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Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Maturation of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3 Years. J Pediatr 2018; 196:91-97.e1. [PMID: 29398063 DOI: 10.1016/j.jpeds.2017.12.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/21/2017] [Accepted: 12/15/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate whether the number of postnatal infections is associated with abnormal white matter maturation and poorer motor neurodevelopmental outcomes at 36 months of corrected age. STUDY DESIGN A prospective longitudinal cohort study was undertaken of 219 newborns born preterm at 24-32 weeks of gestational age recruited between 2006 and 2013 with magnetic resonance imaging of the brain both early in life and at term-equivalent age. Postnatal infection was defined as any clinical infection or positive culture ≥72 hours after birth. White matter maturation was assessed by magnetic resonance spectroscopic imaging, magnetic resonance diffusion tensor imaging, and tract-based spatial statistics. Neurodevelopmental outcomes were assessed in 175 (82% of survivors) infants with Bayley Scales of Infant and Toddler Development-III composite scores and Peabody Developmental Motor Scales at 35 months of corrected age (IQR 34-37 months). Infection groups were compared via the Fisher exact test, Kruskal-Wallis test, and generalized estimating equations. RESULTS Of 219 neonates born preterm (median gestational age 27.9 weeks), 109 (50%) had no postnatal infection, 83 (38%) had 1 or 2 infections, and 27 (12%) had ≥3 infections. Infants with postnatal infections had more cerebellar hemorrhage. Infants with ≥3 infections had lower N-acetylaspartate/choline in the white matter and basal ganglia regions, lower fractional anisotropy in the posterior limb of the internal capsule, and poorer maturation of the corpus callosum, optic radiations, and posterior limb of the internal capsule on tract-based spatial statistics analysis as well as poorer Bayley Scales of Infant and Toddler Development-III (P = .02) and Peabody Developmental Motor Scales, Second Edition, motor scores (P < .01). CONCLUSIONS In newborns born preterm, ≥3 postnatal infections predict impaired development of the motor pathways and poorer motor outcomes in early childhood.
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102
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Qi Y, Liu P, Lin Z, Lu H, Wang X. Hemodynamic and Metabolic Assessment of Neonates With Punctate White Matter Lesions Using Phase-Contrast MRI and T2-Relaxation-Under-Spin-Tagging (TRUST) MRI. Front Physiol 2018; 9:233. [PMID: 29615927 PMCID: PMC5868490 DOI: 10.3389/fphys.2018.00233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
The brain's hemodynamic and metabolism of punctate white matter lesions (PWML) is poorly understood due to a scarcity of non-invasive imaging techniques. The aim of this study was to apply new MRI techniques to quantify cerebral metabolic rate of oxygen (CMRO2), global cerebral blood flow (CBF), oxygen saturation fractions in venous blood (Yv) and oxygen extraction fraction (OEF) in neonates with PWML, for better understanding of the pathophysiology of PWML. Fifty-one newborns were recruited continuously, including 23 neonatal patients with PWML and 28 normal control neonates. Phase-contrast (PC) MRI and T2-Relaxation-Under-Spin-Tagging (TRUST) MRI were performed for the measurement of CBF and Yv. OEF and CMRO2 were calculated from the CBF and Yv values. The total maturation score (TMS) was assessed for each neonate on standard T1, 2-weighted images to evaluate cerebral maturation. The CMRO2, CBF, Yv, and OEF values were compared between groups, and their associations with age and TMS were evaluated. Significant differences between PWML group and control group were found in CMRO2 (P = 0.020), CBF (P = 0.027), Yv (P = 0.012), OEF (P = 0.018). After age/maturation is accounted for, Yv and OEF showed significant dependence on the groups (P < 0.05). Newborns with PWML had lower OEF and higher Yv. CMRO2, CBF and brain volume were correlated with age (P < 0.001) and TMS (P < 0.05). It is feasible to use non-invasive MRI methods to measure cerebral oxygen supply and consumption in neonates with PWML. Newborns with PWML have lower oxygen consumption. Yv and OEF may be helpful for the diagnosis of PWML. The positive correlation between CBF and TMS, and between CMRO2 and TMS suggested that as myelination progresses, the blood supply and oxygen metabolism in the brain increase to meet the escalating energy demand.
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Affiliation(s)
- Ying Qi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zixuan Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xiaoming Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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103
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Ku JK, Heo YJ, Lee KS, Lee BL. Clinical Findings and Neurologic Outcome in Neonatal Encephalopathy With White Matter Injury Accompanied by Rotavirus. J Child Neurol 2018; 33:297-305. [PMID: 29433417 DOI: 10.1177/0883073817753290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to elucidate the clinical characteristics and neurodevelopmental outcomes in neonatal encephalopathy with characteristic white matter injury as compared with other injury patterns on magnetic resonance diffusion-weighted imaging. We conducted a retrospective study comparing clinical and laboratory findings, and neurologic outcomes between 17 newborns with diffuse lesions in the periventricular white matter and white matter tract (group I) and 22 newborns with other patterns (group II). Stool samples indicated that 16 neonates (94.1%) in group I were rotavirus-positive, whereas none in group II had rotavirus infection. Significantly lower calcium levels were found in group I than in group II ( P < .001). Moreover, a more favorable neurodevelopmental outcome was observed in group I than in group II. This study suggests that characteristic white matter injury in neonatal encephalopathy may be related to decreased calcium levels induced by rotavirus, and may have a better neurodevelopmental prognosis than other causes.
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Affiliation(s)
- Jae Kyun Ku
- 1 Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Young Jin Heo
- 2 Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Keun Soo Lee
- 3 Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Bo Lyun Lee
- 1 Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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104
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Heo JS, Kim EK, Choi YH, Shin SH, Sohn JA, Cheon JE, Kim HS. Timing of sepsis is an important risk factor for white matter abnormality in extremely premature infants with sepsis. Pediatr Neonatol 2018; 59:77-84. [PMID: 28827065 DOI: 10.1016/j.pedneo.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/30/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Systemic infection is a major upstream mechanism for white matter abnormality (WMA). Our aim was to evaluate the risk factors for moderate-to-severe WMA in extremely premature infants (gestational age < 28 weeks) with neonatal sepsis. METHODS Extremely premature infants with culture-proven sepsis between 2006 and 2015 in a tertiary neonatal intensive care unit were classified as having none-to-mild or moderate-to-severe WMA based on WM scores of brain magnetic resonance imaging at the term-equivalent age. Various risk factors for WMA were analyzed. RESULTS Sixty-three infants (87.5%) had none-to-mild WMA, and nine infants (12.5%) had moderate-to-severe WMA. Multivariate logistic regression analysis revealed that postmenstrual age (PMA) at sepsis diagnosis (OR: 0.640, 95% CI: 0.435-0.941, p = 0.023) and PMA at sepsis diagnosis <28 weeks (OR: 9.232, 95% CI: 1.020-83.590, p = 0.048) were independently associated with moderate-to-severe WMA. PMA at sepsis diagnosis had a significant negative correlation with WM scores (r = -0.243, p = 0.039). CONCLUSION PMA at sepsis diagnosis might be an important risk factor for moderate-to-severe WMA in extremely premature infants with postnatal sepsis, especially before PMA 28 weeks. Infants who suffer from sepsis before PMA 28 weeks might need additional therapy for neuroprotection.
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Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea; Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin A Sohn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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105
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Pfahl S, Hoehn T, Lohmeier K, Richter-Werkle R, Babor F, Schramm D, Sabir H. Long-term neurodevelopmental outcome following low grade intraventricular hemorrhage in premature infants. Early Hum Dev 2018; 117:62-67. [PMID: 29310024 DOI: 10.1016/j.earlhumdev.2017.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/28/2017] [Accepted: 12/30/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Sebastian Pfahl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich Heine University, Düsseldorf, Germany
| | - Thomas Hoehn
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich Heine University, Düsseldorf, Germany.
| | - Klaus Lohmeier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich Heine University, Düsseldorf, Germany.
| | - Renate Richter-Werkle
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich Heine University, Düsseldorf, Germany.
| | - Florian Babor
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany.
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich Heine University, Düsseldorf, Germany.
| | - Hemmen Sabir
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich Heine University, Düsseldorf, Germany.
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106
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George JM, Pannek K, Rose SE, Ware RS, Colditz PB, Boyd RN. Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:134-146. [PMID: 29193032 DOI: 10.1111/dmcn.13611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/18/2023]
Abstract
AIM To examine the diagnostic ability of early magnetic resonance imaging (MRI; <36wks postmenstrual age) to detect later adverse motor outcomes or cerebral palsy (CP) in infants born preterm. METHOD Studies of infants born preterm with MRI earlier than 36 weeks postmenstrual age and quantitative motor data or a diagnosis of CP at or beyond 1 year corrected age were identified. Study details were extracted and meta-analyses performed where possible. Quality of included studies was evaluated with the QUADAS-2 (a revised tool for the quality assessment of diagnostic accuracy studies). RESULTS Thirty-one articles met the inclusion criteria, five of which reported diagnostic accuracy and five reported data sufficient for calculation of diagnostic accuracy. Early structural MRI global scores detected a later diagnosis of CP with a pooled sensitivity of 100% (95% confidence interval [CI] 86-100) and a specificity of 93% (95% CI 59-100). Global structural MRI scores determined adverse motor outcomes with a pooled sensitivity of 89% (95% CI 44-100) and a specificity of 98% (95% CI 90-100). White matter scores determined adverse motor outcomes with a pooled sensitivity of 33% (95% CI 20-48) and a specificity of 83% (95% CI 78-88). INTERPRETATION Early structural MRI has reasonable sensitivity and specificity to determine adverse motor outcomes and CP in infants born preterm. Greater reporting of diagnostic accuracy in studies examining relationships with motor outcomes and CP is required to facilitate clinical utility of early MRI. WHAT THIS PAPER ADDS Early magnetic resonance imaging (MRI) has reasonable sensitivity and specificity to determine later adverse motor outcomes and cerebral palsy (CP). Detection of infants who progressed to CP was stronger than motor outcomes. Global MRI scores determined adverse motor outcomes more accurately than white matter scores. Few studies report diagnostic accuracy of early MRI findings. Diagnostic accuracy is required to draw clinically meaningful conclusions from early MRI studies.
