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Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM. Antepartum and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy. Pediatrics 2013; 132:e952-9. [PMID: 24019409 DOI: 10.1542/peds.2013-0511] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether antepartum factors alone, intrapartum factors alone, or both in combination, are associated with term neonatal hypoxic-ischemic encephalopathy (HIE). METHODS A total of 405 infants ≥ 35 weeks' gestation with early encephalopathy, born between 1992 and 2007, were compared with 239 neurologically normal infants born between 1996 and 1997. All cases met criteria for perinatal asphyxia, had neuroimaging findings consistent with acute hypoxia-ischemia, and had no evidence for a non-hypoxic-ischemic cause of their encephalopathy. RESULTS Both antepartum and intrapartum factors were associated with the development of HIE on univariate analysis. Case infants were more often delivered by emergency cesarean delivery (CD; 50% vs 11%, P < .001) and none was delivered by elective CD (vs 10% of controls). On logistic regression analysis only 1 antepartum factor (gestation ≥ 41 weeks) and 7 intrapartum factors (prolonged membrane rupture, abnormal cardiotocography, thick meconium, sentinel event, shoulder dystocia, tight nuchal cord, failed vacuum) remained independently associated with HIE (area under the curve 0.88; confidence interval 0.85-0.91; P < .001). Overall, 6.7% of cases and 43.5% of controls had only antepartum factors; 20% of cases and 5.8% of controls had only intrapartum factors; 69.5% of cases and 31% of controls had antepartum and intrapartum factors; and 3.7% of cases and 19.7% of controls had no identifiable risk factors (P < .001). CONCLUSIONS Our results do not support the hypothesis that HIE is attributable to antepartum factors alone, but they strongly point to the intrapartum period as the necessary factor in the development of this condition.
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Affiliation(s)
- Miriam Martinez-Biarge
- MRCPCH, Department of Paediatrics, 5 Floor, Hammersmith House, Hammersmith Hospital, DuCane Rd, London W12 OHS, United Kingdom.
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152
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Bertholdt S, Latal B, Liamlahi R, Pretre R, Scheer I, Goetti R, Dave H, Bernet V, Schmitz A, von Rhein M, Knirsch W. Cerebral lesions on magnetic resonance imaging correlate with preoperative neurological status in neonates undergoing cardiopulmonary bypass surgery. Eur J Cardiothorac Surg 2013; 45:625-32. [DOI: 10.1093/ejcts/ezt422] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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153
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Evaluation of 100 brain examinations using a 3 Tesla MR-compatible incubator—safety, handling, and image quality. Neuroradiology 2013; 55:1241-9. [DOI: 10.1007/s00234-013-1241-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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154
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Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value? Pediatr Res 2013; 74:180-5. [PMID: 23728382 DOI: 10.1038/pr.2013.84] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/20/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypothermia is an established therapy in term neonates to reduce death and disability after perinatal asphyxia. Near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rScO2) and amplitude-integrated electroencephalogram (aEEG)-monitored background pattern have been shown to be early predictors of long-term neurodevelopmental outcome. The aim of this study was to investigate the prognostic value of rScO2 and aEEG for neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. METHODS In neonates with HIE who were subjected to hypothermia, the aEEG background pattern and rScO2 were studied prospectively from admission up to 84 h in relation to early magnetic resonance imaging and neurodevelopmental outcome at 18 mo of age. RESULTS Of 39 infants, 12 neonates died because of neurological deterioration. One had an adverse outcome and 26 had a favorable outcome. The rScO2 was higher in neonates with adverse outcome, although aEEG scores were lower. Positive predictive values at 12, 24, and 36 h of age for adverse outcome ranged from 50 to 67% for rScO2 and aEEG; negative predictive values ranged from 73 to 96% for rScO2 and 90 to 100% for aEEG. Combining rScO2 and aEEG increased positive predictive values (70-91%) and negative predictive values (90-100%). CONCLUSION During hypothermia, rScO2 and aEEG measurements are early predictors of long-term outcome after HIE. Combining both parameters further improves early prediction.
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155
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Tang XJ, Xing F. Calcium-permeable AMPA receptors in neonatal hypoxic-ischemic encephalopathy (Review). Biomed Rep 2013; 1:828-832. [PMID: 24649036 DOI: 10.3892/br.2013.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/18/2013] [Indexed: 11/06/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is an important cause of brain injury in the newborn and may result in long-term devastating consequences. Excessive stimulation of glutamate receptors (GluRs) is a pivotal mechanism underlying ischemia-induced selective and delayed neuronal death. Although initial studies focused on N-methyl-D-aspartic acid (NMDA) receptors as critical mediators in HIE, subsequent studies supported a more central role for α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors (AMPARs), particularly Ca2+-permeable AMPARs, in brain damage associated with hypoxia-ischemia. This study reviewed the important role of Ca2+-permeable AMPARs in HIE and the future potential neuroprotective strategies associated with Ca2+-permeable AMPARs.
