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Arena R, Gallini F, De Rose DU, Conte F, Giraldi L, Pianini T, Perri A, Catenazzi P, Orfeo L, Vento G, Govaert P. Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study. Am J Perinatol 2024; 41:488-497. [PMID: 34814194 DOI: 10.1055/a-1704-1716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain Growth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT). STUDY DESIGN In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, and 7 of life, and then weekly until discharge, and at term) in preterm infants born with gestational age (GA) less than 32 weeks. We evaluated corpus callosum length, corpus callosum-fastigium length, anterior horn width, frontal white matter height, total brain surface, deep grey matter height, hemisphere height, transverse cerebellar diameter in the axial view, and transverse cerebellar diameter coronal view. Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied. RESULTS A total of 528 cranial ultrasounds were performed in 80 neonates (median birth GA: 28+5 weeks and interquartile range: 27+3-30+5). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed. CONCLUSION B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates. KEY POINTS · Overall neonatal brain growth is not routinely monitored using ultrasound.. · Old and new markers were used to build a standardized and non-invasive tool to monitor brain growth.. · All B-GREAT measurements had a good intra-observer and inter-observer agreement..
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Affiliation(s)
- Roberta Arena
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Francesca Conte
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Luca Giraldi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa Pianini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Piero Catenazzi
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paul Govaert
- Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Toma AI, Dima V, Alexe A, Rusu L, Nemeș AF, Gonț BF, Arghirescu A, Necula A, Fieraru A, Stoiciu R. Correlations between Head Ultrasounds Performed at Term-Equivalent Age in Premature Neonates and General Movements Neurologic Examination Patterns. Life (Basel) 2023; 14:46. [PMID: 38255661 PMCID: PMC10821082 DOI: 10.3390/life14010046] [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: 11/05/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND AIM Our research aims to find correlations between the brain imaging performed at term-corrected age and the atypical general movement (GM) patterns noticed during the same visit a-cramped-synchronized (CS) or poor repertoire (PR)-in formerly premature neonates to provide evidence for the structures involved in the modulation of GM patterns that could be injured and result in the appearance of these patterns and further deficits. MATERIALS AND METHODS A total of 44 preterm neonates ((mean GA, 33.59 weeks (+2.43 weeks)) were examined in the follow-up program at Life Memorial Hospital Bucharest at term-equivalent age (TEA). The GM and ultrasound examinations were performed by trained and certified specialists. Three GM pattens were noted (normal, PR, or CS), and the measurements of the following cerebral structures were conducted via head ultrasounds: ventricular index, the short and long axes of the lateral ventricles, the midbody distance of the lateral ventricle, the diagonal of the caudate nucleus, the width of the basal ganglia, the width of the interhemispheric fissure, the sinocortical width, the length and thickness of the callosal body, the anteroposterior diameter of the pons, the diameter of the vermis, and the transverse diameters of the cerebellum and vermis. The ultrasound measurements were compared between the groups in order to find statistically significant correlations by using the FANOVA test (significance p < 0.05). RESULTS The presence of the CS movement pattern was significantly associated with an increased ventricular index (mean 11.36 vs. 8.90; p = 0.032), increased midbody distance of the lateral ventricle-CS versus PR (8.31 vs. 3.73; p = 0.001); CS versus normal (8.31 vs. 3.34; p = 0.001), increased long and short axes of the lateral ventricles (p < 0.001), and decreased width of the basal ganglia-CS versus PR (11.07 vs. 15.69; p = 0.001); CS versus normal pattern (11.07 vs. 15.15; p = 0.0010). The PR movement pattern was significantly associated with an increased value of the sinocortical width when compared to the CS pattern (p < 0.001) and a decreased anteroposterior diameter of the pons when compared to both the CS (12.06 vs. 16.83; p = 0.001) and normal (12.06 vs. 16.78; p = 0.001) patterns. The same correlations were present when the subgroup of infants with a GA ≤ 32 weeks was analyzed. CONCLUSIONS Our study demonstrated that there are correlations between atypical GM patterns (cramped-synchronized-CS and poor repertoire-PR) and abnormalities in the dimensions of the structures measured via ultrasound at the term-equivalent age. The correlations could provide information about the structures that are affected and could lead to a lack of modulation in the GM patterns.