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Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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107
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Relationship between very early brain structure and neuromotor, neurological and neurobehavioral function in infants born <31 weeks gestational age. Early Hum Dev 2018; 117:74-82. [PMID: 29339258 DOI: 10.1016/j.earlhumdev.2017.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/17/2017] [Accepted: 12/31/2017] [Indexed: 11/23/2022]
Abstract
AIM This study aimed to examine associations between structural MRI and concurrent motor, neurological and neurobehavioral measures at 30-32 weeks postmenstrual age (PMA; 'Early'), and at term equivalent age ('Term'). METHOD In this prospective cohort study, infants underwent Early MRI (n = 119; 73 male; median 32 weeks 1 day PMA) and Term MRI (n = 102; 61 male; median 40 weeks 4 days PMA) at 3 T. Structural images were scored generating white matter (WM), cortical gray matter, deep gray matter, cerebellar and global brain abnormality scores. Clinical measures were General Movements Assessment (GMs), Hammersmith Neonatal Neurological Examination (HNNE) and NICU Neonatal Neurobehavioral Scale (NNNS). The Premie-Neuro was administered Early and the Test of Infant Motor Performance (TIMP) and a visual assessment at Term. RESULTS Early MRI cerebellar scores were strongly associated with neurological components of HNNE (reflexes), NNNS (Hypertonicity), the Premie-Neuro neurological subscale (regression coefficient β = -0.06; 95% confidence interval CI = -0.09, -0.04; p < .001) and cramped-synchronized GMs (β = 1.10; 95%CI = 0.57, 1.63; p < .001). Term MRI WM and global scores were strongly associated with the TIMP (WM β = -1.02; 95%CI = -1.67, -0.36; p = .002; global β = -1.59; 95%CI = -2.62, -0.56; p = .001). INTERPRETATION Brain structure on Early and Term MRI was associated with concurrent motor, neurological and neurobehavioral function in very preterm infants.
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108
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Pappas A, Adams-Chapman I, Shankaran S, McDonald SA, Stoll BJ, Laptook AR, Carlo WA, Van Meurs KP, Hintz SR, Carlson MD, Brumbaugh JE, Walsh MC, Wyckoff MH, Das A, Higgins RD. Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage. JAMA Pediatr 2018; 172:32-42. [PMID: 29181530 PMCID: PMC5833521 DOI: 10.1001/jamapediatrics.2017.3545] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. OBJECTIVE To characterize the outcomes of extremely preterm neonates younger than 27 weeks' gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks' postmenstrual age. DESIGN, SETTING, AND PARTICIPANTS This longitudinal observational study was conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks' gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks' postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. MAIN OUTCOMES AND MEASURES The main outcome was neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. RESULTS Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95% CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95% CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95% CI, 2.08-6.51), death/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (OR, 1.09; 95% CI, 0.76-1.57). Behavioral outcomes did not differ. CONCLUSIONS AND RELEVANCE Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.
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Affiliation(s)
- Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Ira Adams-Chapman
- Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Scott A. McDonald
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Barbara J. Stoll
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center, Houston
| | - Abbot R. Laptook
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island
| | | | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Jane E. Brumbaugh
- Department of Pediatrics, University of Iowa, Iowa City,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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109
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Diffusion tensor imaging detects ventilation-induced brain injury in preterm lambs. PLoS One 2017; 12:e0188737. [PMID: 29211751 PMCID: PMC5718608 DOI: 10.1371/journal.pone.0188737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022] Open
Abstract
Purpose Injurious mechanical ventilation causes white matter (WM) injury in preterm infants through inflammatory and haemodynamic pathways. The relative contribution of each of these pathways is not known. We hypothesised that in vivo magnetic resonance imaging (MRI) can detect WM brain injury resulting from mechanical ventilation 24 h after preterm delivery. Further we hypothesised that the combination of inflammatory and haemodynamic pathways, induced by umbilical cord occlusion (UCO) increases brain injury at 24 h. Methods Fetuses at 124±2 days gestation were exposed, instrumented and either ventilated for 15 min using a high tidal-volume (VT) injurious strategy with the umbilical cord intact (INJ; inflammatory pathway only), or occluded (INJ+UCO; inflammatory and haemodynamic pathway). The ventilation groups were compared to lambs that underwent surgery but were not ventilated (Sham), and lambs that did not undergo surgery (unoperated control; Cont). Fetuses were placed back in utero after the 15 min intervention and ewes recovered. Twenty-four hours later, lambs were delivered, placed on a protective ventilation strategy, and underwent MRI of the brain using structural, diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) techniques. Results Absolute MRS concentrations of creatine and choline were significantly decreased in INJ+UCO compared to Cont lambs (P = 0.03, P = 0.009, respectively); no significant differences were detected between the INJ or Sham groups and the Cont group. Axial diffusivities in the internal capsule and frontal WM were lower in INJ and INJ+UCO compared to Cont lambs (P = 0.05, P = 0.04, respectively). Lambs in the INJ and INJ+UCO groups had lower mean diffusivities in the frontal WM compared to Cont group (P = 0.04). DTI colour mapping revealed lower diffusivity in specific WM regions in the Sham, INJ, and INJ+UCO groups compared to the Cont group, but the differences did not reach significance. INJ+UCO lambs more likely to exhibit lower WM diffusivity than INJ lambs. Conclusions Twenty-four hours after injurious ventilation, DTI and MRS showed increased brain injury in the injuriously ventilated lambs compared to controls. DTI colour mapping threshold approach provides evidence that the haemodynamic and inflammatory pathways have additive effects on the progression of brain injury compared to the inflammatory pathway alone.
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110
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Grometto A, Pizzo B, Strozzi MC, Gazzolo F, Gazzolo D. Cerebral NIRS patterns in late preterm and very preterm infants becoming late preterm. J Matern Fetal Neonatal Med 2017; 32:1124-1129. [PMID: 29157051 DOI: 10.1080/14767058.2017.1401605] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND Near Infrared Spectroscopy (NIRS) has been proposed as a useful, noninvasive monitoring technique providing reliable information about central nervous system (CNS) oximetry and function. Recently, brain damage has been reconsidered as a dynamic process evolving over the weeks of gestation. We therefore investigated NIRS cerebral pattern differences between healthy late preterm infants (LPTo) and very preterm infants becoming late preterm (LPT). METHODS We conducted an observational study in 40 healthy late preterm infants, matched for gestational age at monitoring, of whom 20 where LPTo and 20 LPT. Clinical, diagnostic and laboratory monitoring procedures and cerebral oximetry (crSO2) and function (cFTOE) were recorded on admission into the study. RESULTS No significant differences (p > .05, for all) were found between groups regarding clinical, diagnostic or laboratory parameters. Higher crSO2 and lower cFTOE (p < .001, for both) were found in the LPTo group. CONCLUSIONS Our results, showing impaired oximetry and function of CNS in LPT, offer additional support to NIRS parameters as a useful tool for longitudinal CNS monitoring of very preterm infants becoming LPT. Future studies correlating NIRS variables and long-term neurological outcome in LPT are needed to elucidate the concept of dynamic brain damage pathogenesis.
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Affiliation(s)
- Alice Grometto
- a Faculty of Biology , University of Pavia , Pavia , Italy.,b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy
| | - Benedetta Pizzo
- b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy.,c Faculty of Biology , University of Oriental Piedmont , Alessandria , Italy
| | - Maria Chiara Strozzi
- b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy
| | - Francesca Gazzolo
- c Faculty of Biology , University of Oriental Piedmont , Alessandria , Italy
| | - Diego Gazzolo
- b Department of Maternal, Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy.,d Neonatal Intensive Care Unit , "G d'Annunzio" University of Chieti , Chieti , Italy
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111
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Glass TJA, Chau V, Gardiner J, Foong J, Vinall J, Zwicker JG, Grunau RE, Synnes A, Poskitt KJ, Miller SP. Severe retinopathy of prematurity predicts delayed white matter maturation and poorer neurodevelopment. Arch Dis Child Fetal Neonatal Ed 2017; 102:F532-F537. [PMID: 28536205 DOI: 10.1136/archdischild-2016-312533] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether severe retinopathy of prematurity (ROP) is associated with (1) abnormal white matter maturation and (2) neurodevelopmental outcomes at 18 months' corrected age (CA) compared with neonates without severe ROP. DESIGN We conducted a prospective longitudinal cohort of extremely preterm neonates born 24-28 weeks' gestational age recruited between 2006 and 2013 with brain MRIs obtained both early in life and at term-equivalent age. Severe ROP was defined as ROP treated with retinal laser photocoagulation. Using diffusion tensor imaging and tract-based spatial statistics (TBSS), white matter maturation was assessed by mean fractional anisotropy (FA) in seven predefined regions of interest. Neurodevelopmental outcomes were assessed with Bayley Scales of Infant and Toddler Development-III (Bayley-III) composite scores at 18 months' CA. Subjects were compared using Fisher's exact, Kruskal-Wallis and generalised estimating equations. SETTING Families were recruited from the neonatal intensive care unit at BC Women's Hospital. PATIENTS Of 98 extremely preterm neonates (median: 26.0 weeks) assessed locally for ROP, 19 (19%) had severe ROP and 83 (85%) were assessed at 18 months' CA. RESULTS Severe ROP was associated with lower FA in the posterior white matter, and with decreased measures of brain maturation in the optic radiations, posterior limb of the internal capsule (PLIC) and external capsule on TBSS. Bayley-III cognitive and motor scores were lower in infants with severe ROP. CONCLUSIONS Severe ROP is associated with maturational delay in the optic radiations, PLIC, external capsule and posterior white matter, housing the primary visual and motor pathways, and is associated with poorer cognitive and motor outcomes at 18 months' CA.
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Affiliation(s)
- Torin J A Glass
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Canada.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada
| | - Vann Chau
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Canada.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jane Gardiner
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Ophthalmology and Vision Science, University of British Columbia and BC Children's Hospital, Vancouver, Canada
| | - Justin Foong
- Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada
| | - Jillian Vinall
- Department of Anesthesiology, University of Calgary, Calgary, Canada
| | - Jill G Zwicker
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics (Developmental Pediatrics), University of British Columbia and BC Children's and Women's Hospitals, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Vancouver, Canada.,Sunny Hill Health Centre for Children, Vancouver, Canada
| | - Ruth E Grunau
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics (Neonatology), University of British Columbia and BC Children's and Women's Hospitals, Vancouver, Canada
| | - Anne Synnes
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics (Neonatology), University of British Columbia and BC Children's and Women's Hospitals, Vancouver, Canada
| | - Kenneth J Poskitt
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Radiology, University of British Columbia and BC Children's Hospital, Vancouver, Canada
| | - Steven P Miller
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Canada.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
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112
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Tusor N, Benders MJ, Counsell SJ, Nongena P, Ederies MA, Falconer S, Chew A, Gonzalez-Cinca N, Hajnal JV, Gangadharan S, Chatzi V, Kersbergen KJ, Kennea N, Azzopardi DV, Edwards AD. Punctate White Matter Lesions Associated With Altered Brain Development And Adverse Motor Outcome In Preterm Infants. Sci Rep 2017; 7:13250. [PMID: 29038505 PMCID: PMC5643493 DOI: 10.1038/s41598-017-13753-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
Preterm infants who develop neurodevelopmental impairment do not always have recognized abnormalities on cerebral ultrasound, a modality routinely used to assess prognosis. In a high proportion of infants, MRI detects punctate white matter lesions that are not seen on ultrasonography. To determine the relation of punctate lesions to brain development and early neurodevelopmental outcome we used multimodal brain MRI to study a large cohort of preterm infants. Punctate lesions without other focal cerebral or cerebellar lesions were detected at term equivalent age in 123 (24.3%) (59 male) of the 506 infants, predominantly in the centrum semiovale and corona radiata. Infants with lesions had higher gestational age, birth weight, and less chronic lung disease. Punctate lesions showed a dose dependent relation to abnormalities in white matter microstructure, assessed with tract-based spatial statistics, and reduced thalamic volume (p < 0.0001), and predicted unfavourable motor outcome at a median (range) corrected age of 20.2 (18.4–26.3) months with sensitivity (95% confidence intervals) 71 (43–88) and specificity 72 (69–77). Punctate white matter lesions without associated cerebral lesions are common in preterm infants currently not regarded as at highest risk for cerebral injury, and are associated with widespread neuroanatomical abnormalities and adverse early neurodevelopmental outcome.
