1
|
Akin MA, Balci NC, Demirsoz M. Revolutionizing Neonatal Care: A Comprehensive Assessment of Neuromotor Development in At-Risk Infants Using the Novel Neonatal Infant Motor Assessment Scale (NIMAS) Test Battery. CHILDREN (BASEL, SWITZERLAND) 2024; 11:445. [PMID: 38671662 PMCID: PMC11048848 DOI: 10.3390/children11040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
We developed a new neonatal neuromotor test battery, the Neonatal Infant Motor Assessment Scale (NIMAS), to perform a detailed neuromotor and holistic assessment of at-risk infants in the neonatal period. METHODS A total of 68 infants (28-41 Gestational weeks) hospitalised in the Neonatal Intensive Care Unit were included in the study. The NIMAS is a scale consisting of Automatic Motor Area, Functional Motor Area and sociodemographic form. The Dubowitz Neurological Examination and the Amiel-Tison Neurological Assessment Tests were also applied to evaluate the construct validity of the test. RESULTS The mean gestational age at birth was 34.62 ± 3.07 weeks and birth weight was 2305.66 ± 738.95. Fifty-one (75%) of the babies were premature and 17 (25%) were term babies. The KMO value to test the adequacy of the distribution for factor analysis was found to be at a very good level. Barlett's test result was 2198.389 (p < 0.05). The amount of variance obtained as 44.76% in the study was at a sufficient level. The factor loads of the questions in the automatic motor domain dimension varied between 0.523 and 0.694 and the factor loads of the questions in the functional motor domain dimension varied between 0.619 and 0.772. Since Cronbach's alpha was above 0.70, the reliability was adequate. Inter-rater scale agreement in the automatic motor domain was 81.1%; scale agreement in the functional motor domFain was 92.9%; and the NIMAS total score agreement was 93.4%. These agreements were statistically significant (p < 0.05). Total correlation above 0.20 indicates that the item is important for the question. According to the results obtained, total correlation values were between 0.258 and 0.720. CONCLUSIONS The NIMAS is the first test battery to assess the "Functional Motor Area" and this questionnaire, based on the results of the analyses, is a valid, reliable and clinically usable measurement tool for the infant at-risk at the neonatal period.
Collapse
Affiliation(s)
- Mustafa Ali Akin
- Department of Neonatology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55139, Turkey;
| | - Nilay Comuk Balci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ondokuz Mayis University, Samsun 55139, Turkey
| | - Mert Demirsoz
- Department of Biostatistics, Selcuk University, Konya 42130, Turkey;
| |
Collapse
|
2
|
Farrar MA, Kiernan MC, Kariyawasam DS. Presymptomatic spinal muscular atrophy: a cautionary approach to the proposed new terminology. Brain 2023; 146:e65-e66. [PMID: 36856687 DOI: 10.1093/brain/awad061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Michelle A Farrar
- Discipline of Paediatrics and Child Health, UNSW Medicine and Health, UNSW, Sydney, NSW 2052, Australia
- Department of Neurology, Sydney Children's Hospital Network, Sydney, NSW 2031, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Didu S Kariyawasam
- Discipline of Paediatrics and Child Health, UNSW Medicine and Health, UNSW, Sydney, NSW 2052, Australia
- Department of Neurology, Sydney Children's Hospital Network, Sydney, NSW 2031, Australia
| |
Collapse
|
3
|
Correr MT, Pfeifer LI. Cultural adaptation and reliability assessment of the Hammersmith neonatal neurological examination for Brazilian newborns at risk of cerebral palsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:47-54. [PMID: 36918007 PMCID: PMC10014209 DOI: 10.1055/s-0042-1758863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Reliable instruments that lead to early diagnosis for CP are extremely important so that these children are referred for early stimulation, benefiting their development. OBJECTIVE To perform a cross-cultural adaptation and reliability assessment of a Brazilian version of the Hammersmith Neonatal Neurological Examination (HNNE), expanded and summarized. METHODS A methodological, cross-sectional, nonexperimental quantitative analysis was conducted in two phases as follows: cultural adaptation of the HNNE, expanded and summarized, and reliability assessment of the Brazilian version of the HNNE. Phase one was developed in five stages (initial translation, synthesis of the translation, a committee of experts, backtranslation, and submission to the author), with the semantic questions, content, and face validity being evaluated. Phase two included 143 newborns and we analyzed the internal consistency, stability, and equivalence (intra- and interexaminer) of the instrument. Internal consistency was calculated using Cronbach's alpha, and intra- and interexaminer reliability and reproducibility assessed through test-retest were calculated using the intraclass correlation coefficient RESULTS: Although internal consistency, assessed using Cronbach's alpha, showed unsatisfactory results, the results of inter-and intraexaminer equivalence showed a high agreement between the evaluations in all domains. The test-retest also showed excellent agreement between the domains. CONCLUSIONS The Brazilian HNNE expanded and summarized versions can be considered to be adapted and reliable for the neurological assessment of Brazilian newborns to identify changes in neurological development and early referral to the stimulation or early rehabilitation units and as a promising option to be used in the context of primary care in Brazil.