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Affiliation(s)
- Adrian Ioan Toma
- Life Memorial Hospital, 010719 Bucharest, Romania (B.F.G.)
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
| | - Vlad Dima
- Filantropia Clinical Hospital, Neonatology Department, 011132 Bucharest, Romania
| | | | - Lidia Rusu
- Regional Center of Public Health, 700465 Iasi, Romania
| | - Alexandra Floriana Nemeș
- Life Memorial Hospital, 010719 Bucharest, Romania (B.F.G.)
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
| | | | | | - Andreea Necula
- Life Memorial Hospital, 010719 Bucharest, Romania (B.F.G.)
| | - Alina Fieraru
- Life Memorial Hospital, 010719 Bucharest, Romania (B.F.G.)
| | - Roxana Stoiciu
- Life Memorial Hospital, 010719 Bucharest, Romania (B.F.G.)
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Ultrasound measurements of brain structures differ between moderate-late preterm and full-term infants at term equivalent age. Early Hum Dev 2021; 160:105424. [PMID: 34303106 DOI: 10.1016/j.earlhumdev.2021.105424] [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: 05/20/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Brain growth in moderate preterm (MP; gestational age (GA) 32+0-33+6 weeks) and late preterm infants (LP; GA 34+0-36+6 weeks) may be impaired, even in the absence of brain injury. AIMS The aims of this study were to assess brain measurements of MP and LP infants, and to compare these with full-term infants (GA > 37 weeks) using linear cranial ultrasound (cUS) at term equivalent age (TEA). STUDY DESIGN cUS data from two prospective cohorts were combined. Two investigators performed offline measurements on standard cUS planes. Eleven brain structures were compared between MP, LP and full-term infants using uni- and multivariable linear regression. Results were adjusted for postmenstrual age at cUS and corrected for multiple testing. RESULTS Brain measurements of 44 MP, 54 LP and 52 full-term infants were determined on cUS scans at TEA. Biparietal diameter and basal ganglia-insula width were smaller in MP (-9.1 mm and - 1.7 mm, p < 0.001) and LP infants (-7.0 mm and - 1.7 mm, p < 0.001) compared to full-term infants. Corpus callosum - fastigium length was larger in MP (+2.2 mm, p < 0.001) than in full-term infants. No significant differences were found between MP and LP infants. CONCLUSIONS These findings suggest that brain growth in MP and LP infants differs from full-term infants. Whether these differences have clinical implications remains to be investigated.
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Boswinkel V, Krüse-Ruijter MF, Nijboer-Oosterveld J, Nijholt IM, Edens MA, Mulder-de Tollenaer SM, Smit-Wu MN, Boomsma MF, de Vries LS, van Wezel-Meijler G. Incidence of brain lesions in moderate-late preterm infants assessed by cranial ultrasound and MRI: The BIMP-study. Eur J Radiol 2020; 136:109500. [PMID: 33429207 DOI: 10.1016/j.ejrad.2020.109500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the incidence and characteristics of brain lesions in moderate-late preterm (MLPT) infants, born at 32-36 weeks' gestation using cranial ultrasound (cUS) and magnetic resonance imaging (MRI). METHODS Prospective cohort study carried out at Isala Women and Children's Hospital between August 2017 and November 2019. cUS was performed at postnatal day 3-4 (early-cUS), before discharge and repeated at term equivalent age (TEA) in MLPT infants born between 32+0 and 35+6 weeks' gestation. At TEA, MRI was also performed. Several brain lesions were assessed e.g. hemorrhages, white matter and deep gray matter injury. Brain maturation was visually evaluated. Lesions were classified as mild or moderate-severe. Incidences and confidence intervals were calculated. RESULTS 166 MLPT infants were included of whom 127 underwent MRI. One or more mild lesions were present in 119/166 (71.7 %) and moderate-severe lesions in 6/166 (3.6 %) infants on cUS and/or MRI. The most frequent lesions were signs suggestive of white matter injury: inhomogeneous echogenicity in 50/164 infants (30.5 %) at early-cUS, in 12/148 infants (8.1 %) at TEA-cUS and diffuse white matter signal changes (MRI) in 27/127 (23.5 %) infants. Cerebellar hemorrhage (MRI) was observed in 16/127 infants (12.6 %). Delayed maturation (MRI) was seen in 17/117 (13.4 %) infants. Small hemorrhages and punctate white matter lesions were more frequently detected on MRI than on cUS. CONCLUSIONS In MLPT infants mild brain lesions were frequently encountered, especially signs suggestive of white matter injury and small hemorrhages. Moderate-severe lesions were less frequently seen.
