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Xie Q, Liao YH, He WJ, Han PP, Wu J. Evaluation of Neonatal Cerebral Circulation Under Hypoxic Ischemic Risk Factors Based on Quantitative Analysis of Cerebral Veins with Magnetic Resonance Susceptibility Weighted Imaging. Clin Neuroradiol 2024:10.1007/s00062-024-01432-0. [PMID: 38922421 DOI: 10.1007/s00062-024-01432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To observe the regulation of cerebral circulation in vivo based on image segmentation algorithms for deep learning in medical imaging to automatically detect and quantify the neonatal deep medullary veins (DMVs) on susceptibility weighted imaging (SWI) images. To evaluate early cerebral circulation self-rescue for neonates undergoing risk of cerebral hypoxia-ischaemia in vivo. METHODS SWI images and clinical data of 317 neonates with or without risk of cerebral hypoxia-ischaemia were analyzed. Quantitative parameters showing the number, width, and curvature of DMVs were obtained using an image segmentation algorithm. RESULTS The number of DMVs was greater in males than in females (p < 0.01), and in term than in preterm infants (p = 0.001). The width of DMVs was greater in term than in preterm infants (p < 0.01), in low-risk than in high-risk group (p < 0.01), and in neonates without intracranial extracerebral haemorrhage (ICECH) than with ICECH (p < 0.05). The curvature of DMVs was greater in term than in preterm infants (P < 0.05). The width of both bilateral thalamic veins and anterior caudate nucleus veins were positively correlated with the number of DMVs; the width of bilateral thalamic veins was positively correlated with the width of DMVs. CONCLUSION The DMVs quantification based on image segmentation algorithm may provide more detailed and stable quantitative information in neonate. SWI vein quantification may be an observable indicator for in vivo assessment of cerebral circulation self-regulation in neonatal hypoxic-ischemic brain injury.
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Affiliation(s)
- Qi Xie
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China.
| | - Yan-Hui Liao
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
- Department of Nuclear Medicine, Meizhou, People's Hospital, 514031, Meizhou, China
| | - Wen-Juan He
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
| | - Peng-Peng Han
- Institute of Software Application Technology, 511458, Guangzhou, China
| | - Jun Wu
- Institute of Software Application Technology, 511458, Guangzhou, China
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Hall BJ, Ali AMS, Hennigan D, Pettorini B. Hydrocephalus in prematurity: does valve choice make a difference? Childs Nerv Syst 2024; 40:1091-1098. [PMID: 37934253 DOI: 10.1007/s00381-023-06204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Extremely premature neonates diagnosed with post-haemorrhagic hydrocephalus (PHH) are recognised to have particularly poor outcomes. This study assessed the impact of a number of variables on outcomes in this cohort, in particular the choice of shunt valve mechanism. METHODS Electronic case notes were retrospectively reviewed of all premature neonates admitted to our centre for management of hydrocephalus between 2012 and 2021. Data included (i) gestational age, (ii) birth weight, (iii) hydrocephalus aetiology, (iv) surgical intervention, (v) shunt system, (vi) 'surgical burden' and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis performed in SPSS v27.0 RESULTS: N = 53 premature hydrocephalic patients were identified (n = 28 (52.8%) female). Median gestational age at birth was 27 weeks (range: 23-36 + 6 weeks), with n = 35 extremely preterm patients and median birth weight of 1.9 kg (range: 0.8-3.6 kg). Total n = 99 programmable valves were implanted (n = 28 (28.3%) de novo, n = 71 (71.2%) revisions); n = 28 (28.3%) underwent n ≥ 1 pressure alterations, after which n = 21 (75%) patients had symptoms improve. In n = 8 patients exchanged from fixed to programmable valves, a mean reduction of 1.9 revisions per patient after exchange was observed (95%CI: 0.36-3.39, p = 0.02). Mean overall shunt survival was 39.5 weeks (95%CI: 30.6-48.5); 33.2 weeks (95%CI: 25.2-41.1) in programmable valves and 35.1 weeks (95%CI: 19.5-50.6) in fixed pressure (p = 0.22) with 12-month survival rates of 25.7% and 24.7%, respectively (p = 0.22). Shorter de novo shunt survival was associated with higher operation count overall (Pearson's R: - 0.54, 95%CI: - 0.72 to - 0.29, p < 0.01). Wound failure, gestational age and birth weight were significantly associated with shorter de novo shunt survival in a Cox regression proportional hazards model; gestational age had the greatest impact on shunt survival (Exp(B): 0.71, 95%CI: 0.63-0.81, p < 0.01). CONCLUSION Hydrocephalus is especially challenging in extreme prematurity, with a shorter de novo shunt survival associated with higher number of future revisions. Programmable valves provide flexibility with regard to pressure setting, with the potential for fewer shunt revisions in this complex cohort.
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Affiliation(s)
- Benjamin J Hall
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
- Institute of Infection, Veterinary and Ecological Sciences (IVES), The University of Liverpool, Liverpool, UK.
| | - Ahmad M S Ali
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
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Wolfsberger CH, Avian A, Schwaberger B, Pichler G, Wolf M, Urlesberger B. Precision and normal values of cerebral blood volume in preterm neonates using time-resolved near-infrared spectroscopy. Acta Paediatr 2024; 113:677-683. [PMID: 37970733 DOI: 10.1111/apa.17040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
AIM To investigate cerebral blood volume (CBV) in preterm neonates using time-resolved near-infrared spectroscopy. METHODS In this prospective observational study, time-resolved near-infrared spectroscopy measurements of CBV using tNIRS-1 were performed in 70 preterm neonates. For measurements, a sensor was placed for a duration of 1 min, followed by four further reapplications of the sensor, overall five measurements. RESULTS In this study, 70 preterm neonates with a mean ± SD gestational age of 33.4 ± 1.7 weeks and a birthweight of 1931 ± 398 g were included with a postnatal age of 4.7 ± 2.0 days. Altogether, 2383 CBV values were obtained with an overall mean of 1.85 ± 0.30 mL/100 g brain. A total of 95% of the measured CBV values varied in a range from -0.31 to 0.33 from the overall individual mean. Taking the deviation of the mean of each single application for each patient, this range reduced from -0.07 to 0.07. The precision of the measurement defined as within-variation in CBV was 0.24 mL/100 g brain. CONCLUSION The overall mean CBV in stable preterm neonates was 1.85 ± 0.30 mL/100 g brain. The within-variation in CBV was 0.24 mL/100 g brain. Based on the precision obtained by our data, CBV of 1.85 ± 0.30 mL/100 g brain may be assumed as normal value for this cohort.
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Affiliation(s)
- Christina Helene Wolfsberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Macro- and Microcirculation, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Macro- and Microcirculation, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Macro- and Microcirculation, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Macro- and Microcirculation, Medical University of Graz, Graz, Austria
- Research Unit for Cerebral Development and Oximetry Research, Medical University of Graz, Graz, Austria
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Passera S, De Carli A, Fumagalli M, Contini D, Pesenti N, Amendola C, Giovannella M, Durduran T, Weigel UM, Spinelli L, Torricelli A, Greisen G. Cerebrovascular reactivity to carbon dioxide tension in newborns: data from combined time-resolved near-infrared spectroscopy and diffuse correlation spectroscopy. NEUROPHOTONICS 2023; 10:045003. [PMID: 37841558 PMCID: PMC10576436 DOI: 10.1117/1.nph.10.4.045003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/17/2023]
Abstract
Significance Critically ill newborns are at risk of brain damage from cerebrovascular disturbances. A cerebral hemodynamic monitoring system would have the potential role to guide targeted intervention. Aim To obtain, in a population of newborn infants, simultaneous near-infrared spectroscopy (NIRS)-based estimates of cerebral tissue oxygen saturation (StO 2 ) and blood flow during variations of carbon dioxide tension (pCO 2 ) levels within physiologic values up to moderate permissive hypercapnia, and to examine if the derived estimate of metabolic rate of oxygen would stay constant, during the same variations. Approach We enrolled clinically stable mechanically ventilated newborns at postnatal age > 24 h without brain abnormalities at ultrasound. StO 2 and blood flow index were measured using a non-invasive device (BabyLux), which combine time-resolved NIRS and diffuse-correlation spectroscopy. The effect of changes in transcutaneous pCO 2 on StO 2 , cerebral blood flow (CBF), and cerebral metabolic rate of oxygen index (tCMRO 2 i ) were estimated. Results Ten babies were enrolled and three were excluded. Median GA at enrollment was 39 weeks and median weight 2720 g. StO 2 increased 0.58% (95% CI 0.55; 0.61, p < 0.001 ), CBF 2% (1.9; 2.3, p < 0.001 ), and tCMRO 2 0.3% (0.05; 0.46, p = 0.017 ) per mmHg increase in pCO 2 . Conclusions BabyLux device detected pCO 2 -induced changes in cerebral StO 2 and CBF, as expected. The small statistically significant positive relationship between pCO 2 and tCMRO 2 i variation is not considered clinically relevant and we are inclined to consider it as an artifact.
