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Salmon F, Kayem G, Maisonneuve E, Foix-L'Hélias L, Benhammou V, Kaminski M, Marchand-Martin L, Kana G, Subtil D, Lorthe E, Ancel PY, Letouzey M. Clinical Chorioamnionitis and Neurodevelopment at 5 Years of Age in Children Born Preterm: The EPIPAGE-2 Cohort Study. J Pediatr 2024; 267:113921. [PMID: 38242316 DOI: 10.1016/j.jpeds.2024.113921] [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: 03/23/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm. STUDY DESIGN EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 240/7 and 346/7 weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively. RESULTS Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8). CONCLUSIONS We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane.
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Affiliation(s)
- Fanny Salmon
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France; Department of Gynecology and Obstetrics, Robert Debré Hospital, AP-HP, Université Paris-Cité, Paris, France.
| | - Gilles Kayem
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France; Department of Gynecology and Obstetrics, Armand Trousseau Hospital, APHP, Paris Sorbonne University, Paris, France
| | - Emeline Maisonneuve
- Institute of Primary Health Care (BIHAM), University of Bern, Brisbane, Australia
| | - Laurence Foix-L'Hélias
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France; Department of Neonatal Pediatrics, Armand Trousseau Hospital, APHP, Paris Sorbonne University, Paris, France
| | - Valérie Benhammou
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Monique Kaminski
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Laetitia Marchand-Martin
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Gildas Kana
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Damien Subtil
- Department of Obstetrics and Gynecology, CHU Lille, EA 2694 METRICS, University of Lille, Lille, France
| | - Elsa Lorthe
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France; Department of Primary Care Medicine, Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre-Yves Ancel
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France; Center for Clinical Investigation P1419, APHP, APHP. Centre- Université Paris Cité, Paris, France
| | - Mathilde Letouzey
- Université Paris Cité, Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France; Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Clamart, France
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Chevalier G, Garabedian C, Pekar JD, Wojtanowski A, Le Hesran D, Galan LE, Sharma D, Storme L, Houfflin-Debarge V, De Jonckheere J, Ghesquière L. Early heart rate variability changes during acute fetal inflammatory response syndrome: An experimental study in a fetal sheep model. PLoS One 2023; 18:e0293926. [PMID: 38032884 PMCID: PMC10688759 DOI: 10.1371/journal.pone.0293926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Fetal infection during labor with fetal inflammatory response syndrome (FIRS) is associated with neurodevelopmental disabilities, cerebral palsy, neonatal sepsis, and mortality. Current methods to diagnose FIRS are inadequate. Thus, the study aim was to explore whether fetal heart rate variability (HRV) analysis can be used to detect FIRS. MATERIAL AND METHODS In chronically instrumented near-term fetal sheep, lipopolysaccharide (LPS) was injected intravenously to model FIRS. A control group received saline solution injection. Hemodynamic, blood gas analysis, interleukin-6 (IL-6), and 14 HRV indices were recorded for 6 h. In both groups, comparisons were made between the stability phase and the 6 h following injection (H1-H6, respectively) and between LPS and control groups. RESULTS Fifteen lambs were instrumented. In the LPS group (n = 8), IL-6 increased significantly after LPS injection (p < 0.001), confirming the FIRS model. Fetal heart rate increased significantly after H5 (p < 0.01). In our FIRS model without shock or cardiovascular decompensation, five HRV measures changed significantly after H2 until H4 in comparison to baseline. Moreover, significant differences between LPS and control groups were observed in HRV measures between H2 and H4. These changes appear to be mediated by an increase of global variability and a loss of signal complexity. CONCLUSION As significant HRV changes were detected before FHR increase, these indices may be valuable for early detection of acute FIRS.
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Affiliation(s)
- Geoffroy Chevalier
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | - Charles Garabedian
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | | | | | | | | | - Dyuti Sharma
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Pediatric Surgery, CHU Lille, France
| | - Laurent Storme
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Neonatology, CHU Lille, France
| | - Veronique Houfflin-Debarge
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | - Julien De Jonckheere
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- CIC-IT 1403, CHU Lille, France
| | - Louise Ghesquière
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
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3
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Carvalho A, Longo E, Nascimento-Carvalho C, Argollo N, Coelho KE, Sampaio A, Brites C, Lucena R. Do Children With Congenital Zika Syndrome Have Cerebral Palsy? GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00575. [PMID: 36316149 PMCID: PMC9622294 DOI: 10.9745/ghsp-d-21-00575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/20/2022] [Indexed: 01/25/2023]
Abstract
As researchers and practitioners, we have an important role in educating families of children with brain damage caused by Zika virus infection on how a cerebral palsy diagnosis can empower them with more information and enable better access to care and intervention services.
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Affiliation(s)
- Alessandra Carvalho
- SARAH Network of Rehabilitation Hospitals, Salvador, Bahia, Brazil.,Correspondence to Alessandra Carvalho ()
| | - Egmar Longo
- Trairi Health Sciences Faculty (FACISA), Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | | | | | | | - Aline Sampaio
- Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carlos Brites
- Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rita Lucena
- Federal University of Bahia, Salvador, Bahia, Brazil
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4
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Sharma A, Sah N, Kannan S, Kannan RM. Targeted drug delivery for maternal and perinatal health: Challenges and opportunities. Adv Drug Deliv Rev 2021; 177:113950. [PMID: 34454979 PMCID: PMC8544131 DOI: 10.1016/j.addr.2021.113950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Pre-existing conditions at reproductive age, and complications arising during pregnancy can be detrimental to maternal and fetal health. Current therapies to combat obstetric disorders are limited due to the inherent complexity of pregnancy, and can have harmful effects on developing fetus. Emerging research shows intricate signaling between the cells from mother and fetus at maternal-fetal interface, providing unique opportunities for interventions specifically targeted to the mother, fetus, or placenta. Advancements in nanotechnology, stem-cell biology and gene therapy have resulted in target-specific treatments with promising results in pre-clinical maternal and fetal disorder models. Comprehensive understanding of the effect of physicochemical properties of delivery systems on their uptake, retention and accumulation across placenta will help in the better diagnosis and treatment of perinatal disorders. This review describes the factors leading to obstetric complications along with their effect on pregnancy outcomes, and discusses key targeted therapeutic strategies for addressing conditions related to maternal and fetal health.