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Affiliation(s)
- Nora Tusor
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom.
| | - Manon J Benders
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Serena J Counsell
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Phumza Nongena
- Division of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Moegamad A Ederies
- Division of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Nuria Gonzalez-Cinca
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Sunay Gangadharan
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Vasiliki Chatzi
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Karina J Kersbergen
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Nigel Kennea
- St. George's, University of London, London, SW17 0QT, United Kingdom
| | - Denis V Azzopardi
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
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113
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Nattel SN, Adrianzen L, Kessler EC, Andelfinger G, Dehaes M, Côté-Corriveau G, Trelles MP. Congenital Heart Disease and Neurodevelopment: Clinical Manifestations, Genetics, Mechanisms, and Implications. Can J Cardiol 2017; 33:1543-1555. [PMID: 29173597 DOI: 10.1016/j.cjca.2017.09.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022] Open
Abstract
Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental disorders (NDDs) and psychiatric conditions. These include cognitive, adaptive, motor, speech, behavioural, and executive functioning deficits, as well as autism spectrum disorder and psychiatric conditions. Structural and functional neuroimaging have demonstrated brain abnormalities in young children with CHD before undergoing surgical repair, likely as a result of an in utero developmental insult. Surgical factors do not seem to play a significant role in neurodevelopmental outcomes. Specific genetic abnormalities, particularly copy number variants, have been increasingly implicated in both CHD and NDDs. Variations in genes involved in apolipoprotein E (APOE) production, the Wnt signalling pathway, and histone modification, as well as in the 1q21.1, 16p13.1-11, and 8p23.1 genetic loci, have been associated with CHD and NDDs and are important targets for future research. Understanding these associations is important for risk stratification, disease classification, improved screening, and pharmacologic management of individuals with CHD.
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Affiliation(s)
- Sarah N Nattel
- Department of Psychiatry, Albert Einstein College of Medicine and Seaver Autism Center at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura Adrianzen
- Department of Psychiatry, Seaver Autism Center at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Gregor Andelfinger
- Department of Pediatrics, University of Montreal and Ste-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - Mathieu Dehaes
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal and Ste-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - Gabriel Côté-Corriveau
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal and Ste-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - M Pilar Trelles
- Department of Psychiatry, Seaver Autism Center at Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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114
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Back SA. White matter injury in the preterm infant: pathology and mechanisms. Acta Neuropathol 2017; 134:331-349. [PMID: 28534077 PMCID: PMC5973818 DOI: 10.1007/s00401-017-1718-6] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 12/22/2022]
Abstract
The human preterm brain is particularly susceptible to cerebral white matter injury (WMI) that disrupts the normal progression of developmental myelination. Advances in the care of preterm infants have resulted in a sustained reduction in the severity of WMI that has shifted from more severe focal necrotic lesions to milder diffuse WMI. Nevertheless, WMI remains a global health problem and the most common cause of chronic neurological morbidity from cerebral palsy and diverse neurobehavioral disabilities. Diffuse WMI involves maturation-dependent vulnerability of the oligodendrocyte (OL) lineage with selective degeneration of late oligodendrocyte progenitors (preOLs) triggered by oxidative stress and other insults. The magnitude and distribution of diffuse WMI are related to both the timing of appearance and regional distribution of susceptible preOLs. Diffuse WMI disrupts the normal progression of OL lineage maturation and myelination through aberrant mechanisms of regeneration and repair. PreOL degeneration is accompanied by early robust proliferation of OL progenitors that regenerate and augment the preOL pool available to generate myelinating OLs. However, newly generated preOLs fail to differentiate and initiate myelination along their normal developmental trajectory despite the presence of numerous intact-appearing axons. Disrupted preOL maturation is accompanied by diffuse gliosis and disturbances in the composition of the extracellular matrix and is mediated in part by inhibitory factors derived from reactive astrocytes. Signaling pathways implicated in disrupted myelination include those mediated by Notch, WNT-beta catenin, and hyaluronan. Hence, there exists a potentially broad but still poorly defined developmental window for interventions to promote white matter repair and myelination and potentially reverses the widespread disturbances in cerebral gray matter growth that accompanies WMI.
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Affiliation(s)
- Stephen A Back
- Division of Pediatric Neuroscience, Departments of Pediatrics and Neurology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA.
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115
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Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
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Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
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116
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Anderson PJ, Treyvaud K, Neil JJ, Cheong JLY, Hunt RW, Thompson DK, Lee KJ, Doyle LW, Inder TE. Associations of Newborn Brain Magnetic Resonance Imaging with Long-Term Neurodevelopmental Impairments in Very Preterm Children. J Pediatr 2017; 187:58-65.e1. [PMID: 28583705 PMCID: PMC5533625 DOI: 10.1016/j.jpeds.2017.04.059] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/23/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the relationship between brain abnormalities on newborn magnetic resonance imaging (MRI) and neurodevelopmental impairment at 7 years of age in very preterm children. STUDY DESIGN A total of 223 very preterm infants (<30 weeks of gestation or <1250 g) born at Melbourne's Royal Women's Hospital had a brain MRI scan at term equivalent age. Scans were scored using a standardized system that assessed structural abnormality of cerebral white matter, cortical gray matter, deep gray matter, and cerebellum. Children were assessed at 7 years on measures of general intelligence, motor functioning, academic achievement, and behavior. RESULTS One hundred eighty-six very preterm children (83%) had both an MRI at term equivalent age and a 7-year follow-up assessment. Higher global brain, cerebral white matter, and deep gray matter abnormality scores were related to poorer intelligence quotient (IQ) (Ps < .01), spelling (Ps < .05), math computation (Ps < .01), and motor function (Ps < .001). Higher cerebellum abnormality scores were related to poorer IQ (P = .001), math computation (P = .018), and motor outcomes (P = .001). Perinatal, neonatal, and social confounders had little effect on the relationships between the MRI abnormality scores and outcomes. Moderate-severe global abnormality on newborn MRI was associated with a reduction in IQ (-6.9 points), math computation (-7.1 points), and motor (-1.9 points) scores independent of the other potential confounders. CONCLUSIONS Structured evaluation of brain MRI at term equivalent is predictive of outcome at 7 years of age, independent of clinical and social factors.
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Affiliation(s)
- Peter J Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
| | - Karli Treyvaud
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia,Department of Psychology & Counselling, La Trobe University, Melbourne, Victoria, Australia
| | - Jeffrey J Neil
- Department of Neurology, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Harvard University, Boston, USA
| | - Jeanie LY Cheong
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia,Newborn Intensive Care, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Rodney W Hunt
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia,Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia,Newborn Intensive Care, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Terrie E Inder
- Harvard Medical School, Harvard University, Boston, USA,Pediatric Newborn Medicine, The Brigham and Women’s Hospital, Boston, USA
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117
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Volpe JJ. Confusions in Nomenclature: "Periventricular Leukomalacia" and "White Matter Injury"-Identical, Distinct, or Overlapping? Pediatr Neurol 2017. [PMID: 28648484 DOI: 10.1016/j.pediatrneurol.2017.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Joseph J Volpe
- Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts.
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118
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Hong SJ, Lim KJ, Yoon DY, Choi CS, Yun EJ, Seo YL, Cho YK, Yoon SJ, Moon JY, Baek S, Lim YJ, Lee K. The most-cited articles in pediatric imaging: a bibliometric analysis. Minerva Pediatr 2017; 71:461-469. [PMID: 28752735 DOI: 10.23736/s0026-4946.17.05045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The number of citations that an article has received reflects its impact on the scientific community. The purpose of our study was to identify and characterize the 51 most-cited articles in pediatric imaging. EVIDENCE ACQUISITION Based on the database of Journal Citation Reports, we selected 350 journals that were considered as potential outlets for pediatric imaging articles. The Web of Science search tools were used to identify the most-cited articles relevant to pediatric imaging within the selected journals. EVIDENCE SYNTHESIS The 51 most-cited articles in pediatric imaging were published between 1952 and 2011, with 1980-1989 and 2000-2009 producing 15 articles, each. The number of citations ranged from 576-124 and the number of annual citations ranged from 49.05-2.56. The majority of articles were published in pediatric and related journals (N.=26), originated in the USA (N.=23), were original articles (N.=45), used MRI as imaging modality (N.=27), and were concerned with the subspecialty of brain (N.=34). University College London School of Medicine (N.=6) and School of Medicine University of California (N.=4) were the leading institutions and Reynolds EO (N.=7) was the most voluminous author. CONCLUSIONS Our study presents a detailed list and an analysis of the most-cited articles in the field of pediatric imaging, which provides an insight into historical developments and allows for recognition of the important advances in this field.
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Affiliation(s)
- Su J Hong
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea.,Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gywonggi-do, South Korea
| | - Kyoung J Lim
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea -
| | - Dae Y Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Chul S Choi
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Eun J Yun
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young L Seo
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young K Cho
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Soo J Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ji Y Moon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Sora Baek
- Department of Nuclear Medicine, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, South Korea
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119
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George JM, Fiori S, Fripp J, Pannek K, Bursle J, Moldrich RX, Guzzetta A, Coulthard A, Ware RS, Rose SE, Colditz PB, Boyd RN. Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age. AJNR Am J Neuroradiol 2017; 38:1435-1442. [PMID: 28522659 DOI: 10.3174/ajnr.a5191] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/21/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE The diagnostic and prognostic potential of brain MR imaging before term-equivalent age is limited until valid MR imaging scoring systems are available. This study aimed to validate an MR imaging scoring system of brain injury and impaired growth for use at 29 to 35 weeks postmenstrual age in infants born at <31 weeks gestational age. MATERIALS AND METHODS Eighty-three infants in a prospective cohort study underwent early 3T MR imaging between 29 and 35 weeks' postmenstrual age (mean, 32+2 ± 1+3 weeks; 49 males, born at median gestation of 28+4 weeks; range, 23+6-30+6 weeks; mean birthweight, 1068 ± 312 g). Seventy-seven infants had a second MR scan at term-equivalent age (mean, 40+6 ± 1+3 weeks). Structural images were scored using a modified scoring system which generated WM, cortical gray matter, deep gray matter, cerebellar, and global scores. Outcome at 12-months corrected age (mean, 12 months 4 days ± 1+2 weeks) consisted of the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley III), and the Neuro-Sensory Motor Developmental Assessment. RESULTS Early MR imaging global, WM, and deep gray matter scores were negatively associated with Bayley III motor (regression coefficient for global score β = -1.31; 95% CI, -2.39 to -0.23; P = .02), cognitive (β = -1.52; 95% CI, -2.39 to -0.65; P < .01) and the Neuro-Sensory Motor Developmental Assessment outcomes (β = -1.73; 95% CI, -3.19 to -0.28; P = .02). Early MR imaging cerebellar scores were negatively associated with the Neuro-Sensory Motor Developmental Assessment (β = -5.99; 95% CI, -11.82 to -0.16; P = .04). Results were reconfirmed at term-equivalent-age MR imaging. CONCLUSIONS This clinically accessible MR imaging scoring system is valid for use at 29 to 35 weeks postmenstrual age in infants born very preterm. It enables identification of infants at risk of adverse outcomes before the current standard of term-equivalent age.
