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Wu X, Xie C, Cheng F, Li Z, Li R, Xu D, Kim H, Zhang J, Liu H, Liu M. Comparative evaluation of interpretation methods in surface-based age prediction for neonates. Neuroimage 2024; 300:120861. [PMID: 39326769 DOI: 10.1016/j.neuroimage.2024.120861] [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] [Received: 08/18/2024] [Revised: 09/15/2024] [Accepted: 09/18/2024] [Indexed: 09/28/2024] Open
Abstract
Significant changes in brain morphology occur during the third trimester of gestation. The capability of deep learning in leveraging these morphological features has enhanced the accuracy of brain age predictions for this critical period. Yet, the opaque nature of deep learning techniques, often described as "black box" approaches, limits their interpretability, posing challenges in clinical applications. Traditional interpretable methods developed for computer vision and natural language processing may not directly translate to the distinct demands of neuroimaging. In response, our research evaluates the effectiveness and adaptability of two interpretative methods-regional age prediction and the perturbation-based saliency map approach-for predicting the brain age of neonates. Analyzing 664 T1 MRI scans with the NEOCIVET pipeline to extract brain surface and cortical features, we assess how these methods illuminate key brain regions for age prediction, focusing on technical analysis with clinical insight. Through a comparative analysis of the saliency index (SI) with relative brain age (RBA) and the examination of structural covariance networks, we uncover the saliency index's enhanced ability to pinpoint regions vital for accurate indication of clinical factors. Our results highlight the advantages of perturbation techniques in addressing the complexities of medical data, steering clinical interventions for premature neonates towards more personalized and interpretable approaches. This study not only reveals the promise of these methods in complex medical scenarios but also offers a blueprint for implementing more interpretable and clinically relevant deep learning models in healthcare settings.
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Affiliation(s)
- Xiaotong Wu
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China
| | - Chenxin Xie
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Fangxiao Cheng
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Zhuoshuo Li
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China
| | - Ruizhuo Li
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Duan Xu
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Hosung Kim
- Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jianjia Zhang
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China; Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing University of Aeronautics and Astronautics, Nanjing, China.
| | - Hongsheng Liu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
| | - Mengting Liu
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, 518107, China.
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de Groot ER, Wang X, Wojtal K, Janson E, Alderliesten T, Tataranno ML, Benders MJNL, Dudink J. Association between sleep stages and brain microstructure in preterm infants: Insights from DTI analysis. Sleep Med 2024; 121:336-342. [PMID: 39053129 DOI: 10.1016/j.sleep.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
STUDY OBJECTIVES The aim of this study was to investigate the relationship between sleep stages and neural microstructure - measured using diffusion tensor imaging - of the posterior limb of the internal capsule and corticospinal tract in preterm infants. METHODS A retrospective cohort of 50 preterm infants born between 24 + 4 and 29 + 3 weeks gestational age was included in the study. Sleep stages were continuously measured for 5-7 consecutive days between 29 + 0 and 31 + 6 weeks postmenstrual age using an in-house-developed, and recently published, automated sleep staging algorithm based on routinely measured heart rate and respiratory rate. Additionally, a diffusion tensor imaging scan was conducted at term equivalent age as part of standard care. Region of interest analysis of the posterior limb of the internal capsule was performed, and tractography was used to analyze the corticospinal tract. The association between sleep and white matter microstructure of the posterior limb of the internal capsule and corticospinal tract was examined using a multiple linear regression model, adjusted for potential confounders. RESULTS The results of the analyses revealed an interaction effect between sleep stage and days of invasive ventilation on the fractional anisotropy of the left and right posterior limb of the internal capsule (β = 0.04, FDR-adjusted p = 0.001 and β = 0.04, FDR-adjusted p = 0.02, respectively). Furthermore, an interaction effect between sleep stage and days of invasive ventilation was observed for the radial diffusivity of the mean of the left and right PLIC (β = -4.1e-05, FDR-adjusted p = 0.04). CONCLUSIONS Previous research has shown that, in very preterm infants, invasive ventilation has a negative effect on white matter tract maturation throughout the brain. A positive association between active sleep and white matter microstructure of the posterior limb of the internal capsule, may indicate a protective role of sleep in this vulnerable population.
