201
|
Tusor N, Arichi T, Counsell SJ, Edwards AD. Brain development in preterm infants assessed using advanced MRI techniques. Clin Perinatol 2014; 41:25-45. [PMID: 24524445 DOI: 10.1016/j.clp.2013.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Infants who are born preterm have a high incidence of neurocognitive and neurobehavioral abnormalities, which may be associated with impaired brain development. Advanced magnetic resonance imaging (MRI) approaches, such as diffusion MRI (d-MRI) and functional MRI (fMRI), provide objective and reproducible measures of brain development. Indices derived from d-MRI can be used to provide quantitative measures of preterm brain injury. Although fMRI of the neonatal brain is currently a research tool, future studies combining d-MRI and fMRI have the potential to assess the structural and functional properties of the developing brain and its response to injury.
Collapse
Affiliation(s)
- Nora Tusor
- Centre for the Developing Brain, Department of Perinatal Imaging, St Thomas' Hospital, King's College London, Westminster Bridge Road, London SE1 7EH, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, Department of Perinatal Imaging, St Thomas' Hospital, King's College London, Westminster Bridge Road, London SE1 7EH, UK; Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Department of Perinatal Imaging, St Thomas' Hospital, King's College London, Westminster Bridge Road, London SE1 7EH, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging, St Thomas' Hospital, King's College London, Westminster Bridge Road, London SE1 7EH, UK; Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
| |
Collapse
|
202
|
Abstract
Magnetic resonance imaging (MRI) is a safe and high-resolution neuroimaging modality that is increasingly used in the neonatal population to assess brain injury and its consequences on brain development. It is superior to cranial ultrasound for the definition of patterns of both white and gray matter maturation and injury and therefore has the potential to provide prognostic information on the neurodevelopmental outcomes of the preterm population. Furthermore, the development of sophisticated MRI strategies, including diffusion tensor imaging, resting state functional connectivity, and magnetic resonance spectroscopy, may increase the prognostic value, helping to guide parental counseling and allocate early intervention services.
Collapse
|
203
|
Chau V, McFadden DE, Poskitt KJ, Miller SP. Chorioamnionitis in the pathogenesis of brain injury in preterm infants. Clin Perinatol 2014; 41:83-103. [PMID: 24524448 DOI: 10.1016/j.clp.2013.10.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chorioamnionitis (or placental infection) is suspected to be a risk factor for brain injury in premature infants. The suggested association between chorioamnionitis and cystic periventricular leukomalacia and cerebral palsy is uncertain because of the variability of study designs and definitions of chorioamnionitis. Improvements in neonatal intensive care may have attenuated the impact of chorioamnionitis on brain health outcomes. Large multicenter studies using rigorous definitions of chorioamnionitis on placental pathologies and quantitative magnetic resonance techniques may offer the optimal way to clarify the complex role of chorioamnionitis in modifying brain health and long-term outcomes.
Collapse
Affiliation(s)
- Vann Chau
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; University of Toronto, Department of Pediatrics, 563 Spadina Crescent, Toronto, Ontario, M5S 2J7, Canada; Child & Family Research Institute, 950 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada.
| | - Deborah E McFadden
- Child & Family Research Institute, 950 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada; Department of Pathology, BC Children's & Women's Health Center, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada; University of British Columbia, Departments of Pediatrics, Pathology and Radiology, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Kenneth J Poskitt
- Child & Family Research Institute, 950 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada; University of British Columbia, Departments of Pediatrics, Pathology and Radiology, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada; Departments of Pediatrics and Radiology, BC Children's & Women's Health Center, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - Steven P Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; Neurosciences and Mental Health Program, Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; University of Toronto, Department of Pediatrics, 563 Spadina Crescent, Toronto, Ontario, M5S 2J7, Canada; Child & Family Research Institute, 950 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada
| |
Collapse
|
204
|
Pogledic I, Kostovic I, Fallet-Bianco C, Adle-Biassette H, Gressens P, Verney C. Involvement of the subplate zone in preterm infants with periventricular white matter injury. Brain Pathol 2014; 24:128-41. [PMID: 25003178 DOI: 10.1111/bpa.12096] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Studies of periventricular white matter injury (PWMI) in preterm infants suggest the involvement of the transient cortical subplate zone. We studied the cortical wall of noncystic and cystic PWMI cases and controls. Non-cystic PWMI corresponded to diffuse white matter lesions, the predominant injury currently detected by imaging. Glial cell populations were analyzed in post-mortem human frontal lobes from very preterm [24–29 postconceptional weeks (pcw)] and preterm infants (30–34 pcw) using immunohistochemistry for glial fibrillary acidic protein (GFAP), monocarboxylate transporter 1(MCT1), ionized calcium-binding adapter molecule 1 (Iba1), CD68 and oligodendrocyte lineage (Olig2). Glial activation extended into the subplate in non-cystic PWMI but was restricted to the white matter in cystic PWMI. Two major age-related and laminar differences were observed in non-cystic PWMI: in very preterm cases, activated microglial cells were increased and extended into the subplate adjacent to the lesion, whereas in preterm cases, an astroglial reaction was seen not only in the subplate but throughout the cortical plate. There were no differences in Olig2-positive pre-oligodendrocytes in the subplate inPWMI cases compared with controls. The involvement of gliosis in the deep subplate supports the concept of the complex cellular vulnerability of the subplate zone during the preterm period and may explain widespread changes in magnetic resonance signal intensity in early PWMI.
Collapse
Affiliation(s)
- Ivana Pogledic
- Inserm U676, Paris; Croatian Institute for Brain Research, Medical School, University of Zagreb, Zagreb
| | | | | | | | | | | |
Collapse
|
205
|
Brain magnetic resonance imaging in infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation versus medical necrotizing enterocolitis. J Pediatr 2014; 164:410-2.e1. [PMID: 24210927 DOI: 10.1016/j.jpeds.2013.09.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/03/2013] [Accepted: 09/20/2013] [Indexed: 11/23/2022]
Abstract
Magnetic resonance imaging of the brain was performed in 26 preterm infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation at term equivalent age. Infants with surgical NEC or spontaneous intestinal perforation had significantly more brain injury on magnetic resonance imaging compared with infants with medical NEC, even after adjustment for confounders.
Collapse
|
206
|
Blüml S, Wisnowski JL, Nelson MD, Paquette L, Panigrahy A. Metabolic maturation of white matter is altered in preterm infants. PLoS One 2014; 9:e85829. [PMID: 24465731 PMCID: PMC3899075 DOI: 10.1371/journal.pone.0085829] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/02/2013] [Indexed: 11/19/2022] Open
Abstract
Significant physiological switches occur at birth such as the transition from fetal parallel blood flow to a two-circuit serial system with increased arterial oxygenation of blood delivered to all organs including the brain. In addition, the extra-uterine environment exposes premature infants to a host of stimuli. These events could conceivably alter the trajectory of brain development in premature infants. We used in vivo magnetic resonance spectroscopy to measure absolute brain metabolite concentrations in term and premature-born infants without evidence of brain injury at equivalent post-conceptional age. Prematurity altered the developmental time courses of N-acetyl-aspartate, a marker for axonal and neuronal development, creatine, an energy metabolite, and choline, a membrane metabolite, in parietal white matter. Specifically, at term-equivalency, metabolic maturation in preterm infants preceded development in term infants, but then progressed at a slower pace and trajectories merged at ≈340–370 post-conceptional days. In parieto/occipital grey matter similar trends were noticed but statistical significance was not reached. The timing of white matter development and synchronization of white matter and grey matter maturation in premature-born infants is disturbed. This may contribute to the greater risk of long-term neurological problems of premature infants and to their higher risk for white matter injury.
Collapse
Affiliation(s)
- Stefan Blüml
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Rudi Schulte Research Institute, Santa Barbara, California, United States of America
- * E-mail:
| | - Jessica L. Wisnowski
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Dornsife Cognitive Neuroscience Imaging Center, USC, Los Angeles, California, United States of America
| | - Marvin D. Nelson
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Lisa Paquette
- Division of Neonatology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Ashok Panigrahy
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
207
|
Alexandrou G, Mårtensson G, Skiöld B, Blennow M, Ådén U, Vollmer B. White matter microstructure is influenced by extremely preterm birth and neonatal respiratory factors. Acta Paediatr 2014; 103:48-56. [PMID: 24118089 DOI: 10.1111/apa.12445] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/27/2013] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to investigate whether prematurity per se or perinatal risk factors explain altered brain structure after preterm birth, in extremely preterm (EPT) infants without focal brain lesions. METHODS A population-based cohort of 58 EPT infants [gestational age (GA) <27 + 0 weeks] was examined with diffusion magnetic resonance imaging at term-equivalent age and compared with 14 term-born controls. Associations of diffusion measures with prematurity and neonatal risk factors were explored. Data were analysed with tract-based spatial statistics (TBSS) for whole-brain analysis and region-of-interest (ROI) analysis. RESULTS Whole-brain analyses showed lower fractional anisotropy (FA) and higher mean diffusivity (MD) in several white matter (WM) tracts in the preterms, which was essentially confirmed by ROI analyses. Within the preterm GA range (23 + 0 to 26 + 6 weeks), GA at birth was not significantly associated with diffusion measures. Bronchopulmonary dysplasia predicted lower FA in the corpus callosum and right inferior longitudinal fasciculus; mechanical ventilation >2 days was predictive of higher MD in the right external capsule. CONCLUSION White matter microstructure is influenced by preterm birth and by neonatal respiratory factors, whereas the degree of prematurity within the EPT range appears to be of less importance.
