Hippocampal volume and everyday memory in children of very low birth weight

Brain volumes in adult survivors of very low birth weight: a sibling-controlled study

OBJECTIVES

To establish whether adults who were born very low birth weight (VLBW) show altered volumes of certain brain structures.

METHODS

Unmatched case-control study was conducted of 33 individuals from a cohort of VLBW (<1500 g) infants who were born between 1966 and 1977 and 18 of their normal birth weight siblings. Whole brain, gray matter, ventricular, corpus callosum, and hippocampal volumes were measured on structural magnetic resonance imaging scans.

RESULTS

VLBW individuals had a 46% increase in total ventricular volume and a 17% reduction in posterior corpus callosum volume. No differences in whole brain, gray matter, or hippocampal volumes were observed.

CONCLUSION

Specific differences exist in the volumes of certain brain structures in adults who were born VLBW compared with their normal birth weight siblings.

Early alteration of structural and functional brain development in premature infants born with intrauterine growth restriction

Placental insufficiency with fetal intrauterine growth restriction (IUGR) is an important cause of perinatal mortality and morbidity and is subsequently associated with significant neurodevelopmental impairment in cognitive function, attention capacity, and school performance. The underlying biologic cause for this association is unclear. Twenty-eight preterm infants (gestational age 32.5 +/- 1.9 wk) were studied by early and term magnetic resonance imaging (MRI). An advanced quantitative volumetric three-dimensional MRI technique was used to measure brain tissue volumes in 14 premature infants with placental insufficiency, defined by abnormal antenatal Doppler measurements and mean birth weights <10(th) percentile (1246 +/- 299 g) (IUGR) and in 14 preterm infants matched for gestational age with normal mean birth weights 1843 +/- 246 g (control). Functional outcome was measured at term in all infants by a specialized assessment scale of preterm infant behavior. Premature infants with IUGR had a significant reduction in intracranial volume (mean +/- SD: 253.7 +/- 29.9 versus 300.5 +/- 43.5 mL, p < 0.01) and in cerebral cortical gray matter (mean +/- SD: 77.2 +/- 16.3 versus 106.8 +/- 24.6 mL, p < 0.01) when measured within the first 2 wk of life compared with control premature infants. These findings persisted at term with intracranial volume (mean +/- SD: 429.3 +/- 47.9 versus 475.9 +/- 53.4 mL, p < 0.05) and cerebral cortical gray matter (mean +/- SD: 149.3 +/- 29.2 versus 189 +/- 34.2 mL, p < 0.01). Behavioral assessment at term showed a significantly less mature score in the subsystem of attention-interaction availability in IUGR infants (p < 0.01). Cerebral cortical gray matter volume at term correlated with attention-interaction capacity measured at term (r = 0.45, p < 0.05). These results suggest that placental insufficiency with IUGR have specific structural and functional consequences on cerebral cortical brain development. These findings may provide insight into the structural-functional correlate for the developmental deficits associated with IUGR.

Cell proliferation correlates with the postconceptual and not with the postnatal age in the hippocampal dentate gyrus, temporal neocortex and cerebellar cortex of preterm infants

BACKGROUND

In previous studies, lower IQ scores and educational difficulties of preterm children were correlated with the reduced size of several brain areas, including the cerebellum and the hippocampus. The most plausible reason for reduction would be the reduced cell formation following premature birth. However, no data are available about the rate of postnatal cell proliferation in the different brain areas of preterms.

METHODS

Cytoarchitectonics and cell proliferation were examined in the cerebellum, hippocampal formation and temporal neocortex of preterm infants who lived for several weeks or months. Cell proliferation was detected with Ki-67 immunostaining and proliferating cells were identified with vimentin as glial and with CD31 and periodic acid-Schiff (PAS) reaction as endothelial elements.

