA administered within the first weeks after birth in a sample of MPT, LPT and healthy FT infants.
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Affiliation(s)
- Alicia J Spittle
- Physiotherapy Department, University of Melbourne, 7th Floor Alan Gilbert Building, Grattan Street, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia.
| | - Jennifer Walsh
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Pediatric Infant and Perinatal Emergency Retrival, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Emma McInnes
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Abbey L Eeles
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Nisha C Brown
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
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60
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Donald KA, Fouche JP, Roos A, Koen N, Howells FM, Riley EP, Woods RP, Zar HJ, Narr KL, Stein DJ. Alcohol exposure in utero is associated with decreased gray matter volume in neonates. Metab Brain Dis 2016; 31:81-91. [PMID: 26616173 PMCID: PMC6556617 DOI: 10.1007/s11011-015-9771-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/19/2015] [Indexed: 12/20/2022]
Abstract
Neuroimaging studies have indicated that prenatal alcohol exposure is associated with alterations in the structure of specific brain regions. However, the temporal specificity of such changes and their behavioral consequences are less known. Here we explore the brain structure of infants with in utero exposure to alcohol shortly after birth. T2 structural MRI images were acquired from 28 alcohol-exposed infants and 45 demographically matched healthy controls at 2-4 weeks of age on a 3T Siemens Allegra system as part of large birth cohort study, the Drakenstein Child Health Study (DCHS). Neonatal neurobehavior was assessed at this visit; early developmental outcome assessed on the Bayley Scales of Infant Development III at 6 months of age. Volumes of gray matter regions were estimated based on the segmentations of the University of North Carolina neonatal atlas. Significantly decreased total gray matter volume was demonstrated for the alcohol-exposed cohort compared to healthy control infants (p < 0.001). Subcortical gray matter regions that were significantly different between groups after correcting for overall gray matter volume included left hippocampus, bilateral amygdala and left thalamus (p < 0.01). These findings persisted even when correcting for infant age, gender, ethnicity and maternal smoking status. Both early neurobehavioral and developmental adverse outcomes at 6 months across multiple domains were significantly associated with regional volumes primarily in the temporal and frontal lobes in infants with prenatal alcohol exposure. Alcohol exposure during the prenatal period has potentially enduring neurobiological consequences for exposed children. These findings suggest the effects of prenatal alcohol exposure on brain growth is present very early in the first year of life, a period during which the most rapid growth and maturation occurs.
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Affiliation(s)
- Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road/Private Bag, Rondebosch, 7700/7701, Cape Town, South Africa.
- University of Cape Town, South Africa, Cape Town, South Africa.
| | - J P Fouche
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Annerine Roos
- MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa
- Stellenbosch University, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Fleur M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Edward P Riley
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Roger P Woods
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Heather J Zar
- University of Cape Town, South Africa, Cape Town, South Africa
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- University of Cape Town, South Africa, Cape Town, South Africa
- Department of Paediatrics and Child Health and MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health and MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa
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61
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Tran LT, Roos A, Fouche JP, Koen N, Woods RP, Zar HJ, Narr KL, Stein DJ, Donald KA. White Matter Microstructural Integrity and Neurobehavioral Outcome of HIV-Exposed Uninfected Neonates. Medicine (Baltimore) 2016; 95:e2577. [PMID: 26825902 PMCID: PMC5291572 DOI: 10.1097/md.0000000000002577] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The successful implementation of prevention programs for mother-to-child human immunodeficiency virus (HIV) transmission has dramatically reduced the prevalence of infants infected with HIV while increasing that of HIV-exposed uninfected (HEU) children. Neuropsychological assessments indicate that HEU children may exhibit differences in neurodevelopment compared to unexposed children (HUU). Pathological mechanisms leading to such neurodevelopmental delays are not clear. In this observational birth cohort study we explored the integrity of regional white matter microstructure in HEU infants, shortly after birth. Microstructural changes in white matter associated with prenatal HIV exposure were evaluated in HEU infants (n = 15) and matched controls (n = 22) using diffusion tensor imaging and tract-based spatial statistics. Additionally, diffusion values were extracted and compared for white matter tracts of interest, and associations with clinical outcomes from the Dubowitz neonatal neurobehavioral tool were investigated. Higher fractional anisotropy in the middle cerebellar peduncles of HEU compared to HUU neonates was found after correction for age and gender. Scores on the Dubowitz abnormal neurological signs subscale were positively correlated with FA (r = 0.58, P = 0.038) in the left uncinate fasciculus in HEU infants. This is the first study to present data suggesting that prenatal HIV exposure without infection is associated with altered white matter microstructural integrity in the neonatal period. Longitudinal studies of HEU infants as their brains mature are necessary to understand further the significance of prenatal HIV and antiretroviral treatment exposure on white matter integrity and neurodevelopmental outcomes.
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Affiliation(s)
- Linh T Tran
- From the Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town (LTT, KAD); SU/UCT MRC Unit on Anxiety & Stress Disorders, Stellenbosch University (AR); Department of Psychiatry and Mental Health, University of Cape Town (J-PF); Department of Psychiatry, Stellenbosch University (J-PF); Department of Psychiatry and Mental Health, MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa (NK, DJS); Department of Neurology, University of California, Los Angeles, CA (RPW, KLN); and Department of Paediatrics and Child Health and MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa (HJZ)
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62
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Hagmann CF, Chan D, Robertson NJ, Acolet D, Nyombi N, Nakakeeto M, Cowan FM. Neonatal neurological examination in well newborn term Ugandan infants. Early Hum Dev 2015; 91:739-49. [PMID: 26386608 DOI: 10.1016/j.earlhumdev.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/20/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Newborn neurological examinations have mostly been developed in high-resource settings with cohorts comprising predominantly white Caucasian infants. No comparison has been made with different populations. AIMS To (i) establish the range of neurological findings in apparently well newborn term Ugandan infants, (ii) compare these findings to published data for equivalent term UK infants and (iii) correlate the neurological findings with perinatal characteristics and cranial ultrasound (cUS) imaging. METHODS Low-risk term Ugandan infants were recruited from the postnatal ward at Mulago Hospital, Kampala, Uganda. Neurological examination (1) and cUS were performed. The raw data and neurological optimality scores were compared to published data from UK infants (1). Gestational age, postnatal age, sex, maternal parity and HIV status, mode of delivery, birth weight and head circumference were correlated with raw scores. RESULTS Ugandan infants showed significantly stronger palmar grasp, better auditory and visual orientation, less irritability and less need for consoling but had poorer tone, poorer quality of spontaneous movements and more abnormal signs than UK infants. No correlation was found between raw scores and cUS findings, gestational age, sex, birth weight and head circumference. Significantly fewer Ugandan infants had optimal scores based on the UK data. CONCLUSION The neurological status of low-risk hospital-born term Ugandan infants differs from that of low-risk UK infants. The study findings have implications for assessing normality in Ugandan infants and raise concerns about the use of this UK "optimality" score in other research settings. Further work is needed to understand fully the reasons for the differences.
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Affiliation(s)
- C F Hagmann
- EGA UCL Institute for Women's Health, UCL, UK; SBCU Mulago Hospital, Kampala, Uganda.
| | - D Chan
- Department of Paediatrics, Hammersmith and Queen Charlotte's Hospitals, Imperial College, London, UK
| | | | - D Acolet
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - N Nyombi
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - M Nakakeeto
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - F M Cowan
- Department of Paediatrics, Hammersmith and Queen Charlotte's Hospitals, Imperial College, London, UK
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63
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George JM, Boyd RN, Colditz PB, Rose SE, Pannek K, Fripp J, Lingwood BE, Lai MM, Kong AHT, Ware RS, Coulthard A, Finn CM, Bandaranayake SE. PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome. BMC Pediatr 2015; 15:123. [PMID: 26377791 PMCID: PMC4572671 DOI: 10.1186/s12887-015-0439-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12-24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age. METHODS/DESIGN This prospective cohort study will recruit 80 preterm infants born ≤ 30 week's gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women's Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay). DISCUSSION Earlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.