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Affiliation(s)
- Sofia Passera
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Agnese De Carli
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Monica Fumagalli
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Davide Contini
- Politecnico di Milano, Dipartimento di Fisica, Milan, Italy
| | - Nicola Pesenti
- University of Milano-Bicocca, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, Milan, Italy
| | | | - Martina Giovannella
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Casteldefells, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Casteldefells, Spain
- ICREA – Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | | | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Alessandro Torricelli
- Politecnico di Milano, Dipartimento di Fisica, Milan, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Gorm Greisen
- Rigshospitalet and University of Copenhagen, Department of Neonatology, Copenhagen, Denmark
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Viaene AN, Nelson EJ, Santi M. Perinatal hypoxic-ischemic brain injury: What's behind the "ribbon effect"? J Neuropathol Exp Neurol 2023; 82:865-875. [PMID: 37595577 DOI: 10.1093/jnen/nlad067] [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: 08/20/2023] Open
Abstract
Ribbon effect describes a perceived macroscopic color reversal of the gray and white matter, characterized by a pale cortex and diffusely dusky underlying white matter. This finding is thought to be unique to the perinatal period and indicative of hypoxic-ischemic injury. However, the clinical and microscopic correlates of this macroscopic finding have not been clearly defined. A 21-year retrospective study of autopsies was performed. Ribbon effect was seen in 190 subjects, ages 20 weeks gestation to 9.5 months adjusted age. Clinical associations and radiographic findings were similar in ribbon effect cases and controls. A variety of histologic findings were observed including acute neuronal injury, diffuse white matter gliosis, and white matter necrosis. Only white matter vascular congestion was significantly correlated to the macroscopic severity of ribbon effect; the severity of white matter injury and acute neuronal injury were not significantly correlated to ribbon effect. While hypoxic-ischemic changes were present in nearly all cases of ribbon effect, the location, severity, and chronicity of these changes varied considerably, and similar findings were observed in controls. The presence of ribbon effect therefore does not predict microscopic findings apart from vascular congestion, highlighting the importance of microscopic examination in perinatal brain autopsies.
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Affiliation(s)
- Angela N Viaene
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ernest J Nelson
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Paez-Gonzalez P, Lopez-de-San-Sebastian J, Ceron-Funez R, Jimenez AJ, Rodríguez-Perez LM. Therapeutic strategies to recover ependymal barrier after inflammatory damage: relevance for recovering neurogenesis during development. Front Neurosci 2023; 17:1204197. [PMID: 37397456 PMCID: PMC10308384 DOI: 10.3389/fnins.2023.1204197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
The epithelium covering the surfaces of the cerebral ventricular system is known as the ependyma, and is essential for maintaining the physical and functional integrity of the central nervous system. Additionally, the ependyma plays an essential role in neurogenesis, neuroinflammatory modulation and neurodegenerative diseases. Ependyma barrier is severely affected by perinatal hemorrhages and infections that cross the blood brain barrier. The recovery and regeneration of ependyma after damage are key to stabilizing neuroinflammatory and neurodegenerative processes that are critical during early postnatal ages. Unfortunately, there are no effective therapies to regenerate this tissue in human patients. Here, the roles of the ependymal barrier in the context of neurogenesis and homeostasis are reviewed, and future research lines for development of actual therapeutic strategies are discussed.
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Affiliation(s)
- Patricia Paez-Gonzalez
- Department of Cell Biology, Genetics and Physiology, University of Malaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
| | | | - Raquel Ceron-Funez
- Department of Cell Biology, Genetics and Physiology, University of Malaga, Málaga, Spain
| | - Antonio J. Jimenez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
| | - Luis Manuel Rodríguez-Perez
- Department of Cell Biology, Genetics and Physiology, University of Malaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- Department of Human Physiology, Human Histology, Pathological Anatomy and Sports, University of Malaga, Málaga, Spain
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7
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Brossard-Racine M, Rampakakis E, Tardif CL, Gilbert G, White A, Luu TM, Gallagher A, Pinchefsky E, Montreuil T, Simard MN, Wintermark P. Long-term consequences of neonatal encephalopathy in the hypothermia era: protocol for a follow-up cohort study at 9 years of age. BMJ Open 2023; 13:e073063. [PMID: 37055215 PMCID: PMC10106079 DOI: 10.1136/bmjopen-2023-073063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Therapeutic hypothermia (TH) became the standard of care treatment for neonates with moderate and severe neonatal encephalopathy (NE) in most industrialized countries about 10 years ago. Although TH is effective in reducing mortality and the incidence of severe developmental disabilities, the recent literature converges in reporting frequent cognitive and behavioural difficulties at school entry in children with NE-TH. Although these challenges are deemed minor compared with cerebral palsy and intellectual disability, their impacts on a child's self-determination and family's well-being are quite significant. Therefore, the nature and extent of these difficulties need to be comprehensively described so that appropriate care can be offered. METHODS AND ANALYSIS The current study will be the largest follow-up study of neonates with NE treated with TH to characterize their developmental outcomes and associated brain structural profiles at 9 years of age. Specifically, we will compare executive function, attention, social cognition, behaviour, anxiety, self-esteem, peer problems, brain volume, cortical features, white matter microstructure and myelination between children with NE-TH and matched peers without NE. Associations of perinatal risk factors and structural brain integrity with cognitive, behavioural and psycho-emotional deficits will be evaluated to inform about the potential aggravating and protective factors associated with function. ETHICS AND DISSEMINATION This study is supported by the Canadian Institute of Health Research (202203PJT-480065-CHI-CFAC-168509), and received approval from the Pediatric Ethical Review Board of the McGill University Health Center (MP-37-2023-9320). The study findings will be disseminated in scientific journals and conferences and presented to parental associations and healthcare providers to inform best practices. TRIAL REGISTRATION NUMBER NCT05756296.
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Affiliation(s)
- Marie Brossard-Racine
- Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Angela White
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Anne Gallagher
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Elana Pinchefsky
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Tina Montreuil
- Department of Psychiatry, McGill University Montreal, Montreal, Quebec, Canada
- Department of Educational and Counselling Psychology, McGill University Montreal, Montreal, Quebec, Canada
| | - Marie-Noelle Simard
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Pia Wintermark
- Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Tung S, Delavogia E, Fernandez-Gonzalez A, Mitsialis SA, Kourembanas S. Harnessing the therapeutic potential of the stem cell secretome in neonatal diseases. Semin Perinatol 2023; 47:151730. [PMID: 36990921 PMCID: PMC10133192 DOI: 10.1016/j.semperi.2023.151730] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Preterm birth and intrapartum related complications account for a substantial amount of mortality and morbidity in the neonatal period despite significant advancements in neonatal-perinatal care. Currently, there is a noticeable lack of curative or preventative therapies available for any of the most common complications of prematurity including bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia and retinopathy of prematurity or hypoxic-ischemic encephalopathy, the main cause of perinatal brain injury in term infants. Mesenchymal stem/stromal cell-derived therapy has been an active area of investigation for the past decade and has demonstrated encouraging results in multiple experimental models of neonatal disease. It is now widely acknowledged that mesenchymal stem/stromal cells exert their therapeutic effects via their secretome, with the principal vector identified as extracellular vesicles. This review will focus on summarizing the current literature and investigations on mesenchymal stem/stromal cell-derived extracellular vesicles as a treatment for neonatal diseases and examine the considerations to their application in the clinical setting.
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Affiliation(s)
- Stephanie Tung
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Eleni Delavogia
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States; Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Angeles Fernandez-Gonzalez
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - S Alex Mitsialis
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Stella Kourembanas
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States.
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9
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Karimy JK, Newville JC, Sadegh C, Morris JA, Monuki ES, Limbrick DD, McAllister Ii JP, Koschnitzky JE, Lehtinen MK, Jantzie LL. Outcomes of the 2019 hydrocephalus association workshop, "Driving common pathways: extending insights from posthemorrhagic hydrocephalus". Fluids Barriers CNS 2023; 20:4. [PMID: 36639792 PMCID: PMC9838022 DOI: 10.1186/s12987-023-00406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
The Hydrocephalus Association (HA) workshop, Driving Common Pathways: Extending Insights from Posthemorrhagic Hydrocephalus, was held on November 4 and 5, 2019 at Washington University in St. Louis. The workshop brought together a diverse group of basic, translational, and clinical scientists conducting research on multiple hydrocephalus etiologies with select outside researchers. The main goals of the workshop were to explore areas of potential overlap between hydrocephalus etiologies and identify drug targets that could positively impact various forms of hydrocephalus. This report details the major themes of the workshop and the research presented on three cell types that are targets for new hydrocephalus interventions: choroid plexus epithelial cells, ventricular ependymal cells, and immune cells (macrophages and microglia).
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Affiliation(s)
- Jason K Karimy
- Department of Family Medicine, Mountain Area Health Education Center - Boone, North Carolina, 28607, USA
| | - Jessie C Newville
- Department of Pediatrics and Neurosurgery, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Cameron Sadegh
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, MA, Boston, 02114, USA
- Department of Pathology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Jill A Morris
- National Institute of Neurological Disorders and Stroke, Neuroscience Center, National Institutes of Health, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD, 20892, USA
| | - Edwin S Monuki
- Departments of Pathology & Laboratory Medicine and Developmental & Cell Biology, University of California Irvine, Irvine, CA, 92697, USA
| | - David D Limbrick
- Departments of Neurosurgery and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - James P McAllister Ii
- Departments of Neurosurgery and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | | | - Maria K Lehtinen
- Department of Pathology, Boston Children's Hospital, Boston, MA, 02115, USA.
| | - Lauren L Jantzie
- Department of Pediatrics and Neurosurgery, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
- Kennedy Krieger Institute, Baltimore, MD, 21287, USA.
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10
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Pharmacological neuroprotection and clinical trials of novel therapies for neonatal peri-intraventricular hemorrhage: a comprehensive review. Acta Neurol Belg 2022; 122:305-314. [PMID: 35182373 DOI: 10.1007/s13760-022-01889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
Abstract
Peri-intraventricular hemorrhage (PIVH) is a serious condition for preterm infants, caused by traumatic or spontaneous rupture of the germinal matrix (GM) capillary network in the cerebral ventricles. It is a common source of morbidity and mortality in neonates, and risk correlates with earlier delivery, low birth weight, maternal-fetal infection, and vital sign derangements, among others. PIVH typically occurs in the first 72 h of life, and symptoms, when present, manifest most commonly within the first week of life. Prevention remains the primary goal in management, predominantly via prolonging of gestation. Current therapy protocols are center-dependent without consistent consensus guidelines, but infant positioning, homeostatic stabilization, and neuroprotection offer potential options. In this update of pharmacologic neuroprotective therapies for PIVH, we highlight commonly utilized therapies and review the investigative literature. Further multi-institutional clinical trials and basic research studies are required.