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Affiliation(s)
- J M George
- From the Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, Faculty of Medicine
| | - S Fiori
- Stella Maris Scientific Institute (S.F., A.G.), Department of Developmental Neuroscience, Pisa, Italy
| | - J Fripp
- Health and Biosecurity (J.F., K.P., S.E.R.), The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - K Pannek
- Health and Biosecurity (J.F., K.P., S.E.R.), The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - J Bursle
- Department of Medical Imaging (J.B., A.C.)
| | - R X Moldrich
- University of Queensland Centre for Clinical Research (R.X.M., P.B.C.)
| | - A Guzzetta
- Stella Maris Scientific Institute (S.F., A.G.), Department of Developmental Neuroscience, Pisa, Italy
| | - A Coulthard
- Discipline of Medical Imaging (A.C.)
- Department of Medical Imaging (J.B., A.C.)
| | - R S Ware
- Queensland Centre for Intellectual and Developmental Disability (R.S.W.), The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland (R.S.W.), Griffith University, Brisbane, Australia
| | - S E Rose
- Health and Biosecurity (J.F., K.P., S.E.R.), The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - P B Colditz
- University of Queensland Centre for Clinical Research (R.X.M., P.B.C.)
- Perinatal Research Centre (P.B.C.), Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R N Boyd
- From the Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, Faculty of Medicine
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120
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Malhotra A, Fahey MC, Davies-Tuck M, Wong F, Carse E, Whiteley G, Ditchfield M. Comparison of preterm and term equivalent age MRI for the evaluation of preterm brain injury. J Perinatol 2017; 37:864-868. [PMID: 28383535 DOI: 10.1038/jp.2017.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare information obtained from preterm magnetic resonance imaging (MRI; 31-34 weeks) brain scan to that done at term equivalent age. STUDY DESIGN Prospective observational study of premature infants with evidence or suspicion of parenchymal brain injury on cranial ultrasound. Brain injury on two scans scored using a scoring system and analyzed. RESULTS Fourteen infants with a median (range) gestation at birth of 28 (25-29) weeks and birth weight of 1254 (680-1557) grams were studied. There was a strong correlation between the brain injury scores for the two scans (Spearman ρ=0.87, P=0.001) with excellent agreement between two radiologists (interclass correlation coefficient 0.9-0.94). There was also a high level of agreement between the preterm and term MRI two scores (Intraclass correlation coefficient, 0.79 (0.53-0.94)). CONCLUSIONS Preterm MRI is a feasible option for the assessment of preterm brain injury and analysis of data obtained from scan at preterm age is comparable to that obtained at term equivalent age.
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Affiliation(s)
- A Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - M C Fahey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - M Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - F Wong
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - E Carse
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - G Whiteley
- Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - M Ditchfield
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.,Department of Diagnostic Imaging, Monash University, Melbourne, Victoria, Australia
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Merhar SL, Tkach JA, Woods JC, South AP, Wiland EL, Rattan MS, Dumoulin CL, Kline-Fath BM. Neonatal imaging using an on-site small footprint MR scanner. Pediatr Radiol 2017; 47:1001-1011. [PMID: 28470389 DOI: 10.1007/s00247-017-3855-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/09/2017] [Accepted: 03/30/2017] [Indexed: 01/06/2023]
Abstract
With its soft-tissue definition, multiplanar capabilities and advanced imaging techniques, magnetic resonance imaging (MRI) for neonatal care can provide better understanding of pathology, allowing for improved care and counseling to families. However, MR imaging in neonates is often difficult due to patient instability and the complex support necessary for survival. In our institution, we have installed a small footprint magnet in the neonatal intensive care unit (NICU) to minimize patient risks and provide the ability to perform MR imaging safely in this population. With this system, we have been able to provide more information with regard to central nervous system disorders, abdominal pathology, and pulmonary and airway abnormalities, and have performed postmortem imaging as an alternative or supplement to pathological autopsy. In our experience, an MR scanner situated within the NICU has allowed for safer and more expedited imaging of this vulnerable population.
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Affiliation(s)
- Stephanie L Merhar
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, Cincinnati, OH, USA
| | - Jean A Tkach
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Jason C Woods
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew P South
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, OH, USA
| | - Emily L Wiland
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, OH, USA
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Charles L Dumoulin
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
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Brouwer MJ, Kersbergen KJ, van Kooij BJM, Benders MJNL, van Haastert IC, Koopman-Esseboom C, Neil JJ, de Vries LS, Kidokoro H, Inder TE, Groenendaal F. Preterm brain injury on term-equivalent age MRI in relation to perinatal factors and neurodevelopmental outcome at two years. PLoS One 2017; 12:e0177128. [PMID: 28486543 PMCID: PMC5423624 DOI: 10.1371/journal.pone.0177128] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/21/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES First, to apply a recently extended scoring system for preterm brain injury at term-equivalent age (TEA-)MRI in a regional extremely preterm cohort; second, to identify independent perinatal factors associated with this score; and third, to assess the prognostic value of this TEA-MRI score with respect to early neurodevelopmental outcome. STUDY DESIGN 239 extremely preterm infants (median gestational age [range] in weeks: 26.6 [24.3-27.9]), admitted to the Wilhelmina Children's Hospital between 2006 and 2012 were included. Brain abnormalities in white matter, cortical and deep grey matter and cerebellum and brain growth were scored on T1- and T2-weighted TEA-MRI using the Kidokoro scoring system. Neurodevelopmental outcome was assessed at two years corrected age using the Bayley Scales of Infant and Toddler Development, third edition. The association between TEA-MRI and perinatal factors as well as neurodevelopmental outcome was evaluated using multivariable regression analysis. RESULTS The distribution of brain abnormalities and brain metrics in the Utrecht cohort differed from the original St. Louis cohort (p < .05). Mechanical ventilation >7 days (β [95% confidence interval, CI]: 1.3 [.5; 2.0]) and parenteral nutrition >21 days (2.2 [1.2; 3.2]) were independently associated with higher global brain abnormality scores (p < .001). Global brain abnormality scores were inversely associated with cognitive (β in composite scores [95% CI]: -.7 [-1.2; -.2], p = .004), fine motor (β in scaled scores [95% CI]: -.1 [-.3; -.0], p = .007) and gross motor outcome (β in scaled scores [95% CI]: -.2 [-.3; -.1], p < .001) at two years corrected age, although the explained variances were low (R2 ≤.219). CONCLUSION Patterns of brain injury differed between cohorts. Prolonged mechanical ventilation and parenteral nutrition were identified as independent perinatal risk factors. The prognostic value of the TEA-MRI score was rather limited in this well-performing cohort.
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Affiliation(s)
- Margaretha J. Brouwer
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karina J. Kersbergen
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Britt J. M. van Kooij
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J. N. L. Benders
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingrid C. van Haastert
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeffrey J. Neil
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Linda S. de Vries
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Floris Groenendaal
- Department of Perinatology, Wilhelmina Children’s Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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A normative spatiotemporal MRI atlas of the fetal brain for automatic segmentation and analysis of early brain growth. Sci Rep 2017; 7:476. [PMID: 28352082 PMCID: PMC5428658 DOI: 10.1038/s41598-017-00525-w] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/01/2017] [Indexed: 12/25/2022] Open
Abstract
Longitudinal characterization of early brain growth in-utero has been limited by a number of challenges in fetal imaging, the rapid change in size, shape and volume of the developing brain, and the consequent lack of suitable algorithms for fetal brain image analysis. There is a need for an improved digital brain atlas of the spatiotemporal maturation of the fetal brain extending over the key developmental periods. We have developed an algorithm for construction of an unbiased four-dimensional atlas of the developing fetal brain by integrating symmetric diffeomorphic deformable registration in space with kernel regression in age. We applied this new algorithm to construct a spatiotemporal atlas from MRI of 81 normal fetuses scanned between 19 and 39 weeks of gestation and labeled the structures of the developing brain. We evaluated the use of this atlas and additional individual fetal brain MRI atlases for completely automatic multi-atlas segmentation of fetal brain MRI. The atlas is available online as a reference for anatomy and for registration and segmentation, to aid in connectivity analysis, and for groupwise and longitudinal analysis of early brain growth.
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Wagenaar N, Chau V, Groenendaal F, Kersbergen KJ, Poskitt KJ, Grunau RE, Synnes A, Duerden EG, de Vries LS, Miller SP, Benders MJNL. Clinical Risk Factors for Punctate White Matter Lesions on Early Magnetic Resonance Imaging in Preterm Newborns. J Pediatr 2017; 182:34-40.e1. [PMID: 28063691 DOI: 10.1016/j.jpeds.2016.11.073] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/11/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify clinical risk factors for punctate white matter lesions (PWML) on early magnetic resonance imaging (MRI) in 2 cohorts of newborns born extremely preterm in different neonatal centers. STUDY DESIGN A total of 250 newborns born preterm at less than 28 weeks of gestation (mean 26.4 ± 1.1 weeks) with an early MRI were identified from 2 neonatal centers, in Vancouver, Canada (cohort A, n = 100) and Utrecht, the Netherlands (cohort B, n = 150). Cohort A was imaged as part of a prospective research study and cohort B was imaged as part of routine clinical care. PWML were defined as cluster type foci of hyperintensity on T1-weighted imaging and were identified at a mean postmenstrual age of 31.1 (±1.9) weeks. Multivariable analysis was used to identify clinical factors predictive of PWML. RESULTS Cluster type PWML were found in 47 newborns born extremely preterm (18.8%) and were more common in cohort A (32%) than in cohort B (10%). Newborns in cohort A generally were sicker than those in cohort B. Multivariable analyses revealed that greater birth weight (B = 0.002; P < .02), grade II-III intraventricular hemorrhage (B = 0.83; P < .02), and cohort A (B = 1.34; P < .0001) were independent predictors of PWML. CONCLUSION Several risk factors for PWML on early MRI were identified. The interaction among birth weight, intraventricular hemorrhage, and other aspects of postnatal illness as risk factors for PWML warrants further investigation in newborns born extremely preterm and may help to identify modifiable risk factors for PWML.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Vann Chau
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karina J Kersbergen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kenneth J Poskitt
- Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Emma G Duerden
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven P Miller
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Cerebellar Microstructural Organization is Altered by Complications of Premature Birth: A Case-Control Study. J Pediatr 2017; 182:28-33.e1. [PMID: 27843009 DOI: 10.1016/j.jpeds.2016.10.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare regional cerebellar microstructure, as measured by diffusion tensor imaging (DTI), between preterm infants at term-equivalent age and healthy term-born control neonates, and to explore associations between DTI findings and clinical risk factors. STUDY DESIGN In this case-control study, DTI studies were performed in 73 premature infants born ≤32 weeks and ≤1500 g birth weight and 73 full-term-born controls from healthy pregnancies. Using a region of interest approach, fractional anisotropy (FA) and mean diffusivity (MD) were extracted in 7 cerebellar regions including the anterior vermis, the right/left superior cerebellar peduncles, the middle cerebellar peduncle, and the dentate nuclei. To validate further our DTI measurements, we measured FA and MD in the genu of the corpus callosum and splenium. FA and MD were compared between groups using analyses of multiple linear regression models. RESULTS Preterm infants at term-equivalent age presented with higher FA in the dentate nuclei (<.001) and middle cerebellar peduncle (.028), and lower MD in the vermis (.023) compared with controls. Conversely, preterm infants showed reduced FA and increased MD in both the genu of the corpus callosum and splenium (P < .001). Independent risk factors associated with altered FA and MD in the cerebellum included low Apgar score, supratentorial injury, compromised cardiorespiratory function, and surgery for necrotizing enterocolitis and patent ductus arteriosus. CONCLUSIONS This DTI study provides evidence that complications of premature birth are associated with altered cerebellar microstructural organization when compared with term-born control infants.