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Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Stephen E Rose
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Kerstin Pannek
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Jurgen Fripp
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Barbara E Lingwood
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Melissa M Lai
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Annice H T Kong
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia.
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Australia.
| | - Alan Coulthard
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Academic Discipline of Medical Imaging, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Christine M Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sasaka E Bandaranayake
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
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64
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Stjerna S, Lano A, Metsäranta M, Vanhatalo S. Cumulative deviance scores can be used as an alternative to the Hammersmith Neonatal Neurological Examination in scientific research. Acta Paediatr 2015; 104:e414-6. [PMID: 26059722 DOI: 10.1111/apa.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 04/28/2015] [Accepted: 06/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Susanna Stjerna
- Department of Clinical Neurophysiology; HUS Medical Imaging Center; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - Aulikki Lano
- Department of Child Neurology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Marjo Metsäranta
- Department of Pediatrics; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology; HUS Medical Imaging Center; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
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65
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McPherson C, Neil JJ, Tjoeng TH, Pineda R, Inder TE. A pilot randomized trial of high-dose caffeine therapy in preterm infants. Pediatr Res 2015; 78:198-204. [PMID: 25856169 PMCID: PMC4928641 DOI: 10.1038/pr.2015.72] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/19/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Standard-dose caffeine improves white matter microstructural development assessed by diffusion magnetic resonance imaging (MRI). We hypothesized that early high-dose caffeine would result in further improvement in white matter microstructural development. METHODS Seventy-four preterm infants (≤30 wk gestational age) were randomly assigned to either a high (80 mg/kg i.v.) or standard (20 mg/kg i.v.) loading dose of caffeine citrate in the first 24 h of life. MRI and neurobehavioral testing were undertaken at term equivalent age. Infants returned at 2 y of age for developmental testing. RESULTS Clinical characteristics were similar between groups, with the exception of higher maternal age in the high-dose caffeine group. There was an increased incidence of cerebellar hemorrhage in infants randomized to high-dose caffeine (36 vs. 10%, P = 0.03). Infants in the high-dose caffeine group also demonstrated more hypertonicity (P = 0.02) and more deviant neurologic signs (P = 0.04) at term equivalent age. Diffusion measures at term equivalent age and developmental outcomes at 2 y of age did not differ between groups. CONCLUSION Preterm infants randomized to early high-dose caffeine had a higher incidence of cerebellar injury with subsequent alterations in early motor performance. The results of this pilot trial discourage a larger randomized controlled trial.
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Affiliation(s)
- Christopher McPherson
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA,Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeffrey J. Neil
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Tiong Han Tjoeng
- Department of Pediatrics, University of Hawaii, Honolulu, HI, USA
| | - Roberta Pineda
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA,Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Terrie E. Inder
- Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Corresponding Author: Terrie Inder, MD, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, CWN 418, Boston, MA 02115, , Telephone: +1-617-525-6650, Fax: +1-617-270-6983
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66
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A study of the effects of prenatal alcohol exposure on white matter microstructural integrity at birth. Acta Neuropsychiatr 2015; 27:197-205. [PMID: 26022619 PMCID: PMC6465963 DOI: 10.1017/neu.2015.35] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuroimaging studies have indicated that prenatal alcohol exposure is associated with alterations in the structure of specific brain regions in children. However, the temporal and regional specificity of such changes and their behavioural consequences are less known. Here we explore the integrity of regional white matter microstructure in infants with in utero exposure to alcohol, shortly after birth. METHODS Twenty-eight alcohol-exposed and 28 healthy unexposed infants were imaged using diffusion tensor imaging sequences to evaluate white matter integrity using validated tract-based spatial statistics analysis methods. Second, diffusion values were extracted for group comparisons by regions of interest. Differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity were compared between groups and associations with measures from the Dubowitz neonatal neurobehavioural assessment were examined. RESULTS Lower AD values (p<0.05) were observed in alcohol-exposed infants in the right superior longitudinal fasciculus compared with non-exposed infants. Altered FA and MD values in alcohol-exposed neonates in the right inferior cerebellar were associated with abnormal neonatal neurobehaviour. CONCLUSION These exploratory data suggest that prenatal alcohol exposure is associated with reduced white matter microstructural integrity even early in the neonatal period. The association with clinical measures reinforces the likely clinical significance of this finding. The location of the findings is remarkably consistent with previously reported studies of white matter structural deficits in older children with a diagnosis of foetal alcohol spectrum disorders.
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67
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Grinaboldi A, Hinnig P, Moura SPSD, Golin MO. Avaliação neurológica de recém-nascidos pré-termo. ACTA ACUST UNITED AC 2015. [DOI: 10.4181/rnc.2015.23.02.1017.8p] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objetivo. Avaliar o estado neurológico de recém-nascidos pré-termo (RNPT) com registros de intercorrências no período neonatal e verificar se desempenhos abaixo do esperado estavam correlacionados com tais eventos. Método. Trata-se de um estudo transversal com 20 RNPT do Hospital Estadual Mário Covas, em Santo André (SP), avaliados pelo método Dubowitz. Os seguintes dados foram coletados: peso e idade gestacional ao nascimento e intercorrências e intervenções no período neonatal. O método de avaliação foi aplicado ao atingirem idades gestacionais entre 37 e 42 semanas. Resultados. Os participantes apresentaram média de idade gestacional de 31,8 semanas e de peso ao nascimento de 1553 gramas. As intercorrências mais frequentes foram doenças cardíacas, respiratórias e infecciosas. Dentre estes, 70% apresentaram pontuações totais na avaliação abaixo do esperado para a normalidade com alterações mais frequentes nas dimensões: tipo de tônus (65%) e movimento (60%). O peso ao nascimento foi o único fator que apresentou associação significante com o desempenho abaixo do esperado. Conclusão. Na população estudada, as baixas pontuações na avaliação reiteram a literatura científica no tocante ao alto risco de RNPT desenvolverem complicações no período neonatal, com consequentes repercussões neurológicas.
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68
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Gigante DP, Horta BL, Matijasevich A, Mola CLD, Barros AJD, Santos IS, Barros FC, Victora CG. Gestational age and newborn size according to parental social mobility: an intergenerational cohort study. J Epidemiol Community Health 2015; 69:944-9. [PMID: 26109560 PMCID: PMC4602273 DOI: 10.1136/jech-2014-205377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/04/2015] [Indexed: 11/04/2022]
Abstract
Background We examined the associations between socioeconomic trajectories from birth to adulthood and gestational age and birth size in the next generation, using linked data from two population-based birth cohorts carried out in a Brazilian city. By comparing socioeconomic trajectories of mothers and fathers, we attempted to identify-specific effects of maternal and paternal socioeconomic trajectory on offspring birth weight, birth length, head circumference and gestational age at birth. Methods 2 population-based birth cohort studies were carried out in 1982 and 2004 in Pelotas (Brazil); 156 mothers and 110 fathers from the earlier cohort had children in 2004. Gestational age and birth length, weight and head circumference were measured. Analyses were carried out separately for mothers and fathers. Mediation analyses assessed the role of birth weight and adult body mass index (BMI). Results Among mothers, but not for fathers, childhood poverty was strongly associated with smaller size in the next generation (about 400 g in weight and 1.5 cm in height) and shorter gestations (about 2 weeks). Adult poverty did not play a role. For mothers, the associations with gestational age, birth length and weight—but not with head circumference—persisted after adjusting for maternal birth weight and for the height and weight of the grandmother. Maternal birth weight did not mediate the observed associations, but high maternal BMI in adulthood was partly responsible for the association with gestational age. Conclusions Strong effects of early poverty on gestational age and birth size in the next generation were observed among mothers, but not among fathers. These findings suggest a specific maternal effect of socioeconomic trajectory, and in particular of early poverty on offspring size and duration of pregnancy.