Collapse
Affiliation(s)
- Mayara Thais Correr
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Programa de Pós-graduação em Neurologia, Ribeirão Preto SP, Brazil
| | - Luzia Iara Pfeifer
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Programa de Pós-graduação em Neurologia, Ribeirão Preto SP, Brazil
| |
Collapse
|
4
|
Sandoval Karamian AG, Mercimek-Andrews S, Mohammad K, Molloy EJ, Chang T, Chau V, Murray DM, Wusthoff CJ. Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy. Semin Fetal Neonatal Med 2021; 26:101272. [PMID: 34417137 DOI: 10.1016/j.siny.2021.101272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying cause of encephalopathy has important treatment implications. This review outlines conditions that cause NE and may be mistaken for HIE, along with their distinguishing clinical features, pathophysiology, investigations, and treatments. NE due to brain malformations, vascular causes, neuromuscular causes, genetic conditions, neurogenetic disorders and inborn errors of metabolism, central nervous system (CNS) and systemic infections, and toxic/metabolic disturbances are discussed.
Collapse
Affiliation(s)
- A G Sandoval Karamian
- Children's Hospital of Philadelphia, Division of Neurology, 3501 Civic Center Blvd Office 1200.12, Philadelphia, PA, 19104, USA.
| | - S Mercimek-Andrews
- Biochemical Geneticist, Department of Medical Genetics, University of Alberta, 8-39 Medical Sciences Building, 8613 - 144 Street, Edmonton, T6G 2H7, Alberta, Canada.
| | - K Mohammad
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.
| | - E J Molloy
- Trinity College, the University of Dublin, Trinity Translational Medicine Institute, Dublin, Ireland; Children's Health Ireland at Tallaght and Crumlin & and Coombe Women's and Infants University Hospital, Dublin, Ireland; Trinity Research in Childhood Centre (TRiCC), Trinity Academic Centre, Tallaght University Hospital, Dublin 24, Ireland.
| | - T Chang
- George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA; Neonatal Neurology Program, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Vann Chau
- Neurology, Neonatal Neurology Program, The Hospital for Sick Children, 555 University Avenue, Toronto ON, M5G 1X8, Canada.
| | - D M Murray
- Deptartment of Paediatric and Child Health, University College Cork, ARm 2.32, Paediatric Academic Unit, Floor 2, Seahorse Unit, Cork University Hospital, Wilton, Cork, T12 DCA4, Ireland.
| | - Courtney J Wusthoff
- Division of Child Neurology, Division of Pediatrics- Neonatal and Developmental Medicine, Stanford Children's Health, 750 Welch Road, Suite 317, Palo Alto, CA, 94304 USA.
