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Multimodal Executive Function Measurement in Preschool Children Born Very Low Birth Weight and Full Term: Relationships Between Formal Lab-Based Measure Performance, Parent Report, and Naturalistic Observational Coding. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2017. [DOI: 10.1007/s40817-017-0047-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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52
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Inflammatory molecules and neurotrophic factors as biomarkers of neuropsychomotor development in preterm neonates: A Systematic Review. Int J Dev Neurosci 2017; 65:29-37. [PMID: 29051031 DOI: 10.1016/j.ijdevneu.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To provide a systematic review investigating the role of inflammatory molecules and neurotrophic factors as biomarkers of neuropsychomotor development in preterm neonates. DATA SOURCE Databases including PubMed, BIREME, and Scopus were systematically searched. Observational studies, as well as transversal, and cohort studies using human subjects published from 1990 to September 2017 were eligible for inclusion. Two authors independently identified eligible studies and analyzed their characteristics, quality, and accuracy in depth. DATA SYNTHESIS 11 eligible studies clearly investigated the association between peripheral inflammation and motor and/or cognitive development in preterm infants. However, the selected populations differed in relation to the events associated with prematurity and the risk factors to abnormal motor and/or cognitive development. These studies measured circulating levels of cytokines, chemokines, adhesion molecules, acute phase proteins, and growth factors. The most commonly analyzed proteins were IL-1β, IL-6, TNF, CCL5/RANTES, CXCL8/IL-8, IGFBP-1, and VEGF. In seven of the eligible studies, plasma levels of IL-6 correlated with development delay. Two studies reported correlation between CXCL8/IL-8 plasma levels with cognitive and motor delay. In one study, higher levels of MCP-1/CCL2 were associated with better cognitive and motor outcome. CONCLUSION There is preliminary evidence indicating that circulating inflammatory molecules are associated with motor and cognitive development in preterm neonates, even considering different populations.
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Arthursson PMSH, Thompson DK, Spencer-Smith M, Chen J, Silk T, Doyle LW, Anderson PJ. Atypical neuronal activation during a spatial working memory task in 13-year-old very preterm children. Hum Brain Mapp 2017; 38:6172-6184. [PMID: 28940977 DOI: 10.1002/hbm.23820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/22/2017] [Accepted: 09/10/2017] [Indexed: 11/07/2022] Open
Abstract
Children born very preterm (VP; <32 weeks' gestational age) are at risk for unfavorable outcomes in several cognitive domains, including spatial working memory (WM). The underlying neural basis of these cognitive impairments is poorly understood. We investigated differences in neuronal activation during spatial WM using a backward span (BS) task relative to a control (C) task in 45 VP children and 19 term-born controls aged 13 years. VP children showed significantly more activation in the bilateral superior frontal gyrus and significantly less activation in the left parahippocampal gyrus compared with controls. We further explored the distinct contributions of maintenance and manipulation processes of WM using forward span (FS)>C and BS > FS, respectively. There were no significant group differences in neuronal activation for FS > C. However, BS > FS revealed that VP children had significantly greater activation in the left middle frontal gyrus, in the left superior parietal gyrus and right cerebellar tonsil, and significantly less activation in the right precentral and postcentral gyrus and left insula compared with controls. Taken together these results suggest that VP children at 13 years of age show an atypical neuronal activation during spatial WM, specifically related to manipulation of spatial information in WM. It is unclear whether these findings reflect delayed maturation and/or recruitment of alternative neuronal networks as a result of neuroplasticity. Hum Brain Mapp 38:6172-6184, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pia-Maria S H Arthursson
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Megan Spencer-Smith
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, 3800, Australia
| | - Jian Chen
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Tim Silk
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, 3800, Australia
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Farajdokht F, Sadigh-Eteghad S, Dehghani R, Mohaddes G, Abedi L, Bughchechi R, Majdi A, Mahmoudi J. Very low birth weight is associated with brain structure abnormalities and cognitive function impairments: A systematic review. Brain Cogn 2017; 118:80-89. [PMID: 28802183 DOI: 10.1016/j.bandc.2017.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/20/2017] [Accepted: 07/03/2017] [Indexed: 01/08/2023]
Abstract
Very low birth weight (VLBW) children are at risk of structural brain abnormalities and neurocognitive deficits. Since survival rate of the very low birth weight infants has increased over the past decade, a better understanding of the long-term neurocognitive outcomes is needed. The present systematic review investigated the association between VLBW and cognitive function as well as brain structure. PubMed/Medline, Google Scholar, Scopus and Web of Science databases were searched up from January 2000 to January 2015. The study was restricted to the articles that were about VLBW and its association with cognitive function and brain structure. The initial search yielded 721 articles. There were 44 studies eligible for inclusion after applying the exclusion criteria: 24 follow-up, 14 cohort, and 6 longitudinal studies. Based on this systematic review, we suggest that VLBW is positively related to several cognitive problems and brain structure abnormalities. These findings provide evidence about the importance of early assessment of cognitive development and brain structure to identify at-risk children and provide their specific requirements as early as possible.
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Affiliation(s)
- Fereshteh Farajdokht
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Dehghani
- Department of Pharmacology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gisou Mohaddes
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Abedi
- Department of Statistic and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ramin Bughchechi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Majdi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Mahmoudi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
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Maternal dendrimer-based therapy for inflammation-induced preterm birth and perinatal brain injury. Sci Rep 2017; 7:6106. [PMID: 28733619 PMCID: PMC5522481 DOI: 10.1038/s41598-017-06113-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 06/08/2017] [Indexed: 01/06/2023] Open
Abstract
Preterm birth is a major risk factor for adverse neurological outcomes in ex-preterm children, including motor, cognitive, and behavioral disabilities. N-acetyl-L-cysteine therapy has been used in clinical studies; however, it requires doses that cause significant side effects. In this study, we explore the effect of low dose N-acetyl-L-cysteine therapy, delivered using a targeted, systemic, maternal, dendrimer nanoparticle (DNAC), in a mouse model of intrauterine inflammation. Our results demonstrated that intraperitoneal maternal DNAC administration significantly reduced the preterm birth rate and altered placental immune profile with decreased CD8+ T-cell infiltration. Furthermore, we demonstrated that DNAC improved neurobehavioral outcomes and reduced fetal neuroinflammation and long-term microglial activation in offspring. Our study is the first to provide evidence for the role of CD8+ T-cell in the maternal-fetal interface during inflammation and further support the efficacy of DNAC in preventing preterm birth and prematurity-related outcomes.
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56
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Ortega JA, Sirois CL, Memi F, Glidden N, Zecevic N. Oxygen Levels Regulate the Development of Human Cortical Radial Glia Cells. Cereb Cortex 2017; 27:3736-3751. [PMID: 27600849 PMCID: PMC6075453 DOI: 10.1093/cercor/bhw194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 12/17/2022] Open
Abstract
The oxygen (O2) concentration is a vital parameter for controlling the survival, proliferation, and differentiation of neural stem cells. A prenatal reduction of O2 levels (hypoxia) often leads to cognitive and behavioral defects, attributable to altered neural development. In this study, we analyzed the effects of O2 levels on human cortical progenitors, the radial glia cells (RGCs), during active neurogenesis, corresponding to the second trimester of gestation. Small changes in O2 levels profoundly affected RGC survival, proliferation, and differentiation. Physiological hypoxia (3% O2) promoted neurogenesis, whereas anoxia (<1% O2) and severe hypoxia (1% O2) arrested the differentiation of human RGCs, mainly by altering the generation of glutamatergic neurons. The in vitro activation of Wnt-β-catenin signaling rescued the proliferation and neuronal differentiation of RGCs subjected to anoxia. Pathologic hypoxia (≤1% O2) also exerted negative effects on gliogenesis, by decreasing the number of O4+ preoligodendrocytes and increasing the number of reactive astrocytes derived from cortical RGCs. O2-dependent alterations in glutamatergic neurogenesis and oligodendrogenesis can lead to significant changes in cortical circuitry formation. A better understanding of the cellular effects caused by changes in O2 levels during human cortical development is essential to elucidating the etiology of numerous neurodevelopmental disorders.
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Affiliation(s)
- J Alberto Ortega
- Department of Neuroscience, University of Connecticut Health, Farmington, CT 06030, USA
| | - Carissa L Sirois
- Department of Neuroscience, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Fani Memi
- Department of Neuroscience, University of Connecticut Health, Farmington, CT 06030, USA
| | - Nicole Glidden
- Department of Neuroscience, University of Connecticut Health, Farmington, CT 06030, USA
| | - Nada Zecevic
- Department of Neuroscience, University of Connecticut Health, Farmington, CT 06030, USA
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White matter alterations to cingulum and fornix following very preterm birth and their relationship with cognitive functions. Neuroimage 2017; 150:373-382. [PMID: 28216430 PMCID: PMC5405171 DOI: 10.1016/j.neuroimage.2017.02.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 11/12/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Very preterm birth (VPT; <32 weeks of gestation) has been associated with impairments in memory abilities and functional neuroanatomical brain alterations in medial temporal and fronto-parietal areas. Here we investigated the relationship between structural connectivity in memory-related tracts and various aspects of memory in VPT adults (mean age 19) who sustained differing degrees of perinatal brain injury (PBI), as assessed by neonatal cerebral ultrasound. We showed that the neurodevelopmental consequences of VPT birth persist into young adulthood and are associated with neonatal cranial ultrasound classification. At a cognitive level, VPT young adults showed impairments specific to effective organization of verbal information and visuospatial memory, whereas at an anatomical level they displayed reduced volume of memory-related tracts, the cingulum and the fornix, with greater alterations in those individuals who experienced high-grade PBI. When investigating the association between these tracts and memory scores, perseveration errors were associated with the volume of the fornix and dorsal cingulum (connecting medial frontal and parietal lobes). Visuospatial memory scores were associated with the volume of the ventral cingulum (connecting medial parietal and temporal lobes). These results suggest that structural connectivity alterations could underlie memory difficulties in preterm born individuals. Very preterm born adults exhibit memory and learning impairments. White matter tracts implicated in memory are altered following perinatal brain injury. Structural alterations to memory tracts may underlie specific memory impairments.