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Lavric A, Markelj S, Ding J, Mahajan S, Agrawal R, Tekavcic Pompe M. Perinatal risk factors associated with central retinal changes in former preterm children on optical coherence tomography angiography. Acta Ophthalmol 2022; 100:e122-e127. [PMID: 33829666 DOI: 10.1111/aos.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and central retinal structures of former preterm children seen on optical coherence tomography angiography (OCTA). METHODS This prospective cohort study included 40 children with a history of preterm birth and 33 healthy full-term children. We documented their birth weight, gestational age, other significant risk factors for ROP development and presence of ROP. Imaging was performed using swept-source OCTA, and quantitative evaluation was performed. Analytic parameters included the area of foveal avascular zone (FAZ), foveal depth (FD), central subfoveal retinal thickness (CSFT) and capillary density index (CDI) of the deep and superficial capillary plexus. RESULTS Preterm children had significantly smaller FAZ, lower FD and higher CSFT compared to controls (all p < 0.001). Both groups exhibited no differences in total CDI at the superficial (p = 0.969) and deep capillary plexus (p = 0.370). The duration of mechanical ventilation correlated negatively with FAZ and FD but positively with CSFT. The duration of supplemental oxygen treatment correlated negatively with FD. The presence of intraventricular haemorrhage correlated negatively with FAZ and FD but positively with CSFT. Regression analysis found that the duration of mechanical ventilation and the presence of bronchopulmonary dysplasia were associated with lower FD (p = 0.002 and 0.01, respectively) and higher CSFT (p = 0.002 and 0.028, respectively). CONCLUSION Central retinal anomalies were identified in former preterm children using OCTA. Macular changes were associated with several risk factors for ROP development.
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Affiliation(s)
- Alenka Lavric
- Eye Hospital University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Spela Markelj
- Eye Hospital University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Jianbin Ding
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
| | | | - Rupesh Agrawal
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- National healthcare Group Eye Institute Tan Tock Seng Hospital Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
| | - Manca Tekavcic Pompe
- Eye Hospital University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
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12
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Ikeda T, Ito Y, Mikami R, Matsuo K, Kawamura N, Yamoto A, Ito E. Fluctuations in internal cerebral vein and central side veins of preterm infants. Pediatr Int 2021; 63:1319-1326. [PMID: 33544425 DOI: 10.1111/ped.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Studies on the acute management of extremely low birthweight (ELBW) infants reveal a high incidence of intraventricular hemorrhage (IVH) in infants with high-grade internal cerebral vein perfusion waveform fluctuations. In this prospective observational study we investigated the Doppler perfusion waveform fluctuations in the great cerebral vein, straight sinus, and internal cerebral veins of ELBW infants. METHODS We evaluated perfusion waveforms after birth every 12 h until 120 h in 73 ELBW infants (<1,000 g) at our hospital. Fluctuations were categorized into four patterns of increasing magnitude, Grades 0-3. RESULTS The maximum grades of perfusion waveform fluctuations of the internal cerebral veins were 0, 1, 2, and 3 detected in 12, 38, 13, and 10 infants, respectively; those of the great cerebral vein were 0, 1, 2, and 3 detected in 5, 17, 20, and 31 infants, respectively; and those of the straight sinus were 0, 1, 2, and 3 detected in 1, 5, 17, and 50 infants, respectively. Only one of 803 simultaneous measurements of the Doppler perfusion waveforms showed stronger fluctuations of the peripheral vein than those of the central side veins. Intraventricular hemorrhage was associated with high-grade fluctuations in the internal cerebral veins but not in the great cerebral vein or straight sinus. CONCLUSIONS Most infants had high-grade fluctuations in the great cerebral vein and straight sinus, with lower grade fluctuations in the internal cerebral vein, but IVH was not associated with those markers. Intraventricular hemorrhage was correlated with high-grade fluctuations only in the internal cerebral veins.
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Affiliation(s)
- Toshifumi Ikeda
- Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan.,Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuya Ito
- Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Ryosuke Mikami
- Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Koji Matsuo
- Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Naoto Kawamura
- Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akane Yamoto
- Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Etsuro Ito
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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13
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Sorensen DW, Carreon D, Williams JM, Pearce WJ. Hypoxic modulation of fetal vascular MLCK abundance, localization, and function. Am J Physiol Regul Integr Comp Physiol 2021; 320:R1-R18. [PMID: 33112654 PMCID: PMC7847055 DOI: 10.1152/ajpregu.00212.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
Changes in vascular contractility are among the most important physiological effects of acute and chronic fetal hypoxia. Given the essential role of myosin light-chain kinase (MLCK) in smooth muscle contractility and its heterogeneous distribution, this study explores the hypothesis that subcellular changes in MLCK distribution contribute to hypoxic modulation of fetal carotid artery contractility. Relative to common carotid arteries from normoxic term fetal lambs (FN), carotids from fetal lambs gestated at high altitude (3,802 m) (FH) exhibited depressed contractility without changes in MLCK mRNA or protein abundance. Patterns of confocal colocalization of MLCK with α-actin and 20-kDa regulatory myosin light chain (MLC20) enabled calculation of subcellular MLCK fractions: 1) colocalized with the contractile apparatus, 2) colocalized with α-actin distant from the contractile apparatus, and 3) not colocalized with α-actin. Chronic hypoxia did not affect MLCK abundance in the contractile fraction, despite a concurrent decrease in contractility. Organ culture for 72 h under 1% O2 decreased total MLCK abundance in FN and FH carotid arteries, but decreased the contractile MLCK abundance only in FH carotid arteries. Correspondingly, culture under 1% O2 depressed contractility more in FH than FN carotid arteries. In addition, hypoxia appeared to attenuate ubiquitin-independent proteasomal degradation of MLCK, as reported for other proteins. In aggregate, these results demonstrate that the combination of chronic hypoxia followed by hypoxic culture can induce MLCK translocation among at least three subcellular fractions with possible influences on contractility, indicating that changes in MLCK distribution are a significant component of fetal vascular responses to hypoxia.
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Affiliation(s)
- Dane W Sorensen
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Desirelys Carreon
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - James M Williams
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - William J Pearce
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
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14
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Giovannella M, Andresen B, Andersen JB, El-Mahdaoui S, Contini D, Spinelli L, Torricelli A, Greisen G, Durduran T, Weigel UM, Law I. Validation of diffuse correlation spectroscopy against 15O-water PET for regional cerebral blood flow measurement in neonatal piglets. J Cereb Blood Flow Metab 2020; 40:2055-2065. [PMID: 31665953 PMCID: PMC7786848 DOI: 10.1177/0271678x19883751] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/06/2019] [Accepted: 09/19/2019] [Indexed: 11/15/2022]
Abstract
Diffuse correlation spectroscopy (DCS) can non-invasively and continuously asses regional cerebral blood flow (rCBF) at the cot-side by measuring a blood flow index (BFI) in non-traditional units of cm2/s. We have validated DCS against positron emission tomography using 15O-labeled water (15O-water PET) in a piglet model allowing us to derive a conversion formula for BFI to rCBF in conventional units (ml/100g/min). Neonatal piglets were continuously monitored by the BabyLux device integrating DCS and time resolved near infrared spectroscopy (TRS) while acquiring 15O-water PET scans at baseline, after injection of acetazolamide and during induced hypoxic episodes. BFI by DCS was highly correlated with rCBF (R = 0.94, p < 0.001) by PET. A scaling factor of 0.89 (limits of agreement for individual measurement: 0.56, 1.39)×109× (ml/100g/min)/(cm2/s) was used to derive baseline rCBF from baseline BFI measurements of another group of piglets and of healthy newborn infants showing an agreement with expected values. These results pave the way towards non-invasive, cot-side absolute CBF measurements by DCS on neonates.
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Affiliation(s)
- Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Bjørn Andresen
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Julie B Andersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
| | - Sahla El-Mahdaoui
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Davide Contini
- Politecnico di Milano-Dipartimento di Fisica, Milan, Italy
| | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Alessandro Torricelli
- Politecnico di Milano-Dipartimento di Fisica, Milan, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Udo M Weigel
- HemoPhotonics S.L., Castelldefels (Barcelona), Spain
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
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15
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Castel A, Frank YS, Feltner J, Karp FB, Albright CM, Frasch MG. Monitoring Fetal Electroencephalogram Intrapartum: A Systematic Literature Review. Front Pediatr 2020; 8:584. [PMID: 33042922 PMCID: PMC7518218 DOI: 10.3389/fped.2020.00584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Studies about the feasibility of monitoring fetal electroencephalogram (fEEG) during labor began in the early 1940s. By the 1970s, clear diagnostic and prognostic benefits from intrapartum fEEG monitoring were reported, but until today, this monitoring technology has remained a curiosity. Objectives: Our goal was to review the studies reporting the use of fEEG including the insights from interpreting fEEG patterns in response to uterine contractions during labor. We also used the most relevant information gathered from clinical studies to provide recommendations for enrollment in the unique environment of a labor and delivery unit. Data Sources: PubMed. Eligibility Criteria: The search strategy was: ("fetus"[MeSH Terms] OR "fetus"[All Fields] OR "fetal"[All Fields]) AND ("electroencephalography"[MeSH Terms] OR "electroencephalography"[All Fields] OR "eeg"[All Fields]) AND (Clinical Trial[ptyp] AND "humans"[MeSH Terms]). Because the landscape of fEEG research has been international, we included studies in English, French, German, and Russian. Results: From 256 screened studies, 40 studies were ultimately included in the qualitative analysis. We summarize and report features of fEEG which clearly show its potential to act as a direct biomarker of fetal brain health during delivery, ancillary to fetal heart rate monitoring. However, clinical prospective studies are needed to further establish the utility of fEEG monitoring intrapartum. We identified clinical study designs likely to succeed in bringing this intrapartum monitoring modality to the bedside. Limitations: Despite 80 years of studies in clinical cohorts and animal models, the field of research on intrapartum fEEG is still nascent and shows great promise to augment the currently practiced electronic fetal monitoring. Prospero Number: CRD42020147474.