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Clayton BLL, Huang A, Dukala D, Soliven B, Popko B. Neonatal Hypoxia Results in Peripheral Nerve Abnormalities. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:245-251. [PMID: 28062081 PMCID: PMC5397665 DOI: 10.1016/j.ajpath.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Although the adverse effects of neonatal hypoxia associated with premature birth on the central nervous system are well known, the contribution of hypoxic damage to the peripheral nervous system (PNS) has not been addressed. We demonstrate that neonatal hypoxia results in hypomyelination and delayed axonal sorting in mice leading to electrophysiological and motor deficits that persist into adulthood. These findings support a potential role for PNS hypoxic damage in the motor impairment that results from premature birth and suggest that therapies designed to protect the PNS may provide clinical benefit.
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Affiliation(s)
- Benjamin L L Clayton
- Department of Neurology, The University of Chicago Center for Peripheral Neuropathy, The University of Chicago, Chicago, Illinois
| | - Aaron Huang
- Department of Neurology, The University of Chicago Center for Peripheral Neuropathy, The University of Chicago, Chicago, Illinois
| | - Danuta Dukala
- Department of Neurology, The University of Chicago Center for Peripheral Neuropathy, The University of Chicago, Chicago, Illinois
| | - Betty Soliven
- Department of Neurology, The University of Chicago Center for Peripheral Neuropathy, The University of Chicago, Chicago, Illinois
| | - Brian Popko
- Department of Neurology, The University of Chicago Center for Peripheral Neuropathy, The University of Chicago, Chicago, Illinois.
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Guo T, Duerden EG, Adams E, Chau V, Branson HM, Chakravarty MM, Poskitt KJ, Synnes A, Grunau RE, Miller SP. Quantitative assessment of white matter injury in preterm neonates: Association with outcomes. Neurology 2017; 88:614-622. [PMID: 28100727 DOI: 10.1212/wnl.0000000000003606] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/29/2016] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To quantitatively assess white matter injury (WMI) volume and location in very preterm neonates, and to examine the association of lesion volume and location with 18-month neurodevelopmental outcomes. METHODS Volume and location of WMI was quantified on MRI in 216 neonates (median gestational age 27.9 weeks) who had motor, cognitive, and language assessments at 18 months corrected age (CA). Neonates were scanned at 32.1 postmenstrual weeks (median) and 68 (31.5%) had WMI; of 66 survivors, 58 (87.9%) had MRI and 18-month outcomes. WMI was manually segmented and transformed into a common image space, accounting for intersubject anatomical variability. Probability maps describing the likelihood of a lesion predicting adverse 18-month outcomes were developed. RESULTS WMI occurs in a characteristic topology, with most lesions occurring in the periventricular central region, followed by posterior and frontal regions. Irrespective of lesion location, greater WMI volumes predicted poor motor outcomes (p = 0.001). Lobar regional analysis revealed that greater WMI volumes in frontal, parietal, and temporal lobes have adverse motor outcomes (all, p < 0.05), but only frontal WMI volumes predicted adverse cognitive outcomes (p = 0.002). To account for lesion location and volume, voxel-wise odds ratio (OR) maps demonstrate that frontal lobe lesions predict adverse cognitive and language development, with maximum odds ratios (ORs) of 78.9 and 17.5, respectively, while adverse motor outcomes are predicted by widespread injury, with maximum OR of 63.8. CONCLUSIONS The predictive value of frontal lobe WMI volume highlights the importance of lesion location when considering the neurodevelopmental significance of WMI. Frontal lobe lesions are of particular concern.
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Affiliation(s)
- Ting Guo
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Emma G Duerden
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Elysia Adams
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Vann Chau
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Helen M Branson
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - M Mallar Chakravarty
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Kenneth J Poskitt
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Anne Synnes
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Ruth E Grunau
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Steven P Miller
- From Neurosciences and Mental Health (T.G., E.G.D., V.C., S.P.M.), The Hospital for Sick Children Research Institute; Departments of Paediatrics (T.G., E.G.D., E.A., V.C., S.P.M.) and Diagnostic Imaging (H.M.B.), The Hospital for Sick Children and the University of Toronto; Cerebral Imaging Centre (M.M.C.), Douglas Mental Health Research Institute, Verdun; Department of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal; and Department of Pediatrics (K.J.P., A.S., R.E.G.), University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, Canada.
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128
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Weak functional connectivity in the human fetal brain prior to preterm birth. Sci Rep 2017; 7:39286. [PMID: 28067865 PMCID: PMC5221666 DOI: 10.1038/srep39286] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
It has been suggested that neurological problems more frequent in those born preterm are expressed prior to birth, but owing to technical limitations, this has been difficult to test in humans. We applied novel fetal resting-state functional MRI to measure brain function in 32 human fetuses in utero and found that systems-level neural functional connectivity was diminished in fetuses that would subsequently be born preterm. Neural connectivity was reduced in a left-hemisphere pre-language region, and the degree to which connectivity of this left language region extended to right-hemisphere homologs was positively associated with the time elapsed between fMRI assessment and delivery. These results provide the first evidence that altered functional connectivity in the preterm brain is identifiable before birth. They suggest that neurodevelopmental disorders associated with preterm birth may result from neurological insults that begin in utero.
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129
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Neubauer V, Djurdjevic T, Griesmaier E, Biermayr M, Gizewski ER, Kiechl-Kohlendorfer U. Routine Magnetic Resonance Imaging at Term-Equivalent Age Detects Brain Injury in 25% of a Contemporary Cohort of Very Preterm Infants. PLoS One 2017; 12:e0169442. [PMID: 28046071 PMCID: PMC5207745 DOI: 10.1371/journal.pone.0169442] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction In recent years, significant investigation has been undertaken by means of magnetic resonance imaging (MRI) in an attempt to identify preterm infants at risk for adverse outcome. The primary objective is to provide a comprehensive characterization of cerebral injury detected by conventional MRI at term-equivalent age in an unselected, consecutive, contemporary cohort of preterm infants born <32 gestational weeks. Secondly, this study aims to identify risk factors for the different injury types in this population. Methods Data for all preterm infants born <32 gestational weeks and admitted to Innsbruck Medical University Hospital were prospectively collected (October 2010 to December 2015). Cerebral MRI was evaluated retrospectively using a validated scoring system that incorporates intraventricular haemorrhage (IVH), white matter disease (WMD) and cerebellar haemorrhage (CBH). Results 300 infants were included in the study. MRI showed 24.7% of all infants to have some form of brain injury. The most common injury type was IVH (16.0%). WMD and CBH were seen in 10.0% and 8.0%. The prevalence of common neonatal risk factors was greater within the group of infants with CBH. In particular indicators for respiratory disease were observed more often: longer ventilation duration, more frequent need for supplemental oxygen at day 28, higher rates of hydrocortisone treatment. Catecholamine treatment was the only neonatal risk factor that was overrepresented in infants with WMD Discussion Cerebral MRI at term-equivalent age, as addition to cranial ultrasound, detected brain injury in 25% of preterm survivors. The diagnosis of IVH was already made by neonatal ultrasound in most cases. In contrast, only a minority of the CBH and none of the non-cystic WMD have been detected prior to MRI. Decreasing gestational age and neonatal complications involved with immaturity have been identified as risk factors for CBH, whereas WMD was found in relatively mature infants with circulatory disturbances.
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Affiliation(s)
- Vera Neubauer
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Tanja Djurdjevic
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Griesmaier
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlene Biermayr
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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130
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Arberet C, Proisy M, Fausser JL, Curt M, Bétrémieux P, Tréguier C, Rozel C, Pladys P. Isolated neonatal MRI punctate white matter lesions in very preterm neonates and quality of life at school age. J Neonatal Perinatal Med 2017; 10:257-266. [PMID: 28854519 DOI: 10.3233/npm-1691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the quality of life at school age of very preterm infants presenting isolated punctate periventricular white matter lesions (IPWL) on late-preterm or term magnetic resonance imaging (MRI). METHODS In 1996-2000, 16 of the 131 very preterm neonates explored by MRI were found to have IPWL. At the age of 9-14, 12 children from the IPWL group were compared with 54 children born preterm but with a normal MRI (no lesion). Quality of life (Health Status Classification System Pre School questionnaire), school performance, and motor outcome were investigated. RESULTS Overall quality of life did not differ between the groups (classified as perfect in 2/12 of the IPWL vs 20/54 in the no-lesion). The sub-items mobility and dexterity differed significantly between the two groups, with impairment in the IPWL group (p < 0.001 and p < 0.05). This group also displayed higher levels of motor impairment: they began walking later [20(4) vs. 15(3) months), p < 0.01], had higher frequencies of cerebral palsy (6/12 vs. 2/54, p < 0.05), and dyspraxia (4/12 vs. 0/54, p < 0.001). The rate of grade retention did not differ between the groups (3/12 in the IPWL group vs. 17/54 in the no-lesions group) but, as expected, was higher than that of the French general population (17.4%) during the study period. CONCLUSION This long-term follow-up study detected no increase in the risk of subsequent cognitive impairment in very preterm infants with IPWL, but suggests that these children may have a significantly higher risk of dyspraxia, and motor impairment.