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Affiliation(s)
- Denise P Gigante
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Bernardo L Horta
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Alicia Matijasevich
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil Preventive Medicine Department, Sao Paulo University
| | - Christian Loret de Mola
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Aluisio J D Barros
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Ina S Santos
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Fernando C Barros
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil Post-Graduate Programme in Health and Behaviour, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Cesar G Victora
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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69
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Steinhorn R, McPherson C, Anderson PJ, Neil J, Doyle LW, Inder T. Neonatal morphine exposure in very preterm infants-cerebral development and outcomes. J Pediatr 2015; 166:1200-1207.e4. [PMID: 25919729 PMCID: PMC4928575 DOI: 10.1016/j.jpeds.2015.02.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 12/29/2014] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the association of morphine exposure in very preterm infants with cerebral volumes and neurodevelopmental outcome from birth through middle childhood. STUDY DESIGN Observational study of very preterm infants in the Victorian Infant Brain Study cohort. A total of 230 infants born <30 weeks' gestational age or <1250 g were recruited from all admissions to the neonatal intensive care unit of the Royal Women's Hospital. Fifty-seven (25%) infants received morphine analgesia during their neonatal intensive care unit stay at the attending physician's discretion. Primary outcomes were regional brain volumes at term and 7 years; neurobehavioral performance at term; and cognitive, motor, emotional, behavioral, communication, and executive function scores at age 2 and 7 years. Linear regressions were used to compare outcomes between participants who did and did not receive morphine. RESULTS At term, preterm infants who received morphine had similar rates of gray matter injury to no-morphine infants, but a trend toward smaller cortical volumes in the orbitofrontal (Pleft=.002, Pright=.01) and subgenual (Pleft=.01) regions. At 7 years, cortical volumes did not differ between groups. At 2 years, morphine-exposed children were more likely to show behavioral dysregulation (P=.007) than no-morphine children, but at 7 years no detrimental impacts of morphine on neurobehavioral outcome were observed. CONCLUSIONS Low-dose morphine analgesia received during neonatal intensive care was associated with early alterations in cerebral structure and short-term neurobehavioral problems that did not persist into childhood.
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Affiliation(s)
- Rachel Steinhorn
- Departments of Pediatrics, Washington University in St. Louis, 660 South Euclid Ave., St. Louis, MO, USA 63105
| | - Chris McPherson
- Department of Pharmacy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115,Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115
| | - Peter J Anderson
- Department of Paediatrics, Royal Women’s Hospital, The University of Melbourne, Carlton, Vic, 3053,Department of Murdoch Children’s Research Institute, Parkville, Vic, 3052, Australia
| | - Jeffrey Neil
- Department of Neurology, Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115
| | - Lex W Doyle
- Department of Paediatrics, Royal Women’s Hospital, The University of Melbourne, Carlton, Vic, 3053,Department Obstetrics and Gynecology, Royal Women’s Hospital, The University of Melbourne, Carlton, Vic, 3053,Department of Murdoch Children’s Research Institute, Parkville, Vic, 3052, Australia
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA.
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70
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Setänen S, Lahti K, Lehtonen L, Parkkola R, Maunu J, Saarinen K, Haataja L. Neurological examination combined with brain MRI or cranial US improves prediction of neurological outcome in preterm infants. Early Hum Dev 2014; 90:851-6. [PMID: 25463831 DOI: 10.1016/j.earlhumdev.2014.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The predictive value of the combination of neurological examination and brain magnetic resonance imaging (MRI) or cranial ultrasound (cUS) in preterm infants is not known. AIMS To study the prognostic value of the combination of neurological examination and brain MRI at term equivalent age (TEA) or serial neonatal cUS in very preterm infants for neurosensory outcome at 2 years of corrected age. STUDY DESIGN A prospective follow-up study. SUBJECTS A total of 216 very preterm infants (birth weight 1132 g [SD 331 g]) born in Turku University Hospital, from 2001 to 2006, were included. OUTCOME MEASURES The Dubowitz neurologic examination and brain MRI were done at TEA, and serial cUS examinations were performed until TEA. The Hammersmith Infant Neurological Examination (HINE) and neurosensory impairments (NSI) were assessed at 2 years of corrected age. RESULTS Of all infants, 163 (76%) had one or more deviant neurological items at TEA, and 32 (15%) had the HINE total score below the 10th percentile at 2 years of corrected age. A total of 17 (8%) infants had NSI. Neurological examination at TEA improved the negative and positive predictive values of brain MRI for NSI from 99% to 100%, and from 28% to 35%, respectively, and the negative and positive predictive values of cUS from 97% to 100%, and from 61% to 79%, respectively. CONCLUSIONS The combination of the Dubowitz neurologic examination and the brain MRI at TEA or serial neonatal cUS provides a valuable clinical tool for predicting long-term neurosensory outcome in preterm infants.
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Affiliation(s)
- Sirkku Setänen
- Department of Pediatric Neurology, University of Turku, Turku University Hospital, Turku, Finland.
| | - Katri Lahti
- Department of Medicine, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Jonna Maunu
- Department of Pediatric Psychiatry, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Leena Haataja
- Department of Pediatric Neurology, University of Turku, Turku University Hospital, Turku, Finland
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Spittle AJ, Thompson DK, Brown NC, Treyvaud K, Cheong JLY, Lee KJ, Pace CC, Olsen J, Allinson LG, Morgan AT, Seal M, Eeles A, Judd F, Doyle LW, Anderson PJ. Neurobehaviour between birth and 40 weeks' gestation in infants born <30 weeks' gestation and parental psychological wellbeing: predictors of brain development and child outcomes. BMC Pediatr 2014; 14:111. [PMID: 24758605 PMCID: PMC4016657 DOI: 10.1186/1471-2431-14-111] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants born <30 weeks' gestation are at increased risk of long term neurodevelopmental problems compared with term born peers. The predictive value of neurobehavioural examinations at term equivalent age in very preterm infants has been reported for subsequent impairment. Yet there is little knowledge surrounding earlier neurobehavioural development in preterm infants prior to term equivalent age, and how it relates to perinatal factors, cerebral structure, and later developmental outcomes. In addition, maternal psychological wellbeing has been associated with child development. Given the high rate of psychological distress reported by parents of preterm children, it is vital we understand maternal and paternal wellbeing in the early weeks and months after preterm birth and how this influences the parent-child relationship and children's outcomes. Therefore this study aims to examine how 1) early neurobehaviour and 2) parental mental health relate to developmental outcomes for infants born preterm compared with infants born at term. METHODS/DESIGN This prospective cohort study will describe the neurobehaviour of 150 infants born at <30 weeks' gestational age from birth to term equivalent age, and explore how early neurobehavioural deficits relate to brain growth or injury determined by magnetic resonance imaging, perinatal factors, parental mental health and later developmental outcomes measured using standardised assessment tools at term, one and two years' corrected age. A control group of 150 healthy term-born infants will also be recruited for comparison of outcomes. To examine the effects of parental mental health on developmental outcomes, both parents of preterm and term-born infants will complete standardised questionnaires related to symptoms of anxiety, depression and post-traumatic stress at regular intervals from the first week of their child's birth until their child's second birthday. The parent-child relationship will be assessed at one and two years' corrected age. DISCUSSION Detailing the trajectory of infant neurobehaviour and parental psychological distress following very preterm birth is important not only to identify infants most at risk, further understand the parental experience and highlight potential times for intervention for the infant and/or parent, but also to gain insight into the effect this has on parent-child interaction and child development.