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Affiliation(s)
- Aude Castel
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Montreal, QC, Canada
| | - Yael S Frank
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - John Feltner
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Floyd B Karp
- School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Catherine M Albright
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.,Center on Human Development and Disability, University of Washington, Seattle, WA, United States
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16
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Chen D, Sun J, Li Q, Bai W, Mao J. An Important Finding of White Matter Injury in Late Preterm Infant: Deep Medullary Vein Involvement. Front Pediatr 2020; 8:597567. [PMID: 33392116 PMCID: PMC7773939 DOI: 10.3389/fped.2020.597567] [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: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To investigate high risk factors and magnetic resonance imaging (MRI) features in late preterm infants with severe white matter injury (WMI) associated with abnormal deep medullary veins (DMVs). Materials and Methods: Preterm infants with severe WMI, who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2018, were enrolled in this retrospective study. High risk factors and MRI characteristics of infants with abnormal DMVs were analyzed and compared with those of infants without DMV abnormalities. Results: A total of 2032 late preterm infants were examined by MRI; 71 cases (3.5%) had severe WMI and 15 of these (21.1%) had abnormal DMVs. The incidence of maternal diabetes was higher in infants with abnormal DMVs and neonatal convulsions were more likely (P < 0.05). The incidence of grade IV injury (P < 0.05), white matter periventricular cysts and thalamic injury (P < 0.01), cerebral venous sinus thrombus (P < 0.01) and germinal matrix/intraventricular hemorrhage (P < 0.05) were higher in infants with abnormal DMVs than in infants with normal DMVs. Conclusions: Congestion/thrombosis of DMVs may be an important cause of severe WMI in late preterm infants, especially in periventricular leukomalacia-like WMI. WMI with abnormal DMVs is more likely to lead to thalamic injury.
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Affiliation(s)
- Dan Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuyu Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenjuan Bai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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17
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Klebe D, McBride D, Krafft PR, Flores JJ, Tang J, Zhang JH. Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: Established mechanisms and proposed pathways. J Neurosci Res 2020; 98:105-120. [PMID: 30793349 PMCID: PMC6703985 DOI: 10.1002/jnr.24394] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/05/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023]
Abstract
In addition to being the leading cause of morbidity and mortality in premature infants, germinal matrix hemorrhage (GMH) is also the leading cause of acquired infantile hydrocephalus. The pathophysiology of posthemorrhagic hydrocephalus (PHH) development after GMH is complex and vaguely understood, although evidence suggests fibrosis and gliosis in the periventricular and subarachnoid spaces disrupts normal cerebrospinal fluid (CSF) dynamics. Theories explaining general hydrocephalus etiology have substantially evolved from the original bulk flow theory developed by Dr. Dandy over a century ago. Current clinical and experimental evidence supports a new hydrodynamic theory for hydrocephalus development involving redistribution of vascular pulsations and disruption of Starling forces in the brain microcirculation. In this review, we discuss CSF flow dynamics, history and development of theoretical hydrocephalus pathophysiology, and GMH epidemiology and etiology as it relates to PHH development. We highlight known mechanisms and propose new avenues that will further elucidate GMH pathophysiology, specifically related to hydrocephalus.
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Affiliation(s)
- Damon Klebe
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Devin McBride
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Paul R Krafft
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Jerry J Flores
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Jiping Tang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA 92350
- Department of Anesthesiology and Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92350
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18
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Hoffman SB, Cheng YJ, Magder LS, Shet N, Viscardi RM. Cerebral autoregulation in premature infants during the first 96 hours of life and relationship to adverse outcomes. Arch Dis Child Fetal Neonatal Ed 2019; 104:F473-F479. [PMID: 30385514 DOI: 10.1136/archdischild-2018-315725] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that impaired cerebral autoregulation (ICA) increases the susceptibility of premature infants to adverse outcomes, we determined the relationship of ICA and cerebral reactivity (CR) measured in the first 96 hours of life to the outcome of grade 3 or 4 intraventricular haemorrhage (IVH) and/or death within 1 month. SETTING Single-centre level IV neonatal intensive care unit. PATIENTS Neonates 24-29 weeks' gestation less than 12 hours old with invasive blood pressure monitoring. DESIGN Cerebral saturations and mean arterial blood pressure were recorded every 30 s for 96 hours. For each 10 min epoch, the correlation coefficient (r) was calculated for mean arterial blood pressure versus cerebral saturations. The epoch was considered to have ICA if r>0.5 and CR if r<0. RESULTS Sixty-one subjects were included. During the first 96 hours, ICA occurred 17.6% and CR occurred 41% of recorded time. In those without adverse outcomes, ICA decreased and CR increased by postnatal day (p<0.05). Adjusted for birth weight and gestational age, those with IVH and those who died spent more time with ICA and less time with CR (p<0.05) over the entire recording period. Those with IVH had 1.5-fold increase in time with ICA on day 2 (p=0.021), and decrease in time with CR on day 3 (p=0.036). Compared with survivors, non-survivors spent more time with ICA on days 3 and 4 (p<0.005), and less with CR on day 3 (p=0.032). CONCLUSION ICA and CR vary by postnatal day and these patterns are associated with adverse outcomes.
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Affiliation(s)
- Suma B Hoffman
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yun-Ju Cheng
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Narendra Shet
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Michigan Avenue NW, Washington, DC, USA
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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19
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Valdez Sandoval P, Hernández Rosales P, Quiñones Hernández DG, Chavana Naranjo EA, García Navarro V. Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options. Childs Nerv Syst 2019; 35:917-927. [PMID: 30953157 DOI: 10.1007/s00381-019-04127-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/15/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Intraventricular hemorrhage is the most important adverse neurologic event for preterm and very low weight birth infants in the neonatal period. This pathology can lead to various delays in motor, language, and cognition development. The aim of this article is to give an overview of the knowledge in diagnosis, classification, and treatment options of this pathology. METHOD A systematic review has been made. RESULTS The cranial ultrasound can be used to identify the hemorrhage and grade it according to the modified Papile grading system. There is no standardized protocol of intervention as there are controversial results on which of the temporizing neurosurgical procedures is best and about the appropriate parameters to consider a conversion to ventriculoperitoneal shunt. However, it has been established that the most important prognosis factor is the involvement and damage of the white matter. CONCLUSION More evidence is required to create a standardized protocol that can ensure the best possible outcome for these patients.
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Affiliation(s)
- Paola Valdez Sandoval
- Department of Clinical Sciences, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Avenida General Ramón Corona 2514, Guadalajara, 45138, Mexico
| | - Paola Hernández Rosales
- Department of Clinical Sciences, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Avenida General Ramón Corona 2514, Guadalajara, 45138, Mexico
| | - Deyanira Gabriela Quiñones Hernández
- Department of Clinical Sciences, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Avenida General Ramón Corona 2514, Guadalajara, 45138, Mexico
| | | | - Victor García Navarro
- Department of Clinical Sciences, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Avenida General Ramón Corona 2514, Guadalajara, 45138, Mexico. .,Neurosurgery Department, Nuevo Hospital Civil de Guadalajara, Juan I. Menchaca, Guadalajara, 44340, Mexico.
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20
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Chiarelli AM, Mahmoudzadeh M, Low KA, Maclin EL, Kongolo G, Goudjil S, Fabiani M, Wallois F, Gratton G. Assessment of cerebrovascular development and intraventricular hemorrhages in preterm infants with optical measures of the brain arterial pulse wave. J Cereb Blood Flow Metab 2019; 39:466-480. [PMID: 28949275 PMCID: PMC6421243 DOI: 10.1177/0271678x17732694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 12/25/2022]
Abstract
Preterm infants (born at 24-34 weeks of gestational age) suffer from a high incidence of neurological complications. Cerebrovascular lesions (intraventricular hemorrhages, IVH, and ischemic injury) due to the immaturity of the vascular system and its inability to adapt to the extra-uterine environment are the major causes of adverse neurological outcomes. We investigated the feasibility of assessing cerebrovascular status in preterm infants using a novel non-invasive optical procedure, pulse-DOT, usable within the incubator. Pulse-DOT, validated in adults, provides estimates of cerebral arterial status based on optical measurements of the pulse wave. These measurements are taken with a high-density optode montage and provide accurate spatial and temporal information. We found that two pulse parameters (pulse relaxation function, PReFx, and pulse rise time, PRT) in the investigated frontotemporal region, correlated with infant's age at recording, indexing cerebrovascular development. Moreover, PRT differentiated infants with and without concurrent IVH (sensitivity = 100%, specificity = 70%). These values are at least as high as those of the resistivity index obtained with transcranial Doppler of the middle cerebral artery, the current clinical method of choice for investigating arterial elasticity in preterm infants. This makes pulse-DOT a promising tool for investigating cerebrovascular risk factors and related pathologies in preterm infants.
