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Gorham LS, Latham AR, Alexopoulos D, Kenley JK, Iannopollo E, Lean RE, Loseille D, Smyser TA, Neil JJ, Rogers CE, Smyser CD, Garcia K. Children born very preterm experience altered cortical expansion over the first decade of life. Brain Commun 2024; 6:fcae318. [PMID: 39329081 PMCID: PMC11426356 DOI: 10.1093/braincomms/fcae318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/09/2024] [Accepted: 09/16/2024] [Indexed: 09/28/2024] Open
Abstract
The brain develops rapidly from the final trimester of gestation through childhood, with cortical surface area expanding greatly in the first decade of life. However, it is unclear exactly where and how cortical surface area changes after birth, or how prematurity affects these developmental trajectories. Fifty-two very preterm (gestational age at birth = 26 ± 1.6 weeks) and 41 full-term (gestational age at birth = 39 ± 1.2 weeks) infants were scanned using structural magnetic resonance imaging at term-equivalent age and again at 9/10 years of age. Individual cortical surface reconstructions were extracted for each scan. Infant and 9/10 cortical surfaces were aligned using anatomically constrained Multimodal Surface Matching (aMSM), a technique that allows calculation of local expansion gradients across the cortical surface for each individual subject. At the neonatal time point, very preterm infants had significantly smaller surface area than their full-term peers (P < 0.001), but at the age 9/10-year time point, very preterm and full-term children had comparable surface area (P > 0.05). Across all subjects, cortical expansion by age 9/10 years was most pronounced in frontal, temporal, and supramarginal/inferior parietal junction areas, which are key association cortices (P Spin < 0.001). Very preterm children showed greater cortical surface area expansion between term-equivalent age and age 9/10 compared to their full-term peers in the medial and lateral frontal areas, precuneus, and middle temporal/banks of the superior sulcus junction (P < 0.05). Furthermore, within the very preterm group, expansion was highly variable within the orbitofrontal cortex and posterior regions of the brain. By mapping these patterns across the cortex, we identify differences in association cortices that are known to be important for executive functioning, emotion processing, and social cognition. Additional longitudinal work will be needed to understand if increased expansion in very preterm children is adaptive, or if differences persist into adulthood.
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Affiliation(s)
- Lisa S Gorham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aidan R Latham
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Dimitrios Alexopoulos
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeanette K Kenley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Emily Iannopollo
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David Loseille
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tara A Smyser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeffrey J Neil
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kara Garcia
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, Evansville, IN 46202, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
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Murillo C, Eixarch E, Rueda C, Larroya M, Boada D, Grau L, Ponce J, Aldecoa V, Monterde E, Ferrero S, Andreu-Fernández V, Arca G, Oleaga L, Ros O, Hernández MP, Gratacós E, Palacio M, Cobo T. Evidence of brain injury in fetuses of mothers with preterm labor with intact membranes and preterm premature rupture of membranes. Am J Obstet Gynecol 2024:S0002-9378(24)00531-3. [PMID: 38685550 DOI: 10.1016/j.ajog.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers. OBJECTIVE This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator. STUDY DESIGN In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission. RESULTS Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non-intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8-37.6), 35.3 mm (interquartile range, 31.2-39.6), and 35.0 mm (interquartile range, 31.3-38.3), respectively (P=.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5-19.6), 17.2 mm (interquartile range, 16.0-18.9), and 17.1 mm (interquartile range, 15.7-19.0), respectively (P=.041). Second, they presented a lower corpus callosum area (0.72 mm2 [interquartile range, 0.59-0.81], 0.71 mm2 [interquartile range, 0.63-0.82], and 0.78 mm2 [interquartile range, 0.71-0.91], respectively; P=.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth-to-biparietal diameter ratios were 0.14 [interquartile range, 0.12-0.16], 0.14 [interquartile range, 0.13-0.16], and 0.16 [interquartile range, 0.15-0.17], respectively [P<.001], and the right parieto-occipital sulci depth ratios were 0.09 [interquartile range, 0.07-0.12], 0.11 [interquartile range, 0.09-0.14], and 0.11 [interquartile range, 0.09-0.14], respectively [P=.012]). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL [interquartile range, 6213.4-21,098.8], 8397.7 pg/mL [interquartile range, 3682.1-17,398.3], and 2393.7 pg/mL [interquartile range, 1717.1-3209.3], respectively; P<.001), protein S100B (2030.6 pg/mL [interquartile range, 993.0-4883.5], 1070.3 pg/mL [interquartile range, 365.1-1463.2], and 74.8 pg/mL [interquartile range, 44.7-93.7], respectively; P<.001), and glial fibrillary acidic protein (1.01 ng/mL [interquartile range, 0.54-3.88], 0.965 ng/mL [interquartile range, 0.59-2.07], and 0.24 mg/mL [interquartile range, 0.20-0.28], respectively; P=.002). CONCLUSION Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation.
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Affiliation(s)
- Clara Murillo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Claudia Rueda
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marta Larroya
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - David Boada
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Laia Grau
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Júlia Ponce
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Victoria Aldecoa
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Elena Monterde
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain. Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IIS-FRCB-IDIBAPS), Universitat de Barcelona. Barcelona, Spain
| | - Silvia Ferrero
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Vicente Andreu-Fernández
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Biosanitary Research Institute, Valencian International University, Valencia, Spain
| | - Gemma Arca
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Olga Ros
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain
| | - Maria Pilar Hernández
- Department of Radiology, Clinical Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain.
| | - Montse Palacio
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Teresa Cobo
- BCNatal Fetal Medicine Research Center, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia i Neonatología, Barcelona, Spain; Fundació de Recerca Clínica Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
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Kelly CE, Thompson DK, Adamson CL, Ball G, Dhollander T, Beare R, Matthews LG, Alexander B, Cheong JLY, Doyle LW, Anderson PJ, Inder TE. Cortical growth from infancy to adolescence in preterm and term-born children. Brain 2024; 147:1526-1538. [PMID: 37816305 PMCID: PMC10994536 DOI: 10.1093/brain/awad348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/10/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
Early life experiences can exert a significant influence on cortical and cognitive development. Very preterm birth exposes infants to several adverse environmental factors during hospital admission, which affect cortical architecture. However, the subsequent consequence of very preterm birth on cortical growth from infancy to adolescence has never been defined; despite knowledge of critical periods during childhood for establishment of cortical networks. Our aims were to: chart typical longitudinal cortical development and sex differences in cortical development from birth to adolescence in healthy term-born children; estimate differences in cortical development between children born at term and very preterm; and estimate differences in cortical development between children with normal and impaired cognition in adolescence. This longitudinal cohort study included children born at term (≥37 weeks' gestation) and very preterm (<30 weeks' gestation) with MRI scans at ages 0, 7 and 13 years (n = 66 term-born participants comprising 34 with one scan, 18 with two scans and 14 with three scans; n = 201 very preterm participants comprising 56 with one scan, 88 with two scans and 57 with three scans). Cognitive assessments were performed at age 13 years. Cortical surface reconstruction and parcellation were performed with state-of-the-art, equivalent MRI analysis pipelines for all time points, resulting in longitudinal cortical volume, surface area and thickness measurements for 62 cortical regions. Developmental trajectories for each region were modelled in term-born children, contrasted between children born at term and very preterm, and contrasted between all children with normal and impaired cognition. In typically developing term-born children, we documented anticipated patterns of rapidly increasing cortical volume, area and thickness in early childhood, followed by more subtle changes in later childhood, with smaller cortical size in females than males. In contrast, children born very preterm exhibited increasingly reduced cortical volumes, relative to term-born children, particularly during ages 0-7 years in temporal cortical regions. This reduction in cortical volume in children born very preterm was largely driven by increasingly reduced cortical thickness rather than area. This resulted in amplified cortical volume and thickness reductions by age 13 years in individuals born very preterm. Alterations in cortical thickness development were found in children with impaired language and memory. This study shows that the neurobiological impact of very preterm birth on cortical growth is amplified from infancy to adolescence. These data further inform the long-lasting impact on cortical development from very preterm birth, providing broader insights into neurodevelopmental consequences of early life experiences.
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Affiliation(s)
- Claire E Kelly
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Deanne K Thompson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Chris L Adamson
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Gareth Ball
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Richard Beare
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- National Centre for Healthy Ageing and Peninsula Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC 3199, Australia
| | - Lillian G Matthews
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bonnie Alexander
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Neurosurgery, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Newborn Research, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Newborn Research, The Royal Women’s Hospital, Melbourne, VIC 3052, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Terrie E Inder
- Center for Neonatal Research, Children's Hospital of Orange County, Orange, CA 92868, USA
- Department of Pediatrics, University of California, Irvine, Irvine, CA 92697, USA
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Demirci N, Holland MA. Scaling patterns of cortical folding and thickness in early human brain development in comparison with primates. Cereb Cortex 2024; 34:bhad462. [PMID: 38271274 DOI: 10.1093/cercor/bhad462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024] Open
Abstract
Across mammalia, brain morphology follows specific scaling patterns. Bigger bodies have bigger brains, with surface area outpacing volume growth, resulting in increased foldedness. We have recently studied scaling rules of cortical thickness, both local and global, finding that the cortical thickness difference between thick gyri and thin sulci also increases with brain size and foldedness. Here, we investigate early brain development in humans, using subjects from the Developing Human Connectome Project, scanned shortly after pre-term or full-term birth, yielding magnetic resonance images of the brain from 29 to 43 postmenstrual weeks. While the global cortical thickness does not change significantly during this development period, its distribution does, with sulci thinning, while gyri thickening. By comparing our results with our recent work on humans and 11 non-human primate species, we also compare the trajectories of primate evolution with human development, noticing that the 2 trends are distinct for volume, surface area, cortical thickness, and gyrification index. Finally, we introduce the global shape index as a proxy for gyrification index; while correlating very strongly with gyrification index, it offers the advantage of being calculated only from local quantities without generating a convex hull or alpha surface.
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Affiliation(s)
- Nagehan Demirci
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, United States
| | - Maria A Holland
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, United States
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, United States
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5
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Beizaee F, Bona M, Desrosiers C, Dolz J, Lodygensky G. Determining regional brain growth in premature and mature infants in relation to age at MRI using deep neural networks. Sci Rep 2023; 13:13259. [PMID: 37582862 PMCID: PMC10427665 DOI: 10.1038/s41598-023-40244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
Neonatal MRIs are used increasingly in preterm infants. However, it is not always feasible to analyze this data. Having a tool that assesses brain maturation during this period of extraordinary changes would be immensely helpful. Approaches based on deep learning approaches could solve this task since, once properly trained and validated, they can be used in practically any system and provide holistic quantitative information in a matter of minutes. However, one major deterrent for radiologists is that these tools are not easily interpretable. Indeed, it is important that structures driving the results be detailed and survive comparison to the available literature. To solve these challenges, we propose an interpretable pipeline based on deep learning to predict postmenstrual age at scan, a key measure for assessing neonatal brain development. For this purpose, we train a state-of-the-art deep neural network to segment the brain into 87 different regions using normal preterm and term infants from the dHCP study. We then extract informative features for brain age estimation using the segmented MRIs and predict the brain age at scan with a regression model. The proposed framework achieves a mean absolute error of 0.46 weeks to predict postmenstrual age at scan. While our model is based solely on structural T2-weighted images, the results are superior to recent, arguably more complex approaches. Furthermore, based on the extracted knowledge from the trained models, we found that frontal and parietal lobes are among the most important structures for neonatal brain age estimation.
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Affiliation(s)
- Farzad Beizaee
- Software and IT Department, École de Technologie Supérieure, Montreal, QC, H3C 1K3, Canada.