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Affiliation(s)
- C Arberet
- Department of Pediatrics and CIC 1414, CHU Rennes, Rennes, France
| | - M Proisy
- Department of Radiology, CHU Rennes, Rennes, France
| | - J L Fausser
- Department of Pediatrics and CIC 1414, CHU Rennes, Rennes, France
- Université de Rennes 1, Faculté de médecine, Rennes, France
| | - M Curt
- Department of Pediatrics and CIC 1414, CHU Rennes, Rennes, France
| | - P Bétrémieux
- Department of Pediatrics and CIC 1414, CHU Rennes, Rennes, France
| | - C Tréguier
- Department of Radiology, CHU Rennes, Rennes, France
| | - C Rozel
- Department of Radiology, CHU Rennes, Rennes, France
| | - P Pladys
- Department of Pediatrics and CIC 1414, CHU Rennes, Rennes, France
- Université de Rennes 1, Faculté de médecine, Rennes, France
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131
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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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132
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Anblagan D, Pataky R, Evans MJ, Telford EJ, Serag A, Sparrow S, Piyasena C, Semple SI, Wilkinson AG, Bastin ME, Boardman JP. Association between preterm brain injury and exposure to chorioamnionitis during fetal life. Sci Rep 2016; 6:37932. [PMID: 27905410 PMCID: PMC5131360 DOI: 10.1038/srep37932] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/02/2016] [Indexed: 12/27/2022] Open
Abstract
Preterm infants are susceptible to inflammation-induced white matter injury but the exposures that lead to this are uncertain. Histologic chorioamnionitis (HCA) reflects intrauterine inflammation, can trigger a fetal inflammatory response, and is closely associated with premature birth. In a cohort of 90 preterm infants with detailed placental histology and neonatal brain magnetic resonance imaging (MRI) data at term equivalent age, we used Tract-based Spatial Statistics (TBSS) to perform voxel-wise statistical comparison of fractional anisotropy (FA) data and computational morphometry analysis to compute the volumes of whole brain, tissue compartments and cerebrospinal fluid, to test the hypothesis that HCA is an independent antenatal risk factor for preterm brain injury. Twenty-six (29%) infants had HCA and this was associated with decreased FA in the genu, cingulum cingulate gyri, centrum semiovale, inferior longitudinal fasciculi, limbs of the internal capsule, external capsule and cerebellum (p < 0.05, corrected), independent of degree of prematurity, bronchopulmonary dysplasia and postnatal sepsis. This suggests that diffuse white matter injury begins in utero for a significant proportion of preterm infants, which focuses attention on the development of methods for detecting fetuses and placentas at risk as a means of reducing preterm brain injury.
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Affiliation(s)
- Devasuda Anblagan
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Rozalia Pataky
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Margaret J Evans
- Department of Pathology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Emma J Telford
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Ahmed Serag
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Sarah Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Chinthika Piyasena
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Scott I Semple
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Clinical Research Imaging Centre, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
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133
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Early Postnatal Lipopolysaccharide Exposure Leads to Enhanced Neurogenesis and Impaired Communicative Functions in Rats. PLoS One 2016; 11:e0164403. [PMID: 27723799 PMCID: PMC5056722 DOI: 10.1371/journal.pone.0164403] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/23/2016] [Indexed: 11/23/2022] Open
Abstract
Perinatal infection is a well-identified risk factor for a number of neurodevelopmental disorders, including brain white matter injury (WMI) and Autism Spectrum Disorders (ASD). The underlying mechanisms by which early life inflammatory events cause aberrant neural, cytoarchitectural, and network organization, remain elusive. This study is aimed to investigate how systemic lipopolysaccharide (LPS)-induced neuroinflammation affects microglia phenotypes and early neural developmental events in rats. We show here that LPS exposure at early postnatal day 3 leads to a robust microglia activation which is characterized with mixed microglial proinflammatory (M1) and anti-inflammatory (M2) phenotypes. More specifically, we found that microglial M1 markers iNOS and MHC-II were induced at relatively low levels in a regionally restricted manner, whereas M2 markers CD206 and TGFβ were strongly upregulated in a sub-set of activated microglia in multiple white and gray matter structures. This unique microglial response was associated with a marked decrease in naturally occurring apoptosis, but an increase in cell proliferation in the subventricular zone (SVZ) and the dentate gyrus (DG) of hippocampus. LPS exposure also leads to a significant increase in oligodendrocyte lineage population without causing discernible hypermyelination. Moreover, LPS-exposed rats exhibited significant impairments in communicative and cognitive functions. These findings suggest a possible role of M2-like microglial activation in abnormal neural development that may underlie ASD-like behavioral impairments.
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134
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Kawahara J, Brown CJ, Miller SP, Booth BG, Chau V, Grunau RE, Zwicker JG, Hamarneh G. BrainNetCNN: Convolutional neural networks for brain networks; towards predicting neurodevelopment. Neuroimage 2016; 146:1038-1049. [PMID: 27693612 DOI: 10.1016/j.neuroimage.2016.09.046] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/26/2016] [Accepted: 09/19/2016] [Indexed: 01/01/2023] Open
Abstract
We propose BrainNetCNN, a convolutional neural network (CNN) framework to predict clinical neurodevelopmental outcomes from brain networks. In contrast to the spatially local convolutions done in traditional image-based CNNs, our BrainNetCNN is composed of novel edge-to-edge, edge-to-node and node-to-graph convolutional filters that leverage the topological locality of structural brain networks. We apply the BrainNetCNN framework to predict cognitive and motor developmental outcome scores from structural brain networks of infants born preterm. Diffusion tensor images (DTI) of preterm infants, acquired between 27 and 46 weeks gestational age, were used to construct a dataset of structural brain connectivity networks. We first demonstrate the predictive capabilities of BrainNetCNN on synthetic phantom networks with simulated injury patterns and added noise. BrainNetCNN outperforms a fully connected neural-network with the same number of model parameters on both phantoms with focal and diffuse injury patterns. We then apply our method to the task of joint prediction of Bayley-III cognitive and motor scores, assessed at 18 months of age, adjusted for prematurity. We show that our BrainNetCNN framework outperforms a variety of other methods on the same data. Furthermore, BrainNetCNN is able to identify an infant's postmenstrual age to within about 2 weeks. Finally, we explore the high-level features learned by BrainNetCNN by visualizing the importance of each connection in the brain with respect to predicting the outcome scores. These findings are then discussed in the context of the anatomy and function of the developing preterm infant brain.
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Affiliation(s)
- Jeremy Kawahara
- Medical Image Analysis Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Colin J Brown
- Medical Image Analysis Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Steven P Miller
- Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Brian G Booth
- Medical Image Analysis Lab, Simon Fraser University, Burnaby, BC, Canada
| | - Vann Chau
- Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Ruth E Grunau
- Child and Family Research Institute and the University of British Columbia, Vancouver, BC, Canada
| | - Jill G Zwicker
- Child and Family Research Institute and the University of British Columbia, Vancouver, BC, Canada
| | - Ghassan Hamarneh
- Medical Image Analysis Lab, Simon Fraser University, Burnaby, BC, Canada.
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135
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Ko HS, Cheon JY, Choi SK, Lee HW, Lee A, Park IY, Shin JC. Placental histologic patterns and neonatal seizure, in preterm premature rupture of membrane. J Matern Fetal Neonatal Med 2016; 30:793-800. [PMID: 27145920 DOI: 10.1080/14767058.2016.1186634] [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: 10/21/2022]
Abstract
OBJECTIVE To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM). METHODS We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery. RESULTS Mean gestational age at membrane rupture was 29.5 ± 3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p = 0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1 min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242-20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617-34.653). CONCLUSIONS Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.
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Affiliation(s)
- Hyun Sun Ko
- a Department of Obstetrics and Gynecology Catholic University of Korea , Seoul , Republic of Korea , and
| | - Ju Young Cheon
- a Department of Obstetrics and Gynecology Catholic University of Korea , Seoul , Republic of Korea , and
| | - Sae Kyung Choi
- a Department of Obstetrics and Gynecology Catholic University of Korea , Seoul , Republic of Korea , and
| | - Hye Won Lee
- b Department of Pathology , College of Medicine, Catholic University of Korea , Seoul , Republic of Korea
| | - Ahwon Lee
- b Department of Pathology , College of Medicine, Catholic University of Korea , Seoul , Republic of Korea
| | - In Yang Park
- a Department of Obstetrics and Gynecology Catholic University of Korea , Seoul , Republic of Korea , and
| | - Jong Chul Shin
- a Department of Obstetrics and Gynecology Catholic University of Korea , Seoul , Republic of Korea , and
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136
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Smyser CD, Dosenbach NUF, Smyser TA, Snyder AZ, Rogers CE, Inder TE, Schlaggar BL, Neil JJ. Prediction of brain maturity in infants using machine-learning algorithms. Neuroimage 2016; 136:1-9. [PMID: 27179605 DOI: 10.1016/j.neuroimage.2016.05.029] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 12/24/2022] Open
Abstract
Recent resting-state functional MRI investigations have demonstrated that much of the large-scale functional network architecture supporting motor, sensory and cognitive functions in older pediatric and adult populations is present in term- and prematurely-born infants. Application of new analytical approaches can help translate the improved understanding of early functional connectivity provided through these studies into predictive models of neurodevelopmental outcome. One approach to achieving this goal is multivariate pattern analysis, a machine-learning, pattern classification approach well-suited for high-dimensional neuroimaging data. It has previously been adapted to predict brain maturity in children and adolescents using structural and resting state-functional MRI data. In this study, we evaluated resting state-functional MRI data from 50 preterm-born infants (born at 23-29weeks of gestation and without moderate-severe brain injury) scanned at term equivalent postmenstrual age compared with data from 50 term-born control infants studied within the first week of life. Using 214 regions of interest, binary support vector machines distinguished term from preterm infants with 84% accuracy (p<0.0001). Inter- and intra-hemispheric connections throughout the brain were important for group categorization, indicating that widespread changes in the brain's functional network architecture associated with preterm birth are detectable by term equivalent age. Support vector regression enabled quantitative estimation of birth gestational age in single subjects using only term equivalent resting state-functional MRI data, indicating that the present approach is sensitive to the degree of disruption of brain development associated with preterm birth (using gestational age as a surrogate for the extent of disruption). This suggests that support vector regression may provide a means for predicting neurodevelopmental outcome in individual infants.
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Affiliation(s)
- Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
| | - Nico U F Dosenbach
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
| | - Abraham Z Snyder
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Bradley L Schlaggar
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA; Department of Neurobiology, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110-1093, USA.
| | - Jeffrey J Neil
- Department of Neurology, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115, USA.