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Affiliation(s)
- Antonio M Chiarelli
- Beckman Institute, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Mahdi Mahmoudzadeh
- Institut National de la Santé et de la Recherche Médicale (INSERM), GRAMFC, Université de Picardie Jules Verne, Amiens, France
- Service de Réanimation Néonatale, CHU Amiens, Amiens, France
| | - Kathy A Low
- Beckman Institute, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Edward L Maclin
- Beckman Institute, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Guy Kongolo
- Institut National de la Santé et de la Recherche Médicale (INSERM), GRAMFC, Université de Picardie Jules Verne, Amiens, France
- Service de Réanimation Néonatale, CHU Amiens, Amiens, France
| | - Sabrina Goudjil
- Institut National de la Santé et de la Recherche Médicale (INSERM), GRAMFC, Université de Picardie Jules Verne, Amiens, France
- Service de Réanimation Néonatale, CHU Amiens, Amiens, France
| | - Monica Fabiani
- Beckman Institute, University of Illinois at Urbana Champaign, Urbana, IL, USA
- Psychology Department, University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Fabrice Wallois
- Institut National de la Santé et de la Recherche Médicale (INSERM), GRAMFC, Université de Picardie Jules Verne, Amiens, France
- Service d’Explorations Fonctionnelles du Système Nerveux Pédiatrique, CHU Amiens, Amiens, France
| | - Gabriele Gratton
- Beckman Institute, University of Illinois at Urbana Champaign, Urbana, IL, USA
- Psychology Department, University of Illinois at Urbana Champaign, Champaign, IL, USA
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21
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Vasung L, Abaci Turk E, Ferradal SL, Sutin J, Stout JN, Ahtam B, Lin PY, Grant PE. Exploring early human brain development with structural and physiological neuroimaging. Neuroimage 2019; 187:226-254. [PMID: 30041061 PMCID: PMC6537870 DOI: 10.1016/j.neuroimage.2018.07.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Early brain development, from the embryonic period to infancy, is characterized by rapid structural and functional changes. These changes can be studied using structural and physiological neuroimaging methods. In order to optimally acquire and accurately interpret this data, concepts from adult neuroimaging cannot be directly transferred. Instead, one must have a basic understanding of fetal and neonatal structural and physiological brain development, and the important modulators of this process. Here, we first review the major developmental milestones of transient cerebral structures and structural connectivity (axonal connectivity) followed by a summary of the contributions from ex vivo and in vivo MRI. Next, we discuss the basic biology of neuronal circuitry development (synaptic connectivity, i.e. ensemble of direct chemical and electrical connections between neurons), physiology of neurovascular coupling, baseline metabolic needs of the fetus and the infant, and functional connectivity (defined as statistical dependence of low-frequency spontaneous fluctuations seen with functional magnetic resonance imaging (fMRI)). The complementary roles of magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) are discussed. We include a section on modulators of brain development where we focus on the placenta and emerging placental MRI approaches. In each section we discuss key technical limitations of the imaging modalities and some of the limitations arising due to the biology of the system. Although neuroimaging approaches have contributed significantly to our understanding of early brain development, there is much yet to be done and a dire need for technical innovations and scientific discoveries to realize the future potential of early fetal and infant interventions to avert long term disease.
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Affiliation(s)
- Lana Vasung
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Silvina L Ferradal
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jason Sutin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jeffrey N Stout
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Pei-Yi Lin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Morrison JL, Berry MJ, Botting KJ, Darby JRT, Frasch MG, Gatford KL, Giussani DA, Gray CL, Harding R, Herrera EA, Kemp MW, Lock MC, McMillen IC, Moss TJ, Musk GC, Oliver MH, Regnault TRH, Roberts CT, Soo JY, Tellam RL. Improving pregnancy outcomes in humans through studies in sheep. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1123-R1153. [PMID: 30325659 DOI: 10.1152/ajpregu.00391.2017] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Experimental studies that are relevant to human pregnancy rely on the selection of appropriate animal models as an important element in experimental design. Consideration of the strengths and weaknesses of any animal model of human disease is fundamental to effective and meaningful translation of preclinical research. Studies in sheep have made significant contributions to our understanding of the normal and abnormal development of the fetus. As a model of human pregnancy, studies in sheep have enabled scientists and clinicians to answer questions about the etiology and treatment of poor maternal, placental, and fetal health and to provide an evidence base for translation of interventions to the clinic. The aim of this review is to highlight the advances in perinatal human medicine that have been achieved following translation of research using the pregnant sheep and fetus.
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Affiliation(s)
- Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Mary J Berry
- Department of Paediatrics and Child Health, University of Otago , Wellington , New Zealand
| | - Kimberley J Botting
- Department of Physiology, Development, and Neuroscience, University of Cambridge , Cambridge , United Kingdom
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington , Seattle, Washington
| | - Kathryn L Gatford
- Robinson Research Institute and Adelaide Medical School, University of Adelaide , Adelaide, South Australia , Australia
| | - Dino A Giussani
- Department of Physiology, Development, and Neuroscience, University of Cambridge , Cambridge , United Kingdom
| | - Clint L Gray
- Department of Paediatrics and Child Health, University of Otago , Wellington , New Zealand
| | - Richard Harding
- Department of Anatomy and Developmental Biology, Monash University , Clayton, Victoria , Australia
| | - Emilio A Herrera
- Pathophysiology Program, Biomedical Sciences Institute (ICBM), Faculty of Medicine, University of Chile , Santiago , Chile
| | - Matthew W Kemp
- Division of Obstetrics and Gynecology, University of Western Australia , Perth, Western Australia , Australia
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - I Caroline McMillen
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Timothy J Moss
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University , Clayton, Victoria , Australia
| | - Gabrielle C Musk
- Animal Care Services, University of Western Australia , Perth, Western Australia , Australia
| | - Mark H Oliver
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Timothy R H Regnault
- Department of Obstetrics and Gynecology and Department of Physiology and Pharmacology, Western University, and Children's Health Research Institute , London, Ontario , Canada
| | - Claire T Roberts
- Robinson Research Institute and Adelaide Medical School, University of Adelaide , Adelaide, South Australia , Australia
| | - Jia Yin Soo
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ross L Tellam
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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23
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Boskabadi H, Zakerihamidi M, Faramarzi R. The vitamin D level in umbilical cord blood in premature infants with or without intra-ventricular hemorrhage: A cross-sectional study. Int J Reprod Biomed 2018. [DOI: 10.29252/ijrm.16.7.429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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24
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Utility of prenatal Doppler ultrasound to predict neonatal impaired cerebral autoregulation. J Perinatol 2018; 38:474-481. [PMID: 29410542 DOI: 10.1038/s41372-018-0050-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/06/2017] [Accepted: 01/02/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Determine if abnormal prenatal Doppler ultrasound indices are predictive of postnatal impaired cerebral autoregulation. STUDY DESIGN Prospective cohort study of 46 subjects, 240-296 weeks' gestation. Utilizing near-infrared spectroscopy and receiver-operating characteristic analysis, impaired cerebral autoregulation was defined as >16.5% time spent in a dysregulated state within 96 h of life. Normal and abnormal Doppler indices were compared for perinatal outcomes. RESULTS Subjects with abnormal cerebroplacental ratio (n = 12) and abnormal umbilical artery pulsatility index (n = 13) were likely to develop postnatal impaired cerebral autoregulation (p ≤ 0.02). Abnormal cerebroplacental ratio was associated with impaired cerebral autoregulation between 24 and 48 h of life (p = 0.016). These subjects have increased risk for fetal growth restriction, lower birth weight, lower Apgar scores, acidosis, and severe intraventricular hemorrhage and/or death (p < 0.05). CONCLUSION Abnormal cerebroplacental ratio and umbilical artery pulsatility index are associated with postnatal impairment in cerebral autoregulation and adverse outcome.
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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26
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Goyal D, Goyal R. Developmental Maturation and Alpha-1 Adrenergic Receptors-Mediated Gene Expression Changes in Ovine Middle Cerebral Arteries. Sci Rep 2018; 8:1772. [PMID: 29379105 PMCID: PMC5789090 DOI: 10.1038/s41598-018-20210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 11/23/2022] Open
Abstract
The Alpha Adrenergic Signaling Pathway is one of the chief regulators of cerebrovascular tone and cerebral blood flow (CBF), mediating its effects in the arteries through alpha1-adrenergic receptors (Alpha1AR). In the ovine middle cerebral artery (MCA), with development from a fetus to an adult, others and we have shown that Alpha1AR play a key role in contractile responses, vascular development, remodeling, and angiogenesis. Importantly, Alpha1AR play a significant role in CBF autoregulation, which is incompletely developed in a premature fetus as compared to a near-term fetus. However, the mechanistic pathways are not completely known. Thus, we tested the hypothesis that as a function of maturation and in response to Alpha1AR stimulation there is a differential gene expression in the ovine MCA. We conducted microarray analysis on transcripts from MCAs of premature fetuses (96-day), near-term fetuses (145-day), newborn lambs, and non-pregnant adult sheep (2-year) following stimulation of Alpha1AR with phenylephrine (a specific agonist). We observed several genes which belonged to pro-inflammatory and vascular development/angiogenesis pathway significantly altered in all of the four age groups. We also observed age-specific changes in gene expression–mediated by Alpha1AR stimulation in the different developmental age groups. These findings imply complex regulatory mechanisms of cerebrovascular development.
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Affiliation(s)
- Dipali Goyal
- Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Ravi Goyal
- Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
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27
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Taoka T, Fukusumi A, Miyasaka T, Kawai H, Nakane T, Kichikawa K, Naganawa S. Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders. Radiographics 2017; 37:281-297. [PMID: 28076020 DOI: 10.1148/rg.2017160061] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images. ©RSNA, 2017.