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Kashou NH, Dar IA, El-Mahdy MA, Pluto C, Smith M, Gulati IK, Lo W, Jadcherla SR. Brain Lesions among Orally Fed and Gastrostomy-Fed Dysphagic Preterm Infants: Can Routine Qualitative or Volumetric Quantitative Magnetic Resonance Imaging Predict Feeding Outcomes? Front Pediatr 2017; 5:73. [PMID: 28443270 PMCID: PMC5385332 DOI: 10.3389/fped.2017.00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/24/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The usefulness of qualitative or quantitative volumetric magnetic resonance imaging (MRI) in early detection of brain structural changes and prediction of adverse outcomes in neonatal illnesses warrants further investigation. Our aim was to correlate certain brain injuries and the brain volume of feeding-related cortical and subcortical regions with feeding method at discharge among preterm dysphagic infants. MATERIALS AND METHODS Using a retrospective observational study design, we examined MRI data among 43 (22 male; born at 31.5 ± 0.8 week gestation) infants who went home on oral feeding or gastrostomy feeding (G-tube). MRI scans were segmented, and volumes of brainstem, cerebellum, cerebrum, basal ganglia, thalamus, and vermis were quantified, and correlations were made with discharge feeding outcomes. Chi-squared tests were used to evaluate MRI findings vs. feeding outcomes. ANCOVA was performed on the regression model to measure the association of maturity and brain volume between groups. RESULTS Out of 43 infants, 44% were oral-fed and 56% were G-tube fed at hospital discharge (but not at time of the study). There was no relationship between qualitative brain lesions and feeding outcomes. Volumetric analysis revealed that cerebellum was greater (p < 0.05) in G-tube fed infants, whereas cerebrum volume was greater (p < 0.05) in oral-fed infants. Other brain regions did not show volumetric differences between groups. CONCLUSION This study concludes that neither qualitative nor quantitative volumetric MRI findings correlate with feeding outcomes. Understanding the complexity of swallowing and feeding difficulties in infants warrants a comprehensive and in-depth functional neurological assessment.
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Affiliation(s)
- Nasser H Kashou
- Wright State University, Image Analysis Lab, Dayton, OH, USA
| | - Irfaan A Dar
- Wright State University, Image Analysis Lab, Dayton, OH, USA.,Innovative Research Program in Neonatal and Infant Feeding Disorders, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Mohamed A El-Mahdy
- Innovative Research Program in Neonatal and Infant Feeding Disorders, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Pluto
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ish K Gulati
- Innovative Research Program in Neonatal and Infant Feeding Disorders, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Warren Lo
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sudarshan R Jadcherla
- Innovative Research Program in Neonatal and Infant Feeding Disorders, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Korpela S, Nyman A, Munck P, Ahtola A, Matomäki J, Korhonen T, Parkkola R, Haataja L. Working memory in very-low-birthweight children at the age of 11 years. Child Neuropsychol 2016; 24:338-353. [PMID: 27907284 DOI: 10.1080/09297049.2016.1260101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study is to investigate the working memory (WM) of very-low-birthweight (VLBW, ≤ 1500 g) children at the age of 11 years using Baddeley's WM model. A regional cohort of 95 VLBW children was assessed for the domains of the WM model (central executive [CE], visuospatial sketchpad [VS], and phonological loop [PL]) using subtests from the Working Memory Test Battery for Children (WMTB-C) and the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). VLBW children were categorized into three groups according to their degree of brain pathology (normal, minor, or major) in neonatal brain magnetic resonance imaging at the term age, and the WM performance was compared between groups to test norms. The structure of the WM model was studied by analyzing correlations among domains. Even VLBW children with normal cognitive development (general ability index ≥ 85) performed worse compared to the test norms (M = 100, SD = 15) on CE (M = 87.64, SD = 20.54, p < .001) and VS (M = 91.65, SD = 11.03, p < .001), but their performance on PL was above the norm (M = 110.79, SD = 13.79, p < .001). VLBW children with major brain pathology performed significantly worse on VS and PL compared to the other groups. The correlations among the WM domains of the VLBW children differ from earlier findings in normative populations. To conclude, the WM of the VLBW children in the study differ-especially in the CE and VS subtest scores-from the normative population irrespective of the degree of brain pathology and level of cognitive development.
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Affiliation(s)
- Satu Korpela
- a Department of Psychology , University of Turku , Finland.,b Helsinki University Hospital , Child Neurology , Finland
| | - Anna Nyman
- a Department of Psychology , University of Turku , Finland.,c Turku University Hospital , Child Neurology , Finland
| | - Petriina Munck
- a Department of Psychology , University of Turku , Finland.,c Turku University Hospital , Child Neurology , Finland
| | | | - Jaakko Matomäki
- d Clinical Research Center , Turku University Hospital , Finland
| | - Tapio Korhonen
- a Department of Psychology , University of Turku , Finland
| | - Riitta Parkkola
- e Department of Radiology, Turku PET Center , Turku University Hospital , Finland.,f Department of Medicine , University of Turku , Finland
| | - Leena Haataja
- b Helsinki University Hospital , Child Neurology , Finland.,g Department of Pediatric Neurology, Children's Hospital , University of Helsinki , Finland
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van de Weijer-Bergsma E, Wijnroks L, van Haastert IC, Boom J, Jongmans MJ. Does the development of executive functioning in infants born preterm benefit from maternal directiveness? Early Hum Dev 2016; 103:155-160. [PMID: 27689894 DOI: 10.1016/j.earlhumdev.2016.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Problems in early development of executive functioning may underlie the vulnerability and individual variability of infants born preterm for behavioral and learning problems. Parenting behaviors may aggravate or temper this increased risk for dysfunction. This study assessed how maternal parenting behaviors predict individual differences in early development of executive functioning in infants born preterm, and whether this varies with infant temperament, i.e., self-regulation. METHODS Participants were 76 infants born preterm (≤36weeks' gestation and <2500g birth weight) and their mothers. Maternal sensitive responsiveness and directiveness were observed during a mother-infant interaction situation at 7, 10 and 14months corrected age. At the same ages, executive functioning was measured using the A-not-B task. An infant self-regulation questionnaire (IBQ-R) was completed by mothers at 7months. RESULTS After controlling for perinatal risk factors, Multivariate Latent Growth Modeling showed that consistently higher levels of maternal directiveness predicted a stronger increase in A-not-B performance, which did not vary with infant self-regulation. No relationship between maternal sensitive responsiveness and development in A-not-B performance in infants born preterm was found. CONCLUSIONS These results suggest that preterm infants' early executive functioning development in the first year of life may benefit from a more and consistent directive approach by their mothers. These findings have important implications for early intervention programs aimed at facilitating preterm infants' development.
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Affiliation(s)
- Eva van de Weijer-Bergsma
- Utrecht University, Faculty of Social and Behavioral Sciences, Department of Pedagogical and Educational Sciences, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| | - Lex Wijnroks
- Utrecht University, Faculty of Social and Behavioral Sciences, Department of Pedagogical and Educational Sciences, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Ingrid C van Haastert
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Jan Boom
- Utrecht University, Faculty of Social and Behavioral Sciences, Department of Developmental Psychology, Utrecht, The Netherlands
| | - Marian J Jongmans
- Utrecht University, Faculty of Social and Behavioral Sciences, Department of Pedagogical and Educational Sciences, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
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Parikh NA. Advanced neuroimaging and its role in predicting neurodevelopmental outcomes in very preterm infants. Semin Perinatol 2016; 40:530-541. [PMID: 27863706 PMCID: PMC5951398 DOI: 10.1053/j.semperi.2016.09.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Up to 35% of very preterm infants survive with neurodevelopmental impairments (NDI) such as cognitive deficits, cerebral palsy, and attention deficit disorder. Advanced MRI quantitative tools such as brain morphometry, diffusion MRI, magnetic resonance spectroscopy, and functional MRI at term-equivalent age are ideally suited to improve current efforts to predict later development of disabilities. This would facilitate application of targeted early intervention therapies during the first few years of life when neuroplasticity is optimal. A systematic search and review identified 47 published studies of advanced MRI to predict NDI. Diffusion MRI and morphometry studies were the most commonly studied modalities. Despite several limitations, studies clearly showed that brain structural and metabolite biomarkers are promising independent predictors of NDI. Large representative multicenter studies are needed to validate these studies.
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Affiliation(s)
- Nehal A. Parikh
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Correspondence address: Cincinnati Children’s Hospital, Perinatal Institute, 3333 Burnet Ave., MLC 7009, Cincinnati, OH.
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Abstract
Executive function (EF) refers to the set of cognitive processes involved in the self-regulation of emotion and goal-directed behavior. These skills and the brain systems that support them develop throughout childhood and are frequently compromised in preterm children, even in those with broadly average global cognitive ability. Risks for deficits in EF in preterm children and attendant problems in learning and psychosocial functioning are higher in those with more extreme prematurity, neonatal complications, and related brain abnormalities. Associations of higher levels of EF with more supportive home and school environments suggest a potential for attenuating these risks, especially with early identification. Further research is needed to understand how deficits in EF evolve in preterm children, refine assessment methods, and develop interventions that either promote the development of EF in this population or help children to compensate for these weaknesses.
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Affiliation(s)
- H. Gerry Taylor
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Caron A.C. Clark
- Department of Education, University of Nebraska-Lincoln, Lincoln, NE, USA
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63
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Region-specific growth restriction of brain following preterm birth. Sci Rep 2016; 6:33995. [PMID: 27658730 PMCID: PMC5034268 DOI: 10.1038/srep33995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022] Open
Abstract
Regional brain sizes of very-preterm infants at term-equivalent age differ from those of term-born peers, which have been linked with later cognitive impairments. However, dependence of regional brain volume loss on gestational age has not been studied in detail. To investigate the spatial pattern of brain growth in neonates without destructive brain lesions, head MRI of 189 neonates with a wide range of gestational age (24–42 weeks gestation) was assessed using simple metrics measurements. Dependence of MRI findings on gestational age at birth (Agebirth) and the corrected age at MRI scan (AgeMRI) were assessed. The head circumference was positively correlated with AgeMRI, but not Agebirth. The bi-parietal width, deep grey matter area and the trans-cerebellar diameter were positively correlated with both Agebirth and AgeMRI. The callosal thickness (positive), atrial width of lateral ventricle (negative) and the inter-hemispheric distance (negative) were exclusively correlated with Agebirth. The callosal thickness and cerebral/cerebellar transverse diameters showed predominant dependence on Agebirth over AgeMRI, suggesting that brain growth after preterm-birth was considerably restricted or even became negligible compared with that in utero. Such growth restriction after preterm birth may extensively affect relatively more matured infants, considering the linear relationships observed between brain sizes and Agebirth.