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Affiliation(s)
- Xiao-Juan Tang
- Department of Neonatology, Children's Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215003, P.R. China
| | - Feng Xing
- Department of Neonatology, Children's Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215003, P.R. China
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156
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Jia F, Du L, Hao Y, Liu S, Li N, Jiang H. Thioperamide treats neonatal hypoxic-ischemic encephalopathy by postsynaptic H1 receptors. Neural Regen Res 2013; 8:1814-22. [PMID: 25206478 PMCID: PMC4145950 DOI: 10.3969/j.issn.1673-5374.2013.19.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/25/2013] [Indexed: 11/22/2022] Open
Abstract
Thioperamide, a selective histamine H3 receptor antagonist, can increase histamine content in the brain, improve brain edema, and exert a neuroprotective effect. This study aimed to examine the mechanism of action of thioperamide during brain edema in a rat model of neonatal hypoxic-ischemic encephalopathy. Our results showed that thioperamide significantly decreased brain water content and malondialdehyde levels, while significantly increased histamine levels and superoxide dismutase activity in the hippocampus. This evidence demonstrates that thioperamide could prevent oxidative damage and attenuate brain edema following neonatal hypoxic-ischemic encephalolopathy. We further observed that changes in the above indexes occurred after combined treatment of thioperamide with the H1 receptor antagonist, pyrilamine, and the H2 receptor antagonist, tidine. Experimental findings indicated that pyrilamine reversed the effects of thioperamide; however, cimetidine had no significant influence on the effects of thioperamide. Our present findings suggest that thioperamide can increase brain histamine content and attenuate brain edema and oxidative damage by acting in combination with postsynaptic H1 receptors in a rat model of neonatal ic-ischemic encephalopathy.
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Affiliation(s)
- Feiyong Jia
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Lin Du
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Yunpeng Hao
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Shicheng Liu
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Ning Li
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China
| | - Huiyi Jiang
- Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China,
Corresponding author: Huiyi Jiang, Attending physician, Division of Pediatric Neurorehabilitation, Department of Pediatrics, Second Part of First Hospital of Jilin University, Changchun 130031, Jilin Province, China, . (N20110714001)
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157
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Harteman JC, Groenendaal F, Toet MC, Benders MJ, Van Haastert IC, Nievelstein RA, Koopman-Esseboom C, de Vries LS. Diffusion-weighted imaging changes in cerebral watershed distribution following neonatal encephalopathy are not invariably associated with an adverse outcome. Dev Med Child Neurol 2013; 55:642-53. [PMID: 23550687 DOI: 10.1111/dmcn.12122] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 11/30/2022]
Abstract
AIM Patterns of injury in term-born infants with neonatal encephalopathy following hypoxia-ischaemia are seen earlier and are more conspicuous on diffusion-weighted magnetic resonance imaging (DW-MRI) than on conventional imaging. Although the prognostic value of DW-MRI in infants with basal ganglia and thalamic damage has been established, data in infants in whom there is extensive injury in a watershed distribution are limited. The aim of this study was to assess cognitive and functional motor outcome in a cohort of infants with changes in a predominantly watershed distribution injury on neonatal cerebral MRI, including DWI. METHOD DW-MRI findings in infants with neonatal encephalopathy following hypoxia-ischaemia were evaluated retrospectively. Twenty-two infants in whom DWI changes exhibited a predominantly watershed distribution were enrolled in the study (10 males, 12 females; mean birthweight 3337 g, 2830-3900 g; mean gestational age 40.5 wks, 37.9-42.1 wks). Follow-up MRI data at the age of 3 months (n=15) and over the age of 18 months (n=7) were analysed. In survivors, neurodevelopmental outcome was assessed with the Griffiths Mental Development Scales at the age of at least 18 months. Amplitude-integrated electroencephalography was used to score background patterns and the occurrence of epileptiform activity. RESULTS DW-MRI revealed abnormalities that were bilateral in all infants and symmetrical in 10. The posterior regions were more severely affected in five infants and the anterior regions in three. Watershed injury occurred in isolation in 10 out of 22 infants and was associated with involvement of the basal ganglia and thalami in the other 12, of whom seven died. Cystic evolution, seen on MRI at age 3 months, occurred in three of the 15 surviving infants. Neurodevelopmental assessment of the surviving infants was performed at a median age of 35 months (range 18-48 mo). Of the five survivors with basal ganglia and thalamic involvement, two developed cerebral palsy, one had a developmental quotient of less than 85, and two had a normal outcome. Of the 10 infants with isolated watershed injury, nine had an early normal motor and cognitive outcome. In all infants with a favourable outcome, background recovery was seen on amplitude integrated EEG within 48 hours after birth. CONCLUSION Extensive DWI changes in a watershed distribution in term-born neonates are not invariably associated with adverse sequelae, even in the presence of cystic evolution. Associated lesions of the basal ganglia and thalami are a better predictor of adverse sequelae than the extent and severity of the watershed abnormalities seen on DW-MRI.