| |
Collapse
|
5
|
Sigafoos J, Roche L, O’Reilly MF, Lancioni GE. Persistence of Primitive Reflexes in Developmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-021-00232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
6
|
Lo Presti D, Dall’Orso S, Muceli S, Arichi T, Neumane S, Lukens A, Sabbadini R, Massaroni C, Caponero MA, Formica D, Burdet E, Schena E. An fMRI Compatible Smart Device for Measuring Palmar Grasping Actions in Newborns. SENSORS 2020; 20:s20216040. [PMID: 33114180 PMCID: PMC7660640 DOI: 10.3390/s20216040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/09/2023]
Abstract
Grasping is one of the first dominant motor behaviors that enable interaction of a newborn infant with its surroundings. Although atypical grasping patterns are considered predictive of neuromotor disorders and injuries, their clinical assessment suffers from examiner subjectivity, and the neuropathophysiology is poorly understood. Therefore, the combination of technology with functional magnetic resonance imaging (fMRI) may help to precisely map the brain activity associated with grasping and thus provide important insights into how functional outcomes can be improved following cerebral injury. This work introduces an MR-compatible device (i.e., smart graspable device (SGD)) for detecting grasping actions in newborn infants. Electromagnetic interference immunity (EMI) is achieved using a fiber Bragg grating sensor. Its biocompatibility and absence of electrical signals propagating through the fiber make the safety profile of the SGD particularly favorable for use with fragile infants. Firstly, the SGD design, fabrication, and metrological characterization are described, followed by preliminary assessments on a preterm newborn infant and an adult during an fMRI experiment. The results demonstrate that the combination of the SGD and fMRI can safely and precisely identify the brain activity associated with grasping behavior, which may enable early diagnosis of motor impairment and help guide tailored rehabilitation programs.
Collapse
Affiliation(s)
- Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
| | - Sofia Dall’Orso
- Division of Signal Processing and Biomedical Engineering, Department of Electrical Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; (S.D.); (S.M.)
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
| | - Silvia Muceli
- Division of Signal Processing and Biomedical Engineering, Department of Electrical Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; (S.D.); (S.M.)
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Sara Neumane
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (T.A.); (S.N.)
- NeuroDiderot Unit UMR1141, Université de Paris, INSERM, F-75019 Paris, France
- UNIACT, Université Paris-Saclay, CEA, NeuroSpin, F-91191 Gif-sur-Yvette, France
| | - Anna Lukens
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Riccardo Sabbadini
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
| | - Michele Arturo Caponero
- Photonics Micro- and Nanostructures Laboratory, ENEA Research Center of Frascati, 00044 Frascati (RM), Italy;
| | - Domenico Formica
- Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXt Lab), Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Etienne Burdet
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK;
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (D.L.P.); (R.S.); (C.M.)
- Correspondence: ; Tel.: +39-062-2541-9650
| |
Collapse
|
7
|
Coutinho CM, Negrini SFBM, Araujo DCA, Teixeira SR, Amaral FR, Moro MCR, Fernandes JDCP, Motta MSF, Negrini BVM, Caldas CACT, Anastasio ART, Furtado JM, Bárbaro AAT, Yamamoto AY, Duarte G, Mussi‐Pinhata MM. Early maternal Zika infection predicts severe neonatal neurological damage: results from the prospective Natural History of Zika Virus Infection in Gestation cohort study. BJOG 2020; 128:317-326. [DOI: 10.1111/1471-0528.16490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Affiliation(s)
- CM Coutinho
- Department of Gynaecology and Obstetrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - SFBM Negrini
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - DCA Araujo
- Epidemiology and Disease Control Division Department of Public Health and Surveillance Secretary of Health Ribeirão Preto Brazil
| | - SR Teixeira
- Department of Imaging, Haematology and Oncology Ribeirão Preto Medical SchoolUniversity of São Paulo Ribeirão Preto Brazil
| | - FR Amaral
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - MCR Moro
- Department of Gynaecology and Obstetrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - JDCP Fernandes
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - MSF Motta
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - BVM Negrini
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - CACT Caldas
- Rehabilitation Centre of Clinics Hospital at the Ribeirão Preto School of Medicine Ribeirão Preto Brazil
| | - ART Anastasio
- Department of Health Sciences Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - JM Furtado
- Division of Ophthalmology Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - AAT Bárbaro
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - AY Yamamoto
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - G Duarte
- Department of Gynaecology and Obstetrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | - MM Mussi‐Pinhata
- Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
| | | |
Collapse
|
8
|
Zlatanović D, Čolović H, Živković V, Kocić M, Stanković A, Vučić J, Bojović N, Raičević M, Golubović M, Dinić L, Stanković T. THE IMPORTANCE OF THE PRECHTL METHOD FOR ULTRA-EARLY PREDICTION OF NEUROLOGICAL ABNORMALITIES IN NEWBORNS AND INFANTS. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
9
|
Kitase Y, Sato Y, Takahashi H, Shimizu M, Ishikawa C, Yamamoto H, Hayakawa M. A new type of swaddling clothing improved development of preterm infants in neonatal intensive care units. Early Hum Dev 2017; 112:25-28. [PMID: 28675824 DOI: 10.1016/j.earlhumdev.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preterm infants undergo stress owing to essential treatments and exposure to the extrauterine environment in neonatal intensive care units. AIMS The aim of this study was to enable preterm infants to maintain adequate positioning with a newly developed swaddling clothing, in order to improve low muscle tone and sleep quality, and to confirm the safety of the clothing. STUDY DESIGN This prospective clinical trial included an intervention group (preterm infants wearing bag-shaped clothing, allowing only exposure of the head, n=27), and a control group (preterm infants managed only with conventional swaddling, n=12). OUTCOME MEASURES We used the Dubowitz method to analyze behavior, recorded the frequency of vomiting and apnea in both groups, and assessed the sleep state in the intervention group. RESULTS Muscle tone and total score for the Dubowitz method significantly improved in the intervention group, compared with those in the control group. We evaluated the sleep state before and after the introduction of the device in the intervention group, and State 1 increased from 53.5% to 69.2% after introduction. No significant difference was seen in the frequency of vomiting and apnea between the groups. CONCLUSIONS The new swaddling clothing with enhanced stretch capacity improved the muscle tone and increased sleep time by decreasing the state level of preterm infants. This is an effective tool to assist in infant development in neonatal intensive care units.