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Affiliation(s)
- Vivian Boswinkel
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | | | | | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, the Netherlands
| | | | - Mei-Nga Smit-Wu
- Department of Pediatrics, Isala Women and Children's Hospital, Zwolle, the Netherlands
| | | | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Agut T, Alarcon A, Cabañas F, Bartocci M, Martinez-Biarge M, Horsch S. Preterm white matter injury: ultrasound diagnosis and classification. Pediatr Res 2020; 87:37-49. [PMID: 32218534 PMCID: PMC7098888 DOI: 10.1038/s41390-020-0781-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential neuroimaging in preterm infants, and is reliable for the diagnosis of cystic periventricular leukomalacia. Although magnetic resonance imaging is superior to CUS in detecting the diffuse and more subtle forms of WMI that prevail in very premature infants surviving nowadays, recent improvement in the quality of neonatal CUS imaging has broadened the spectrum of preterm white matter abnormalities that can be detected with this technique. We propose a structured CUS assessment of WMI of prematurity that seeks to account for both cystic and non-cystic changes, as well as signs of white matter loss and impaired brain growth and maturation, at or near term equivalent age. This novel assessment system aims to improve disease description in both routine clinical practice and clinical research. Whether this systematic assessment will improve prediction of outcome in preterm infants with WMI still needs to be evaluated in prospective studies.
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Affiliation(s)
- Thais Agut
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - Ana Alarcon
- 0000 0001 0663 8628grid.411160.3Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Fernando Cabañas
- 0000 0000 8970 9163grid.81821.32Department of Neonatology, Quironsalud Madrid University Hospital and Biomedical Research Foundation, La Paz University Hospital Madrid, Madrid, Spain
| | - Marco Bartocci
- Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Miriam Martinez-Biarge
- 0000 0001 2113 8111grid.7445.2Department of Paediatrics, Imperial College London, London, UK
| | - Sandra Horsch
- 0000 0000 8778 9382grid.491869.bDepartment of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany ,0000 0004 1937 0626grid.4714.6Department Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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6
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Cuzzilla R, Spittle AJ, Lee KJ, Rogerson S, Cowan FM, Doyle LW, Cheong JLY. Postnatal Brain Growth Assessed by Sequential Cranial Ultrasonography in Infants Born <30 Weeks' Gestational Age. AJNR Am J Neuroradiol 2018; 39:1170-1176. [PMID: 29773561 DOI: 10.3174/ajnr.a5679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/05/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Brain growth in the early postnatal period following preterm birth has not been well described. This study of infants born at <30 weeks' gestational age and without major brain injury aimed to accomplish the following: 1) assess the reproducibility of linear measures made from cranial ultrasonography, 2) evaluate brain growth using sequential cranial ultrasonography linear measures from birth to term-equivalent age, and 3) explore perinatal predictors of postnatal brain growth. MATERIALS AND METHODS Participants comprised 144 infants born at <30 weeks' gestational age at a single center between January 2011 and December 2013. Infants with major brain injury seen on cranial ultrasonography or congenital or chromosomal abnormalities were excluded. Brain tissue and fluid spaces were measured from cranial ultrasonography performed as part of routine clinical care. Brain growth was assessed in 3 time intervals: <7, 7-27, and >27 days' postnatal age. Data were analyzed using intraclass correlation coefficients and mixed-effects regression. RESULTS A total of 429 scans were assessed for 144 infants. Several linear measures showed excellent reproducibility. All measures of brain tissue increased with postnatal age, except for the biparietal diameter, which decreased within the first postnatal week and increased thereafter. Gestational age of ≥28 weeks at birth was associated with slower growth of the biparietal diameter and ventricular width compared with gestational age of <28 weeks. Postnatal corticosteroid administration was associated with slower growth of the corpus callosum length, transcerebellar diameter, and vermis height. Sepsis and necrotizing enterocolitis were associated with slower growth of the transcerebellar diameter. CONCLUSIONS Postnatal brain growth in infants born at <30 weeks' gestational age can be evaluated using sequential linear measures made from routine cranial ultrasonography and is associated with perinatal predictors of long-term development.
