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Roto S, Nupponen I, Kalliala I, Kaijomaa M. Risk factors for neonatal hypoxic ischemic encephalopathy and therapeutic hypothermia: a matched case-control study. BMC Pregnancy Childbirth 2024; 24:421. [PMID: 38867160 PMCID: PMC11167761 DOI: 10.1186/s12884-024-06596-8] [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: 05/31/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be difficult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the significance of different antenatal and delivery related risk factors for moderate and severe HIE and the need for therapeutic hypothermia. METHODS We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated. RESULTS Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia. CONCLUSIONS Smoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.
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Affiliation(s)
- Suoma Roto
- Department of obstetrics and gynecology, Helsinki University Women's Hospital, Haartmaninkatu 2, Helsinki, 00029, Finland
| | - Irmeli Nupponen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Kalliala
- Department of obstetrics and gynecology, Helsinki University Women's Hospital, Haartmaninkatu 2, Helsinki, 00029, Finland
| | - Marja Kaijomaa
- Department of obstetrics and gynecology, Helsinki University Women's Hospital, Haartmaninkatu 2, Helsinki, 00029, Finland.
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Javvaji CK, Vagha JD, Meshram RJ, Taksande A. Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications. Cureus 2023; 15:e47939. [PMID: 38034189 PMCID: PMC10685081 DOI: 10.7759/cureus.47939] [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: 09/27/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Ghirelli EA, Silva FPGD, Oricil AGG, Paula CBVD, Nagashima S, Oldenburg Neto CF, Storti E, Sakiyama FYR, Kayano RM, Sakiyama RR, Moreira VDS, Sotomaior VS, Noronha LD. Role of the NF-kB/parkin/vegfr-1 pathway associated with hypoxic-ischemic insult in germinal matrix samples of newborn infants. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022034. [PMID: 37132761 PMCID: PMC10144076 DOI: 10.1590/1984-0462/2023/41/2022034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/27/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Given the high proliferative activity of germinal matrix and its direct correlation with hypoxemia, it is necessary to investigate the possible molecular regulation pathways, to understand the existing clinical relationship between the hypoxic-ischemic insult and the biomarkers NF-kB, AKT-3, Parkin, TRK-C and VEGFR-1. METHODS A hundred and eighteen germinal matrix samples of the central nervous system of patients who died in the first 28 days of life were submitted to histological and immunohistochemistry analysis to identify the tissue immunoexpression of those biomarkers related to asphyxia, prematurity, and death events within 24h. RESULTS A significantly increased tissue immunoexpression of NF-kB, AKT-3 and Parkin was observed in the germinal matrix of preterm infants. In addition, significantly decreased tissue immunoexpression of VEGFR-1 and NF-kB was observed in patients who experienced asphyxia followed by death within 24 hours. CONCLUSIONS The results suggest a direct involvement between the hypoxic-ischemic insult and NF-kB and VEGFR-1 markers since a decreased immunoexpression of these biomarkers was observed in asphyxiated patients. Furthermore, it is suggested that there was not enough time for VEGFR-1 to be transcribed, translated and expressed on the surface of the plasma membrane. This temporality can be observed in the relationship between NF-kB expression and the survival time of individuals who died within 24 hours, suggesting that this factor is essential for the production of VEGFR-1 and, therefore, to carry out the necessary remodeling effect to neovascularize the affected region.
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Affiliation(s)
| | | | | | | | - Seigo Nagashima
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Eduardo Storti
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | | - Lucia de Noronha
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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4
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Tsaousi M, Iliodromiti Z, Iacovidou N, Karapati E, Sulaj A, Tsantes AG, Petropoulou C, Boutsikou T, Tsantes AE, Sokou R. Hemostasis in Neonates with Perinatal Hypoxia—Laboratory Approach: A Systematic Review. Semin Thromb Hemost 2022; 49:391-401. [PMID: 36368691 DOI: 10.1055/s-0042-1758148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractBirth asphyxia, with an estimated prevalence of 1 to 6 per 1,000 live births, may lead to multiorgan dysfunction due to impaired oxygen and/or blood supply to various organ systems, including the hemostatic system. Coagulopathy, a common complication of perinatal asphyxia, has been described since the 1960s. The aim of this study was to systematically review the literature for records on the use of hemostasis tests in the evaluation of coagulation disorders, in neonates who had suffered from perinatal hypoxia or asphyxia. We identified published studies by searching PubMed and Scopus, up until April 2022. The literature search retrieved 37 articles fulfilling the inclusion criteria of the review. According to the bibliography, thrombocytopenia is commonly associated with perinatal hypoxia/asphyxia. The thrombocytopenia is usually described as mild and platelets return to normal levels by the 10th day of life. Additionally, hypoxic neonates usually present with a hypocoagulable profile, as reflected by the prolongation of standard coagulation tests, including prothrombin time, activated partial thromboplastin time, and international normalized ratio, findings commonly associated with disseminated intravascular coagulation, and by the reduction of the levels of the physiologic inhibition of coagulation system. A few studies thus far using ROTEM/TEG in hypoxic neonates have come to the same conclusion as well; hypoxic newborns seem to be characterized by a hypocoagulable profile compared with healthy neonates. It should be emphasized, however, that standard coagulation tests provide only a rough estimation of the true bleeding or thrombotic risk of hypoxic neonates. On the contrary, viscoelastic methods seem to be more precise in the early detection of hemostasis disorders in the neonatal population. However, until now, there was uncertainty as to the most appropriate coagulation assays for diagnosis and management of coagulation derangement in neonates with perinatal hypoxia indicating the need for further research on this field.
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Affiliation(s)
- Marina Tsaousi
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Karapati
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alma Sulaj
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysa Petropoulou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, Piraeus, Greece
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Wang B, Zeng H, Liu J, Sun M. Effects of Prenatal Hypoxia on Nervous System Development and Related Diseases. Front Neurosci 2021; 15:755554. [PMID: 34759794 PMCID: PMC8573102 DOI: 10.3389/fnins.2021.755554] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
The fetal origins of adult disease (FOAD) hypothesis, which was proposed by David Barker in the United Kingdom in the late 1980s, posited that adult chronic diseases originated from various adverse stimuli in early fetal development. FOAD is associated with a wide range of adult chronic diseases, including cardiovascular disease, cancer, type 2 diabetes and neurological disorders such as schizophrenia, depression, anxiety, and autism. Intrauterine hypoxia/prenatal hypoxia is one of the most common complications of obstetrics and could lead to alterations in brain structure and function; therefore, it is strongly associated with neurological disorders such as cognitive impairment and anxiety. However, how fetal hypoxia results in neurological disorders remains unclear. According to the existing literature, we have summarized the causes of prenatal hypoxia, the effects of prenatal hypoxia on brain development and behavioral phenotypes, and the possible molecular mechanisms.
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Affiliation(s)
- Bin Wang
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongtao Zeng
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingliu Liu
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Miao Sun
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Mammen JJ, Asirvatham ES, Lakshmanan J, Sarman CJ, Mani T, Charles B, Upadhyaya S, Rajan S. A national level estimation of population need for blood in India. Transfusion 2021; 61:1809-1821. [PMID: 33991428 DOI: 10.1111/trf.16369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The population need for blood is the total volume required to transfuse all the individuals who need transfusion in a defined population over a defined period. The clinical demand will arise when people with a disease or condition who require transfusion, access healthcare services, and subsequently the clinicians request blood. Essentially, the conversion of need to demand must be maximum to avoid preventable mortality and morbidity. The study estimated the population need for blood in India. METHODS The methodology included a comprehensive literature review to determine the diseases and conditions requiring transfusion, the population at risk, and prevalence or incidence; and Delphi method to estimate the percentage of people requiring transfusion, and the quantum. RESULTS The estimated annual population need was 26.2 million units (95% CI; 17.9-38.0) of whole blood to address the need for red cells and other components after the separation process. The need for medical conditions was 11.0 million units (95% CI:8.7-14.7), followed by surgery 6.6 million (95% CI:3.8-10.0), pediatrics 5.0 million (95% CI:3.5-7.0), and obstetrics and gynecology 3.6 million units (95% CI:1.9-6.2). The gap between need and demand which depends upon the access and efficiency of healthcare service provision was estimated at 13 million units. CONCLUSION The study brings evidence to highlight the gap between need and demand and the importance of addressing it. It cannot be just the responsibility of blood transfusion or health systems, it requires a multi-sectoral approach to address the barriers affecting the conversion of need to clinical demand for blood.