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Affiliation(s)
- Toshiaki Taoka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Akio Fukusumi
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiteru Miyasaka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Hisashi Kawai
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiki Nakane
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Kimihiko Kichikawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Shinji Naganawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
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28
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Sanapo L, Whitehead MT, Bulas DI, Ahmadzia HK, Pesacreta L, Chang T, du Plessis A. Fetal intracranial hemorrhage: role of fetal MRI. Prenat Diagn 2017. [DOI: 10.1002/pd.5096] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Sanapo
- Division of Fetal and Transitional Medicine; Children's National Health System; Washington DC USA
| | - Matthew T. Whitehead
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington DC USA
| | - Dorothy I. Bulas
- Division of Fetal and Transitional Medicine; Children's National Health System; Washington DC USA
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington DC USA
| | - Homa K. Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology; The George Washington University School of Medicine and Health Science; Washington DC USA
| | - Lindsay Pesacreta
- Division of Fetal and Transitional Medicine; Children's National Health System; Washington DC USA
| | - Taeun Chang
- Division of Neurology; Children's National Health System; Washington DC USA
| | - Adre du Plessis
- Division of Fetal and Transitional Medicine; Children's National Health System; Washington DC USA
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29
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Kooi EMW, Verhagen EA, Elting JWJ, Czosnyka M, Austin T, Wong FY, Aries MJ. Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature. Expert Rev Neurother 2017. [DOI: 10.1080/14737175.2017.1346472] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabeth M. W. Kooi
- Beatrix Children’s Hospital, Division of Neonatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise A. Verhagen
- Sophia Children’s Hospital, University of Rotterdam, Erasmus University Hospital, Rotterdam, The Netherlands
| | - Jan Willem J. Elting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marek Czosnyka
- Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Topun Austin
- Cambridge University Hospitals NHS Foundation Trust, Rosie Hospital, Cambridge, UK
| | - Flora Y. Wong
- Monash Newborn, Monash Medical Centre; Department of Paediatrics, Monash University; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Marcel J.H. Aries
- Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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30
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Kumar N, Al-Faiadh W, Tailor J, Mallucci C, Chandler C, Bassi S, Pettorini B, Zebian B. Neonatal post-haemorrhagic hydrocephalus in the UK: a survey of current practice. Br J Neurosurg 2016; 31:307-311. [PMID: 27687144 DOI: 10.1080/02688697.2016.1226260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Naveen Kumar
- Faculty of Medicine, King’s College London, London, UK
| | | | - Jignesh Tailor
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Eaton Road, West Derby, Liverpool, UK
| | - Chris Chandler
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Sanj Bassi
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children’s Hospital, Eaton Road, West Derby, Liverpool, UK
| | - Bassel Zebian
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
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31
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Positron emission tomography/magnetic resonance hybrid scanner imaging of cerebral blood flow using (15)O-water positron emission tomography and arterial spin labeling magnetic resonance imaging in newborn piglets. J Cereb Blood Flow Metab 2015; 35:1703-10. [PMID: 26058699 PMCID: PMC4635240 DOI: 10.1038/jcbfm.2015.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 11/08/2022]
Abstract
Abnormality in cerebral blood flow (CBF) distribution can lead to hypoxic-ischemic cerebral damage in newborn infants. The aim of the study was to investigate minimally invasive approaches to measure CBF by comparing simultaneous (15)O-water positron emission tomography (PET) and single TI pulsed arterial spin labeling (ASL) magnetic resonance imaging (MR) on a hybrid PET/MR in seven newborn piglets. Positron emission tomography was performed with IV injections of 20 MBq and 100 MBq (15)O-water to confirm CBF reliability at low activity. Cerebral blood flow was quantified using a one-tissue-compartment-model using two input functions: an arterial input function (AIF) or an image-derived input function (IDIF). The mean global CBF (95% CI) PET-AIF, PET-IDIF, and ASL at baseline were 27 (23; 32), 34 (31; 37), and 27 (22; 32) mL/100 g per minute, respectively. At acetazolamide stimulus, PET-AIF, PET-IDIF, and ASL were 64 (55; 74), 76 (70; 83) and 79 (67; 92) mL/100 g per minute, respectively. At baseline, differences between PET-AIF, PET-IDIF, and ASL were 22% (P<0.0001) and -0.7% (P=0.9). At acetazolamide, differences between PET-AIF, PET-IDIF, and ASL were 19% (P=0.001) and 24% (P=0.0003). In conclusion, PET-IDIF overestimated CBF. Injected activity of 20 MBq (15)O-water had acceptable concordance with 100 MBq, without compromising image quality. Single TI ASL was questionable for regional CBF measurements. Global ASL CBF and PET CBF were congruent during baseline but not during hyperperfusion.
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32
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Schwaberger B, Pichler G, Avian A, Binder-Heschl C, Baik N, Urlesberger B. Do Sustained Lung Inflations during Neonatal Resuscitation Affect Cerebral Blood Volume in Preterm Infants? A Randomized Controlled Pilot Study. PLoS One 2015; 10:e0138964. [PMID: 26406467 PMCID: PMC4583511 DOI: 10.1371/journal.pone.0138964] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 09/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn't been investigated yet. OBJECTIVE Do SLI affect cerebral blood volume (CBV) in preterm infants? METHODS Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial. Within the first 15 minutes after birth near-infrared spectroscopy (NIRS) measurements using 'NIRO-200-NX' (Hamamatsu, Japan) were performed to evaluate changes in CBV and cerebral tissue oxygenation. Two groups were compared based on RS: In SLI group RS was given by applying 1-3 SLI (30 cmH2O for 15 s) continued by respiratory standard care. Control group received respiratory standard care only. RESULTS 40 infants (20 in each group) with mean gestational age of 32 weeks one day (±2 days) and birth weight of 1707 (±470) g were included. In the control group ΔCBV was significantly decreasing, whereas in SLI group ΔCBV showed similar values during the whole period of 15 minutes. Comparing both groups within the first 15 minutes ΔCBV showed a tendency toward different overall courses (p = 0.051). CONCLUSION This is the first study demonstrating an impact of SLI on CBV. Further studies are warranted including reconfirmation of the present findings in infants with lower gestational age. Future investigations on SLI should not only focus on respiratory outcome but also on the consequences on the developing brain. TRIAL REGISTRATION German Clinical Trials Register DRKS00005161 https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do.
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Affiliation(s)
- Bernhard Schwaberger
- Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Corinna Binder-Heschl
- Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Nariae Baik
- Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
- * E-mail:
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Abstract
Injury to the developing brain remains an important complication in critically ill newborns, placing them at risk for future neurodevelopment impairments. Abnormal brain perfusion is often a key mechanism underlying neonatal brain injury. A better understanding of how alternations in brain perfusion can affect normal brain development will permit the development of therapeutic strategies that prevent and/or minimize brain injury and improve the neurodevelopmental outcome of these high-risk newborns. Recently, non-invasive MR perfusion imaging of the brain has been successfully applied to the neonatal brain, which is known to be smaller and have lower brain perfusion compared to older children and adults. This article will present an overview of the potential role of non-invasive perfusion imaging by MRI to study maturation, injury, and repair in perinatal brain injury and demonstrate why this perfusion sequence is an important addition to current neonatal imaging protocols, which already include different sequences to assess the anatomy and metabolism of the neonatal brain.
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Affiliation(s)
- Pia Wintermark
- Department of Pediatrics, Montreal Children's Hospital, McGill University, 2300 rue Tupper, C-920, Montreal, Quebec, Canada H3H 1P3.
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Back SA, Riddle A, Hohimer AR. The Sheep as a Model of Brain Injury in the Premature Infant. ANIMAL MODELS OF NEURODEVELOPMENTAL DISORDERS 2015. [DOI: 10.1007/978-1-4939-2709-8_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Schwaberger B, Pichler G, Binder-Heschl C, Baik N, Avian A, Urlesberger B. Transitional Changes in Cerebral Blood Volume at Birth. Neonatology 2015; 108:253-8. [PMID: 26338713 DOI: 10.1159/000437347] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) enables non-invasive measurements of changes in the concentration of oxygenated (x0394;HbO2) and reduced (x0394;HbR) haemoglobin. Changes in total haemoglobin (x0394;HbT = x0394;HbO2 + x0394;HbR) provide information on changes in cerebral blood volume (CBV). OBJECTIVE The aim was to evaluate the behaviour of CBV during immediate postnatal transition in term infants. DESIGN This observational study was conducted at the Medical University of Graz. NIRS measurements were carried out in term infants without need for respiratory support by using 'NIRO 200-NX' (Hamamatsu) over the first 15 min after birth. RESULTS 109 infants with a mean gestational age of 38 + 6 weeks (±7 days) and birth weight of 3,242 g (±481) were included. Related to a reference value at minute 15, a significant decrease of HbT was observed for each minute within the study period. The mean (±SD) decrease of HbT of 17 (±40) µmol/l from minutes 2 to 15 represents a decrease of CBV of 1.0 ml/100 g brain (±2.2). CONCLUSIONS In healthy newborns, CBV decreased over the whole study period. This likely reflects a physiological process. The impact and clinical relevance of different CBV behaviour during immediate transition needs to be investigated in further studies.