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Affiliation(s)
- Johanna C Harteman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, the Netherlands
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158
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Yoshida S, Faria AV, Oishi K, Kanda T, Yamori Y, Yoshida N, Hirota H, Iwami M, Okano S, Hsu J, Li X, Jiang H, Li Y, Hayakawa K, Mori S. Anatomical characterization of athetotic and spastic cerebral palsy using an atlas-based analysis. J Magn Reson Imaging 2013; 38:288-98. [PMID: 23737247 DOI: 10.1002/jmri.23931] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/02/2012] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze diffusion tensor imaging (DTI) in two types of cerebral palsy (CP): the athetotic-type and the spastic-type, using an atlas-based anatomical analysis of the entire brain, and to investigate whether these images have unique anatomical characteristics that can support functional diagnoses. MATERIALS AND METHODS We retrospectively analyzed the DTI of seven children with athetotic-type, 11 children with spastic-type, and 20 healthy control children, all age-matched. The severity of motor dysfunction was evaluated with the Gross Motor Function Classification System (GMFCS). The images were normalized using a linear transformation, followed by large deformation diffeomorphic metric mapping. For 205 parcellated brain areas, the volume, fractional anisotropy, and mean diffusivity were measured. Principal component analysis (PCA) was performed for the Z-scores of these parameters. RESULTS The GMFCS scores in athetotic-type were significantly higher than those in spastic-type (P < 0.001). PCA extracted anatomical components that comprised the two types of CP, as well as the severity of motor dysfunction. In the athetotic group, the abnormalities were more severe than in the spastic group. In the spastic group, significant changes were concentrated in the lateral ventricle and periventricular structures. CONCLUSION Our results quantitatively delineated anatomical characteristics that reflected the functional findings in two types of CP.
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Affiliation(s)
- Shoko Yoshida
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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159
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Umbilical cord blood cells regulate endogenous neural stem cell proliferation via hedgehog signaling in hypoxic ischemic neonatal rats. Brain Res 2013; 1518:26-35. [DOI: 10.1016/j.brainres.2013.04.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 04/04/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Feng Z, Liu J, Ju R. Hyperbaric oxygen treatment promotes neural stem cell proliferation in the subventricular zone of neonatal rats with hypoxic-ischemic brain damage. Neural Regen Res 2013; 8:1220-7. [PMID: 25206416 PMCID: PMC4107609 DOI: 10.3969/j.issn.1673-5374.2013.13.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/10/2013] [Indexed: 02/05/2023] Open
Abstract
Hyperbaric oxygen therapy for the treatment of neonatal hypoxic-ischemic brain damage has been used clinically for many years, but its effectiveness remains controversial. In addition, the mechanism of this potential neuroprotective effect remains unclear. This study aimed to investigate the influence of hyperbaric oxygen on the proliferation of neural stem cells in the subventricular zone of neonatal Sprague-Dawley rats (7 days old) subjected to hypoxic-ischemic brain damage. Six hours after modeling, rats were treated with hyperbaric oxygen once daily for 7 days. Immunohistochemistry revealed that the number of 5-bromo-2'-deoxyuridine positive and nestin positive cells in the subventricular zone of neonatal rats increased at day 3 after hypoxic-ischemic brain damage and peaked at day 5. After hyperbaric oxygen treatment, the number of 5-bromo-2'-deoxyuridine positive and nestin positive cells began to increase at day 1, and was significantly higher than that in normal rats and model rats until day 21. Hematoxylin-eosin staining showed that hyperbaric oxygen treatment could attenuate pathological changes to brain tissue in neonatal rats, and reduce the number of degenerating and necrotic nerve cells. Our experimental findings indicate that hyperbaric oxygen treatment enhances the proliferation of neural stem cells in the subventricular zone of neonatal rats with hypoxic-ischemic brain damage, and has therapeutic potential for promoting neurological recovery following brain injury.
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Affiliation(s)
- Zhichun Feng
- Department of Neonatology & Neonatal Intensive Care Unit, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China
| | - Jing Liu
- Department of Neonatology & Neonatal Intensive Care Unit, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China
- Corresponding author: Jing Liu, Chief physician, Professor, Department of Neonatology & Neonatal Intensive Care Unit, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China, (N20120314002)
| | - Rong Ju
- Department of Neonatology & Neonatal Intensive Care Unit, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China
- Department of Neonatology, Chengdu Women's & Children's Central Hospital, Chengdu 610031, Sichuan Province, China
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161
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Bi Y, Gong M, He Y, Wei X, Chen J, Li T. Adenovirus-mediated RAR-β over-expression enhances ATRA-induced neuronal differentiation of rat mesenchymal stem cells. Arch Med Sci 2013; 9:314-22. [PMID: 23671444 PMCID: PMC3648816 DOI: 10.5114/aoms.2012.31410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 12/28/2011] [Accepted: 02/22/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The retinoic acid (RA) signaling pathway plays important roles in neural development. All-trans retinoic acid (ATRA) activates the RA signal by regulating RAR-β in mesenchymal stem cell (MSC)-derived neuron cells. Here, we try to investigate whether RAR-β over-expression can affect neuronal differentiation of MSCs. MATERIAL AND METHODS The RAR-β gene was constructed into adenovirus Ad-RAR-β by using the AdEasy system. The MSCs were infected with Ad-RAR-β. Real time-polymerase chain reaction (RT-PCR), Western blot and immunofluorescence were performed to detect the expression and localization of RAR-β. The MSCs were treated with 1 µmol/l ATRA and modified neuronal induction medium (MNM). Soma size and axon length of induced neurons were measured. Neural specific markers were detected by RT-PCR, western blot and immunofluorescence to evaluate neuronal differentiation. RESULTS The 1300 bp fragment of RAR-β gene was confirmed to be correctly cloned in the adenovirus vector. Cloudiness amplification of Ad-RAR-β was observed in HEK293 cells during package. After 48 h of Ad-RAR-β infection, about 70% of MSCs were RFP-positive. RAR-β expression was increased by about 1988-fold and located in the nucleus. RAR-β over-expression did not affect neuronal differentiation efficiency; however, soma size of induced neuron cells enlarged from 716.25 ±95.96 µm(2) to 1160.12 ±352.65 µm(2) and axon length from 64.17 ±11.88 µm to 83.98 ±13.69 µm. Neural markers other than nestin - NSE, MAP-2, Tau, and Tuj1 - were increased by 4- to 11-fold in RAR-β over-expressed neuron cells with ATRA/MNM induction compared with the Ad-null control group. CONCLUSIONS Our results have demonstrated that adenovirus-mediated RAR-β over-expression could facilitate neuron cell types of MSCs in vitro, indicating that the RAR-β-activated RA signal might be a vital factor in neuronal differentiation.