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Aasen IE, Håberg AK, Olsen A, Brubakk AM, Evensen KAI, Sølsnes AE, Skranes J, Brunner JF. The relevance of the irrelevant: Attention and task-set adaptation in prematurely born adults. Clin Neurophysiol 2016; 127:3225-33. [PMID: 27522488 DOI: 10.1016/j.clinph.2016.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate attention and task-set adaptation in a preterm born very low birth weight (PT/VLBW) population by means of event-related potential components from an adapted cued go/no-go task. METHODS P3 components after target and non-target cues, as well as target, no-go and non-target imperative stimuli were compared in 30 PT/VLBW young adults and 33 term-born controls. Changes in P3 amplitudes as a function of time-on-task were also investigated. RESULTS The PT/VLBW group had larger P3 amplitudes to non-target cues and non-targets compared with controls. There were no significant group differences in the P3s to target or no-go stimuli. Moreover, the amplitude of the P3 to non-target cues and non-targets decreased significantly over time in the control group but not in the PT/VLBW group. CONCLUSIONS PT/VLBW young adults allocate more attention to behaviorally irrelevant information than term-born controls, and persist in attending to this information over time. SIGNIFICANCE This is the first study to investigate ERP components in an adult population born preterm with very low birth weight.
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Affiliation(s)
- Ida Emilia Aasen
- Department of Medical Imaging, St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway.
| | - Asta Kristine Håberg
- Department of Medical Imaging, St. Olavs Hospital, Trondheim University Hospital, Norway; Department of Neuroscience, NTNU, Trondheim, Norway
| | - Alexander Olsen
- MI Lab and Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Ann-Mari Brubakk
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Trondheim, Norway; Department of Public Health and General Practice, NTNU, Trondheim, Norway; Department of Physiotherapy, Trondheim Municipality, Norway
| | - Anne Elisabeth Sølsnes
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Trondheim, Norway
| | - Jon Skranes
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Trondheim, Norway; Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - Jan Ferenc Brunner
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway; Department of Neuroscience, NTNU, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Norway
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Cheong JLY, Thompson DK, Spittle AJ, Potter CR, Walsh JM, Burnett AC, Lee KJ, Chen J, Beare R, Matthews LG, Hunt RW, Anderson PJ, Doyle LW. Brain Volumes at Term-Equivalent Age Are Associated with 2-Year Neurodevelopment in Moderate and Late Preterm Children. J Pediatr 2016; 174:91-97.e1. [PMID: 27174146 DOI: 10.1016/j.jpeds.2016.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/02/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the association between brain maturation, injury, and volumes at term-equivalent age with 2-year development in moderate and late preterm children. STUDY DESIGN Moderate and late preterm infants were recruited at birth and assessed at age 2 years using the Bayley Scales of Infant and Toddler Development, Third Edition. Brain magnetic resonance imaging (MRI) was performed at term-equivalent age and qualitatively assessed for brain maturation (myelination of the posterior limb of the internal capsule and gyral folding) and injury. Brain volumes were measured using advanced segmentation techniques. The associations between brain MRI measures with developmental outcomes were explored using linear regression analyses. RESULTS A total of 197 children underwent MRI and assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Larger total brain tissue volumes were associated with higher cognitive and language scores (adjusted coefficients per 10% increase in brain size; 95% CI of 3.2 [0.4, 5.6] and 5.6 [2.4, 8.8], respectively). Similar relationships were documented for white matter volumes with cognitive and language scores, multiple cerebral structures with language scores, and cerebellar volumes with motor scores. Larger cerebellar volumes were independently associated with better language and motor scores, after adjustment for other perinatal factors. There was little evidence of relationships between myelination of the posterior limb of the internal capsule, gyral folding, or injury with 2-year development. CONCLUSIONS Larger total brain tissue, white matter, and cerebellar volumes at term-equivalent age are associated with better neurodevelopment in moderate and late preterm children. Brain volumes may be an important marker for neurodevelopmental deficits described in moderate and late preterm children.
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Affiliation(s)
- Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Parkville, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Alicia J Spittle
- Neonatal Services, Royal Women's Hospital, Parkville, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Cody R Potter
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jennifer M Walsh
- Neonatal Services, Royal Women's Hospital, Parkville, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Pediatric, Infant, Perinatal Emergency Retrieval, Royal Children's Hospital, Melbourne, Australia
| | - Alice C Burnett
- Neonatal Services, Royal Women's Hospital, Parkville, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Department of Medicine, Monash Medical Center, Monash University, Melbourne, Australia
| | - Richard Beare
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Department of Medicine, Monash Medical Center, Monash University, Melbourne, Australia
| | - Lillian G Matthews
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Rod W Hunt
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Parkville, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
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Very Early Brain Damage Leads to Remodeling of the Working Memory System in Adulthood: A Combined fMRI/Tractography Study. J Neurosci 2016; 35:15787-99. [PMID: 26631462 DOI: 10.1523/jneurosci.4769-14.2015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The human brain can adapt to overcome injury even years after an initial insult. One hypothesis states that early brain injury survivors, by taking advantage of critical periods of high plasticity during childhood, should recover more successfully than those who suffer injury later in life. This hypothesis has been challenged by recent studies showing worse cognitive outcome in individuals with early brain injury, compared with individuals with later brain injury, with working memory particularly affected. We invited individuals who suffered perinatal brain injury (PBI) for an fMRI/diffusion MRI tractography study of working memory and hypothesized that, 30 years after the initial injury, working memory deficits in the PBI group would remain, despite compensatory activation in areas outside the typical working memory network. Furthermore we hypothesized that the amount of functional reorganization would be related to the level of injury to the dorsal cingulum tract, which connects medial frontal and parietal working memory structures. We found that adults who suffered PBI did not significantly differ from controls in working memory performance. They exhibited less activation in classic frontoparietal working memory areas and a relative overactivation of bilateral perisylvian cortex compared with controls. Structurally, the dorsal cingulum volume and hindrance-modulated orientational anisotropy was significantly reduced in the PBI group. Furthermore there was uniquely in the PBI group a significant negative correlation between the volume of this tract and activation in the bilateral perisylvian cortex and a positive correlation between this activation and task performance. This provides the first evidence of compensatory plasticity of the working memory network following PBI.
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Gaudet CM, Lim YP, Stonestreet BS, Threlkeld SW. Effects of age, experience and inter-alpha inhibitor proteins on working memory and neuronal plasticity after neonatal hypoxia-ischemia. Behav Brain Res 2016; 302:88-99. [PMID: 26778784 DOI: 10.1016/j.bbr.2016.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 01/15/2023]
Abstract
Neonatal cerebral hypoxia-ischemia (HI) commonly results in cognitive and sensory impairments. Early behavioral experience has been suggested to improve cognitive and sensory outcomes in children and animal models with perinatal neuropathology. In parallel, we previously showed that treatment with immunomodulator Inter-alpha Inhibitor Proteins (IAIPs) improves cellular and behavioral outcomes in neonatal HI injured rats. The purpose of the current study was to evaluate the influences of early experience and typical maturation in combination with IAIPs treatment on spatial working and reference memory after neonatal HI injury. A second aim was to determine the effects of these variables on hippocampal CA1 neuronal morphology. Subjects were divided into two groups that differed with respect to the time when exposed to eight arm radial water maze testing: Group one was tested as juveniles (early experience, Postnatal day (P) 36-61) and adults (P88-113), and Group two was tested in adulthood only (P88-113; without early experience). Three treatment conditions were included in each experience group (HI+Vehicle, HI+IAIPs, and Sham subjects). Incorrect arm entries (errors) were compared between treatment and experience groups across three error types (reference memory (RM), working memory incorrect (WMI), working memory correct (WMC)). Early experience led to improved working memory performance regardless of treatment. Combining IAIPs intervention with early experience provided a long-term behavioral advantage on the WMI component of the task in HI animals. Anatomically, early experience led to a decrease in the average number of basal dendrites per CA1 pyramidal neuron for IAIP treated subjects and a significant reduction in basal dendritic length in control subjects, highlighting the importance of pruning in typical early life learning. Our results support the hypothesis that early behavioral experience combined with IAIPs improve outcome on a relativity demanding cognitive task, beyond that of a single intervention strategy, and appears to facilitate neuronal plasticity following neonatal brain injury.
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Affiliation(s)
- Cynthia M Gaudet
- Department of Biology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA
| | - Yow-Pin Lim
- ProThera Biologics, Inc., 349 Eddy Street, Providence, RI 02903, USA
| | - Barbara S Stonestreet
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
| | - Steven W Threlkeld
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave. Providence, RI 02904, USA.
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van der Burg JW, Sen S, Chomitz VR, Seidell JC, Leviton A, Dammann O. The role of systemic inflammation linking maternal BMI to neurodevelopment in children. Pediatr Res 2016; 79:3-12. [PMID: 26375474 PMCID: PMC4888781 DOI: 10.1038/pr.2015.179] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/01/2015] [Indexed: 11/09/2022]
Abstract
Children of obese mothers are at increased risk of developmental adversities. Maternal obesity is linked to an inflammatory in utero environment, which, in turn, is associated with neurodevelopmental impairments in the offspring. This is an integrated mechanism review of animal and human literature related to the hypothesis that maternal obesity causes maternal and fetal inflammation, and that this inflammation adversely affects the neurodevelopment of children. We propose integrative models in which several aspects of inflammation are considered along the causative pathway linking maternal obesity with neurodevelopmental limitations.