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Affiliation(s)
- R Cuzzilla
- From the Victorian Infant Brain Studies research group (R.C., A.J.S., K.J.L., L.W.D., J.L.Y.C.), Murdoch Childrens Research Institute, Melbourne, Australia .,Departments of Obstetrics and Gynaecology (R.C., S.R., L.W.D., J.L.Y.C.).,Neonatal Services (R.C., A.J.S., S.R., L.W.D., J.L.Y.C.), The Royal Women's Hospital, Melbourne, Australia
| | - A J Spittle
- From the Victorian Infant Brain Studies research group (R.C., A.J.S., K.J.L., L.W.D., J.L.Y.C.), Murdoch Childrens Research Institute, Melbourne, Australia.,Physiotherapy (A.J.S.), University of Melbourne, Melbourne, Australia.,Neonatal Services (R.C., A.J.S., S.R., L.W.D., J.L.Y.C.), The Royal Women's Hospital, Melbourne, Australia
| | - K J Lee
- From the Victorian Infant Brain Studies research group (R.C., A.J.S., K.J.L., L.W.D., J.L.Y.C.), Murdoch Childrens Research Institute, Melbourne, Australia.,Paediatrics (K.J.L., L.W.D.)
| | - S Rogerson
- Departments of Obstetrics and Gynaecology (R.C., S.R., L.W.D., J.L.Y.C.).,Neonatal Services (R.C., A.J.S., S.R., L.W.D., J.L.Y.C.), The Royal Women's Hospital, Melbourne, Australia
| | - F M Cowan
- Department of Paediatrics (F.M.C.), Imperial College, London, UK
| | - L W Doyle
- From the Victorian Infant Brain Studies research group (R.C., A.J.S., K.J.L., L.W.D., J.L.Y.C.), Murdoch Childrens Research Institute, Melbourne, Australia.,Departments of Obstetrics and Gynaecology (R.C., S.R., L.W.D., J.L.Y.C.).,Paediatrics (K.J.L., L.W.D.).,Neonatal Services (R.C., A.J.S., S.R., L.W.D., J.L.Y.C.), The Royal Women's Hospital, Melbourne, Australia
| | - J L Y Cheong
- From the Victorian Infant Brain Studies research group (R.C., A.J.S., K.J.L., L.W.D., J.L.Y.C.), Murdoch Childrens Research Institute, Melbourne, Australia.,Departments of Obstetrics and Gynaecology (R.C., S.R., L.W.D., J.L.Y.C.).,Neonatal Services (R.C., A.J.S., S.R., L.W.D., J.L.Y.C.), The Royal Women's Hospital, Melbourne, Australia
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Koning IV, Roelants JA, Groenenberg IAL, Vermeulen MJ, Willemsen SP, Reiss IKM, Govaert PP, Steegers-Theunissen RPM, Dudink J. New Ultrasound Measurements to Bridge the Gap between Prenatal and Neonatal Brain Growth Assessment. AJNR Am J Neuroradiol 2017; 38:1807-1813. [PMID: 28663264 DOI: 10.3174/ajnr.a5278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Most ultrasound markers for monitoring brain growth can only be used in either the prenatal or the postnatal period. We investigated whether corpus callosum length and corpus callosum-fastigium length could be used as markers for both prenatal and postnatal brain growth. MATERIALS AND METHODS A 3D ultrasound study embedded in the prospective Rotterdam Periconception Cohort was performed at 22, 26 and 32 weeks' gestational age in fetuses with fetal growth restriction, congenital heart defects, and controls. Postnatally, cranial ultrasound was performed at 42 weeks' postmenstrual age. First, reliability was evaluated. Second, associations between prenatal and postnatal corpus callosum and corpus callosum-fastigium length were investigated. Third, we created reference curves and compared corpus callosum and corpus callosum-fastigium length growth trajectories of controls with growth trajectories of fetuses with fetal growth retardation and congenital heart defects. RESULTS We included 199 fetuses; 22 with fetal growth retardation, 20 with congenital heart defects, and 157 controls. Reliability of both measurements was excellent (intraclass correlation coefficient ≥ 0.97). Corpus callosum growth trajectories were significantly decreased in fetuses with fetal growth restriction and congenital heart defects (β = -2.295; 95% CI, -3.320-1.270; P < .01; β = -1.267; 95% CI, -0.972-0.562; P < .01, respectively) compared with growth trajectories of controls. Corpus callosum-fastigium growth trajectories were decreased in fetuses with fetal growth restriction (β = -1.295; 95% CI, -2.595-0.003; P = .05). CONCLUSIONS Corpus callosum and corpus callosum-fastigium length may serve as reliable markers for monitoring brain growth from the prenatal into the postnatal period. The clinical applicability of these markers was established by the significantly different corpus callosum and corpus callosum-fastigium growth trajectories in fetuses at risk for abnormal brain growth compared with those of controls.