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Affiliation(s)
| | | | | | | | | | - Bimal Charles
- Christian Medical Association of India (CMAI), New Delhi, India
| | - Sunita Upadhyaya
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organization (NACO), New Delhi, India
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Scherer J, Whybra-Trümpler C, Mildenberger E. Ergebnisse des Hypothermienetzwerks des Universitätsklinikums Dresden von 2010–2017. Entwicklung der Hypothermietherapie bei Neugeborenen in Deutschland. Z Geburtshilfe Neonatol 2020; 224:367-373. [DOI: 10.1055/a-1164-7174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungEinleitung Die Hypothermiebehandlung (TH) verbessert bei Neugeborenen mit hypoxisch-ischämischer Enzephalopathie (HIE) das Outcome und sollte bei Hinweisen für eine perinatale Asphyxie und Zeichen einer moderaten oder schweren HIE angewendet werden.Material/Methode Die Häufigkeit der HIE und der Anwendung der TH wurde aus den Daten der Neonatalerhebung und den Daten des 2010 etablierten Hypothermieregisters extrahiert. Letztere wurden darüber hinaus zur Analyse des kurzfristigen Outcomes herangezogen.Ergebnisse Zwischen 2010 und 2017 schlossen sich 106 der 213 (Stand März 2020) deutschen Perinatalzentren dem Register an. Die Rückantwortquote lag zwischen 22 und 60%. Im Register wurden pro Jahr im Median 164 (IQR 115–224) TH bei Neugeborenen mit HIE erfasst, in der Neonatalerhebung 517 (382–664) bei 543 (432–583) Fällen von HIE. Seit 2014 lag die Zahl der TH über den berichteten Fällen von HIE. Nach TH bei klassischer Indikationsstellung verstarben 10,4% (8–13%) der Neugeborenen. 81% (78–82%) der Neugeborenen wurden nach Hause entlassen, 3,6% (3–5%) in eine Rehabilitationseinrichtung bzw. 5,4% (5–7%) in eine andere Klinik verlegt. Bei Entlassung wurden 89% (87–89%) der Patienten ausschließlich oral ernährt.Diskussion Nach Etablierung der TH in die klinische Routine stieg die Zahl der behandelten Neugeborenen kontinuierlich an. Aktuell liegt die Zahl der TH über der Anzahl der Neugeborenen mit HIE, was nur schwer zu erklären ist, da das Vorliegen einer moderaten oder schweren HIE Voraussetzung für die TH ist. Die Daten des Hypothermieregisters zeigen für den untersuchten Zeitraum keine deutlichen Veränderungen bezüglich Mortalität oder neurologischem Outcome.
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Affiliation(s)
- Jonas Scherer
- Neonatologie, Universitätsmedizin Zentrum für Kinder- und Jugendmedizin, Johannes Gutenberg-Universität Mainz, Mainz
| | - Catharina Whybra-Trümpler
- Neonatologie, Universitätsmedizin Zentrum für Kinder- und Jugendmedizin, Johannes Gutenberg-Universität Mainz, Mainz
| | - Eva Mildenberger
- Neonatologie, Universitätsmedizin Zentrum für Kinder- und Jugendmedizin, Johannes Gutenberg-Universität Mainz, Mainz
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Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Costas-Carrera A, Garcia-Rizo C, Bitanihirwe B, Penadés R. Obstetric Complications and Brain Imaging in Schizophrenia: A Systematic Review. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:1077-1084. [PMID: 33012683 DOI: 10.1016/j.bpsc.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
Schizophrenia is a complex disorder in which clinical symptomatology typically reflects underlying brain abnormalities that coalign with multiple physical health comorbidities. The pathogenesis of schizophrenia involves the interplay between genetic and environmental factors, with obstetric complications widely described as key players in elevating the risk of psychosis. In this regard, understanding the anatomical and functional alterations associated with obstetric complications may help to elucidate potential mechanisms through which birth complications could contribute to schizophrenia pathogenesis. We conducted a systematic review of the extant literature describing brain abnormalities and obstetric complications in patients with schizophrenia and related disorders in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A total of 471 studies were retrieved and screened, and 33 studies met inclusion criteria for our review. Studies varied considerably in their methods, with 11 studies employing computed tomography, 1 using magnetic resonance spectroscopy, and 21 using magnetic resonance imaging. The scientific quality of the included studies was assessed and documented. Obstetric complications increase the risk of provoking brain abnormalities. These abnormalities range from decreased gray matter volume and abnormal brain-ventricle ratios to a reduction of volume in limbic regions-which relate to what is commonly observed in schizophrenia. However, current evidence from neuroimaging studies remains scant in relation to establishing obstetric complications as an independent risk factor for schizophrenia.
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Affiliation(s)
- Ana Costas-Carrera
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Agusti Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Psychiatry Unit, Department of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Byron Bitanihirwe
- Centre for Global Health, Trinity College, Dublin, Ireland; Department of Psychology, Trinity College, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - Rafael Penadés
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Agusti Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Psychiatry Unit, Department of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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10
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Saboute M, Balasi J, Tajalli S, Hajipour M, Heshmat S, Khalesi N, Allahqoli L. Effect of Aminophylline in Preventing Renal Dysfunction among Neonates with Prenatal Asphyxia: A Clinical Trial. ARCHIVES OF IRANIAN MEDICINE 2020; 23:312-318. [PMID: 32383615 DOI: 10.34172/aim.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 01/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND As there are different views on the effects of aminophylline on neonatal renal function, we intended to observe the effects of aminophylline on renal dysfunction in neonates with prenatal asphyxia. METHODS This randomized trial was conducted in the Obstetrics and Gynecology Hospital, Tehran, Iran, from June 2016 to May 2017, in neonates with moderate to severe asphyxia during birth. Fifty-six neonates were divided randomly into two groups. The intervention group received one dose of 5mg/kg slow intravenous aminophylline injection and the placebo group received 2 mL/kg of intravenous 10% solution of dextrose saline during the first hour of life. They were monitored and compared for renal functional indices, electrolytes, and complications of asphyxia during the three days of life. RESULTS The mean of Cr (37.9 ± 8.8 vs 38.5 ± 9.4 and 20.8 ± 4.8 vs 30.1 ± 5.2 μmol/L), GFR (21.55 ± 4.7 vs 20.25 ± 4.4 and 30.8 ± 7.1 vs 20.1 ± 6.5 mL/minute/1.73 m2), Na (135.1 ± 12.4 vs134.5 ± 11.2 and 128.9 ± 11.5 vs 134.2 ± 10.9 mEq/L), and urine output (98.2 ± 25 vs 96.8 ± 23 and 148.7 ± 35 vs 108.8 ± 20 cc) were in the aminophylline treated and placebo group on the 1st and 3rd days, respectively. The mean difference of Cr (-9.3 (-8.9; -9.7) μmol/L); (P = 0.02), GFR (10.7 (10.1; 11.3) mL/minute/1.73 m2) (P = 0.009), Na (-5.3 (-5.9; -4.7) mEq/L) (P = 0.002), and urine volume (39.9 (24.9; 54.9) cc) (P = 0.001) presented statistically significant differences on the third day between the intervention and placebo group. CONCLUSION Aminophylline was effective in preventing renal dysfunction in neonates with asphyxia. Neonates who received aminophylline indicated a significant improvement in GFR and urine output on the first day of life.
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Affiliation(s)
- Maryam Saboute
- Department of Neonatology, Akbar Abadi Hospital, Iran University of Medical Sciences, (IUMS), Tehran, Iran
| | - Javad Balasi
- Department of Neonatology, Ali Asghar Hospital, Iran University of Medical Sciences, (IUMS), Tehran, Iran
| | - Saleheh Tajalli
- School of Nursing and Midwifery, Iran University of Medical Sciences, (IUMS), Tehran, Iran
| | - Mahmoud Hajipour
- Student Research Committee, Epidemiology Department, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Heshmat
- Department of Neonatology, Ali Asghar Hospital, Iran University of Medical Sciences, (IUMS), Tehran, Iran
| | - Nasrin Khalesi
- Department of Neonatology, Ali Asghar Hospital, Iran University of Medical Sciences, (IUMS), Tehran, Iran
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Urinary I-FABP, L-FABP, TFF-3, and SAA Can Diagnose and Predict the Disease Course in Necrotizing Enterocolitis at the Early Stage of Disease. J Immunol Res 2020; 2020:3074313. [PMID: 32190704 PMCID: PMC7072107 DOI: 10.1155/2020/3074313] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/08/2020] [Indexed: 12/24/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease affecting mainly preterm newborns. It is characterized by unexpected onset and rapid progression with specific diagnostic signs as pneumatosis intestinalis or gas in the portal vein appearing later in the course of the disease. Therefore, we analyzed diagnostic and prognostic potential of the markers of early NEC pathogenesis, such as excessive inflammatory response (serum amyloid A (SAA)) and gut epithelium damage (intestinal and liver fatty acid-binding protein (I-FABP and L-FABP, respectively) and trefoil factor-3 (TFF-3)). We used ELISA to analyze these biomarkers in the urine of patients with suspected NEC, either spontaneous or surgery-related, or in infants without gut surgery (controls). Next, we compared their levels with the type of the disease (NEC or sepsis) and its severity. Already at the time of NEC suspicion, infants who developed NEC had significantly higher levels of all tested biomarkers than controls and higher levels of I-FABP and L-FABP than those who will later develop sepsis. Infants who will develop surgery-related NEC had higher levels of I-FABP and L-FABP than those who will develop sepsis already during the first 6 hours after the abdominal surgery. I-FABP was able to discriminate between infants who will develop NEC or sepsis and the SAA was able to discriminate between medical and surgical NEC. Moreover, the combination of TFF-3 with I-FABP and SAA could predict pneumatosis intestinalis, and the combination of I-FABP, L-FABP, and SAA could predict gas in the portal vein or long-term hospitalization and low SAA predicts early full enteral feeding. Thus, these biomarkers may be useful not only in the early, noninvasive diagnostics but also in the subsequent NEC management.