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Affiliation(s)
- Jelske W. van der Burg
- Department of Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sarbattama Sen
- Department of Pediatrics and Mother Infant Research Institute, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, USA
- Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Virginia R. Chomitz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jaap C. Seidell
- Department of Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Alan Leviton
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Perinatal Epidemiology Unit, Hannover Medical School, Hannover, Germany
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Gopagondanahalli KR, Li J, Fahey MC, Hunt RW, Jenkin G, Miller SL, Malhotra A. Preterm Hypoxic-Ischemic Encephalopathy. Front Pediatr 2016; 4:114. [PMID: 27812521 PMCID: PMC5071348 DOI: 10.3389/fped.2016.00114] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is a recognizable and defined clinical syndrome in term infants that results from a severe or prolonged hypoxic-ischemic episode before or during birth. However, in the preterm infant, defining hypoxic-ischemic injury (HII), its clinical course, monitoring, and outcomes remains complex. Few studies examine preterm HIE, and these are heterogeneous, with variable inclusion criteria and outcomes reported. We examine the available evidence that implies that the incidence of hypoxic-ischemic insult in preterm infants is probably higher than recognized and follows a more complex clinical course, with higher rates of adverse neurological outcomes, compared to term infants. This review aims to elucidate the causes and consequences of preterm hypoxia-ischemia, the subsequent clinical encephalopathy syndrome, diagnostic tools, and outcomes. Finally, we suggest a uniform definition for preterm HIE that may help in identifying infants most at risk of adverse outcomes and amenable to neuroprotective therapies.
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Affiliation(s)
| | - Jingang Li
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia
| | - Michael C Fahey
- Monash Children's Hospital, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rod W Hunt
- The Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Atul Malhotra
- Monash Children's Hospital, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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Shin SH, Kim EK, Yoo H, Choi YH, Kim S, Lee BK, Jung YH, Kim HY, Kim HS, Choi JH. Surgical Necrotizing Enterocolitis versus Spontaneous Intestinal Perforation in White Matter Injury on Brain Magnetic Resonance Imaging. Neonatology 2016; 110:148-54. [PMID: 27105356 DOI: 10.1159/000444387] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND White matter injury (WMI) is the most common form of brain injury in preterm infants. It could be induced by a systemic inflammatory response in preterm infants. OBJECTIVES We hypothesized that surgical necrotizing enterocolitis (surgNEC) results in more severe WMI than spontaneous intestinal perforation (SIP) on brain magnetic resonance imaging (MRI) at term-equivalent age (TEA). METHODS The medical records of 33 preterm infants born at less than 32 weeks of gestation who underwent surgery due to either NEC or SIP were reviewed retrospectively. White matter abnormality (WMA) on brain MRI was scored according to the diagnosis of surgNEC or SIP. RESULTS Nine patients were diagnosed with SIP and 24 with surgNEC. The median (range) gestational age of the SIP and surgNEC groups was 26+6 (23+3-27+6) and 25+5 weeks (23+3-31+2), respectively (p = 0.454). There were no differences in 1- and 5-min Apgar scores, mode of delivery, use of antenatal steroids, histologic chorioamnionitis, or incidence of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) between the two groups. Males were more prevalent in the surgNEC group (75.0 vs. 33.3%, p = 0.044), and the incidence of sepsis was higher in the surgNEC group than in the SIP group (75.0 vs. 33.3%, p = 0.044). Multivariate regression showed that the difference in WMA scores between the two groups remained significant (estimated difference = 2.418; 95% CI 0.107-4.729). CONCLUSION In preterm infants at less than 32 weeks of gestation, those with surgNEC showed more severe WMI than infants with SIP on brain MRI at TEA.
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Affiliation(s)
- Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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van Tilborg E, Heijnen CJ, Benders MJ, van Bel F, Fleiss B, Gressens P, Nijboer CH. Impaired oligodendrocyte maturation in preterm infants: Potential therapeutic targets. Prog Neurobiol 2015; 136:28-49. [PMID: 26655283 DOI: 10.1016/j.pneurobio.2015.11.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 12/20/2022]
Abstract
Preterm birth is an evolving challenge in neonatal health care. Despite declining mortality rates among extremely premature neonates, morbidity rates remain very high. Currently, perinatal diffuse white matter injury (WMI) is the most commonly observed type of brain injury in preterm infants and has become an important research area. Diffuse WMI is associated with impaired cognitive, sensory and psychological functioning and is increasingly being recognized as a risk factor for autism-spectrum disorders, ADHD, and other psychological disturbances. No treatment options are currently available for diffuse WMI and the underlying pathophysiological mechanisms are far from being completely understood. Preterm birth is associated with maternal inflammation, perinatal infections and disrupted oxygen supply which can affect the cerebral microenvironment by causing activation of microglia, astrogliosis, excitotoxicity, and oxidative stress. This intricate interplay of events negatively influences oligodendrocyte development, causing arrested oligodendrocyte maturation or oligodendrocyte cell death, which ultimately results in myelination failure in the developing white matter. This review discusses the current state in perinatal WMI research, ranging from a clinical perspective to basic molecular pathophysiology. The complex regulation of oligodendrocyte development in healthy and pathological conditions is described, with a specific focus on signaling cascades that may play a role in WMI. Furthermore, emerging concepts in the field of WMI and issues regarding currently available animal models are put forward. Novel insights into the molecular mechanisms underlying impeded oligodendrocyte maturation in diffuse WMI may aid the development of novel treatment options which are desperately needed to improve the quality-of-life of preterm neonates.
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Affiliation(s)
- Erik van Tilborg
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cobi J Heijnen
- Laboratory of Neuroimmunology, Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Manon J Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bobbi Fleiss
- Inserm, Paris U1141, France; Université Paris Diderot, Sorbonne Paris Cité, UMRS, Paris 1141, France; Centre for the Developing Brain, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Pierre Gressens
- Inserm, Paris U1141, France; Université Paris Diderot, Sorbonne Paris Cité, UMRS, Paris 1141, France; Centre for the Developing Brain, Department of Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Cora H Nijboer
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands.
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Domnick NK, Gretenkord S, De Feo V, Sedlacik J, Brockmann MD, Hanganu-Opatz IL. Neonatal hypoxia–ischemia impairs juvenile recognition memory by disrupting the maturation of prefrontal–hippocampal networks. Exp Neurol 2015; 273:202-14. [DOI: 10.1016/j.expneurol.2015.08.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 11/28/2022]
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Parikh NA, Kennedy KA, Lasky RE, Tyson JE. Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone. PLoS One 2015; 10:e0137051. [PMID: 26376074 PMCID: PMC4573756 DOI: 10.1371/journal.pone.0137051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/11/2015] [Indexed: 12/17/2022] Open
Abstract
Objective To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants. Study Design We recruited 64 extremely low birth weight (birth weight ≤1000g) infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18–22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth. Results Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68%) died or survived with impairment compared with 22 of the 29 infants (76%) assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14). The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42). Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications. Conclusions In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18–22 months. These results may inform the design and conduct of future clinical trials. Trial Registration ClinicalTrials.gov NCT00167544
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Affiliation(s)
- Nehal A. Parikh
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, United States of America
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, United States of America
- * E-mail:
| | - Kathleen A. Kennedy
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, United States of America
| | - Robert E. Lasky
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, United States of America
| | - Jon E. Tyson
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, United States of America
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Boltze J, Arnold A, Walczak P, Jolkkonen J, Cui L, Wagner DC. The Dark Side of the Force - Constraints and Complications of Cell Therapies for Stroke. Front Neurol 2015; 6:155. [PMID: 26257702 PMCID: PMC4507146 DOI: 10.3389/fneur.2015.00155] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/23/2015] [Indexed: 12/16/2022] Open
Abstract
Cell therapies are increasingly recognized as a promising option to augment the limited therapeutic arsenal available to fight ischemic stroke. During the last two decades, cumulating preclinical evidence has indicated a substantial efficacy for most cell treatment paradigms and first clinical trials are currently underway to assess safety and feasibility in patients. However, the strong and still unmet demand for novel stroke treatment options and exciting findings reported from experimental studies may have drawn our attention away from potential side effects related to cell therapies and the ways by which they are commonly applied. This review summarizes common and less frequent adverse events that have been discovered in preclinical and clinical investigations assessing cell therapies for stroke. Such adverse events range from immunological and neoplastic complications over seizures to cell clotting and cell-induced embolism. It also describes potential complications of clinically applicable administration procedures, detrimental interactions between therapeutic cells, and the pathophysiological environment that they are placed into, as well as problems related to cell manufacturing. Virtually each therapeutic intervention comes at a certain risk for complications. Side effects do therefore not generally compromise the value of cell treatments for stroke, but underestimating such complications might severely limit therapeutic safety and efficacy of cell treatment protocols currently under development. On the other hand, a better understanding will provide opportunities to further improve existing therapeutic strategies and might help to define those circumstances, under which an optimal effect can be realized. Hence, the review eventually discusses strategies and recommendations allowing us to prevent or at least balance potential complications in order to ensure the maximum therapeutic benefit at minimum risk for stroke patients.