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, H3T 1C5, Canada.
| | - Michele Bona
- Software and IT Department, École de Technologie Supérieure, Montreal, QC, H3C 1K3, Canada
| | - Christian Desrosiers
- Software and IT Department, École de Technologie Supérieure, Montreal, QC, H3C 1K3, Canada
| | - Jose Dolz
- Software and IT Department, École de Technologie Supérieure, Montreal, QC, H3C 1K3, Canada
| | - Gregory Lodygensky
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, H3T 1C5, Canada
- Canadian Neonatal Brain Platform, Montreal, QC, Canada
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6
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de Vareilles H, Rivière D, Mangin JF, Dubois J. Development of cortical folds in the human brain: An attempt to review biological hypotheses, early neuroimaging investigations and functional correlates. Dev Cogn Neurosci 2023; 61:101249. [PMID: 37141790 PMCID: PMC10311195 DOI: 10.1016/j.dcn.2023.101249] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
The folding of the human brain mostly takes place in utero, making it challenging to study. After a few pioneer studies looking into it in post-mortem foetal specimen, modern approaches based on neuroimaging have allowed the community to investigate the folding process in vivo, its normal progression, its early disturbances, and its relationship to later functional outcomes. In this review article, we aimed to first give an overview of the current hypotheses on the mechanisms governing cortical folding. After describing the methodological difficulties raised by its study in fetuses, neonates and infants with magnetic resonance imaging (MRI), we reported our current understanding of sulcal pattern emergence in the developing brain. We then highlighted the functional relevance of early sulcal development, through recent insights about hemispheric asymmetries and early factors influencing this dynamic such as prematurity. Finally, we outlined how longitudinal studies have started to relate early folding markers and the child's sensorimotor and cognitive outcome. Through this review, we hope to raise awareness on the potential of studying early sulcal patterns both from a fundamental and clinical perspective, as a window into early neurodevelopment and plasticity in relation to growth in utero and postnatal environment of the child.
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Affiliation(s)
- H de Vareilles
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, CNRS, Gif-sur-Yvette, France.
| | - D Rivière
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, CNRS, Gif-sur-Yvette, France
| | - J F Mangin
- Université Paris-Saclay, NeuroSpin-BAOBAB, CEA, CNRS, Gif-sur-Yvette, France
| | - J Dubois
- Université Paris Cité, NeuroDiderot, Inserm, Paris, France; Université Paris-Saclay, NeuroSpin-UNIACT, CEA, Gif-sur-Yvette, France
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7
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Williams LZJ, Fitzgibbon SP, Bozek J, Winkler AM, Dimitrova R, Poppe T, Schuh A, Makropoulos A, Cupitt J, O'Muircheartaigh J, Duff EP, Cordero-Grande L, Price AN, Hajnal JV, Rueckert D, Smith SM, Edwards AD, Robinson EC. Structural and functional asymmetry of the neonatal cerebral cortex. Nat Hum Behav 2023; 7:942-955. [PMID: 36928781 DOI: 10.1038/s41562-023-01542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
Features of brain asymmetry have been implicated in a broad range of cognitive processes; however, their origins are still poorly understood. Here we investigated cortical asymmetries in 442 healthy term-born neonates using structural and functional magnetic resonance images from the Developing Human Connectome Project. Our results demonstrate that the neonatal cortex is markedly asymmetric in both structure and function. Cortical asymmetries observed in the term cohort were contextualized in two ways: by comparing them against cortical asymmetries observed in 103 preterm neonates scanned at term-equivalent age, and by comparing structural asymmetries against those observed in 1,110 healthy young adults from the Human Connectome Project. While associations with preterm birth and biological sex were minimal, significant differences exist between birth and adulthood.
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Affiliation(s)
- Logan Z J Williams
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK.
| | - Sean P Fitzgibbon
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Anderson M Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ralica Dimitrova
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Tanya Poppe
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andreas Schuh
- Department of Computing, Imperial College London, London, UK
| | - Antonios Makropoulos
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - John Cupitt
- Department of Computing, Imperial College London, London, UK
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Eugene P Duff
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- UK Dementia Research Institute, Department of Brain Sciences, Imperial College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, ISCIII, Madrid, Spain
| | - Anthony N Price
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephen M Smith
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Emma C Robinson
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, London, UK.
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8
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Romantsik O, Moreira A, Thébaud B, Ådén U, Ley D, Bruschettini M. Stem cell-based interventions for the prevention and treatment of intraventricular haemorrhage and encephalopathy of prematurity in preterm infants. Cochrane Database Syst Rev 2023; 2:CD013201. [PMID: 36790019 PMCID: PMC9932000 DOI: 10.1002/14651858.cd013201.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Germinal matrix-intraventricular haemorrhage (GMH-IVH) and encephalopathy of prematurity (EoP) remain substantial issues in neonatal intensive care units worldwide. Current therapies to prevent or treat these conditions are limited. Stem cell-based therapies offer a potential therapeutic approach to repair, restore, or regenerate injured brain tissue. These preclinical findings have now culminated in ongoing human neonatal studies. This is an update of the 2019 review, which did not include EoP. OBJECTIVES To evaluate the benefits and harms of stem cell-based interventions for prevention or treatment of GM-IVH and EoP in preterm infants. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was April 2022. SELECTION CRITERIA We attempted to include randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing 1. stem cell-based interventions versus control; 2. mesenchymal stromal cells (MSCs) of type or source versus MSCs of other type or source; 3. stem cell-based interventions other than MSCs of type or source versus stem cell-based interventions other than MSCs of other type or source; or 4. MSCs versus stem cell-based interventions other than MSCs. For prevention studies, we included extremely preterm infants (less than 28 weeks' gestation), 24 hours of age or less, without ultrasound diagnosis of GM-IVH or EoP; for treatment studies, we included preterm infants (less than 37 weeks' gestation), of any postnatal age, with ultrasound diagnosis of GM-IVH or with EoP. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause neonatal mortality, 2. major neurodevelopmental disability, 3. GM-IVH, 4. EoP, and 5. extension of pre-existing non-severe GM-IVH or EoP. We planned to use GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified no studies that met our inclusion criteria. Three studies are currently registered and ongoing. Phase 1 trials are described in the 'Excluded studies' section. AUTHORS' CONCLUSIONS No evidence is currently available to evaluate the benefits and harms of stem cell-based interventions for treatment or prevention of GM-IVH or EoP in preterm infants. We identified three ongoing studies, with a sample size range from 20 to 200. In two studies, autologous cord blood mononuclear cells will be administered to extremely preterm infants via the intravenous route; in one, intracerebroventricular injection of MSCs will be administered to preterm infants up to 34 weeks' gestational age.
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Affiliation(s)
- Olga Romantsik
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Alvaro Moreira
- Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Bernard Thébaud
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Ottawa Hospital Research Institute, Sprott Centre for Stem Cell Research, Ottawa, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Ulrika Ådén
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David Ley
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
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9
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Pagnozzi AM, van Eijk L, Pannek K, Boyd RN, Saha S, George J, Bora S, Bradford D, Fahey M, Ditchfield M, Malhotra A, Liley H, Colditz PB, Rose S, Fripp J. Early brain morphometrics from neonatal MRI predict motor and cognitive outcomes at 2-years corrected age in very preterm infants. Neuroimage 2023; 267:119815. [PMID: 36529204 DOI: 10.1016/j.neuroimage.2022.119815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Infants born very preterm face a range of neurodevelopmental challenges in cognitive, language, behavioural and/or motor domains. Early accurate identification of those at risk of adverse neurodevelopmental outcomes, through clinical assessment and Magnetic Resonance Imaging (MRI), enables prognostication of outcomes and the initiation of targeted early interventions. This study utilises a prospective cohort of 181 infants born <31 weeks gestation, who had 3T MRIs acquired at 29-35 weeks postmenstrual age and a comprehensive neurodevelopmental evaluation at 2 years corrected age (CA). Cognitive, language and motor outcomes were assessed using the Bayley Scales of Infant and Toddler Development - Third Edition and functional motor outcomes using the Neuro-sensory Motor Developmental Assessment. By leveraging advanced structural MRI pre-processing steps to standardise the data, and the state-of-the-art developing Human Connectome Pipeline, early MRI biomarkers of neurodevelopmental outcomes were identified. Using Least Absolute Shrinkage and Selection Operator (LASSO) regression, significant associations between brain structure on early MRIs with 2-year outcomes were obtained (r = 0.51 and 0.48 for motor and cognitive outcomes respectively) on an independent 25% of the data. Additionally, important brain biomarkers from early MRIs were identified, including cortical grey matter volumes, as well as cortical thickness and sulcal depth across the entire cortex. Adverse outcome on the Bayley-III motor and cognitive composite scores were accurately predicted, with an Area Under the Curve of 0.86 for both scores. These associations between 2-year outcomes and patient prognosis and early neonatal MRI measures demonstrate the utility of imaging prior to term equivalent age for providing earlier commencement of targeted interventions for infants born preterm.
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Affiliation(s)
- Alex M Pagnozzi
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Liza van Eijk
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; Department of Psychology, James Cook University, Townsville, Queensland, Australia
| | - Kerstin Pannek
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Roslyn N Boyd
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Susmita Saha
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Joanne George
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - DanaKai Bradford
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Michael Fahey
- Monash Health Paediatric Neurology Unit and Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael Ditchfield
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Atul Malhotra
- Monash Health Paediatric Neurology Unit and Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Helen Liley
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul B Colditz
- Perinatal Research Centre, Faculty of Medicine, The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Rose
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia
| | - Jurgen Fripp
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia
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10
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Tseng WL, Chen CH, Chang JH, Peng CC, Jim WT, Lin CY, Hsu CH, Liu TY, Chang HY. Risk Factors of Language Delay at Two Years of Corrected Age among Very-Low-Birth-Weight Preterm Infants: A Population-Based Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020189. [PMID: 36832318 PMCID: PMC9955016 DOI: 10.3390/children10020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Language delays are often underestimated in very-low-birth-weight (VLBW) preterm infants. We aimed to identify the risk factors of language delay at two years of corrected age in this vulnerable population. VLBW infants, who were assessed at two years of corrected age using the Bayley Scale of Infant Development, third edition, were included using a population-based cohort database. Language delay was defined as mild to moderate if the composite score was between 70 and 85 and severe if the score was < 70. Multivariable logistic regression analysis was used to identify the perinatal risk factors associated with language delay. The study comprised 3797 VLBW preterm infants; 678 (18%) had a mild to moderate delay and 235 (6%) had a severe delay. After adjusting for confounding factors, low maternal education level, low maternal socioeconomic status, extremely low birth weight, male sex, and severe intraventricular hemorrhage (IVH) and/or cystic periventricular leukomalacia (PVL) were found to be significantly associated with both mild to moderate and severe delays. Resuscitation at delivery, necrotizing enterocolitis, and patent ductus arteriosus requiring ligation showed significant associations with severe delay. The strongest factors predicting both mild to moderate and severe language delays were the male sex and severe IVH and/or cystic PVL; thus, early targeted intervention is warranted in these populations.
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Affiliation(s)
- Wei-Lun Tseng
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
| | - Chia-Huei Chen
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251020, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251020, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251020, Taiwan
| | - Wai-Tim Jim
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251020, Taiwan
| | - Chia-Ying Lin
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
| | - Tzu-Yu Liu
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30046, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251020, Taiwan
- Correspondence: ; Tel.: +886-2543-3535; Fax: +886-2523-2448
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11
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Vanes LD, Murray RM, Nosarti C. Adult outcome of preterm birth: Implications for neurodevelopmental theories of psychosis. Schizophr Res 2022; 247:41-54. [PMID: 34006427 DOI: 10.1016/j.schres.2021.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
Preterm birth is associated with an elevated risk of developmental and adult psychiatric disorders, including psychosis. In this review, we evaluate the implications of neurodevelopmental, cognitive, motor, and social sequelae of preterm birth for developing psychosis, with an emphasis on outcomes observed in adulthood. Abnormal brain development precipitated by early exposure to the extra-uterine environment, and exacerbated by neuroinflammation, neonatal brain injury, and genetic vulnerability, can result in alterations of brain structure and function persisting into adulthood. These alterations, including abnormal regional brain volumes and white matter macro- and micro-structure, can critically impair functional (e.g. frontoparietal and thalamocortical) network connectivity in a manner characteristic of psychotic illness. The resulting executive, social, and motor dysfunctions may constitute the basis for behavioural vulnerability ultimately giving rise to psychotic symptomatology. There are many pathways to psychosis, but elucidating more precisely the mechanisms whereby preterm birth increases risk may shed light on that route consequent upon early neurodevelopmental insult.