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Udovin LD, Kobiec T, Herrera MI, Toro-Urrego N, Kusnier CF, Kölliker-Frers RA, Ramos-Hryb AB, Luaces JP, Otero-Losada M, Capani F. Partial Reversal of Striatal Damage by Palmitoylethanolamide Administration Following Perinatal Asphyxia. Front Neurosci 2020; 13:1345. [PMID: 31969800 PMCID: PMC6960201 DOI: 10.3389/fnins.2019.01345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/29/2019] [Indexed: 01/27/2023] Open
Abstract
Perinatal asphyxia (PA) is a clinical condition brought by a birth temporary oxygen deprivation associated with long-term damage in the corpus striatum, one of the most compromised brain areas. Palmitoylethanolamide (PEA) is a neuromodulator well known for its protective effects in brain injury models, including PA, albeit not deeply studied regarding its particular effects in the corpus striatum following PA. Using Bjelke et al. (1991) PA model, full-term pregnant rats were decapitated, and uterus horns were placed in a water bath at 37°C for 19 min. One hour later, the pups were injected with PEA 10 mg/kg s.c., and placed with surrogate mothers. After 30 days, the animals were perfused, and coronal striatal sections were collected to analyze protein-level expression by Western blot and the reactive area by immunohistochemistry for neuron markers: phosphorylated neurofilament-heavy/medium-chain (pNF-H/M) and microtubule-associated protein-2 (MAP-2), and the astrocyte marker, glial fibrillary acidic protein (GFAP). Results indicated that PA produced neuronal damage and morphological changes. Asphyctic rats showed a decrease in pNF-H/M and MAP-2 reactive areas, GFAP+ cells number, and MAP-2 as well as pNF-H/M protein expression in the striatum. Treatment with PEA largely restored the number of GFAP+ cells. Most important, it ameliorated the decrease in pNF-H/M and MAP-2 reactive areas in asphyctic rats. Noticeably, PEA treatment reversed the decrease in MAP-2 protein expression and largely prevented PA-induced decrease in pNF-H/M protein expression. PA did not affect the GFAP protein level. Treatment with PEA attenuated striatal damage induced by PA, suggesting its therapeutic potential for the prevention of neurodevelopmental disorders.
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Affiliation(s)
- Lucas D Udovin
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Tamara Kobiec
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina.,Centro de Investigaciones en Psicología y Psicopedagogía (CIPP), Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - María I Herrera
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina.,Centro de Investigaciones en Psicología y Psicopedagogía (CIPP), Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Nicolás Toro-Urrego
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Carlos F Kusnier
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Rodolfo A Kölliker-Frers
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Ana B Ramos-Hryb
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Juan P Luaces
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Matilde Otero-Losada
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina
| | - Francisco Capani
- Institute of Cardiological Research, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina.,Departamento de Biología, Universidad Argentina John F. Kennedy (UAJK), Buenos Aires, Argentina
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13
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Kariya V, Jain M, Jategaonkar S. Study of hepatic enzymes in term neonates with perinatal asphyxia. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_116_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Leikos S, Tokariev A, Koolen N, Nevalainen P, Vanhatalo S. Cortical responses to tactile stimuli in preterm infants. Eur J Neurosci 2019; 51:1059-1073. [PMID: 31679163 DOI: 10.1111/ejn.14613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/07/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022]
Abstract
The conventional assessment of preterm somatosensory functions using averaged cortical responses to electrical stimulation ignores the characteristic components of preterm somatosensory evoked responses (SERs). Our study aimed to systematically evaluate the occurrence and development of SERs after tactile stimulus in preterm infants. We analysed SERs performed during 45 electroencephalograms (EEGs) from 29 infants at the mean post-menstrual age of 30.7 weeks. Altogether 2,087 SERs were identified visually at single-trial level from unfiltered signals capturing also their slowest components. We observed salient SERs with a high-amplitude slow component at a high success rate after hand (95%) and foot (83%) stimuli. There was a clear developmental change in both the slow wave and the higher-frequency components of the SERs. Infants with intraventricular haemorrhage (IVH; eleven infants) had initially normal SERs, but those with bilateral IVH later showed a developmental decrease in the ipsilateral SER occurrence after 30 weeks of post-menstrual age. Our study shows that tactile stimulus applied at bedside elicits salient SERs with a large slow component and an overriding fast oscillation, which are specific to the preterm period. Prior experimental research indicates that such SERs allow studying both subplate and cortical functions. Our present findings further suggest that they might offer a window to the emergence of neurodevelopmental sequelae after major structural brain lesions and, hence, an additional tool for both research and clinical neurophysiological evaluation of infants before term age.
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Affiliation(s)
- Susanna Leikos
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anton Tokariev
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ninah Koolen
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi Nevalainen
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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15
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Hendrix MLE, Bons JAP, Alers NO, Severens-Rijvers CAH, Spaanderman MEA, Al-Nasiry S. Maternal vascular malformation in the placenta is an indicator for fetal growth restriction irrespective of neonatal birthweight. Placenta 2019; 87:8-15. [PMID: 31520871 DOI: 10.1016/j.placenta.2019.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/12/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To study the association between placental pathology and neonatal birthweight and outcomes, and whether a combination of first trimester biomarkers and fetal growth velocity can predict placental lesions. METHODS The presence of maternal vascular malperfusion (MVM) lesions (Amsterdam criteria) was recorded in a retrospective cohort of singleton pregnancies in the Maastricht University Medical Centre, 2011-2018. First trimester maternal characteristics and PAPP-A, PlGF and sFlt-1 levels were collected. Fetal growth velocities were calculated (mm/week) from 20 to 32 weeks for abdominal circumference, biparietal diameter, head circumference and femur length. Data were compared between neonates with 'small for gestational age' (SGA < p10) and different categories of 'appropriate for gestational age (AGA)': AGAp10-30, AGAp30-50 and AGA > p50 (reference), using one-way ANOVA and post hoc test. RESULTS There were significantly more MVM lesions in the SGA group (94.6% p < .0001), but also in the AGAp10-30 (67.3% p < .0001) and AGAp30-50 (41.6% p = 0.002), compared to the reference AGA group (19.3%). The prediction of MVM for a 20% false-positive rate, with maternal characteristics was25.2%. The addition of birthweight percentile gave a prediction of 51.7% for MVM. However adding placental biomarkers and fetal growth velocities (instead of birthweight percentile) to the maternal characteristics, gave a prediction of 81.8% (PPV 49.5%, NPV 53.7%). DISCUSSION Placental MVM lesions correlated inversely with birthweight even in AGA neonates, and was associated with slower fetal growth and more adverse outcome in SGA neonates. A combination of first trimester biomarkers and fetal growth velocity had good prediction of placental MVM lesions, as an indicator of fetal growth restriction irrespective of neonatal weight.
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Affiliation(s)
- M L E Hendrix
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - J A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht (MUMC+), The Netherlands
| | - N O Alers
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - C A H Severens-Rijvers
- Department of Pathology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - S Al-Nasiry
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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16
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Hendrix MLE, Bons JAP, Snellings RRG, Bekers O, van Kuijk SMJ, Spaanderman MEA, Al-Nasiry S. Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome? Fetal Diagn Ther 2019; 46:274-284. [PMID: 31067557 PMCID: PMC6878734 DOI: 10.1159/000499580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. METHOD A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11-13 weeks of gestational age (GA) and two fetal growth scans were performed (18-22 and 30-34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10-90) and SGA (birth weight percentile <10). Combinations of the biomarkers and fetal growth velocity were added to baseline screening for the prediction of SGA and adverse neonatal outcome. RESULTS We included 296 singleton pregnancies. Compared to AGA (n = 251), SGA neonates (n = 45) had significantly lower growth velocities in the abdominal circumference (mm/week): 10.1 ± 0.98 versus 10.8 ± 0.98, p = 0.001. Compared with AGA, the SGA neonates had higher sFlt-1 multiples of the median (MoM): 0.89 (0.55) versus 0.76 (0.44), p = 0.023, and a higher sFlt-1/PlGF MoM ratio: 1.09 (1.03) versus 0.90 (0.64), p = 0.027. For a 15% false-positive rate, the prediction of SGA neonates increased from 44.8% for the baseline screening model to 56.5% after the addition of fetal growth velocities, and to 73.9% after the further addition of maternal biomarkers (PPV 9.6%, NPV 82.4%). The corresponding AUC for the three models were 0.722, 0.804, and 0.839, respectively. In addition, AGA neonates with reduced fetal growth velocity had more adverse neonatal outcomes compared to the AGA reference group (12.4 vs. 3.9%, p = 0.013). CONCLUSIONS Combining fetal growth velocity with first trimester biomarkers resulted in a better prediction of SGA compared to baseline screening parameters alone. This approach could possibly result in reduced adverse neonatal outcomes in neonates, who are at a potential risk due to late mild placental dysfunction.