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Affiliation(s)
- Johannes Boltze
- Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology , Leipzig , Germany ; Translational Center for Regenerative Medicine, University of Leipzig , Leipzig , Germany
| | - Antje Arnold
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Institute for Cell Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Piotr Walczak
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Institute for Cell Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Jukka Jolkkonen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Lili Cui
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Daniel-Christoph Wagner
- Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology , Leipzig , Germany
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Janowski M, Wagner DC, Boltze J. Stem Cell-Based Tissue Replacement After Stroke: Factual Necessity or Notorious Fiction? Stroke 2015; 46:2354-63. [PMID: 26106118 DOI: 10.1161/strokeaha.114.007803] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/28/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Miroslaw Janowski
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research (M.J.) and Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering (M.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; NeuroRepair Department (M.J.) and Department of Neurosurgery (M.J.), Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology, Translational Centre for Regenerative Medicine, Leipzig, Germany (D.-C.W., J.B.); and Stroke and Neurovascular Regulation Laboratory, Neuroscience Center at Massachussets General Hospital, Harvard Medical School, Stroke and Neurovascular Regulation Laboratory, Charlestown, MA (J.B.)
| | - Daniel-Christoph Wagner
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research (M.J.) and Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering (M.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; NeuroRepair Department (M.J.) and Department of Neurosurgery (M.J.), Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology, Translational Centre for Regenerative Medicine, Leipzig, Germany (D.-C.W., J.B.); and Stroke and Neurovascular Regulation Laboratory, Neuroscience Center at Massachussets General Hospital, Harvard Medical School, Stroke and Neurovascular Regulation Laboratory, Charlestown, MA (J.B.)
| | - Johannes Boltze
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research (M.J.) and Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering (M.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; NeuroRepair Department (M.J.) and Department of Neurosurgery (M.J.), Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Cell Therapy, Fraunhofer-Institute for Cell Therapy and Immunology, Translational Centre for Regenerative Medicine, Leipzig, Germany (D.-C.W., J.B.); and Stroke and Neurovascular Regulation Laboratory, Neuroscience Center at Massachussets General Hospital, Harvard Medical School, Stroke and Neurovascular Regulation Laboratory, Charlestown, MA (J.B.).
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Duvall SW, Erickson SJ, MacLean P, Lowe JR. Perinatal medical variables predict executive function within a sample of preschoolers born very low birth weight. J Child Neurol 2015; 30:735-40. [PMID: 25117418 PMCID: PMC4326618 DOI: 10.1177/0883073814542945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
The goal was to identify perinatal predictors of early executive dysfunction in preschoolers born very low birth weight. Fifty-seven preschoolers completed 3 executive function tasks: Dimensional Change Card Sort-Separated (inhibition, working memory, and cognitive flexibility), Bear Dragon (inhibition and working memory), and Gift Delay Open (inhibition). Relationships between executive function and perinatal medical severity factors (gestational age, days on ventilation, size for gestational age, maternal steroids, and number of surgeries) and chronological age were investigated by multiple linear regression and logistic regression. Different perinatal medical severity factors were predictive of executive function tasks, with gestational age predicting Bear Dragon and Gift Open; and number of surgeries and maternal steroids predicting performance on Dimensional Change Card Sort-Separated. By understanding the relationship between perinatal medical severity factors and preschool executive outcomes, we can identify children at highest risk for future executive dysfunction, thereby focusing targeted early intervention services.
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Affiliation(s)
- Susanne W Duvall
- Oregon Health & Science University, Institute on Development & Disability, Portland, OR, USA
| | - Sarah J Erickson
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Peggy MacLean
- UNM HSC School of Medicine Center for Development and Disability, Albuquerque, NM, USA
| | - Jean R Lowe
- Department of Pediatrics, Division of Neonatology, University of New Mexico, Albuquerque, NM, USA
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77
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Anderson PJ, Cheong JLY, Thompson DK. The predictive validity of neonatal MRI for neurodevelopmental outcome in very preterm children. Semin Perinatol 2015; 39:147-58. [PMID: 25724792 DOI: 10.1053/j.semperi.2015.01.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Very preterm children are at a high risk for neurodevelopmental impairments, but there is variability in the pattern and severity of outcome. Neonatal magnetic resonance imaging (MRI) enhances the capacity to detect brain injury and altered brain development and assists in the prediction of high-risk children who warrant surveillance and early intervention. This review describes the application of conventional and advanced MRI with very preterm neonates, specifically focusing on the relationship between neonatal MRI findings and later neurodevelopmental outcome. Research demonstrates that conventional MRI is strongly associated with neurodevelopmental outcome in childhood. Further studies are needed to examine the role of advanced MRI techniques in predicting outcome in very preterm children, but early research findings are promising. In conclusion, neonatal MRI is predictive of later neurodevelopment but is dependent on appropriately trained specialists and should be interpreted in conjunction with other clinical and social information.
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Affiliation(s)
- Peter J Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Neonatal Services, Royal Women׳s Hospital, Melbourne, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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78
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Kim J, Choi IY, Dong Y, Wang WT, Brooks WM, Weiner CP, Lee P. Chronic fetal hypoxia affects axonal maturation in guinea pigs during development: A longitudinal diffusion tensor imaging and T2 mapping study. J Magn Reson Imaging 2014; 42:658-65. [PMID: 25504885 DOI: 10.1002/jmri.24825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/01/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the impact of chronic hypoxia on neonatal brains, and follow developmental alterations and adaptations noninvasively in a guinea pig model. Chronic hypoxemia is the prime cause of fetal brain injury and long-term sequelae such as neurodevelopmental compromise, seizures, and cerebral palsy. MATERIALS AND METHODS Thirty guinea pigs underwent either normoxic and hypoxemic conditions during the critical stage of brain development (0.7 gestation) and studied prenatally (n = 16) or perinatally (n = 14). Fourteen newborns (7 hypoxia and 7 normoxia group) were scanned longitudinally to characterize physiological and morphological alterations, and axonal myelination and injury using in vivo diffusion tensor imaging (DTI), T2 mapping, and T2 -weighted magnetic resonance imaging (MRI). Sixteen fetuses (8 hypoxia and 8 normoxia) were studied ex vivo to assess hypoxia-induced neuronal injury/loss using Nissl staining and quantitative reverse transcriptase polymerase chain reaction methods. RESULTS Developmental brains in the hypoxia group showed lower fractional anisotropy in the corpus callosum (-12%, P = 0.02) and lower T2 values in the hippocampus (-16%, P = 0.003) compared with the normoxia group with no differences in the cortex (P > 0.07), indicating vulnerability of the hippocampus and cerebral white matter during early development. Fetal guinea pig brains with chronic hypoxia demonstrated an over 10-fold increase in expression levels of hypoxia index genes such as erythropoietin and HIF-1α, and an over 40% reduction in neuronal density, confirming prenatal brain damage. CONCLUSION In vivo MRI measurement, such as DTI and T2 mapping, provides quantitative parameters to characterize neurodevelopmental abnormalities and to monitor the impact of prenatal insult on the postnatal brain maturation of guinea pigs.
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Affiliation(s)
- Jieun Kim
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - In-Young Choi
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USA.,The Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yafeng Dong
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Center for the Developmental Origins of Adult Health and Disease, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Wen-Tung Wang
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - William M Brooks
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carl P Weiner
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Center for the Developmental Origins of Adult Health and Disease, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Phil Lee
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USA
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79
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Kalpakidou AK, Allin MPG, Walshe M, Giampietro V, McGuire PK, Rifkin L, Murray RM, Nosarti C. Functional neuroanatomy of executive function after neonatal brain injury in adults who were born very preterm. PLoS One 2014; 9:e113975. [PMID: 25438043 PMCID: PMC4250191 DOI: 10.1371/journal.pone.0113975] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
Individuals who were born very preterm (VPT; <33 gestational weeks) are at risk of experiencing deficits in tasks involving executive function in childhood and beyond. In addition, the type and severity of neonatal brain injury associated with very preterm birth may exert differential effects on executive functioning by altering its neuroanatomical substrates. Here we addressed this question by investigating with functional magnetic resonance imaging (fMRI) the haemodynamic response during executive-type processing using a phonological verbal fluency and a working memory task in VPT-born young adults who had experienced differing degrees of neonatal brain injury. 12 VPT individuals with a history of periventricular haemorrhage and ventricular dilatation (PVH+VD), 17 VPT individuals with a history of uncomplicated periventricular haemorrhage (UPVH), 13 VPT individuals with no history of neonatal brain injury and 17 controls received an MRI scan whilst completing a verbal fluency task with two cognitive loads (‘easy’ and ‘hard’ letters). Two groups of VPT individuals (PVH+VD; n = 10, UPVH; n = 8) performed an n-back task with three cognitive loads (1-, 2-, 3-back). Results demonstrated that VPT individuals displayed hyperactivation in frontal, temporal, and parietal cortices and in caudate nucleus, insula and thalamus compared to controls, as demands of the verbal fluency task increased, regardless of type of neonatal brain injury. On the other hand, during the n-back task and as working memory load increased, the PVH+VD group showed less engagement of the frontal cortex than the UPVH group. In conclusion, this study suggests that the functional neuroanatomy of different executive-type processes is altered following VPT birth and that neural activation associated with specific aspects of executive function (i.e., working memory) may be particularly sensitive to the extent of neonatal brain injury.
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Affiliation(s)
- Anastasia K. Kalpakidou
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
- * E-mail:
| | - Matthew P. G. Allin
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Muriel Walshe
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Philip K. McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Larry Rifkin
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
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80
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Cimadevilla JM, Roldán L, París M, Arnedo M, Roldán S. Spatial learning in a virtual reality-based task is altered in very preterm children. J Clin Exp Neuropsychol 2014; 36:1002-8. [DOI: 10.1080/13803395.2014.963520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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81
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Memory function and hippocampal volumes in preterm born very-low-birth-weight (VLBW) young adults. Neuroimage 2014; 105:76-83. [PMID: 25451477 DOI: 10.1016/j.neuroimage.2014.10.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 10/05/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022] Open
Abstract
The hippocampi are regarded as core structures for learning and memory functions, which is important for daily functioning and educational achievements. Previous studies have linked reduction in hippocampal volume to working memory problems in very low birth weight (VLBW; ≤ 1500 g) children and reduced general cognitive ability in VLBW adolescents. However, the relationship between memory function and hippocampal volume has not been described in VLBW subjects reaching adulthood. The aim of the study was to investigate memory function and hippocampal volume in VLBW young adults, both in relation to perinatal risk factors and compared to term born controls, and to look for structure-function relationships. Using Wechsler Memory Scale-III and MRI, we included 42 non-disabled VLBW and 61 control individuals at age 19-20 years, and related our findings to perinatal risk factors in the VLBW-group. The VLBW young adults achieved lower scores on several subtests of the Wechsler Memory Scale-III, resulting in lower results in the immediate memory indices (visual and auditory), the working memory index, and in the visual delayed and general memory delayed indices, but not in the auditory delayed and auditory recognition delayed indices. The VLBW group had smaller absolute and relative hippocampal volumes than the controls. In the VLBW group inferior memory function, especially for the working memory index, was related to smaller hippocampal volume, and both correlated with lower birth weight and more days in the neonatal intensive care unit (NICU). Our results may indicate a structural-functional relationship in the VLBW group due to aberrant hippocampal development and functioning after preterm birth.
