1
|
Scher MS. Interdisciplinary fetal-neonatal neurology training improves brain health across the lifespan. Front Neurol 2024; 15:1411987. [PMID: 39026582 PMCID: PMC11254674 DOI: 10.3389/fneur.2024.1411987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Integrated fetal, neonatal, and pediatric training constitute an interdisciplinary fetal-neonatal neurology (FNN) program. A dynamic neural exposome concept strengthens curriculum content. Trainees participate in mentoring committee selection for guidance during a proposed two-year program. Prenatal to postnatal clinical learning re-enforces early toxic stressor interplay that influences gene-environment interactions. Maternal-placental-fetal triad, neonatal, or childhood diseases require diagnostic and therapeutic decisions during the first 1,000 days when 80 % of neural connections contribute to life-course phenotypic expression. Pediatric follow-up through 3 years adjusts to gestational ages of preterm survivors. Cumulative reproductive, pregnancy, pediatric and adult exposome effects require educational experiences that emphasize a principle-to-practice approach to a brain capital strategy across the lifespan. More rigorous training during fetal, neonatal, and pediatric rotations will be offered to full time trainees. Adult neurology residents, medical students, and trainees from diverse disciplines will learn essential topics during time-limited rotations. Curriculum content will require periodic re-assessments using educational science standards that maintain competence while promoting creative and collaborative problem-solving. Continued career-long learning by FNN graduates will strengthen shared healthcare decisions by all stakeholders. Recognition of adaptive or maladaptive neuroplasticity mechanisms requires analytic skills that identify phenotypes associated with disease pathways. Developmental origins and life-course concepts emphasize brain health across the developmental-aging continuum, applicable to interdisciplinary research collaborations. Social determinants of health recognize diversity, equity, and inclusion priorities with each neurological intervention, particularly for those challenged with disparities. Diagnostic and therapeutic strategies must address resource challenges particularly throughout the Global South to effectively lower the worldwide burden of neurologic disease. Sustainable development goals proposed by the World Health Organization offer universally applicable guidelines in response to ongoing global and regional polycrises. Gender, race, ethnicity, and socio-economic equality promote effective preventive, rescue and reparative neuroprotective interventions. Global synergistic efforts can be enhanced by establishing leadership within academic teaching hubs in FNN training to assist with structure and guidance for smaller healthcare facilities in each community that will improve practice, education and research objectives. Reduced mortality with an improved quality of life must prioritize maternal-pediatric health and well-being to sustain brain health across each lifespan with transgenerational benefits.
Collapse
Affiliation(s)
- Mark S. Scher
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| |
Collapse
|
2
|
Yates EF, Mulkey SB. Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned. Pediatr Res 2024; 96:64-72. [PMID: 38509227 PMCID: PMC11257821 DOI: 10.1038/s41390-024-03145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
Pregnant individuals with viral illness may experience significant morbidity and have higher rates of pregnancy and neonatal complications. With the growing number of viral infections and new viral pandemics, it is important to examine the effects of infection during pregnancy on both the gestational parent and the offspring. Febrile illness and inflammation during pregnancy are correlated with risk for autism, attention deficit/hyperactivity disorder, and developmental delay in the offspring in human and animal models. Historical viral epidemics had limited follow-up of the offspring of affected pregnancies. Infants exposed to seasonal influenza and the 2009 H1N1 influenza virus experienced increased risks of congenital malformations and neuropsychiatric conditions. Zika virus exposure in utero can lead to a spectrum of abnormalities, ranging from severe microcephaly to neurodevelopmental delays which may appear later in childhood and in the absence of Zika-related birth defects. Vertical infection with severe acute respiratory syndrome coronavirus-2 has occurred rarely, but there appears to be a risk for developmental delays in the infants with antenatal exposure. Determining how illness from infection during pregnancy and specific viral pathogens can affect pregnancy and neurodevelopmental outcomes of offspring can better prepare the community to care for these children as they grow. IMPACT: Viral infections have impacted pregnant people and their offspring throughout history. Antenatal exposure to maternal fever and inflammation may increase risk of developmental and neurobehavioral disorders in infants and children. The recent SARS-CoV-2 pandemic stresses the importance of longitudinal studies to follow pregnancies and offspring neurodevelopment.