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Affiliation(s)
- Manouk L E Hendrix
- Department of Obstetrics and Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands,
| | - Judith A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Roy R G Snellings
- Department of Obstetrics and Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Salwan Al-Nasiry
- Department of Obstetrics and Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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17
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Hendrix MLE, van Kuijk SMJ, Gavilanes AWD, Kramer D, Spaanderman MEA, Al Nasiry S. Reduced fetal growth velocities and the association with neonatal outcomes in appropriate-for-gestational-age neonates: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19:31. [PMID: 30646865 PMCID: PMC6332558 DOI: 10.1186/s12884-018-2167-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 12/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background Fetal growth restriction is, despite advances in neonatal care and uptake of antenatal ultrasound scanning, still a major cause of perinatal morbidity. Neonates with birth weight > 10th percentile are assumed to be appropriate-for-gestational-age (AGA), although many are at increased risk of perinatal morbidity, because of undetected mild restriction of growth potential. We hypothesized that within AGA neonates, reduced fetal growth velocities are associated with adverse neonatal outcome. Methods A retrospective cohort study of singleton pregnancies, in the Maastricht University Medical Centre (MUMC) between 2010 and 2016. Women had two fetal biometry scans (18–22 weeks and 30–34 weeks of gestational age) and delivered a newborn with a birth weight between the 10th–80th percentile. Differences in growth velocities of the abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and femur length (FL) were compared between the suboptimal AGA (sAGA) (birth weight centiles 10–50) and optimal AGA (oAGA) (birth weight centiles 50–80) group. We assessed the association between velocities and neonatal outcomes. Results We included 934 singleton pregnancies. In the suboptimal AGA group, fetal growth velocities were lower (in mm/week): AC 10.72 ± 1.00 vs 11.23 ± 1.00 (p < .001), HC 10.50 ± 0.80 vs 10.68 ± 0.77 (p = 0.001), BPD 3.01 ± 0.28 vs 3.08 ± 0.27 (p < .0001) and FL 2.47 ± 0.21 vs 2.50 ± 0.22 (p = 0.014), compared to the optimal AGA group. Neonates with an adverse neonatal outcome had significantly lower growth velocities (in mm/week) of: AC 10.57 vs 10.94 (p = 0.034), HC 10.28 vs 10.59 (p = 0.003) and BPD 2.97 vs 3.04 (p = 0.043) compared to those with normal outcome. An inverse association was observed between the AC velocity and a composite adverse neonatal outcome (OR) = 0.667 (95%CI 0.507–0.879, p = 0.004), and between the AC velocity and neonates with NICU stay (OR) = 0.733 (95%CI 0.570–0.942, p = 0.015). Neonates with a birthweight lower than expected (based on the abdominal circumference at 20 weeks) had significantly more composite adverse neonatal outcomes 8.5% vs 5.0% (p = 0.047), NICU stays 9.6% vs 3.8% (p < .0001) and hospital stays 44.4% vs 35.6% (p = 0.006). Conclusions Appropriate-for-gestational-age neonates are a heterogeneous group with some showing suboptimal fetal growth. Abnormal fetal growth velocities, especially abdominal circumference velocity, are associated with adverse neonatal outcome and can potentially improve the detection of mild growth restriction when used in multivariate models.
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Affiliation(s)
- M L E Hendrix
- Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, University Medical Centre (MUMC), Maastricht, The Netherlands
| | - A W D Gavilanes
- Department of Paediatrics, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - D Kramer
- Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - S Al Nasiry
- Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
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18
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Singh DK, Ling EA, Kaur C. Hypoxia and myelination deficits in the developing brain. Int J Dev Neurosci 2018; 70:3-11. [PMID: 29964158 DOI: 10.1016/j.ijdevneu.2018.06.012] [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: 04/19/2018] [Revised: 05/28/2018] [Accepted: 06/26/2018] [Indexed: 12/15/2022] Open
Abstract
Myelination is a complex and orderly process during brain development that is essential for normal motor, cognitive and sensory functions. Cellular and molecular interactions between myelin-forming oligodendrocytes and axons are required for normal myelination in the developing brain. Oligodendrocyte progenitor cells (OPCs) proliferate and differentiate into mature myelin-forming oligodendrocytes. In this connection, astrocytes and microglia are also involved in survival and proliferation of OPCs. Hypoxic insults during the perinatal period affect the normal development, differentiation and maturation of the OPCs or cause their death resulting in impaired myelination. Several factors such as augmented release of proinflammatory cytokines by activated microglia and astrocytes, extracellular accumulation of excess glutamate and increased levels of nitric oxide are some of the underlying factors for hypoxia induced damage to the OPCs. Additionally, hypoxia also leads to down-regulation of several genes involved in oligodendrocyte differentiation encoding proteolipid protein, platelet-derived growth factor receptor and myelin-associated glycoprotein in the developing brain. Furthermore, oligodendrocytes may also accumulate increased amounts of iron in hypoxic conditions that triggers endoplasmic reticulum stress, misfolding of proteins and generation of reactive oxygen species that ultimately would lead to myelination deficits. More in-depth studies to elucidate the pathophysiological mechanisms underlying the inability of oligodendrocytes to myelinate the developing brain in hypoxic insults are desirable to develop new therapeutic options or strategies for myelination deficits.
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Affiliation(s)
- Dhiraj Kumar Singh
- Department of Anatomy, Yong Loo Lin School of Medicine, MD10, 4 Medical drive, National University of Singapore, 117597, Singapore
| | - Eng-Ang Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, MD10, 4 Medical drive, National University of Singapore, 117597, Singapore
| | - Charanjit Kaur
- Department of Anatomy, Yong Loo Lin School of Medicine, MD10, 4 Medical drive, National University of Singapore, 117597, Singapore.
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19
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Zhang Y, Zhang M, Li L, Wei B, He A, Lu L, Li X, Zhang L, Xu Z, Sun M. Methylation-reprogrammed Wnt/β-catenin signalling mediated prenatal hypoxia-induced brain injury in foetal and offspring rats. J Cell Mol Med 2018; 22:3866-3874. [PMID: 29808608 PMCID: PMC6050486 DOI: 10.1111/jcmm.13660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022] Open
Abstract
Prenatal hypoxia (PH) is a common pregnancy complication, harmful to brain development. This study investigated whether and how PH affected Wnt pathway in the brain. Pregnant rats were exposed to hypoxia (10.5% O2) or normoxia (21% O2; Control). Foetal brain weight and body weight were decreased in the PH group, the ratio of brain weight to body weight was increased significantly. Prenatal hypoxia increased mRNA expression of Wnt3a, Wnt7a, Wnt7b and Fzd4, but not Lrp6. Activated β‐catenin protein and Fosl1 expression were also significantly up‐regulated. Increased Hif1a expression was found in the PH group associated with the higher Wnt signalling. Among 5 members of the Sfrp family, Sfrp4 was down‐regulated. In the methylation‐regulating genes, higher mRNA expressions of Dnmt1 and Dnmt3b were found in the PH group. Sodium bisulphite and sequencing revealed hyper‐methylation in the promoter region of Sfrp4 gene in the foetal brain, accounting for its decreased expression and contributing to the activation of the Wnt‐Catenin signalling. The study of PC12 cells treated with 5‐aza further approved that decreased methylation could result in the higher Sfrp4 expression. In the offspring hippocampus, protein levels of Hif1a and mRNA expression of Sfrp4 were unchanged, whereas Wnt signal pathway was inhibited. The data demonstrated that PH activated the Wnt pathway in the foetal brain, related to the hyper‐methylation of Sfrp4 as well as Hif1a signalling. Activated Wnt signalling might play acute protective roles to the foetal brain in response to hypoxia, also would result in disadvantageous influence on the offspring in long‐term.