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82
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Kim DJ, Davis EP, Sandman CA, Sporns O, O'Donnell BF, Buss C, Hetrick WP. Longer gestation is associated with more efficient brain networks in preadolescent children. Neuroimage 2014; 100:619-27. [PMID: 24983711 PMCID: PMC4138264 DOI: 10.1016/j.neuroimage.2014.06.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/09/2014] [Accepted: 06/22/2014] [Indexed: 12/21/2022] Open
Abstract
Neurodevelopmental benefits of increased gestation have not been fully characterized in terms of network organization. Since brain function can be understood as an integrated network of neural information from distributed brain regions, investigation of the effects of gestational length on network properties is a critical goal of human developmental neuroscience. Using diffusion tensor imaging and fiber tractography, we investigated the effects of gestational length on the small-world attributes and rich club organization of 147 preadolescent children, whose gestational length ranged from 29 to 42 weeks. Higher network efficiency was positively associated with longer gestation. The longer gestation was correlated with increased local efficiency in the posterior medial cortex, including the precuneus, cuneus, and superior parietal regions. Rich club organization was also observed indicating the existence of highly interconnected structural hubs formed in preadolescent children. Connectivity among rich club members and from rich club regions was positively associated with the length of gestation, indicating the higher level of topological benefits of structural connectivity from longer gestation in the predominant regions of brain networks. The findings provide evidence that longer gestation is associated with improved topological organization of the preadolescent brain, characterized by the increased communication capacity of the brain network and enhanced directional strength of brain connectivity with central hub regions.
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Affiliation(s)
- Dae-Jin Kim
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO 80208, USA; Department of Psychiatry and Human Behavior, University of California Irvine, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California Irvine, USA
| | - Olaf Sporns
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, USA
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, USA
| | - Claudia Buss
- Institut für Medizinische Psychologie, Charité Centrum für Human-und Gesundheitswissenschaften, Charité Universitätsmedizin, Berlin, Germany
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN 47405, USA.
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83
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Clark CAC, Woodward LJ. Relation of perinatal risk and early parenting to executive control at the transition to school. Dev Sci 2014; 18:525-42. [PMID: 25288501 DOI: 10.1111/desc.12232] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 06/27/2014] [Indexed: 11/27/2022]
Abstract
Executive control (EC) develops rapidly during the preschool years and is central to academic achievement and functional outcome. Although children with perinatal adversity are at known risk for EC impairments, little is known about the underlying nature of these impairments or the mechanisms that contribute to their development over time. Drawing on a cohort of 110 high-risk children born very preterm (VPT; < 33 weeks / < 1500 g) and 113 healthy full-term children, this study examined the implications of perinatal adversity and early parenting for children's EC as they transitioned to formal schooling. Parent supportive presence, intrusiveness, and parent-child synchrony were observed during a series of problem-solving tasks at ages 2 and 4 years. At age 6, children completed a comprehensive battery of EC tasks. Academic outcomes were assessed at age 9. The VPT group showed global EC impairments at age 6, although the unitary factor that best characterized the structure of EC was the same in both groups. High-risk dyads were characterized by more intrusive and less synchronous parent-child interactions in early childhood, which in turn predicted poorer child EC at age 6. EC partially mediated the relation of risk status to poorer academic achievement at age 9. Findings demonstrate the cumulative effects of perinatal adversity on children's EC in the crucial transition to schooling. They also highlight the importance of the parent-child relationship as a target for intervention efforts to help mitigate these effects.
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Affiliation(s)
- Caron A C Clark
- Department of Psychology and Prevention Science Institute, University of Oregon, USA
| | - Lianne J Woodward
- Departments of Pediatric Newborn Medicine, Brigham & Women's Hospital, Harvard Medical School, USA.,Department of Psychology, University of Canterbury, Christchurch, New Zealand
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84
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Lowe J, Erickson SJ, MacLean P, Duvall SW, Ohls RK, Duncan AF. Associations between maternal scaffolding and executive functioning in 3 and 4 year olds born very low birth weight and normal birth weight. Early Hum Dev 2014; 90:587-93. [PMID: 25127288 PMCID: PMC4170051 DOI: 10.1016/j.earlhumdev.2014.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers. AIMS The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW. SUBJECTS A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study. OUTCOME MEASURES VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence - Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions. STUDY DESIGN Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender. RESULTS Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon. CONCLUSION Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.
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Affiliation(s)
- Jean Lowe
- University of New Mexico, School of Medicine, Albuquerque, NM, USA.
| | - Sarah J Erickson
- University of New Mexico, Department of Psychology, Albuquerque, NM, USA
| | - Peggy MacLean
- University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Susanne W Duvall
- Oregon Health & Science University, Division of Psychology, Institute on Development & Disability, Portland, OR, USA
| | - Robin K Ohls
- University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Andrea F Duncan
- University of New Mexico, School of Medicine, Albuquerque, NM, USA
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85
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Stålnacke J, Lundequist A, Böhm B, Forssberg H, Smedler AC. Individual cognitive patterns and developmental trajectories after preterm birth. Child Neuropsychol 2014; 21:648-67. [PMID: 25265400 DOI: 10.1080/09297049.2014.958071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cognitive outcome after preterm birth is heterogeneous, and group level analyses may disguise individual variability in development. Using a person-oriented approach, this study investigated individual cognitive patterns and developmental trajectories from preschool age to late adolescence. As part of a prospective longitudinal study, 118 adolescents born preterm, with a birth weight < 1,500 g, participated in neuropsychological assessments at age 5½ years and at 18 years. At each age, four cognitive indices, two tapping general ability and two tapping executive functions, were formed to reflect each individual's cognitive profile. Cluster analyses were performed at each age separately, and individual movements between clusters across time were investigated. At both 5½ and 18 years, six distinct, and similar, cognitive patterns were identified. Executive functions were a weakness for some but not all subgroups, and verbal ability was a strength primarily among those whose overall performance fell within the normal range. Overall, cognitive ability at 5½ years was highly predictive of ability at age 18. Those who performed at low levels at 5½ years did not catch up but rather deteriorated in relative performance. Over half of the individuals who performed above the norm at 5½ years improved their relative performance by age 18. Among those performing around the norm at 5½ years, half improved their relative performance over time, whereas the other half faced increased problems, indicating a need for further developmental monitoring. Perinatal factors were not conclusively related to outcome, stressing the need for cognitive follow-up assessment of the preterm-born child before school entry.
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86
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Cui H, Han W, Yang L, Chang Y. Expression of hypoxia-inducible factor 1 alpha and oligodendrocyte lineage gene-1 in cultured brain slices after oxygen-glucose deprivation. Neural Regen Res 2014; 8:328-37. [PMID: 25206673 PMCID: PMC4107529 DOI: 10.3969/j.issn.1673-5374.2013.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/09/2013] [Indexed: 02/03/2023] Open
Abstract
Oligodendrocyte lineage gene-1 expressed in oligodendrocytes may trigger the repair of neuronal myelin impairment, and play a crucial role in myelin repair. Hypoxia-inducible factor 1α, a transcription factor, is of great significance in premature infants with hypoxic-ischemic brain damage. There is little evidence of direct regulatory effects of hypoxia-inducible factor 1α on oligodendrocyte lineage gene-1. In this study, brain slices of Sprague-Dawley rats were cultured and subjected to oxygen-glucose deprivation. Then, slices were transfected with hypoxia-inducible factor 1α or oligodendrocyte lineage gene-1. The expression levels of hypoxia-inducible factor 1α and oligodendrocyte lineage gene-1 were significantly up-regulated in rat brains prior to transfection, as detected by immunohistochemical staining. Eight hours after transfection of slices with hypoxia-inducible factor 1α, oligodendrocyte lineage gene-1 expression was upregulated, and reached a peak 24 hours after transfection. Oligodendrocyte lineage gene-1 transfection induced no significant differences in hypoxia-inducible factor 1α levels in rat brain tissues with oxygen-glucose deprivation. These experimental findings indicate that hypoxia-inducible factor 1α can regulate oligodendrocyte lineage gene-1 expression in hypoxic brain tissue, thus repairing the neural impairment.
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Affiliation(s)
- Hong Cui
- College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, China ; Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Weijuan Han
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lijun Yang
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yanzhong Chang
- College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, China
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87
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Thompson DK, Omizzolo C, Adamson C, Lee KJ, Stargatt R, Egan GF, Doyle LW, Inder TE, Anderson PJ. Longitudinal growth and morphology of the hippocampus through childhood: Impact of prematurity and implications for memory and learning. Hum Brain Mapp 2014; 35:4129-39. [PMID: 24523026 PMCID: PMC5516043 DOI: 10.1002/hbm.22464] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/06/2013] [Accepted: 01/07/2013] [Indexed: 11/08/2022] Open
Abstract
The effects of prematurity on hippocampal development through early childhood are largely unknown. The aims of this study were to (1) compare the shape of the very preterm (VPT) hippocampus to that of full-term (FT) children at 7 years of age, and determine if hippocampal shape is associated with memory and learning impairment in VPT children, (2) compare change in shape and volume of the hippocampi from term-equivalent to 7 years of age between VPT and FT children, and determine if development of the hippocampi over time predicts memory and learning impairment in VPT children. T1 and T2 magnetic resonance images were acquired at both term equivalent and 7 years of age in 125 VPT and 25 FT children. Hippocampi were manually segmented and shape was characterized by boundary point distribution models at both time-points. Memory and learning outcomes were measured at 7 years of age. The VPT group demonstrated less hippocampal infolding than the FT group at 7 years. Hippocampal growth between infancy and 7 years was less in the VPT compared with the FT group, but the change in shape was similar between groups. There was little evidence that the measures of hippocampal development were related to memory and learning impairments in the VPT group. This study suggests that the developmental trajectory of the human hippocampus is altered in VPT children, but this does not predict memory and learning impairment. Further research is required to elucidate the mechanisms for memory and learning difficulties in VPT children.