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Affiliation(s)
- Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Level 7, Building 104, 161 Barry Street, Carlton, Victoria 3053, Australia
- Neonatal Services, Royal Women's Hospital, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
| | - Nisha C Brown
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
| | - Jeanie LY Cheong
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Neonatal Services, Royal Women's Hospital, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
| | - Katherine J Lee
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
| | - Carmen C Pace
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, 12th Floor, Redmond Barry Building, Parkville, Victoria 3010, Australia
| | - Joy Olsen
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
| | - Leesa G Allinson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Level 7, Building 104, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Angela T Morgan
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
- Language and Literacy Group, Murdoch Childrens Research Institute, 5th Floor, Flemington Road, Parkville, Victoria 3052, Australia
| | - Marc Seal
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
| | - Abbey Eeles
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
| | - Fiona Judd
- Neonatal Services, Royal Women's Hospital, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 4th Floor, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, 7th Floor, Cnr Grattan Street and Flemington Road, Parkville, Victoria 3052, Australia
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72
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Pineda R, Neil J, Dierker D, Smyser C, Wallendorf M, Kidokoro H, Reynolds L, Walker S, Rogers C, Mathur A, Van Essen D, Inder T. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. J Pediatr 2014; 164:52-60.e2. [PMID: 24139564 PMCID: PMC3872171 DOI: 10.1016/j.jpeds.2013.08.047] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/17/2013] [Accepted: 08/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate associations between neonatal intensive care unit (NICU) room type (open ward and private room) and medical outcomes; neurobehavior, electrophysiology, and brain structure at hospital discharge; and developmental outcomes at 2 years of age. STUDY DESIGN In this prospective longitudinal cohort study, we enrolled 136 preterm infants born <30 weeks gestation from an urban, 75-bed level III NICU from 2007-2010. Upon admission, each participant was assigned to a bedspace in an open ward or private room within the same hospital, based on space and staffing availability, where they remained for the duration of hospitalization. The primary outcome was developmental performance at 2 years of age (n = 86 infants returned for testing, which was 83% of survivors) measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition. Secondary outcomes were: (1) medical factors throughout the hospitalization; (2) neurobehavior; and (3) cerebral injury and maturation (determined by magnetic resonance imaging and electroencephalography). RESULTS At term equivalent age, infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores (P = .02; β = -0.52 [CI -0.95, -0.10]). At age 2 years, infants from private rooms had lower language scores (P = .006; β = -8.3 [CI -14.2, -2.4]) and a trend toward lower motor scores (P = .02; β = -6.3 [CI -11.7, -0.99]), which persisted after adjustment for potential confounders. CONCLUSION These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment.
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Affiliation(s)
- Roberta Pineda
- Department of Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
,Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jeff Neil
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
,Department of Neurology, Washington University School of Medicine, St Louis, Missouri
,Department of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Donna Dierker
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, Missouri
| | - Chris Smyser
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
,Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Lauren Reynolds
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie Walker
- Department of Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
| | - Cynthia Rogers
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - David Van Essen
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, Missouri
| | - Terrie Inder
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
,Department of Neurology, Washington University School of Medicine, St Louis, Missouri
,Department of Radiology, Washington University School of Medicine, St Louis, Missouri
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73
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Abstract
The neurological exam can be a challenging part of a newborn's full evaluation. At the same time, the neonatal neurological exam is a useful tool in identifying babies needing closer evaluation for potential problems. The Dubowitz assessment is a standardised approach to the neonatal neurological exam designed for use by paediatricians in routine practice. Evidence has validated this technique and delineated its utility as a screening exam in various populations. This paper reviews clinical application of the Dubowitz assessment of the newborn.
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Affiliation(s)
- Courtney J Wusthoff
- Division of Child Neurology, Stanford University, 750 Welch Road, Suite 317, Palo Alto, CA 94304, USA.
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74
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Neonatal neurological examination of late preterm babies. Early Hum Dev 2013; 89:537-45. [PMID: 23380499 DOI: 10.1016/j.earlhumdev.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 12/25/2012] [Accepted: 01/07/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUNDS Healthy late-preterm (LP) infants examined at term equivalent age showed wider median and range of neurological scores than full-term infants; differences between infants born at 34 and those born at 35-36 weeks were also observed. AIMS The aim of this study is to establish the range and frequency distribution of neonatal neurological scores in a cohort of low risk LP infants assessed during the first 3 days from birth. STUDY DESIGN AND SUBJECTS 118 low-risk infants born between 34 and 36 weeks of gestational age (GA) were assessed between 48 and 72 h from birth. OUTCOME MEASURES The full version of the Hammersmith Neonatal Neurologic Assessment and the screening proforma were used to assess all the infants. The raw scores obtained were compared to those of full-term infants using the same examination. RESULTS The distribution of neurological scores was similar among the 3 GAs for 26 items, with different median scores among LP infants born at 36 weeks and those born at 34 and 35 in only 2 items. LP infants showed a wider range of findings for each item than that of full term infants assessed soon after birth. Using the screening proforma, in our cohort, for each item the findings falling outside the 90% level were identical to those found in term-born and very preterm infants assessed at term age. CONCLUSIONS The neurological scores obtained in our cohort could help as reference data when examining LP infants at birth compared to age matched low risk infants.
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75
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McGready R, Simpson JA, Arunjerdja R, Golfetto I, Ghebremeskel K, Taylor A, Siemieniuk A, Mercuri E, Harper G, Dubowitz L, Crawford M, Nosten F. Delayed visual maturation in Karen refugee infants. ACTA ACUST UNITED AC 2013; 23:193-204. [PMID: 14567835 DOI: 10.1179/027249303322296510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Thirty-eight babies born to Karen mothers living in camps for displaced persons in north-western Thailand have delayed visual maturation (DVM type 1) that recovers within 6 months. Vitamin A concentrations were deficient in 16% of breast-milk samples from lactating mothers and vitamin B(1) concentrations were deficient in 60% of plasma samples. Infantile beriberi was common in this population. The levels of fatty acids in plasma and milk in Karen women were excellent at birth and in the postpartum period. The degree of deficiencies in these vitamins and the concentration of essential fatty acids in cord blood and maternal breast-milk did not correlate significantly with visual impairment in the infants. DVM might be caused by nutritional deficiency or toxic effects during critical periods of gestation that lead to delayed cortical myelination or structural defects which impinge on parietal cortex function.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, Mae Sot and Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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76
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Ramos G, Brotschi B, Latal B, Bernet V, Wagner B, Hagmann C. Therapeutic hypothermia in term infants after perinatal encephalopathy: the last 5 years in Switzerland. Early Hum Dev 2013; 89:159-64. [PMID: 23116611 DOI: 10.1016/j.earlhumdev.2012.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/25/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Therapeutic hypothermia (TH) following perinatal asphyxial encephalopathy in term infants improves mortality and neurodevelopmental outcome. In Europe, most neonatal units perform active cooling whereas in Switzerland passive cooling is predominantly used. AIMS (i) To determine how many infants were cooled within the last 5years in Switzerland, (ii) to assess the cooling methods, (iii) to evaluate the variation of temperature of different cooling methods, and (iv) to evaluate the use of neuromonitoring. STUDY DESIGN Retrospective cohort study. PATIENTS Notes of all cooled term infants between March 2005 and December 2010 in 9 perinatal and two paediatric intensive care centres were retrospectively reviewed. Active cooling was compared to passive cooling alone and to passive cooling in combination with gel packs. RESULTS 150 infants were cooled. Twenty-seven (18.2%) were cooled actively, 34 (23%) passively and 87 (58.8%) passively in combination with gel packs. Variation of temperature was significantly different between the three methods. Passive cooling had a significant higher variation of temperature (SD of 0.89) than both passive cooling in combination with gel packs (SD of 0.79) and active cooling (SD of 0.76). aEEG before TH was obtained in 35.8% of the infants and 86.5% had full EEG. One cUS was performed in 95.3% and MRI in 62.2% of the infants. CONCLUSION Target temperature can be achieved with all three cooling methods. Passive cooling has the highest variation of temperature. Neuromonitoring should be improved in Swiss neonatal and paediatric intensive care units. Our results stress the importance of national registries.
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Affiliation(s)
- G Ramos
- Clinic of Neonatology, University Hospital Zurich, Zurich, Switzerland
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77
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Leone D, Brogna C, Ricci D, Romeo DM, Leo G, Serrao F, Gallini F, Cioni G, Romagnoli C, Mercuri E. Development of clinical signs in low risk term born infants with neonatal hyperexcitability. Early Hum Dev 2013; 89:65-8. [PMID: 22884006 DOI: 10.1016/j.earlhumdev.2012.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/12/2012] [Accepted: 07/17/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several studies have reported on neonatal tremors or "jitteriness" or, as described by Precthl "hyperexcitability syndrome" including tremors and increased resistance to passive movement. AIM To describe the evolution of signs and the outcome at one year in low risk term born infants with neonatal tremors persisting beyond 10 days. SUBJECTS 84 low risk term born neonates with tremors at birth and persisting after 10 days, underwent a longitudinal neurological assessment paying attention to the evolution of tremors and increased resistance to passive movement. RESULTS At 1 month 74 of the 84 infants had persistent tremors, isolated in 27 or associated with increased resistance to passive movement in the other 47. The remaining 10 had isolated increased resistance to passive movement and none had a normal assessment. The percentage of infants with a normal assessment progressively increased at 6, 9 and 12 months (34.5%, 77%, 93% respectively). CONCLUSION Our data suggest that neonatal tremors can have a variable evolution and rate of resolution, with 70% of recovery by 9 months with a normal outcome at 24 months in all. The risk of persistence of signs (at 12 months) in infants with either isolated tremors or increased resistance to passive movements is lower than in the subgroup with both signs at one month.