RESULTS

The rate of cell formation and the width of the cytoarchitectonic layers of the cerebellum of preterm infants corresponded to that of the age-matched controls. In the hippocampal dentate gyrus, the rate of cell formation and the density of proliferating cells were slightly higher in the preterm infants than in the full-term age-matched controls. Endothelial cell proliferation and the surface area of the capillaries were larger in the dentate gyrus of preterms than in age-matched controls.

CONCLUSION

Rate of cell proliferation that correlates with the postconceptual age is not reduced in preterms, therefore the reduced size of the cerebellum and hippocampal formation is unlikely to be the result of decreased cell formation.

Fetal adaptation to stress. Part I: acceleration of fetal maturation and earlier birth triggered by placental insufficiency in humans

This review is an attempt to provide an integrative view for the biological changes triggered by fetal stress through a multidisciplinary approach. Acceleration of brain and lung maturation in certain risk pregnancies was first described clinically and confirmed by biochemical, electrophysiological and experimental data. Moreover, new experimental findings suggest that a fetal clock centrally mediated by fetal nutritional status could determine timing of parturition. However, some skepticism persisted about the usefulness of this body of knowledge for obstetrical management in developed countries. The interest concerning this adaptation to intrauterine stress was later renewed from various sources, as developed in Part II.

Caudate and hippocampal volumes, intelligence, and motor impairment in 7-year-old children who were born preterm

Children who survive very preterm birth without major disability have a high prevalence of learning difficulty, attention deficit, and minor motor impairment (MMI). To determine whether these difficulties are associated with structural brain abnormalities, we studied 105 preterm children (<32 wk) at 7 y with tests of IQ and MMI (Movement ABC) and detailed magnetic resonance brain scans. Scans were assessed qualitatively for visible cerebral lesions. Volume measurements of the caudate nuclei and hippocampal formations were made. Total brain volume (TBV) was estimated from the head circumference. Qualitative assessment of the scans showed evidence of cerebral lesions in 20 (19%), which were associated with lower IQ and more frequent MMI. IQ correlated with right and left caudate volume (Spearman's rho 0.304 and 0.349; p < 0.01). This association persisted (except for verbal IQ) when caudate volume was expressed as a percentage of estimated TBV to allow for overall brain size. No significant correlations with hippocampal volumes were observed. These differences persisted when only scans from children without visible lesions on scan were considered. MMI was significantly associated only with TBV and was more common in children with evidence of thinning of the posterior corpus callosum, although most children with MMI have a normal corpus callosum. Lower IQs in children who were born preterm are related to poorer development of the caudate relative to the rest of the brain, independent of other lesions. These findings suggest abnormal brain development after perinatal injury or postnatal nutritional deficits is responsible for cognitive deficits in preterm children.

A limited range of measures of 2-D ultrasound correlate with 3-D MRI cerebral volumes in the premature infant at term

Two-dimensional (2-D) cranial ultrasound (US) is the principal method for the detection of cerebral injury in the newborn. The aim of this study was to compare 2-D sonographic methods with more advanced 3-D magnetic resonance imaging (MRI) for assessing brain structure. From July 1998 to November 2000, we conducted a prospective methodological study comparing 2-D cranial sonographic measurements with volumes of cerebrospinal fluid (CSF), white matter, grey matter and total volume of brain obtained using 3-D MRI. The study group comprised 63 infants (33 boys), mean gestational age 28 weeks (range 23 to 33 weeks), with imaging studies within 15 days of term equivalent. The highest correlations were between the occipital horn length and total brain volume (R2 = 0.30), the subarachnoid space and both CSF volume (R2 = 0.46) and relative intracranial space occupied by brain tissue (R2 = 0.48). Only 8 (30%) of the 2-D cranial US measures demonstrated good reproducibility. 2-D sonographic measures are limited in reflecting variations in overall cerebral structure, although certain measures, such as subarachnoid space and occipital lobe measures, may be useful in better defining cerebral parenchymal and CSF volumes.

Neurophysiologic correlates of deficient phonological representations and object naming in prematurely born children

OBJECTIVE

The aim of this follow-up study was to evaluate the development of object naming ability and auditory processing in prematurely born children. Furthermore, we investigated whether the mismatch negativity (MMN) parameters at the age of 4 years correlate with the MMN parameters and naming ability at the age of 6 years.