Collapse
Affiliation(s)
- Georgios Alexandrou
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Gustaf Mårtensson
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Beatrice Skiöld
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
| | - Mats Blennow
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
- Department of CLINTEC; Karolinska Institutet; Stockholm Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
| | - Brigitte Vollmer
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| |
Collapse
|
208
|
Chau V, Synnes A, Grunau RE, Poskitt KJ, Brant R, Miller SP. Abnormal brain maturation in preterm neonates associated with adverse developmental outcomes. Neurology 2013; 81:2082-9. [PMID: 24212394 DOI: 10.1212/01.wnl.0000437298.43688.b9] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Our objective was to determine the association of early brain maturation with neurodevelopmental outcome in premature neonates. METHODS Neonates born between 24 and 32 weeks' gestation (April 2006 to August 2010) were prospectively studied with MRI early in life and again at term-equivalent age. Using diffusion tensor imaging and magnetic resonance spectroscopic imaging, fractional anisotropy (FA) (microstructure) and N-acetylaspartate (NAA)/choline (metabolism) were measured from the basal nuclei, white matter tracts, and superior white matter. Brain maturation is characterized by increasing FA and NAA/choline from early in life to term-equivalent age. In premature neonates, systemic illness and critical care therapies have been linked to abnormalities of these measures. Of the 177 neonates in this cohort, 5 died and 157 (91% of survivors) were assessed at 18 months' corrected age (adjusted for prematurity) using the Bayley Scales of Infant and Toddler Development III motor, cognitive, and language composite scores (mean = 100, SD = 15). RESULTS Among these 157 infants, white matter injury was seen in 48 (30%). Severe white matter injury, in 10 neonates (6%), was associated with a decrease in motor (-18 points; p < 0.001) and cognitive (-8 points; p = 0.085) scores. With greater severity of adverse neurodevelopmental outcomes, slower increases in FA and NAA/choline were observed in the basal nuclei and brain white matter regions as neonates matured to term-equivalent age, independent of the presence of white matter injury. CONCLUSIONS In the preterm neonate, abnormal brain maturation evolves through the period of neonatal intensive care and is associated with adverse neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Vann Chau
- From the Departments of Pediatrics (S.P.M.), Divisions of Neurology (V.C.) and Neonatology (A.S., R.E.G.), Radiology (K.J.P.), and Statistics (R.B.), BC Children's & Women's Hospitals and University of British Columbia, and the Child & Family Research Institute (V.C., A.S., R.E.G., K.J.P., R.B., S.P.M.), Vancouver; and Department of Pediatrics (S.P.M., V.C.), Neurology, the Hospital for Sick Children and University of Toronto, Canada
| | | | | | | | | | | |
Collapse
|
209
|
Ranger M, Chau CMY, Garg A, Woodward TS, Beg MF, Bjornson B, Poskitt K, Fitzpatrick K, Synnes AR, Miller SP, Grunau RE. Neonatal pain-related stress predicts cortical thickness at age 7 years in children born very preterm. PLoS One 2013; 8:e76702. [PMID: 24204657 PMCID: PMC3800011 DOI: 10.1371/journal.pone.0076702] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/25/2013] [Indexed: 01/13/2023] Open
Abstract
Background Altered brain development is evident in children born very preterm (24–32 weeks gestational age), including reduction in gray and white matter volumes, and thinner cortex, from infancy to adolescence compared to term-born peers. However, many questions remain regarding the etiology. Infants born very preterm are exposed to repeated procedural pain-related stress during a period of very rapid brain development. In this vulnerable population, we have previously found that neonatal pain-related stress is associated with atypical brain development from birth to term-equivalent age. Our present aim was to evaluate whether neonatal pain-related stress (adjusted for clinical confounders of prematurity) is associated with altered cortical thickness in very preterm children at school age. Methods 42 right-handed children born very preterm (24–32 weeks gestational age) followed longitudinally from birth underwent 3-D T1 MRI neuroimaging at mean age 7.9 yrs. Children with severe brain injury and major motor/sensory/cognitive impairment were excluded. Regional cortical thickness was calculated using custom developed software utilizing FreeSurfer segmentation data. The association between neonatal pain-related stress (defined as the number of skin-breaking procedures) accounting for clinical confounders (gestational age, illness severity, infection, mechanical ventilation, surgeries, and morphine exposure), was examined in relation to cortical thickness using constrained principal component analysis followed by generalized linear modeling. Results After correcting for multiple comparisons and adjusting for neonatal clinical factors, greater neonatal pain-related stress was associated with significantly thinner cortex in 21/66 cerebral regions (p-values ranged from 0.00001 to 0.014), predominately in the frontal and parietal lobes. Conclusions In very preterm children without major sensory, motor or cognitive impairments, neonatal pain-related stress appears to be associated with thinner cortex in multiple regions at school age, independent of other neonatal risk factors.
Collapse
Affiliation(s)
- Manon Ranger
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Cecil M. Y. Chau
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- BC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
| | - Amanmeet Garg
- Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Todd S. Woodward
- BC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
- Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mirza Faisal Beg
- Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bruce Bjornson
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kenneth Poskitt
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Fitzpatrick
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Anne R. Synnes
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- BC Children’s and Women’s Hospitals, Vancouver, British Columbia, Canada
| | - Steven P. Miller
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ruth E. Grunau
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- BC Children’s and Women’s Hospitals, Vancouver, British Columbia, Canada
- * E-mail:
| |
Collapse
|
210
|
Paquette LB, Wisnowski JL, Ceschin R, Pruetz JD, Detterich JA, Del Castillo S, Nagasunder AC, Kim R, Painter MJ, Gilles FH, Nelson MD, Williams RG, Blüml S, Panigrahy A. Abnormal cerebral microstructure in premature neonates with congenital heart disease. AJNR Am J Neuroradiol 2013; 34:2026-33. [PMID: 23703146 DOI: 10.3174/ajnr.a3528] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Abnormal cerebral microstructure has been documented in term neonates with congenital heart disease, portending risk for injury and poor neurodevelopmental outcome. Our hypothesis was that preterm neonates with congenital heart disease would demonstrate diffuse cerebral microstructural abnormalities when compared with critically ill neonates without congenital heart disease. A secondary aim was to identify any association between microstructural abnormalities, white matter injury (eg, punctate white matter lesions), and other clinical variables, including heart lesions. MATERIALS AND METHODS With the use of tract-based spatial statistics, an unbiased, voxelwise method for analyzing diffusion tensor imaging data, we compared 21 preterm neonates with congenital heart disease with 2 cohorts of neonates without congenital heart disease: 28 term and 27 preterm neonates, identified from the same neonatal intensive care unit. RESULTS Compared with term neonates without congenital heart disease, preterm neonates with congenital heart disease had microstructural abnormalities in widespread regions of the central white matter. However, 42% of the preterm neonates with congenital heart disease had punctate white matter lesions. When neonates with punctate white matter lesions were excluded, microstructural abnormalities remained only in the splenium. Preterm neonates with congenital heart disease had similar microstructure to preterm neonates without congenital heart disease. CONCLUSIONS Diffuse microstructural abnormalities were observed in preterm neonates with congenital heart disease, strongly associated with punctate white matter lesions. Independently, regional vulnerability of the splenium, a structure associated with visual spatial function, was observed in all preterm neonates with congenital heart disease.
Collapse
|
211
|
Vinall J, Grunau RE, Brant R, Chau V, Poskitt KJ, Synnes AR, Miller SP. Slower postnatal growth is associated with delayed cerebral cortical maturation in preterm newborns. Sci Transl Med 2013; 5:168ra8. [PMID: 23325801 DOI: 10.1126/scitranslmed.3004666] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Slower postnatal growth is an important predictor of adverse neurodevelopmental outcomes in infants born preterm. However, the relationship between postnatal growth and cortical development remains largely unknown. Therefore, we examined the association between neonatal growth and diffusion tensor imaging measures of microstructural cortical development in infants born very preterm. Participants were 95 neonates born between 24 and 32 weeks gestational age studied twice with diffusion tensor imaging: scan 1 at a median of 32.1 weeks (interquartile range, 30.4 to 33.6) and scan 2 at a median of 40.3 weeks (interquartile range, 38.7 to 42.7). Fractional anisotropy and eigenvalues were recorded from 15 anatomically defined cortical regions. Weight, head circumference, and length were recorded at birth and at the time of each scan. Growth between scans was examined in relation to diffusion tensor imaging measures at scans 1 and 2, accounting for gestational age, birth weight, sex, postmenstrual age, known brain injury (white matter injury, intraventricular hemorrhage, and cerebellar hemorrhage), and neonatal illness (patent ductus arteriosus, days intubated, infection, and necrotizing enterocolitis). Impaired weight, length, and head growth were associated with delayed microstructural development of the cortical gray matter (fractional anisotropy: P < 0.001), but not white matter (fractional anisotropy: P = 0.529), after accounting for prenatal growth, neonatal illness, and brain injury. Avoiding growth impairment during neonatal care may allow cortical development to proceed optimally and, ultimately, may provide an opportunity to reduce neurological disabilities related to preterm birth.