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Affiliation(s)
- Eline R de Groot
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Xiaowan Wang
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Klaudia Wojtal
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Els Janson
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Maria Luisa Tataranno
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
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Henkel RD, Fu TT, Barnes-Davis ME, Sahay RD, Liu C, Hill CD, Ehrlich SR, Parikh NA. Effects of Early Enteral to Parenteral Protein Ratios on Brain Volume and Somatic Growth in Very Low Birth Weight Infants. J Pediatr 2024; 275:114253. [PMID: 39181317 DOI: 10.1016/j.jpeds.2024.114253] [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: 04/10/2024] [Revised: 07/19/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To evaluate whether a higher proportion of enteral vs parenteral protein ratio (E:P ratio) in the first 28 days after birth is associated with increased brain volume and somatic growth in very low birth weight (VLBW; birth weight <1500 g) infants. STUDY DESIGN This was a retrospective analysis of a subcohort of VLBW infants (n = 256, gestational age mean 28.07 [SD 2.17] weeks, birth weight 1038.80 [SD 262.95] grams) from the Cincinnati Infant Neurodevelopment Early Prediction Study, a regional prospective study of infants born at ≤32 weeks' gestation. Brain magnetic resonance imaging was obtained at term-equivalent age. Macronutrient intake and growth metrics for the first 28 days were collected retrospectively. The primary outcome was total brain tissue volume. The relationships between E:P ratio, total and regional brain tissue volumes, and somatic growth were analyzed by multivariable linear regression models; composite variables were used to adjust for potential confounders including pregnancy risk factors and initial severity of illness. RESULTS Higher E:P ratio was associated with increased total brain tissue volume but was not associated with change in head circumference z score. In secondary analyses, higher E:P ratio was associated with increased weight velocity. There were no significant associations between E:P ratio and change in weight or length z scores or regional brain volumes. CONCLUSIONS Higher E:P ratio in the first 28 days was positively associated with total brain volume and weight gain. Promoting the provision of enteral over parenteral protein may improve brain and somatic growth in VLBW infants.
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Affiliation(s)
- Rebecca D Henkel
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Ting Ting Fu
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Maria E Barnes-Davis
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Crystal D Hill
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shelley R Ehrlich
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nehal A Parikh
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Yu WH, Chu CH, Chen LW, Lin YC, Koh CL, Huang CC. The developmental phenotype of motor delay in extremely preterm infants following early-life respiratory adversity is influenced by brain dysmaturation in the parietal lobe. J Neurodev Disord 2024; 16:38. [PMID: 39010007 PMCID: PMC11247839 DOI: 10.1186/s11689-024-09546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Research indicates that preterm infants requiring prolonged mechanical ventilation often exhibit suboptimal neurodevelopment at follow-up, coupled with altered brain development as detected by magnetic resonance imaging (MRI) at term-equivalent age (TEA). However, specific regions of brain dysmaturation and the subsequent neurodevelopmental phenotype following early-life adverse respiratory exposures remain unclear. Additionally, it is uncertain whether brain dysmaturation mediates neurodevelopmental outcomes after respiratory adversity. This study aims to investigate the relationship between early-life adverse respiratory exposures, brain dysmaturation at TEA, and the developmental phenotype observed during follow-up in extremely preterm infants. METHODS 89 infants born < 29 weeks' gestation from 2019 to 2021 received MRI examinations at TEA for structural and lobe brain volumes, which were adjusted with sex-and-postmenstrual-age expected volumes for volume residuals. Assisted ventilation patterns in the first 8 