METHODS

Twelve very low birth weight (VLBW) preterm children (mean age 5 years 7 months) and matched controls were studied. Object naming was measured by the Boston naming test. Auditory event-related potentials (ERPs), especially the MMN, were recorded for Finnish syllables (standard /taa/; deviants /ta/ and /kaa/) in an oddball paradigm.

RESULTS

VLBW preterm children scored significantly lower in the object naming test than their controls. The MMN amplitude for consonant change was significantly smaller in the preterm group compared to the controls. The MMN amplitude at the age of 4 years correlated with the MMN amplitude at the age of 6 years. Furthermore, absence of the MMN at the age of 4 years predicted naming difficulties at the age of 6 years.

CONCLUSIONS

VLBW preterm children with a difficulty to preattentively discriminate changes in syllables, as indexed by the diminished change detection response, MMN, seem to have sustained naming difficulty. Therefore, it is reasonable to record the MMN along with the language development from infancy, in order to identify the children at risk for language deficiencies and to provide appropriate rehabilitation.

Magnetic resonance imaging and T2 relaxometry of cerebral white matter and hippocampus in children born preterm

The objective of this study was to determine whether intelligence and minor motor impairments in children who are born preterm without major disability are associated with cerebral white matter (CWM) and hippocampal abnormalities on magnetic resonance imaging (MRI). A total of 103 preterm children were studied at age 7 y with detailed magnetic resonance brain scans, including a T2-mapping sequence from which T2 relaxation times of the CWM and hippocampal formations were calculated. All of the children had no major motor disability, attended normal school, and had undergone assessment of IQ and a test for minor motor impairment (MMI). Twenty children had visible lesions on MRI, which were associated with lower IQ and more frequent MMI. Mean (SD) IQ was 90 (14.1). Twenty-five children were shown to have MMI (Movement ABC at below the fifth centile). This group was shown to have significantly longer T2 relaxation times for CWM (mean difference 2.1 ms right, 3.1 ms left) but not the hippocampus than the children without MMI. These differences persisted when only children without visible lesions on scans were considered (mean difference 1.5 ms bilaterally). There was no significant correlation between IQ and T2 relaxation times. Children who are born preterm without subsequent major neurodisability may, in addition to visible lesions on MRI scans, have a diffuse abnormality of CWM, manifest as an increase in T2 relaxation time. This abnormality shows a close correlation with minor motor impairment but not with full-scale IQ.

Developmental amnesia and its relationship to degree of hippocampal atrophy

Two groups of adolescents, one born preterm and one with a diagnosis of developmental amnesia, were compared with age-matched normal controls on measures of hippocampal volume and memory function. Relative to control values, the preterm group values showed a mean bilateral reduction in hippocampal volume of 8-9% (ranging to 23%), whereas the developmental amnesic group values showed a reduction of 40% (ranging from 27% to 56%). Despite equivalent IQ and immediate memory scores in the two study groups, there were marked differences between them on a wide variety of verbal and visual delayed memory tasks. Consistent with their diagnosis, the developmental amnesic group was impaired relative to both other groups on nearly all delayed memory measures. The preterm group, by contrast, was significantly impaired relative to the controls on only a few memory measures, i.e., route following and prospective memory. We suggest that early hippocampal pathology leads to the disabling memory impairments associated with developmental amnesia when the volume of this structure is reduced below normal by approximately 20-30% on each side. Whether this is a sufficient condition for the disorder or whether abnormality in other brain regions is also necessary remains to be determined.