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Affiliation(s)
- Bernhard Schwaberger
- Research Unit for Cerebral Development and Oximetry, Medical University of Graz, Graz, Austria
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Kim KR, Jung SW, Kim DW. Risk factors associated with germinal matrix-intraventricular hemorrhage in preterm neonates. J Korean Neurosurg Soc 2014; 56:334-7. [PMID: 25371784 PMCID: PMC4219192 DOI: 10.3340/jkns.2014.56.4.334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/31/2014] [Accepted: 09/18/2014] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study is to identify the risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) and the relationship of the severity of disease and prematurity. Methods A total of 168 premature neonates whose birth weight ≤1500 g or gestational age ≤34 weeks were examined by cranial ultrasound (CUS) for detection of GM-IVH among the babies admitted between January 2011 and December 2012 in our medical center neonatal intensive care unit. The babies were divided into two groups : GM-IVH and non-IVH. Clinical presentations, precipitating factors of the patients and maternal factors were analyzed. Results In univariate analysis, gestational age, birth weight, delivery method, presence of premature rupture of membrane (PROM) and level of sodium and glucose were statistically meaningful factors (p<0.05). But only two factors, gestational age and presence of patent ductus arteriosus (PDA) were statistically meaningful in multivariate logistic regression (p<0.05). Delivery method [normal vaginal delivery (NVD) to Caeserean section] was borderline significant (p<0.10). Conclusion Presence of PDA and gestational age were the important risk factors associated with development of GM-IVH.
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Affiliation(s)
- Kwang-Ryeol Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Won Jung
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Dong-Won Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Brew N, Walker D, Wong FY. Cerebral vascular regulation and brain injury in preterm infants. Am J Physiol Regul Integr Comp Physiol 2014; 306:R773-86. [PMID: 24647591 DOI: 10.1152/ajpregu.00487.2013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebrovascular lesions, mainly germinal matrix hemorrhage and ischemic injury to the periventricular white matter, are major causes of adverse neurodevelopmental outcome in preterm infants. Cerebrovascular lesions and neuromorbidity increase with decreasing gestational age, with the white matter predominantly affected. Developmental immaturity in the cerebral circulation, including ongoing angiogenesis and vasoregulatory immaturity, plays a major role in the severity and pattern of preterm brain injury. Prevention of this injury requires insight into pathogenesis. Cerebral blood flow (CBF) is low in the preterm white matter, which also has blunted vasoreactivity compared with other brain regions. Vasoreactivity in the preterm brain to cerebral perfusion pressure, oxygen, carbon dioxide, and neuronal metabolism is also immature. This could be related to immaturity of both the vasculature and vasoactive signaling. Other pathologies arising from preterm birth and the neonatal intensive care environment itself may contribute to impaired vasoreactivity and ineffective CBF regulation, resulting in the marked variations in cerebral hemodynamics reported both within and between infants depending on their clinical condition. Many gaps exist in our understanding of how neonatal treatment procedures and medications have an impact on cerebral hemodynamics and preterm brain injury. Future research directions for neuroprotective strategies include establishing cotside, real-time clinical reference values for cerebral hemodynamics and vasoregulatory capacity and to demonstrate that these thresholds improve long-term outcomes for the preterm infant. In addition, stimulation of vascular development and repair with growth factor and cell-based therapies also hold promise.
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Affiliation(s)
- Nadine Brew
- The Ritchie Centre, Monash Institute of Medical Research-Prince Henry's Institute, Melbourne, Clayton, Victoria, Australia; and
| | - David Walker
- The Ritchie Centre, Monash Institute of Medical Research-Prince Henry's Institute, Melbourne, Clayton, Victoria, Australia; and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Flora Y Wong
- The Ritchie Centre, Monash Institute of Medical Research-Prince Henry's Institute, Melbourne, Clayton, Victoria, Australia; and Monash Newborn, Monash Medical Centre, Melbourne, Victoria, Australia; and Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
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Abstract
Intraventricular hemorrhage (IVH) is a major neurologic complication of prematurity. Pathogenesis of IVH is attributed to intrinsic fragility of germinal matrix vasculature and to the fluctuation in the cerebral blood flow. Germinal matrix exhibits rapid angiogenesis orchestrating formation of immature vessels. Prenatal glucocorticoid exposure remains the most effective means of preventing IVH. Therapies targeted to enhance the stability of the germinal matrix vasculature and minimize fluctuation in the cerebral blood flow might lead to more effective strategies in preventing IVH.
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Affiliation(s)
- Praveen Ballabh
- Department of Pediatrics, Cell Biology and Anatomy, Regional Neonatal Center, New York Medical College, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA.
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Back SA. Cerebral white and gray matter injury in newborns: new insights into pathophysiology and management. Clin Perinatol 2014; 41:1-24. [PMID: 24524444 PMCID: PMC3947650 DOI: 10.1016/j.clp.2013.11.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Increasing numbers of preterm neonates survive with motor and cognitive disabilities related to less destructive forms of cerebral injury that still result in reduced cerebral growth. White matter injury results in myelination disturbances related to aberrant responses to death of pre-myelinating oligodendrocytes (preOLs). PreOLs are rapidly regenerated but fail to mature to myelinating cells. Although immature projection neurons are more resistant to hypoxia-ischemia than preOLs, they display widespread disturbances in dendritic arbor maturation, which provides an explanation for impaired cerebral growth. Thus, large numbers of cells fail to fully mature during a critical window in development of neural circuitry. These recently recognized forms of cerebral gray and white matter dysmaturation suggest new therapeutic directions centered on reversal of the processes that promote dysmaturation.
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Affiliation(s)
- Stephen A. Back
- Professor of Pediatrics and Neurology Oregon Health & Science University Clyde and Elda Munson Professor of Pediatric Research Director, Neuroscience Section, Pape' Family Pediatric Research Institute
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Qureshi AI, Adil MM, Shafizadeh N, Majidi S. A 2-fold higher rate of intraventricular hemorrhage-related mortality in African American neonates and infants. J Neurosurg Pediatr 2013; 12:49-53. [PMID: 23682817 DOI: 10.3171/2013.4.peds12568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite the recognition of racial or ethnic differences in preterm gestation, such differences in the rate of intraventricular hemorrhage (IVH), frequently associated with preterm gestation, are not well studied. The authors performed the current study to identify racial or ethnic differences in the incidence of IVH-related mortality within the national population of the US. METHODS Using the ICD-10 codes P52.0, P52.1, P52.2, P52.3, and P10.2 and the Multiple Cause of Death data from 2000 to 2009, the authors identified all IVH-related mortalities that occurred in neonates and infants aged less than 1 year. The live births for whites and African Americans from the census for 2000-2009 were used to derive the incidence of IVH-related mortality for whites and African Americans per 100,000 live births. The IVH rate ratio (RR, 95% confidence interval [CI]) and annual percent change (APC) in the incidence rates from 2000 to 2009 were also calculated. RESULTS A total of 3249 IVH-related mortality cases were reported from 2000 to 2009. The incidence rates of IVH were higher among African American infants (16 per 100,000 live births) than among whites (7.8 per 100,000 live births). African American infants had a 2-fold higher risk of IVH-related mortality compared with whites (RR 2.0, 95% CI 1.2-3.2). The rate of increase over the last 10 years was less in African American infants (APC 1.6%) than in white infants (APC 4.3%). CONCLUSIONS The rate of IVH-related mortality is 2-fold higher among African American than white neonates and infants. Further studies are required to understand the underlying reasons for this prominent disparity in one of the most significant causes of infant mortality.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Scher MS. Normal and abnormal cerebrovascular development. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:1021-42. [DOI: 10.1016/b978-0-444-52910-7.00021-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Back SA, Riddle A, Dean J, Hohimer AR. The instrumented fetal sheep as a model of cerebral white matter injury in the premature infant. Neurotherapeutics 2012; 9:359-70. [PMID: 22399133 PMCID: PMC3337024 DOI: 10.1007/s13311-012-0108-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Despite advances in neonatal intensive care, survivors of premature birth remain highly susceptible to unique patterns of developmental brain injury that manifest as cerebral palsy and cognitive-learning disabilities. The developing brain is particularly susceptible to cerebral white matter injury related to hypoxia-ischemia. Cerebral white matter development in fetal sheep shares many anatomical and physiological similarities with humans. Thus, the fetal sheep has provided unique experimental access to the complex pathophysiological processes that contribute to injury to the human brain during successive periods in development. Recent refinements have resulted in models that replicate major features of acute and chronic human cerebral injury and have provided access to complex clinically relevant studies of cerebral blood flow and neuroimaging that are not feasible in smaller laboratory animals. Here, we focus on emerging insights and methodologies from studies in fetal sheep that have begun to define cellular and vascular factors that contribute to white matter injury. Recent advances include spatially defined measurements of cerebral blood flow in utero, the definition of cellular maturational factors that define the topography of injury and the application of high-field magnetic resonance imaging to define novel neuroimaging signatures for specific types of chronic white matter injury. Despite the higher costs and technical challenges of instrumented preterm fetal sheep models, they provide powerful access to clinically relevant studies that provide a more integrated analysis of the spectrum of insults that appear to contribute to cerebral injury in human preterm infants.
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Affiliation(s)
- Stephen A Back
- Department of Pediatrics, Oregon Health Sciences University, Portland, OR 97239, USA.
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Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 2012; 9:242-58. [PMID: 22380952 PMCID: PMC3842211 DOI: 10.3171/2011.12.peds11136] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECT Preterm infants are at risk for perinatal complications, including germinal matrix-intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH). This review summarizes the current understanding of the epidemiology, pathophysiology, management, and outcomes of IVH and PHH in preterm infants. METHODS The MEDLINE database was systematically searched using terms related to IVH, PHH, and relevant neurosurgical procedures to identify publications in the English medical literature. To complement information from the systematic search, pertinent articles were selected from the references of articles identified in the initial search. RESULTS This review summarizes the current knowledge regarding the epidemiology and pathophysiology of IVH and PHH, primarily using evidence-based studies. Advances in obstetrics and neonatology over the past few decades have contributed to a marked improvement in the survival of preterm infants, and neurological morbidity is also starting to decrease. The incidence of IVH is declining, and the incidence of PHH will likely follow. Currently, approximately 15% of preterm infants who suffer severe IVH will require permanent CSF diversion. The clinical presentation and surgical management of symptomatic PHH with temporary ventricular reservoirs (ventricular access devices) and ventriculosubgaleal shunts and permanent ventriculoperitoneal shunts are discussed. Preterm infants who develop PHH that requires surgical treatment remain at high risk for other related neurological problems, including cerebral palsy, epilepsy, and cognitive and behavioral delay. This review highlights numerous opportunities for further study to improve the care of these children. CONCLUSIONS A better grasp of the pathophysiology of IVH is beginning to impact the incidence of IVH and PHH. Neonatologists conduct rigorous Class I and II studies to advance the outcomes of preterm infants. The need for well-designed multicenter trials is essential because of the declining incidence of IVH and PHH, variations in referral patterns, and neonatal ICU and neurosurgical management. Well-designed multicenter trials will eventually produce evidence to enable neurosurgeons to provide their smallest, most vulnerable patients with the best practices to minimize perioperative complications and permanent shunt dependence, and most importantly, optimize long-term neurodevelopmental outcomes.