Collapse
Affiliation(s)
- Jillian Vinall
- Neuroscience, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | | | | | | | | | | | | |
Collapse
|
212
|
Abstract
OBJECTIVE To investigate the link between infection-related risk factors for cerebral palsy subtypes in children born at term. METHODS A case-control study was performed in a population-based series of children with cerebral palsy born at term (n=309) matched with a control group (n=618). The cases were divided into cerebral palsy subtypes: spastic hemiplegia, spastic diplegia, spastic tetraplegia, and dyskinetic cerebral palsy. All forms of spastic cerebral palsy were also analyzed together. All records were examined for maternal and neonatal signs of infection. Univariate and adjusted analyses were performed. RESULTS Infection-related risk factors were shown to be independent risk factors for spastic cerebral palsy in the adjusted analyses. This was especially pronounced in the subgroup with spastic hemiplegia in which bacterial growth in urine during pregnancy (n=11 [7.5%], odds ratio [OR] 4.7, 95% confidence interval [CI] 1.5-15.2), any infectious disease during pregnancy (n=57 [39.0%], OR 2.9, 95% CI 1.7-4.8), severe infection during pregnancy (n=12 [8.2%], OR 15.4, 95% CI 3.0-78.1), antibiotic therapy once during pregnancy (n=33 [22.6%], OR 6.3, 95% CI 3.0-15.2) as well as several times during pregnancy (n=9 [6.2%], OR 15.6, 95% CI 1.8-134.2) constituted strong independent risk factors. However, only neonatal infection (n=11 [9.1%], OR 14.7, 95% CI 1.7-126.5) was independently significantly associated with an increased risk of spastic diplegia and tetraplegia. CONCLUSIONS Infection-related factors are strong independent risk factors for the subgroup with spastic hemiplegia in children with cerebral palsy born at term. The finding is less pronounced in the subgroups with spastic diplegia or tetraplegia. LEVEL OF EVIDENCE II.
Collapse
|
213
|
|
214
|
Whyte HEA, Blaser S. Limitations of routine neuroimaging in predicting outcomes of preterm infants. Neuroradiology 2013; 55 Suppl 2:3-11. [DOI: 10.1007/s00234-013-1238-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 11/29/2022]
|
215
|
Duerden EG, Brown-Lum M, Chau V, Poskitt KJ, Grunau RE, Synnes A, Miller SP. Resuscitation intensity at birth is associated with changes in brain metabolic development in preterm neonates. Neuroradiology 2013; 55 Suppl 2:47-54. [PMID: 23921419 DOI: 10.1007/s00234-013-1243-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/10/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Intensive resuscitation at birth has been linked to intraventricular haemorrhage (IVH) in the preterm neonate. However, the impact of less intensive resuscitation on more subtle alterations in brain metabolic development is largely unknown. Our objective was to determine the relationship between the intensity of neonatal resuscitation following preterm birth on brain metabolic development. METHODS One hundred thirty-three very preterm-born neonates (median gestational age [GA] 27 ± 2 weeks) underwent MR spectroscopic imaging early in life (median postmenstrual age 32 weeks) and again at term-equivalent age (median 40 weeks). Severity of white matter injury, IVH and cerebellar haemorrhage on magnetic resonance imaging were scored. Ratios of N-acetylaspartate (NAA) and lactate to choline (Cho) were calculated in eight regions of interest and were assessed in relation to intensiveness of resuscitation strategy (bag and mask, continuous positive airway pressure [CPAP], intubation, cardiopulmonary resuscitation [CPR]). RESULTS Within the first hour of life, 14 newborns had no intervention, 3 received bag and mask, 30 had CPAP, 79 were intubated and 7 had CPR. Resuscitated infants were more likely to have IVH (p = 0.02). More intensive resuscitation was associated with decreased NAA/Cho maturation (p < 0.001, adjusting for birth GA). Metabolic development was similar in neonates requiring CPAP in comparison to those receiving no intervention. The change in lactate/Cho did not differ across resuscitation categories (p = 0.8). CONCLUSIONS Intensity of resuscitation at birth is related to changes in metabolic brain development from early in life to term-equivalent age. Results suggest that preventing the need for intensive neonatal resuscitation may provide an opportunity to improve brain development in preterm neonates.
Collapse
Affiliation(s)
- Emma G Duerden
- Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
216
|
Reynolds LC, Duncan MM, Smith GC, Mathur A, Neil J, Inder T, Pineda RG. Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior. J Perinatol 2013; 33:636-41. [PMID: 23412640 PMCID: PMC3700586 DOI: 10.1038/jp.2013.4] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/06/2012] [Accepted: 01/04/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the effects of parental presence and infant holding in the neonatal intensive care unit (NICU) on neurobehavior at term equivalent. STUDY DESIGN Prospective cohort enrolled 81 infants born 30 weeks gestation. Nurses tracked parent visitation, holding and skin-to-skin care throughout the NICU hospitalization. At term, the NICU Network Neurobehavioral Scale was administered. Associations between visitation, holding and early neurobehavior were determined using linear and logistic regression. RESULT The mean hours per week of parent visitation was 21.33±20.88 (median=13.90; interquartile range 10.10 to 23.60). Infants were held an average of 2.29±1.47 days per week (median=2.00; interquartile range 1.20 to 3.10). Over the hospital stay, visitation hours decreased (P=0.01), while holding frequencies increased (P<0.001). More visitation was associated with better quality of movement (P=0.02), less arousal (P=0.01), less excitability (P=0.03), more lethargy (P=0.01) and more hypotonia (P<0.01). More holding was associated with improved quality of movement (P<0.01), less stress (P<0.01), less arousal (P=0.04) and less excitability (P<0.01). CONCLUSION Infants of caregivers who were visited and held more often in the NICU had differences in early neurobehavior by term equivalent, which supports the need for and importance of early parenting in the NICU.
Collapse
Affiliation(s)
- Lauren C. Reynolds
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Mallory M. Duncan
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Gillian C. Smith
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jeffrey Neil
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Terrie Inder
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Roberta G. Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| |
Collapse
|
217
|
Mann PC, Woodrum DE, Wilfond BS. Fuzzy images: Ethical implications of using routine neuroimaging in premature neonates to predict neurologic outcomes. J Pediatr 2013; 163:587-92. [PMID: 23623529 DOI: 10.1016/j.jpeds.2013.03.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/07/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Paul C Mann
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98105, USA.
| | | | | |
Collapse
|
218
|
Gover A, Chau V, Miller SP, Brant R, McFadden DE, Poskitt KJ, Synnes A, Weinberg J, Grunau RE. Prenatal and postnatal inflammation in relation to cortisol levels in preterm infants at 18 months corrected age. J Perinatol 2013; 33:647-51. [PMID: 23558431 PMCID: PMC3819325 DOI: 10.1038/jp.2013.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/25/2013] [Accepted: 02/11/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine whether early inflammation is related to cortisol levels at 18 months corrected age (CA) in children born very preterm. STUDY DESIGN Infants born ≤ 32 weeks of gestational age were recruited in the neonatal intensive care unit (NICU), and placental histopathology, magnetic resonance imaging (MRI) and chart review were obtained. At 18 months CA, developmental assessment and collection of three salivary cortisol samples were carried out. Generalized least squares was used to analyze data from 85 infants providing 222 cortisol samples. RESULT Infants exposed to chorioamnionitis with funisitis had a significantly different pattern of cortisol across the samples compared with infants with chorioamnionitis alone or no prenatal inflammation (F(4, 139)=7.3996, P<0.0001). Postnatal infections, necrotizing enterocolitis and chronic lung disease were not significantly associated with the cortisol pattern at 18 months CA. CONCLUSION In children born very preterm, prenatal inflammatory stress may contribute to altered programming of the hypothalamic-pituitary-adrenal (HPA) axis.
Collapse
Affiliation(s)
- Ayala Gover
- Developmental Neurosciences & Child Health, Child & Family Research Institute, University of British Columbia, Vancouver, Canada,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Vann Chau
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Steven P. Miller
- Developmental Neurosciences & Child Health, Child & Family Research Institute, University of British Columbia, Vancouver, Canada,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Rollin Brant
- Developmental Neurosciences & Child Health, Child & Family Research Institute, University of British Columbia, Vancouver, Canada
| | | | - Kenneth J. Poskitt
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Anne Synnes
- Developmental Neurosciences & Child Health, Child & Family Research Institute, University of British Columbia, Vancouver, Canada,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Ruth E. Grunau
- Developmental Neurosciences & Child Health, Child & Family Research Institute, University of British Columbia, Vancouver, Canada,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
219
|
Goff DA, Shera DM, Tang S, Lavin NA, Durning SM, Nicolson SC, Montenegro LM, Rome JJ, Gaynor JW, Spray TL, Vossough A, Licht DJ. Risk factors for preoperative periventricular leukomalacia in term neonates with hypoplastic left heart syndrome are patient related. J Thorac Cardiovasc Surg 2013; 147:1312-8. [PMID: 23879933 DOI: 10.1016/j.jtcvs.2013.06.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/01/2013] [Accepted: 06/14/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preoperative brain injury is common in neonates with complex congenital heart disease. Increasing evidence suggests a complex interaction of prenatal and postnatal risk factors for development of brain white matter injury, called periventricular leukomalacia (PVL), in neonates with complex congenital heart disease. To date, there remains a limited understanding of the risk factors contributing to preoperative PVL in hypoplastic left heart syndrome (HLHS). METHODS Neonates with HLHS or HLHS variants from 3 prospective magnetic resonance imaging studies (2003-2010) were selected for this cohort. Preoperative brain magnetic resonance imaging was performed the morning of the surgery. Stepwise multilogistic regression of patient characteristics, mode of delivery (cesarean section vs vaginal), time of diagnosis (prenatal vs postnatal), HLHS subtypes, brain total maturation score, time to surgery, individual averaged daily preoperative blood gases, and complete blood cell count values was used to determine significant associations. RESULTS A total of 57 neonates with HLHS were born at 38.7 ± 2.3 weeks; 86% (49/57) had a prenatal diagnosis, with 31% (18/57) delivered by cesarean section. HLHS with aortic atresia (AA) was common in this cohort, 71% (41/57). Preoperative PVL was identified in 19% (11/57). Male patients with AA (P = .004) were at higher risk for PVL. Lower total brain maturation score was also identified as a strong predictor for preoperative PVL (P = .005). CONCLUSIONS In neonates with HLHS, nonmodifiable patient-related factors, including male sex with AA (lack of antegrade blood flow) and lower total brain maturation score, placed neonates at the greatest risk for preoperative white matter injury.