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Affiliation(s)
- Lucy D Vanes
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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12
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Associations of gestational age with gyrification and neurocognition in healthy adults. Eur Arch Psychiatry Clin Neurosci 2022; 273:467-479. [PMID: 35904633 PMCID: PMC10070217 DOI: 10.1007/s00406-022-01454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
Epidemiological studies have shown that gestational age and birth weight are linked to cognitive performance in adults. On a neurobiological level, this effect is hypothesized to be related to cortical gyrification, which is determined primarily during fetal development. The relationships between gestational age, gyrification and specific cognitive abilities in adults are still poorly understood. In 542 healthy participants, gyrification indices were calculated from structural magnetic resonance imaging T1 data at 3 T using CAT12. After applying a battery of neuropsychological tests, neuropsychological factors were extracted with a factor analysis. We conducted regressions to test associations between gyrification and gestational age as well as birth weight. Moderation analyses explored the relationships between gestational age, gyrification and neuropsychological factors. Gestational age is significantly positively associated with cortical folding in the left supramarginal, bilaterally in the superior frontal and the lingual cortex. We extracted two neuropsychological factors that describe language abilities and working memory/attention. The association between gyrification in the left superior frontal gyrus and working memory/attention was moderated by gestational age. Further, the association between gyrification in the left supramarginal cortex and both, working memory/attention as well as language, were moderated by gestational age. Gyrification is associated with gestational age and related to specific neuropsychological outcomes in healthy adulthood. Implications from these findings for the cortical neurodevelopment of cognitive domains and mental health are discussed.
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13
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Womack SR, Beam CR, Winders Davis D, Finkel D, Turkheimer E. Genetic and environmental correlates of the nonlinear recovery of cognitive ability in Twins. Dev Psychol 2022; 58:535-550. [PMID: 34881967 PMCID: PMC9637322 DOI: 10.1037/dev0001305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Twins regularly score nearly a standard deviation below the population mean on standardized measures of cognitive development in infancy but recover to the population mean by early childhood, making rapid gains through the toddler years. To date, only polynomial growth models have been fit to model cognitive recovery across childhood, limiting the applicability of the growth parameters to later developmental periods. We fit a nonlinear asymptotic Gompertz growth model to prospective cognitive scores from 1,153 individual twins from 578 families (47.9% male, 91.5% White, 61.6% monozygotic) measured at 16 time points between 3 months and 15 years. Twins displayed a lower asymptote of 86.47 (.90 SD below the population mean) and gained on average 17.01 points, achieving an upper asymptote of 103.48. Growth was observed to be most rapid at 3.26 years, highlighting the importance of the toddler years in cognitive development. Biometric analyses revealed that shared environmental factors accounted for the majority of the variance in initial cognitive ability as well as asymptotic growth in cognitive ability. Gestational age and family socioeconomic status (SES) were robust predictors of cognitive growth. Results from the present study provide insight into the growth processes underlying the recovery of cognitive ability to the population mean for children evincing slight delays in their initial cognitive ability. In particular, findings highlight prenatal factors and family economic resources as important aspects of the environment in the recovery of cognitive ability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Sean R. Womack
- Department of Psychology, University of Virginia
- Correspondence may be sent to Sean R. Womack at the Department of Psychology, University of Virginia, Millmont Building 316, 1023 Millmont Street Charlottesville, VA 22904. Phone: (248) 821-8647
| | | | | | - Deborah Finkel
- Department of Psychology, Indiana University Southeast & Institute for Gerontology, Jönköping University
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14
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Vesoulis ZA, Alexopoulos D, Rogers C, Neil J, Smyser C. Seizure burden in preterm infants and smaller brain volume at term-equivalent age. Pediatr Res 2022; 91:955-961. [PMID: 33903729 PMCID: PMC8546006 DOI: 10.1038/s41390-021-01542-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Seizures are underrecognized in preterm infants, and little is known about their impact on brain growth. We aimed to define the association between early seizures and subsequent brain growth. METHODS Infants <30 weeks gestation underwent 72 h of prospective amplitude-integrated electroencephalography (aEEG) monitoring, term-equivalent age (TEA) magnetic resonance imaging (MRI), and 2-year neurodevelopmental testing. Seizures were defined as trains of sharp waves >10 s, evolving in frequency/amplitude/morphology, and identified using automated algorithms with manual review. Using T2-weighted images, cortical surface area (CSA) and gyrification index (GI) were calculated and volumes were segmented into five tissue classes: cerebrospinal fluid, gray matter, white matter (WM), deep nuclear gray matter, and cerebellum. Correlations between total seizure burden and tissue-specific volumes were evaluated, controlling for clinical variables of interest. RESULTS Ninety-nine infants underwent aEEG/MRI assessments (mean GA = 26.3 weeks, birthweight = 899 g). Seizure incidence was 55% with a median of two events; median length = 66 s and mean burden = 285 s. Greater seizure burden was associated with smaller CSA and volumes across all tissue types, most prominently in WM (R2 = -0.603, p < 0.01), even after controlling for confounders. There was no association with GI. CONCLUSIONS Seizures in preterm infants are common and associated with smaller TEA brain volumes. This relationship was strongest for WM and independent of clinical factors. IMPACT Seizures in preterm infants are common. Little is known about the association between early seizures and later brain growth. Greater seizure burden is linked with smaller volumes of all brain tissue types, most prominently the WM. This relationship is true even controlling for other factors. Additional study is needed to identify the optimal EEG monitoring and seizure treatment strategy for improved brain growth and neurodevelopmental outcomes.
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Affiliation(s)
- Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, MO, USA.
| | - Dimitrios Alexopoulos
- Division of Child Neurology, Department of Neurology, Washington University, St. Louis, MO, USA
| | - Cynthia Rogers
- Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, MO, USA
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Jeffrey Neil
- Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, MO, USA
- Division of Child Neurology, Department of Neurology, Washington University, St. Louis, MO, USA
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Christopher Smyser
- Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, MO, USA
- Division of Child Neurology, Department of Neurology, Washington University, St. Louis, MO, USA
- Department of Radiology, Washington University, St. Louis, MO, USA
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15
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Dimitrova R, Pietsch M, Ciarrusta J, Fitzgibbon SP, Williams LZJ, Christiaens D, Cordero-Grande L, Batalle D, Makropoulos A, Schuh A, Price AN, Hutter J, Teixeira RP, Hughes E, Chew A, Falconer S, Carney O, Egloff A, Tournier JD, McAlonan G, Rutherford MA, Counsell SJ, Robinson EC, Hajnal JV, Rueckert D, Edwards AD, O'Muircheartaigh J. Preterm birth alters the development of cortical microstructure and morphology at term-equivalent age. Neuroimage 2021; 243:118488. [PMID: 34419595 PMCID: PMC8526870 DOI: 10.1016/j.neuroimage.2021.118488] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/16/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The dynamic nature and complexity of the cellular events that take place during the last trimester of pregnancy make the developing cortex particularly vulnerable to perturbations. Abrupt interruption to normal gestation can lead to significant deviations to many of these processes, resulting in atypical trajectory of cortical maturation in preterm birth survivors. METHODS We sought to first map typical cortical micro- and macrostructure development using invivo MRI in a large sample of healthy term-born infants scanned after birth (n = 259). Then we offer a comprehensive characterization of the cortical consequences of preterm birth in 76 preterm infants scanned at term-equivalent age (37-44 weeks postmenstrual age). We describe the group-average atypicality, the heterogeneity across individual preterm infants, and relate individual deviations from normative development to age at birth and neurodevelopment at 18 months. RESULTS In the term-born neonatal brain, we observed heterogeneous and regionally specific associations between age at scan and measures of cortical morphology and microstructure, including rapid surface expansion, greater cortical thickness, lower cortical anisotropy and higher neurite orientation dispersion. By term-equivalent age, preterm infants had on average increased cortical tissue water content and reduced neurite density index in the posterior parts of the cortex, and greater cortical thickness anteriorly compared to term-born infants. While individual preterm infants were more likely to show extreme deviations (over 3.1 standard deviations) from normative cortical maturation compared to term-born infants, these extreme deviations were highly variable and showed very little spatial overlap between individuals. Measures of regional cortical development were associated with age at birth, but not with neurodevelopment at 18 months. CONCLUSION We showed that preterm birth alters cortical micro- and macrostructural maturation near the time of full-term birth. Deviations from normative development were highly variable between individual preterm infants.
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Affiliation(s)
- Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Judit Ciarrusta
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sean P Fitzgibbon
- Centre for Functional MRI of the Brain (FMRIB), Welcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Logan Z J Williams
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Electrical Engineering, ESAT/PSI, KU Leuven, Belgium
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pag Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Emma C Robinson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Faculty of Informatics and Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom.
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Gamage TKJB, Fraser M. The Role of Extracellular Vesicles in the Developing Brain: Current Perspective and Promising Source of Biomarkers and Therapy for Perinatal Brain Injury. Front Neurosci 2021; 15:744840. [PMID: 34630028 PMCID: PMC8498217 DOI: 10.3389/fnins.2021.744840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
This comprehensive review focuses on our current understanding of the proposed physiological and pathological functions of extracellular vesicles (EVs) in the developing brain. Furthermore, since EVs have attracted great interest as potential novel cell-free therapeutics, we discuss advances in the knowledge of stem cell- and astrocyte-derived EVs in relation to their potential for protection and repair following perinatal brain injury. This review identified 13 peer-reviewed studies evaluating the efficacy of EVs in animal models of perinatal brain injury; 12/13 utilized mesenchymal stem cell-derived EVs (MSC-EVs) and 1/13 utilized astrocyte-derived EVs. Animal model, method of EV isolation and size, route, timing, and dose administered varied between studies. Notwithstanding, EV treatment either improved and/or preserved perinatal brain structures both macroscopically and microscopically. Additionally, EV treatment modulated inflammatory responses and improved brain function. Collectively this suggests EVs can ameliorate, or repair damage associated with perinatal brain injury. These findings warrant further investigation to identify the optimal cell numbers, source, and dosage regimens of EVs, including long-term effects on functional outcomes.
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Parikh NA, Sharma P, He L, Li H, Altaye M, Illapani VSP. Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age Magnetic Resonance Imaging in Infants Born Very Preterm. J Pediatr 2021; 233:58-65.e3. [PMID: 33259857 PMCID: PMC8290900 DOI: 10.1016/j.jpeds.2020.11.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/24/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify perinatal clinical diseases and treatments that are associated with the development of objectively diagnosed diffuse white matter abnormality (DWMA) on structural magnetic resonance imaging (MRI) at term-equivalent age in infants born very preterm. STUDY DESIGN A prospective cohort of 392 infants born very preterm (≤32 weeks of gestational age) was enrolled from 5 level III/IV neonatal intensive care units between September 2016 and November 2019. MRIs of the brain were collected at 39 to 45 weeks of postmenstrual age to evaluate DWMA volume. A predefined list of pertinent maternal characteristics, pregnancy/delivery data, and neonatal intensive care unit data were collected for enrolled patients to identify antecedents of objectively diagnosed DWMA. RESULTS Of the 392 infants in the cohort, 377 (96%) had high-quality MRI data. Their mean (SD) gestational age was 29.3 (2.5) weeks. In multivariable linear regression analyses, pneumothorax (P = .027), severe bronchopulmonary dysplasia (BPD) (P = .009), severe retinopathy of prematurity (P < .001), and male sex (P = .041) were associated with increasing volume of DWMA. The following factors were associated with decreased risk of DWMA: postnatal dexamethasone therapy for severe BPD (P = .004), duration of caffeine therapy for severe BPD (P = .009), and exclusive maternal milk diet at neonatal intensive care unit discharge (P = .049). CONCLUSIONS Severe retinopathy of prematurity and BPD exhibited the strongest adverse association with development of DWMA. We also identified treatments and nutritional factors that appear protective against the development of DWMA that also have implications for the clinical care of infants born very preterm.