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Affiliation(s)
- Anjali Sharma
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Nirnath Sah
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sujatha Kannan
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Hugo W. Moser Research Institute at Kennedy Krieger, Inc., Baltimore MD, 21205, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Hugo W. Moser Research Institute at Kennedy Krieger, Inc., Baltimore MD, 21205, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore MD, 21218, USA.
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5
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Zaidi H, Lamalmi N, Lahlou L, Slaoui M, Barkat A, Alamrani S, Alhamany Z. Clinical predictive factors of histological chorioamnionitis: case-control study. Heliyon 2020; 6:e05698. [PMID: 33364485 PMCID: PMC7750559 DOI: 10.1016/j.heliyon.2020.e05698] [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: 06/07/2020] [Revised: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 10/30/2022] Open
Abstract
Introduction Histological chorioamnionitis or "intrauterine inflammation or infection" (Triple I) it is an acute inflammation of amniotic membrane, chorionic plate and umbilical cord. Subject To assess in the event of the clinical predictive factors associated to histological chorioamnionitis. Methods Prospective examination of 50 placentas from aberrant pregnancies, and 50 placentas from 'normal' deliveries. The Placentas analyzed by the conventional histopathology method, and the severity of chorioamnionitis was classified histologically according to the intensity and the topography of placental inflammation.The clinical and histopathological features of the study groups were introduced into the SPSS 13 database (License University Mohammed V-Rabat). Results 36/50 placentas of aberrant pregnancies showed a histological chorioamnionitis often associated to a funisitis, and 11/50 normal placentas have shown some lesions of histological chorioamnionitis mainly grade one without funisitis.On the other hand we noted a statistically significant association between histological chorioamnionitis and premature rupture of the membranes (PROM) over than 12h (p < 0.001). Conclusions Our study confirmed the predominance of histological chorioamnionitis lesions in clinically suspected cases of chorioamnionitis with 72% versus 22% in the controls group.Among the clinical parameters studied, only the premature rupture of the Membranes was shown a statistically significant association with the appearance of histological signs of chorioamnionitis.In conclusion, chorioamnionitis is sometimes clinically silent. Morphological placental study could be a confirmation of this pathology, which is predominantly associated to PROM over than 12 h.
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Affiliation(s)
- H Zaidi
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| | - N Lamalmi
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| | - L Lahlou
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Biostatistics and Clinical Research, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco
| | - M Slaoui
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco
| | - A Barkat
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Neonatology Department P5, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| | - S Alamrani
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Maternity Souissi, CHU Ibn Sina, 10170, Rabat, Morocco
| | - Z Alhamany
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
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Abstract
Fetal Inflammatory Response Syndrome (FIRS) is the fetal counterpart of systemic inflammatory response syndrome (SIRS) described in adults. When the fetus is directly exposed to inflammation of the fetal membranes or the placental-fetal circulation, and organs are adversely affected, the disorder is known as FIRS. This syndrome can significantly affect multiple organs with significant short and long term implications for the newborn. In cases of neonatal encephalopathy when no obvious etiology is identified, FIRS needs to be considered. Based on the significant incidence of chorioamnionitis and its potential effects on the newborn, any evidence of maternal, fetal, or neonatal infection should mandate further evaluation of the placenta and membrane histopathology.
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Affiliation(s)
- Jonathan Muraskas
- Loyola University Medical Center, 2160 South 1st Avenue, Division of Neonatal and Perinatal Medicine, Maywood, IL, 60153, USA.
| | - Lauren Astrug
- Loyola University Medical Center, 2160 South 1st Avenue, Division of Neonatal and Perinatal Medicine, Maywood, IL, 60153, USA
| | - Sachin Amin
- Loyola University Medical Center, 2160 South 1st Avenue, Division of Neonatal and Perinatal Medicine, Maywood, IL, 60153, USA
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7
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Preterm birth and sustained inflammation: consequences for the neonate. Semin Immunopathol 2020; 42:451-468. [PMID: 32661735 PMCID: PMC7508934 DOI: 10.1007/s00281-020-00803-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Abstract
Almost half of all preterm births are caused or triggered by an inflammatory process at the feto-maternal interface resulting in preterm labor or rupture of membranes with or without chorioamnionitis (“first inflammatory hit”). Preterm babies have highly vulnerable body surfaces and immature organ systems. They are postnatally confronted with a drastically altered antigen exposure including hospital-specific microbes, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia (“second inflammatory hit”). This is of particular importance to extremely preterm infants born before 28 weeks, as they have not experienced important “third-trimester” adaptation processes to tolerate maternal and self-antigens. Instead of a balanced adaptation to extrauterine life, the delicate co-regulation between immune defense mechanisms and immunosuppression (tolerance) to allow microbiome establishment is therefore often disturbed. Hence, preterm infants are predisposed to sepsis but also to several injurious conditions that can contribute to the onset or perpetuation of sustained inflammation (SI). This is a continuing challenge to clinicians involved in the care of preterm infants, as SI is regarded as a crucial mediator for mortality and the development of morbidities in preterm infants. This review will outline the (i) role of inflammation for short-term consequences of preterm birth and (ii) the effect of SI on organ development and long-term outcome.
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8
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PI3K-Akt-Wnt Pathway Is Implicated in Exercise-Induced Improvement of Short-term Memory in Cerebral Palsy Rats. Int Neurourol J 2018; 22:S156-164. [PMID: 30396265 PMCID: PMC6234731 DOI: 10.5213/inj.1836224.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/07/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Maternal lipopolysaccharide (LPS) injection induces neurodevelopmental disorders, such as cerebral palsy. Exercise activates phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) signaling pathway that enhances neurogenesis. Wnt ligands are also implicated in the hippocampal neurogenesis and synaptic plasticity. Glycogen synthase kinase-3β (GSK-3β) is a downstream molecule of Akt, and GSK-3β is known to modulate hippocampal neurogenesis negatively. METHODS Cerebral palsy was made by maternal LPS-injection. On the 5 weeks after birth, treadmill running was applied to the rat pups of the exercise groups, for 30 minutes, 5 times a week during 6 weeks. RESULTS Treadmill running alleviated short-term memory impairments of the cerebral palsy rat pups. Hippocampal cell proliferation was increased and hippocampal apoptosis was suppressed by treadmill running in the cerebral palsy rat pups. Hippocampal phosphorylated-PI3K/PI3K ratio, phosphorylated-Akt/Akt ratio, and Wnt expression were enhanced by treadmill running in the cerebral palsy rat pups. In contrast, hippocampal phosphorylated-GSK-3β/GSK-3β ratio and β-catenin expression were suppressed by treadmill running in the cerebral palsy rat pups. CONCLUSION The results of this study showed that short-term memory improvement due to treadmill running in cerebral palsy occurs via activation of the PI3K-Akt-Wnt pathway.