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Affiliation(s)
- Yang Bi
- Nutritional Research Center and Key Laboratory of Developmental Diseases in Childhood, Ministry of Education, Children's Hospital, Chongqing Medical University, Chongqing, China
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162
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Li J, Funato M, Tamai H, Wada H, Nishihara M, Iwamoto H, Okazaki Y, Shintaku H. Predictors of neurological outcome in cooled neonates. Pediatr Int 2013; 55:169-76. [PMID: 23163603 DOI: 10.1111/ped.12008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 09/01/2012] [Accepted: 10/18/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND We define clinical predictors of neurological outcome in neonates with hypoxic-ischemic encephalopathy undergoing hypothermia therapy. METHODS Twenty-one neonates who underwent selective head cooling between 2004 and 2010 and were followed neurologically for ≥ 24 months were investigated retrospectively. Patients were divided according to the neurological outcome at 2 years of age into group A (n = 11), patients with normal neurological function, and group B (n = 10), patients with neurological disabilities (n = 9) or those who died (n = 1). Predictors were determined by χ(2) and Mann-Whitney U-tests, anova, Spearman rank correlations and receiver-operator curves. RESULTS Group B showed higher average blood lactate levels during the first day, particularly at 24 h of life; lower day-3 cerebral blood flow resistance index; higher maximum dobutamine dose used; higher rate of thiamylal sodium used; more severe background electroencephalogram suppression during the first week (group A: 11/11 cases ≤ grade 3; group B: 7/9 cases at grade 4-5) and higher rate of cerebral lesions on magnetic resonance imaging in the second week (group A: 1/11 case; group B: 9/10 cases) than group A. The most useful predictor of poor prognosis was cerebral parenchymal lesions on magnetic resonance imaging with 90%, 90% and 90% of sensitivity, specificity and accuracy, followed by week-1 background electroencephalogram ≥ grade 4 with 70%, 100% and 85% and day-3 cerebral blood flow resistance index < 0.46 with 71%, 88% and 80%, respectively. CONCLUSIONS Prediction of post-cooling neurological outcome could be improved substantially by evaluating multiple factors.
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Affiliation(s)
- Jingang Li
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
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163
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Englander ZA, Pizoli CE, Batrachenko A, Sun J, Worley G, Mikati MA, Kurtzberg J, Song AW. Diffuse reduction of white matter connectivity in cerebral palsy with specific vulnerability of long range fiber tracts. Neuroimage Clin 2013; 2:440-7. [PMID: 24179798 PMCID: PMC3777769 DOI: 10.1016/j.nicl.2013.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 11/25/2022]
Abstract
Cerebral palsy (CP) is a heterogeneous group of non-progressive motor disorders caused by injury to the developing fetal or infant brain. Although the defining feature of CP is motor impairment, numerous other neurodevelopmental disabilities are associated with CP and contribute greatly to its morbidity. The relationship between brain structure and neurodevelopmental outcomes in CP is complex, and current evidence suggests that motor and developmental outcomes are related to the spatial pattern and extent of brain injury. Given that multiple disabilities are frequently associated with CP, and that there is increasing burden of neurodevelopmental disability with increasing motor severity, global white matter (WM) connectivity was examined in a cohort of 17 children with bilateral CP to test the hypothesis that increased global WM damage will be seen in the group of severely affected (Gross Motor Function Classification Scale (GMFCS) level of IV) as compared to moderately affected (GMFCS of II or III) individuals. Diffusion tensor tractography was performed and the resulting fibers between anatomically defined brain regions were quantified and analyzed in relation to GMFCS levels. Overall, a reduction in total WM connectivity throughout the brain in severe versus moderate CP was observed, including but not limited to regions associated with the sensorimotor system. Our results also show a diffuse and significant reduction in global inter-regional connectivity between severity groups, represented by inter-regional fiber count, throughout the brain. Furthermore, it was also observed that there is a significant difference (p = 0.02) in long-range connectivity in patients with severe CP as compared to those with moderate CP, whereas short-range connectivity was similar between groups. This new finding, which has not been previously reported in the CP literature, demonstrates that CP may involve distributed, network-level structural disruptions.