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Affiliation(s)
- Nehal A. Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States,Correspondence: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH, 45229, United States, , Phone number: 513.803.7584
| | - Puneet Sharma
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States
| | - Lili He
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States
| | - Hailong Li
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati, College of Medicine United States,Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, United States
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18
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Advances in functional and diffusion neuroimaging research into the long-term consequences of very preterm birth. J Perinatol 2021; 41:689-706. [PMID: 33099576 DOI: 10.1038/s41372-020-00865-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022]
Abstract
Very preterm birth (<32 weeks of gestation) has been associated with lifelong difficulties in a variety of neurocognitive functions. Magnetic resonance imaging (MRI) combined with advanced analytical approaches have been employed in order to increase our understanding of the neurodevelopmental problems that many very preterm born individuals face as they grow up. In this review, we will focus on two novel imaging techniques that have explored relationships between specific brain mechanisms and behavioural outcomes. These are functional MRI, which maps regional, time-varying changes in brain metabolism and diffusion-weighted MRI, which measures the displacement of water molecules in tissue and provides quantitative information about tissue microstructure. Identifying the neurobiological underpinning of the long-term sequelae associated with very preterm birth could inform the development and implementation of preventative interventions (before any cognitive problem emerges) and could facilitate the identification of behavioural targets for improving the life course outcomes of very preterm individuals.
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Lu YC, Kapse K, Andersen N, Quistorff J, Lopez C, Fry A, Cheng J, Andescavage N, Wu Y, Espinosa K, Vezina G, du Plessis A, Limperopoulos C. Association Between Socioeconomic Status and In Utero Fetal Brain Development. JAMA Netw Open 2021; 4:e213526. [PMID: 33779746 PMCID: PMC8008281 DOI: 10.1001/jamanetworkopen.2021.3526] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Children raised in settings with lower parental socioeconomic status are at increased risk for neuropsychological disorders. However, to date, the association between socioeconomic status and fetal brain development remains poorly understood. OBJECTIVE To determine the association between parental socioeconomic status and in vivo fetal brain growth and cerebral cortical development using advanced, 3-dimensional fetal magnetic resonance imaging. DESIGN, SETTING, AND PARTICIPANTS This cohort study of fetal brain development enrolled 144 healthy pregnant women from 2 low-risk community obstetrical hospitals from 2012 through 2019 in the District of Columbia. Included women had a prenatal history without complications that included recommended screening laboratory and ultrasound studies. Exclusion criteria were multiple gestation pregnancy, known or suspected congenital infection, dysmorphic features of the fetus, and documented chromosomal abnormalities. T2-weighted fetal brain magnetic resonance images were acquired. Each pregnant woman was scanned at up to 2 points in the fetal period. Data were analyzed from June through November 2020. EXPOSURES Parental education level and occupation status were documented. MAIN OUTCOMES AND MEASURES Regional fetal brain tissue volume (for cortical gray matter, white matter, cerebellum, deep gray matter, and brainstem) and cerebral cortical features (ie, lobe volume, local gyrification index, and sulcal depth) in the frontal, parietal, temporal, and occipital lobes were calculated. RESULTS Fetal brain magnetic resonance imaging studies were performed among 144 pregnant women (median [interquartile range] age, 32.5 [27.0-36.1] years) with gestational age from 24.0 to 39.4 weeks; 75 fetuses (52.1%) were male, and 69 fetuses (47.9%) were female. Higher parental education level was associated with significantly increased volume in the fetal white matter (mothers: β, 2.86; 95% CI, 1.26 to 4.45; P = .001; fathers: β, 2.39; 95% CI, 0.97 to 3.81; P = .001), deep gray matter (mothers: β, 0.16; 95% CI, 0.002 to 0.32; P = .048; fathers: β, 0.16; 95% CI, 0.02 to 0.31; P = .02), and brainstem (mothers: β, 0.06; 95% CI, 0.02 to 0.10; P = .01; fathers: β, 0.04; 95% CI, 0.004 to 0.08; P = .03). Higher maternal occupation status was associated with significantly increased volume in the fetal white matter (β, 2.07; 95% CI, 0.88 to 3.26; P = .001), cerebellum (β, 0.17; 95% CI, 0.04 to 0.29; P = .01), and brainstem (β, 0.03; 95% CI, 0.001 to 0.07; P = .04), and higher paternal occupation status was associated with significantly increased white matter volume (β, 1.98; 95% CI, 0.71 to 3.25; P < .01). However, higher socioeconomic status was associated with significantly decreased fetal cortical gray matter volume (mothers: β, -0.11; 95% CI, -0.18 to -0.03; P = .01; fathers: β, -0.10; 95% CI, -0.18 to -0.03; P = .01). Higher parental socioeconomic status was associated with increased volumes of 3 brain lobes of white matter: frontal lobe (mothers: β, 0.07; 95% CI, 0.02 to 0.13; P = .01; fathers: β, 0.06; 95% CI, 0.01 to 0.11; P = .03), parietal lobe (mothers: β, 0.07; 95% CI, 0.03 to 0.11; P < .001; fathers: β, 0.06; 95% CI, 0.03 to 0.10; P = .001), and temporal lobe (mothers: β, 0.04; 95% CI, 0.02 to 0.07; P < .001; fathers: β, 0.04; 95% CI, 0.02 to 0.07; P < .001), and maternal SES score was associated with significantly decreased volume in the occipital lobe (β, 0.02; 95% CI, 0.002 to 0.04; P = .03). Higher parental socioeconomic status was associated with decreased cortical local gyrification index (for example, for the frontal lobe, mothers: β, -1.1; 95% CI, -1.9 to -0.3; P = .01; fathers: β, -0.8; 95% CI, -1.6 to -0.1; P = .03) and sulcal depth, except for the frontal lobe (for example, for the parietal lobe, mothers: β, -9.5; 95% CI, -13.8 to -5.3; P < .001; fathers: β, -8.7; 95% CI, -13.0 to -4.4; P < .001). CONCLUSIONS AND RELEVANCE This cohort study found an association between parental socioeconomic status and altered in vivo fetal neurodevelopment. While being born and raised in a lower socioeconomic status setting is associated with poorer neuropsychological, educational, and socioeconomic outcomes in children, these findings suggest that altered prenatal programming may be associated with these outcomes and that future targeted prenatal interventions may be needed.
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Affiliation(s)
- Yuan-Chiao Lu
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Nicole Andersen
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Jessica Quistorff
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Catherine Lopez
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Andrea Fry
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Jenhao Cheng
- Department of Quality and Patient Safety, Children's National Hospital, Washington, District of Columbia
| | - Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Yao Wu
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Kristina Espinosa
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Gilbert Vezina
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
| | - Adre du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, District of Columbia
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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20
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Duffy BA, Zhao L, Sepehrband F, Min J, Wang DJ, Shi Y, Toga AW, Kim H. Retrospective motion artifact correction of structural MRI images using deep learning improves the quality of cortical surface reconstructions. Neuroimage 2021; 230:117756. [PMID: 33460797 DOI: 10.1016/j.neuroimage.2021.117756] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022] Open
Abstract
Head motion during MRI acquisition presents significant challenges for neuroimaging analyses. In this work, we present a retrospective motion correction framework built on a Fourier domain motion simulation model combined with established 3D convolutional neural network (CNN) architectures. Quantitative evaluation metrics were used to validate the method on three separate multi-site datasets. The 3D CNN was trained using motion-free images that were corrupted using simulated artifacts. CNN based correction successfully diminished the severity of artifacts on real motion affected data on a separate test dataset as measured by significant improvements in image quality metrics compared to a minimal motion reference image. On the test set of 13 image pairs, the mean peak signal-to-noise-ratio was improved from 31.7 to 33.3 dB. Furthermore, improvements in cortical surface reconstruction quality were demonstrated using a blinded manual quality assessment on the Parkinson's Progression Markers Initiative (PPMI) dataset. Upon applying the correction algorithm, out of a total of 617 images, the number of quality control failures was reduced from 61 to 38. On this same dataset, we investigated whether motion correction resulted in a more statistically significant relationship between cortical thickness and Parkinson's disease. Before correction, significant cortical thinning was found to be restricted to limited regions within the temporal and frontal lobes. After correction, there was found to be more widespread and significant cortical thinning bilaterally across the temporal lobes and frontal cortex. Our results highlight the utility of image domain motion correction for use in studies with a high prevalence of motion artifacts, such as studies of movement disorders as well as infant and pediatric subjects.
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Affiliation(s)
- Ben A Duffy
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lu Zhao
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joyce Min
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Danny Jj Wang
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hosung Kim
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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21
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Yun HJ, Perez JDR, Sosa P, Valdés JA, Madan N, Kitano R, Akiyama S, Skotko BG, Feldman HA, Bianchi DW, Grant PE, Tarui T, Im K. Regional Alterations in Cortical Sulcal Depth in Living Fetuses with Down Syndrome. Cereb Cortex 2021; 31:757-767. [PMID: 32940649 PMCID: PMC7786357 DOI: 10.1093/cercor/bhaa255] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022] Open
Abstract
Down syndrome (DS) is the most common genetic cause of developmental disabilities. Advanced analysis of brain magnetic resonance imaging (MRI) has been used to find brain abnormalities and their relationship to neurocognitive impairments in children and adolescents with DS. Because genetic factors affect brain development in early fetal life, there is a growing interest in analyzing brains from living fetuses with DS. In this study, we investigated regional sulcal folding depth as well as global cortical gyrification from fetal brain MRIs. Nine fetuses with DS (29.1 ± 4.24 gestational weeks [mean ± standard deviation]) were compared with 17 typically developing [TD] fetuses (28.4 ± 3.44). Fetuses with DS showed lower whole-brain average sulcal depths and gyrification index than TD fetuses. Significant decreases in sulcal depth were found in bilateral Sylvian fissures and right central and parieto-occipital sulci. On the other hand, significantly increased sulcal depth was shown in the left superior temporal sulcus, which is related to atypical hemispheric asymmetry of cortical folding. Moreover, these group differences increased as gestation progressed. This study demonstrates that regional sulcal depth is a sensitive marker for detecting alterations of cortical development in DS during fetal life, which may be associated with later neurocognitive impairment.
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Affiliation(s)
- Hyuk Jin Yun
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Juan David Ruiz Perez
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Patricia Sosa
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - J Alejandro Valdés
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Neel Madan
- Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA
| | - Rie Kitano
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA
| | - Shizuko Akiyama
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA
| | - Brian G Skotko
- Down Syndrome Program, Genetics, Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Henry A Feldman
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Diana W Bianchi
- Prenatal Genomics and Fetal Therapy Section, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - P Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tomo Tarui
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA
| | - Kiho Im
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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22
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Chavoshnejad P, Li X, Zhang S, Dai W, Vasung L, Liu T, Zhang T, Wang X, Razavi MJ. Role of axonal fibers in the cortical folding patterns: A tale of variability and regularity. BRAIN MULTIPHYSICS 2021. [DOI: 10.1016/j.brain.2021.100029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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23
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Automated brain morphometric biomarkers from MRI at term predict motor development in very preterm infants. NEUROIMAGE-CLINICAL 2020; 28:102475. [PMID: 33395969 PMCID: PMC7649646 DOI: 10.1016/j.nicl.2020.102475] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
Nearly 1/3 of very preterm (VPT) infants develop motor impairments later in life. Better early biomarkers are needed for risk-stratification and early intervention. We used MRI morphometrics at term to predict 2-year motor ability in VPT infants. Inner cortical curvature at term is a novel biomarker of early motor aptitude. In regression models, morphometrics explained nearly 50% of motor score variance.