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9
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Choi CW. Chorioamnionitis: Is a major player in the development of bronchopulmonary dysplasia? KOREAN JOURNAL OF PEDIATRICS 2017; 60:203-207. [PMID: 28861110 PMCID: PMC5573742 DOI: 10.3345/kjp.2017.60.7.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/02/2017] [Accepted: 06/14/2017] [Indexed: 12/23/2022]
Abstract
Chorioamnionitis is an inflammation in the fetal membranes or placenta. When chorioamnionitis develops, fetal lungs are exposed to inflammatory cytokines and mediators via amniotic fluid. Because inflammation plays a pivotal role in the development of bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity, fetal lung inflammation induced by chorioamnionitis has been considered to be one of the major pathogenetic factors for BPD. Although there have been a number of studies that demonstrated the relationship between chorioamnionitis and BPD, there are still controversies on this issue. The controversies on the relationship between chorioamnionitis and BPD arise from not-unified definitions of chorioamnionitis and BPD, different study populations, and the proportion of contribution between inflammation and infectious microorganisms. The publication bias also contributes to the controversies. Clinical trials targeting chorioamnionitis or microorganisms that cause chorioamnionitis will answer on the actual relationship between chorioamnionitis and BPD and provide a novel prophylactic strategy against BPD based on that relationship.
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Affiliation(s)
- Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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10
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Jung E, Choi CW, Kim SY, Sung TJ, Kim H, Park KU, Kim HS, Kim BI, Choi JH. Coexistence of Ureaplasma and chorioamnionitis is associated with prolonged mechanical ventilation. Pediatr Int 2017; 59:34-40. [PMID: 27337221 DOI: 10.1111/ped.13072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/27/2016] [Accepted: 06/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Both histologic chorioamnionitis (HCAM) and Ureaplasma infection are considered important contributors to perinatal lung injury. We tested the hypothesis that coexistence of maternal HCAM and perinatal Ureaplasma exposure increases the risk of prolonged mechanical ventilation in extremely low-birthweight (ELBW) infants. METHODS A retrospective cohort study was carried out of all ELBW infants born between January 2008 and December 2013 at a single academic center. Placental pathology and gastric fluid Ureaplasma data were available for all infants. Culture and polymerase chain reaction were used to detect Ureaplasma in gastric fluid. Prolonged mechanical ventilation was defined as mechanical ventilation that began within 28 days after birth and continued. RESULTS Of 111 ELBW infants enrolled, 84 survived beyond 36 weeks of postmenstrual age (PMA) and were included in the analysis. Eighteen infants (21.4%) had both HCAM and Ureaplasma exposure. Seven infants (8.3%) required mechanical ventilation beyond 36 weeks of PMA. Coexistence of HCAM and Ureaplasma in gastric fluid was significantly associated with prolonged mechanical ventilation after adjustment for gestational age, sex, mode of delivery, and use of macrolide antibiotics (OR, 8.7; 95%CI: 1.1-67.2). CONCLUSIONS Coexistence of maternal HCAM and perinatal Ureaplasma exposure significantly increases the risk of prolonged mechanical ventilation in ELBW infants.
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Affiliation(s)
- Euiseok Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tae-Jung Sung
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Chatue Kamga HB. Neuroimaging Complication of Neonatal Meningitis in Full-Term and Near-Term Newborns: A Retrospective Study of One Center. Glob Pediatr Health 2016; 3:2333794X16681673. [PMID: 28229093 PMCID: PMC5308528 DOI: 10.1177/2333794x16681673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine complication of neonatal meningitis due to streptococcus group B in full-term and near–full-term newborns in a tertiary-level neonate intensive care unit.
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12
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Cardoso FL, Herz J, Fernandes A, Rocha J, Sepodes B, Brito MA, McGavern DB, Brites D. Systemic inflammation in early neonatal mice induces transient and lasting neurodegenerative effects. J Neuroinflammation 2015; 12:82. [PMID: 25924675 PMCID: PMC4440597 DOI: 10.1186/s12974-015-0299-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/10/2015] [Indexed: 12/11/2022] Open
Abstract
Background The inflammatory mediator lipopolysaccharide (LPS) has been shown to induce acute gliosis in neonatal mice. However, the progressive effects on the murine neurodevelopmental program over the week that follows systemic inflammation are not known. Thus, we investigated the effects of repeated LPS administration in the first postnatal week in mice, a condition mimicking sepsis in late preterm infants, on the developing central nervous system (CNS). Methods Systemic inflammation was induced by daily intraperitoneal administration (i.p.) of LPS (6 mg/kg) in newborn mice from postnatal day (PND) 4 to PND6. The effects on neurodevelopment were examined by staining the white matter and neurons with Luxol Fast Blue and Cresyl Violet, respectively. The inflammatory response was assessed by quantifying the expression/activity of matrix metalloproteinases (MMP), toll-like receptor (TLR)-4, high mobility group box (HMGB)-1, and autotaxin (ATX). In addition, B6 CX3CR1gfp/+ mice combined with cryo-immunofluorescence were used to determine the acute, delayed, and lasting effects on myelination, microglia, and astrocytes. Results LPS administration led to acute body and brain weight loss as well as overt structural changes in the brain such as cerebellar hypoplasia, neuronal loss/shrinkage, and delayed myelination. The impaired myelination was associated with alterations in the proliferation and differentiation of NG2 progenitor cells early after LPS administration, rather than with excessive phagocytosis by CNS myeloid cells. In addition to disruptions in brain architecture, a robust inflammatory response to LPS was observed. Quantification of inflammatory biomarkers revealed decreased expression of ATX with concurrent increases in HMGB1, TLR-4, and MMP-9 expression levels. Acute astrogliosis (GFAP+ cells) in the brain parenchyma and at the microvasculature interface together with parenchymal microgliosis (CX3CR1+ cells) were also observed. These changes preceded the migration/proliferation of CX3CR1+ cells around the vessels at later time points and the subsequent loss of GFAP+ astrocytes. Conclusion Collectively, our study has uncovered a complex innate inflammatory reaction and associated structural changes in the brains of neonatal mice challenged peripherally with LPS. These findings may explain some of the neurobehavioral abnormalities that develop following neonatal sepsis.