Collapse
Affiliation(s)
- Donna A Goff
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Division of Cardiology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, Calif.
| | - David M Shera
- Division of Biometrics Research, Merck & Co, Inc, North Wales, Pa
| | - Stephen Tang
- Division of Neurology, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Natasha A Lavin
- Department of Pediatrics, the Division of Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Susan M Durning
- Department of Pediatrics, the Division of Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Susan C Nicolson
- Department of Anesthesia and Critical Care Medicine, the Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Lisa M Montenegro
- Department of Anesthesia and Critical Care Medicine, the Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Jonathan J Rome
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Department of Anesthesia and Critical Care Medicine, the Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Thomas L Spray
- Department of Anesthesia and Critical Care Medicine, the Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Arastoo Vossough
- Department of Surgery, and the Department of Radiology, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Daniel J Licht
- Division of Neurology, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| |
Collapse
|
220
|
Tam EWY. Potential mechanisms of cerebellar hypoplasia in prematurity. Neuroradiology 2013; 55 Suppl 2:41-6. [PMID: 23842990 DOI: 10.1007/s00234-013-1230-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/27/2013] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The cerebellum undergoes dramatic growth and maturation over the neonatal period after preterm birth and is thus particularly sensitive to impaired development due to various clinical factors. METHODS Impairments in growth can occur independent of cerebellar parenchymal damage, such as from local hemorrhage, resulting from reduced expression of sonic hedgehog signaling to trigger the appropriate expansion of the granule precursor cells. RESULTS The primary risk factors for impaired cerebellar development include postnatal glucocorticoid exposure, which has direct effects on the sonic hedgehog pathway, and supratentorial brain injury, including intraventricular hemorrhage and white matter injury, which may result in crossed cerebellar diaschisis and local toxic effects of blood products on the external granular layer. Other cardiorespiratory and nutritional factors may also exist. Impaired cerebellar development is associated with adverse outcomes in motor and cognitive development. CONCLUSION New approaches to care to counteract these risk factors may help improve long-term outcome after preterm birth.
Collapse
Affiliation(s)
- Emily W Y Tam
- Division of Neurology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.
| |
Collapse
|
221
|
Smyser CD, Snyder AZ, Shimony JS, Blazey TM, Inder TE, Neil JJ. Effects of white matter injury on resting state fMRI measures in prematurely born infants. PLoS One 2013; 8:e68098. [PMID: 23874510 PMCID: PMC3706620 DOI: 10.1371/journal.pone.0068098] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/24/2013] [Indexed: 01/16/2023] Open
Abstract
The cerebral white matter is vulnerable to injury in very preterm infants (born prior to 30 weeks gestation), resulting in a spectrum of lesions. These range from severe forms, including cystic periventricular leukomalacia and periventricular hemorrhagic infarction, to minor focal punctate lesions. Moderate to severe white matter injury in preterm infants has been shown to predict later neurodevelopmental disability, although outcomes can vary widely in infants with qualitatively comparable lesions. Resting state functional connectivity magnetic resonance imaging has been increasingly utilized in neurodevelopmental investigations and may provide complementary information regarding the impact of white matter injury on the developing brain. We performed resting state functional connectivity magnetic resonance imaging at term equivalent postmenstrual age in fourteen preterm infants with moderate to severe white matter injury secondary to periventricular hemorrhagic infarction. In these subjects, resting state networks were identifiable throughout the brain. Patterns of aberrant functional connectivity were observed and depended upon injury severity. Comparisons were performed against data obtained from prematurely-born infants with mild white matter injury and healthy, term-born infants and demonstrated group differences. These results reveal structural-functional correlates of preterm white matter injury and carry implications for future investigations of neurodevelopmental disability.
Collapse
Affiliation(s)
- Christopher D Smyser
- Department of Neurology, Washington University, Saint Louis, Missouri, United States of America.
| | | | | | | | | | | |
Collapse
|
222
|
The premature brain: developmental and lesional anatomy. Neuroradiology 2013; 55 Suppl 2:23-40. [DOI: 10.1007/s00234-013-1231-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 01/14/2023]
|
223
|
Movsas TZ, Pinto-Martin JA, Whitaker AH, Feldman JF, Lorenz JM, Korzeniewski SJ, Levy SE, Paneth N. Autism spectrum disorder is associated with ventricular enlargement in a low birth weight population. J Pediatr 2013; 163:73-8. [PMID: 23410601 PMCID: PMC4122247 DOI: 10.1016/j.jpeds.2012.12.084] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/03/2012] [Accepted: 12/27/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the relation of neonatal cranial ultrasound abnormalities to autism spectrum disorders (ASD) in low birth weight (LBW) adult survivors, a population at increased ASD risk. STUDY DESIGN This is a secondary analysis of a prospectively-followed regional birth cohort of 1105 LBW infants systematically screened for perinatal brain injury with cranial ultrasound in the first week of life and later assessed for ASD using a two-stage process [screening at age 16 years (n = 623) followed by diagnostic assessment at age 21 years of a systematically selected subgroup of those screened (n = 189)]; 14 cases of ASD were identified. For this analysis, cranial ultrasound abnormalities were defined as ventricular enlargement (indicative of diffuse white matter injury), parenchymal lesions (indicative of focal white matter injury), and isolated germinal matrix/intraventricular hemorrhage. RESULTS Compared with no cranial ultrasound abnormalities, any type of white matter injury (ventricular enlargement and/or parenchymal lesion) tripled the risk for screening positively for ASD [3.0 (2.2, 4.1)]. However, the risk of being diagnosed with ASD depended on type of white matter injury. With ventricular enlargement, the risk of ASD diagnosis was almost seven-fold that of no cranial ultrasound abnormality [6.7 (2.3, 19.7)], and no elevated risk was found for parenchymal lesion without ventricular enlargement [1.8 (0.2, 13.6)]. Isolated germinal matrix/intraventricular hemorrhage did not increase risk for a positive ASD screen or diagnosis. CONCLUSION In LBW neonates, cranial ultrasound evidence of ventricular enlargement is a strong and significant risk factor for subsequent development of rigorously-diagnosed ASD.
Collapse
Affiliation(s)
- Tammy Z. Movsas
- Midland County Dept of Public Health Clinical Assistant Professor of Pediatrics & Human Development, Michigan State University 220 West Ellsworth St Midland, MI 48640
| | | | - Agnes H Whitaker
- New York State Psychiatric Institute, Dept of Psychiatry, Columbia Univ Medical Center
| | - Judith F Feldman
- New York State Psychiatric Institute, Dept of Psychiatry, Columbia Univ Medical Center
| | - John M Lorenz
- Dept of Pediatrics, College of Physicians and Surgeons, Columbia Univ Medical Center
| | | | - Susan E Levy
- The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
| | - Nigel Paneth
- Dept of Epidemiology & Biostatistics and Pediatrics & Human Development, College of Human Medicine, Michigan State Univ
| |
Collapse
|
224
|
Neurodevelopmental outcomes of very low birth weight infants with neonatal sepsis: systematic review and meta-analysis. J Perinatol 2013; 33:558-64. [PMID: 23328927 DOI: 10.1038/jp.2012.167] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the impact of neonatal sepsis on the long-term neurodevelopmental outcome in very low birth weight (VLBW) infants. STUDY DESIGN Systematic review and meta-analysis of observational studies comparing neurodevelopmental outcomes in VLBW infants exposed to culture-proven sepsis in the neonatal period with similar infants without sepsis. RESULT Seventeen studies involving 15,331 infants were included in the meta-analysis. Sepsis in VLBW infants was associated with an increased risk of one or more long-term neurodevelopmental impairments (odds ratio (OR) 2.09; 95% confidence interval (CI) 1.65 to 2.65) including cerebral palsy (CP; OR 2.09; 95% CI 1.78 to 2.45). Heterogeneity (I(2)=36.9%; P=0.06) between the studies was significant and related to variations in patient characteristics, causative pathogens and follow-up methods. Sensitivity analyses based on study design, follow-up rate and year of birth were not significantly different from the overall analysis. CONCLUSION The meta-analysis suggests that sepsis in VLBW infants is associated with a worse neurodevelopmental outcome including higher incidence of CP.
Collapse
|
225
|
Brain metabolite concentrations are associated with illness severity scores and white matter abnormalities in very preterm infants. Pediatr Res 2013; 74:75-81. [PMID: 23575877 PMCID: PMC4965266 DOI: 10.1038/pr.2013.62] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/29/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Magnetic resonance spectroscopy allows for the noninvasive study of brain metabolism and therefore may provide useful information about brain injuries. We examined the associations of brain metabolite ratios in very preterm infants with white matter lesions and overall health status at birth. METHODS Spectroscopy data were obtained from 99 very preterm infants (born ≤32 wk gestation) imaged shortly after birth and from 67 of these infants at term-equivalent age. These data were processed using LCModel. Multiple regression was used to examine the association of metabolite ratios with focal noncystic white matter lesions visible on conventional magnetic resonance imaging (MRI) and with at-birth illness severity scores. RESULTS Within 2 wk of birth, the ratio of N-acetylaspartate + N-acetylaspartylglutamate to creatine + phosphocreatine was significantly lower in those infants showing white matter abnormalities on conventional MRI. Increased lactate to creatine + phosphocreatine and lactate to glycerophosphocholine + phosphocholine ratios were significantly associated with increasing severity of Clinical Risk Index for Babies II and Apgar scores taken at 1 and 5 min after birth. CONCLUSION Both overall health status at birth and white matter injury in preterm neonates are reflected in metabolite ratios measured shortly after birth. Long-term follow-up will provide additional insight into the prognostic value of these measures.