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Affiliation(s)
- Yingying Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Mengshu Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Lingjun Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Bin Wei
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Axin He
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Likui Lu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xiang Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Lubo Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China.,Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, USA
| | - Zhice Xu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China.,Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, USA
| | - Miao Sun
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
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20
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Shikuku DN, Milimo B, Ayebare E, Gisore P, Nalwadda G. Practice and outcomes of neonatal resuscitation for newborns with birth asphyxia at Kakamega County General Hospital, Kenya: a direct observation study. BMC Pediatr 2018; 18:167. [PMID: 29764391 PMCID: PMC5953400 DOI: 10.1186/s12887-018-1127-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/30/2018] [Indexed: 12/02/2022] Open
Abstract
Background About three – quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital. Methods Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi – square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics. Results Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08–7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22–8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12–0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10–1.75) were associated with newborn outcome at 1 h. Conclusions Mentorship and regular cost – effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR. Electronic supplementary material The online version of this article (10.1186/s12887-018-1127-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duncan N Shikuku
- Department of Nursing, Makerere University, School of Health Sciences, Kampala, Uganda.
| | - Benson Milimo
- Department of Midwifery and Gender, Moi University, School of Nursing, Eldoret, Kenya
| | - Elizabeth Ayebare
- Department of Nursing, Makerere University, School of Health Sciences, Kampala, Uganda
| | - Peter Gisore
- Department of Child Health & Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - Gorrette Nalwadda
- Department of Nursing, Makerere University, School of Health Sciences, Kampala, Uganda
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21
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Elmas AT, Tabel Y, Özdemir R. Risk factors and mortality rate in premature babies with acute kidney injury. J Clin Lab Anal 2018; 32:e22441. [PMID: 29604124 DOI: 10.1002/jcla.22441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/02/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common morbidity in neonatal intensive care units and associated with poor outcome. This study aimed to determine the prevalence of AKI and provide a demographic data and risk factors associated with the mortality and morbidity. METHODS This is a retrospective study included 105 premature babies. Diagnosis of AKI was based on neonatal KDIGO classification criteria. The babies were stratified into two groups according to AKI status during the hospitalization. Clinical and laboratory characteristics of the AKI group were compared to non-AKI group. RESULTS AKI occurred in 21 (20.0%) of 105 premature babies, and mortality rate in these babies was 61.9%. Lower gestational weeks, lower Apgar scores at 5 minutes, lower systolic blood pressures, and inotropic supports were independent risk factors for the development of AKI in preterm babies (P < .05, for each). Oliguria, preeclampsia/eclampsia, resuscitation at birth, lower diastolic blood pressure, patent ductus arteriosus (PDA), inotropic support, and furosemide treatment were associated with the mortality (P < .05, for each). CONCLUSIONS Prenatal risk factors and medical interventions are associated with AKI, and AKI is associated with increased morbidity and mortality. Therefore, identification of AKI is very important in this vulnerable population and it should be performed as quickly as possible in all babies who are at high risk for developing of AKI.
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Affiliation(s)
- Ahmet Taner Elmas
- Department of Pediatric Nephrology, Faculty of Medicine, University of İnönü, Malatya, Turkey
| | - Yılmaz Tabel
- Department of Pediatric Nephrology, Faculty of Medicine, University of İnönü, Malatya, Turkey
| | - Ramazan Özdemir
- Departments of Neonatology, Faculty of Medicine, University of İnönü, Malatya, Turkey
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22
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Herrera MI, Udovin LD, Toro-Urrego N, Kusnier CF, Luaces JP, Capani F. Palmitoylethanolamide Ameliorates Hippocampal Damage and Behavioral Dysfunction After Perinatal Asphyxia in the Immature Rat Brain. Front Neurosci 2018; 12:145. [PMID: 29662433 PMCID: PMC5890174 DOI: 10.3389/fnins.2018.00145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/22/2018] [Indexed: 12/19/2022] Open
Abstract
Perinatal asphyxia (PA) is an obstetric complication associated with an impaired gas exchange. This health problem continues to be a determinant of neonatal mortality and neurodevelopmental disorders. Palmitoylethanolamide (PEA) has exerted neuroprotection in several models of brain injury and neurodegeneration. We aimed at evaluating the potential neuroprotective role of PEA in an experimental model, which induces PA in the immature rat brain. PA was induced by placing Sprague Dawley newborn rats in a water bath at 37°C for 19 min. Once their physiological conditions improved, they were given to surrogate mothers that had delivered normally within the last 24 h. The control group was represented by non-fostered vaginally delivered pups, mimicking the clinical situation. Treatment with PEA (10 mg/kg) was administered within the first hour of life. Modifications in the hippocampus were analyzed with conventional electron microscopy, immunohistochemistry (for NeuN, pNF-H/M, MAP-2, and GFAP) and western blot (for pNF H/M, MAP-2, and GFAP). Behavior was also studied throughout Open Field (OF) Test, Passive Avoidance (PA) Task and Elevated Plus Maze (EPM) Test. After 1 month of the PA insult, we observed neuronal nucleus degeneration in CA1 using electron microscopy. Immunohistochemistry revealed a significant increase in pNF-H/M and decrease in MAP-2 in CA1 reactive area. These changes were also observed when analyzing the level of expression of these markers by western blot. Vertical exploration impairments and anxiety-related behaviors were encountered in the OF and EPM tests. PEA treatment attenuated PA-induced hippocampal damage and its corresponding behavioral alterations. These results contribute to the elucidation of PEA neuroprotective role after PA and the future establishment of therapeutic strategies for the developing brain.
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Affiliation(s)
- María I Herrera
- Centro de Investigaciones en Psicología y Psicopedagogía, Facultad de Psicología, Universidad Católica Argentina, Buenos Aires, Argentina.,Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Lucas D Udovin
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Nicolás Toro-Urrego
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Carlos F Kusnier
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Juan P Luaces
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Francisco Capani
- Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Facultad de Medicina, Universidad Católica Argentina, Buenos Aires, Argentina.,Universidad Autónoma de Chile, Santiago de Chile, Chile
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23
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Summanen M, Bäck S, Voipio J, Kaila K. Surge of Peripheral Arginine Vasopressin in a Rat Model of Birth Asphyxia. Front Cell Neurosci 2018; 12:2. [PMID: 29403357 PMCID: PMC5780440 DOI: 10.3389/fncel.2018.00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 12/29/2022] Open
Abstract
Mammalian birth is accompanied by a period of obligatory asphyxia, which consists of hypoxia (drop in blood O2 levels) and hypercapnia (elevation of blood CO2 levels). Prolonged, complicated birth can extend the asphyxic period, leading to a pathophysiological situation, and in humans, to the diagnosis of clinical birth asphyxia, the main cause of hypoxic-ischemic encephalopathy (HIE). The neuroendocrine component of birth asphyxia, in particular the increase in circulating levels of arginine vasopressin (AVP), has been extensively studied in humans. Here we show for the first time that normal rat birth is also accompanied by an AVP surge, and that the fetal AVP surge is further enhanced in a model of birth asphyxia, based on exposing 6-day old rat pups to a gas mixture containing 4% O2 and 20% CO2 for 45 min. Instead of AVP, which is highly unstable with a short plasma half-life, we measured the levels of copeptin, the C-terminal part of prepro-AVP that is biochemically much more stable. In our animal model, the bulk of AVP/copeptin release occurred at the beginning of asphyxia (mean 7.8 nM after 15 min of asphyxia), but some release was still ongoing even 90 min after the end of the 45 min experimental asphyxia (mean 1.2 nM). Notably, the highest copeptin levels were measured after hypoxia alone (mean 14.1 nM at 45 min), whereas copeptin levels were low during hypercapnia alone (mean 2.7 nM at 45 min), indicating that the hypoxia component of asphyxia is responsible for the increase in AVP/copeptin release. Alternating the O2 level between 5 and 9% (CO2 at 20%) with 5 min intervals to mimic intermittent asphyxia during prolonged labor resulted in a slower but quantitatively similar rise in copeptin (peak of 8.3 nM at 30 min). Finally, we demonstrate that our rat model satisfies the standard acid-base criteria for birth asphyxia diagnosis, namely a drop in blood pH below 7.0 and the formation of a negative base excess exceeding -11.2 mmol/l. The mechanistic insights from our work validate the use of the present rodent model in preclinical work on birth asphyxia.
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Affiliation(s)
- Milla Summanen
- Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Susanne Bäck
- Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Juha Voipio
- Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Kai Kaila
- Department of Biosciences, University of Helsinki, Helsinki, Finland.,Neuroscience Center and HiLife, University of Helsinki, Helsinki, Finland
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24
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Allanson ER, Pattinson RC, Nathan EA, Dickinson JE. The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward. J Matern Fetal Neonatal Med 2017; 31:1272-1278. [DOI: 10.1080/14767058.2017.1315094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. R. Allanson
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R. C. Pattinson
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - E. A. Nathan
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
| | - J. E. Dickinson
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
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25
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Barquero-Pérez Ó, Santiago-Mozos R, Lillo-Castellano JM, García-Viruete B, Goya-Esteban R, Caamaño AJ, Rojo-Álvarez JL, Martín-Caballero C. Fetal Heart Rate Analysis for Automatic Detection of Perinatal Hypoxia Using Normalized Compression Distance and Machine Learning. Front Physiol 2017; 8:113. [PMID: 28293198 PMCID: PMC5329001 DOI: 10.3389/fphys.2017.00113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/13/2017] [Indexed: 11/17/2022] Open
Abstract
Accurate identification of Perinatal Hypoxia from visual inspection of Fetal Heart Rate (FHR) has been shown to have limitations. An automated signal processing method for this purpose needs to deal with time series of different lengths, recording interruptions, and poor quality signal conditions. We propose a new method, robust to those issues, for automated detection of perinatal hypoxia by analyzing the FHR during labor. Our system consists of several stages: (a) time series segmentation; (b) feature extraction from FHR signals, including raw time series, moments, and usual heart rate variability indices; (c) similarity calculation with Normalized Compression Distance, which is the key element for dealing with FHR time series; and (d) a simple classification algorithm for providing the hypoxia detection. We analyzed the proposed system using a database with 32 fetal records (15 controls). Time and frequency domain and moment features had similar performance identifying fetuses with hypoxia. The final system, using the third central moment of the FHR, yielded 92% sensitivity and 85% specificity at 3 h before delivery. Best predictions were obtained in time intervals more distant from delivery, i.e., 4-3 h and 3-2 h.