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Affiliation(s)
- Filipa L Cardoso
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
| | - Jasmin Herz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1430, USA.
| | - Adelaide Fernandes
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal. .,Department of Biochemistry and Human Biology, Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
| | - João Rocha
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
| | - Bruno Sepodes
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
| | - Maria A Brito
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal. .,Department of Biochemistry and Human Biology, Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
| | - Dorian B McGavern
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1430, USA.
| | - Dora Brites
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal. .,Department of Biochemistry and Human Biology, Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.
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Eliwan HO, Watson RWG, Aslam S, Regan I, Philbin B, O'Hare FM, O'Neill A, Preston R, Blanco A, Grant T, Nolan B, Smith O, Molloy EJ. Neonatal brain injury and systemic inflammation: modulation by activated protein C ex vivo. Clin Exp Immunol 2015; 179:477-84. [PMID: 25204207 DOI: 10.1111/cei.12453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/04/2023] Open
Abstract
Infection and inflammation can be antecedents of neonatal encephalopathy (NE) and increase the risk of neurological sequelae. Activated protein C (APC) has anti-coagulant and anti-inflammatory effects and provides neuroprotection in brain and spinal cord injury. We examined neutrophil and monocyte responses to lipopolysaccharide (LPS) in infants with NE compared with healthy adult and neonatal controls, and also studied the effect of APC. Whole blood was incubated with LPS and APC and Toll-like receptor (TLR)-4 (LPS recognition), CD11b expression (activation) and intracellular reactive oxygen intermediate (ROI; function) release from neutrophils and monocytes was examined by flow cytometry serially from days 1 to 7. We found a significant increase in neutrophil ROI in infants with NE on day 3 following LPS compared to neonatal controls and this augmented response was reduced significantly by APC. Neutrophil and monocyte CD11b expression was increased significantly on day 1 in infants with NE compared to neonatal controls. LPS-induced neutrophil TLR-4 expression was increased significantly in infants with NE on days 3 and 7 and was reduced by APC. LPS-induced monocyte TLR-4 was increased significantly in infants with NE on day 7. Neutrophil and monocyte activation and production of ROIs may mediate tissue damage in infants with NE. APC modified LPS responses in infants with NE. APC may reduce the inflammatory responses in NE and may ameliorate multi-organ dysfunction. Further study of the immunomodulatory effects of protein C may be warranted using mutant forms with decreased bleeding potential.
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Affiliation(s)
- H O Eliwan
- Paediatrics, National Maternity Hospital, Dublin, Ireland; UCD School of Medicine and Medical Science and Conway Institute for Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland; National Children Research Centre, Dublin, Ireland; Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Cilla A, Arnaez J, Suarez J, Megias G, Cabrerizo M, Garcia-Alix A. Perinatal infection and hypoxic-ischemic encephalopathy: a pilot study. J Matern Fetal Neonatal Med 2014; 29:140-2. [PMID: 25423183 DOI: 10.3109/14767058.2014.991303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies suggest a synergic effect of infection and hypoxia-ischemia in the causation of perinatal brain damage. We conducted a prospective pilot study on the presence of infection in hypoxic-ischemic encephalopathy (HIE), focusing on neurotropic viruses. Sixteen newborns with HIE were included in the study. There were no confirmed cases of viral infection. There was a case of bacterial early onset sepsis and four cases of suspected sepsis due to clinical and/or analytical signs, but with negative cultures. Our results do not support universal screening for viral infection in cases of HIE.
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Affiliation(s)
| | | | | | - Gregoria Megias
- c Department of Microbiology , Burgos University Hospital , Burgos , Spain
| | - María Cabrerizo
- d National Centre of Microbiology, Instituto de Salud Carlos III , Madrid , Spain , and
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15
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Maternal immune activation and abnormal brain development across CNS disorders. Nat Rev Neurol 2014; 10:643-60. [PMID: 25311587 DOI: 10.1038/nrneurol.2014.187] [Citation(s) in RCA: 595] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies have shown a clear association between maternal infection and schizophrenia or autism in the progeny. Animal models have revealed maternal immune activation (mIA) to be a profound risk factor for neurochemical and behavioural abnormalities in the offspring. Microglial priming has been proposed as a major consequence of mIA, and represents a critical link in a causal chain that leads to the wide spectrum of neuronal dysfunctions and behavioural phenotypes observed in the juvenile, adult or aged offspring. Such diversity of phenotypic outcomes in the mIA model are mirrored by recent clinical evidence suggesting that infectious exposure during pregnancy is also associated with epilepsy and, to a lesser extent, cerebral palsy in children. Preclinical research also suggests that mIA might precipitate the development of Alzheimer and Parkinson diseases. Here, we summarize and critically review the emerging evidence that mIA is a shared environmental risk factor across CNS disorders that varies as a function of interactions between genetic and additional environmental factors. We also review ongoing clinical trials targeting immune pathways affected by mIA that may play a part in disease manifestation. In addition, future directions and outstanding questions are discussed, including potential symptomatic, disease-modifying and preventive treatment strategies.