Dendritic morphology is altered in hippocampal neurons following prenatal compromise

Chronic placental insufficiency (CPI), a known cause of intrauterine growth restriction, can lead to structural alterations in the developing brain that might underlie postnatal neurological deficits. We have previously demonstrated significant reductions in the volumes of hippocampal neuropil layers in fetal guinea pig brains following experimentally induced growth restriction. To determine the components of the neuropil affected in the brains of growth restricted (GR) fetuses, the dendritic morphology of CA1 pyramidal neurons and dentate granule cells was examined. CPI was induced by unilateral uterine artery ligation in pregnant guinea pigs at midgestation (term approximately 67 days). Hippocampi from control and GR fetuses were stained using the Rapid Golgi technique and the growth and branching of the dendritic arbors were quantified using the Sholl method. In addition, the density of dendritic spines was determined on the apical arbors of each population. In GR brains (n = 7) compared to controls (n = 7), there was a reduction in dendritic elongation (p < 0.005) and an alteration in the branch point distribution in CA1 basal arbors, and a reduction both in the outgrowth (p < 0.05) and branch point number (p < 0.05) of CA1 apical arbors. Dentate granule cells from GR brains also demonstrated reduced dendritic outgrowth (p < 0.05). There was an increase in dendritic spine density in both neuronal populations; this might be due either to altered synaptic pruning or as a compensatory mechanism for reduced dendritic length. These findings demonstrate that a chronic prenatal insult causes selective changes in the morphology of hippocampal cell dendrites and may lead to alterations in hippocampal function in the postnatal period.

Effects on brain development leading to cognitive impairment: a worldwide epidemic

This article reviews causes of cognitive impairment in children with a focus on those in developing countries. The number of children with cognitive limitations is increasing, and for the majority there is little access to professional expertise. Causes include malnutrition, genetic diseases, infectious diseases such as meningitis, parasites, and cerebral malaria, in utero drug and alcohol exposure, newborn asphyxia, low birth weight, head injuries, and endocrine disorders. Many of these are preventable; however, resources for prevention are limited in most developing areas of the world. The challenge for this century is to encourage community leaders and government officials to take on the prevention of cognitive impairment as the highest priority for society. This article proposes that specialists in child behavior and development work with United Nations agencies to develop a "world cognitive impairment watch" to assess and assist each country annually in terms of risk factors, prevention programs, and early intervention programs.

Human hippocampus and viewpoint dependence in spatial memory

Virtual reality was used to sequentially present objects within a town square and to test recognition of object locations from the same viewpoint as presentation, or from a shifted viewpoint. A developmental amnesic case with focal bilateral hippocampal pathology showed a massive additional impairment when tested from the shifted viewpoint compared with a mild, list length-dependent, impairment when tested from the same viewpoint. While the same-view condition could be solved by visual pattern matching, the shifted-view condition requires a viewpoint independent representation or an equivalent mechanism for translating or rotating viewpoints in memory. The latter mechanism was indicated by control subjects' response latencies in the shifted-view condition, although the amnesic case is not impaired in tests of mental rotation of single objects. These results show that the human hippocampus supports viewpoint independence in spatial memory, and suggest that it does so by providing a mechanism for viewpoint manipulation in memory. In addition, they suggest an extremely sensitive test for human hippocampal damage, and hint at the nature of the hippocampal role in episodic recollection.

Cognitive and behavioral deficits in premature graduates of intensive care

A substantial number of VLBW graduates of intensive care develop cognitive and behavioral problems, even in the absence of neuroimaging abnormalities. Although this article has highlighted the potential, important, contributing role of medical and stressful, neonatal, environmental conditions to the development of these deficits, it is not all-encompassing, and there are additional prenatal (ie, in utero stress, drug exposure) and neonatal (ie, infectious) contributing factors. The long-term, outcome data presented in this article are pertinent to the more mature, VLBW infant, and it remains unclear and critically important to delineate the long-term, neurobehavioral outcome of those extremely low birth-weight survivors born at the cutting limit of viability.

Perinatal infection, fetal inflammatory response, white matter damage, and cognitive limitations in children born preterm

Only sparse information is available about a possible association between antenatal infection outside the brain and subsequent cognitive limitations among preterm infants. Based on published studies, we provide a theoretical schema that links them via the fetal inflammatory response and neonatal white matter damage. We conclude that the relationship between antenatal infection and cognitive limitations deserves much further attention by researchers interested in the prevention of this undesirable outcome of prematurity.