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137
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Zwicker JG, Miller SP, Grunau RE, Chau V, Brant R, Studholme C, Liu M, Synnes A, Poskitt KJ, Stiver ML, Tam EWY. Smaller Cerebellar Growth and Poorer Neurodevelopmental Outcomes in Very Preterm Infants Exposed to Neonatal Morphine. J Pediatr 2016; 172:81-87.e2. [PMID: 26763312 PMCID: PMC5462546 DOI: 10.1016/j.jpeds.2015.12.024] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/10/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the relationship between morphine exposure and growth of the cerebellum and cerebrum in very preterm neonates from early in life to term-equivalent age, as well as to examine morphine exposure and brain volumes in relation to neurodevelopmental outcomes at 18 months corrected age (CA). STUDY DESIGN A prospective cohort of 136 very preterm neonates (24-32 weeks gestational age) was serially scanned with magnetic resonance imaging near birth and at term-equivalent age for volumetric measurements of the cerebellum and cerebrum. Motor outcomes were assessed with the Peabody Developmental Motor Scales, Second Edition and cognitive outcomes with the Bayley Scales of Infant and Toddler Development, Third Edition at 18 months CA. Generalized least squares models and linear regression models were used to assess relationships between morphine exposure, brain volumes, and neurodevelopmental outcomes. RESULTS A 10-fold increase in morphine exposure was associated with a 5.5% decrease in cerebellar volume, after adjustment for multiple clinical confounders and total brain volume (P = .04). When infants exposed to glucocorticoids were excluded, the association of morphine was more pronounced, with an 8.1% decrease in cerebellar volume. Morphine exposure was not associated with cerebral volume (P = .30). Greater morphine exposure also predicted poorer motor (P < .001) and cognitive outcomes (P = .006) at 18 months CA, an association mediated, in part, by slower brain growth. CONCLUSIONS Morphine exposure in very preterm neonates is independently associated with impaired cerebellar growth in the neonatal period and poorer neurodevelopmental outcomes in early childhood. Alternatives to better manage pain in preterm neonates that optimize brain development and functional outcomes are urgently needed.
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Affiliation(s)
- Jill G Zwicker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Child and Family Research Institute, Vancouver, Canada.
| | - Steven P Miller
- Department of Pediatrics, University of British Columbia, Vancouver, Canada,Child & Family Research Institute, Vancouver, Canada,Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, Canada,Child & Family Research Institute, Vancouver, Canada,British Columbia Women’s Hospital, Vancouver, Canada
| | - Vann Chau
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rollin Brant
- Child & Family Research Institute, Vancouver, Canada,Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Colin Studholme
- Departments of Bioengineering & Pediatrics, University of Washington, Seattle, USA
| | - Mengyuan Liu
- Departments of Bioengineering & Pediatrics, University of Washington, Seattle, USA
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, Canada,Child & Family Research Institute, Vancouver, Canada,British Columbia Women’s Hospital, Vancouver, Canada
| | - Kenneth J Poskitt
- Child & Family Research Institute, Vancouver, Canada,Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Mikaela L Stiver
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Emily WY Tam
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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138
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Tam EW, Chau V, Barkovich AJ, Ferriero DM, Miller SP, Rogers EE, Grunau RE, Synnes AR, Xu D, Foong J, Brant R, Innis SM. Early postnatal docosahexaenoic acid levels and improved preterm brain development. Pediatr Res 2016; 79:723-30. [PMID: 26761122 PMCID: PMC4853254 DOI: 10.1038/pr.2016.11] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preterm birth has a dramatic impact on polyunsaturated fatty acid exposures for the developing brain. This study examined the association between postnatal fatty acid levels and measures of brain injury and development, as well as outcomes. METHODS A cohort of 60 preterm newborns (24-32 wk gestational age) was assessed using early and near-term magnetic resonance imaging (MRI) studies. Red blood cell fatty acid composition was analyzed coordinated with each scan. Outcome at a mean of 33 mo corrected age was assessed using the Bayley Scales of Infant Development, 3rd edition. RESULTS Adjusting for confounders, a 1% increase in postnatal docosahexaenoic acid (DHA) levels at early MRI was associated with 4.3-fold decreased odds of intraventricular hemorrhage, but was not associated with white matter injury or cerebellar haemorrhage. Higher DHA and lower linoleic acid (LA) levels at early MRI were associated with lower diffusivity in white matter tracts and corresponding improved developmental scores in follow-up. CONCLUSION Higher DHA and lower LA levels in the first few weeks of life are associated with decreased intraventricular haemorrhage, improved microstructural brain development, and improved outcomes in preterm born children. Early and possibly antenatal interventions in high-risk pregnancies need to be studied for potential benefits in preterm developmental outcomes.
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Affiliation(s)
- Emily W.Y. Tam
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada
| | - Vann Chau
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada
| | - A. James Barkovich
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA,Department of Pediatrics, University of California San Francisco,Department of Radiology & Diagnostic Imaging, University of California San Francisco
| | - Donna M. Ferriero
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA,Department of Pediatrics, University of California San Francisco
| | - Steven P. Miller
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada,Department of Pediatrics, University of British Columbia
| | | | - Ruth E. Grunau
- Department of Pediatrics, University of British Columbia
| | - Anne R. Synnes
- Department of Pediatrics, University of British Columbia
| | - Duan Xu
- Department of Radiology & Diagnostic Imaging, University of California San Francisco
| | - Justin Foong
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada,Centre for Computational Medicine, Hospital for Sick Children
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
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139
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Peyvandi S, De Santiago V, Chakkarapani E, Chau V, Campbell A, Poskitt KJ, Xu D, Barkovich AJ, Miller S, McQuillen P. Association of Prenatal Diagnosis of Critical Congenital Heart Disease With Postnatal Brain Development and the Risk of Brain Injury. JAMA Pediatr 2016; 170:e154450. [PMID: 26902528 PMCID: PMC5083633 DOI: 10.1001/jamapediatrics.2015.4450] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The relationship of prenatal diagnosis of critical congenital heart disease (CHD) with brain injury and brain development is unknown. Given limited improvement of CHD outcomes with prenatal diagnosis, the effect of prenatal diagnosis on brain health may reveal additional benefits. OBJECTIVE To compare the prevalence of preoperative and postoperative brain injury and the trajectory of brain development in neonates with prenatal vs postnatal diagnosis of CHD. DESIGN, SETTING, AND PARTICIPANTS Cohort study of term newborns with critical CHD recruited consecutively from 2001 to 2013 at the University of California, San Francisco and the University of British Columbia. Term newborns with critical CHD were studied with brain magnetic resonance imaging preoperatively and postoperatively to determine brain injury severity and microstructural brain development with diffusion tensor imaging by measuring fractional anisotropy and the apparent diffusion coefficient. Comparisons of magnetic resonance imaging findings and clinical variables were made between prenatal and postnatal diagnosis of critical CHD. A total of 153 patients with transposition of the great arteries and single ventricle physiology were included in this analysis. MAIN OUTCOMES AND MEASURES The presence of brain injury on the preoperative brain magnetic resonance imaging and the trajectory of postnatal brain microstructural development. RESULTS Among 153 patients (67% male), 96 had transposition of the great arteries and 57 had single ventricle physiology. The presence of brain injury was significantly higher in patients with postnatal diagnosis of critical CHD (41 of 86 [48%]) than in those with prenatal diagnosis (16 of 67 [24%]) (P = .003). Patients with prenatal diagnosis demonstrated faster brain development in white matter fractional anisotropy (rate of increase, 2.2%; 95% CI, 0.1%-4.2%; P = .04) and gray matter apparent diffusion coefficient (rate of decrease, 0.6%; 95% CI, 0.1%-1.2%; P = .02). Patients with prenatal diagnosis had lower birth weight (mean, 3184.5 g; 95% CI, 3050.3-3318.6) than those with postnatal diagnosis (mean, 3397.6 g; 95% CI, 3277.6-3517.6) (P = .02). Those with prenatal diagnosis had an earlier estimated gestational age at delivery (mean, 38.6 weeks; 95% CI, 38.2-38.9) than those with postnatal diagnosis (mean, 39.1 weeks; 95% CI, 38.8-39.5) (P = .03). CONCLUSIONS AND RELEVANCE Newborns with prenatal diagnosis of single ventricle physiology and transposition of the great arteries demonstrate less preoperative brain injury and more robust microstructural brain development than those with postnatal diagnosis. These results are likely secondary to improved cardiovascular stability. The impact of these findings on neurodevelopmental outcomes warrants further study.
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Affiliation(s)
- Shabnam Peyvandi
- Department of Pediatrics, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - Veronica De Santiago
- Department of Pediatrics, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - Elavazhagan Chakkarapani
- School of Clinical Sciences, University of Bristol and St Michael’s Hospital, Bristol, England3Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vann Chau
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Andrew Campbell
- Department of Pediatric Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth J. Poskitt
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Duan Xu
- Department of Radiology, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - A. James Barkovich
- Department of Radiology, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - Steven Miller
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada4Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Patrick McQuillen
- Department of Pediatrics, University of California, San Francisco, Benioff Children’s Hospital, San Francisco8Department of Neurology, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
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140
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Choi JY, Rha DW, Park ES. The Effects of the Severity of Periventricular Leukomalacia on the Neuropsychological Outcomes of Preterm Children. J Child Neurol 2016; 31:603-12. [PMID: 26385973 DOI: 10.1177/0883073815604229] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/27/2015] [Indexed: 11/16/2022]
Abstract
This study investigates the developmental outcomes of preterm children according to severity of periventricular leukomalacia. One hundred preterm children with periventricular leukomalacia evident on brain magnetic resonance imaging and who had undergone neuropsychologic evaluation were selected. Intellectual disability was noted in 27.8% of the children with mild periventricular leukomalacia, 53.2% with moderate periventricular leukomalacia, and 77.1% with severe periventricular leukomalacia. The rates of major neurodevelopmental impairments such as cerebral palsy or intellectual disability were related to the severity of periventricular leukomalacia but not to gestational age or epilepsy. There were significant differences in the intelligence quotient (IQ) and social maturity quotient between 3 groups of periventricular leukomalacia. The performance IQ was significantly lower than the verbal IQ. Behavioral problems were noted in about one-third of the children but the rate was not related with the severity of periventricular leukomalacia. Our study revealed the significant associations between severity of periventricular leukomalacia and cognitive and social adaptive functions in the preterm children.
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Affiliation(s)
- Ja Young Choi
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-wook Rha
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Sook Park
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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141
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Lynch JM, Licht DJ. First things first: The importance of the preoperative period for neurocognitive outcomes in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2016; 151:1367-8. [PMID: 27085617 DOI: 10.1016/j.jtcvs.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 01/17/2023]
Affiliation(s)
| | - Daniel J Licht
- June and Steve Wolfson Laboratory for Clinical and Biomedical Optics, Neurology and Pediatrics, Philadelphia, Pa.