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Affiliation(s)
- Daniela Leone
- Paediatric Neurology Unit, Catholic University, Rome, Italy
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78
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Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; 2013:CD003311. [PMID: 23440789 PMCID: PMC7003568 DOI: 10.1002/14651858.cd003311.pub3] [Citation(s) in RCA: 785] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Newborn animal studies and pilot studies in humans suggest that mild hypothermia following peripartum hypoxia-ischaemia in newborn infants may reduce neurological sequelae without adverse effects. OBJECTIVES To determine the effect of therapeutic hypothermia in encephalopathic asphyxiated newborn infants on mortality, long-term neurodevelopmental disability and clinically important side effects. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group as outlined in The Cochrane Library (Issue 2, 2007). Randomised controlled trials evaluating therapeutic hypothermia in term and late preterm newborns with hypoxic ischaemic encephalopathy were identified by searching the Oxford Database of Perinatal Trials, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2007, Issue 2), MEDLINE (1966 to June 2007), previous reviews including cross-references, abstracts, conferences, symposia proceedings, expert informants and journal handsearching. We updated this search in May 2012. SELECTION CRITERIA We included randomised controlled trials comparing the use of therapeutic hypothermia with standard care in encephalopathic term or late preterm infants with evidence of peripartum asphyxia and without recognisable major congenital anomalies. The primary outcome measure was death or long-term major neurodevelopmental disability. Other outcomes included adverse effects of cooling and 'early' indicators of neurodevelopmental outcome. DATA COLLECTION AND ANALYSIS Four review authors independently selected, assessed the quality of and extracted data from the included studies. Study authors were contacted for further information. Meta-analyses were performed using risk ratios (RR) and risk differences (RD) for dichotomous data, and weighted mean difference for continuous data with 95% confidence intervals (CI). MAIN RESULTS We included 11 randomised controlled trials in this updated review, comprising 1505 term and late preterm infants with moderate/severe encephalopathy and evidence of intrapartum asphyxia. Therapeutic hypothermia resulted in a statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age (typical RR 0.75 (95% CI 0.68 to 0.83); typical RD -0.15, 95% CI -0.20 to -0.10); number needed to treat for an additional beneficial outcome (NNTB) 7 (95% CI 5 to 10) (8 studies, 1344 infants). Cooling also resulted in statistically significant reductions in mortality (typical RR 0.75 (95% CI 0.64 to 0.88), typical RD -0.09 (95% CI -0.13 to -0.04); NNTB 11 (95% CI 8 to 25) (11 studies, 1468 infants) and in neurodevelopmental disability in survivors (typical RR 0.77 (95% CI 0.63 to 0.94), typical RD -0.13 (95% CI -0.19 to -0.07); NNTB 8 (95% CI 5 to 14) (8 studies, 917 infants). Some adverse effects of hypothermia included an increase sinus bradycardia and a significant increase in thrombocytopenia. AUTHORS' CONCLUSIONS There is evidence from the 11 randomised controlled trials included in this systematic review (N = 1505 infants) that therapeutic hypothermia is beneficial in term and late preterm newborns with hypoxic ischaemic encephalopathy. Cooling reduces mortality without increasing major disability in survivors. The benefits of cooling on survival and neurodevelopment outweigh the short-term adverse effects. Hypothermia should be instituted in term and late preterm infants with moderate-to-severe hypoxic ischaemic encephalopathy if identified before six hours of age. Further trials to determine the appropriate techniques of cooling, including refinement of patient selection, duration of cooling and method of providing therapeutic hypothermia, will refine our understanding of this intervention.
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Affiliation(s)
- Susan E Jacobs
- Neonatal Services, Royal Women’s Hospital, Parkville, Melbourne, Australia.
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79
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Abstract
PURPOSE To determine factors associated with mothers' concern about infant development and intent to access therapy services following neonatal intensive care unit (NICU) discharge. METHODS Infant medical factors, magnetic resonance imaging results, neurobehavior at term, maternal factors, and maternal perceptions about developmental concern and intent to access therapy at NICU discharge were prospectively collected in 84 infants born premature (<30 weeks gestation). Regression was used to determine factors associated with developmental concern and intent to access therapy at NICU discharge. RESULTS Decreased developmental concern was reported by mothers with more children (P = .007). Infant stress signs (P = .038), higher maternal education (P = .047), reading books (P = .030), and maternal depression (P = .018) were associated with increased developmental concern. More maternal education was associated with more intent to access services (P = .040). CONCLUSION Maternal factors, rather than infant factors, had important associations with caregiver concern. In contrast, abnormal term neurobehavior and/or the presence of cerebral injury were not associated with caregiver concern about development.
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80
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Koldewijn K, van Hus J, van Wassenaer A, Jeukens-Visser M, Kok J, Nollet F, Wolf MJ. Reliability, sensitivity and responsiveness of the Infant Behavioral Assessment in very preterm infants. Acta Paediatr 2012; 101:258-63. [PMID: 21981307 DOI: 10.1111/j.1651-2227.2011.02481.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study is to investigate the reliability, sensitivity and responsiveness of the Infant Behavioral Assessment (IBA) to evaluate neurobehavioural organization in very preterm infants. METHODS Videotaped assessments of very preterm infants participating in a recent trial served to evaluate a standardized IBA observation. Inter-rater reliability was based on 40 videos scored by two independent observers, using percentage agreement and weighted Kappa's. Sensitivity was evaluated by comparing the IBA results of 169 infants at 35-38 weeks postmenstrual age, dichotomized according to two developmental risk factors. For responsiveness, the effect size (ES) was calculated between 0 and 6 months corrected age in all intervention and control infants and in subgroups of high-risk intervention and control infants with oxygen dependency ≥28 days. RESULTS Inter-rater agreement was 93% in the total assessment; Kappa agreement was moderate to good in the behavioural categories. Significant differences were found between groups with or without risk factors. Larger differences between ESs in the randomized groups with oxygen dependency ≥28 days than in the total randomized groups reflect the responsiveness of the IBA. CONCLUSION In this study, we found satisfactory to good clinimetric characteristics of the IBA in very preterm born infants.
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Affiliation(s)
- K Koldewijn
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands.
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81
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Mercuri E, Ricci D, Romeo DM. Neurological and visual assessments in very and late low-risk preterm infants. Early Hum Dev 2012; 88 Suppl 1:S31-3. [PMID: 22285782 DOI: 10.1016/j.earlhumdev.2011.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this review, we report our experience on early neurological and visual developments in preterm infants assessed during the neonatal period using the Dubowitz neonatal neurological assessment and a new battery for visual assessment. The assessments were performed in both very and late low-risk preterm infants and in healthy term-born infants. We report the findings in the three cohorts, evaluating the influence of gestational age and extrauterine exposure on both neurological and visual developments.
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Affiliation(s)
- Eugenio Mercuri
- Paediatric Neurology Unit, Catholic University, Rome, Italy.