Very preterm infants are at high risk for motor impairments. Early interventions can improve outcomes in this cohort, but they would be most effective if clinicians could accurately identify the highest-risk infants early. A number of biomarkers for motor development exist, but currently none are sufficiently accurate for early risk-stratification. We prospectively enrolled very preterm (gestational age ≤31 weeks) infants from four level-III NICUs. Structural brain MRI was performed at term-equivalent age. We used a established pipeline to automatically derive brain volumetrics and cortical morphometrics – cortical surface area, sulcal depth, gyrification index, and inner cortical curvature – from structural MRI. We related these objective measures to Bayley-III motor scores (overall, gross, and fine) at two-years corrected age. Lasso regression identified the three best predictive biomarkers for each motor scale from our initial feature set. In multivariable regression, we assessed the independent value of these brain biomarkers, over-and-above known predictors of motor development, to predict motor scores. 75 very preterm infants had high-quality T2-weighted MRI and completed Bayley-III motor testing. All three motor scores were positively associated with regional cortical surface area and subcortical volumes and negatively associated with cortical curvature throughout the majority of brain regions. In multivariable regression modeling, thalamic volume, curvature of the temporal lobe, and curvature of the insula were significant predictors of overall motor development on the Bayley-III, independent of known predictors. Objective brain morphometric biomarkers at term show promise in predicting motor development in very preterm infants.
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24
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Rana S, Shishegar R, Quezada S, Johnston L, Walker DW, Tolcos M. The Subplate: A Potential Driver of Cortical Folding? Cereb Cortex 2020; 29:4697-4708. [PMID: 30721930 DOI: 10.1093/cercor/bhz003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 01/06/2023] Open
Abstract
In many species of Mammalia, the surface of the brain develops from a smooth structure to one with many fissures and folds, allowing for vast expansion of the surface area of the cortex. The importance of understanding what drives cortical folding extends beyond mere curiosity, as conditions such as preterm birth, intrauterine growth restriction, and fetal alcohol syndrome are associated with impaired folding in the infant and child. Despite being a key feature of brain development, the mechanisms driving cortical folding remain largely unknown. In this review we discuss the possible role of the subplate, a developmentally transient compartment, in directing region-dependent development leading to sulcal and gyral formation. We discuss the development of the subplate in species with lissencephalic and gyrencephalic cortices, the characteristics of the cells found in the subplate, and the possible presence of molecular cues that guide axons into, and out of, the overlying and multilayered cortex before the appearance of definitive cortical folds. An understanding of what drives cortical folding is likely to help in understanding the origins of abnormal folding patterns in clinical pathologies.
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Affiliation(s)
- Shreya Rana
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Rosita Shishegar
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sebastian Quezada
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Leigh Johnston
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - David W Walker
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Mary Tolcos
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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25
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Kubo KI, Deguchi K. Human neocortical development as a basis to understand mechanisms underlying neurodevelopmental disabilities in extremely preterm infants. J Obstet Gynaecol Res 2020; 46:2242-2250. [PMID: 32924239 DOI: 10.1111/jog.14468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 01/21/2023]
Abstract
AIM Recent advances in perinatal and neonatal medicine have resulted in marked improvements in the survival rates of extremely preterm infants (born before 28 gestational weeks) around the world, and Japan is among the countries with the highest reported survival rates of extremely preterm infants. However, it remains a major concern that many survivors develop neurodevelopmental disabilities, including cognitive dysfunctions and neurodevelopmental disorders later in life. In order to understand the pathophysiological mechanisms underlying the neurodevelopmental disabilities observed in the survivors of extremely preterm births, we reviewed recently reported findings about the development of the human neocortex. METHODS First, we have summarized the current knowledge about the development of the neocortex, including recently reported human- and/or primate-specific developmental events. Next, we discussed the possible causal mechanisms underlying the development of neurodevelopmental disabilities in extremely preterm infants. RESULTS Around the birth of extremely preterm infants, neurogenesis and succeeding neuronal migrations are ongoing in the neocortex of human brain. Expansion and maturation of the subplate, which is thought to reflect the axonal wiring in the neocortex, is also prominent at this time. CONCLUSION Brain injuries that occur around the birth of extremely preterm infants are presumed to affect the dynamic developmental events in the neocortex, such as neurogenesis, neuronal migrations and maturation of the subplate, which could underlie the neurodevelopmental disabilities that often develop subsequently in extremely preterm infants. These possibilities should be borne in mind while considering maternal and neonatal care to further improve the long-term outcomes of extremely preterm infants.
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Affiliation(s)
- Ken-Ichiro Kubo
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan.,Department of Anatomy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kimiko Deguchi
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan.,Department of Pediatrics, Deguchi Pediatric Clinic, Omura, Japan
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26
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Kline JE, Illapani VSP, He L, Altaye M, Logan JW, Parikh NA. Early cortical maturation predicts neurodevelopment in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2020; 105:460-465. [PMID: 31704737 PMCID: PMC7205568 DOI: 10.1136/archdischild-2019-317466] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the ability of four objectively defined, cortical maturation features-surface area, gyrification index, sulcal depth and curvature-from structural MRI at term-equivalent age (TEA) to independently predict cognitive and language development at 2 years corrected age in very preterm (VPT) infants. DESIGN Population-based, prospective cohort study. Structural brain MRI was performed at term, between 40 and 44 weeks postmenstrual age and processed using the developing Human Connectome Project pipeline. SETTING Multicentre study comprising four regional level III neonatal intensive care units in the Columbus, Ohio region. PATIENTS 110 VPT infants (gestational age (GA) ≤ 31 weeks). MAIN OUTCOME MEASURES Cognitive and language scores at 2 years corrected age on the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS Of the 94 VPT infants with high-quality T2-weighted MRI scans, 75 infants (80%) returned for Bayley-III testing. Cortical surface area was positively correlated with cognitive and language scores in nearly every brain region. Curvature of the inner cortex was negatively correlated with Bayley scores in the frontal, parietal and temporal lobes. In multivariable regression models, adjusting for GA, sex, socioeconomic status, and injury score on MRI, regional measures of surface area and curvature independently explained more than one-third of the variance in cognitive and language scores at 2 years corrected age in our cohort. CONCLUSIONS We identified increased cortical curvature at TEA as a new prognostic biomarker of adverse neurodevelopment in very premature infants. When combined with cortical surface area, it enhanced prediction of cognitive and language development. Larger studies are needed to externally validate our findings.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA,Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - John Wells Logan
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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27
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Fleiss B, Gressens P, Stolp HB. Cortical Gray Matter Injury in Encephalopathy of Prematurity: Link to Neurodevelopmental Disorders. Front Neurol 2020; 11:575. [PMID: 32765390 PMCID: PMC7381224 DOI: 10.3389/fneur.2020.00575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Preterm-born infants frequently suffer from an array of neurological damage, collectively termed encephalopathy of prematurity (EoP). They also have an increased risk of presenting with a neurodevelopmental disorder (e.g., autism spectrum disorder; attention deficit hyperactivity disorder) later in life. It is hypothesized that it is the gray matter injury to the cortex, in addition to white matter injury, in EoP that is responsible for the altered behavior and cognition in these individuals. However, although it is established that gray matter injury occurs in infants following preterm birth, the exact nature of these changes is not fully elucidated. Here we will review the current state of knowledge in this field, amalgamating data from both clinical and preclinical studies. This will be placed in the context of normal processes of developmental biology and the known pathophysiology of neurodevelopmental disorders. Novel diagnostic and therapeutic tactics required integration of this information so that in the future we can combine mechanism-based approaches with patient stratification to ensure the most efficacious and cost-effective clinical practice.
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Affiliation(s)
- Bobbi Fleiss
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Pierre Gressens
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Helen B. Stolp
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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28
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Jha SC, Xia K, Ahn M, Girault JB, Li G, Wang L, Shen D, Zou F, Zhu H, Styner M, Gilmore JH, Knickmeyer RC. Environmental Influences on Infant Cortical Thickness and Surface Area. Cereb Cortex 2020; 29:1139-1149. [PMID: 29420697 DOI: 10.1093/cercor/bhy020] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 01/07/2023] Open
Abstract
Cortical thickness (CT) and surface area (SA) vary widely between individuals and are associated with intellectual ability and risk for various psychiatric and neurodevelopmental conditions. Factors influencing this variability remain poorly understood, but the radial unit hypothesis, as well as the more recent supragranular cortex expansion hypothesis, suggests that prenatal and perinatal influences may be particularly important. In this report, we examine the impact of 17 major demographic and obstetric history variables on interindividual variation in CT and SA in a unique sample of 805 neonates who received MRI scans of the brain around 2 weeks of age. Birth weight, postnatal age at MRI, gestational age at birth, and sex emerged as important predictors of SA. Postnatal age at MRI, paternal education, and maternal ethnicity emerged as important predictors of CT. These findings suggest that individual variation in infant CT and SA is explained by different sets of environmental factors with neonatal SA more strongly influenced by sex and obstetric history and CT more strongly influenced by socioeconomic and ethnic disparities. Findings raise the possibility that interventions aimed at reducing disparities and improving obstetric outcomes may alter prenatal/perinatal cortical development.
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Affiliation(s)
- Shaili C Jha
- Curriculum in Neuroscience, University of North Carolina, Chapel Hill, NC, USA
| | - Kai Xia
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Mihye Ahn
- Department of Mathematics and Statistics, University of Nevada, Reno, NV, USA
| | - Jessica B Girault
- Curriculum in Neuroscience, University of North Carolina, Chapel Hill, NC, USA
| | - Gang Li
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Li Wang
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dinggang Shen
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Fei Zou
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Hongtu Zhu
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA.,Department of Biostatistics, University of Texas, MD Andersen Cancer Center, Houston, TX, USA
| | - Martin Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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29
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Altered Cortical Gyrification in Adults Who Were Born Very Preterm and Its Associations With Cognition and Mental Health. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:640-650. [PMID: 32198001 DOI: 10.1016/j.bpsc.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The last trimester of pregnancy is a critical period for the establishment of cortical gyrification, and altered folding patterns have been reported following very preterm birth (< 33 weeks of gestation) in childhood and adolescence. However, research is scant on the persistence of such alterations in adulthood and their associations with cognitive and psychiatric outcomes. METHODS We studied 79 very preterm and 81 age-matched full-term control adults. T1-weighted magnetic resonance images were used to measure a local gyrification index (LGI), indicating the degree of folding across multiple vertices of the reconstructed cortical surface. Group and group-by-sex LGI differences were assessed by means of per-vertex adjustment for cortical thickness and overall intracranial volume. Within-group correlations were also computed between LGI and functional outcomes, including general intelligence (IQ) and psychopathology. RESULTS Very preterm adults had significantly reduced LGI in extensive cortical regions encompassing the frontal, anterior temporal, and occipitoparietal lobes. Alterations in lateral fronto-temporal-parietal and medial occipitoparietal regions were present in both men and women, although men showed more extensive alterations. In both very preterm and control adults, higher LGI was associated with higher IQ and lower psychopathology scores, with the spatial distribution of these associations substantially differing between the two groups. CONCLUSIONS Very preterm adults' brains are characterized by significant and widespread local hypogyria, and these alterations might be implicated in cognitive and psychiatric outcomes. Gyrification reflects an early developmental process and provides a fingerprint for very preterm birth.