Collapse
Affiliation(s)
- Yuma Kitase
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Japan; Division of Neonatology, Toyota Memorial Hospital, Japan.
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Japan
| | | | - Misaki Shimizu
- Division of Neonatology, Toyota Memorial Hospital, Japan
| | - Chie Ishikawa
- Division of Neonatology, Toyota Memorial Hospital, Japan
| | | | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Japan
| |
Collapse
|
10
|
Lavongtheung A, Jedraszak G, Naepels P, Tourneux P, Gondry-Jouet C, Le Moing AG, Gondry J, Chevreau J. Should isolated fetal ventriculomegaly measured below 12 mm be viewed as a variant of the norm? Results of a 5-year experience in a prenatal referral center. J Matern Fetal Neonatal Med 2017; 31:2325-2331. [DOI: 10.1080/14767058.2017.1342801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anaïs Lavongtheung
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Guillaume Jedraszak
- Department of Genetics, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Philippe Naepels
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Pierre Tourneux
- Department of Neonatology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Catherine Gondry-Jouet
- Department of Radiology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Anne-Gaëlle Le Moing
- Department of Pediatric Neurology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| |
Collapse
|
11
|
CAHILL AG, MATHUR AM, SMYSER CD, MCKINSTRY RC, ROEHL KA, LÓPEZ JD, INDER TE, MACONES GA. Neurologic Injury in Acidemic Term Infants. Am J Perinatol 2017; 34:668-675. [PMID: 27926973 PMCID: PMC6283275 DOI: 10.1055/s-0036-1597135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective To determine whether arterial umbilical cord gas (aUCG) pH, in anatomically normal-term infants, could select infants at risk for brain injury identified on magnetic resonance imaging (MRI). Study Design We performed a nested case-control within a prospective cohort of 8,580 women. Cases, with an aUCG pH < 7.10, were temporally, age, and sex matched to controls with an aUCG pH ≥ 7.20. Bi- and multivariable analyses compared the presence and severity of brain injury. Secondary analyses estimated whether elevated arterial base excess or lactate were associated with brain injury. Results Fifty-five cases were matched to 165 controls. There was no statistical difference in brain injury between the groups (adjusted odds ratio [aOR]: 1.8, 95% confidence interval [CI]: 0.7-4.4]). Base excess ≥ -8 mEq/L was not significantly associated with brain injury (p = 0.12). There was no increase in risk of injury based on elevation of arterial lactate ≥ 4 mmol ⁄L (p = 1.00). Cases were significantly more likely to have an abnormal score in several domains of the Dubowitz neurologic examination. Conclusion The aUCG acid-base parameters alone are not sufficient clinical markers to identify term infants that might benefit from MRI of the brain to identify injury.