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16
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Gonzales-Portillo GS, Sanberg PR, Franzblau M, Gonzales-Portillo C, Diamandis T, Staples M, Sanberg CD, Borlongan CV. Mannitol-enhanced delivery of stem cells and their growth factors across the blood-brain barrier. Cell Transplant 2014; 23:531-9. [PMID: 24480552 PMCID: PMC4083632 DOI: 10.3727/096368914x678337] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Ischemic brain injury in adults and neonates is a significant clinical problem with limited therapeutic interventions. Currently, clinicians have only tPA available for stroke treatment and hypothermia for cerebral palsy. Owing to the lack of treatment options, there is a need for novel treatments such as stem cell therapy. Various stem cells including cells from embryo, fetus, perinatal, and adult tissues have proved effective in preclinical and small clinical trials. However, a limiting factor in the success of these treatments is the delivery of the cells and their by-products (neurotrophic factors) into the injured brain. We have demonstrated that mannitol, a drug with the potential to transiently open the blood-brain barrier and facilitate the entry of stem cells and trophic factors, as a solution to the delivery problem. The combination of stem cell therapy and mannitol may improve therapeutic outcomes in adult stroke and neonatal cerebral palsy.
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Affiliation(s)
- Gabriel S. Gonzales-Portillo
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Paul R. Sanberg
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Max Franzblau
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Chiara Gonzales-Portillo
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Theo Diamandis
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Meaghan Staples
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Cyndy D. Sanberg
- Saneron CCEL Therapeutics, Saneron CCEL Therapeutics, Inc., Tampa, FL, USA
| | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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17
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Suguna Narasimhulu S, Hendricks-Muñoz KD, Borkowsky W, Mally P. Usefulness of urinary immune biomarkers in the evaluation of neonatal sepsis: a pilot project. Clin Pediatr (Phila) 2013; 52:520-6. [PMID: 23539685 DOI: 10.1177/0009922813482751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our hypothesis is that specific proinflammatory and anti-inflammatory urinary cytokines are useful in the diagnostic evaluation of risk for sepsis in term neonates. We conducted a pilot, prospective hospital-based longitudinal observational study to test the urine of term neonates with a 13 biomarker panel of cytokines. METHODS Infants were divided into 2 groups: The control group (n = 15) consisted of infants admitted to newborn nursery, and the test group (n = 15) consisted of infants admitted to the neonatal intensive care unit for presumed sepsis. Bagged urine samples were collected from 30 term neonates for testing our hypothesis. RESULTS Urinary interleukin (IL)-8 (P = .004*), inducible protein (IP)-10 (P = .007*), and monocyte chemoattractant protein (MCP)-1 (P = .02) were significantly increased in the test group compared with the control group. CONCLUSIONS Urinary IL-8, IP-10, and MCP-1 are proinflammatory cytokines that are increased in the neonate during an infectious inflammatory process. These may be useful predictors as an adjunct to the current protocols to recognize neonatal sepsis.
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Borlongan CV, Glover LE, Sanberg PR, Hess DC. Permeating the blood brain barrier and abrogating the inflammation in stroke: implications for stroke therapy. Curr Pharm Des 2012; 18:3670-6. [PMID: 22574981 DOI: 10.2174/138161212802002841] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/24/2012] [Indexed: 01/18/2023]
Abstract
Cell therapy has been shown as a potential treatment for stroke and other neurological disorders. Human umbilical cord blood (HUCB) may be a promising source of stem cells for cell therapy. The most desired outcomes occur when stem cells cross the blood brain barrier (BBB) and eventually reach the injured brain site. We propose, from our previous studies, that mannitol is capable of disrupting the BBB, allowing the transplanted cells to enter the brain from the periphery. However, when the BBB is compromised, the inflammatory response from circulation may also be able to penetrate the brain and thus may actually exacerbate the stroke rather than afford therapeutic effects. We discuss how an NF-kB decoy can inhibit the inflammatory responses in the stroke brain thereby reducing the negative effects associated with BBB disruption. In this review, we propose the combination of mannitol-induced BBB permeation and NF-kB decoy for enhancing the therapeutic benefits of cell therapy in stroke.
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Affiliation(s)
- Cesar V Borlongan
- Department of Neurology, Georgia Health Sciences University, Augusta, Georgia 30912, USA.
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19
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Breen K, Brown A, Burd I, Chai J, Friedman A, Elovitz MA. TLR-4-dependent and -independent mechanisms of fetal brain injury in the setting of preterm birth. Reprod Sci 2012; 19:839-50. [PMID: 22825738 DOI: 10.1177/1933719112438439] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In this study, we sought to assess how essential activation of toll-like receptor 4 (TLR-4) is to fetal brain injury from intrauterine inflammation. Both wild-type and TLR-4 mutant fetal central nervous system cells were exposed to inflammation using lipopolysaccharide in vivo or in vitro. Inflammation could not induce neuronal injury in the absence of glial cells, in either wild-type or TLR-4 mutant neurons. However, injured neurons could induce injury in other neurons regardless of TLR-4 competency. Our results indicate that initiation of neuronal injury is a TLR-4-dependent event, while propagation is a TLR-4-independent event.
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Affiliation(s)
- Kelsey Breen
- Maternal and Child Health Research Program, Department of OBGYN, Center for Research on Reproduction and Women's Health, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
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Abstract
Glycemic control is an important aspect of patient care in the surgical Infections of the nervous system are among the most difficult infections in terms of the morbidity and mortality posed to patients, and thereby require urgent and accurate diagnosis. Although viral meningitides are more common, it is the bacterial meningitides that have the potential to cause a rapidly deteriorating condition that the physician should be familiar with. Viral encephalitis frequently accompanies viral meningitis, and can produce focal neurologic findings and cognitive difficulties that can mimic other neurologic disorders. Brain abscesses also have the potential to mimic and present like other neurologic disorders, and cause more focal deficits. Finally, other infectious diseases of the central nervous system, such as prion disease and cavernous sinus thrombosis, are explored in this review.