Collapse
Affiliation(s)
- Emma F Yates
- Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| |
Collapse
|
3
|
Scher MS, Agarwal S, Venkatesen C. Clinical decisions in fetal-neonatal neurology II: Gene-environment expression over the first 1000 days presenting as "four great neurological syndromes". Semin Fetal Neonatal Med 2024; 29:101522. [PMID: 38637242 DOI: 10.1016/j.siny.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Interdisciplinary fetal-neonatal neurology (FNN) training considers a woman's reproductive and pregnancy health histories when assessing the "four great neonatal neurological syndromes". This maternal-child dyad exemplifies the symptomatic neonatal minority, compared with the silent majority of healthy children who experience preclinical diseases with variable expressions over the first 1000 days. Healthy maternal reports with reassuring fetal surveillance testing preceded signs of fetal distress during parturition. An encephalopathic neonate with seizures later exhibited childhood autistic spectrum behaviors and intractable epilepsy correlated with identified genetic biomarkers. A systems biology approach to etiopathogenesis guides the diagnostic process to interpret phenotypic form and function. Evolving gene-environment interactions expressed by changing phenotypes reflect a dynamic neural exposome influenced by reproductive and pregnancy health. This strategy considers critical/sensitive periods of neuroplasticity beyond two years of life to encompass childhood and adolescence. Career-long FNN experiences reenforce earlier training to strengthen the cognitive process and minimize cognitive biases when assessing children or adults. Prioritizing social determinants of healthcare for persons with neurologic disorders will help mitigate the global burden of brain diseases for all women and children.
Collapse
Affiliation(s)
- Mark S Scher
- Pediatrics and Neurology, Rainbow Babies and Children's Hospital Case Western Reserve University School of Medicine, USA.
| | - Sonika Agarwal
- Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, USA.
| | - Charu Venkatesen
- Neurology and Pediatrics, Cincinnati Children's Hospital, Cincinnati School of Medicine, USA.
| |
Collapse
|
4
|
Litt JS, Halfon N, Msall ME, Russ SA, Hintz SR. Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2024; 11:146. [PMID: 38397258 PMCID: PMC10886801 DOI: 10.3390/children11020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Children born prematurely (<37 weeks' gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course.
Collapse
Affiliation(s)
- Jonathan S. Litt
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Social and Behavioral Pediatrics, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA
| | - Michael E. Msall
- Department of Pediatrics, Sections of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Shirley Ann Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA;
| |
Collapse
|
5
|
Scher MS. Interdisciplinary fetal-neonatal neurology training applies neural exposome perspectives to neurology principles and practice. Front Neurol 2024; 14:1321674. [PMID: 38288328 PMCID: PMC10824035 DOI: 10.3389/fneur.2023.1321674] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype-genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene-environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.
Collapse
Affiliation(s)
- Mark S. Scher
- Division of Pediatric Neurology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| |
Collapse
|
6
|
Tarui T, Venkatesan C, Gano D, Lemmon ME, Mulkey SB, Pardo AC, Emrick L, Scher M, Agarwal S. Fetal Neurology Practice Survey: Current Practice and the Future Directions. Pediatr Neurol 2023; 145:74-79. [PMID: 37290231 DOI: 10.1016/j.pediatrneurol.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Fetal neurology is a rapidly evolving field. Consultations aim to diagnose, prognosticate, and coordinate prenatal and perinatal management along with other specialists and counsel expectant parents. Practice parameters and guidelines are limited. METHODS A 48-question online survey was administered to child neurologists. Questions targeted current care practices and perceived priorities for the field. RESULTS Representatives from 43 institutions in the United States responded; 83% had prenatal diagnosis centers, and the majority performed on-site neuroimaging. The earliest gestational age for fetal magnetic resonance imaging was variable. Annual consultations ranged from <20 to >100 patients. Fewer than half (n = 17.40%) were subspecialty trained. Most respondents (n = 39.91%) were interested in participating in a collaborative registry and educational initiatives. CONCLUSIONS The survey highlights heterogeneity in clinical practice. Large multisite and multidisciplinary collaborations are essential to gather data that inform outcomes for fetuses evaluated across institutions through registries as well as creation of guidelines and educational material.