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Affiliation(s)
- Zoë A. Englander
- Brain Imaging and Analysis Center, Duke University Medical Center, USA
| | - Carolyn E. Pizoli
- Brain Imaging and Analysis Center, Duke University Medical Center, USA
- Department of Pediatrics, Duke University Medical Center, USA
| | | | - Jessica Sun
- Department of Pediatrics, Duke University Medical Center, USA
- The Robertson Cell and Translational Therapy Center, Duke University Medical Center, USA
| | - Gordon Worley
- Department of Pediatrics, Duke University Medical Center, USA
| | | | - Joanne Kurtzberg
- Department of Pediatrics, Duke University Medical Center, USA
- The Robertson Cell and Translational Therapy Center, Duke University Medical Center, USA
| | - Allen W. Song
- Brain Imaging and Analysis Center, Duke University Medical Center, USA
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164
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Kontio T, Toet MC, Hellström-Westas L, van Handel M, Groenendaal F, Stjerna S, Vanhatalo S, de Vries LS. Early neurophysiology and MRI in predicting neurological outcome at 9-10 years after birth asphyxia. Clin Neurophysiol 2013; 124:1089-94. [PMID: 23403266 DOI: 10.1016/j.clinph.2012.12.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/18/2012] [Accepted: 12/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether early somatosensory evoked potentials (SEP) predict long-term neurodevelopmental outcome in normothermic, full-term infants with mild to moderate neonatal encephalopathy (NE), and to compare their predictive value to already available amplitude integrated EEG (aEEG) and magnetic resonance imaging (MRI). METHODS Fifty-six infants with post-asphyxia NE were prospectively recruited, and their SEP, aEEG and MRI data were acquired during the first five days. Follow-up continued to 9-10 years for assessment of neuromotor and neurocognitive development. We analysed SEP latency (N1 component), normality of aEEG background pattern, as well as patterns of injury on the neonatal MRI. Neurological outcome measures at 9-10 years included conventional MRI, Movement-ABC and the WISC-III NL. RESULTS A SEP latency <50 ms during the first five days was associated with a normal neuromotor outcome (p < 0.03), and a prolonged day 3 latency was associated with lower childhood IQ (p = 0.02). The presence of multiple seizures in aEEG, as well as a moderate or severe injury on the neonatal MRI was associated with a poor neuromotor score (p = 0.03 and p < 0.01, respectively). Combination of multiple techniques improved prediction of long-term outcome compared to single modality. CONCLUSION Early SEPs provide information that is comparable to the already available aEEG and MRI paradigms in the prediction of long-term outcome of full-term infants with mild to moderate neonatal encephalopathy. SIGNIFICANCE The present results call for further studies using early SEP to aid early assessment of infants treated with hypothermia.
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Affiliation(s)
- T Kontio
- Department of Children's Clinical Neurophysiology, Helsinki University Hospital, and Department of Neurological Sciences, University of Helsinki, Finland.
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165
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Martinez-Biarge M, Bregant T, Wusthoff CJ, Chew ATM, Diez-Sebastian J, Rutherford MA, Cowan FM. White matter and cortical injury in hypoxic-ischemic encephalopathy: antecedent factors and 2-year outcome. J Pediatr 2012; 161:799-807. [PMID: 22682614 DOI: 10.1016/j.jpeds.2012.04.054] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/26/2012] [Accepted: 04/24/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the spectrum of isolated white matter (WM)/cortical injury and its relation to outcomes in infants with hypoxic-ischemic encephalopathy (HIE) and normal appearing basal ganglia and thalami. STUDY DESIGN From 1992-2007, 84 term infants with HIE and normal basal ganglia and thalami on neonatal magnetic resonance imaging were studied; WM/cortical lesions were classified by site and severity. Neurodevelopmental outcomes and head growth were documented at a median age of 2 years. RESULTS The WM was normal or mildly abnormal in 33.5%, moderate in 40.5%, and severely abnormal in 26% of infants. Cortical involvement was not seen or was only mild in 75.5%, moderate in 13%, and severe in 12% of infants. WM and cortical injury severity were highly correlated (Spearman ρ = 0.74; P < .001). Infants with severe WM injury had more severe neonatal courses and a higher incidence of hypoglycemia. No infant died. Five infants (6%) developed cerebral palsy but all could walk independently. Cognitive, visual, language, behavioral, and seizure problems were highly prevalent and correlated significantly with the severity of WM injury and poor postnatal head growth. CONCLUSION Infants with HIE and selective WM/cortical injury have a low prevalence of cerebral palsy but have a wide range of other problems, which occur more often with severe WM/cortical lesions.
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Affiliation(s)
- Miriam Martinez-Biarge
- Department of Pediatrics and Imaging Sciences, Imperial College, Hammersmith Hospital Campus, London, United Kingdom
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166
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Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxic-ischaemic injury. Eur J Paediatr Neurol 2012; 16:688-96. [PMID: 22658307 DOI: 10.1016/j.ejpn.2012.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Basal ganglia and thalamic (BGT) injury is common after acute perinatal hypoxia-ischaemia. Cerebral palsy is the most obvious consequence of BGT injury affecting 70-75% of survivors and is predictable from neonatal magnetic resonance imaging (MRI). However there is no equivalent predictive data for other specific outcomes. Feeding and communication impairments are also common in children following hypoxic-ischaemic encephalopathy (HIE) and BGT injury. AIMS To describe, in infants with HIE and BGT injury, the prevalence of feeding and communication impairments; and to evaluate the accuracy of early MRI for predicting these outcomes. METHODS 175 term infants with HIE and BGT injury were studied. Brain lesions were classified by site and severity from the MRI scans. Motor, feeding and communication impairments were documented at 2 years. RESULTS Feeding and communication impairments occurred in 65% and 82% of 126 survivors respectively and related strongly to the severity of motor impairment. Forty-one children had a gastrostomy or long-term nasogastric tube. Injury severity in all brain regions was significantly associated with feeding and communication impairment on univariate analysis. On logistic regression analysis BGT (OR 10.9) and mesencephalic lesions (OR 3.7) were independently associated with feeding impairment; BGT (OR 10.5) and pontine lesions (OR 3.8) were associated with gastrostomy; the severity of BGT lesions (OR 20.1) was related to the severity of communication impairment. CONCLUSIONS Feeding and communication impairment are very common in children with BGT and brainstem injury of neonatal origin and can be well predicted from early MRI scans.