postnatal weeks were analyzed using kmlShape analyses. Patterns for motor, cognition, and language development were evaluated from corrected age 6 to 12 months using Bayley Scales of Infant Development, third edition. Mediation effects of brain volumes between early-life respiratory exposures and neurodevelopmental phenotypes were adjusted for sex, gestational age, maternal education, and severe brain injury. RESULTS Two distinct respiratory trajectories with varying severity were identified: improving (n = 35, 39%) and delayed improvement (n = 54, 61%). Compared with the improving group, the delayed improvement group exhibited selectively reduced brain volume residuals in the parietal lobe (mean - 4.9 cm3, 95% confidence interval - 9.4 to - 0.3) at TEA and lower motor composite scores (- 8.7, - 14.2 to - 3.1) at corrected age 12 months. The association between delayed respiratory improvement and inferior motor performance (total effect - 8.7, - 14.8 to - 3.3) was partially mediated through reduced parietal lobe volume (natural indirect effect - 1.8, - 4.9 to - 0.01), suggesting a mediating effect of 20%. CONCLUSIONS Early-life adverse respiratory exposure is specifically linked to the parietal lobe dysmaturation and neurodevelopmental phenotype of motor delay at follow-up. Dysmaturation of the parietal lobe serves as a mediator in the connection between respiratory adversity and compromised motor development. Optimizing respiratory critical care may emerge as a potential avenue to mitigate the consequences of altered brain growth and motor developmental delay in this extremely preterm population.
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Affiliation(s)
- Wen-Hao Yu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Hsiang Chu
- Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 70101, Taiwan.
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei, 23561, Taiwan.
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5
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Tang X, Sha S, Bei F, Shen N, Zhu Z, Ren Z, Gao W, Wang Q, Tian S, Jin Q, Shayiti S, Zhang Y. Uni- and multimodal sensory-supported interventions for very preterm and extremely preterm infants in the neonatal intensive care unit: An overview of systematic reviews and interventional studies. Nurs Crit Care 2024. [PMID: 38945698 DOI: 10.1111/nicc.13112] [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: 03/28/2023] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Very and extremely preterm infants (VEPIs) experience sensory deprivation in the neonatal intensive care unit (NICU). While various sensory-supported interventions might improve immediate physiological response, their impact on long-term development remains unclear. Additionally, these interventions may pose challenges in the NICU environment due to complex treatments and monitoring requirements. AIMS This review aimed to understand the current evidence on sensory-supported interventions in the NICU, identify the components of these interventions and determine their effects on the VEPIs. STUDY DESIGN A systematic search across nine electronic databases (PubMed, EBSCO, EMBASE, Web of Science, Scopus, Cochrane, Cochrane trial, IEEE Xplore DL and ACM DL) was conducted in December 2020 and updated in September 2022. The search gathers information on sensory-supported interventions for VEPIs in the NICU. RESULTS The search yielded 23 systematic reviews and 22 interventional studies, categorized into auditory (19), tactile/kinesthetic (5), positional/movement support (7), visual (1) and multisensory (13) interventions. While unimodal and multimodal interventions showed short-term benefits, their long-term effects on VEPIs are indeterminate. Translating these findings into clinical practice remains a challenge due to identified gaps. CONCLUSION Our reviews indicate that sensory-supported interventions have a transient impact, with intervention studies reporting positive effects. Future research should develop and test comprehensive, continuous multisensory interventions tailored for the early NICU stage. RELEVANCE TO CLINICAL PRACTICE Multimodal sensory interventions show promise for VEPIs, but long-term effects need further study. Standardizing protocols for NICU integration and parental involvement is crucial. Ongoing research and collaboration are essential for optimizing interventions and personalized care.