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82
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Romeo DM, Ricci D, Brogna C, Cilauro S, Lombardo ME, Romeo MG, Mercuri E. Neurological examination of late-preterm infants at term age. Eur J Paediatr Neurol 2011; 15:353-60. [PMID: 21514859 DOI: 10.1016/j.ejpn.2011.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/17/2011] [Accepted: 03/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late-preterm infants represent 70% of the whole preterm population. AIMS To establish the range and frequency distribution of neonatal neurological scores in a large cohort of low risk late-preterm infants and the possible differences with full-term infants. METHODS Three hundred-seventy-five healthy infants born between 34 and 36 weeks gestational age (GA) without major brain lesions were assessed between 39 and 41 weeks post-menstrual age using the Hammersmith Neonatal Neurologic Assessment and compared to the scores obtained using the same examination in full-term infants. RESULTS Infants born at 35 and 36 weeks GA had similar median scores in 32 of the 34 items. Infants born at 34 weeks GA had a different profile of scores compared to those born at 35 and 36 weeks, mainly in the tone items. While in infants born at 34 weeks the assessment at term age showed similar median scores to those obtained in full-term infants in 25/34 items, in those born at 35 and 36 GA the number of scores similar to full-term infants increased to 29/34. The main differences involved the tone items, with more marked flexor tone in the limbs and better head control for those born at 35 and 36 weeks. CONCLUSIONS This data can help as reference data when examining late-preterm infants at term age to see where the individual child stands compared to age matched low risk infants and to identify signs that are outside the reported range in infants with lesions or other risk factors.
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Affiliation(s)
- Domenico M Romeo
- Department of Pediatrics, Child Neurology and Psychiatry, Catholic University, Rome, Italy
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83
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Robertson NJ, Hagmann CF, Acolet D, Allen E, Nyombi N, Elbourne D, Costello A, Jacobs I, Nakakeeto M, Cowan F. Pilot randomized trial of therapeutic hypothermia with serial cranial ultrasound and 18-22 month follow-up for neonatal encephalopathy in a low resource hospital setting in Uganda: study protocol. Trials 2011; 12:138. [PMID: 21639927 PMCID: PMC3127769 DOI: 10.1186/1745-6215-12-138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 06/04/2011] [Indexed: 11/26/2022] Open
Abstract
Background There is now convincing evidence that in industrialized countries therapeutic hypothermia for perinatal asphyxial encephalopathy increases survival with normal neurological function. However, the greatest burden of perinatal asphyxia falls in low and mid-resource settings where it is unclear whether therapeutic hypothermia is safe and effective. Aims Under the UCL Uganda Women's Health Initiative, a pilot randomized controlled trial in infants with perinatal asphyxia was set up in the special care baby unit in Mulago Hospital, a large public hospital with ~20,000 births in Kampala, Uganda to determine: (i) The feasibility of achieving consent, neurological assessment, randomization and whole body cooling to a core temperature 33-34°C using water bottles (ii) The temperature profile of encephalopathic infants with standard care (iii) The pattern, severity and evolution of brain tissue injury as seen on cranial ultrasound and relation with outcome (iv) The feasibility of neurodevelopmental follow-up at 18-22 months of age Methods/Design Ethical approval was obtained from Makerere University and Mulago Hospital. All infants were in-born. Parental consent for entry into the trial was obtained. Thirty-six infants were randomized either to standard care plus cooling (target rectal temperature of 33-34°C for 72 hrs, started within 3 h of birth) or standard care alone. All other aspects of management were the same. Cooling was performed using water bottles filled with tepid tap water (25°C). Rectal, axillary, ambient and surface water bottle temperatures were monitored continuously for the first 80 h. Encephalopathy scoring was performed on days 1-4, a structured, scorable neurological examination and head circumference were performed on days 7 and 17. Cranial ultrasound was performed on days 1, 3 and 7 and scored. Griffiths developmental quotient, head circumference, neurological examination and assessment of gross motor function were obtained at 18-22 months. Discussion We will highlight differences in neonatal care and infrastructure that need to be taken into account when considering a large safety and efficacy RCT of therapeutic hypothermia in low and mid resource settings in the future. Trial registration Current controlled trials ISRCTN92213707
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Affiliation(s)
- Nicola J Robertson
- Institute for Women's Health, 86-96 Chenies Mews, University College London, London, UK.
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84
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Hagmann CF, Robertson NJ, Acolet D, Nyombi N, Ondo S, Nakakeeto M, Cowan FM. Cerebral measurements made using cranial ultrasound in term Ugandan newborns. Early Hum Dev 2011; 87:341-7. [PMID: 21353402 DOI: 10.1016/j.earlhumdev.2011.01.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few cUS studies of cerebral measurements are available for normal term infants. Normative data is important for evaluating cerebral structure size in symptomatic term infants and assessing preterm brain growth by term age. OBJECTIVES To (i) make linear measurements using cranial ultrasound (cUS) for major cerebral structures and intracranial spaces in normal newborn term infants, (ii) correlate these measurements with gestational age (GA), birth weight (BW), head circumference (HC), gender and within one infant (iii) examine inter/intra-observer variation, and (iv) compare these data with those currently available. DESIGN, SETTING AND PATIENTS Linear cUS measurements of major cerebral structures were made in well term-born Ugandan infants at Mulago University Hospital, Kampala. Correlations between the measurements and gender, HC, BW and GA were calculated. Intra- and inter-observer agreements were assessed. RESULTS Data from 106 infants (mean GA 39.20±1.4SD weeks) were analysed. Intra/inter-observer agreement was substantial/excellent. Significant correlations were found between HC and pons anterior-posterior diameter (p<0.01), corpus callosal (CC) length (p=0.02) and transverse cerebellar diameter (TCD, p<0.01) and between BW and CC length (p=0.02), vermis height (<0.01) and thalamo-occipital distance (p=0.03); no significant correlation was found with GA. Within infants CC length and TCD correlated significantly (p=0.019). Males had larger left ventricular indices than females (p=0.04). The data was similar to those from other populations. CONCLUSIONS These data provide reliable reference values for linear measurements of many cerebral structures made using cUS. The data agree well with those from other populations suggesting that cerebral size is similar in different ethnic groups.
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Affiliation(s)
- C F Hagmann
- EGA UCL Institute for Women's Health, UCL, UK
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85
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Moraes MVM, Tudella E, Ribeiro J, Beltrame TS, Krebs RJ. Reliability of the M-FLEX™: Equipment to measure palmar grasp strength in infants. Infant Behav Dev 2011; 34:226-34. [DOI: 10.1016/j.infbeh.2010.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 09/28/2010] [Accepted: 12/03/2010] [Indexed: 11/27/2022]
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86
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El-Dib M, Massaro AN, Glass P, Aly H. Neurodevelopmental assessment of the newborn: An opportunity for prediction of outcome. Brain Dev 2011; 33:95-105. [PMID: 20494536 DOI: 10.1016/j.braindev.2010.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/12/2010] [Accepted: 04/19/2010] [Indexed: 12/01/2022]
Abstract
Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardiac and respiratory support, now more time, effort and research are concerned about brain development of the term and preterm infants. There is no single standardized neurodevelopmental assessment tool that can be advocated for infants in the neonatal intensive care unit. The tools that are currently available vary in their physiological bases, pre requisite training and expertise, time allotted to perform and score, and clinical utility and validity. In this communication, we describe the neurobehavioral and sensory capabilities of the neonate. We then compare the commonly used neurobehavioral examinations with an emphasis on premature infants. We envision this effort as an essential step before the development of a universal and comprehensive assessment tool.
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Affiliation(s)
- Mohamed El-Dib
- Department of Neonatology, Children's National Medical Center, The George Washington University, Washington, DC, USA.
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87
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Jacobs SE, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cochrane Review: Cooling for newborns with hypoxic ischaemic encephalopathy. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/ebch.527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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88
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Azzopardi D. Clinical management of the baby with hypoxic ischaemic encephalopathy. Early Hum Dev 2010; 86:345-50. [PMID: 20605382 DOI: 10.1016/j.earlhumdev.2010.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
The results of randomized clinical trials indicate that the optimal management for infants with hypoxic ischaemic encephalopathy is therapeutic hypothermia combined with high quality standard neonatal intensive care. In addition to therapeutic hypothermia clinical management of the infant with hypoxic ischaemic encephalopathy should include the management of multiorgan dysfunction, obtaining and documenting detailed clinical information and performing appropriate investigations and assessment to confirm the diagnosis and to help direct care, and providing counseling and support to the family. This article is a summary of the in hospital clinical management of infants with hypoxic ischaemic encephalopathy.