Collapse
Affiliation(s)
- Tomo Tarui
- Division of Pediatric Neurology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Charu Venkatesan
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dawn Gano
- Department of Neurology & Pediatrics, University of California San Francisco, San Francisco, California
| | - Monica E Lemmon
- Department of Pediatrics and Population Health Sciences, Duke University School of Medicine
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia; Departments of Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Andrea C Pardo
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Lisa Emrick
- Department of Pediatrics, Neurology and Developmental Neuroscience, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Mark Scher
- Emeritus Full Professor Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sonika Agarwal
- Division of Neurology & Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
7
|
Lemmon ME, Barks MC, Bansal S, Bernstein S, Kaye EC, Glass HC, Ubel PA, Brandon D, Pollak KI. The ALIGN Framework: A Parent-Informed Approach to Prognostic Communication for Infants With Neurologic Conditions. Neurology 2023; 100:e800-e807. [PMID: 36456199 PMCID: PMC9984217 DOI: 10.1212/wnl.0000000000201600] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinicians often communicate complex, uncertain, and distressing information about neurologic prognosis to parents of critically ill infants. Although communication tools have been developed in other disciplines and settings, none address the unique needs of the neonatal and pediatric neurology context. We aimed to develop a parent-informed framework to guide clinicians in communicating information about neurologic prognosis. METHODS Parents of infants with neurologic conditions in the intensive care unit were enrolled in a longitudinal study of shared decision-making from 2018 to 2020. Parents completed semistructured interviews following recorded family meetings with the health care team, at hospital discharge, and 6 months after discharge. All interviews targeted information about parent preferences for prognostic disclosure. We analyzed the data using a conventional content analysis approach. Two study team members independently coded all interview transcripts, and discrepancies were resolved in consensus. We used NVIVO 12 qualitative software to index and organize codes. RESULTS Fifty-two parents of 37 infants completed 123 interviews. Parents were predominantly mothers (n = 37/52, 71%) with a median age of 31 (range 19-46) years. Half were Black (n = 26/52, 50%), and a minority reported Hispanic ethnicity (n = 2/52, 4%). Inductive analysis resulted in the emergence of 5 phases of prognostic communication (Approach, Learn, Inform, Give support, and Next steps: ALIGN): (1) Approach: parents appreciated receiving consistent information about their child's neurologic outcome from clinicians who knew their child well. (2) Learn: parents valued when clinicians asked them how they preferred receiving information and what they already knew about their child's outcome prior to information delivery. (3) Inform: parents valued honest, thorough, and balanced information that disclosed prognostic uncertainty and acknowledged room for hope. (4) Give support: parents valued empathic communication and appreciated clinicians who offered real-time emotional support. (5) Next steps: parents appreciated clinicians who connected them to resources, including peer support. DISCUSSION The ALIGN framework offers a novel, parent-informed strategy to effectively communicate neurologic prognosis. Although ALIGN represents key elements of a conversation about prognosis, each clinician can adapt this framework to their own approach. Future work will assess the effectiveness of this framework on communication quality and prognostic understanding.
Collapse
Affiliation(s)
- Monica E Lemmon
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC.
| | - Mary C Barks
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Simran Bansal
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Sarah Bernstein
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Erica C Kaye
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Hannah C Glass
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Peter A Ubel
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Debra Brandon
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| | - Kathryn I Pollak
- From the Departments of Pediatrics (M.E.L., M.C.B., S. Bansal, S. Bernstein), Population Health Sciences (M.E.L., K.I.P.), Duke University School of Medicine, Durham, NC; University of Utah School of Medicine (S. Bernstein), Salt Lack City; Department of Oncology (E.C.K.), St. Jude Children's Research Hospital, Memphis, TN; Departments of Neurology and Pediatrics (E.C.K.), UCSF Benioff Children's Hospital and Department of Epidemiology & Biostatistics (H.C.G.), University of California, San Francisco; Fuqua School of Business and Sanford School of Public Policy (P.A.U.), Duke University, Durham; and Duke University School of Nursing (D.B.), Durham; Cancer Prevention and Control (KIP), Duke Cancer Institute, Durham, NC
| |
Collapse
|
8
|
Scher MS. A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities. Biomedicines 2022; 10:3290. [PMID: 36552046 PMCID: PMC9775202 DOI: 10.3390/biomedicines10123290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.