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167
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Volpe JJ. Neonatal encephalopathy: an inadequate term for hypoxic-ischemic encephalopathy. Ann Neurol 2012; 72:156-66. [PMID: 22926849 DOI: 10.1002/ana.23647] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This Point of View article addresses neonatal encephalopathy (NE) presumably caused by hypoxia-ischemia and the terminology currently in wide use for this disorder. The nonspecific term NE is commonly utilized for those infants with the clinical and imaging characteristics of neonatal hypoxic-ischemic encephalopathy (HIE). Multiple magnetic resonance imaging studies of term infants with the clinical setting of presumed hypoxia-ischemia near the time of delivery have delineated a topography of lesions highly correlated with that defined by human neuropathology and by animal models, including primate models, of hypoxia-ischemia. These imaging findings, coupled with clinical features consistent with perinatal hypoxic-ischemic insult(s), warrant the specific designation of neonatal HIE.
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Affiliation(s)
- Joseph J Volpe
- Department of Neurology, Harvard Medical School, Children's Hospital Boston, Boston, MA 02115, USA.
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168
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Yang H, Einspieler C, Shi W, Marschik PB, Wang Y, Cao Y, Li H, Liao YG, Shao XM. Cerebral palsy in children: movements and postures during early infancy, dependent on preterm vs. full term birth. Early Hum Dev 2012; 88:837-43. [PMID: 22795821 PMCID: PMC3437561 DOI: 10.1016/j.earlhumdev.2012.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/15/2012] [Accepted: 06/19/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND A deviant motor behaviour at age 3 to 5 months is predictive of cerebral palsy (CP). Particular features of the early motor repertoire even proved predictive of the degree of functional limitations as classified on the Gross Motor Function Classification System (GMFCS) in children with CP, born preterm. AIMS We aimed to determine whether an association between the early motor repertoire and the GMFCS also holds true for children born at term. STUDY DESIGN Longitudinal study. SUBJECTS 79 infants (60 boys and 19 girls; 47 infants born at term; video recorded for the assessment of movements and posture at age 9 to 20 weeks postterm age) who developed CP. OUTCOME MEASURES The GMFCS was applied at age 2 to 5 years. RESULTS Motor optimality at age 3 to 5 months showed a significant correlation with functional mobility and activity limitation as classified on the GMFCS at age 2 to 5 years in both children born at term (Spearman rho=-0.66, p<0.001) and born preterm (rho=-0.37, p<0.05). Infants born preterm were more likely to show normal movement patterns than infants born at term. A normal posture and an abnormal, jerky (yet not monotonous) movement character resulted in better levels of function and mobility. With the exception of one, none of the infants showed fidgety movements. A cramped-synchronised movement character, repetitive opening and closing of the mouth, and abnormal finger postures characterised children who would show a poor self-mobility later. CONCLUSIONS Assessing the quality of motor performance at 9 to 20 weeks postterm age (irrespective of the gestational age) improves our ability to predict later functional limitations in children with CP.
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Affiliation(s)
- Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Christa Einspieler
- Institute of Physiology (Developmental Physiology and Developmental Neurology), Center for Physiological Medicine, Medical University of Graz, Austria,Corresponding author at: Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria. Tel.: + 43 316 380 4266; fax: + 43 316 380 9630.
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Peter B. Marschik
- Institute of Physiology (Developmental Physiology and Developmental Neurology), Center for Physiological Medicine, Medical University of Graz, Austria,Center for Genetic Disorders of Cognition and Behavior, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, PR China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, PR China
| | - Hui Li
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Yuan-Gui Liao
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Xiao-Mei Shao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, PR China
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169
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Chang T, du Plessis A. Neurodiagnostic techniques in neonatal critical care. Curr Neurol Neurosci Rep 2012; 12:145-52. [PMID: 22318538 DOI: 10.1007/s11910-012-0254-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article reviews recent advances in the neurodiagnostic tools available to clinicians practicing in neonatal critical care. The advent of induced mild hypothermia for acute neonatal hypoxic-ischemic encephalopathy in 2005 has been responsible for renewed urgency in the development of precise and reliable neonatal neurodiagnostic techniques. Traditional evaluations of bedside head ultrasounds, head computed tomography scans, and routine electroencephalograms (EEGs) have been upgraded in most tertiary pediatric centers to incorporate protocols for MRI, continuous EEG monitoring with remote bedside access, amplitude-integrated EEG, and near-infrared spectroscopy. Meanwhile, recent studies supporting the association between placental pathology and neonatal brain injury highlight the need for closer examination of the placenta in the neurodiagnostic evaluation of the acutely ill newborn. As the pursuit of more effective neuroprotection moves into the "hypothermia plus" era, the identification, evaluation, and treatment of the neurologically affected newborn in the neonatal intensive care unit has increasing significance.