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Affiliation(s)
- Shenandoah Robinson
- Rainbow Babies and Children’s Hospital, Neurological Institute, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
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Scher MS. Developmental origins of cerebrovascular disease II: considering gene-environment interactions when developing neuroprotective strategies. J Child Neurol 2012; 27:238-50. [PMID: 22180566 DOI: 10.1177/0883073811417715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second part of this review of the developmental origins of cerebrovascular disease discusses prenatal gene-environment interactions concerning maternal, placental, and fetal conditions that culminate in specific injuries such as perinatal stroke, as well as complications of intrauterine growth restriction and congenital heart disease. A greater understanding of gene-environment influences on cerebrovascular health and disease in early life will contribute to the successful development of neuroprotective strategies throughout the lifespan.
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Affiliation(s)
- Mark S Scher
- School of Medicine, Case Western Reserve University, and Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Rainbow Babies and Children's Hospital, Case Medical Center, University Hospitals of Cleveland, OH, USA.
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Distefano G, Praticò AD. Actualities on molecular pathogenesis and repairing processes of cerebral damage in perinatal hypoxic-ischemic encephalopathy. Ital J Pediatr 2010; 36:63. [PMID: 20846380 PMCID: PMC2954868 DOI: 10.1186/1824-7288-36-63] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/16/2010] [Indexed: 11/12/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is the most important cause of cerebral damage and long-term neurological sequelae in the perinatal period both in term and preterm infant. Hypoxic-ischemic (H-I) injuries develop in two phases: the ischemic phase, dominated by necrotic processes, and the reperfusion phase, dominated by apoptotic processes extending beyond ischemic areas. Due to selective ischemic vulnerability, cerebral damage affects gray matter in term newborns and white matter in preterm newborns with the typical neuropathological aspects of laminar cortical necrosis in the former and periventricular leukomalacia in the latter. This article summarises the principal physiopathological and biochemical processes leading to necrosis and/or apoptosis of neuronal and glial cells and reports recent insights into some endogenous and exogenous cellular and molecular mechanisms aimed at repairing H-I cerebral damage.
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Affiliation(s)
- Giuseppe Distefano
- Department of Pediatrics, Division of Neonatology, University of Catania, Catania, Italy.
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Kallankari H, Kaukola T, Ojaniemi M, Herva R, Perhomaa M, Vuolteenaho R, Kingsmore SF, Hallman M. Chemokine CCL18 predicts intraventricular hemorrhage in very preterm infants. Ann Med 2010; 42:416-25. [PMID: 20608885 DOI: 10.3109/07853890.2010.481085] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) in very preterm infants is a common disease associated with long-term consequences. Risk factors of IVH remain to be further defined. AIMS To determine whether specific immunoproteins at birth predict the risk of IVH and whether their receptors are localized at the bleeding site. METHODS A prospective cohort consisted of 163 infants born before 32 weeks of gestation. Altogether 107 cord blood immunoproteins and 12 cytokines from peripheral blood obtained 1 and 7 days after birth were analyzed. Serial brain ultrasounds were assessed. Immunohistochemistry of a chemokine receptor from 14 autopsies was studied. RESULTS Low levels of cord chemokine CCL18 (chemokine (C-C motif) ligand 18) robustly predicted the risk of IVH grade II-IV when ante- and neonatal risk factors were considered. Cord CCL18 increased from 32 weeks to term. During the first week after very preterm birth CCL18 increased as the risk of new IVH cases decreased. CCL18 receptor, CCR3, was detectable in choroid plexus, periventricular capillary endothelium, ependymal cells, and in germinal matrix. CONCLUSION Low cord blood CCL18 is an independent risk factor of IVH. CCL18 may inhibit signal transduction of its receptor in periventricular cells. Defining the function and regulation of CCL18 may help to decrease the risk of IVH.
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Affiliation(s)
- Hanna Kallankari
- Institute of Clinical Medicine, Department of Pediatrics, University of Oulu, FIN-90014, Oulu, Finland
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Liem KD, Greisen G. Monitoring of cerebral haemodynamics in newborn infants. Early Hum Dev 2010; 86:155-8. [PMID: 20219296 DOI: 10.1016/j.earlhumdev.2010.01.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 01/29/2010] [Indexed: 11/19/2022]
Abstract
The most important cerebrovascular injuries in newborn infants, particularly in preterm infants, are cerebral haemorrhage and ischemic injury. The typical cerebral vascular anatomy and the disturbance of cerebral haemodynamics play important roles in the pathophysiology. The term 'cerebral haemodynamics' includes cerebral blood flow (CBF), cerebral blood flow velocity, and cerebral blood volume (CBV). Therapy aimed at changing vascular anatomy is not available. Therefore, prevention of disturbances in CBF and CBV is pivotal. However, continuous monitoring of CBF and CBV is still unavailable for clinical use. Tissue oxygenation may be used as a surrogate for CBF, although precision is still questionable. General knowledge of the regulation of CBF and CBV is important. Although this knowledge is still incomplete, especially regarding autoregulation and the exact role of CBV, it is still useful. Using it even without knowing the exact level of CBF and CBV, it is possible to aim to keep CBF and CBV stable. Future research should focus on development of monitoring tools, gaining more insight in neonatal cerebral autoregulation, and demonstrating clinical benefits of a 'cerebral perfusion-oriented' therapy.
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Affiliation(s)
- K Djien Liem
- Department of Neonatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
Advances in medical and surgical care of the high-risk neonate have led to increased survival. A significant number of these neonates suffer from neurodevelopmental delays and failure in school. The focus of clinical research has shifted to understanding events contributing to neurological morbidity in these patients. Assessing changes in cerebral oxygenation and regulation of cerebral blood flow (CBF) is important in evaluating the status of the central nervous system. Traditional CBF imaging methods fail for both ethical and logistical reasons. Optical near infrared spectroscopy (NIRS) is increasingly being used for bedside monitoring of cerebral oxygenation and blood volume in both very low birth weight infants and neonates with congenital heart disease. Although trends in CBF may be inferred from changes in cerebral oxygenation and/or blood volume, NIRS does not allow a direct measure of CBF in these populations. Two relatively new modalities, arterial spin-labeled perfusion magnetic resonance imaging and optical diffuse correlation spectroscopy, provide direct, noninvasive measures of cerebral perfusion suitable for the high-risk neonates. Herein we discuss the instrumentation, applications, and limitations of these noninvasive imaging techniques for measuring and/or monitoring CBF.
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Affiliation(s)
- Donna A. Goff
- Department of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Erin M. Buckley
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Turgut Durduran
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, Institut de Ciències Fotòniques, Castelldefels (Barcelona), Spain, Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Jiongjong Wang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Licht
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
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Abstract
Intraventricular hemorrhage (IVH) is a major complication of prematurity. IVH typically initiates in the germinal matrix, which is a richly vascularized collection of neuronal-glial precursor cells in the developing brain. The etiology of IVH is multifactorial and is primarily attributed to the intrinsic fragility of the germinal matrix vasculature and the disturbance in the cerebral blood flow (CBF). Although this review broadly describes the pathogenesis of IVH, the main focus is on the recent development in molecular mechanisms that elucidates the fragility of the germinal matrix vasculature. The microvasculature of the germinal matrix is frail because of an abundance of angiogenic blood vessels that exhibit paucity of pericytes, immaturity of basal lamina, and deficiency of glial fibrillary acidic protein (GFAP) in the ensheathing astrocytes endfeet. High VEGF and angiopoietin-2 levels activate a rapid angiogenesis in the germinal matrix. The elevation of these growth factors may be ascribed to a relative hypoxia of the germinal matrix perhaps resulting from high metabolic activity and oxygen consumption of the neural progenitor cells. Hence, the rapid stabilization of the angiogenic vessels and the restoration of normal CBF on the first day of life are potential strategies to prevent IVH in premature infants.
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Affiliation(s)
- Praveen Ballabh
- Department of Pediatrics, Anatomy and Cell Biology, New York Medical College-Westchester Medical Center, Valhalla, New York 10595, USA.
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Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol 2009; 36:737-62, v. [PMID: 19944833 DOI: 10.1016/j.clp.2009.07.014] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
New discoveries in neonatal imaging, cerebral monitoring, and hemodynamics, and greater understanding of inflammatory and genetic mechanisms involved in intracranial hemorrhage (ICH) in the preterm infant are creating opportunities for innovative early detection and prevention approaches. This article covers the spectrum of ICH in the preterm infant, including germinal matrix intraventricular hemorrhage, its complications, and associated phenomena, such as the emerging role of cerebellar hemorrhage. The overall aim of this article is to review the current knowledge of the mechanisms, diagnosis, outcome, and management of preterm ICH; to revisit the origins from which they develop; and to discuss future expectations.
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Affiliation(s)
- Haim Bassan
- Pediatric Neurology Unit, Neonatal Neurology Service, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel.
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