Collapse
Affiliation(s)
- Mark S. Scher
- Pediatrics and Neurology, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Department of Pediatrics, Division of Pediatric Neurology Fetal/Neonatal Neurology Program, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| |
Collapse
|
9
|
Ream MA, Mulkey SB. A Neurologist's Practical Guide to Conducting a Fetal Consultation. Semin Pediatr Neurol 2022; 42:100957. [PMID: 35868732 DOI: 10.1016/j.spen.2022.100957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Fetal and neonatal neurology is increasingly recognized as a subspecialty within child neurology and fellowship training programs are emerging. Most child neurologists have not received formal training in the interpretation of fetal data and the practice of fetal neurology consultation. However, they can be valuable members of the fetal care team and bring important perspective to the diagnosis of fetal neurologic conditions. With a systematic approach and a planned format for counseling, child neurologists without formal training in fetal consultations can apply their postnatal neurology expertise to the prenatal neurology patient. In this article we offer a brief practical guide to assist child neurologists in their approach to and practice of fetal neurology consultation.
Collapse
Affiliation(s)
- Margie A Ream
- Division of Child Neurology, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, OH.
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Departments of Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
10
|
Scher MS. Neurologic Sequelae Associated with Hypertensive Disorders of Pregnancy. CHILDREN (BASEL, SWITZERLAND) 2021; 8:945. [PMID: 34828658 PMCID: PMC8617864 DOI: 10.3390/children8110945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) contribute to adverse gene-environment interactions prior to conception and continue throughout pregnancy. Embryonic/fetal brain disorders occur from interactions between genetic susceptibilities interacting with acquired diseases or conditions affecting the maternal/placental fetal (MPF) triad. Trimester-specific pathophysiological mechanisms, such as maternal immune activation and ischemic placental syndrome, contribute to adverse peripartum, neonatal and childhood outcomes. Two diagnostic approaches provide timelier diagnoses over the first 1000 days from conception until two years of age. Horizontal analyses assess the maturation of the triad, neonate and child. Vertical analyses consider systems-biology from genetic, molecular, cellular, tissue through organ networks during each developmental niche. Disease expressions associated with HDP have cumulative adverse effects across the lifespan when subjected to subsequent adverse events. Critical/sensitive periods of developmental neuroplasticity over the first 1000 days are more likely to result in permanent sequelae. Novel diagnostic approaches, beginning during pre-conception, will facilitate the development of effective preventive, rescue and reparative neurotherapeutic strategies in response to HDP-related trimester-specific disease pathways. Public health policies require the inclusion of women's health advocacy during and beyond their reproductive years to reduce sequelae experienced by mothers and their offspring. A lower global burden of neurologic disease from HDP will benefit future generations.
Collapse
Affiliation(s)
- Mark S. Scher
- Pediatrics and Neurology, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Department of Pediatrics, Division of Pediatric Neurology Fetal/Neonatal Neurology Program, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| |
Collapse
|
11
|
Transitory and Vestigial Structures of the Developing Human Nervous System. Pediatr Neurol 2021; 123:86-101. [PMID: 34416613 DOI: 10.1016/j.pediatrneurol.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/23/2022]
Abstract
As with many body organs, the human central nervous system contains many structures and cavities that may have had functions in embryonic and fetal life but are vestigial or atrophic at maturity. Examples are the septum pellucidum, remnants of the lamina terminalis, Cajal-Retzius neurons, induseum griseum, habenula, and accessory olfactory bulb. Other structures are transitory in fetal or early postnatal life, disappearing from the mature brain. Examples are the neural crest, subpial granular glial layer of Brun over cerebral cortex, radial glial cells, and subplate zone of cerebral cortex. At times persistent fetal structures that do not regress may cause neurological problems or indicate a pathologic condition, such as Blake pouch cyst. Transitory structures thus can become vestigial. Examples are an excessively wide cavum septi pellucidi, suprapineal recess of the third ventricle, trigeminal artery of the posterior fossa circulation, and hyaloid ocular artery. Arrested maturation might be considered another aspect of vestigial structure. An example is the persistent microcolumnar cortical architecture in focal cortical dysplasia type Ia, in cortical zones of chronic fetal ischemia, and in some metabolic/genetic congenital encephalopathies. Some transitory structures in human brain are normal adult structures in lower vertebrates. Recognition of transitory and vestigial structures by fetal or postnatal neuroimaging and neuropathologically enables better understanding of cerebral ontogenesis and avoids misinterpretations.