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Affiliation(s)
- Vevek Parikh
- University of California, San Francisco, CA, USA
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21
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Petit E, Abergel A, Dedet B, Subtil D. [The role of infection in preterm birth]. ACTA ACUST UNITED AC 2011; 41:14-25. [PMID: 22192232 DOI: 10.1016/j.jgyn.2011.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 10/08/2011] [Accepted: 10/13/2011] [Indexed: 12/26/2022]
Abstract
Intrauterine infection could be responsible for 25% up to 40% of preterm births. This relationship was initially demonstrated using animal models, inducing their abortion by injecting bacteria or endotoxins. In human research, examination of amniocentesis fluid showed the anteriority of infection over labor induction, and the existence of a subclinical latency phase between these two phenomena. The ascending route is preponderant, and four stages can be distinguished: cervical and vaginal infection, chorio-decidual infection, intra-amniotic infection, fetal infection. The intrauterine infection is very frequent in case of early preterm birth (<30 WG). It is associated with an increase of neurological and pulmonary morbidity. Most commonly found bacterial species are mycoplasma species, but also Escherichia coli, Gardnerella vaginalis and streptococcus B. Several markers of the infection have been studied: a maternal leukocytosis>15,000/mm(3) or a C-Reactive Protein (CRP)>20mg/l, an increase of fibronectin and/or IL-6 cervical, a short cervical length especially before 32 WG, a leukocytosis of the amniotic fluid, and/or high interleukin concentrations. The main marker used for the newborn is the CRP, but other markers can also be used for an early diagnosis of an infection, especially interleukin 6.
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Affiliation(s)
- E Petit
- Pôle d'obstétrique, clinique d'obstétrique, hôpital Jeanne-de-Flandre, université Lille II, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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22
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Chirico G, Loda C. Laboratory aid to the diagnosis and therapy of infection in the neonate. Pediatr Rep 2011; 3:e1. [PMID: 21647274 PMCID: PMC3103129 DOI: 10.4081/pr.2011.e1] [Citation(s) in RCA: 37] [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: 12/06/2010] [Accepted: 02/21/2011] [Indexed: 02/02/2023] Open
Abstract
Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. For years, investigators have sought a test or panel of tests able to identify septic neonates accurately and rapidly in order to obtain an early diagnosis and develop a specific effective treatment for a successful outcome. In addition to the standard procedures (blood, CSF, and urine cultures), such panels have included a combination of haematological investigations (total, differential and immature cell counts), and levels of acute-phase reactants (principally CRP and procalcitonin), and cytokines (such as IL-6 or neutrophil CD64). Furthermore, the science of proteomics and genomics has been applied to the search for bio-markers, production of protein profiles and genetic polymorphisms that can rapidly help the prediction, early diagnosis, and treatment of human diseases, but, for now, data are as yet insufficient to confirm their validity.
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Affiliation(s)
- Gaetano Chirico
- Department of Neonatology and Neonatal Intensive Care, Children Hospital, Spedali Civili, Brescia, Italy
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23
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WONG L, MACLENNAN AH. Gathering the evidence: Cord gases and placental histology for births with low Apgar scores. Aust N Z J Obstet Gynaecol 2011; 51:17-21. [DOI: 10.1111/j.1479-828x.2010.01275.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yasuhara T, Hara K, Maki M, Xu L, Yu G, Ali MM, Masuda T, Yu SJ, Bae EK, Hayashi T, Matsukawa N, Kaneko Y, Kuzmin-Nichols N, Ellovitch S, Cruz EL, Klasko SK, Sanberg CD, Sanberg PR, Borlongan CV. Mannitol facilitates neurotrophic factor up-regulation and behavioural recovery in neonatal hypoxic-ischaemic rats with human umbilical cord blood grafts. J Cell Mol Med 2010; 14:914-21. [PMID: 20569276 PMCID: PMC3823123 DOI: 10.1111/j.1582-4934.2008.00671.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We recently demonstrated that blood–brain barrier permeabilization using mannitol enhances the therapeutic efficacy of systemically administered human umbilical cord blood (HUCB) by facilitating the entry of neurotrophic factors from the periphery into the adult stroke brain. Here, we examined whether the same blood–brain barrier manipulation approach increases the therapeutic effects of intravenously delivered HUCB in a neonatal hypoxic-ischaemic (HI) injury model. Seven-day-old Sprague–Dawley rats were subjected to unilateral HI injury and then at day 7 after the insult, animals intravenously received vehicle alone, mannitol alone, HUCB cells (15k mononuclear fraction) alone or a combination of mannitol and HUCB cells. Behavioural tests at post-transplantation days 7 and 14 showed that HI animals that received HUCB cells alone or when combined with mannitol were significantly less impaired in motor asymmetry and motor coordination compared with those that received vehicle alone or mannitol alone. Brain tissues from a separate animal cohort from the four treatment conditions were processed for enzyme-linked immunosorbent assay at day 3 post-transplantation, and revealed elevated levels of GDNF, NGF and BDNF in those that received HUCB cells alone or when combined with mannitol compared with those that received vehicle or mannitol alone, with the combined HUCB cells and mannitol exhibiting the most robust neurotropic factor up-regulation. Histological assays revealed only sporadic detection of HUCB cells, suggesting that the trophic factor–mediated mechanism, rather than cell replacement per se, principally contributed to the behavioural improvement. These findings extend the utility of blood–brain barrier permeabilization in facilitating cell therapy for treating neonatal HI injury.
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Affiliation(s)
- T Yasuhara
- Department of Neurology, Medical College of Georgia, Augusta, GA, USA
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A Proposed Evidence-Based Neonatal Work-up to Confirm or Refute Allegations of Intrapartum Asphyxia. Obstet Gynecol 2010; 116:261-268. [DOI: 10.1097/aog.0b013e3181e7d267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Guo R, Hou W, Dong Y, Yu Z, Stites J, Weiner CP. Brain injury caused by chronic fetal hypoxemia is mediated by inflammatory cascade activation. Reprod Sci 2010; 17:540-8. [PMID: 20360591 DOI: 10.1177/1933719110364061] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of cerebral palsy (CP) shows little temporal or geographic variation and is associated with preterm birth, maternal/fetal infection/inflammation, and fetal growth restriction (IUGR), a potential surrogate for chronic fetal hypoxemia (CHX). We previously demonstrated CHX causes a fetal inflammatory response syndrome (FIRS). Herein, we test the hypothesis that CHX may cause fetal brain injury by upregulating inflammatory cytokine cascades, culminating in apoptosis pathway activation. Time-mated guinea pigs were housed in 12% or 10.5% O(2) for the last 21% of gestation. Chronic fetal hypoxemia increased the lactate/pyruvate and decreased the glutathione (GSH)/oxidized glutathione (GSSH) ratios, confirming a shift to a prooxidant state. The end result was a >30% decrease in hippocampal neuron density. Based on a microarray spotted with 113 cytokines and receptors, 22 genes were upregulated by CHX in proportion to the degree of hypoxia; the findings were confirmed by quantitative polymerase chain reaction (PCR). Thus, CHX triggers fetal brain inflammation inversely proportional to its severity characterized by increased apoptosis and neuronal loss. We suggest CHX fetal brain injury is not directly caused by oxygen deprivation but rather is an adaptive response that becomes maladaptive.