Collapse
Affiliation(s)
- Alison G. CAHILL
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Amit M. MATHUR
- Department of Pediatrics, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8116, St. Louis, Missouri, 63110
| | - Christopher D. SMYSER
- Department of Neurology, Department of Pediatrics, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8111, St. Louis, Missouri, 63110
| | - Robert C. MCKINSTRY
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly A. ROEHL
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Julia D. LÓPEZ
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Terrie E. INDER
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, 02115
| | - George A. MACONES
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| |
Collapse
|
12
|
Allievi AG, Arichi T, Tusor N, Kimpton J, Arulkumaran S, Counsell SJ, Edwards AD, Burdet E. Maturation of Sensori-Motor Functional Responses in the Preterm Brain. Cereb Cortex 2015; 26:402-413. [PMID: 26491066 PMCID: PMC4677983 DOI: 10.1093/cercor/bhv203] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Preterm birth engenders an increased risk of conditions like cerebral palsy and therefore this time may be crucial for the brain's developing sensori-motor system. However, little is known about how cortical sensori-motor function matures at this time, whether development is influenced by experience, and about its role in spontaneous motor behavior. We aimed to systematically characterize spatial and temporal maturation of sensori-motor functional brain activity across this period using functional MRI and a custom-made robotic stimulation device. We studied 57 infants aged from 30 + 2 to 43 + 2 weeks postmenstrual age. Following both induced and spontaneous right wrist movements, we saw consistent positive blood oxygen level–dependent functional responses in the contralateral (left) primary somatosensory and motor cortices. In addition, we saw a maturational trend toward faster, higher amplitude, and more spatially dispersed functional responses; and increasing integration of the ipsilateral hemisphere and sensori-motor associative areas. We also found that interhemispheric functional connectivity was significantly related to ex-utero exposure, suggesting the influence of experience-dependent mechanisms. At term equivalent age, we saw a decrease in both response amplitude and interhemispheric functional connectivity, and an increase in spatial specificity, culminating in the establishment of a sensori-motor functional response similar to that seen in adults.
Collapse
Affiliation(s)
| | - Tomoki Arichi
- Department of Bioengineering.,Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London SE1 7EH, UK
| | - Nora Tusor
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, LondonSE1 7EH, UK
| | - Jessica Kimpton
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, LondonSE1 7EH, UK
| | - Sophie Arulkumaran
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, LondonSE1 7EH, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, LondonSE1 7EH, UK
| | - A David Edwards
- Department of Bioengineering.,Division of Brain Sciences, Department of Medicine, Imperial College of Science, Technology and Medicine, London SW7 2AZ, UK.,Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London SE1 7EH, UK
| | | |
Collapse
|
13
|
Arichi T, Counsell SJ, Allievi AG, Chew AT, Martinez-Biarge M, Mondi V, Tusor N, Merchant N, Burdet E, Cowan FM, Edwards AD. The effects of hemorrhagic parenchymal infarction on the establishment of sensori-motor structural and functional connectivity in early infancy. Neuroradiology 2014; 56:985-94. [PMID: 25119253 PMCID: PMC4210651 DOI: 10.1007/s00234-014-1412-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/18/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objective of the study was to characterize alterations of structural and functional connectivity within the developing sensori-motor system in infants with focal perinatal brain injury and at high risk of cerebral palsy. METHODS Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) data were used to study the developing functional and structural connectivity framework in six infants born prematurely at term equivalent age. This was first characterised in three infants without focal pathology, which was then compared to that derived from three infants with unilateral haemorrhagic parenchymal infarction and a subsequent focal periventricular white matter lesion who developed later haemiparesis. RESULTS Functional responses to passive hand movement were in the contralateral perirolandic cortex, regardless of focal pathology. In infants with unilateral periventricular injury, afferent thalamo-cortical tracts appeared to have developed compensatory trajectories which circumvented areas of damage. In contrast, efferent corticospinal tracts showed marked asymmetry at term equivalent age following focal brain injury. Sensori-motor network analysis suggested that inter-hemispheric functional connectivity is largely preserved despite pathology and that impairment may be associated with adverse neurodevelopmental outcome. CONCLUSION Following focal perinatal brain injury, altered structural and functional connectivity is already present and can be characterized with MRI at term equivalent age. The results of this small case series suggest that these techniques may provide valuable new information about prognosis and the pathophysiology underlying cerebral palsy.