Collapse
|
12
|
Pitta JLDLP, Vasconcelos CRDS, Wallau GDL, Campos TDL, Rezende AM. In silico predictions of protein interactions between Zika virus and human host. PeerJ 2021; 9:e11770. [PMID: 34513323 PMCID: PMC8395582 DOI: 10.7717/peerj.11770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background The ZIKA virus (ZIKV) belongs to the Flaviviridae family, was first isolated in the 1940s, and remained underreported until its global threat in 2016, where drastic consequences were reported as Guillan-Barre syndrome and microcephaly in newborns. Understanding molecular interactions of ZIKV proteins during the host infection is important to develop treatments and prophylactic measures; however, large-scale experimental approaches normally used to detect protein-protein interaction (PPI) are onerous and labor-intensive. On the other hand, computational methods may overcome these challenges and guide traditional approaches on one or few protein molecules. The prediction of PPIs can be used to study host-parasite interactions at the protein level and reveal key pathways that allow viral infection. Results Applying Random Forest and Support Vector Machine (SVM) algorithms, we performed predictions of PPI between two ZIKV strains and human proteomes. The consensus number of predictions of both algorithms was 17,223 pairs of proteins. Functional enrichment analyses were executed with the predicted networks to access the biological meanings of the protein interactions. Some pathways related to viral infection and neurological development were found for both ZIKV strains in the enrichment analysis, but the JAK-STAT pathway was observed only for strain PE243 when compared with the FSS13025 strain. Conclusions The consensus network of PPI predictions made by Random Forest and SVM algorithms allowed an enrichment analysis that corroborates many aspects of ZIKV infection. The enrichment results are mainly related to viral infection, neuronal development, and immune response, and presented differences among the two compared ZIKV strains. Strain PE243 presented more predicted interactions between proteins from the JAK-STAT signaling pathway, which could lead to a more inflammatory immune response when compared with the FSS13025 strain. These results show that the methodology employed in this study can potentially reveal new interactions between the ZIKV and human cells.
Collapse
Affiliation(s)
| | | | | | - Túlio de Lima Campos
- Bioinformatics Platform, Aggeu Magalhães Institute-FIOCRUZ/PE, Recife, PE, Brasil
| | | |
Collapse
|
13
|
"The Child Is the Father of the Man": A Tribute to Ken Swaiman. Pediatr Neurol 2021; 122:119-121. [PMID: 34325982 DOI: 10.1016/j.pediatrneurol.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
|
14
|
Penn AA, Wintermark P, Chalak LF, Armstrong J, Redline R, Scher MS, Nelson KB. Placental contribution to neonatal encephalopathy. Semin Fetal Neonatal Med 2021; 26:101276. [PMID: 34420894 DOI: 10.1016/j.siny.2021.101276] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Placental assessment, although currently underused, can inform our understanding of the etiology and timing of Neonatal Encephalopathy (NE). We review our current understanding of the links between placental dysfunction and NE and how this information may inform clinical decisions, now and in the future, emphasizing the four major placental lesions associated with NE. In addition, we discuss maternal and fetal factors that are hypothesized to contribute to specific placental pathologies, especially innate or acquired thrombophilias. We outline the importance of assessing placenta across trimesters and after delivery. As this field continues to evolve, currently available placental histopathological examination methods may need to be combined with advanced prenatal molecular and imaging assessments of placenta and be applied in well-designed studies in large representative populations to better define the links between placental dysfunction and NE.
Collapse
Affiliation(s)
- A A Penn
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, NY, USA.
| | - P Wintermark
- Division of Newborn Medicine, Montreal Children's Hospital, Montreal, Canada
| | - L F Chalak
- Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, USA
| | - J Armstrong
- Department of Pediatrics (Section of Child Neurology, Neurology, and OB/GYN), University of Colorado Anschutz Medical Campus, Hemophilia and Thrombosis Center, Aurora, CO, USA
| | - R Redline
- Department of Pathology, UH Cleveland Medical Center, Cleveland, OH, USA
| | - M S Scher
- Case Western Reserve University School of Medicine, Department of Pediatrics, Department of Neurology, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, UH Cleveland Medical Center, Cleveland, OH, USA
| | - K B Nelson
- National Institutes of Health, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
| | | |
Collapse
|
15
|
Neonatal encephalopathy: Focus on epidemiology and underexplored aspects of etiology. Semin Fetal Neonatal Med 2021; 26:101265. [PMID: 34305025 DOI: 10.1016/j.siny.2021.101265] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neonatal Encephalopathy (NE) is a neurologic syndrome in term and near-term infants who have depressed consciousness, difficulty initiating and maintaining respiration, and often abnormal tone, reflexes and neonatal seizures in varying combinations. Moderate/severe NE affects 0.5-3/1000 live births in high-income countries, more in low- and middle-income countries, and carries high risk of mortality or disability, including cerebral palsy. Reduced blood flow and/or oxygenation around the time of birth, as with ruptured uterus, placental abruption or umbilical cord prolapse can cause NE. This subset of NE, with accompanying low Apgar scores and acidemia, is termed Hypoxic-Ischemic Encephalopathy. Other causes of NE that can present similarly, include infections, inflammation, toxins, metabolic disease, stroke, placental disease, and genetic disorders. Aberrant fetal growth and congenital anomalies are strongly associated with NE, suggesting a major role for maldevelopment. As new tools for differential diagnosis emerge, their application for prevention, individualized treatment and prognostication will require further systematic studies of etiology of NE.