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30
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De Bisschop B, Camfferman F, Hengel‐Jacobs M, Delanghe G, Vanderhasselt T, Govaert P. Abnormal primary gyration in relation to deep brain injury in preterm infants. Acta Paediatr 2020; 109:204-205. [PMID: 31483907 DOI: 10.1111/apa.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara De Bisschop
- Department of Neonatology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Fleur Camfferman
- Department of Neonatology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Marjoleine Hengel‐Jacobs
- Department of Neonatology Erasmus Medisch Centrum‐Sophia Kinderziekenhuis Rotterdam The Netherlands
| | | | - Tim Vanderhasselt
- Department of Radiology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussels Belgium
| | - Paul Govaert
- Department of Neonatology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Neonatology Erasmus Medisch Centrum‐Sophia Kinderziekenhuis Rotterdam The Netherlands
- Department of Neonatology ZNA Middelheim Antwerpen Belgium
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31
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Kline JE, Illapani VSP, He L, Altaye M, Parikh NA. Retinopathy of Prematurity and Bronchopulmonary Dysplasia are Independent Antecedents of Cortical Maturational Abnormalities in Very Preterm Infants. Sci Rep 2019; 9:19679. [PMID: 31873183 PMCID: PMC6928014 DOI: 10.1038/s41598-019-56298-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023] Open
Abstract
Very preterm (VPT) infants are at high-risk for neurodevelopmental impairments, however there are few validated biomarkers at term-equivalent age that accurately measure abnormal brain development and predict future impairments. Our objectives were to quantify and contrast cortical features between full-term and VPT infants at term and to associate two key antecedent risk factors, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), with cortical maturational changes in VPT infants. We prospectively enrolled a population-based cohort of 110 VPT infants (gestational age ≤31 weeks) and 51 healthy full-term infants (gestational age 38-42 weeks). Structural brain MRI was performed at term. 94 VPT infants and 46 full-term infants with high-quality T2-weighted MRI were analyzed. As compared to full-term infants, VPT infants exhibited significant global cortical maturational abnormalities, including reduced surface area (-5.9%) and gyrification (-6.7%) and increased curvature (5.9%). In multivariable regression controlled for important covariates, BPD was significantly negatively correlated with lobar and global cortical surface area and ROP was significantly negatively correlated with lobar and global sulcal depth in VPT infants. Our cohort of VPT infants exhibited widespread cortical maturation abnormalities by term-equivalent age that were in part anteceded by two of the most potent neonatal diseases, BPD and ROP.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Divison of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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32
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Abstract
Advances in neonatology have led to unprecedented improvements in neonatal survival such that those born as early as 22 weeks of gestation now have some chance of survival, and over 70% of those born at 24 weeks of gestation survive. Up to 50% of infants born extremely preterm develop poor outcomes involving long-term neurodevelopmental impairments affecting cognition and learning, or motor problems such as cerebral palsy. Poor outcomes arise because the preterm brain is vulnerable both to direct injury (by events such as intracerebral hemorrhage, infection, and/or hypoxia), or indirect injury due to disruption of normal development. This neonatal brain injury and/or dysmaturation is called "encephalopathy of prematurity". Current and future strategies to improve outcomes in this population include prevention of preterm birth, and pre-, peri-, and postnatal approaches to protect the developing brain. This review will describe mechanisms of preterm brain injury, and current and upcoming therapies in the antepartum and postnatal period to improve preterm encephalopathy.
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Affiliation(s)
- Pratik Parikh
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA.
| | - Sandra E Juul
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA.
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33
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Hasler HM, Brown TT, Akshoomoff N. Variations in brain morphometry among healthy preschoolers born preterm. Early Hum Dev 2019; 140:104929. [PMID: 31751933 PMCID: PMC7231635 DOI: 10.1016/j.earlhumdev.2019.104929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/04/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preterm birth is associated with an increased risk of neonatal brain injury, which can lead to alterations in brain maturation. Despite being born without the most significant medical consequences of preterm birth, infants born early remain at increased risk for subtle brain injury that affects future neurodevelopment and functioning. AIMS To investigate the gray matter morphometry measures of cortical thickness, cortical surface area, and sulcal depth using MRI at 5 years of age in healthy children born preterm. STUDY DESIGN Cohort study. SUBJECTS Participants were 52 children born preterm (<33 weeks gestational age) and 37 children born full term. OUTCOME MEASURES Cortical segmentation and calculation of morphometry measures were completed using FreeSurfer version 5.3.0 and compared between groups using surface-based, voxel-wise analyses. RESULTS The preterm group had a significantly thinner cortex in temporal and parietal regions while cortical thickness was significantly larger within occipital and inferior frontal regions. Surface area was significantly reduced within the fusiform gyrus. Sulcal depth was significantly lower within the posterior parietal and inferior temporal regions but greater in the middle temporal and medial parietal regions. CONCLUSIONS Regional differences were found between preschoolers born preterm and full term in cortical thickness, surface area, and sulcal depth. Cortical thickness differences primarily overlapped with regions found in previous studies of older children and adults. Differences in sulcal depth may represent additional areas of maturational differences in preterm children. These findings likely represent a combination of delayed maturation and permanent alterations caused by the perinatal processes associated with preterm birth.
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Affiliation(s)
- Holly M. Hasler
- Center for Human Development, University of California San Diego, United States of America,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, United States of America
| | - Timothy T. Brown
- Center for Human Development, University of California San Diego, United States of America,Department of Neurosciences, University of California, San Diego School of Medicine, United States of America
| | - Natacha Akshoomoff
- Center for Human Development, University of California San Diego, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, United States of America.
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34
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Rallis D, Karagianni P, Goutsiou E, Soubasi-Griva V, Banerjee J, Tsakalidis C. The association of the cerebral oxygenation during neonatal sepsis with the Bayley-III Scale of Infant and Toddler Development index scores at 18-24 months of age. Early Hum Dev 2019; 136:49-53. [PMID: 31310860 DOI: 10.1016/j.earlhumdev.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/29/2019] [Accepted: 07/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal sepsis has been associated with poor neurodevelopmental outcome, however the evidence regarding the exact mechanism of the inflammation to the developing neonatal brain are inconclusive. AIMS To investigate association between cerebral oxygenation during neonatal sepsis and neurodevelopmental outcome. STUDY DESIGN Follow-up assessment of a previously described prospective case-control study. SUBJECTS A cohort of late preterm (34-37 weeks' gestation) and preterm (<34 weeks' gestation) infants with sepsis and healthy controls, evaluated at 18-24 months of corrected gestational age with Bayley-III Scales for Infant and Toddler Development (BSID-III). OUTCOME MEASURES To evaluate the association between cerebral tissue oxygenation index (cTOI) and fractional tissue oxygen extraction (FTOE), measured with near-infrared spectroscopy, during sepsis and the composite cognitive and motor index scores. RESULTS Thirty-one infants with blood culture confirmed neonatal sepsis and thirty-five controls were recruited. The cerebral oxygenation was significantly lower in septic neonates, compared to controls (61 ± 7 compared to 72 ± 5; p < 0.001). Infants with sepsis had significantly lower cognitive and motor index scores and higher proportion of suboptimal cognitive (16% compared to 3%, p = 0.045) and motor (16% compared to none, p = 0.008) index score. The low mean cTOI and FTOE noted in septic infants were significantly associated with worse cognitive and motor composite index scores. CONCLUSIONS Infants with lower cerebral oxygenation during neonatal sepsis are at increased risk of worse cognitive and motor scores in the neurodevelopmental assessment.
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Affiliation(s)
- Dimitrios Rallis
- 2nd Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Imperial College Healthcare NHS Trust, London, UK.
| | - Paraskevi Karagianni
- 2nd Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evanthia Goutsiou
- 2nd Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Soubasi-Griva
- 2nd Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christos Tsakalidis
- 2nd Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
OBJECTIVES To characterize state regulation and behavior of preterm infants after discharge from the neonatal intensive care unit (NICU). METHODS We recruited singleton infants born at ≤35 weeks of gestational age (GA) before NICU discharge. Parents completed surveys at discharge and 1, 3, and 6 months after discharge. Infant medical history was gleaned from the medical record. Surveys captured sociodemographic information and measures of infant state regulation (Baby Pediatric Symptom Checklist [BPSC]) and feeding behaviors. We calculated the median BPSC subscale scores at each time point and the proportion of infants with scores in the problem range (≥3/5). We explored longitudinal and cross-sectional correlates of BPSC scores. RESULTS Fifty families completed the discharge questionnaire, and 42 (84%) completed the 6-month questionnaire. The median GA at birth was 34 weeks (IQR 30.1, 34.4 weeks); the median birth weight was 1930 g (IQR 1460, 2255 g). The median scores were above population norms for irritability and difficulty with routines. Twenty-one infants (40%) had irritability subscale scores in the problem range at 1 month, and 20 (38%) had problem scores on difficulties with routines. Only 9 infants (17%) had problem scores on the inflexibility subscale. Scores in all 3 domains showed different patterns from population norms from 1 to 6 months. BPSC scores were correlated with infant feeding behaviors at 1, 3, and 6 months. CONCLUSION Scores for irritability and difficulty with routines among preterm infants were high compared with population norms and differed from normative values through 6 months after discharge. Preterm infants demonstrate problems with state regulation after NICU discharge that may require directed intervention.
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Abstract
Despite the advances in neonatal intensive care, the preterm brain remains vulnerable to white matter injury (WMI) and disruption of normal brain development (i.e., dysmaturation). Compared to severe cystic WMI encountered in the past decades, contemporary cohorts of preterm neonates experience milder WMIs. More than destructive lesions, disruption of the normal developmental trajectory of cellular elements of the white and the gray matter occurs. In the acute phase, in response to hypoxia-ischemia and/or infection and inflammation, multifocal areas of necrosis within the periventricular white matter involve all cellular elements. Later, chronic WMI is characterized by diffuse WMI with aberrant regeneration of oligodendrocytes, which fail to mature to myelinating oligodendrocytes, leading to myelination disturbances. Complete neuronal degeneration classically accompanies necrotic white matter lesions, while altered neurogenesis, represented by a reduction of the dendritic arbor and synapse formation, is observed in response to diffuse WMI. Neuroimaging studies now provide more insight in assessing both injury and dysmaturation of both gray and white matter. Preterm brain injury remains an important cause of neurodevelopmental disabilities, which are still observed in up to 50% of the preterm survivors and take the form of a complex combination of motor, cognitive, and behavioral concerns.
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Affiliation(s)
- Juliane Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Steven P Miller
- Division of Neurology and Centre for Brain and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.
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37
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Quezada S, Castillo-Melendez M, Walker DW, Tolcos M. Development of the cerebral cortex and the effect of the intrauterine environment. J Physiol 2018; 596:5665-5674. [PMID: 30325048 DOI: 10.1113/jp277151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
The human brain is one of the most complex structures currently under study. Its external shape is highly convoluted, with folds and valleys over the entire surface of the cortex. Disruption of the normal pattern of folding is associated with a number of abnormal neurological outcomes, some serious for the individual. Most of our knowledge of the normal development and folding of the cerebral cortex (gyrification) focuses on the internal, biological (i.e. genetically driven) mechanisms of the brain that drive gyrification. However, the impact of an adverse intrauterine and maternal physiological environment on cortical folding during fetal development has been understudied. Accumulating evidence suggests that the state of the intrauterine and maternal environment can have a significant impact on gyrification of the fetal cerebral cortex. This review summarises our current knowledge of how development in a suboptimal intrauterine and maternal environment can affect the normal development of the folded cerebral cortex.
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Affiliation(s)
- Sebastian Quezada
- Monash University, Wellington Rd, Clayton, Melbourne, Australia, 3168.,The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, Melbourne, Australia, 3168
| | - Margie Castillo-Melendez
- Monash University, Wellington Rd, Clayton, Melbourne, Australia, 3168.,The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, Melbourne, Australia, 3168
| | - David W Walker
- School of Health & Biomedical Sciences, RMIT University, Plenty Rd., Bundoora, Melbourne, Australia, 3083
| | - Mary Tolcos
- School of Health & Biomedical Sciences, RMIT University, Plenty Rd., Bundoora, Melbourne, Australia, 3083
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38
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Neil JJ, Smyser CD. Recent advances in the use of MRI to assess early human cortical development. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 293:56-69. [PMID: 29894905 PMCID: PMC6047926 DOI: 10.1016/j.jmr.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 05/18/2023]
Abstract
Over the past decade, a number of advanced magnetic resonance-based methods have been brought to bear on questions related to early development of the human cerebral cortex. Herein, we describe studies employing analysis of cortical surface folding (cortical cartography), cortical microstructure (diffusion anisotropy), and cortically-based functional networks (resting state-functional connectivity MRI). The fundamentals of each MR method are described, followed by a discussion of application of the method to developing cortex and potential clinical uses. We use premature birth as an exemplar of how these modalities can be used to investigate the effects of medical and environmental variables on early cortical development.