Collapse
Affiliation(s)
- T Arichi
- Department of Perinatal Imaging & Health, Division of Imaging Sciences & Biomedical Engineering, Kings College London, St Thomas' Hospital, 1st floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
The neurological exam can be a challenging part of a newborn's full evaluation. At the same time, the neonatal neurological exam is a useful tool in identifying babies needing closer evaluation for potential problems. The Dubowitz assessment is a standardised approach to the neonatal neurological exam designed for use by paediatricians in routine practice. Evidence has validated this technique and delineated its utility as a screening exam in various populations. This paper reviews clinical application of the Dubowitz assessment of the newborn.
Collapse
Affiliation(s)
- Courtney J Wusthoff
- Division of Child Neurology, Stanford University, 750 Welch Road, Suite 317, Palo Alto, CA 94304, USA.
| |
Collapse
|
15
|
Romeo DM, Ricci D, van Haastert IC, de Vries LS, Haataja L, Brogna C, Gallini F, Romagnoli C, Cowan FM, Mercuri E. Neurologic assessment tool for screening preterm infants at term age. J Pediatr 2012; 161:1166-8. [PMID: 22910101 DOI: 10.1016/j.jpeds.2012.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/14/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
The screening assessment tool of the Dubowitz neonatal neurologic assessment was adapted for preterm infants. The findings identified as "warning signs" in preterm infants were identical to those found in full-term infants, suggesting that this screening tool can also be used in preterm infants at term age.
Collapse
|
16
|
Arichi T, Fagiolo G, Varela M, Melendez-Calderon A, Allievi A, Merchant N, Tusor N, Counsell SJ, Burdet E, Beckmann CF, Edwards AD. Development of BOLD signal hemodynamic responses in the human brain. Neuroimage 2012; 63:663-73. [PMID: 22776460 PMCID: PMC3459097 DOI: 10.1016/j.neuroimage.2012.06.054] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/08/2012] [Accepted: 06/21/2012] [Indexed: 12/19/2022] Open
Abstract
In the rodent brain the hemodynamic response to a brief external stimulus changes significantly during development. Analogous changes in human infants would complicate the determination and use of the hemodynamic response function (HRF) for functional magnetic resonance imaging (fMRI) in developing populations. We aimed to characterize HRF in human infants before and after the normal time of birth using rapid sampling of the Blood Oxygen Level Dependent (BOLD) signal. A somatosensory stimulus and an event related experimental design were used to collect data from 10 healthy adults, 15 sedated infants at term corrected post menstrual age (PMA) (median 41 + 1 weeks), and 10 preterm infants (median PMA 34 + 4 weeks). A positive amplitude HRF waveform was identified across all subject groups, with a systematic maturational trend in terms of decreasing time-to-peak and increasing positive peak amplitude associated with increasing age. Application of the age-appropriate HRF models to fMRI data significantly improved the precision of the fMRI analysis. These findings support the notion of a structured development in the brain's response to stimuli across the last trimester of gestation and beyond.
Collapse
Affiliation(s)
- Tomoki Arichi
- Centre for the Developing Brain, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Prenatal programming of human neurological function. INTERNATIONAL JOURNAL OF PEPTIDES 2011; 2011:837596. [PMID: 21760821 PMCID: PMC3133795 DOI: 10.1155/2011/837596] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 02/10/2011] [Indexed: 12/13/2022]
Abstract
The human placenta expresses the genes for proopiomelanocortin and the major stress hormone, corticotropin-releasing hormone (CRH), profoundly altering the "fight or flight" stress system in mother and fetus. As pregnancy progresses, the levels of these stress hormones, including maternal cortisol, increase dramatically. These endocrine changes are important for fetal maturation, but if the levels are altered (e.g., in response to stress), they influence (program) the fetal nervous system with long-term consequences. The evidence indicates that fetal exposure to elevated levels of stress hormones (i) delays fetal nervous system maturation, (ii) restricts the neuromuscular development and alters the stress response of the neonate, (iii) impairs mental development and increases fearful behavior in the infant, and (iv) may result in diminished gray matter volume in children. The studies reviewed indicate that fetal exposure to stress peptides and hormones exerts profound programming influences on the nervous system and may increase the risk for emotional and cognitive impairment.