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Affiliation(s)
- I V Koning
- From the Department of Obstetrics and Gynecology (I.V.K., J.A.R., I.A.L.G., S.P.W., R.P.M.S.-T.), Division of Obstetrics and Prenatal Medicine.,Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J A Roelants
- From the Department of Obstetrics and Gynecology (I.V.K., J.A.R., I.A.L.G., S.P.W., R.P.M.S.-T.), Division of Obstetrics and Prenatal Medicine.,Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - I A L Groenenberg
- From the Department of Obstetrics and Gynecology (I.V.K., J.A.R., I.A.L.G., S.P.W., R.P.M.S.-T.), Division of Obstetrics and Prenatal Medicine
| | - M J Vermeulen
- Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S P Willemsen
- From the Department of Obstetrics and Gynecology (I.V.K., J.A.R., I.A.L.G., S.P.W., R.P.M.S.-T.), Division of Obstetrics and Prenatal Medicine.,Department of Biostatistics (S.P.W.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - I K M Reiss
- Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - P P Govaert
- Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neonatology (P.P.G.), ZNA Koningin Paola Ziekenhuis, Antwerp, Belgium
| | - R P M Steegers-Theunissen
- From the Department of Obstetrics and Gynecology (I.V.K., J.A.R., I.A.L.G., S.P.W., R.P.M.S.-T.), Division of Obstetrics and Prenatal Medicine.,Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J Dudink
- Department of Pediatrics (I.V.K., J.A.R., M.J.V., I.K.M.R., P.P.G., R.P.M.S.-T., J.D.), Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands .,Department of Neonatology (J.D.), Wilhelmina's Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Clay DE, Linke AC, Cameron DJ, Stojanoski B, Rulisa S, Wasunna A, de Ribaupierre S, Cusack R. Evaluating Affordable Cranial Ultrasonography in East African Neonatal Intensive Care Units. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:119-128. [PMID: 27773345 DOI: 10.1016/j.ultrasmedbio.2016.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/18/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Abstract
Neuroimaging is a valuable diagnostic tool for the early detection of neonatal brain injury, but equipment and radiologic staff are expensive and unavailable to most hospitals in developing countries. We evaluated an affordable, portable ultrasound machine as a quantitative and qualitative diagnostic tool and to establish whether a novice sonographer could effectively operate the equipment and obtain clinically important information. Cranial ultrasonography was performed on term healthy, pre-term and term asphyxiated neonates in Rwandan and Kenyan hospitals. To evaluate the detection of ventriculomegaly and compression injuries, we measured the size of the lateral ventricles and corpus callosum. The images were also assessed for the presence of other cerebral abnormalities. Measurements were reliable across images, and cases of clinically relevant ventriculomegaly were detected. A novice sonographer had good-to-excellent agreement with an expert. This study demonstrates that affordable equipment and cranial ultrasound protocols can be used in low-resource settings to assess the newborn brain.
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Affiliation(s)
- David E Clay
- Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Annika C Linke
- Brain and Mind Institute, Western University, London, Ontario, Canada.