Collapse
|
16
|
Ezenwa BN, Olorunfemi G, Fajolu I, Adeniyi T, Oleolo-Ayodeji K, Kene-Udemezue B, Olamijulo JA, Ezeaka C. Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study. PLoS One 2021; 16:e0250633. [PMID: 33901237 PMCID: PMC8075215 DOI: 10.1371/journal.pone.0250633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Globally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria. Objective We assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital. Methods A temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software. Results The median age of the newborns at admission was 26.5 (10–53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03). Conclusion The case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.
Collapse
Affiliation(s)
- Beatrice Nkolika Ezenwa
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- * E-mail:
| | - Gbenga Olorunfemi
- Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Iretiola Fajolu
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Toyin Adeniyi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Joseph A. Olamijulo
- Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinyere Ezeaka
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| |
Collapse
|
17
|
Allegra A, Giarratana RM, Scola L, Balistreri CR. The close link between the fetal programming imprinting and neurodegeneration in adulthood: The key role of "hemogenic endothelium" programming. Mech Ageing Dev 2021; 195:111461. [PMID: 33600833 DOI: 10.1016/j.mad.2021.111461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
The research on neurodegenerative diseases (NeuroDegD) has been traditionally focused on later life stages. There is now an increasing evidence, that they may be programmed during early development. Here, we propose that NeuroDegD are the result of the complex process of imprinting on fetal hemogenic endothelium, from which the microglial cells make to origin. The central role of placenta and epigenetic mechanisms (methylation of DNA, histone modifications and regulation by non-coding RNAs) in mediating the short and long-term effects has been also described. Precisely, it reports their role in impacting plasticity and memory of microglial cells. In addition, we also underline the necessity of further studies for clearing all mechanisms involved and developing epigenetic methods for identifying potential targets as biomarkers, and for developing preventive measures. Such biomarkers might be used to identify individuals at risk to NeuroDegD. Finally, the sex dependence of fetal programming process has been discussed. It might justify the sex differences in the epidemiologic, imaging, biomarkers, and pathology studies of these pathologies. The discovery of related mechanisms might have important clinical implications in both the etiology of disorders and the management of pregnant women for encouraging healthy long-term outcomes for their children, and future generations. Impending research on the mechanisms related to transgenerational transmission of prenatal stress might consent the development and application of therapies and/or intervention strategies for these disorders in humans.
Collapse
Affiliation(s)
| | - Rosa Maria Giarratana
- Department of BioMedicine, Neuroscience, and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Letizia Scola
- Department of BioMedicine, Neuroscience, and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Carmela Rita Balistreri
- Department of BioMedicine, Neuroscience, and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy.
| |
Collapse
|
18
|
Scher MS. "The First Thousand Days" Define a Fetal/Neonatal Neurology Program. Front Pediatr 2021; 9:683138. [PMID: 34408995 PMCID: PMC8365757 DOI: 10.3389/fped.2021.683138] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023] Open
Abstract
Gene-environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.