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142
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Hielkema T, Hadders-Algra M. Motor and cognitive outcome after specific early lesions of the brain - a systematic review. Dev Med Child Neurol 2016; 58 Suppl 4:46-52. [PMID: 27027607 DOI: 10.1111/dmcn.13047] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2015] [Indexed: 11/30/2022]
Abstract
The aim of this systematic review was to study motor and cognitive outcome in infants with severe early brain lesions and to evaluate effects of side of the lesion, sex, and social economic status on outcome. A literature search was performed using the databases Pubmed and Embase. Included studies involved infants with either cystic periventricular leukomalacia (cPVL), preterm, or term stroke (i.e. parenchymal lesion of the brain). Outcome was expressed as cerebral palsy (CP) and intellectual disability (mental retardation). Median prevalence rates of CP after cPVL, preterm, and term stroke were 86%, 71%, and 29% respectively; of intellectual disability 50%, 27%, and 33%. Most infants with cPVL developed bilateral CP, those with term stroke unilateral CP, whereas after preterm stroke bilateral and unilateral CP occurred equally often. Information on the effects of sex and social economic status on outcome after specific brain lesions was very limited. Our findings show that the risk for CP is high after cPVL, moderate after preterm stroke, and lowest after term stroke. The risk for intellectual disability after an early brain lesion is lower than that for CP. Predicting outcome at individual level remains difficult; new imaging techniques may improve predicting developmental trajectories.
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Affiliation(s)
- Tjitske Hielkema
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
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143
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Young JM, Morgan BR, Powell TL, Moore AM, Whyte HEA, Smith ML, Taylor MJ. Associations of Perinatal Clinical and Magnetic Resonance Imaging Measures with Developmental Outcomes in Children Born Very Preterm. J Pediatr 2016; 170:90-6. [PMID: 26707586 DOI: 10.1016/j.jpeds.2015.11.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/25/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify perinatal risk factors associated with long-term neurocognitive and behavioral impairments in children born very preterm using a multivariate, partial least squares approach. STUDY DESIGN Twenty-seven perinatal clinical and magnetic resonance imaging measures were collected at birth and during the neonatal intensive care stay for 105 neonates born very preterm (≤ 32 weeks gestational age). One-half of the children returned for neuropsychological assessments at 2 and 4 years of age. Parent-reported behavioral measures were also obtained at 4 years of age. Three partial least squares analyses were performed to determine associations between clinical and radiologic measures with cognitive outcomes at 2 and 4 years of age, as well as with behavioral measures at 4 years of age. RESULTS Within the first components of each analysis, only intrauterine growth restriction, male sex, and absence of antenatal corticosteroid use were associated with poorer cognitive and language ability at 2 and 4 years of age, accounting for 79.6% and 71.4% of the total variance, respectively. In addition, white matter injury at term-equivalent age contributed to more problematic internalizing behaviors, behavioral symptoms, and impaired executive function at 4 years of age, accounting for 67.9% of the total variance. CONCLUSIONS Using this data-driven multivariate approach, specific measures in prenatal and early postnatal life are shown to be selectively and significantly associated with cognitive and behavioral outcomes in children born very preterm. Early detection of risk factors can help inform prognoses of children at greatest risk of long-term impairments.
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Affiliation(s)
- Julia M Young
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
| | - Benjamin R Morgan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tamara L Powell
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aideen M Moore
- Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hilary E A Whyte
- Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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144
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Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy. Pediatr Radiol 2016; 46:270-9. [PMID: 26554854 DOI: 10.1007/s00247-015-3473-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/01/2015] [Accepted: 10/07/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. OBJECTIVE The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. MATERIALS AND METHODS Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. RESULTS Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. CONCLUSION The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach.
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145
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Picciolini O, Montirosso R, Porro M, Giannì ML, Mosca F. Neurofunctional assessment at term equivalent age can predict 3-year neurodevelopmental outcomes in very low birth weight infants. Acta Paediatr 2016; 105:e47-53. [PMID: 26497156 DOI: 10.1111/apa.13248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/23/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Abstract
AIM Preterm infants are at high risk of developing motor delay, learning difficulties and behavioural problems and the availability of valid neurodevelopmental assessments is a major clinical issue. This study evaluated the relationship between preterm infants' neurofunctional assessment at term equivalent age and neurodevelopment outcome at three years of chronological age. METHODS Neurofunctional assessment was performed in 70 very low birth weight infants at term equivalent age and neurodevelopmental outcome was assessed at three years of chronological age with the Griffiths Mental Development Scale - Extended Revised. RESULTS At term equivalent age, 81% of the children had normal neurofunctional scores and 82.5% of those showed normal neurodevelopmental outcome at three years. Of the 19% who had impaired development at term equivalent age, 38.5% had neurodevelopmental delay at three years. Impaired neurofunctional status was associated with an increased risk of developmental delay in the global quotient (odds ratio 12.1) and locomotor sub-quotient (odds ratio 18.35) compared with normal neurofunctional status. Infants with sepsis or necrotising enterocolitis also faced a higher risk of neurodevelopmental delay. CONCLUSION Neurofunctional assessment performed at term equivalent age appeared to provide early identification of preterm infants at risk of neurodevelopmental delay at three years of chronological age.
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Affiliation(s)
- Odoardo Picciolini
- Pediatric Rehabilitation Unit; NICU; Department of Clinical Sciences and Community Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milano Italy
| | - Rosario Montirosso
- Centre for the Study of Social Emotional Development of the At-Risk Infant - Scientific Institute; IRCCS Eugenio Medea; Bosisio Parini (LC) Italy
| | - Matteo Porro
- Pediatric Rehabilitation Unit; NICU; Department of Clinical Sciences and Community Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milano Italy
| | - Maria L. Giannì
- NICU; Department of Clinical Sciences and Community Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milano Italy
| | - Fabio Mosca
- NICU; Department of Clinical Sciences and Community Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milano Italy
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146
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Zonnenberg IA, Vermeulen RJ, Rohaan MW, van Weissenbruch MM, Groenendaal F, de Vries LS. Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome. Neonatology 2016; 109:282-8. [PMID: 26886231 DOI: 10.1159/000443320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Severe neonatal anaemia can impair cerebral oxygen supply. Data on long-term outcomes following severe neonatal anaemia are scarce. METHODS Clinical data and neurodevelopmental outcome of 49 (near) term infants with haemoglobin concentration after birth <6.0 mmol/l were retrospectively collected and analysed. In a subgroup of 28 patients, amplitude-integrated EEG was available and in 25 infants cerebral MRI was obtained. Infants were followed up at 14-35 months of age and assessed with the Griffiths Scale of Mental Development or Bayley Scale of Infant Development. RESULTS Eighteen patients (37%) died during the neonatal period. In 25 patients MRI was performed. A predominant pattern of injury on MRI was seen in the basal ganglia and thalami in 7 patients (28%), whereas some form of white matter injury was present in 16 (64%) and a combination in 3 (12%). Follow-up data were available for 26 patients (84% of survivors). Formal assessment of neurodevelopmental outcome was performed in 20 of 31 (65%) infants who survived (median age: 19 months, range: 14-35). Sixteen infants (80%) had a developmental quotient appropriate for age in the first 2 years after birth. On motor outcome, 1 patient (5%) scored below average (Z-score -1.10). One patient developed cerebral palsy. CONCLUSION Early neurodevelopmental outcome in surviving patients with severe neonatal anaemia was within the normal range in the majority of the survivors. MRI showed mild-to-moderate white matter injury in two thirds of the infants. Prospectively collected data with a longer follow-up period are needed.
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147
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Levman J, Takahashi E. Pre-Adult MRI of Brain Cancer and Neurological Injury: Multivariate Analyses. Front Pediatr 2016; 4:65. [PMID: 27446888 PMCID: PMC4917540 DOI: 10.3389/fped.2016.00065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
Brain cancer and neurological injuries, such as stroke, are life-threatening conditions for which further research is needed to overcome the many challenges associated with providing optimal patient care. Multivariate analysis (MVA) is a class of pattern recognition technique involving the processing of data that contains multiple measurements per sample. MVA can be used to address a wide variety of neuroimaging challenges, including identifying variables associated with patient outcomes; understanding an injury's etiology, development, and progression; creating diagnostic tests; assisting in treatment monitoring; and more. Compared to adults, imaging of the developing brain has attracted less attention from MVA researchers, however, remarkable MVA growth has occurred in recent years. This paper presents the results of a systematic review of the literature focusing on MVA technologies applied to brain injury and cancer in neurological fetal, neonatal, and pediatric magnetic resonance imaging (MRI). With a wide variety of MRI modalities providing physiologically meaningful biomarkers and new biomarker measurements constantly under development, MVA techniques hold enormous potential toward combining available measurements toward improving basic research and the creation of technologies that contribute to improving patient care.
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Affiliation(s)
- Jacob Levman
- Department of Medicine, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Emi Takahashi
- Department of Medicine, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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148
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Slaughter LA, Bonfante-Mejia E, Hintz SR, Dvorchik I, Parikh NA. Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants. Neonatology 2016; 110:47-54. [PMID: 27050735 PMCID: PMC5768198 DOI: 10.1159/000444179] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/21/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Extremely-low-birth-weight (ELBW; ≤1,000 g) infants are at high risk for neurodevelopmental impairments. Conventional brain MRI at term-equivalent age is increasingly used for prediction of outcomes. However, optimal prediction models remain to be determined, especially for cognitive outcomes. OBJECTIVE The aim was to evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments. METHODS 122 ELBW infants had a brain MRI performed at term-equivalent age. Conventional MRI findings were scored with a standardized algorithm and tested using a multivariable regression model to predict neurodevelopmental impairment, defined as one or more of the following at 18-24 months' corrected age: cerebral palsy, bilateral blindness, bilateral deafness requiring amplification, and/or cognitive/language delay. Results were compared with a commonly cited scoring system. RESULTS In multivariable analyses, only moderate-to-severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (OR: 12.6, 95% CI: 2.6, 62.0; p < 0.001). Moderate-to-severe gyral maturational delay also predicted cognitive delay, cognitive delay/death, and neurodevelopmental impairment/death. Diffuse cystic abnormality was a significant predictor of cerebral palsy (OR: 33.6, 95% CI: 4.9, 229.7; p < 0.001). These predictors exhibited high specificity (range: 94-99%) but low sensitivity (30-67%) for the above outcomes. White or gray matter scores, determined using a commonly cited scoring system, did not show significant association with neurodevelopmental impairment. CONCLUSIONS In our cohort, conventional MRI at term-equivalent age exhibited high specificity in predicting neurodevelopmental outcomes. However, sensitivity was suboptimal, suggesting additional clinical factors and biomarkers are needed to enable accurate prognostication.
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Affiliation(s)
- Laurel A Slaughter
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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149
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Abstract
Preterm newborns are highly susceptible to brain injury. White matter injury is among the dominant patterns of brain injury in preterm newborns. the purpose of this review is to discuss the pathogenesis, diagnosis, management, and prevention of white matter injury in premature newborns. the long-term outcome of white matter injury in children born prematurely is also addressed.
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Affiliation(s)
- Dawn Gano
- UCSF Benioff Children's Hospital, 550 16th Street, Box 0137, San Francisco, CA 94158, USA
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150
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STEAM — Statistical Template Estimation for Abnormality Mapping: A personalized DTI analysis technique with applications to the screening of preterm infants. Neuroimage 2016; 125:705-723. [DOI: 10.1016/j.neuroimage.2015.08.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 01/15/2023] Open
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