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Affiliation(s)
- Deanne K Thompson
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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88
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Threlkeld SW, Gaudet CM, La Rue ME, Dugas E, Hill CA, Lim YP, Stonestreet BS. Effects of inter-alpha inhibitor proteins on neonatal brain injury: Age, task and treatment dependent neurobehavioral outcomes. Exp Neurol 2014; 261:424-33. [PMID: 25084519 DOI: 10.1016/j.expneurol.2014.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/10/2014] [Accepted: 07/20/2014] [Indexed: 12/18/2022]
Abstract
Hypoxic-ischemic (HI) brain injury is frequently associated with premature and/or full term birth related complications. HI injury often results in learning and processing deficits that reflect widespread damage to an extensive range of cortical and sub-cortical brain structures. Further, inflammation has been implicated in the long-term progression and severity of HI injury. Recently, inter-alpha inhibitor proteins (IAIPs) have been shown to attenuate inflammation in models of systemic infection. Importantly, preclinical studies of neonatal HI injury and neuroprotection often focus on single time windows of assessment or single behavioral domains. This approach limits translational validity, given evidence for a diverse spectrum of neurobehavioral deficits that may change across developmental windows following neonatal brain injury. Therefore, the aims of this research were to assess the effects of human IAIPs on early neocortical cell death (72h post-insult), adult regional brain volume measurements (cerebral cortex, hippocampus, striatum, corpus callosum) and long-term behavioral outcomes in juvenile (P38-50) and adult (P80+) periods across two independent learning domains (spatial and non-spatial learning), after postnatal day 7 HI injury in rats. Here, for the first time, we show that IAIPs reduce acute neocortical neuronal cell death and improve brain weight outcome 72h following HI injury in the neonatal rat. Further, these longitudinal studies are the first to show age, task and treatment dependent improvements in behavioral outcome for both spatial and non-spatial learning following systemic administration of IAIPs in neonatal HI injured rats. Finally, results also show sparing of brain regions critical for spatial and non-spatial learning in adult animals treated with IAIPs at the time of injury onset. These data support the proposal that inter-alpha inhibitor proteins may serve as novel therapeutics for brain injury associated with premature birth and/or neonatal brain injury and highlight the importance of assessing multiple ages, brain regions and behavioral domains when investigating experimental treatment efficacy.
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Affiliation(s)
- Steven W Threlkeld
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA.
| | - Cynthia M Gaudet
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA
| | - Molly E La Rue
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
| | - Ethan Dugas
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA
| | - Courtney A Hill
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
| | - Yow-Pin Lim
- ProThera Biologics, Inc., East Providence, RI 02914, USA
| | - Barbara S Stonestreet
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
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89
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Murray AL, Scratch SE, Thompson DK, Inder TE, Doyle LW, Anderson JFI, Anderson PJ. Neonatal brain pathology predicts adverse attention and processing speed outcomes in very preterm and/or very low birth weight children. Neuropsychology 2014; 28:552-62. [PMID: 24708047 PMCID: PMC4106799 DOI: 10.1037/neu0000071] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study aimed to examine attention and processing speed outcomes in very preterm (VPT; < 32 weeks' gestational age) or very low birth weight (VLBW; < 1,500 g) children, and to determine whether brain abnormality measured by neonatal MRI can be used to predict outcome in these domains. METHOD A cohort of 198 children born < 30 weeks' gestational age and/or < 1,250 g and 70 term controls were examined. Neonatal MRI scans at term equivalent age were quantitatively assessed for white matter, cortical gray matter, deep gray matter, and cerebellar abnormalities. Attention and processing speed were assessed at 7 years using standardized neuropsychological tests. Group differences were tested in attention and processing speed, and the relationships between these cognitive domains and brain abnormalities at birth were investigated. RESULTS At 7 years of age, the VPT/VLBW group performed significantly poorer than term controls on all attention and processing speed outcomes. Associations between adverse attention and processing speed performances at 7 years and higher neonatal brain abnormality scores were found; in particular, white matter and deep gray matter abnormalities were reasonable predictors of long-term cognitive outcomes. CONCLUSION Attention and processing speed are significant areas of concern in VPT/VLBW children. This is the first study to show that adverse attention and processing speed outcomes at 7 years are associated with neonatal brain pathology.
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90
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Bora S, Pritchard VE, Chen Z, Inder TE, Woodward LJ. Neonatal cerebral morphometry and later risk of persistent inattention/hyperactivity in children born very preterm. J Child Psychol Psychiatry 2014; 55:828-38. [PMID: 24438003 PMCID: PMC4065623 DOI: 10.1111/jcpp.12200] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention problems are among the most prevalent neurobehavioral morbidities affecting very preterm (VPT) born children. The first study aim was to document rates of persistent attention/hyperactivity problems from ages 4 to 9 years in a regional cohort of VPT born children. The second aim was to examine the extent to which persistent problems were related to cerebral white matter abnormality and structural development on neonatal MRI. METHODS Data were drawn from a prospective longitudinal study of 110 VPT (≤32 weeks gestation) and 113 full-term (FT) children born from 1998 to 2000. At term equivalent, all VPT and 10 FT children underwent cerebral structural MRI, with scans analyzed qualitatively for white matter abnormalities and quantitatively for cortical and subcortical gray matter, myelinated and unmyelinated white matter, and cerebrospinal fluid volumes. At ages 4, 6, and 9 years, each child's parent and teacher completed the Inattention/Hyperactivity subscale of the Strengths and Difficulties Questionnaire. RESULTS VPT born children had a fivefold increased risk of persistent attention/hyperactivity problems compared with FT children (13.1% vs. 2.8%; p = .002). No association was found between neonatal white matter abnormalities and later persistent inattention/hyperactivity risk (p ≥ .24). In contrast, measures of cerebral structural development including volumetric estimates of total cerebral tissue and cerebrospinal fluid relative to intracranial volume were associated with an increased risk of persistent attention/hyperactivity problems in VPT born children (p = .001). The dorsal prefrontal region showed the largest volumetric reduction (↓3.2-8.2 mL). These brain-behavior associations persisted and in some cases, strengthened after covariate adjustment for postmenstrual age at MRI, gender, and family socioeconomic status. CONCLUSIONS Just over one in 10 VPT born children are subject to early onset and persistent attention/hyperactivity problems during childhood. These problems appear to reflect, at least in part, neonatal disturbances in cerebral growth and development rather than the effects of white matter injury.
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Affiliation(s)
- Samudragupta Bora
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Verena E. Pritchard
- Department of Psychology, Aberystwyth University, Aberystwyth, Ceredigion, Wales, UK
| | - Zhe Chen
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lianne J. Woodward
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA,Department of Psychology, University of Canterbury, Christchurch, New Zealand
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91
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Abstract
Children born prematurely at very low birth weight (<1500 g) are at increased risk for impairments affecting social functioning, including autism spectrum disorders (e.g., Johnson et al., 2010). In the current study, we used the Happé-Frith animated triangles task (Abell, Happé, & Frith, 2000) to study social attribution skills in this population. In this task, typical viewers attribute intentionality and mental states to shapes, based on characteristics of their movements. Participants included 34 preterm children and 36 full-term controls, aged 8-11 years. Groups were comparable in terms of age at test, gender, handedness, and socioeconomic status; they also performed similarly on tests of selective attention/processing speed and verbal intelligence. Relative to full-term peers, preterm children's descriptions of the animations were less appropriate overall; they also overattributed intentionality/mental states to randomly moving shapes and underattributed intentionality/mental states to shapes that seemed to be interacting socially. Impairments in the ability to infer the putative mental states of triangles from movement cues alone were most evident in children displaying more "autistic-like" traits, and this may reflect atypical development of and/or functioning in, or atypical connections between, parts of the social brain.
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92
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Ohls RK, Kamath-Rayne BD, Christensen RD, Wiedmeier SE, Rosenberg A, Fuller J, Lacy CB, Roohi M, Lambert DK, Burnett JJ, Pruckler B, Peceny H, Cannon DC, Lowe JR. Cognitive outcomes of preterm infants randomized to darbepoetin, erythropoietin, or placebo. Pediatrics 2014; 133:1023-30. [PMID: 24819566 PMCID: PMC4531269 DOI: 10.1542/peds.2013-4307] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We previously reported decreased transfusions and donor exposures in preterm infants randomized to Darbepoetin (Darbe) or erythropoietin (Epo) compared with placebo. As these erythropoiesis-stimulating agents (ESAs) have shown promise as neuroprotective agents, we hypothesized improved neurodevelopmental outcomes at 18 to 22 months among infants randomized to receive ESAs. METHODS We performed a randomized, masked, multicenter study comparing Darbe (10 μg/kg, 1×/week subcutaneously), Epo (400 U/kg, 3×/week subcutaneously), and placebo (sham dosing 3×/week) given through 35 weeks' postconceptual age, with transfusions administered according to a standardized protocol. Surviving infants were evaluated at 18 to 22 months' corrected age using the Bayley Scales of Infant Development III. The primary outcome was composite cognitive score. Assessments of object permanence, anthropometrics, cerebral palsy, vision, and hearing were performed. RESULTS Of the original 102 infants (946 ± 196 g, 27.7 ± 1.8 weeks' gestation), 80 (29 Epo, 27 Darbe, 24 placebo) returned for follow-up. The 3 groups were comparable for age at testing, birth weight, and gestational age. After adjustment for gender, analysis of covariance revealed significantly higher cognitive scores among Darbe (96.2 ± 7.3; mean ± SD) and Epo recipients (97.9 ± 14.3) compared with placebo recipients (88.7 ± 13.5; P = .01 vs ESA recipients) as was object permanence (P = .05). No ESA recipients had cerebral palsy, compared with 5 in the placebo group (P < .001). No differences among groups were found in visual or hearing impairment. CONCLUSIONS Infants randomized to receive ESAs had better cognitive outcomes, compared with placebo recipients, at 18 to 22 months. Darbe and Epo may prove beneficial in improving long-term cognitive outcomes of preterm infants.