Collapse
Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Department of Pediatrics, Fetal/Neonatal Neurology Program, Emeritus Scholar Tenured Full Professor in Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| |
Collapse
|
19
|
Blommaert J, Radwan A, Sleurs C, Maggen C, van Gerwen M, Wolters V, Christiaens D, Peeters R, Dupont P, Sunaert S, Van Calsteren K, Deprez S, Amant F. The impact of cancer and chemotherapy during pregnancy on child neurodevelopment: A multimodal neuroimaging analysis. EClinicalMedicine 2020; 28:100598. [PMID: 33294813 PMCID: PMC7700909 DOI: 10.1016/j.eclinm.2020.100598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study applies multimodal MRI to investigate neurodevelopment in nine-year-old children born to cancer-complicated pregnancies. METHODS In this cohort study, children born after cancer-complicated pregnancies were recruited alongside 1:1 matched controls regarding age, sex and gestational age at birth (GA). Multimodal MRI was used to investigate whole-brain and subcortical volume, cortical structure (using surface-based morphometry), white matter microstructure (using fixel-based analysis) and functional connectivity (using resting-state blood-oxygen-level-dependant signal correlations). Graph theory probed whole-brain structural and functional organization. For each imaging outcome we conducted two group comparisons: 1) children born after cancer-complicated pregnancies versus matched controls, and 2) the subgroup of children with prenatal chemotherapy exposure versus matched controls. In both models, we used the covariate of GA and the group-by-GA interaction, using false-discovery-rate (FDR) or family-wise-error (FWE) correction for multiple comparisons. Exploratory post-hoc analyses investigated the relation between brain structure/function, neuropsychological outcome and maternal oncological/obstetrical history. FINDINGS Forty-two children born after cancer-complicated pregnancies were included in this study, with 30 prenatally exposed to chemotherapy. Brain organization and functional connectivity were not significantly different between groups. Both cancer and chemotherapy in pregnancy, as compared to matched controls, were associated with a lower travel depth, indicating less pronounced gyrification, in the left superior temporal gyrus (pFDR ≤ 006), with post-hoc analysis indicating platinum derivatives during pregnancy as a potential risk factor (p = .028). Both cancer and chemotherapy in pregnancy were related to a lower fibre cross-section (FCS) and lower fibre density and cross-section (FDC) in the posterior corpus callosum and its tapetal fibres, compared to controls. Higher FDC in the chemotherapy subgroup and higher FCS in the whole study group were observed in the anterior thalamic radiations. None of the psycho-behavioural parameters correlated significantly with any of the brain differences in the study group or chemotherapy subgroup. INTERPRETATION Prenatal exposure to maternal cancer and its treatment might affect local grey and white matter structure, but not functional connectivity or global organization. While platinum-based therapy was identified as a potential risk factor, this was not the case for chemotherapy in general. FUNDING This project has received funding from the European Union's Horizon 2020 research and innovation program (European Research council, grant no 647,047), the Foundation against cancer (Stichting tegen kanker, grant no. 2014-152) and the Research Foundation Flanders (FWO, grants no. 11B9919N, 12ZV420N).
Collapse
Affiliation(s)
- J. Blommaert
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - A. Radwan
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - C. Sleurs
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - C. Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - M. van Gerwen
- Department of Gynecology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Princess Máxima Center for pediatric oncology, Utrecht, Netherlands
| | - V. Wolters
- Department of Gynecology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - D. Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - R. Peeters
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P. Dupont
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - S. Sunaert
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - K. Van Calsteren
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Unit Woman and child, KU Leuven, Leuven, Belgium
| | - S. Deprez
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynaecologic Oncology Amsterdam, Netherlands Cancer Institute and University Medical Centers, Amsterdam, Netherlands
| |
Collapse
|
20
|
Affiliation(s)
- Mark S Scher
- From Pediatrics and Neurology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, OH.
| |
Collapse
|
21
|
Aravamuthan BR, Shevell M, Kim YM, Wilson JL, O'Malley JA, Pearson TS, Kruer MC, Fahey M, Waugh JL, Russman B, Shapiro B, Tilton A. Role of child neurologists and neurodevelopmentalists in the diagnosis of cerebral palsy: A survey study. Neurology 2020; 95:962-972. [PMID: 33046609 DOI: 10.1212/wnl.0000000000011036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To contextualize the role of child neurologists and neurodevelopmentalists (CNs/NDDs) in cerebral palsy (CP) care, we review the changing landscape of CP diagnosis and survey stakeholder CNs/NDDs regarding their roles in CP care. METHODS The optimal roles of the multiple specialties involved in CP care are currently unclear, particularly regarding CP diagnosis. We developed recommendations regarding the role of CNs/NDDs noting (1) increasing complexity of CP diagnosis given a growing number of genetic etiologies and treatable motor disorders that can be misdiagnosed as CP and (2) the views of a group of physician stakeholders (CNs/NDDs from the Child Neurology Society Cerebral Palsy Special Interest Group). RESULTS CNs/NDDs felt that they were optimally suited to diagnose CP. Many (76%) felt that CNs/NDDs should always be involved in CP diagnosis. However, 42% said that their patients with CP were typically not diagnosed by CNs/NDDs, and 18% did not receive referrals to establish the diagnosis of CP at all. CNs/NDDs identified areas of their expertise critical for CP diagnosis including knowledge of the neurologic examination across development and early identification of features atypical for CP. This contrasts with their views on CP management, where CNs/NDDs felt that they could contribute to the medical team, but were necessary primarily when neurologic coexisting conditions were present. DISCUSSION Given its increasing complexity, we recommend early referral for CP diagnosis to a CN/NDD or specialist with comparable expertise. This contrasts with current consensus guidelines, which either do not address or do not recommend specific specialist referral for CP diagnosis.