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Affiliation(s)
- Óscar Barquero-Pérez
- Department of Signal Theory and Communications, University Rey Juan CarlosFuenlabrada, Spain
| | - Ricardo Santiago-Mozos
- Department of Signal Theory and Communications, University Rey Juan CarlosFuenlabrada, Spain
| | | | - Beatriz García-Viruete
- Department of Signal Theory and Communications, University Rey Juan CarlosFuenlabrada, Spain
| | - Rebeca Goya-Esteban
- Department of Signal Theory and Communications, University Rey Juan CarlosFuenlabrada, Spain
| | - Antonio J. Caamaño
- Department of Signal Theory and Communications, University Rey Juan CarlosFuenlabrada, Spain
| | - José L. Rojo-Álvarez
- Department of Signal Theory and Communications, University Rey Juan CarlosFuenlabrada, Spain
| | - Carlos Martín-Caballero
- Department of Obstetrics and Gynaecology, Hospital Universitario Fundación de AlcorcónMadrid, Spain
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26
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Adhikari S, Rao KS. Neurodevelopmental outcome of term infants with perinatal asphyxia with hypoxic ischemic encephalopathy stage II. Brain Dev 2017; 39:107-111. [PMID: 27697304 DOI: 10.1016/j.braindev.2016.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Perinatal asphyxia with hypoxic ischemic encephalopathy (HIE) causes significant mortality and morbidity in developing countries. There is limited information about long term neurodevelopmental outcome of infants with neonatal encephalopathy. METHODS Term infants with the diagnosis of perinatal asphyxia were followed up in neurodevelopmental clinics of Manipal Teaching hospital, Nepal. Study design was prospective mixed longitudinal study. Prematurity, major congenital malformations, other intracranial pathology, birth weight <2500g and chromosomal abnormalities were excluded. After consent and enrollment their detailed perinatal history, Apgar score, resuscitation measures and outcome parameters were recorded on a predesigned proforma. Developmental assessment was done with Denver Developmental Screening Tool 2nd edition (DDST 2) at the age of 3months, 6months, 9months, 1year, 18months and 2years. RESULTS Total 187 assessments done in the age group of 3months to 2years among HIE stage 2 patients. Impaired hearing and vision was noted in 5.3% while language delay was observed in 19.2% of infants. Abnormal tone and deep tendon reflexes were noted in 46.2% infants at 3months. Abnormal tone and reflexes were noted only in 18.8% and 9.4% respectively at the age of 2years. Overall, gross motor delay was noted in 55(29.4%) of patient, 34(18.2%) showed fine motor delay and 17.1% social delay. Seizures were persistent in 15.6% patients at 2years age. CONCLUSION Infants affected with HIE have delay in all sectors of developmental milestones. Motor abnormalities are common and tend to improve with advancing age.
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Affiliation(s)
- Sudhir Adhikari
- Department of Pediatrics, Manipal College of Medical Sciences, Pokhara, Nepal.
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27
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Faa G, Manchia M, Pintus R, Gerosa C, Marcialis MA, Fanos V. Fetal programming of neuropsychiatric disorders. ACTA ACUST UNITED AC 2016; 108:207-223. [DOI: 10.1002/bdrc.21139] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Gavino Faa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine; University of Cagliari; Cagliari Italy
- Department of Pharmacology; Dalhousie University; Halifax Nova Scotia Canada
| | - Roberta Pintus
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Clara Gerosa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
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28
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Jiménez-Bravo M, Mota-Rojas D, Orozco-Gregorio H, Pérez-Guille B, Soriano-Rosales R, Roldan-Santiago P, Alonso-Spilsbury M, Arch-Tirado E, Mora-Medina P, Martínez-Burnes J. Evaluation of the protective effect of thiamine pyrophosphate based on the biochemical analysis of rabbit foetuses at 30 days of gestation. Reprod Toxicol 2016; 65:359-364. [DOI: 10.1016/j.reprotox.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 09/03/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
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29
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Tapia-Bustos A, Perez-Lobos R, Vío V, Lespay-Rebolledo C, Palacios E, Chiti-Morales A, Bustamante D, Herrera-Marschitz M, Morales P. Modulation of Postnatal Neurogenesis by Perinatal Asphyxia: Effect of D 1 and D 2 Dopamine Receptor Agonists. Neurotox Res 2016; 31:109-121. [PMID: 27638511 DOI: 10.1007/s12640-016-9669-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 01/18/2023]
Abstract
Perinatal asphyxia (PA) is associated to delayed cell death, affecting neurocircuitries of basal ganglia and hippocampus, and long-term neuropsychiatric disabilities. Several compensatory mechanisms have been suggested to take place, including cell proliferation and neurogenesis. There is evidence that PA can increase postnatal neurogenesis in hippocampus and subventricular zone (SVZ), modulated by dopamine, by still unclear mechanisms. We have studied here the effect of selective dopamine receptor agonists on cell death, cell proliferation and neurogenesis in organotypic cultures from control and asphyxia-exposed rats. Hippocampus and SVZ sampled at 1-3 postnatal days were cultured for 20-21 days. At day in vitro (DIV) 19, cultures were treated either with SKF38393 (10 and 100 µM, a D1 agonist), quinpirole (10 µM, a D2 agonist) or sulpiride (10 μM, a D2 antagonist) + quinpirole (10 μM) and BrdU (10 μM, a mitosis marker) for 24 h. At DIV 20-21, cultures were processed for immunocytochemistry for microtubule-associated protein-2 (MAP-2, a neuronal marker), and BrdU, evaluated by confocal microscopy. Some cultures were analysed for cell viability at DIV 20-21 (LIVE/DEAD kit). PA increased cell death, cell proliferation and neurogenesis in hippocampus and SVZ cultures. The increase in cell death, but not in cell proliferation, was inhibited by both SKF38393 and quinpirole treatment. Neurogenesis was increased by quinpirole, but only in hippocampus, in cultures from both asphyxia-exposed and control-animals, effect that was antagonised by sulpiride, leading to the conclusion that dopamine modulates neurogenesis in hippocampus, mainly via D2 receptors.
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Affiliation(s)
- A Tapia-Bustos
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - R Perez-Lobos
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - V Vío
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - C Lespay-Rebolledo
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - E Palacios
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - A Chiti-Morales
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - D Bustamante
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - M Herrera-Marschitz
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile.,Biomedical Neuroscience Institute, BNI, ICBM, Medical Faculty, University of Chile, Santiago, Chile
| | - P Morales
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile. .,Biomedical Neuroscience Institute, BNI, ICBM, Medical Faculty, University of Chile, Santiago, Chile.
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30
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Buoli M, Bertino V, Caldiroli A, Dobrea C, Serati M, Ciappolino V, Altamura AC. Are obstetrical complications really involved in the etiology and course of schizophrenia and mood disorders? Psychiatry Res 2016; 241:297-301. [PMID: 27232550 DOI: 10.1016/j.psychres.2016.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/19/2016] [Accepted: 05/10/2016] [Indexed: 12/18/2022]
Abstract
The impact of stressful experiences during gestation or early life, leading to increased psychiatric disorders susceptibility, is currently well described in literature, however, few data are available on the association between obstetrical complications and later development of specific diagnoses or clinical features (e.g. psychotic symptoms). Aim of the present paper was to evaluate obstetrical complications frequency in different psychiatric diagnoses and their association with clinical features. Three hundred and eighty-eight patients with a diagnosis of schizophrenia, bipolar disorder or major depressive disorder were compared in terms of clinical presentation according to the presence, type and severity of obstetrical complications. Seventeen percent of the total sample (N=65) had history of at least one obstetrical complication. Patients with a history of at least one obstetrical complication result in an earlier age of onset (F=3.93, p=0.04) and a current higher GAF score (F=6.46, p=0.01). Lewis-Murray scale score was directly correlated with GAF scores (t=2.9, p=0.004) and inversely correlated with age at onset (t=-2.77, p=0.006). Obstetrical complications are frequently registered in patients with schizophrenia or mood disorders. In our sample, they appear to have an anticipatory effect on illness onset, but they seem not to be associated with a specific psychiatric diagnosis.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy.
| | - Vincenzo Bertino
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Cristina Dobrea
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Valentina Ciappolino
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
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31
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Elmas AT, Karadag A, Tabel Y, Ozdemir R, Otlu G. Analysis of urine biomarkers for early determination of acute kidney injury in non-septic and non-asphyxiated critically ill preterm neonates. J Matern Fetal Neonatal Med 2016; 30:302-308. [PMID: 27020372 DOI: 10.3109/14767058.2016.1171311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We designed the present study to test the hypothesis that urinary biomarkers might predict acute kidney injury (AKI) development in non-septic and non-asphyxiated critically ill preterm infants. We evaluated urine (u) sistatin-C (uCys-C), kidney injury molecule-1 (uKIM-1) and neutrophil gelatinase associate lipocaline (uNGAL) as markers of AKI. METHODS Sixty-four preterm infants with gestational age between 28 and 32 weeks were included in this study. Biomarkers were measured on day of life (DOL) 1, 3, and 7. RESULTS uNGAL levels in the AKI group were significantly higher than in no-AKI group on DOL 1, 3 and 7 (p = 0.016, p = 0.007 and p = 0.0014, respectively). CONCLUSIONS uNGAL is sensitive, early, and noninvasive AKI biomarkers, increasing significantly in non-septic and non-asphyxiated critically ill preterm neonates.