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Affiliation(s)
- Xiaoli Tang
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sha Sha
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Bei
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nanping Shen
- Department of Nursing, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyu Zhu
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijin Ren
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Wenying Gao
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Qihui Wang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Siying Tian
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Qian Jin
- Department of Neonatology, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Subinuer Shayiti
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
- Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Zhang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
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Moltu SJ, Nordvik T, Rossholt ME, Wendel K, Chawla M, Server A, Gunnarsdottir G, Pripp AH, Domellöf M, Bratlie M, Aas M, Hüppi PS, Lapillonne A, Beyer MK, Stiris T, Maximov II, Geier O, Pfeiffer H. Arachidonic and docosahexaenoic acid supplementation and brain maturation in preterm infants; a double blind RCT. Clin Nutr 2024; 43:176-186. [PMID: 38061271 DOI: 10.1016/j.clnu.2023.11.037] [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] [Received: 08/25/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are important structural components of neural cellular membranes and possess anti-inflammatory properties. Very preterm infants are deprived of the enhanced placental supply of these fatty acids, but the benefit of postnatal supplementation on brain development is uncertain. The aim of this study was to test the hypothesis that early enteral supplementation with ARA and DHA in preterm infants improves white matter (WM) microstructure assessed by diffusion-weighted MRI at term equivalent age. METHODS In this double-blind, randomized controlled trial, infants born before 29 weeks gestational age were allocated to either 100 mg/kg ARA and 50 mg/kg DHA (ARA:DHA group) or medium chain triglycerides (control). Supplements were started on the second day of life and provided until 36 weeks postmenstrual age. The primary outcome was brain maturation assessed by diffusion tensor imaging (DTI) using Tract-Based Spatial Statistics (TBSS) analysis. RESULTS We included 120 infants (60 per group) in the trial; mean (range) gestational age was 26+3 (22+6 - 28+6) weeks and postmenstrual age at scan was 41+3 (39+1 - 47+0) weeks. Ninety-two infants underwent MRI imaging, and of these, 90 had successful T1/T2 weighted MR images and 74 had DTI data of acceptable quality. TBSS did not show significant differences in mean or axial diffusivity between the groups, but demonstrated significantly higher fractional anisotropy in several large WM tracts in the ARA:DHA group, including corpus callosum, the anterior and posterior limb of the internal capsula, inferior occipitofrontal fasciculus, uncinate fasciculus, and the inferior longitudinal fasciculus. Radial diffusivity was also significantly lower in several of the same WM tracts in the ARA:DHA group. CONCLUSION This study suggests that supplementation with ARA and DHA at doses matching estimated fetal accretion rates improves WM maturation compared to control treatment, but further studies are needed to ascertain any functional benefit. CLINICAL TRIAL REGISTRATION www. CLINICALTRIALS gov; ID:NCT03555019.
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Affiliation(s)
- Sissel J Moltu
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway.
| | - Tone Nordvik
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Madelaine E Rossholt
- Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Kristina Wendel
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Maninder Chawla
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Andres Server
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, 90185 Umeå, Sweden
| | - Marianne Bratlie
- Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Marlen Aas
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Petra S Hüppi
- Department of Woman, Child and Adolescent Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Alexandre Lapillonne
- Department of Neonatal Intensive Care, APHP Necker-Enfants Malades Hospital, Paris University, 75015 Paris, France
| | - Mona K Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Stiris
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivan I Maximov
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Oliver Geier
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norwary
| | - Helle Pfeiffer
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway; Department of Pediatric Neurology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Buchmayer J, Kasprian G, Jernej R, Stummer S, Schmidbauer V, Giordano V, Klebermass-Schrehof K, Berger A, Goeral K. Magnetic Resonance Imaging-Based Reference Values for Two-Dimensional Quantitative Brain Metrics in a Cohort of Extremely Preterm Infants. Neonatology 2023; 121:97-105. [PMID: 37866350 PMCID: PMC10836753 DOI: 10.1159/000534009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Cerebral magnetic resonance imaging (cMRI) is an important diagnostic tool in neonatology. In addition to qualitative analysis, quantitative measurements may help identify infants with impaired brain growth. This study aimed to create reference values for brain metrics of various brain areas in neonates without major brain injuries born before 28 weeks of gestation. METHODS This retrospective study analyzes cMRI imaging data of high-risk patients without severe brain pathologies at term-equivalent age, collected over 4 years since November 2017. Nineteen brain areas were measured, reference values created, and compared to published values from fetal and postnatal MRI. Furthermore, correlations between brain metrics and gestational age at birth were evaluated. RESULTS A total of 174 cMRI examinations were available for analysis. Reference values including cut-offs for impaired brain growth were established for different gestational age groups. There was a significant correlation between gestational age at birth and larger "tissue" parameters, as well as smaller "fluid" parameters, including intracerebral and extracerebral spaces. DISCUSSION With quantitative brain metrics infants with impaired brain growth might be detected earlier. Compared to preexisting reference values, these are the first of a contemporary collective of extremely preterm neonates without severe brain injuries. Measurements can be easily performed by radiologists as well as neonatologists without specialized equipment or computational expertise. CONCLUSION Two-dimensional cMRI brain measurements at term-equivalent age represent an easy and reliable approach for the evaluation of brain size and growth in infants at high risk for neurodevelopmental impairment.