Collapse
|
18
|
Moraes MVM, Tudella E, Ribeiro J, Beltrame TS, Krebs RJ. Reliability of the M-FLEX™: Equipment to measure palmar grasp strength in infants. Infant Behav Dev 2011; 34:226-34. [DOI: 10.1016/j.infbeh.2010.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 09/28/2010] [Accepted: 12/03/2010] [Indexed: 11/27/2022]
|
19
|
Ellman LM, Schetter CD, Hobel CJ, Chicz-Demet A, Glynn LM, Sandman CA. Timing of fetal exposure to stress hormones: effects on newborn physical and neuromuscular maturation. Dev Psychobiol 2008; 50:232-41. [PMID: 18335490 PMCID: PMC2851937 DOI: 10.1002/dev.20293] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of the study was to determine the specific periods during pregnancy in which human fetal exposure to stress hormones affects newborn physical and neuromuscular maturation. Blood was collected from 158 women at 15, 19, 25, and 31 weeks' gestation. Levels of placental corticotropin-releasing hormone (CRH) and maternal cortisol were determined from plasma. Newborns were evaluated with the New Ballard Maturation Score. Results indicated that increases in maternal cortisol at 15, 19, and 25 weeks and increases in placental CRH at 31 weeks were significantly associated with decreases in infant maturation among males (even after controlling for length of gestation). Results also suggested that increases in maternal cortisol at 31 weeks were associated with increases in infant maturation among females, although these results were not significant after controlling for length of gestation. Findings suggest that stress hormones have effects on human fetal neurodevelopment that are independent of birth outcome.
Collapse
Affiliation(s)
- Lauren M Ellman
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 23, New York, New York 10032, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
Despite the broad technologic advancements of medicine, screening for illness in infants is highly reliant on a complete physical exam. For this reason it is critical that the examining physician not only have a thorough understanding of abnormal findings but also the normal findings and their variants. The vast majority of infants are healthy and findings predictive of future health problems are subtle and infrequent. Yet, outcomes can be devastating. Therefore it is critical the physician remain diligent when screening for these. It is our hope that this article will assist you in this task and allow for more accurate and timely diagnosis that prevents or minimizes long-term health problems in children.
Collapse
Affiliation(s)
- Merlin C Lowe
- Department of Pediatrics, The University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5073, USA
| | | |
Collapse
|
21
|
Fitzgerald KC, Williams LS, Garg BP, Golomb MR. Epilepsy in children with delayed presentation of perinatal stroke. J Child Neurol 2007; 22:1274-80. [PMID: 18006956 DOI: 10.1177/0883073807307106] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A subgroup of children with perinatal stroke do not present clinically until after the perinatal period. Detailed epilepsy outcomes in these children have not been well studied. A retrospective cohort study of 45 children with delayed presentation of perinatal stroke identified by review of pediatric stroke clinic records, physician referral, and International Classification of Diseases, Ninth edition, code searches of hospital records, was performed at a tertiary pediatric hospital in Indianapolis, Indiana. A modified version of the Engel scale was used to grade epilepsy outcomes. The chi(2) test, Fisher's exact test, and relative risks were calculated to examine the association of epilepsy at time of last follow-up with initial presentation with seizures, infantile spasms, radiographic findings, and initial abnormal electroencephalogram (EEG). These tests were also used to examine the association of epilepsy with cognitive or motor disability and the association of initial abnormal EEG with motor disability. Patients presented with hemiparesis (40; 89%), seizures (4; 9%), or headaches (1; 2%). All had unilateral infarcts on cranial imaging. Four children (9%) had infantile spasms, 2 at presentation and 2 later. Nineteen children received at least 1 EEG for suspicious spells or frank seizures; initial EEG was abnormal in 16 patients (84%). At last follow-up, 17 patients (38%) had epilepsy, which was severe in 4 (24% of those with epilepsy). Initial presentation with seizures (relative risk = 3.2; 95% confidence interval, 2.0-4.9) and infantile spasms (relative risk = 3.2; confidence interval, 2.0-4.9) were associated with epilepsy at last follow-up. Infantile spasms were also associated with moderate-to-severe epilepsy at last follow-up (relative risk = 10.3; confidence interval, 1.9-54.4). Epilepsy at last follow-up was associated with cognitive disability (P = .05). Initial abnormal EEG was not associated with cerebral palsy (P = .30). Epilepsy is frequent in children with delayed presentation of perinatal stroke and is associated with initial presentation with seizures and infantile spasms at any point in time. Cognitive disability often accompanies epilepsy in these children.
Collapse
Affiliation(s)
- Karima C Fitzgerald
- Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | | | | |
Collapse
|