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Affiliation(s)
- A T Elmas
- a Department of Pediatric Nephrology
| | | | - Y Tabel
- a Department of Pediatric Nephrology
| | | | - G Otlu
- c Department of Biochemistry , İnönü University Medical Faculty , Malatya , Turkey
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32
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Devesa J, Lema H, Zas E, Munín B, Taboada P, Devesa P. Learning and Memory Recoveries in a Young Girl Treated with Growth Hormone and Neurorehabilitation. J Clin Med 2016; 5:jcm5020014. [PMID: 26821051 PMCID: PMC4773770 DOI: 10.3390/jcm5020014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/16/2016] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
Background-To describe the results obtained after treating a non growth hormone-deficient 10-year-old girl who suffered asphyxia during delivery, resulting in important cognitive deficits, with growth hormone (GH) and neurorehabilitation. Methods-GH was administered (mg/day) at doses of 0.5 over three months followed by 0.9, every two weeks over three months, and then alternating 1.2 three days/week and 0.3 two days/week. Neurorehabilitation consisted of daily sessions of neurostimulation, speech therapy, occupational therapy and auditive stimulation. Treatment lasted nine months. Results-Scores obtained in all the areas treated showed that, at discharge, the patient clearly increased her cognitive abilities, memory and language competence index; her intelligence quotient score increased from 51 to 80, and the index of functional independence measure reached a value of 120 over 126 (maximal value). Conclusions-This case suggests that GH administration may play a role in improving cognitive deficits during neurorehabilitation in children with brain damage suffered during delivery. This agrees with the known effects of GH on cognition.
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Affiliation(s)
- Jesús Devesa
- Medical Centre Foltra, Travesía de Montouto 24, Teo 15886, Spain.
- Department of Physiology, School of Medicine, University of Santiago de Compostela, Santiago de Compostela 15710, Spain.
| | - Hortensia Lema
- Medical Centre Foltra, Travesía de Montouto 24, Teo 15886, Spain.
| | - Eva Zas
- Medical Centre Foltra, Travesía de Montouto 24, Teo 15886, Spain.
| | - Borja Munín
- Medical Centre Foltra, Travesía de Montouto 24, Teo 15886, Spain.
| | - Pilar Taboada
- Medical Centre Foltra, Travesía de Montouto 24, Teo 15886, Spain.
| | - Pablo Devesa
- Medical Centre Foltra, Travesía de Montouto 24, Teo 15886, Spain.
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33
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Mwaniki MK, Baya EJ, Mwangi-Powell F, Sidebotham P. 'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: "inserting new ideas into a timeless wine skin". BMC Pregnancy Childbirth 2016; 16:14. [PMID: 26809881 PMCID: PMC4727279 DOI: 10.1186/s12884-016-0803-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/07/2016] [Indexed: 11/30/2022] Open
Abstract
Background Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. Discussion The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries Conclusion In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS.
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Affiliation(s)
- Michael K Mwaniki
- University Research Co., LLC (URC) 7200 Wisconsin Avenue, Ste. 600, Bethesda, MD, 20814, USA. .,Afya Research Africa, P.O. Box 20880, 00202, Nairobi, Kenya.
| | - Evaline J Baya
- Afya Research Africa, P.O. Box 20880, 00202, Nairobi, Kenya.,Nairobi University, College of Health sciences, Kenyatta National Hospital, P. O. Box 19676-00202, Nairobi, Kenya
| | - Faith Mwangi-Powell
- University Research Co., LLC (URC) 7200 Wisconsin Avenue, Ste. 600, Bethesda, MD, 20814, USA
| | - Peter Sidebotham
- Mental Health & Wellbeing, University of Warwick, Medical school Building, Gibbet Hill Campus, Coventry, CV4 7AL, UK
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Farías JG, Herrera EA, Carrasco-Pozo C, Sotomayor-Zárate R, Cruz G, Morales P, Castillo RL. Pharmacological models and approaches for pathophysiological conditions associated with hypoxia and oxidative stress. Pharmacol Ther 2015; 158:1-23. [PMID: 26617218 DOI: 10.1016/j.pharmthera.2015.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypoxia is the failure of oxygenation at the tissue level, where the reduced oxygen delivered is not enough to satisfy tissue demands. Metabolic depression is the physiological adaptation associated with reduced oxygen consumption, which evidently does not cause any harm to organs that are exposed to acute and short hypoxic insults. Oxidative stress (OS) refers to the imbalance between the generation of reactive oxygen species (ROS) and the ability of endogenous antioxidant systems to scavenge ROS, where ROS overwhelms the antioxidant capacity. Oxidative stress plays a crucial role in the pathogenesis of diseases related to hypoxia during intrauterine development and postnatal life. Thus, excessive ROS are implicated in the irreversible damage to cell membranes, DNA, and other cellular structures by oxidizing lipids, proteins, and nucleic acids. Here, we describe several pathophysiological conditions and in vivo and ex vivo models developed for the study of hypoxic and oxidative stress injury. We reviewed existing literature on the responses to hypoxia and oxidative stress of the cardiovascular, renal, reproductive, and central nervous systems, and discussed paradigms of chronic and intermittent hypobaric hypoxia. This systematic review is a critical analysis of the advantages in the application of some experimental strategies and their contributions leading to novel pharmacological therapies.
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Affiliation(s)
- Jorge G Farías
- Facultad de Ingeniería y Ciencias, Departamento de Ingeniería Química, Universidad de la Frontera, Casilla 54-D, Temuco, Chile
| | - Emilio A Herrera
- Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, Chile; International Center for Andean Studies (INCAS), Universidad de Chile, Chile
| | | | - Ramón Sotomayor-Zárate
- Centro de Neurobiología y Plasticidad Cerebral (CNPC), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Chile
| | - Gonzalo Cruz
- Centro de Neurobiología y Plasticidad Cerebral (CNPC), Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Chile
| | - Paola Morales
- Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Chile
| | - Rodrigo L Castillo
- Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, Chile.
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Effect of Marine Collagen Peptides on Physiological and Neurobehavioral Development of Male Rats with Perinatal Asphyxia. Mar Drugs 2015; 13:3653-71. [PMID: 26058015 PMCID: PMC4483650 DOI: 10.3390/md13063653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/21/2015] [Accepted: 06/01/2015] [Indexed: 11/17/2022] Open
Abstract
Asphyxia during delivery produces long-term deficits in brain development. We investigated the neuroprotective effects of marine collagen peptides (MCPs), isolated from Chum Salmon skin by enzymatic hydrolysis, on male rats with perinatal asphyxia (PA). PA was performed by immersing rat fetuses with uterine horns removed from ready-to-deliver rats into a water bath for 15 min. Caesarean-delivered pups were used as controls. PA rats were intragastrically administered with 0.33 g/kg, 1.0 g/kg and 3.0 g/kg body weight MCPs from postnatal day 0 (PND 0) till the age of 90-days. Behavioral tests were carried out at PND21, PND 28 and PND 90. The results indicated that MCPs facilitated early body weight gain of the PA pups, however had little effects on early physiological development. Behavioral tests revealed that MCPs facilitated long-term learning and memory of the pups with PA through reducing oxidative damage and acetylcholinesterase (AChE) activity in the brain, and increasing hippocampus phosphorylated cAMP-response element binding protein (p-CREB) and brain derived neurotrophic factor (BDNF) expression.
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Bharathi B, Bhat BV, Negi VS, Adhisivam B. Inflammatory mediators as predictors of outcome in perinatal asphyxia. Indian J Pediatr 2015; 82:433-8. [PMID: 25278280 DOI: 10.1007/s12098-014-1575-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify biomarkers for neuronal injury and outcome in perinatal asphyxia. METHODS This prospective cohort study was done in authors' level III NICU involving 80 neonates - 40 babies with perinatal asphyxia and 40 weight and gender matched normal neonates. Levels of cytokines IL-6, IL -1β, IL-2 and TNF -α in cord blood of these neonates were estimated and correlated with the severity of asphyxia and developmental outcome at 6 mo using Baroda Developmental Score. RESULTS The baseline parameters revealed that there was no statistically significant difference between the two groups in terms of maternal age, parity, gestational age, gender and birth weight. The levels of cytokines IL-6 (p < 0.001) and IL-1beta (p < 0.03) were significantly higher in babies with perinatal asphyxia and correlated with the severity of asphyxia. The levels of IL-6 and IL-1β had significant negative correlation with developmental score at 6 mo. A cut off level of 14.18 pg/ml for IL-6 had 92.3 % sensitivity and 57.7 % specificity [Area under the curve = 0.80 (0.62-0.84)] for adverse neuro-developmental outcome while it was 11.17 pg/ml for IL-1β with a sensitivity of 69.2 % and specificity of 71.2 % [Area under the curve = 0.67 (0.57-0.80)]. CONCLUSIONS IL-6 and IL-1 β are good predictive markers of severity of asphyxia and adverse neurological outcome.