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Affiliation(s)
- Julia Buchmayer
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria,
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Raphaela Jernej
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sophie Stummer
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Victor Schmidbauer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Erdei C, Bell KA, Garvey AA, Blaschke C, Belfort MB, Inder TE. Novel metrics to characterize temporal lobe of very preterm infants on term-equivalent brain MRI. Pediatr Res 2023; 94:979-986. [PMID: 36934213 DOI: 10.1038/s41390-023-02567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Preterm birth adversely impacts brain development and contributes to neurodevelopmental impairment; the temporal lobe may be particularly vulnerable to the impact of very preterm (VP) birth. Yet, no prior magnetic resonance imaging (MRI) scoring system incorporated a method to quantify temporal lobe size in VP infants. METHODS We developed and applied three metrics (temporal lobe length, extra-axial space, and temporal horn width) to quantify temporal lobe structure on term-equivalent brain MRIs obtained from 74 VP and 16 term infants. We compared metrics between VP and term infants and explored associations of each metric with perinatal risk factors. RESULTS All metrics had excellent reliability (intra-class correlation coefficient 0.62-0.98). VP infants had lower mean temporal lobe length (76.8 mm versus 79.2 mm, p = 0.02); however, the difference attenuated after correction for postmenstrual age. VP infants had larger temporal horn widths compared with term infants (2.6 mm versus 1.8 mm, p < 0.001). Temporal lobe length was positively associated with gestational age, birth weight, and male sex, and negatively associated with the duration of parenteral nutrition. CONCLUSIONS The proposed metrics are reliable and sensitive in distinguishing differences in temporal lobe development between VP and full-term infants. IMPACT We developed a novel method for quantifying temporal lobe size among very preterm infants at term equivalent using simple metrics performed on brain MRI. Temporal lobe metrics were reliable, correlated with brain volume from volumetric analysis, and were sensitive in identifying differences in temporal lobe development among preterm compared with term infants, specifically larger temporal horn size in preterm infants. This temporal lobe metric system will enable future work to delineate the perinatal and postnatal factors that impact temporal lobe growth, and better understand the relationship between temporal lobe disturbance and neurodevelopment in very preterm infants.