Collapse
|
226
|
Costello JM, McQuillen PS, Claud EC, Steinhorn RH. Prematurity and congenital heart disease. World J Pediatr Congenit Heart Surg 2013; 2:457-67. [PMID: 23803997 DOI: 10.1177/2150135111408445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant advances in technology and therapy have led to dramatic improvements in the survival of preterm babies over the last 2 decades. Similarly, improvements in surgical and cardiac intensive care techniques have increased the feasibility of supporting even very small babies to the point of surgical repair, leading some to adopt an approach of early and complete surgical repair in preterm infants, with the aim of minimizing potential preoperative morbidity associated with extended medical management or surgical palliation. (1,2) However, multiple diagnostic and therapeutic challenges complicate the care of premature infants. Major errors in echocardiography are more common in neonates weighing less than 2.5 kg, (3) and the ideal timing and type of surgical intervention in premature infants remains unknown. These problems are compounded by the need for critical care practices that optimize management of immature cardiopulmonary, gastrointestinal, and neurological systems. This review will summarize some of the recent advances in neonatal and perinatal medicine, which have the potential to contribute to improved management of preterm infants with critical cardiac disease.
Collapse
Affiliation(s)
- John M Costello
- Department of Pediatrics, Children's Memorial Hospital and Northwestern University, Chicago, IL, USA
| | | | | | | |
Collapse
|
227
|
Omizzolo C, Scratch SE, Stargatt R, Kidokoro H, Thompson DK, Lee KJ, Cheong J, Neil J, Inder TE, Doyle LW, Anderson PJ. Neonatal brain abnormalities and memory and learning outcomes at 7 years in children born very preterm. Memory 2013; 22:605-15. [PMID: 23805915 DOI: 10.1080/09658211.2013.809765] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Using prospective longitudinal data from 198 very preterm and 70 full term children, this study characterised the memory and learning abilities of very preterm children at 7 years of age in both verbal and visual domains. The relationship between the extent of brain abnormalities on neonatal magnetic resonance imaging (MRI) and memory and learning outcomes at 7 years of age in very preterm children was also investigated. Neonatal MRI scans were qualitatively assessed for global, white-matter, cortical grey-matter, deep grey-matter, and cerebellar abnormalities. Very preterm children performed less well on measures of immediate memory, working memory, long-term memory, and learning compared with term-born controls. Neonatal brain abnormalities, and in particular deep grey-matter abnormality, were associated with poorer memory and learning performance at 7 years in very preterm children. Findings support the importance of cerebral neonatal pathology for predicting later memory and learning function.
Collapse
Affiliation(s)
- Cristina Omizzolo
- a Murdoch Childrens Research Institute, Royal Children's Hospital , Parkville , VIC , Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
228
|
Chau V, Taylor MJ, Miller SP. Visual function in preterm infants: visualizing the brain to improve prognosis. Doc Ophthalmol 2013; 127:41-55. [PMID: 23761036 DOI: 10.1007/s10633-013-9397-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/05/2013] [Indexed: 11/28/2022]
Abstract
Considerable development of the visual system occurs in the third trimester of life, a time when very preterm-born infants are in a neonatal intensive care unit (NICU). Their very early birth during a period of rapid and marked neurodevelopment and their clinical course makes them a very high-risk population. A range of different events impacts brain development and the visual system, leading to significant long-term visual dysfunction. Improved neuroimaging techniques provide an important window on the early brain and visual system development of these vulnerable infants. Greater understanding of the etiology of visual impairment subsequent to preterm birth and the timing of critical processes will allow early recognition and the earlier implementations of interventions. In the longer term, this will help clinicians optimize NICU practice to reduce the incidence of visual dysfunction in these children.
Collapse
Affiliation(s)
- Vann Chau
- Department of Pediatrics (Neurology), University of British Columbia, Vancouver, Canada
| | | | | |
Collapse
|
229
|
Duerden EG, Taylor MJ, Miller SP. Brain development in infants born preterm: looking beyond injury. Semin Pediatr Neurol 2013; 20:65-74. [PMID: 23948681 DOI: 10.1016/j.spen.2013.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infants born very preterm are high risk for acquired brain injury and disturbances in brain maturation. Although survival rates for preterm infants have increased in the last decades owing to improved neonatal intensive care, motor disabilities including cerebral palsy persist, and impairments in cognitive, language, social, and executive functions have not decreased. Evidence from neuroimaging studies exploring brain structure, function, and metabolism has indicated abnormalities in the brain development trajectory of very preterm-born infants that persist through to adulthood. In this chapter, we review neuroimaging approaches for the identification of brain injury in the preterm neonate. Advances in medical imaging and availability of specialized equipment necessary to scan infants have facilitated the feasibility of conducting longitudinal studies to provide greater understanding of early brain injury and atypical brain development and their effects on neurodevelopmental outcome. Improved understanding of the risk factors for acquired brain injury and associated factors that affect brain development in this population is setting the stage for improving the brain health of children born preterm.
Collapse
Affiliation(s)
- Emma G Duerden
- Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
230
|
Cortical somatosensory processing measured by magnetoencephalography predicts neurodevelopment in extremely low-gestational-age infants. Pediatr Res 2013; 73:763-71. [PMID: 23478643 DOI: 10.1038/pr.2013.46] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Higher cortical function during sensory processing can be examined by recording specific somatosensory-evoked magnetic fields (SEFs) with magnetoencephalography (MEG). We evaluated whether, in extremely low-gestational-age (ELGA) infants, abnormalities in MEG-recorded SEFs at term age are associated with adverse neurodevelopment at 2 y of corrected age. METHODS SEFs to tactile stimulation of the index finger were recorded at term age in 30 ELGA infants (26.5 ± 1.2 wk, birth weight: 884 g ± 181 g). Neurodevelopment was evaluated at 2 y of corrected age. Controls were 11 healthy term infants. RESULTS In nine of the ELGA infants (30.0%), SEFs were categorized as abnormal on the basis of lack of response from secondary somatosensory cortex (SII). At 2 y, these infants had a significantly worse mean developmental quotient and locomotor subscale on the Griffiths Mental Development Scales than the ELGA infants with normal responses. Mild white matter abnormalities in magnetic resonance imaging at term age were detected in 21% of infants, but these abnormalities were not associated with adverse neurodevelopment. CONCLUSION Abnormal SII responses at term predict adverse neuromotor development at 2 y of corrected age. This adverse development may not be foreseen with conventional neuroimaging methods, suggesting a role for evaluating SII responses in the developmental risk assessment of ELGA infants.
Collapse
|
231
|
Plaisier A, Govaert P, Lequin MH, Dudink J. Optimal timing of cerebral MRI in preterm infants to predict long-term neurodevelopmental outcome: a systematic review. AJNR Am J Neuroradiol 2013; 35:841-7. [PMID: 23639558 DOI: 10.3174/ajnr.a3513] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Advances in neonatal neuroimaging have improved detection of preterm brain injury responsible for abnormal neuromotor and cognitive development. Increasingly sophisticated MR imaging setups allow scanning during early preterm life. In this review, we investigated how brain MR imaging in preterm infants should be timed to best predict long-term outcome. Given the strong evidence that structural brain abnormalities are related to long-term neurodevelopment, MR imaging should preferably be performed at term-equivalent age. Early MR imaging is promising because it can guide early intervention studies and is indispensable in research on preterm brain injury.
Collapse
Affiliation(s)
- A Plaisier
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - P Govaert
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - M H Lequin
- Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - J Dudink
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| |
Collapse
|
232
|
De Bruïne FT, Van Wezel-Meijler G, Leijser LM, Steggerda SJ, Van Den Berg-Huysmans AA, Rijken M, Van Buchem MA, Van Der Grond J. Tractography of white-matter tracts in very preterm infants: a 2-year follow-up study. Dev Med Child Neurol 2013; 55:427-33. [PMID: 23441853 DOI: 10.1111/dmcn.12099] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine whether tractography of white-matter tracts can independently predict neurodevelopmental outcome in very preterm infants. METHOD Out of 84 very preterm infants admitted to a neonatal intensive care unit, 64 (41 males, 23 females; median gestational age 29.1 weeks [range 25.6-31.9]; birthweight 1163 g [range 585-1960]) underwent follow-up at 2 years. Diffusion tensor imaging (DTI) values obtained around term were associated with a neurological examination and mental and psychomotor developmental index scores at 2 years based on the Bayley Scales of Infant Development (version 3). Univariate and logistic regression analyses tested for associations between DTI values and follow-up parameters. Cut-off values predicting motor delay and cerebral palsy (CP) were determined for fractional anisotropy, apparent diffusion coefficient (ADC), and fibre lengths. RESULTS Infants with psychomotor delay and CP had significantly lower fractional anisotropy values (p=0.002, p=0.04 respectively) and shorter fibre lengths (p=0.02, p=0.02 respectively) of the posterior limb of the internal capsule. Infants with psychomotor delay also had significantly higher ADC values (p=0.03) and shorter fibre lengths (p=0.002) of the callosal splenium. Fractional anisotropy values of the posterior limb of the internal capsule independently predicted motor delay and CP, with sensitivity between 80 and 100% and specificity between 66 and 69%. ADC values of the splenium independently predicted motor delay with sensitivity of 100% and specificity of 65%. INTERPRETATION Diffusion tensor imaging tractography at term-equivalent age independently predicts psychomotor delay at 2 years of age in preterm infants.