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Affiliation(s)
- Denis Azzopardi
- The Institute of Clinical Sciences, Hammersmith Campus, Imperial College London, United Kingdom.
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89
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Koldewijn K, van Wassenaer A, Wolf MJ, Meijssen D, Houtzager B, Beelen A, Kok J, Nollet F. A neurobehavioral intervention and assessment program in very low birth weight infants: outcome at 24 months. J Pediatr 2010; 156:359-65. [PMID: 19880139 DOI: 10.1016/j.jpeds.2009.09.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 07/06/2009] [Accepted: 09/02/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the Infant Behavioral Assessment and Intervention Program (IBAIP) improves development and behavior in very low birth weight (VLBW) infants at 24-month corrected age. STUDY DESIGN In a multicenter, randomized, controlled trial 86 infants received postdischarge intervention until 6-month corrected age. The intervention consisted of supporting infants' self-regulation and development, and facilitating sensitive parent-infant interactions; 90 control infants received regular care. At 6 months, positive intervention effects were found. At 24 months, development and behavior were evaluated with the Bayley Scales of Infant Development-II (BSID-II) and the Child Behavior Check List (CBCL). RESULTS Eighty-three intervention and 78 control infants were available for follow-up. After adjustment for differences in perinatal characteristics, an intervention effect of 6.4 points (+/- standard error, 2.4) on the Psychomotor Developmental Index favored the intervention infants. Groups did not differ on the Mental Developmental Index, the Behavioral Rating Scale of the BSID-II, or on the CBCL. Subgroup analyses revealed improved motor as well as improved mental outcomes in intervention infants with bronchopulmonary dysplasia and with combined biological and social risk factors. CONCLUSIONS The IBAIP shows sustained motor improvement in VLBW infants until 2-year corrected age.
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Affiliation(s)
- Karen Koldewijn
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands
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90
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Munck P, Haataja L, Maunu J, Parkkola R, Rikalainen H, Lapinleimu H, Lehtonen L. Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006. Acta Paediatr 2010; 99:359-66. [PMID: 19912142 DOI: 10.1111/j.1651-2227.2009.01589.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data. METHODS A regional cohort of 182 VLBW infants born between 2001 and 2006 was followed up. Brain ultrasounds (US) were examined serially until term age and brain magnetic resonance imaging at term age. Neurological status was examined systematically. Cognitive development was assessed using the Mental Developmental Index (MDI) of Bayley Scales at 2 years of corrected age. A total of 192 healthy full-term (FT) controls were assessed with the MDI at 2 years of age. RESULTS The mean MDI in VLBW infants was 101.7 (SD 15.4), which was lower compared with FT controls (109.8, SD 11.7, p < 0.001). In regression analysis of the demographic and medical data of VLBW infants, postnatal corticosteroids (p = 0.04), intestinal perforation (p = 0.03) and major brain pathology (p = 0.02) were negatively associated with the MDI. In VLBW infants, the prevalence of neurodevelopmental impairment was 9.9% (3.3% MDI below 70, 7.1% cerebral palsy, 2.2% hearing aid, no blind infants). CONCLUSION Cognitive development of VLBW infants seemed to have improved in comparison with earlier publications, but it differed from the FT controls. Neonatal factors affected cognitive development. Therefore, updated regional follow-up data are important for clinicians.
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Affiliation(s)
- P Munck
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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91
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Yu Z, Guo X, Han S, Lu J, Sun Q. Erythropoietin for term and late preterm infants with hypoxic ischemic encephalopathy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zhangbin Yu
- Nanjing Maternal and Child Health Hospital of Nanjing Medical University; Department of Pediatrics, Section of Neonatology; No. 123 Tian Fei Xiang Mo Chou Road Nanjing China 210004
| | - Xirong Guo
- Nanjing Maternal and Child Health Hospital of Nanjing Medical University; Department of Pediatrics, Section of Neonatology; No. 123 Tian Fei Xiang Mo Chou Road Nanjing China 210004
| | - Shuping Han
- Nanjing Maternal and Child Health Hospital of Nanjing Medical University; Department of Pediatrics, Section of Neonatology; No. 123 Tian Fei Xiang Mo Chou Road Nanjing China 210004
| | - Junjie Lu
- Nanjing Maternal and Child Health Hospital of Nanjing Medical University; Department of Pediatrics, Section of Neonatology; No. 123 Tian Fei Xiang Mo Chou Road Nanjing China 210004
| | - Qing Sun
- Nanjing Maternal and Child Health Hospital of Nanjing Medical University; Department of Pediatrics, Section of Neonatology; No. 123 Tian Fei Xiang Mo Chou Road Nanjing China 210004
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92
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DiPietro JA, Kivlighan KT, Costigan KA, Rubin SE, Shiffler DE, Henderson JL, Pillion JP. Prenatal antecedents of newborn neurological maturation. Child Dev 2010; 81:115-30. [PMID: 20331657 PMCID: PMC2846092 DOI: 10.1111/j.1467-8624.2009.01384.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fetal neurobehavioral development was modeled longitudinally using data collected at weekly intervals from 24 to 38 weeks gestation in a sample of 112 healthy pregnancies. Predictive associations between 3 measures of fetal neurobehavioral functioning and their developmental trajectories to neurological maturation in the first weeks after birth were examined. Prenatal measures included fetal heart rate (FHR) variability, fetal movement, and coupling between fetal motor activity and heart rate patterning; neonatal outcomes include a standard neurologic examination (n = 97) and brainstem auditory evoked potential (BAEP; n = 47). Optimality in newborn motor activity and reflexes was predicted by fetal motor activity, FHR variability, and somatic-cardiac coupling predicted BAEP parameters. Maternal pregnancy-specific psychological stress was associated with accelerated neurologic maturation.
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Affiliation(s)
- Janet A DiPietro
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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93
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de Vries LS, Cowan FM. Evolving understanding of hypoxic-ischemic encephalopathy in the term infant. Semin Pediatr Neurol 2009; 16:216-25. [PMID: 19945656 DOI: 10.1016/j.spen.2009.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our aim was to document changes in the evaluation and prognosis of term-born infants with neonatal encephalopathy of hypoxic-ischemic origin, with particular reference to our own experiences and influences, and to summarize the debate on causation and the relative importance of antenatal and perinatal factors. High quality neonatal cranial ultrasound and magnetic resonance imaging and spectroscopy have enabled the accurate early visualization of different patterns of hypoxic-ischemic brain injury and prediction of their associated outcomes. Long-term follow-up shows that cognitive and memory difficulties may follow even in children without motor deficits. The very early use of electrophysiologic methods has allowed broad prognostic categorization of infants when this is not possible from clinical assessment or imaging, providing a rationale for entry into intervention trials, such as therapeutic hypothermia. This work has also shown that most of these infants have evidence of acute hypoxic-ischemic brain injury that explains their symptoms and outcomes.
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Affiliation(s)
- Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, UMC, Utrecht, The Netherlands
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94
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Golin MO, Souza FISD, Sarni ROS. Avaliação neurológica pelo método Dubowitz em recém-nascidos prematuros com idade corrigida de termo comparada a de nascidos a termo. REVISTA PAULISTA DE PEDIATRIA 2009. [DOI: 10.1590/s0103-05822009000400009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Comparar a avaliação neurológica de recém-nascidos pré-termo em idade de termo com a de recém-nascidos a termo e verificar a presença de associação entre alterações na avaliação neurológica e características e intercorrências clínicas nos prematuros. MÉTODO: Estudo transversal de 60 nascidos a termo e 30 prematuros do Hospital Estadual Mário Covas, em Santo André (SP), avaliados pelo método Dubowitz. Os pontos de corte da pontuação total foram 30,5 e 26 para comparar recém-nascidos pré-termo e a termo, respectivamente. Os prematuros foram avaliados com idade correspondente ao termo, na 37ª semana, e os do grupo controle, 48 horas após o nascimento. Todos os neonatos foram avaliados pela mesma examinadora, entre as mamadas, nos estágios 4 e 5 de sono e vigília. Para análise estatística, utilizaram-se testes de associação. RESULTADOS: 90% dos nascidos pré-termo não atingiram a pontuação esperada para a idade de termo (p<0,0001), com alterações mais evidentes nas dimensões: tônus, tipo de tônus e movimentos. Dentre os prematuros, 57% não atingiram pontuação total igual ou superior a 26. A sepse neonatal foi a única intercorrência associada de maneira significante, com pontuações abaixo da normalidade em recém-nascidos pré-termo (p=0,009). CONCLUSÃO: Os recém-nascidos pré-termo avaliados com 37 semanas de idade corrigida, quando comparados aos nascidos a termo, apresentaram menor pontuação no exame neurológico e apenas a sepse se associou a alterações neurológicas.