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Affiliation(s)
- Taeun Chang
- Division, Neurophysiology and Epilepsy, Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC 20010, USA.
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170
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Prediction of neurodevelopmental outcome after hypoxic-ischemic encephalopathy treated with hypothermia by diffusion tensor imaging analyzed using tract-based spatial statistics. Pediatr Res 2012; 72:63-9. [PMID: 22447318 DOI: 10.1038/pr.2012.40] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Objective biomarkers are needed to assess neuroprotective therapies after perinatal hypoxic-ischemic encephalopathy (HIE). We tested the hypothesis that, in infants who underwent therapeutic hypothermia after perinatal HIE, neurodevelopmental performance was predicted by fractional anisotropy (FA) values in the white matter (WM) on early diffusion tensor imaging (DTI) as assessed by means of tract-based spatial statistics (TBSS). METHODS We studied 43 term infants with HIE. Developmental assessments were carried out at a median (range) age of 24 (12-28) mo. RESULTS As compared with infants with favorable outcomes, those with unfavorable outcomes had significantly lower FA values (P < 0.05) in the centrum semiovale, corpus callosum (CC), anterior and posterior limbs of the internal capsule, external capsules, fornix, cingulum, cerebral peduncles, optic radiations, and inferior longitudinal fasciculus. In a second analysis in 32 assessable infants, the Griffiths Mental Development Scales (Revised) (GMDS-R) showed a significant linear correlation (P < 0.05) between FA values and developmental quotient (DQ) and all its component subscale scores. DISCUSSION DTI analyzed by TBSS provides a qualified biomarker that can be used to assess the efficacy of additional neuroprotective therapies after HIE.
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171
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Bonifacio SL, Saporta A, Glass HC, Lee P, Glidden DV, Ferriero DM, Barkovich AJ, Xu D. Therapeutic hypothermia for neonatal encephalopathy results in improved microstructure and metabolism in the deep gray nuclei. AJNR Am J Neuroradiol 2012; 33:2050-5. [PMID: 22595900 DOI: 10.3174/ajnr.a3117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Therapeutic hypothermia has reduced morbidity and mortality and is associated with a lower burden of lesions on conventional imaging in NE. However, its effects on brain microstructure and metabolism have not been fully characterized. We hypothesized that therapeutic hypothermia improves measures of brain microstructure and metabolism. MATERIALS AND METHODS Forty-one neonates with moderate/severe NE (29 treated with hypothermia, 12 nontreated) and 12 healthy neonates underwent MR imaging, DTI, and (1)H-MR spectroscopy. MR imaging scans were scored by the predominant pattern of brain injury: normal, watershed, and BG/thalamus. ADC, FA, Lac:NAA, and NAA:Cho values from bilateral BG and thalamus ROIs were averaged. T test and linear regression analysis were used to determine the association between hypothermia and MR imaging quantitative measures. RESULTS Conventional MR imaging findings were normal in 41% of treated neonates; all nontreated neonates had brain injury. Values of MR imaging metrics were closer to normal in treated neonates compared with nontreated neonates: ADC was 63% higher in the BG and 116% higher in the thalamus (both P < .05), and Lac:NAA was 76% lower (P = .04) in the BG. Treated neonates with normal MR imaging findings had normal (1)H-MR spectroscopy metabolites, and ADC was higher by 35% in the thalamus (P = .03) compared with healthy neonates. CONCLUSIONS Therapeutic hypothermia may reduce disturbances of brain metabolism and preserve its microstructure in the setting of NE, possibly by minimizing cytotoxic edema and cell death. Long-term follow-up studies are required to determine whether early post-treatment DTI and (1)H-MR spectroscopy will be useful biomarkers of treatment response.
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Affiliation(s)
- S L Bonifacio
- Department of Pediatrics, Division of Neonatology, UCSF School of Medicine, 533 Parnassus Ave, Room U-585, Box 0748, San Francisco, CA 94143-0748, USA.
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172
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Abstract
With the wider use of magnetic resonance imaging, the recognition of different patterns of injury has become established. These patterns vary in relation to the level of immaturity of the infant. This review will outline the major patterns of abnormality that are found in the term born and preterm infant.