Collapse
|
233
|
Kidokoro H, Neil JJ, Inder TE. New MR imaging assessment tool to define brain abnormalities in very preterm infants at term. AJNR Am J Neuroradiol 2013; 34:2208-14. [PMID: 23620070 DOI: 10.3174/ajnr.a3521] [Citation(s) in RCA: 332] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE WM injury is the dominant form of injury in preterm infants. However, other cerebral structures, including the deep gray matter and the cerebellum, can also be affected by injury and/or impaired growth. Current MR imaging injury assessment scales are subjective and are challenging to apply. Thus, we developed a new assessment tool and applied it to MR imaging studies obtained from very preterm infants at term age. MATERIALS AND METHODS MR imaging scans from 97 very preterm infants (< 30 weeks' gestation) and 22 healthy term-born infants were evaluated retrospectively. The severity of brain injury (defined by signal abnormalities) and impaired brain growth (defined with biometrics) was scored in the WM, cortical gray matter, deep gray matter, and cerebellum. Perinatal variables for clinical risks were collected. RESULTS In very preterm infants, brain injury was observed in the WM (n=23), deep GM (n=5), and cerebellum (n=23). Combining measures of injury and impaired growth showed moderate to severe abnormalities most commonly in the WM (n=38) and cerebellum (n=32) but still notable in the cortical gray matter (n=16) and deep gray matter (n=11). WM signal abnormalities were associated with a reduced deep gray matter area but not with cerebellar abnormality. Intraventricular and/or parenchymal hemorrhage was associated with cerebellar signal abnormality and volume reduction. Multiple clinical risk factors, including prolonged intubation, prolonged parenteral nutrition, postnatal corticosteroid use, and postnatal sepsis, were associated with increased global abnormality on MR imaging. CONCLUSIONS Very preterm infants demonstrate a high prevalence of injury and growth impairment in both the WM and gray matter. This MR imaging scoring system provides a more comprehensive and objective classification of the nature and extent of abnormalities than existing measures.
Collapse
|
234
|
Wisnowski JL, Blüml S, Paquette L, Zelinski E, Nelson MD, Painter MJ, Damasio H, Gilles F, Panigrahy A. Altered glutamatergic metabolism associated with punctate white matter lesions in preterm infants. PLoS One 2013; 8:e56880. [PMID: 23468888 PMCID: PMC3582631 DOI: 10.1371/journal.pone.0056880] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/15/2013] [Indexed: 12/21/2022] Open
Abstract
Preterm infants (∼10% of all births) are at high-risk for long-term neurodevelopmental disabilities, most often resulting from white matter injury sustained during the neonatal period. Glutamate excitotoxicity is hypothesized to be a key mechanism in the pathogenesis of white matter injury; however, there has been no in vivo demonstration of glutamate excitotoxicity in preterm infants. Using magnetic resonance spectroscopy (MRS), we tested the hypothesis that glutamate and glutamine, i.e., markers of glutamatergic metabolism, are altered in association with punctate white matter lesions and "diffuse excessive high signal intensity" (DEHSI), the predominant patterns of preterm white matter injury. We reviewed all clinically-indicated MRS studies conducted on preterm infants at a single institution during a six-year period and determined the absolute concentration of glutamate, glutamine, and four other key metabolites in the parietal white matter in 108 of those infants after two investigators independently evaluated the studies for punctate white matter lesions and DEHSI. Punctate white matter lesions were associated with a 29% increase in glutamine concentration (p = 0.002). In contrast, there were no differences in glutamatergic metabolism in association with DEHSI. Severe DEHSI, however, was associated with increased lactate concentration (p = 0.001), a marker of tissue acidosis. Findings from this study support glutamate excitotoxicity in the pathogenesis of punctate white matter lesions, but not necessarily in DEHSI, and suggest that MRS provides a useful biomarker for determining the pathogenesis of white matter injury in preterm infants during a period when neuroprotective agents may be especially effective.
Collapse
Affiliation(s)
- Jessica L. Wisnowski
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
- Brain and Creativity Institute, University of Southern California, Los Angeles, California, United States of America
| | - Stefan Blüml
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Lisa Paquette
- Department of Pediatrics, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Elizabeth Zelinski
- Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Marvin D. Nelson
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Michael J. Painter
- Department of Pediatrics, Division of Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
| | - Hanna Damasio
- Brain and Creativity Institute, University of Southern California, Los Angeles, California, United States of America
| | - Floyd Gilles
- Department of Pathology and Laboratory Medicine, Neuropathology Section, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
235
|
Score for neonatal acute physiology-II and neonatal pain predict corticospinal tract development in premature newborns. Pediatr Neurol 2013; 48:123-129.e1. [PMID: 23337005 PMCID: PMC4489879 DOI: 10.1016/j.pediatrneurol.2012.10.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
Abstract
Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of antenatal, perinatal, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks' gestational age) underwent serial brain imaging near birth and at term-equivalent age. With diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development. The perinatal risk factor of greater early illness severity (as measured by the Score for Neonatal Acute Physiology-II [SNAP-II]) was associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.02), even after correcting for gestational age at birth and postnatal risk factors (P = 0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.03 and 0.02, respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.
Collapse
|
236
|
Physiological evidence consistent with reduced neuroplasticity in human adolescents born preterm. J Neurosci 2013; 32:16410-6. [PMID: 23152623 DOI: 10.1523/jneurosci.3079-12.2012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Preterm-born children commonly experience motor, cognitive, and learning difficulties that may be accompanied by altered brain microstructure, connectivity, and neurochemistry. However, the mechanisms linking the altered neurophysiology with the behavioral outcomes are unknown. Here we provide the first physiological evidence that human adolescents born preterm at or before 37 weeks of completed gestation have a significantly reduced capacity for cortical neuroplasticity, the key overall mechanism underlying learning and memory. We examined motor cortex neuroplasticity in three groups of adolescents who were born after gestations of ≤32 completed weeks (early preterm), 33-37 weeks (late preterm), and 38-41 weeks (term) using a noninvasive transcranial magnetic brain stimulation technique to induce long-term depression (LTD)-like neuroplasticity. Compared with term-born adolescents, both early and late preterm adolescents had reduced LTD-like neuroplasticity in response to brain stimulation that was also associated with low salivary cortisol levels. We also compared neuroplasticity in term-born adolescents with that in term-born young adults, finding that the motor cortex retains a relatively enhanced neuroplastic capacity in adolescence. These findings provide a possible mechanistic link between the altered brain physiology of preterm birth and the subsequent associated behavioral deficits, particularly in learning and memory. They also suggest that altered hypothalamic-pituitary-adrenal axis function due to preterm birth may be a significant modulator of this altered neuroplasticity. This latter finding may offer options in the development of possible therapeutic interventions.
Collapse
|
237
|
Kim HY, Choi HY, Lee JW. A Case of Optic Atrophy and Visual Field Defect in Periventricular Leukomalacia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.6.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ho Yun Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Ji Woong Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|
238
|
Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J 2013; 4:e0025. [PMID: 24228168 PMCID: PMC3820298 DOI: 10.5041/rmmj.10132] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Effects of early life psychosocial adversity have received a great deal of attention, such as maternal separation in experimental animal models and abuse/neglect in young humans. More recently, long-term effects of the physical stress of repetitive procedural pain have begun to be addressed in infants hospitalized in neonatal intensive care. Preterm infants are more sensitive to pain and stress, which cannot be distinguished in neonates. The focus of this review is clinical studies of long-term effects of repeated procedural pain-related stress in the neonatal intensive care unit (NICU) in relation to brain development, neurodevelopment, programming of stress systems, and later pain sensitivity in infants born very preterm (24-32 weeks' gestational age). Neonatal pain exposure has been quantified as the number of invasive and/or skin-breaking procedures during hospitalization in the NICU. Emerging studies provide convincing clinical evidence for an adverse impact of neonatal pain/stress in infants at a time of physiological immaturity, rapidly developing brain microstructure and networks, as well as programming of the hypothalamic-pituitary-adrenal axis. Currently it appears that early pain/stress may influence the developing brain and thereby neurodevelopment and stress-sensitive behaviors, particularly in the most immature neonates. However, there is no evidence for greater prevalence of pain syndromes compared to children and adults born healthy at full term. In addressing associations between pain/stress and outcomes, careful consideration of confounding clinical factors related to prematurity is essential. The need for pain management for humanitarian care is widely advocated. Non-pharmacological interventions to help parents reduce their infant's stress may be brain-protective.