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95
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Brown NC, Inder TE, Bear MJ, Hunt RW, Anderson PJ, Doyle LW. Neurobehavior at term and white and gray matter abnormalities in very preterm infants. J Pediatr 2009; 155:32-8, 38.e1. [PMID: 19394041 DOI: 10.1016/j.jpeds.2009.01.038] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 12/05/2008] [Accepted: 01/14/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between very preterm infant neurobehavior at term and concurrent magnetic resonance-defined cerebral abnormalities. STUDY DESIGN 168 very preterm infants (birth weight <1250 g or gestation <30 weeks) were examined at term with 2 standardized neurobehavioral assessments, the Revised Hammersmith Neonatal Neurological Examination and the Neonatal Intensive Care Unit Network Neurobehavioral Scale. The relationship between composite neurobehavioral scores and qualitative white and gray matter abnormalities on magnetic resonance imaging was determined. RESULTS Poorer neurobehavioral performance related to magnetic resonance-defined cerebral abnormalities. Composite neurobehavioral scores related to the total grade of white matter abnormality, and worse neurobehavior related most strongly to 2 components of this grade: white matter signal abnormalities and reduction in white matter volumes. Neurobehavior was not related to the total grade of gray matter abnormality. However, delayed gyral maturation, a component of the total gray matter grade, was related to poorer performance on both neurobehavioral scales. CONCLUSION Very preterm infant neurobehavior at term is related to concurrent cerebral abnormalities in both white and gray matter defined by qualitative magnetic resonance imaging.
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Affiliation(s)
- Nisha C Brown
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.
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96
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Amess P, McFerran C, Khan Y, Rabe H. Early prediction of neurological outcome by term neurological examination and cranial ultrasound in very preterm infants. Acta Paediatr 2009; 98:448-53. [PMID: 18976368 DOI: 10.1111/j.1651-2227.2008.01062.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To assess the value of term neurological examination and cranial ultrasound in the early prediction of neurological outcome at 12 months corrected age in a cohort of very preterm infants. METHODS A cohort of 102 preterm infants born at <32 weeks gestation or with a birth weight of <1500 g were assessed using the Hammersmith Term Neurological Examination. They underwent cranial ultrasound examinations according to local guidelines. The Hammersmith Infant Neurological Examination was performed at 12 months corrected age. Scores for the term examinations were compared with scores derived from healthy infants born at term and with scores from low-risk preterm infants at term equivalent age. Term neurological scores and cranial ultrasound findings were compared in the prediction of 12-month neurological outcome. RESULTS Seventy-eight (76.5%) preterm infants had suboptimal total neurological scores at term when compared to healthy infants born at term. However, most went on to have optimal neurological scores at 12 months corrected age. When our cohort was compared with low-risk preterm infants at term equivalent age only 14 (13.7%) scored outside the normal range. Neither system of scoring predicted neurological outcome at 12 months corrected age as reliably as cranial ultrasound (sensitivity 0.83, specificity 0.87). CONCLUSION Neurological examination of preterm babies at term may be unreliable in the prediction of neurological outcome at 12 months corrected age. For early prediction of neurological outcome cranial ultrasound examination was found to be more reliable.
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Affiliation(s)
- P Amess
- Department of Neonatology, Brighton and Sussex University Hospitals, Brighton, UK.
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97
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Koldewijn K, Wolf MJ, van Wassenaer A, Meijssen D, van Sonderen L, van Baar A, Beelen A, Nollet F, Kok J. The Infant Behavioral Assessment and Intervention Program for very low birth weight infants at 6 months corrected age. J Pediatr 2009; 154:33-38.e2. [PMID: 18783797 DOI: 10.1016/j.jpeds.2008.07.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 06/13/2008] [Accepted: 07/17/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether the Infant Behavioral Assessment and Intervention Program (IBAIP), designed to support and enhance infants' self-regulatory competence, improved developmental and neurobehavioral outcomes in very low birth weight (VLBW) infants. STUDY DESIGN We randomized 86 infants to 1 intervention before discharge and to 6 to 8 home interventions until 6 months corrected age, and 90 control infants received standard care. Developmental and behavioral outcomes were evaluated at 6 months corrected age with the Bayley Scales of Infant Development-II (BSID-II). Neurobehavioral functioning was evaluated with the Infant Behavioral Assessment (IBA) at baseline and at 6 months corrected age. RESULTS Despite randomization, some differences in neonatal characteristics were found between the intervention and control infants. After adjustment, intervention effects of 7.2 points (+/- standard error 3.1) on the Mental Developmental Index and 6.4 +/- 2.4 points on the Psychomotor Developmental Index favored the intervention infants. The Behavioral Rating Scale of the BSID-II (P = .000) and the IBA (more approach [P = .003] and less stress [P = .001] over time) also favored the intervention infants. CONCLUSIONS The IBAIP improved the mental, motor, and behavioral outcomes of VLBW infants at 6 months corrected age.
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Affiliation(s)
- Karen Koldewijn
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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98
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Jacobs SE, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cochrane Review: Cooling for newborns with hypoxic ischaemic encephalopathy. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/ebch.293] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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99
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Ricci D, Romeo DMM, Haataja L, van Haastert IC, Cesarini L, Maunu J, Pane M, Gallini F, Luciano R, Romagnoli C, de Vries LS, Cowan FM, Mercuri E. Neurological examination of preterm infants at term equivalent age. Early Hum Dev 2008; 84:751-61. [PMID: 18614301 DOI: 10.1016/j.earlhumdev.2008.05.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 05/02/2008] [Accepted: 05/08/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND We previously reported the neurological findings of the Dubowitz neonatal examination in a cohort of 157 low-risk preterms born between 25 and 33 weeks gestational age (GA) and examined at term equivalent age (TEA). Median and range of scores were wider than those found in term-born infants and preterms showed a different neurological behaviour in specific items. However, the cohort number was too small to draw any definitive conclusion about the distribution of findings. AIMS We provide normative data from a low-risk cohort of 380 preterm infants; we also assess the findings and their relationship to motor outcome in preterms with major cranial ultrasound (US) abnormality. STUDY DESIGN We assessed, at TEA, 380 low-risk preterms born <35 weeks gestation (range 25-34.9, median 29) with normal 2 year motor outcome and 85 preterm infants with major US abnormality. RESULTS At TEA low-risk preterms had less flexor limb tone, poorer head control but better visual following than term-born infants. For 28/34 of the neurological items the range and median scores were similar across gestational ages. In infants with major US lesions the range and median scores differed from low-risk preterms in 20/34 items; 40% of infants developing a diplegia and 80% developing a tetraplegia had >7 items outside the 90th centile; all infants with >12 items outside the 90th centile developed a tetraplegia. CONCLUSIONS We provide reference values for the neurological examination of low-risk preterms at TEA. In infants with major US abnormality the number of items outside the 90th centile was an indicator of outcome severity.
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Affiliation(s)
- Daniela Ricci
- Department of Paediatrics and Imaging Sciences, Hammersmith Campus, Imperial College, London, UK.
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100
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Robertson NJ, Nakakeeto M, Hagmann C, Cowan FM, Acolet D, Iwata O, Allen E, Elbourne D, Costello A, Jacobs I. Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial. Lancet 2008; 372:801-3. [PMID: 18774411 DOI: 10.1016/s0140-6736(08)61329-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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