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Affiliation(s)
- Jeffrey J Neil
- Department of Pediatric Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics and Radiology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8111, St. Louis, MO 63110, United States.
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Dubois J, Lefèvre J, Angleys H, Leroy F, Fischer C, Lebenberg J, Dehaene-Lambertz G, Borradori-Tolsa C, Lazeyras F, Hertz-Pannier L, Mangin JF, Hüppi PS, Germanaud D. The dynamics of cortical folding waves and prematurity-related deviations revealed by spatial and spectral analysis of gyrification. Neuroimage 2018. [PMID: 29522888 DOI: 10.1016/j.neuroimage.2018.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the human brain, the appearance of cortical sulci is a complex process that takes place mostly during the second half of pregnancy, with a relatively stable temporal sequence across individuals. Since deviant gyrification patterns have been observed in many neurodevelopmental disorders, mapping cortical development in vivo from the early stages on is an essential step to uncover new markers for diagnosis or prognosis. Recently this has been made possible by MRI combined with post-processing tools, but the reported results are still fragmented. Here we aimed to characterize the typical folding progression ex utero from the pre- to the post-term period, by considering 58 healthy preterm and full-term newborns and infants imaged between 27 and 62 weeks of post-menstrual age. Using a method of spectral analysis of gyrification (SPANGY), we detailed the spatial-frequency structure of cortical patterns in a quantitative way. The modeling of developmental trajectories revealed three successive waves that might correspond to primary, secondary and tertiary folding. Some deviations were further detected in 10 premature infants without apparent neurological impairment and imaged at term equivalent age, suggesting that our approach is sensitive enough to highlight the subtle impact of preterm birth and extra-uterine life on folding.
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Affiliation(s)
- Jessica Dubois
- INSERM, UMR992, CEA, NeuroSpin Center, University Paris Saclay, Gif-sur-Yvette, France.
| | - Julien Lefèvre
- Institut de Neurosciences de la Timone, CNRS UMR7289, Aix-Marseille University, Marseille, France
| | - Hugo Angleys
- INSERM, UMR992, CEA, NeuroSpin Center, University Paris Saclay, Gif-sur-Yvette, France
| | - François Leroy
- INSERM, UMR992, CEA, NeuroSpin Center, University Paris Saclay, Gif-sur-Yvette, France
| | - Clara Fischer
- CEA, NeuroSpin Center, UNATI, University Paris Saclay, Gif-sur-Yvette, France
| | - Jessica Lebenberg
- INSERM, UMR992, CEA, NeuroSpin Center, University Paris Saclay, Gif-sur-Yvette, France; CEA, NeuroSpin Center, UNATI, University Paris Saclay, Gif-sur-Yvette, France
| | | | | | | | | | | | - Petra S Hüppi
- Geneva University Hospitals, Department of Pediatrics, Switzerland
| | - David Germanaud
- CEA, NeuroSpin, UNIACT, Neuropediatry Team, Gif-sur-Yvette, France; INSERM, Sorbonne Paris Cité University (USPC), CEA, UMR 1129, Paris, France; Paris Diderot University (USPC), AP-HP, Robert-Debré Hospital, DHU Protect, Department of Pediatric Neurology and Metabolic Diseases, Paris, France
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40
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Makropoulos A, Robinson EC, Schuh A, Wright R, Fitzgibbon S, Bozek J, Counsell SJ, Steinweg J, Vecchiato K, Passerat-Palmbach J, Lenz G, Mortari F, Tenev T, Duff EP, Bastiani M, Cordero-Grande L, Hughes E, Tusor N, Tournier JD, Hutter J, Price AN, Teixeira RPAG, Murgasova M, Victor S, Kelly C, Rutherford MA, Smith SM, Edwards AD, Hajnal JV, Jenkinson M, Rueckert D. The developing human connectome project: A minimal processing pipeline for neonatal cortical surface reconstruction. Neuroimage 2018. [PMID: 29409960 DOI: 10.1101/125526] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Developing Human Connectome Project (dHCP) seeks to create the first 4-dimensional connectome of early life. Understanding this connectome in detail may provide insights into normal as well as abnormal patterns of brain development. Following established best practices adopted by the WU-MINN Human Connectome Project (HCP), and pioneered by FreeSurfer, the project utilises cortical surface-based processing pipelines. In this paper, we propose a fully automated processing pipeline for the structural Magnetic Resonance Imaging (MRI) of the developing neonatal brain. This proposed pipeline consists of a refined framework for cortical and sub-cortical volume segmentation, cortical surface extraction, and cortical surface inflation, which has been specifically designed to address considerable differences between adult and neonatal brains, as imaged using MRI. Using the proposed pipeline our results demonstrate that images collected from 465 subjects ranging from 28 to 45 weeks post-menstrual age (PMA) can be processed fully automatically; generating cortical surface models that are topologically correct, and correspond well with manual evaluations of tissue boundaries in 85% of cases. Results improve on state-of-the-art neonatal tissue segmentation models and significant errors were found in only 2% of cases, where these corresponded to subjects with high motion. Downstream, these surfaces will enhance comparisons of functional and diffusion MRI datasets, supporting the modelling of emerging patterns of brain connectivity.
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Affiliation(s)
- Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Emma C Robinson
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Robert Wright
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Johannes Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Passerat-Palmbach
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Gregor Lenz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Filippo Mortari
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Tencho Tenev
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nora Tusor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Murgasova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
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Bouyssi-Kobar M, Murnick J, Brossard-Racine M, Chang T, Mahdi E, Jacobs M, Limperopoulos C. Altered Cerebral Perfusion in Infants Born Preterm Compared with Infants Born Full Term. J Pediatr 2018; 193:54-61.e2. [PMID: 29212618 PMCID: PMC5794508 DOI: 10.1016/j.jpeds.2017.09.083] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare regional cerebral cortical blood flow (CBF) in infants born very preterm at term-equivalent age (TEA) and healthy newborns born full term and to examine the impact of clinical risk factors on CBF in the cohort born preterm. STUDY DESIGN This prospective, cross-sectional study included infants born very preterm (gestational age at birth <32 weeks; birth weight <1500 g) and healthy infants born full term. Using noninvasive 3T arterial spin labeling magnetic resonance imaging, we quantified regional CBF in the cerebral cortex: sensorimotor/auditory/visual cortex, superior medial/dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)/posterior cingulate cortex, insula, and lateral posterior parietal cortex, as well as in the brainstem, and deep gray matter. Analyses were performed controlling for sex, gestational age, and age at magnetic resonance imaging. RESULTS We studied 202 infants: 98 born preterm and 104 born full term at TEA. Infants born preterm demonstrated greater global CBF (β = 9.03; P < .0001) and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, ACC and auditory cortex were decreased significantly in infants born preterm compared with their peers born at full term (P < .0001; P = .026; P = .036, respectively). In addition, the presence of parenchymal brain injury correlated with lower global and regional CBF (insula, ACC, sensorimotor, auditory, and visual cortices) whereas the need for cardiac vasopressor support correlated with lower regional CBF in the insula and visual cortex. CONCLUSIONS Altered regional cortical CBF in infants born very preterm at TEA may reflect early brain dysmaturation despite the absence of cerebral cortical injury. Furthermore, specific cerebral cortical areas may be vulnerable to early hemodynamic instability and parenchymal brain injury.
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Affiliation(s)
- Marine Bouyssi-Kobar
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC; Institute for Biomedical Sciences, George Washington University, Washington, DC
| | - Jonathan Murnick
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
| | - Marie Brossard-Racine
- Department of Pediatrics Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Québec, Canada
| | - Taeun Chang
- Department of Neurology, Children's National Health System, Washington, DC
| | - Eman Mahdi
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
| | - Marni Jacobs
- Department of Epidemiology and Biostatistics, Children's Research Institute, Children's National Health System, Washington, DC
| | - Catherine Limperopoulos
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
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42
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Makropoulos A, Robinson EC, Schuh A, Wright R, Fitzgibbon S, Bozek J, Counsell SJ, Steinweg J, Vecchiato K, Passerat-Palmbach J, Lenz G, Mortari F, Tenev T, Duff EP, Bastiani M, Cordero-Grande L, Hughes E, Tusor N, Tournier JD, Hutter J, Price AN, Teixeira RPAG, Murgasova M, Victor S, Kelly C, Rutherford MA, Smith SM, Edwards AD, Hajnal JV, Jenkinson M, Rueckert D. The developing human connectome project: A minimal processing pipeline for neonatal cortical surface reconstruction. Neuroimage 2018; 173:88-112. [PMID: 29409960 DOI: 10.1016/j.neuroimage.2018.01.054] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 12/11/2022] Open
Abstract
The Developing Human Connectome Project (dHCP) seeks to create the first 4-dimensional connectome of early life. Understanding this connectome in detail may provide insights into normal as well as abnormal patterns of brain development. Following established best practices adopted by the WU-MINN Human Connectome Project (HCP), and pioneered by FreeSurfer, the project utilises cortical surface-based processing pipelines. In this paper, we propose a fully automated processing pipeline for the structural Magnetic Resonance Imaging (MRI) of the developing neonatal brain. This proposed pipeline consists of a refined framework for cortical and sub-cortical volume segmentation, cortical surface extraction, and cortical surface inflation, which has been specifically designed to address considerable differences between adult and neonatal brains, as imaged using MRI. Using the proposed pipeline our results demonstrate that images collected from 465 subjects ranging from 28 to 45 weeks post-menstrual age (PMA) can be processed fully automatically; generating cortical surface models that are topologically correct, and correspond well with manual evaluations of tissue boundaries in 85% of cases. Results improve on state-of-the-art neonatal tissue segmentation models and significant errors were found in only 2% of cases, where these corresponded to subjects with high motion. Downstream, these surfaces will enhance comparisons of functional and diffusion MRI datasets, supporting the modelling of emerging patterns of brain connectivity.
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Affiliation(s)
- Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Emma C Robinson
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Robert Wright
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Johannes Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Passerat-Palmbach
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Gregor Lenz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Filippo Mortari
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Tencho Tenev
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nora Tusor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Murgasova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
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Machine learning shows association between genetic variability in PPARG and cerebral connectivity in preterm infants. Proc Natl Acad Sci U S A 2017; 114:13744-13749. [PMID: 29229843 PMCID: PMC5748164 DOI: 10.1073/pnas.1704907114] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Preterm birth affects 11% of births globally; 35% of infants develop long-term neurocognitive problems, and prematurity leads to the loss of 75 million disability adjusted life years per annum worldwide. Imaging studies have shown that these infants have extensive alterations in brain development, but little is known about the molecular or cellular mechanisms involved. This imaging genetics study found a strong association between abnormal cerebral connectivity and variability in the PPARG gene, implicating PPARG signaling in abnormal white-matter development in preterm infants and suggesting a tractable new target for therapeutic research. Preterm infants show abnormal structural and functional brain development, and have a high risk of long-term neurocognitive problems. The molecular and cellular mechanisms involved are poorly understood, but novel methods now make it possible to address them by examining the relationship between common genetic variability and brain endophenotype. We addressed the hypothesis that variability in the Peroxisome Proliferator Activated Receptor (PPAR) pathway would be related to brain development. We employed machine learning in an unsupervised, unbiased, combined analysis of whole-brain diffusion tractography together with genomewide, single-nucleotide polymorphism (SNP)-based genotypes from a cohort of 272 preterm infants, using Sparse Reduced Rank Regression (sRRR) and correcting for ethnicity and age at birth and imaging. Empirical selection frequencies for SNPs associated with cerebral connectivity ranged from 0.663 to zero, with multiple highly selected SNPs mapping to genes for PPARG (six SNPs), ITGA6 (four SNPs), and FXR1 (two SNPs). SNPs in PPARG were significantly overrepresented (ranked 7–11 and 67 of 556,000 SNPs; P < 2.2 × 10−7), and were mostly in introns or regulatory regions with predicted effects including protein coding and nonsense-mediated decay. Edge-centric graph-theoretic analysis showed that highly selected white-matter tracts were consistent across the group and important for information transfer (P < 2.2 × 10−17); they most often connected to the insula (P < 6 × 10−17). These results suggest that the inhibited brain development seen in humans exposed to the stress of a premature extrauterine environment is modulated by genetic factors, and that PPARG signaling has a previously unrecognized role in cerebral development.