Neurobehavioral deficits in premature graduates of intensive care--potential medical and neonatal environmental risk factors

There is growing evidence that a large number of very low birth weight infants are exhibiting neurobehavioral problems in the absence of cerebral palsy at follow-up that has extended into school age and adolescence. Many clinical factors (ie, chronic lung disease, recurrent apnea and bradycardia, transient hypothyroxemia of prematurity, hyperbilirubinemia, nutritional deficiencies, glucocorticoid exposure), as well as stressful environmental conditions, including infant-provider interaction, constant noise, and bright light, may act in combination to impact on the developing brain, even in the absence of overt hemorrhage and/or ischemia. Any potential intervention strategy designed to prevent cognitive and behavioral problems has to account for the numerous biological and clinical conditions and/or interventions, as well as postdischarge social and environmental influences.

Dissociations in cognitive memory: the syndrome of developmental amnesia

The dearth of studies on amnesia in children has led to the assumption that when damage to the medial temporal lobe system occurs early in life, the compensatory capacity of the immature brain rescues memory functions. An alternative view is that such damage so interferes with the development of learning and memory that it results not in selective cognitive impairments but in general mental retardation. Data will be presented to counter both of these arguments. Results obtained from a series of 11 amnesic patients with a history of hypoxic ischaemic damage sustained perinatally or during childhood indicate that regardless of age at onset of hippocampal pathology, there is a pronounced dissociation between episodic memory, which is severely impaired, and semantic memory, which is relatively preserved. A second dissociation is characterized by markedly impaired recall and relatively spared recognition leading to a distinction between recollection-based versus familiarity-based judgements. These findings are discussed in terms of the locus and extent of neuropathology associated with hypoxic ischaemic damage, the neural basis of 'remembering' versus 'knowing', and a hierarchical model of cognitive memory.

School-age consequences of birth weight less than 750 g: a review and update

Recent advances in perinatal care have led to the survival of increasing numbers of children born at the lower limits of viability. Children with very low birth weight (LBW; less than 1,500 g, 3 lb 5 oz) have been studied extensively. Findings document poorer outcomes relative to normal birth weight term-born controls in neurologic and health status, cognitive-neuropsychological skills, school performance, academic achievement, and behavior. This report reviews current knowledge regarding LBW children, with special emphasis on outcomes for children with birth weight less than 750 g (1 lb 10 oz). Results from an ongoing longitudinal study suggest a gradient of sequelae, with poorer outcomes in less than 750 g birth weight children compared to both 750 g to 1,499 g birth weight children and term-born controls. Children with less than 750 g birth weight fail to catch up with their peers over time and may even be at risk for age-related increases in sequelae. Outcomes are highly variable but related to neonatal medical complications of prematurity and social risk factors. Further research is needed to understand the etiology and neuropathological basis of sequelae, the long-term developmental implications of LBW, and treatment needs.

Structural brain imaging and the prevention of schizophrenia: can we identify neuroanatomical markers for young people at risk for the development of schizophrenia?

OBJECTIVE

To examine the potential role of measures derived from structural brain imaging as phenotypic markers for the development of schizophrenia.

METHOD

Literature review of results of MRI-based assessments of brain structure in patients with schizophrenia, their first-degree relatives and factors that affect interpretation of such results.

RESULTS

Reliable differences in brain structure can be detected in patients with schizophrenia, including those experiencing a first episode of psychosis. Further research is required to determine whether these differences are progressive, how they relate to potential confounding factors such as comorbid substance abuse and the functional consequences of the relatively subtle changes observed.

CONCLUSIONS

Further research is needed before structural brain change can be considered as a phenotypic marker for those at risk of developing schizophrenia. Large-scale collaborative research in clinical and normal volunteer groups using standardised assessment protocols would enable the early identification of those findings with predictive power in at-risk populations.