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Affiliation(s)
- Rong Guo
- Department of Pathophysiology, Xian Jiaotong University School of Medicine, Xian, Shannxi, PR China
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28
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Amin SB, Wang H. Histologic chorioamnionitis and acute neurologic impairment in premature infants. J Matern Fetal Neonatal Med 2010; 23:1165-71. [PMID: 20350238 DOI: 10.3109/14767050903580383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if histologic chorioamnionitis is associated with acute neurologic impairment as evaluated by auditory brainstem response in premature infants. METHODS A prospective study was performed to compare auditory neural function at birth between premature infants with maternal histologic chorioamnionitis and infants without maternal histologic chorioamnionitis. Our inclusion criteria was 28-33 weeks gestational age (GA) infants who had maternal placental histopathology performed. Infants with toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex (TORCH) infections, chromosomal disorders, cranio-facial anomalies and/or unstable condition were excluded. Bilateral monaural auditory brainstem evoked responses were performed using 80 dB nHL click stimuli at a repetition rate of 29.9/s within 48 h after birth. RESULTS Of 101 infants who met study criteria, 29 infants were born with history of maternal histologic chorioamnionitis. There were no significant differences between infants with histologic chorioamnionitis and infants without histologic chorioamnionitis in perinatal factors except for GA, pregnancy induced hypertension, and exposure to antenatal magnesium sulphate. After controlling for confounders, histologic chorioamnionitis was not associated with prolonged absolute wave latencies I, III, and V and/or decreased frequency of mature auditory waveform compared to infants without histologic chorioamnionitis. CONCLUSION Histologic chorioamnionitis is not associated with neurologic impairment at birth in premature infants.
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Affiliation(s)
- Sanjiv B Amin
- Division of Neonatology, Department of Pediatrics, The University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA.
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29
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Trichomoniasis in pregnancy and mental retardation in children. Ann Epidemiol 2010; 19:891-9. [PMID: 19944351 DOI: 10.1016/j.annepidem.2009.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/23/2009] [Accepted: 08/12/2009] [Indexed: 11/23/2022]
Abstract
PURPOSE Trichomoniasis is a highly prevalent sexually transmitted infection and is associated with premature rupture of membranes, preterm birth, and low birth weight. This study examines the association between maternal trichomoniasis and intellectual disability (ID) in children. METHODS This study utilized linked maternal, infant, and child records for 134,596 Medicaid-insured singleton births in South Carolina from 1996 through 2002. Data were obtained from Medicaid billing records, birth certificates, and administrative data from the South Carolina Department of Education (DOE) and the Department of Disabilities and Special Needs (DDSN). Pregnancies during which women were diagnosed with urinary tract infection, chlamydia, gonorrhea, or vulvovaginal candidiasis were excluded, as were children diagnosed with a known cause of mental retardation. Odds of diagnosed ID in children were modeled using population averaged generalized estimating equation models. RESULTS Controlling for potential confounders, women with trichomoniasis were significantly more likely to have a child with ID (hazard ratio [HR] = 1.28; 95% confidence interval [CI], 1.12-1.46). The association was stronger for moderate to severe ID documented by the school system or DDSN (HR = 1.84; 95% CI, 1.35-2.51). Second-trimester trichomoniasis was associated with more than a three-fold increase in the odds a child was identified as trainable mentally handicapped or profoundly mentally handicapped in the public school system, or was receiving ID services from DDSN. There was not a significant difference in the risk of ID in children of women with treated versus untreated trichomoniasis. CONCLUSION Maternal trichomoniasis may be a preventable risk factor for ID.
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Igarashi K, Akira S, Imaki J, Takeshita T. Systemic endotoxin induces gene expression of inducible nitric oxide synthase in fetal rat brain. J NIPPON MED SCH 2009; 76:232-9. [PMID: 19915306 DOI: 10.1272/jnms.76.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies have examined the response of the fetus under stress, such as with maternal infection. Recent work has indicated that nitric oxide (NO) modulates corticotropin-releasing hormone (CRH) secretion by the hypothalamus, but details of the action of NO on the fetus remain unclear. Therefore, we investigated the expression of inducible nitric oxide synthase (iNOS) mRNA and the response pattern following lipopolysaccharide (LPS) loading using a rat model of fetal infection. METHODS Fetuses were delivered by cesarean section on day 20 of gestation and immediately placed in a chamber maintained at 37 degrees C and 100% relative humidity. The LPS group (n=12) was given 400 microg of LPS/100 g body weight, and the physiologic saline group (n=12) was given physiologic saline. Fetuses were then incubated for a further 3 hours. Fetuses were decapitated, the trunk blood was collected immediately after cesarean section or after 3 hours of incubation, and the fetal brains were fixed in formaldehyde and cryopreserved. Coronal cryosections of the brains were prepared, and a (35)S-uridine triphosphate-labeled antisense RNA probe for iNOS was then prepared. In situ hybridization was performed, and iNOS expression was evaluated semiquantitatively on the basis of optical density. In both groups, plasma corticosterone levels were determined with radioimmunoassay. RESULTS Expression of iNOS mRNA was not noted in the physiologic saline group (3 hours postpartum). In the LPS group, iNOS mRNA expression was observed in the subfornical organ, but not in the paraventricular nucleus. Plasma corticosterone levels were significantly elevated in the LPS group. CONCLUSIONS In 20-day-old rat fetuses, the hypothalamic-pituitary-adrenal axis was already mobilized in response to LPS-induced stress. These results suggest that iNOS is not involved in the acute response of the hypothalamic-pituitary-adrenal axis to LPS challenge in 20-day-old rat fetuses.