| | - Daniel J Cameron
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Bobby Stojanoski
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Stephen Rulisa
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Aggrey Wasunna
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Sandrine de Ribaupierre
- Anatomy and Cell Biology, Western University, London, Ontario, Canada; Brain and Mind Institute, Western University, London, Ontario, Canada; Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Rhodri Cusack
- Brain and Mind Institute, Western University, London, Ontario, Canada
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Roelants JA, Koning IV, Raets MMA, Willemsen SP, Lequin MH, Steegers-Theunissen RPM, Reiss IKM, Vermeulen MJ, Govaert P, Dudink J. A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth. AJNR Am J Neuroradiol 2016; 37:1516-22. [PMID: 26988817 DOI: 10.3174/ajnr.a4731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preterm neonates are at risk for neurodevelopmental impairment, but reliable, bedside-available markers to monitor preterm brain growth during hospital stay are still lacking. The aim of this study was to assess the feasibility of corpus callosum-fastigium length as a new cranial sonography marker for monitoring of preterm brain growth. MATERIALS AND METHODS In this longitudinal prospective cohort study, cranial ultrasound was planned on the day of birth, days 1, 2, 3, and 7 of life; and then weekly until discharge in preterm infants born before 29 weeks of gestational age. Reproducibility and associations between clinical variables and corpus callosum-fastigium growth trajectories were studied. RESULTS A series of 1-8 cranial ultrasounds was performed in 140 infants (median gestational age at birth, 27(+2) weeks (interquartile range, 26(+1) to 28(+1); 57.9% male infants). Corpus callosum-fastigium measurements showed good-to-excellent agreement for inter- and intraobserver reproducibility (intraclass correlation coefficient >0.89). Growth charts for preterm infants between 24 and 32 weeks of gestation were developed. Male sex and birth weight SD score were positively associated with corpus callosum-fastigium growth rate. CONCLUSIONS Corpus callosum-fastigium length measurement is a new reproducible marker applicable for bedside monitoring of preterm brain growth during neonatal intensive care stay.
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Affiliation(s)
- J A Roelants
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - I V Koning
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - M M A Raets
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - S P Willemsen
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.) Biostatistics (S.P.W.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M H Lequin
- Department of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - I K M Reiss
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - M J Vermeulen
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - P Govaert
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - J Dudink
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Department of Radiology (J.D.) Intensive Care Unit (J.D.), Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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10
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Tann CJ, Nakakeeto M, Hagmann C, Webb EL, Nyombi N, Namiiro F, Harvey-Jones K, Muhumuza A, Burgoine K, Elliott AM, Kurinczuk JJ, Robertson NJ, Cowan FM. Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study. Pediatr Res 2016; 80:190-6. [PMID: 27064242 PMCID: PMC4992358 DOI: 10.1038/pr.2016.77] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury. METHODS Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status. RESULTS Scans were performed at median age 11.5 (interquartile range (IQR): 5.2-20.2) and 8.4 (IQR: 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61-6.95)). CONCLUSION In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischemia (HI). Early abnormalities were a significant predictor of death.
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Affiliation(s)
- Cally J. Tann
- Institute for Women's Health, University College London, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
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| | | | - Cornelia Hagmann
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Emily L. Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - Natasha Nyombi
- Department of Paediatrics, Mulago Hospital, Kampala, Uganda
| | | | | | - Anita Muhumuza
- Department of Paediatrics, Mulago Hospital, Kampala, Uganda
| | - Kathy Burgoine
- Institute for Women's Health, University College London, London, UK
| | - Alison M. Elliott
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
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Scott GG, Margulies SS, Coats B. Utilizing multiple scale models to improve predictions of extra-axial hemorrhage in the immature piglet. Biomech Model Mechanobiol 2015; 15:1101-19. [DOI: 10.1007/s10237-015-0747-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
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12
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Ultrasound detection of posterior fossa abnormalities in full-term neonates. Early Hum Dev 2012; 88:233-9. [PMID: 21924565 DOI: 10.1016/j.earlhumdev.2011.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/11/2011] [Accepted: 08/23/2011] [Indexed: 11/20/2022]
Abstract
Routine cranial ultrasonography, using the anterior fontanelle as acoustic window enables visualization of the supratentorial brain structures in neonates and young infants. The mastoid fontanelle enables a better view of the infratentorial structures, especially cerebellar hemorrhage in preterm infants. Reports on the usefulness and reliability of cranial ultrasonography using the mastoid fontanelle approach for the detection of posterior fossa abnormalities, focusing only on full-term neonates are limited. This article describes the technique of mastoid fontanelle ultrasonography in full-term neonates and the features of posterior fossa abnormalities that may be encountered in various neonatal disorders and conditions, combined with subsequent MRI in the same patients. Cranial ultrasound through the mastoid fontanelle plays a pivotal role in the early detection of posterior fossa pathology and selection of neonates with an indication for MRI.
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