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Affiliation(s)
- Carmina Erdei
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Katherine A Bell
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aisling A Garvey
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Clementine Blaschke
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Neonatology, University of California Irvine, Irvine, CA, USA
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Romantsik O, Moreira A, Thébaud B, Ådén U, Ley D, Bruschettini M. Stem cell-based interventions for the prevention and treatment of intraventricular haemorrhage and encephalopathy of prematurity in preterm infants. Cochrane Database Syst Rev 2023; 2:CD013201. [PMID: 36790019 PMCID: PMC9932000 DOI: 10.1002/14651858.cd013201.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Germinal matrix-intraventricular haemorrhage (GMH-IVH) and encephalopathy of prematurity (EoP) remain substantial issues in neonatal intensive care units worldwide. Current therapies to prevent or treat these conditions are limited. Stem cell-based therapies offer a potential therapeutic approach to repair, restore, or regenerate injured brain tissue. These preclinical findings have now culminated in ongoing human neonatal studies. This is an update of the 2019 review, which did not include EoP. OBJECTIVES To evaluate the benefits and harms of stem cell-based interventions for prevention or treatment of GM-IVH and EoP in preterm infants. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was April 2022. SELECTION CRITERIA We attempted to include randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing 1. stem cell-based interventions versus control; 2. mesenchymal stromal cells (MSCs) of type or source versus MSCs of other type or source; 3. stem cell-based interventions other than MSCs of type or source versus stem cell-based interventions other than MSCs of other type or source; or 4. MSCs versus stem cell-based interventions other than MSCs. For prevention studies, we included extremely preterm infants (less than 28 weeks' gestation), 24 hours of age or less, without ultrasound diagnosis of GM-IVH or EoP; for treatment studies, we included preterm infants (less than 37 weeks' gestation), of any postnatal age, with ultrasound diagnosis of GM-IVH or with EoP. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause neonatal mortality, 2. major neurodevelopmental disability, 3. GM-IVH, 4. EoP, and 5. extension of pre-existing non-severe GM-IVH or EoP. We planned to use GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified no studies that met our inclusion criteria. Three studies are currently registered and ongoing. Phase 1 trials are described in the 'Excluded studies' section. AUTHORS' CONCLUSIONS No evidence is currently available to evaluate the benefits and harms of stem cell-based interventions for treatment or prevention of GM-IVH or EoP in preterm infants. We identified three ongoing studies, with a sample size range from 20 to 200. In two studies, autologous cord blood mononuclear cells will be administered to extremely preterm infants via the intravenous route; in one, intracerebroventricular injection of MSCs will be administered to preterm infants up to 34 weeks' gestational age.
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Affiliation(s)
- Olga Romantsik
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Alvaro Moreira
- Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Bernard Thébaud
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
- Ottawa Hospital Research Institute, Sprott Centre for Stem Cell Research, Ottawa, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Ulrika Ådén
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David Ley
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
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10
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Ruiz-González E, Benavente-Fernández I, Lubián-Gutiérrez M, Segado-Arenas A, Zafra-Rodríguez P, Méndez-Abad P, Lubián-López SP. Ultrasonographic evaluation of the early brain growth pattern in very low birth weight infants. Pediatr Res 2023:10.1038/s41390-022-02425-w. [PMID: 36624287 DOI: 10.1038/s41390-022-02425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preterm infants develop smaller brain volumes compared to term newborns. Our aim is to study early brain growth related to perinatal factors in very low birth weight infants (VLBWI). METHODS Manual segmentation of total brain volume (TBV) was performed in weekly 3D-ultrasonographies in our cohort of VLBWI. We studied the brain growth pattern related to term magnetic resonance image (term-MRI). RESULTS We found different brain growth trajectories, with smaller brain volumes and a decrease in brain growth rate in those VLBWI who would later have an abnormal term-MRI (mean TBV 190.68 vs. 213.9 cm3; P = 0.0001 and mean TBV growth rate 14.35 (±1.27) vs. 16.94 (±2.29) cm3/week; P = 0.0001). TBV in those with normal term-MRI was related to gestational age (GA), being small for gestational age (SGA), sex, and duration of parenteral nutrition (TPN) while in those with abnormal term-MRI findings it was related to GA, SGA, TPN, and comorbidities. We found a deceleration in brain growth rate in those with ≥3 comorbidities. CONCLUSIONS An altered brain growth pattern in VLBWI who subsequently present worst scores on term-MRI is related to GA, being SGA and comorbidities. Early ultrasonographic monitoring of TBV could be useful to detect deviated patterns of brain growth. IMPACT STATEMENT We describe the brain growth pattern in very low birth weight infants during their first postnatal weeks. Brain growth may be affected in the presence of certain perinatal factors and comorbidities, conditioning a deviation of the normal growth pattern. The serial ultrasound follow-up of these at-risk patients allows identifying these brain growth patterns early, which offers a window of opportunity for implementing earlier interventions.