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Affiliation(s)
- Kenji Igarashi
- Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries. Pediatr Neonatol 2009; 50:217-21. [PMID: 19856865 DOI: 10.1016/s1875-9572(09)60066-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Histologic chorioamnionitis (HCA) is associated with preterm delivery and with neonatal morbidity and mortality. Because HCA is usually subclinical, histologic examination of the placenta is essential for confirmatory diagnosis. In the present study, the correlations between subclinical HCA and relevant clinical and laboratory parameters were analyzed. METHODS This was a retrospective study. We reviewed the placental histopathologic findings and the charts of patients who were admitted to our neonatal intensive care unit after delivery and their mothers between January 2007 and March 2008. A total of 77 preterm infants [gastational age (GA): 32.2 3.4 weeks, birth weight (BW): 1718 +/- 554 g] were categorized as group A with histologic evidence of placental inflammation (n=27) or group B without histologic evidence of placental inflammation (n=50). Placental histology was studied to identify the presence of inflammatory states such as chorioamnionitis, funisitis and deciduitis. Laboratory parameters including complete blood count, differential count, and C-reactive protein (CRP) level of mothers and initial arterial blood gas, glucose Level and mean blood pressure of the infants were documented. Gestational age, Apgar score, history of prolonged premature rupture of membrane (prolonged PROM), gestational diabetes mellitus, meconium-stained amniotic fluid, pregnancy-induced hypertension and signs of pre-eclampsia were also collected as clinical parameters. All data were analyzed using independent t tests and Fisher's exact test, as appropriate. RESULTS Group A newborns had a significantly lower gestational age (30.8 +/- 4.1 weeks vs. 33.0 +/- 2.6 weeks, p < 0.05) and higher CRP level (0.56 +/- 0.92 mg/dL vs. 0.12 +/- 0.14 mg/dL, p < 0.05), together with higher maternal WBC count (13,002 +/- 4344/microL vs. 10,850 +/- 3722/microL, p < 0.05) and higher rate of prolonged PROM [14/27 (51.85%) vs. 8/37 (21.62%), p < 0.05] compared with group B newborns. CONCLUSION We found that HCA was significantly correlated with lower gestational age, higher CRP level of preterm infants, higher maternal WBC count, and a higher rate of prolonged PROM. Our results demonstrate a significant association between HCA with an elevated CRP level in preterm infants. These findings further confirmed the association between maternal inflammation and preterm deliveries.
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Freeman RK. Medical and legal implications for necessary requirements to diagnose damaging hypoxic-ischemic encephalopathy leading to later cerebral palsy. Am J Obstet Gynecol 2008; 199:585-6. [PMID: 19084095 DOI: 10.1016/j.ajog.2008.06.096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 06/30/2008] [Indexed: 11/18/2022]
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Bianco-Batlles MD, Sosunov A, Polin RA, Ten VS. Systemic inflammation following hind-limb ischemia-reperfusion affects brain in neonatal mice. Dev Neurosci 2008; 30:367-73. [PMID: 18854644 DOI: 10.1159/000164686] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/18/2008] [Indexed: 11/19/2022] Open
Abstract
Antenatal and postnatal infection and inflammation are associated with neurological injury in neonates. However, no direct role for systemic inflammation in mediating neurodamage has been shown. The study was aimed to determine whether systemic inflammation following ischemia-reperfusion (IR) of an organ remotely located from the brain results in cerebral injury. Neonatal mice were subjected to 2 h of hind-limb IR. At 48 h of reperfusion, brains were examined for activation of microglia and caspase-3. Lungs were assessed for pulmonary edema and granulocyte infiltration. The levels of circulating inflammatory mediators were measured at 24 h of reperfusion. In a separate cohort of mice, changes in the cerebral and hind-limb blood flow were measured. All data were compared to that in sham mice. Compared to shams the degree of pulmonary edema in IR mice was 33% (p = 0.04) greater. This was associated with significantly (p = 0.0006) greater granulocytic infiltration and a markedly increased level of circulating cytokines. The brains of these same mice exhibited significantly (p = 0.02) greater numbers of caspase-3-immunopositive cells and activation of microglia compared to sham mice. These data indicate that systemic inflammation following IR in the organ remote from the brain can induce neuroinflammation and cerebral proapoptotic changes.
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Wang X, Hagberg H, Nie C, Zhu C, Ikeda T, Mallard C. Dual Role of Intrauterine Immune Challenge on Neonatal and Adult Brain Vulnerability to Hypoxia-Ischemia. J Neuropathol Exp Neurol 2007; 66:552-61. [PMID: 17549015 DOI: 10.1097/01.jnen.0000263870.91811.6f] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Epidemiologic evidence has underlined the impact of prenatal inflammation on the development of postnatal hypoxia-ischemia (HI) brain injury. To study to what extent prenatal inflammation affects CNS vulnerability later during development, C57BL/6 mice were subjected to intrauterine injection of lipopolysaccharide (LPS) at gestational day 15. At postnatal day (PND) 5, 9, and 70, the offspring were subjected to HI. It was found that, in neonatal mice, LPS-exposed brains showed markedly enhanced brain injury after HI, whereas in adult mice, LPS exposure resulted in a significant reduction in tissue loss after HI. Reduced myelin in subcortical white matter was noticed after HI in the LPS-exposed brains at PND14 and PND75. Increased activities of nuclear factor-kappaB and caspase-3 were obtained in fetal/neonatal brain after LPS administration. Conclusions were that 1) a prenatal low dose of LPS sensitized to HI-induced brain injury in neonates but confers protection in adulthood, 2) reduced myelination is seen after prenatal LPS exposure and HI in both neonatal and adult mice despite the fact that LPS reduced total tissue loss in adult mice; and 3) nuclear factor-kappaB and caspase-3 activation early after LPS exposure may play a role in the sensitization/protection (preconditioning) effects.
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Affiliation(s)
- Xiaoyang Wang
- Departments of Physiology, Clinical Neurosciences, Perinatal Center, Sahlgrenska Academy, Göteborg, Sweden
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