Collapse
Affiliation(s)
- Bhooma R Aravamuthan
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA.
| | - Michael Shevell
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Young-Min Kim
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Jenny L Wilson
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Jennifer A O'Malley
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Toni S Pearson
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Michael C Kruer
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Michael Fahey
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Jeff L Waugh
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Barry Russman
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Bruce Shapiro
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| | - Ann Tilton
- From the Department of Neurology (B.R.A., T.S.P.), Division of Pediatric Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO; Departments of Pediatrics and Neurology/Neurosurgery (M.S.), Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Division of Pediatric Neurology (J.L.Wilson, B.R.), Oregon Health & Science University, Portland, OR; Department of Pediatrics (Y-M.K.), Division of Pediatric Neurology, Loma Linda University School of Medicine, Loma Linda, CA; Stanford University School of Medicine (J.A.O.), Palo Alto, CA; Departments of Child Health (M.C.K.), Neurology & Genetics, University of Arizona College of Medicine, Phoenix, AZ; Program in Neuroscience (M.C.K.), Arizona State University, Tempe, AZ; Pediatric Movement Disorders Program and Neurogenetics Research Program (M.C.K.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ; Department of Paediatrics (M.F.), Monash University, Melbourne, Australia; Department of Pediatrics (J.L.Waugh), Division of Pediatric Neurology and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX; Department of Neurology and Developmental Medicine (B.S.), The Kennedy Krieger Institute, Baltimore, MD; Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans (A.T.), New Orleans, LA
| |
Collapse
|
22
|
Malinger G, Birnbam R, Haratz KK. Dedicated neurosonography for recognition of pathology associated with mild-to-moderate ventriculomegaly. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:319-323. [PMID: 32870586 DOI: 10.1002/uog.22155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G Malinger
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Birnbam
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K K Haratz
- Fetal Neurology Clinic, Division of Ultrasound in Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
23
|
Scher MS. Neurologic outcome after fetal inflammatory response syndrome: Trimester-specific considerations. Semin Fetal Neonatal Med 2020; 25:101137. [PMID: 33158496 DOI: 10.1016/j.siny.2020.101137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Clinical signs and neuroimaging patterns associated with the fetal inflammatory response syndrome (FIRS) worsen or mimic the clinical repertoire after intrapartum hypoxic-ischemic encephalopathy (HIE) during labor and/or parturition. Diagnostic considerations expressed as neonatal encephalopathy (NE) must consider chronic as well as acute factors associated with FIRS. Trimester-specific factors adversely alter the interactions of the maternal/placental/fetal (MPF) triad and influence the postnatal phenotype of FIRS. Anticipatory guidance for families by clinicians caring for survivors with FIRS, as well as researchers, must consider acute and chronic effects that influence neurologic outcome. Novel neurotherapeutic interventions must include prenatal preventive as well as peripartum/postnatal rescue and repair strategies to effectively reduce the presence and severity of sequelae from FIRS.
Collapse
Affiliation(s)
- Mark S Scher
- Emeritus Full Professor of Pediatrics and Neurology, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, 11100 Euclid Avenue Cleveland, Ohio, 44106, USA.
| |
Collapse
|
24
|
Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 2020; 20:3. [PMID: 32086598 PMCID: PMC7035308 DOI: 10.1007/s11910-020-1022-z] [Citation(s) in RCA: 427] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
Collapse
Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Michael Fahey
- Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Maria Mc Namara
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Madison Cb Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Himanshu Popat
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Emma Stanton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Olivia P Finemore
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Alice Tricks
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Leigha Dark
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Natalie Morton
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| |
Collapse
|