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Affiliation(s)
- Robin K. Ohls
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | | | | | | | - Adam Rosenberg
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | | | - Mahshid Roohi
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | | | | | - Barbara Pruckler
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Hannah Peceny
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Daniel C. Cannon
- Department of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Jean R. Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
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93
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Loe IM, Chatav M, Alduncin N. Complementary assessments of executive function in preterm and full-term preschoolers. Child Neuropsychol 2014; 21:331-53. [PMID: 24754400 DOI: 10.1080/09297049.2014.906568] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Executive functions (EFs) are interrelated cognitive processes that have been studied in relation to behavior, attention, academic achievement, and developmental disorders. Studies of EF skills assessed through parent report and performance-based measures show correlations between them ranging from none to modest. Few studies have examined the relationship between EF skills measured through parent report and performance-based measures in relation to adaptive function. The present study included preschool children born preterm as a population at high risk for EF impairments. Preschool children (N = 149) completed a battery of EF tasks that assess working memory, response inhibition, idea generation, and attention shifting or cognitive flexibility. Parents reported on children's EF and adaptive skills. Preterm children showed more parent-rated and performance-based EF impairments than did full-term children. The combined use of either parent report or performance-based measures resulted in the identification of a large number of children at risk for EF impairment, especially in the preterm group. Both parent report and performance-based EF measures were associated with children's adaptive function. EF skills are measurable in young child'ren, and we suggest that EF skills may serve as targets for intervention to improve functional outcomes. We recommend the use of both parent report and performance-based measures to characterize children's EF profiles and to customize treatment.
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Affiliation(s)
- Irene M Loe
- a Division of Neonatal and Developmental Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
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94
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Abstract
Magnetic resonance imaging (MRI) is a safe and high-resolution neuroimaging modality that is increasingly used in the neonatal population to assess brain injury and its consequences on brain development. It is superior to cranial ultrasound for the definition of patterns of both white and gray matter maturation and injury and therefore has the potential to provide prognostic information on the neurodevelopmental outcomes of the preterm population. Furthermore, the development of sophisticated MRI strategies, including diffusion tensor imaging, resting state functional connectivity, and magnetic resonance spectroscopy, may increase the prognostic value, helping to guide parental counseling and allocate early intervention services.
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95
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Visuospatial working memory in very preterm and term born children--impact of age and performance. Dev Cogn Neurosci 2014; 9:106-16. [PMID: 24631800 PMCID: PMC6989762 DOI: 10.1016/j.dcn.2014.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/06/2014] [Accepted: 02/11/2014] [Indexed: 11/20/2022] Open
Abstract
41 preterms performed equally to 36 controls on a visuospatial working memory task. Preterms showed different involvement of frontal areas compared to controls. Young and low-performing preterms recruited an atypical working memory network. Older and high-performing preterms recruited a typical network similar to controls. Findings point toward the use of compensational mechanisms in preterms.
Working memory is crucial for meeting the challenges of daily life and performing academic tasks, such as reading or arithmetic. Very preterm born children are at risk of low working memory capacity. The aim of this study was to examine the visuospatial working memory network of school-aged preterm children and to determine the effect of age and performance on the neural working memory network. Working memory was assessed in 41 very preterm born children and 36 term born controls (aged 7–12 years) using functional magnetic resonance imaging (fMRI) and neuropsychological assessment. While preterm children and controls showed equal working memory performance, preterm children showed less involvement of the right middle frontal gyrus, but higher fMRI activation in superior frontal regions than controls. The younger and low-performing preterm children presented an atypical working memory network whereas the older high-performing preterm children recruited a working memory network similar to the controls. Results suggest that younger and low-performing preterm children show signs of less neural efficiency in frontal brain areas. With increasing age and performance, compensational mechanisms seem to occur, so that in preterm children, the typical visuospatial working memory network is established by the age of 12 years.
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96
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Brockmann MD, Kukovic M, Schönfeld M, Sedlacik J, Hanganu-Opatz IL. Hypoxia-ischemia disrupts directed interactions within neonatal prefrontal-hippocampal networks. PLoS One 2013; 8:e83074. [PMID: 24376636 PMCID: PMC3869754 DOI: 10.1371/journal.pone.0083074] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/07/2013] [Indexed: 02/04/2023] Open
Abstract
Due to improved survival rates and outcome of human infants experiencing a hypoxic-ischemic episode, cognitive dysfunctions have become prominent. They might result from abnormal communication within prefrontal-hippocampal networks, as synchrony and directed interactions between the prefrontal cortex and hippocampus account for mnemonic and executive performance. Here, we elucidate the structural and functional impact of hypoxic-ischemic events on developing prefrontal-hippocampal networks in an immature rat model of injury. The magnitude of infarction, cell loss and astrogliosis revealed that an early hypoxic-ischemic episode had either a severe or a mild/moderate outcome. Without affecting the gross morphology, hypoxia-ischemia with mild/moderate outcome diminished prefrontal neuronal firing and gamma network entrainment. This dysfunction resulted from decreased coupling synchrony within prefrontal-hippocampal networks and disruption of hippocampal theta drive. Thus, early hypoxia-ischemia may alter the functional maturation of neuronal networks involved in cognitive processing by disturbing the communication between the neonatal prefrontal cortex and hippocampus.
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Affiliation(s)
- Marco D. Brockmann
- Developmental Neurophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Kukovic
- Developmental Neurophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schönfeld
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ileana L. Hanganu-Opatz
- Developmental Neurophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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97
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Lowe JR, Duncan AF, Bann CM, Fuller J, Hintz SR, Das A, Higgins RD, Watterberg KL. Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months. Early Hum Dev 2013; 89:1055-61. [PMID: 23993309 PMCID: PMC3830714 DOI: 10.1016/j.earlhumdev.2013.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/07/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Difficulties with executive function have been found in preterm children, resulting in difficulties with learning and school performance. AIM This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. STUDY DESIGN Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. SUBJECTS Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. OUTCOME MEASURES Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. RESULTS There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. CONCLUSIONS Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children.
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Affiliation(s)
- Jean R Lowe
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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98
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Omizzolo C, Thompson DK, Scratch SE, Stargatt R, Lee KJ, Cheong J, Roberts G, Doyle LW, Anderson PJ. Hippocampal volume and memory and learning outcomes at 7 years in children born very preterm. J Int Neuropsychol Soc 2013; 19:1065-75. [PMID: 23947431 PMCID: PMC3964592 DOI: 10.1017/s1355617713000891] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Using magnetic resonance imaging, this study compared hippocampal volume between 145 very preterm children and 34 children born full-term at 7 years of age. The relationship between hippocampal volume and memory and learning impairments at 7 years was also investigated. Manual hippocampal segmentation and subsequent three-dimensional volumetric analysis revealed reduced hippocampal volumes in very preterm children compared with term peers. However, this relationship did not remain after correcting for whole brain volume and neonatal brain abnormality. Contrary to expectations, hippocampal volume in the very preterm cohort was not related to memory and learning outcomes. Further research investigating the effects of very preterm birth on more extensive networks in the brain that support memory and learning in middle childhood is needed.
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Affiliation(s)
- Cristina Omizzolo
- 1 Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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99
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Understanding neurodevelopmental outcomes of prematurity: education priorities for NICU parents. Adv Neonatal Care 2013; 13 Suppl 5:S21-6. [PMID: 24042181 DOI: 10.1097/anc.0000000000000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
NICU nurses have an important role to play in many aspects of parent education. This article stresses the need for an increased focus on teaching parents about the central role that self-regulation will play in their infant's neurobehavioral development not only during the early infancy period but throughout all of childhood and adolescence. Suggestions are made about how to conceptualize the relation between cognition and emotions in humans and how to help parents understand that continued vigilance concerning potential problems in attention and self-regulation will be necessary.
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100
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Jantzie LL, Talos DM, Jackson MC, Park HK, Graham DA, Lechpammer M, Folkerth RD, Volpe JJ, Jensen FE. Developmental expression of N-methyl-D-aspartate (NMDA) receptor subunits in human white and gray matter: potential mechanism of increased vulnerability in the immature brain. ACTA ACUST UNITED AC 2013; 25:482-95. [PMID: 24046081 DOI: 10.1093/cercor/bht246] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The pathophysiology of perinatal brain injury is multifactorial and involves hypoxia-ischemia (HI) and inflammation. N-methyl-d-aspartate receptors (NMDAR) are present on neurons and glia in immature rodents, and NMDAR antagonists are protective in HI models. To enhance clinical translation of rodent data, we examined protein expression of 6 NMDAR subunits in postmortem human brains without injury from 20 postconceptional weeks through adulthood and in cases of periventricular leukomalacia (PVL). We hypothesized that the developing brain is intrinsically vulnerable to excitotoxicity via maturation-specific NMDAR levels and subunit composition. In normal white matter, NR1 and NR2B levels were highest in the preterm period compared with adult. In gray matter, NR2A and NR3A expression were highest near term. NR2A was significantly elevated in PVL white matter, with reduced NR1 and NR3A in gray matter compared with uninjured controls. These data suggest increased NMDAR-mediated vulnerability during early brain development due to an overall upregulation of individual receptors subunits, in particular, the presence of highly calcium permeable NR2B-containing and magnesium-insensitive NR3A NMDARs. These data improve understanding of molecular diversity and heterogeneity of NMDAR subunit expression in human brain development and supports an intrinsic prenatal vulnerability to glutamate-mediated injury; validating NMDAR subunit-specific targeted therapies for PVL.
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Affiliation(s)
- Lauren L Jantzie
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA
| | - Delia M Talos
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA Current address: Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michele C Jackson
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA
| | - Hyun-Kyung Park
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA
| | - Dionne A Graham
- Harvard Medical School, Boston, MA 02115, USA Clinical Research Center
| | - Mirna Lechpammer
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA Department of Pathology (Neuropathology), Boston Children's Hospital, Boston, MA 02115, USA
| | - Rebecca D Folkerth
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA Department of Pathology (Neuropathology), Boston Children's Hospital, Boston, MA 02115, USA
| | - Joseph J Volpe
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA
| | - Frances E Jensen
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA Harvard Medical School, Boston, MA 02115, USA Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA Current address: Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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