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173
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Moore GS, Kneitel AW, Walker CK, Gilbert WM, Xing G. Autism risk in small- and large-for-gestational-age infants. Am J Obstet Gynecol 2012; 206:314.e1-9. [PMID: 22464070 PMCID: PMC9884028 DOI: 10.1016/j.ajog.2012.01.044] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/14/2012] [Accepted: 01/30/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We sought to determine whether small-for-gestational age (SGA) and large-for-gestational age (LGA) birthweights increase autism risk. STUDY DESIGN This was a retrospective cohort analysis comparing children with autism (n = 20,206) within a birth cohort (n = 5,979,605). Stratification by sex and birthweight percentile (SGA, <5th or 5-10th percentile; appropriate size for gestational age [GA], >10th to <90th percentile; LGA, either 90-95th or >95th percentile) preceded Cochran-Mantel-Haenszel analysis for GA effect, and multivariate analysis. RESULTS Autism risk was increased in preterm SGA (<5th percentile) infants 23-31 weeks (adjusted odds ratio [aOR], 1.60; 95% confidence interval [CI], 1.09-2.35) and 32-33 weeks (aOR, 1.83; 95% CI, 1.16-2.87), and term LGA (>95th percentile) infants 39-41 weeks (aOR, 1.16; 95% CI, 1.08-1.26), but was decreased in preterm LGA infants 23-31 weeks (aOR, 0.45; 95% CI, 0.21-0.95). CONCLUSION SGA was associated with autism in preterm infants, while LGA demonstrated dichotomous risk by GA, with increased risk at term, and decreased risk in the premature infants. These findings likely reflect disparate pathophysiologies, and should influence prenatal counseling, pediatric autism screening, and further autism research.
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Affiliation(s)
- Gaea Schwaebe Moore
- Department of Obstetrics and Gynecology, University of California Davis,Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Aurora, CO
| | | | - Cheryl K. Walker
- Department of Obstetrics and Gynecology, University of California Davis
| | - William M. Gilbert
- Department of Obstetrics and Gynecology, University of California Davis,Department of Obstetrics and Gynecology, Sutter Medical Center
| | - Guibo Xing
- Department of Obstetrics and Gynecology, University of California Davis,Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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174
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Swarte RMC, Cherian PJ, Lequin M, Visser GH, Govaert P. Somatosensory evoked potentials are of additional prognostic value in certain patterns of brain injury in term birth asphyxia. Clin Neurophysiol 2012; 123:1631-8. [PMID: 22264394 DOI: 10.1016/j.clinph.2011.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE (a) To relate MRI patterns of brain injury to somatosensory evoked potentials (SEPs), and (b) to determine the prognostic value of SEPs in addition to continuous EEG monitoring (cEEG) and cerebral imaging, in term asphyxiated newborns. METHODS Fifty one consecutive neonates were studied. Survivors were followed for at least 2 years. cEEG, started within 24h, was done for ≥ 24 h and scored. SEPs and MRIs were performed in the first week. Brain injury patterns were classified. RESULTS Bilaterally abnormal SEPs had a sensitivity of 90% (28/31) and specificity of 85% (17/20) in predicting a poor outcome, defined as death or severe handicap. SEPs were of particular value in predicting outcome in isolated symmetrical white matter injury and predicting the development of hemiparesis in isolated asymmetrical watershed injury. Binary logistic regression analysis revealed a significant relation to outcome separately for cEEG, deep grey matter injury on MRI and SEPs. SEPs provided additional value when added to cEEG and MRI in the model (p=0.034). CONCLUSIONS SEPs are of additional prognostic value after term birth asphyxia. SIGNIFICANCE In certain patterns of postasphyxial neonatal brain injury like asymmetrical watershed lesions and symmetrical white matter injury, EPs are complementary to information obtained from cEEG and MRI for prognostication.
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Affiliation(s)
- Renate M C Swarte
- Department of Neonatology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
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175
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Kesar TM, Sawaki L, Burdette JH, Cabrera MN, Kolaski K, Smith BP, O'Shea TM, Koman LA, Wittenberg GF. Motor cortical functional geometry in cerebral palsy and its relationship to disability. Clin Neurophysiol 2011; 123:1383-90. [PMID: 22153667 DOI: 10.1016/j.clinph.2011.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 10/31/2011] [Accepted: 11/06/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate motor cortical map patterns in children with diplegic and hemiplegic cerebral palsy (CP), and the relationships between motor cortical geometry and motor function in CP. METHODS Transcranial magnetic stimulation (TMS) was used to map motor cortical representations of the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles in 13 children with CP (age 9-16 years, 6 males.) The Gross Motor Function Measure (GMFM) and Melbourne upper extremity function were used to quantify motor ability. RESULTS In the hemiplegic participants (N = 7), the affected (right) FDI cortical representation was mapped on the ipsilateral (N = 4), contralateral (N = 2), or bilateral (N = 1) cortex. Participants with diplegia (N = 6) showed either bilateral (N = 2) or contralateral (N = 4) cortical hand maps. The FDI and TA motor map center-of-gravity mediolateral location ranged from 2-8 cm and 3-6 cm from the midline, respectively. Among diplegics, more lateral FDI representation locations were associated with lower Melbourne scores, i.e. worse hand motor function (Spearman's rho = -0.841, p = 0.036). CONCLUSIONS Abnormalities in TMS-derived motor maps cut across the clinical classifications of hemiplegic and diplegic CP. The lateralization of the upper and lower extremity motor representation demonstrates reorganization after insults to the affected hemispheres of both diplegic and hemiplegic children. SIGNIFICANCE The current study is a step towards defining the relationship between changes in motor maps and functional impairments in CP. These results suggest the need for further work to develop improved classification schemes that integrate clinical, radiologic, and neurophysiologic measures in CP.
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Affiliation(s)
- T M Kesar
- Dept of Physical Therapy, University of Delaware, Newark, DE, United States
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177
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Millichap JG. Early Brain MRI Predicts Outcome of Term HIE. Pediatr Neurol Briefs 2011. [DOI: 10.15844/pedneurbriefs-25-8-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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