Collapse
Affiliation(s)
- Ruth Eckstein Grunau
- Department of Pediatrics, University of British Columbia and Child & Family Research Institute, Vancouver, Canada; and School of Nursing and Midwifery, Queen's University Belfast, UK
| |
Collapse
|
239
|
Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children. PLoS One 2012; 7:e51879. [PMID: 23284800 PMCID: PMC3532310 DOI: 10.1371/journal.pone.0051879] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cerebral white matter abnormalities on term MRI are a strong predictor of motor disability in children born very preterm. However, their contribution to cognitive impairment is less certain. OBJECTIVE Examine relationships between the presence and severity of cerebral white matter abnormalities on neonatal MRI and a range of neurocognitive outcomes assessed at ages 4 and 6 years. DESIGN/METHODS The study sample consisted of a regionally representative cohort of 104 very preterm (≤32 weeks gestation) infants born from 1998-2000 and a comparison group of 107 full-term infants. At term equivalent, all preterm infants underwent a structural MRI scan that was analyzed qualitatively for the presence and severity of cerebral white matter abnormalities, including cysts, signal abnormalities, loss of white matter volume, ventriculomegaly, and corpus callosal thinning/myelination. At corrected ages 4 and 6 years, all children underwent a comprehensive neurodevelopmental assessment that included measures of general intellectual ability, language development, and executive functioning. RESULTS At 4 and 6 years, very preterm children without cerebral white matter abnormalities showed no apparent neurocognitive impairments relative to their full-term peers on any of the domain specific measures of intelligence, language, and executive functioning. In contrast, children born very preterm with mild and moderate-to-severe white matter abnormalities were characterized by performance impairments across all measures and time points, with more severe cerebral abnormalities being associated with increased risks of cognitive impairment. These associations persisted after adjustment for gender, neonatal medical risk factors, and family social risk. CONCLUSIONS Findings highlight the importance of cerebral white matter connectivity for later intact cognitive functioning amongst children born very preterm. Preterm born children without cerebral white matter abnormalities on their term MRI appear to be spared many of the cognitive impairments commonly associated with preterm birth. Further follow-up will be important to assess whether this finding persists into the school years.
Collapse
|
240
|
Cerebral white matter and neurodevelopment of preterm infants after coagulase-negative staphylococcal sepsis. Pediatr Crit Care Med 2012; 13:678-84. [PMID: 22805155 DOI: 10.1097/pcc.0b013e3182455778] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Coagulase-negative staphylococci are the most common pathogens causing late-onset sepsis in the neonatal intensive care unit. Neonatal sepsis can be associated with cerebral white matter damage in preterm infants. Neurodevelopment has been shown to be correlated with apparent diffusion coefficients, fractional anisotropy, and axial and radial diffusivities of the white matter. DESIGN Prospective cohort study. SETTING Twenty-eight-bed neonatal intensive care unit at a tertiary care children's hospital. PATIENTS Seventy preterm infants (gestational age <32 wks), 28 with coagulase-negative staphylococcal sepsis (group 1) and 42 without sepsis (group 2). INTERVENTION The values of apparent diffusion coefficients, fractional anisotropy, and axial and radial diffusivity of three white matter regions (parietal, frontal, and occipital), estimated with diffusion-tensor magnetic resonance imaging with a 3.0-T magnetic resonance imaging system, were obtained at term-equivalent age. Neurodevelopmental outcome assessments were performed at 15 months (Griffiths Mental Developmental Scales) and 24 months (Bayley Scales of Infant and Toddler Development, Third Edition) corrected age. MEASUREMENTS AND MAIN RESULTS Values of apparent diffusion coefficients, fractional anisotropy, and axial and radial diffusivity of the left and right white matter regions were equal in all patients. There was no significant difference in apparent diffusion coefficient values (mean of total: 1.593 ± 0.090 × 10mm(-3)/sec(2) and 1.601 ± 0.117 × 10mm(-3)/sec(2), respectively, p = .684), fractional anisotropy values (mean of total: 0.19 ± 0.04 and 0.19 ± 0.03, respectively, p = .350), radial diffusivity (mean of total: 1.420 ± 0.09 × 10mm(-3)/sec(2)and 1.425 ± 0.12 × 10mm(-3)/sec(2), respectively, p = .719), and axial diffusivity (mean of total: 1.940 ± 0.12 × 10mm(-3)/sec(2) and 1.954 ± 0.13 × 10mm(-3)/sec(2), respectively, p = .590) in the three combined regions between the two groups. No significant differences were found in neurodevelopmental outcome at 24 months. CONCLUSIONS No association was found between coagulase-negative staphylococcal sepsis in preterm infants and cerebral white matter damage as determined by values of apparent diffusion coefficients, fractional anisotropy, and radial and axial diffusivity at term-equivalent age, and no adverse effect was seen on early neurodevelopmental outcome.
Collapse
|
241
|
Pitcher JB, Schneider LA, Burns NR, Drysdale JL, Higgins RD, Ridding MC, Nettelbeck TJ, Haslam RR, Robinson JS. Reduced corticomotor excitability and motor skills development in children born preterm. J Physiol 2012; 590:5827-44. [PMID: 22966161 DOI: 10.1113/jphysiol.2012.239269] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The mechanisms underlying the altered neurodevelopment commonly experienced by children born preterm, but without brain lesions, remain unknown. While individuals born the earliest are at most risk, late preterm children also experience significant motor, cognitive and behavioural dysfunction from school age, and reduced income and educational attainment in adulthood. We used transcranial magnetic stimulation and functional assessments to examine corticomotor development in 151 children without cerebral palsy, aged 10-13 years and born after gestations of 25-41 completed weeks. We hypothesized that motor cortex and corticospinal development are altered in preterm children, which underpins at least some of their motor dysfunction. We report for the first time that every week of reduced gestation is associated with a reduction in corticomotor excitability that remains evident in late childhood. This reduced excitability was associated with poorer motor skill development, particularly manual dexterity. However, child adiposity, sex and socio-economic factors regarding the child's home environment soon after birth were also powerful influences on development of motor skills. Preterm birth was also associated with reduced left hemisphere lateralization, but without increasing the likelihood of being left handed per se. These corticomotor findings have implications for normal motor development, but also raise questions regarding possible longer term consequences of preterm birth on motor function.
Collapse
Affiliation(s)
- Julia B Pitcher
- Research Centre for Early Origins of Health and Disease, Robinson Institute, School of Paediatrics & Reproductive Health, University of Adelaide, SA 5005, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
242
|
Smyser CD, Kidokoro H, Inder TE. Magnetic resonance imaging of the brain at term equivalent age in extremely premature neonates: to scan or not to scan? J Paediatr Child Health 2012; 48:794-800. [PMID: 22970674 PMCID: PMC3595093 DOI: 10.1111/j.1440-1754.2012.02535.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the last decade, the role of magnetic resonance imaging (MRI) in neonatal care for prematurely born infants has rapidly expanded and evolved. Recent investigations addressed many of the practical issues pertaining to image acquisition and interpretation, enabling high-quality MR images to be obtained without sedating medications in preterm infants at any institution. Expanded application has demonstrated that MRI provides superior ability to assess cerebral development and identify and define cerebral injury in comparison to other imaging modalities. Term equivalent MRI results have been shown to correlate with neurodevelopmental outcomes, providing improved predictive ability over other neuroimaging, clinical or physical examination measures. Regular utilisation of MRI in this population is fundamental to gaining the knowledge and expertise necessary for rational, accurate application. Ongoing experiences will continue to shape the nature and type of information available to clinicians and families using MRI, further refining its role as a routine element of neonatal care.
Collapse
|
243
|
Bennet L, Tan S, Van den Heuij L, Derrick M, Groenendaal F, van Bel F, Juul S, Back SA, Northington F, Robertson NJ, Mallard C, Gunn AJ. Cell therapy for neonatal hypoxia-ischemia and cerebral palsy. Ann Neurol 2012; 71:589-600. [PMID: 22522476 DOI: 10.1002/ana.22670] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Perinatal hypoxic-ischemic brain injury remains a major cause of cerebral palsy. Although therapeutic hypothermia is now established to improve recovery from hypoxia-ischemia (HI) at term, many infants continue to survive with disability, and hypothermia has not yet been tested in preterm infants. There is increasing evidence from in vitro and in vivo preclinical studies that stem/progenitor cells may have multiple beneficial effects on outcome after hypoxic-ischemic injury. Stem/progenitor cells have shown great promise in animal studies in decreasing neurological impairment; however, the mechanisms of action of stem cells, and the optimal type, dose, and method of administration remain surprisingly unclear, and some studies have found no benefit. Although cell-based interventions after completion of the majority of secondary cell death appear to have potential to improve functional outcome for neonates after HI, further rigorous testing in translational animal models is required before randomized controlled trials should be considered.
Collapse
Affiliation(s)
- Laura Bennet
- Department of Physiology, University of Auckland, New Zealand
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
244
|
Tam EWY, Chau V, Ferriero DM, Barkovich AJ, Poskitt KJ, Studholme C, Fok EDY, Grunau RE, Glidden DV, Miller SP. Preterm cerebellar growth impairment after postnatal exposure to glucocorticoids. Sci Transl Med 2012; 3:105ra105. [PMID: 22013125 DOI: 10.1126/scitranslmed.3002884] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
As survival rates of preterm newborns improve as a result of better medical management, these children increasingly show impaired cognition. These adverse cognitive outcomes are associated with decreases in the volume of the cerebellum. Because animals exhibit reduced preterm cerebellar growth after perinatal exposure to glucocorticoids, we sought to determine whether glucocorticoid exposure and other modifiable factors increased the risk for these adverse outcomes in human neonates. We studied 172 preterm neonatal infants from two medical centers, the University of British Columbia and the University of California, San Francisco, by performing serial magnetic resonance imaging examinations near birth and again near term-equivalent age. After we adjusted for associated clinical factors, antenatal betamethasone was not associated with changes in cerebellar volume. Postnatal exposure to clinically routine doses of hydrocortisone or dexamethasone was associated with impaired cerebellar, but not cerebral, growth. Alterations in treatment after preterm birth, particularly glucocorticoid exposure, may help to decrease risk for adverse neurological outcome after preterm birth.