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Welch MG, Stark RI, Grieve PG, Ludwig RJ, Isler JR, Barone JL, Myers MM. Family nurture intervention in preterm infants increases early development of cortical activity and independence of regional power trajectories. Acta Paediatr 2017; 106:1952-1960. [PMID: 28850710 DOI: 10.1111/apa.14050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
Abstract
AIM Premature delivery and maternal separation during hospitalisation increase infant neurodevelopmental risk. Previously, a randomised controlled trial of Family Nurture Intervention (FNI) in the neonatal intensive care unit demonstrated improvement across multiple mother and infant domains including increased electroencephalographic (EEG) power in the frontal polar region at term age. New aims were to quantify developmental changes in EEG power in all brain regions and frequencies and correlate developmental changes in EEG power among regions. METHODS EEG (128 electrodes) was obtained at 34-44 weeks postmenstrual age from preterm infants born 26-34 weeks. Forty-four infants were treated with Standard Care and 53 with FNI. EEG power was computed in 10 frequency bands (1-48 Hz) in 10 brain regions and in active and quiet sleep. RESULTS Percent change/week in EEG power was increased in FNI in 132/200 tests (p < 0.05), 117 tests passed a 5% False Discovery Rate threshold. In addition, FNI demonstrated greater regional independence in those developmental rates of change. CONCLUSION This study strengthens the conclusion that FNI promotes cerebral cortical development of preterm infants. The findings indicate that developmental changes in EEG may provide biomarkers for risk in preterm infants as well as proximal markers of effects of FNI.
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Affiliation(s)
- Martha G. Welch
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
- Department of Psychiatry; Columbia University College of Physicians & Surgeons; New York USA
- Department of Developmental Neuroscience; New York State Psychiatric Institute; New York USA
- Department of Pathology & Cell Biology; Columbia University College of Physicians & Surgeons; New York USA
| | - Raymond I. Stark
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
| | - Philip G. Grieve
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
| | - Robert J. Ludwig
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
| | - Joseph R. Isler
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
| | - Joseph L. Barone
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
| | - Michael M. Myers
- Department of Pediatrics; Columbia University College of Physicians & Surgeons; New York USA
- Department of Psychiatry; Columbia University College of Physicians & Surgeons; New York USA
- Department of Developmental Neuroscience; New York State Psychiatric Institute; New York USA
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45
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Back SA. White matter injury in the preterm infant: pathology and mechanisms. Acta Neuropathol 2017; 134:331-349. [PMID: 28534077 PMCID: PMC5973818 DOI: 10.1007/s00401-017-1718-6] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 12/22/2022]
Abstract
The human preterm brain is particularly susceptible to cerebral white matter injury (WMI) that disrupts the normal progression of developmental myelination. Advances in the care of preterm infants have resulted in a sustained reduction in the severity of WMI that has shifted from more severe focal necrotic lesions to milder diffuse WMI. Nevertheless, WMI remains a global health problem and the most common cause of chronic neurological morbidity from cerebral palsy and diverse neurobehavioral disabilities. Diffuse WMI involves maturation-dependent vulnerability of the oligodendrocyte (OL) lineage with selective degeneration of late oligodendrocyte progenitors (preOLs) triggered by oxidative stress and other insults. The magnitude and distribution of diffuse WMI are related to both the timing of appearance and regional distribution of susceptible preOLs. Diffuse WMI disrupts the normal progression of OL lineage maturation and myelination through aberrant mechanisms of regeneration and repair. PreOL degeneration is accompanied by early robust proliferation of OL progenitors that regenerate and augment the preOL pool available to generate myelinating OLs. However, newly generated preOLs fail to differentiate and initiate myelination along their normal developmental trajectory despite the presence of numerous intact-appearing axons. Disrupted preOL maturation is accompanied by diffuse gliosis and disturbances in the composition of the extracellular matrix and is mediated in part by inhibitory factors derived from reactive astrocytes. Signaling pathways implicated in disrupted myelination include those mediated by Notch, WNT-beta catenin, and hyaluronan. Hence, there exists a potentially broad but still poorly defined developmental window for interventions to promote white matter repair and myelination and potentially reverses the widespread disturbances in cerebral gray matter growth that accompanies WMI.
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Affiliation(s)
- Stephen A Back
- Division of Pediatric Neuroscience, Departments of Pediatrics and Neurology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239-3098, USA.
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46
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Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
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Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
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Pineda R, Durant P, Mathur A, Inder T, Wallendorf M, Schlaggar BL. Auditory Exposure in the Neonatal Intensive Care Unit: Room Type and Other Predictors. J Pediatr 2017; 183:56-66.e3. [PMID: 28189301 PMCID: PMC5378448 DOI: 10.1016/j.jpeds.2016.12.072] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/31/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To quantify early auditory exposures in the neonatal intensive care unit (NICU) and evaluate how these are related to medical and environmental factors. We hypothesized that there would be less auditory exposure in the NICU private room, compared with the open ward. STUDY DESIGN Preterm infants born at ≤ 28 weeks gestation (33 in the open ward, 25 in private rooms) had auditory exposure quantified at birth, 30 and 34 weeks postmenstrual age (PMA), and term equivalent age using the Language Environmental Acquisition device. RESULTS Meaningful language (P < .0001), the number of adult words (P < .0001), and electronic noise (P < .0001) increased across PMA. Silence increased (P = .0007) and noise decreased (P < .0001) across PMA. There was more silence in the private room (P = .02) than the open ward, with an average of 1.9 hours more silence in a 16-hour period. There was an interaction between PMA and room type for distant words (P = .01) and average decibels (P = .04), indicating that changes in auditory exposure across PMA were different for infants in private rooms compared with infants in the open ward. Medical interventions were related to more noise in the environment, although parent presence (P = .009) and engagement (P = .002) were related to greater language exposure. Average sound levels in the NICU were 58.9 ± 3.6 decibels, with an average peak level of 86.9 ± 1.4 decibels. CONCLUSIONS Understanding the NICU auditory environment paves the way for interventions that reduce high levels of adverse sound and enhance positive forms of auditory exposure, such as language.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
| | - Polly Durant
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Bradley L Schlaggar
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; Department of Radiology, Washington University School of Medicine, St. Louis, MO; Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
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Hong SJ, Bernhardt BC, Caldairou B, Hall JA, Guiot MC, Schrader D, Bernasconi N, Bernasconi A. Multimodal MRI profiling of focal cortical dysplasia type II. Neurology 2017; 88:734-742. [PMID: 28130467 DOI: 10.1212/wnl.0000000000003632] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/30/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize in vivo MRI signatures of focal cortical dysplasia (FCD) type IIA and type IIB through combined analysis of morphology, intensity, microstructure, and function. METHODS We carried out a multimodal 3T MRI profiling of 33 histologically proven FCD type IIA (9) and IIB (24) lesions. A multisurface approach operating on manual consensus labels systematically sampled intracortical and subcortical lesional features. Geodesic distance mapping quantified the same features in the lesion perimeter. Logistic regression assessed the relationship between MRI and histology, while supervised pattern learning was used for individualized subtype prediction. RESULTS FCD type IIB was characterized by abnormal morphology, intensity, diffusivity, and function across all surfaces, while type IIA lesions presented only with increased fluid-attenuated inversion recovery signal and reduced diffusion anisotropy close to the gray-white matter interface. Similar to lesional patterns, perilesional anomalies were more marked in type IIB extending up to 16 mm. Structural MRI markers correlated with categorical histologic characteristics. A profile-based classifier predicted FCD subtypes with equal sensitivity of 85%, while maintaining a high specificity of 94% against healthy and disease controls. CONCLUSIONS Image processing applied to widely available MRI contrasts has the ability to dissociate FCD subtypes at a mesoscopic level. Integrating in vivo staging of pathologic traits with automated lesion detection is likely to provide an objective definition of lesional boundary and assist emerging approaches, such as minimally invasive thermal ablation, which do not supply tissue specimen.
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Affiliation(s)
- Seok-Jun Hong
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Boris C Bernhardt
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Benoit Caldairou
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Jeffery A Hall
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Marie C Guiot
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Dewi Schrader
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Neda Bernasconi
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada
| | - Andrea Bernasconi
- From the Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital (S.-J.H., B.C.B., B.C., J.A.H., M.C.G., N.B., A.B.), Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre (S.-J.H., B.C.B., B.C., D.S., N.B., A.B.), and Department of Pathology (M.C.G.), McGill University, Montreal, Canada.
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Folding, But Not Surface Area Expansion, Is Associated with Cellular Morphological Maturation in the Fetal Cerebral Cortex. J Neurosci 2017; 37:1971-1983. [PMID: 28069920 DOI: 10.1523/jneurosci.3157-16.2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 01/26/2023] Open
Abstract
Altered macroscopic anatomical characteristics of the cerebral cortex have been identified in individuals affected by various neurodevelopmental disorders. However, the cellular developmental mechanisms that give rise to these abnormalities are not understood. Previously, advances in image reconstruction of diffusion magnetic resonance imaging (MRI) have made possible high-resolution in utero measurements of water diffusion anisotropy in the fetal brain. Here, diffusion anisotropy within the developing fetal cerebral cortex is longitudinally characterized in the rhesus macaque, focusing on gestation day (G85) through G135 of the 165 d term. Additionally, for subsets of animals characterized at G90 and G135, immunohistochemical staining was performed, and 3D structure tensor analyses were used to identify the cellular processes that most closely parallel changes in water diffusion anisotropy with cerebral cortical maturation. Strong correlations were found between maturation of dendritic arbors on the cellular level and the loss of diffusion anisotropy with cortical development. In turn, diffusion anisotropy changes were strongly associated both regionally and temporally with cortical folding. Notably, the regional and temporal dependence of diffusion anisotropy and folding were distinct from the patterns observed for cerebral cortical surface area expansion. These findings strengthen the link proposed in previous studies between cellular-level changes in dendrite morphology and noninvasive diffusion MRI measurements of the developing cerebral cortex and support the possibility that, in gyroencephalic species, structural differentiation within the cortex is coupled to the formation of gyri and sulci.SIGNIFICANCE STATEMENT Abnormal brain morphology has been found in populations with neurodevelopmental disorders. However, the mechanisms linking cellular level and macroscopic maturation are poorly understood, even in normal brains. This study contributes new understanding to this subject using serial in utero MRI measurements of rhesus macaque fetuses, from which macroscopic and cellular information can be derived. We found that morphological differentiation of dendrites was strongly associated both regionally and temporally with folding of the cerebral cortex. Interestingly, parallel associations were not observed with cortical surface area expansion. These findings support the possibility that perturbed morphological differentiation of cells within the cortex may underlie abnormal macroscopic characteristics of individuals affected by neurodevelopmental disorders.
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Kersbergen KJ, Leroy F, Išgum I, Groenendaal F, de Vries LS, Claessens NH, van Haastert IC, Moeskops P, Fischer C, Mangin JF, Viergever MA, Dubois J, Benders MJ. Relation between clinical risk factors, early cortical changes, and neurodevelopmental outcome in preterm infants. Neuroimage 2016; 142:301-310. [DOI: 10.1016/j.neuroimage.2016.07.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/30/2016] [Accepted: 07/05/2016] [Indexed: 01/08/2023] Open
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