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Affiliation(s)
- B Bharathi
- Division of Neonatology, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605 006, India
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Favaro A, Tenconi E, Degortes D, Manara R, Santonastaso P. Effects of obstetric complications on volume and functional connectivity of striatum in anorexia nervosa patients. Int J Eat Disord 2014; 47:686-95. [PMID: 24938422 DOI: 10.1002/eat.22320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the volume and functional connectivity of dorsal and ventral striatal nuclei in anorexia nervosa (AN) and their relationship with early exposure to obstetric complications. METHOD Fifty-one patients with lifetime AN (35 acute, 16 recovered) and 34 healthy controls underwent high-resolution and resting-state functional magnetic resonance imaging. RESULTS The AN group showed reduced functional connectivity of the putamen compared with healthy women, and this reduction was more evident in patients with lifetime binge eating/purging. Both acute and recovered AN groups showed a larger left accumbens area compared with that of healthy women. The functional connectivity of bilateral nucleus accumbens and putamen showed significant negative correlations with number of obstetric complications in the AN group. DISCUSSION This study supports the hypothesis that AN is associated with structural and functional alterations of striatal networks, and reveals the possible role of obstetric complications in the pathogenesis of striatal dysfunction.
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Affiliation(s)
- Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy; Centro di Neuroscienze Cognitive, Università di Padova
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Haukvik UK, McNeil T, Lange EH, Melle I, Dale AM, Andreassen OA, Agartz I. Pre- and perinatal hypoxia associated with hippocampus/amygdala volume in bipolar disorder. Psychol Med 2014; 44:975-985. [PMID: 23803260 PMCID: PMC3936825 DOI: 10.1017/s0033291713001529] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pre- and perinatal adversities may increase the risk for schizophrenia and bipolar disorder. Hypoxia-related obstetric complications (OCs) are associated with brain anatomical abnormalities in schizophrenia, but their association with brain anatomy variation in bipolar disorder is unknown. METHOD Magnetic resonance imaging brain scans, clinical examinations and data from the Medical Birth Registry of Norway were obtained for 219 adults, including 79 patients with a DSM-IV diagnosis of bipolar disorder (age 29.4 years, s.d. = 11.8 years, 39% male) and 140 healthy controls (age 30.8 years, s.d. = 12.0 years, 53% male). Severe hypoxia-related OCs throughout pregnancy/birth and perinatal asphyxia were each studied in relation to a priori selected brain volumes (hippocampus, lateral ventricles and amygdala, obtained with FreeSurfer), using linear regression models covarying for age, sex, medication use and intracranial volume. Multiple comparison adjustment was applied. RESULTS Perinatal asphyxia was associated with smaller left amygdala volume (t = -2.59, p = 0.012) in bipolar disorder patients, but not in healthy controls. Patients with psychotic bipolar disorder showed distinct associations between perinatal asphyxia and smaller left amygdala volume (t = -2.69, p = 0.010), whereas patients with non-psychotic bipolar disorder showed smaller right hippocampal volumes related to both perinatal asphyxia (t = -2.60, p = 0.015) and severe OCs (t = -3.25, p = 0.003). No associations between asphyxia or severe OCs and the lateral ventricles were found. CONCLUSIONS Pre- and perinatal hypoxia-related OCs are related to brain morphometry in bipolar disorder in adulthood, with specific patterns in patients with psychotic versus non-psychotic illness.
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Affiliation(s)
- U. K. Haukvik
- Department of Psychiatric Research,
Diakonhjemmet Hospital, Oslo,
Norway
- K. G. Jebsen Centre for Psychosis Research,
Institute of Clinical Medicine, University of Oslo,
Oslo, Norway
| | - T. McNeil
- Department of Psychiatric Epidemiology,
Lund University, Lund,
Sweden
- School of Psychiatry and Clinical
Neurosciences, University of Western Australia,
Perth, WA, Australia
| | - E. H. Lange
- Department of Psychiatric Research,
Diakonhjemmet Hospital, Oslo,
Norway
- K. G. Jebsen Centre for Psychosis Research,
Institute of Clinical Medicine, University of Oslo,
Oslo, Norway
| | - I. Melle
- K. G. Jebsen Centre for Psychosis Research,
Institute of Clinical Medicine, University of Oslo,
Oslo, Norway
- K. G. Jebsen Centre for Psychosis Research, Division
of Mental Health and Addiction, Oslo University
Hospital, Oslo, Norway
| | - A. M. Dale
- Department of Neurosciences,
University of California San Diego, La Jolla,
CA, USA
- Department of Radiology,
University of California San Diego, La Jolla,
CA, USA
| | - O. A. Andreassen
- K. G. Jebsen Centre for Psychosis Research,
Institute of Clinical Medicine, University of Oslo,
Oslo, Norway
- K. G. Jebsen Centre for Psychosis Research, Division
of Mental Health and Addiction, Oslo University
Hospital, Oslo, Norway
| | - I. Agartz
- Department of Psychiatric Research,
Diakonhjemmet Hospital, Oslo,
Norway
- K. G. Jebsen Centre for Psychosis Research,
Institute of Clinical Medicine, University of Oslo,
Oslo, Norway
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Herrera-Marschitz M, Neira-Pena T, Rojas-Mancilla E, Espina-Marchant P, Esmar D, Perez R, Muñoz V, Gutierrez-Hernandez M, Rivera B, Simola N, Bustamante D, Morales P, Gebicke-Haerter PJ. Perinatal asphyxia: CNS development and deficits with delayed onset. Front Neurosci 2014; 8:47. [PMID: 24723845 PMCID: PMC3972459 DOI: 10.3389/fnins.2014.00047] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/22/2014] [Indexed: 12/21/2022] Open
Abstract
Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD+ during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.
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Affiliation(s)
- Mario Herrera-Marschitz
- Millenium Institute BNI-Chile Santiago, Chile ; Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | - Tanya Neira-Pena
- Millenium Institute BNI-Chile Santiago, Chile ; Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile ; Department of Chemical-Biological Science, University Bernardo O'Higgins Santiago, Chile
| | | | | | - Daniela Esmar
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | - Ronald Perez
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | - Valentina Muñoz
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | | | - Benjamin Rivera
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | - Nicola Simola
- Department of Biomedical Sciences, Section of Neuropsychopharmacology, Cagliari University Cagliari, Italy
| | - Diego Bustamante
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | - Paola Morales
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile
| | - Peter J Gebicke-Haerter
- Department of Molecular and Clinical Pharmacology, ICBM, Medical Faculty, University of Chile Santiago, Chile ; Department of Psychopharmacology, Central Institute of Mental Health J5 Mannheim, Germany
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Schmitt A, Malchow B, Hasan A, Falkai P. The impact of environmental factors in severe psychiatric disorders. Front Neurosci 2014; 8:19. [PMID: 24574956 PMCID: PMC3920481 DOI: 10.3389/fnins.2014.00019] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/23/2014] [Indexed: 01/08/2023] Open
Abstract
During the last decades, schizophrenia has been regarded as a developmental disorder. The neurodevelopmental hypothesis proposes schizophrenia to be related to genetic and environmental factors leading to abnormal brain development during the pre- or postnatal period. First disease symptoms appear in early adulthood during the synaptic pruning and myelination process. Meta-analyses of structural MRI studies revealing hippocampal volume deficits in first-episode patients and in the longitudinal disease course confirm this hypothesis. Apart from the influence of risk genes in severe psychiatric disorders, environmental factors may also impact brain development during the perinatal period. Several environmental factors such as antenatal maternal virus infections, obstetric complications entailing hypoxia as common factor or stress during neurodevelopment have been identified to play a role in schizophrenia and bipolar disorder, possibly contributing to smaller hippocampal volumes. In major depression, psychosocial stress during the perinatal period or in adulthood is an important trigger. In animal studies, chronic stress or repeated administration of glucocorticoids have been shown to induce degeneration of glucocorticoid-sensitive hippocampal neurons and may contribute to the pathophysiology of affective disorders. Epigenetic mechanisms altering the chromatin structure such as histone acetylation and DNA methylation may mediate effects of environmental factors to transcriptional regulation of specific genes and be a prominent factor in gene-environmental interaction. In animal models, gene-environmental interaction should be investigated more intensely to unravel pathophysiological mechanisms. These findings may lead to new therapeutic strategies influencing epigenetic targets in severe psychiatric disorders.
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Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany ; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo São Paulo, Brazil
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Munich Munich, Germany
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