Collapse
Affiliation(s)
- Emily W Y Tam
- Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
245
|
Microglial reaction in axonal crossroads is a hallmark of noncystic periventricular white matter injury in very preterm infants. J Neuropathol Exp Neurol 2012; 71:251-64. [PMID: 22318128 DOI: 10.1097/nen.0b013e3182496429] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Disabilities after brain injury in very preterm infants have mainly been attributed to noncystic periventricular white matter injury (PWMI). We analyzed spatiotemporal patterns of PWMI in the brains of 18 very preterm infants (25-29 postconceptional weeks [pcw]), 7 preterm infants (30-34 pcw), and 10 preterm controls without PWMI. In very preterm infants, we examined PWMI in detail in 2 axonal crossroad areas in the frontal lobe: C1 (lateral to the lateral angle of the anterior horn of the lateral ventricle, at the exit of the internal capsule radiations) and C2 (above the corpus callosum and dorsal angle of the anterior horn). These brains had greater microglia-macrophage densities and activation but lesser astroglial reaction (glial fibrillary acidic protein and monocarboxylate transporter 1 expression) than in preterm cases with PWMI. In preterm infants, scattered necrotic foci were rimmed by axonal spheroids and ionized calcium binding adaptor molecule 1-positive macrophages. Diffuse lesions near these foci consisted primarily of hypertrophic and reactive astrocytes associated with fewer microglia. No differences in Olig2-positive preoligodendrocytes between noncystic PWMI and control cases were found. These data show that the growing axonal crossroad areas are highly vulnerable to PWMI in very preterm infants and highlight differences in glial activation patterns between very preterm and preterm infants.
Collapse
|
246
|
Skiöld B, Vollmer B, Böhm B, Hallberg B, Horsch S, Mosskin M, Lagercrantz H, Ådén U, Blennow M. Neonatal magnetic resonance imaging and outcome at age 30 months in extremely preterm infants. J Pediatr 2012; 160:559-566.e1. [PMID: 22056283 DOI: 10.1016/j.jpeds.2011.09.053] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 08/08/2011] [Accepted: 09/26/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To examine associations between brain white matter abnormalities, including diffuse excessive high signal intensities, detected on neonatal magnetic resonance imaging (MRI) with neurodevelopmental outcome at age 30 months. STUDY DESIGN This was a prospective, population-based study of infants born at <27 weeks gestation (n=117) undergoing conventional MRI at term equivalent age (n=107). At age 30 months corrected, 91 of the preterm infants (78%) and 85 term-born controls were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). RESULTS Cerebral palsy (CP) was present in 7% of the preterm group. On the BSID-III, mean composite scores were 96±9.5 for the cognitive scale, 97±14 for language scales, and 103±15 for motor scales, all within the normal range for age. Compared with the term-born controls, however, the preterm infants did not perform as well on all 3 scales, also when MRI was normal. Significant associations were seen between moderate to severe white matter abnormalities and CP (P<.001). The presence of diffuse excessive high signal intensities was not associated with performance on the BSID-III or with CP. CONCLUSION This 3-year cohort of extremely preterm infants had low rates of major brain injury and impaired outcome. Neonatal MRI provides useful information, but this information needs to be treated with caution when predicting outcome.
Collapse
Affiliation(s)
- Béatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
247
|
Back SA, Riddle A, Dean J, Hohimer AR. The instrumented fetal sheep as a model of cerebral white matter injury in the premature infant. Neurotherapeutics 2012; 9:359-70. [PMID: 22399133 PMCID: PMC3337024 DOI: 10.1007/s13311-012-0108-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Despite advances in neonatal intensive care, survivors of premature birth remain highly susceptible to unique patterns of developmental brain injury that manifest as cerebral palsy and cognitive-learning disabilities. The developing brain is particularly susceptible to cerebral white matter injury related to hypoxia-ischemia. Cerebral white matter development in fetal sheep shares many anatomical and physiological similarities with humans. Thus, the fetal sheep has provided unique experimental access to the complex pathophysiological processes that contribute to injury to the human brain during successive periods in development. Recent refinements have resulted in models that replicate major features of acute and chronic human cerebral injury and have provided access to complex clinically relevant studies of cerebral blood flow and neuroimaging that are not feasible in smaller laboratory animals. Here, we focus on emerging insights and methodologies from studies in fetal sheep that have begun to define cellular and vascular factors that contribute to white matter injury. Recent advances include spatially defined measurements of cerebral blood flow in utero, the definition of cellular maturational factors that define the topography of injury and the application of high-field magnetic resonance imaging to define novel neuroimaging signatures for specific types of chronic white matter injury. Despite the higher costs and technical challenges of instrumented preterm fetal sheep models, they provide powerful access to clinically relevant studies that provide a more integrated analysis of the spectrum of insults that appear to contribute to cerebral injury in human preterm infants.
Collapse
Affiliation(s)
- Stephen A Back
- Department of Pediatrics, Oregon Health Sciences University, Portland, OR 97239, USA.
| | | | | | | |
Collapse
|
248
|
Regional differences in susceptibility to hypoxic-ischemic injury in the preterm brain: exploring the spectrum from white matter loss to selective grey matter injury in a rat model. Neurol Res Int 2012; 2012:725184. [PMID: 22530125 PMCID: PMC3317060 DOI: 10.1155/2012/725184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/03/2011] [Indexed: 02/02/2023] Open
Abstract
Models of premature brain injury have largely focused on the white matter injury thought to underlie periventricular leukomalacia (PVL). However, with increased survival of very low birth weight infants, injury patterns involving grey matter are now recognized. We aimed to determine how grey matter lesions relate to hypoxic-ischemic- (HI) mediated white matter injury by modifying our rat model of PVL. Following HI, microglial infiltration, astrocytosis, and neuronal and axonal degeneration increased in a region-specific manner dependent on the severity of myelin loss in pericallosal white matter. The spectrum of injury ranged from mild, where diffuse white matter abnormalities were dominant and were associated with mild axonal injury and local microglial activation, to severe HI injury characterized by focal MBP loss, widespread neuronal degeneration, axonal damage, and gliosis throughout the neocortex, caudate putamen, and thalamus. In sum, selective regional white matter loss occurs in the preterm rat concomitantly with a clinically relevant spectrum of grey matter injury. These data demonstrate an interspecies similarity of brain injury patterns and further substantiates the reliable use of this model for the study of preterm brain injury.
Collapse
|
249
|
Van Kooij BJM, Benders MJNL, Anbeek P, Van Haastert IC, De Vries LS, Groenendaal F. Cerebellar volume and proton magnetic resonance spectroscopy at term, and neurodevelopment at 2 years of age in preterm infants. Dev Med Child Neurol 2012; 54:260-6. [PMID: 22211363 DOI: 10.1111/j.1469-8749.2011.04168.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess the relation between cerebellar volume and spectroscopy at term equivalent age, and neurodevelopment at 24 months corrected age in preterm infants. METHODS Magnetic resonance imaging of the brain was performed around term equivalent age in 112 preterm infants (mean gestational age 28wks 3d [SD 1wk 5d]; birthweight 1129g [SD 324g]). Cerebellar volume (60 males, 52 females), and proton magnetic resonance spectroscopy ((1) H-MRS) of the cerebellum in a subgroup of 58 infants were assessed in relation to cognitive, fine motor, and gross motor scores on the Bayley Scales of Infant and Toddler Development-III. Different neonatal variables and maternal education were regarded possible confounders. RESULTS Cerebellar volume was significantly associated with postmenstrual age at time of magnetic resonance imaging. Cerebellar volume corrected for postmenstrual age was significantly and positively associated with cognition. Cognitive scores related significantly with N-acetylaspartate/choline (NAA/Cho) ratio obtained from cerebellar (1) H-MRS in 53 infants. Correction for neonatal and maternal variables did not change these results. Cerebellar variables were not related to motor performance. INTERPRETATION In preterm infants, both cerebellar volume and cerebellar NAA/Cho ratio at term equivalent age were positively associated with cognition; however, no relation was found with motor outcome at 2 years of age. These findings support the importance of the cerebellum in cognitive development in preterm infants.
Collapse
Affiliation(s)
- Britt J M Van Kooij
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | |
Collapse
|
250
|
Abstract
INTRODUCTION Infection is a risk factor for adverse neurodevelopmental outcome in preterm newborns. Our objective was to characterize the association of postnatal infection with adverse microstructural and metabolic brain development in premature newborns. RESULTS In 34/117 newborns studied, clinical signs were accompanied by positive cultures whereas 17 had clinical signs of sepsis alone. White matter injury (WMI) was identified in 34 newborns. In multivariate regression models, infected newborns had brain imaging measures indicative of delayed brain development: lower N-acetylaspartate/choline, elevated average diffusivity (D(AV)), and decreased white matter fractional anisotropy. These widespread brain abnormalities were found in both newborns with positive-culture infection and in those with clinical infection. DISCUSSION These findings suggest that postnatal infection, even without a positive culture, is an important risk factor for widespread abnormalities in brain development. These abnormalities extend beyond brain injuries apparent with conventional magnetic resonance injury (MRI). METHODS 117 preterm newborns (24-32 wk gestation) were studied prospectively at a median of 32.0 and 40.3 wk ostmenstrual age with MRI (WMI, hemorrhage), magnetic resonance (MR) spectroscopy (metabolism), and diffusion tensor imaging (microstructure). Newborns were categorized as having "no infection," "clinical infection," or "positive-culture infection." We compared brain injuries as well as metabolic and microstructural development across these infection groups.
Collapse
|