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Affiliation(s)
- Estefanía Ruiz-González
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Isabel Benavente-Fernández
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain. .,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain. .,Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, C/Doctor Marañon, 3, Cádiz, Spain.
| | - Manuel Lubián-Gutiérrez
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Division of Neurology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain
| | - Antonio Segado-Arenas
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Pamela Zafra-Rodríguez
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Paula Méndez-Abad
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Simón P Lubián-López
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
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11
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Sensory-based interventions in the NICU: systematic review of effects on preterm brain development. Pediatr Res 2022; 92:47-60. [PMID: 34508227 DOI: 10.1038/s41390-021-01718-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infants born preterm are known to be at risk for abnormal brain development and adverse neurobehavioral outcomes. To improve early neurodevelopment, several non-pharmacological interventions have been developed and implemented in the neonatal intensive care unit (NICU). Sensory-based interventions seem to improve short-term neurodevelopmental outcomes in the inherently stressful NICU environment. However, how this type of intervention affects brain development in the preterm population remains unclear. METHODS A systematic review of the literature was conducted for published studies in the past 20 years reporting the effects of early, non-pharmacological, sensory-based interventions on the neonatal brain after preterm birth. RESULTS Twelve randomized controlled trials (RCT) reporting short-term effects of auditory, tactile, and multisensory interventions were included after the screening of 1202 articles. Large heterogeneity was identified among studies in relation to both types of intervention and outcomes. Three areas of focus for sensory interventions were identified: auditory-based, tactile-based, and multisensory interventions. CONCLUSIONS Diversity in interventions and outcome measures challenges the possibility to perform an integrative synthesis of results and to translate these for evidence-based clinical practice. This review identifies gaps in the literature and methodological challenges for the implementation of RCTs of sensory interventions in the NICU. IMPACT This paper represents the first systematic review to investigate the effect of non-pharmacological, sensory-based interventions in the NICU on neonatal brain development. Although reviewed RCTs present evidence on the impact of such interventions on the neonatal brain following preterm birth, it is not yet possible to formulate clear guidelines for clinical practice. This review integrates existing literature on the effect of sensory-based interventions on the brain after preterm birth and identifies methodological challenges for the conduction of high-quality RCTs.
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12
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Abstract
White matter injury (WMI) represents a frequent form of parenchymal brain injury in preterm neonates. Several dimensions of WMI are recognized, with distinct neuropathologic features involving a combination of destructive and maturational anomalies. Hypoxia-ischemia is the main mechanism leading to WMI and adverse white matter development, which result from injury to the oligodendrocyte precursor cells. Inflammation might act as a potentiator for WMI. A combination of hypoxia-ischemia and inflammation is frequent in several neonatal comorbidities such as postnatal infections, NEC and bronchopulmonary dysplasia, all known contributors to WMI. White matter injury is an important predictor of adverse neurodevelopmental outcomes. When WMI is detected on neonatal brain imaging, a detailed characterization of the injury (pattern of injury, severity and location) may enhance the ability to predict outcomes. This clinically-oriented review will provide an overview of the pathophysiology and imaging diagnosis of the multiple dimensions of WMI, will explore the association between postnatal complications and WMI, and will provide guidance on the signification of white matter anomalies for motor and cognitive development.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada; Department of Pediatrics (Neonatology), Université Laval and Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Steven P Miller
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada.
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13
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Mild brain lesions do not affect brain volumes in moderate-late preterm infants. Eur J Paediatr Neurol 2021; 34:91-98. [PMID: 34438235 DOI: 10.1016/j.ejpn.2021.08.003] [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: 05/06/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE It is unknown whether frequently occurring mild brain lesions affect brain volumes in moderate (MP2; 32+0-33+6 weeks' gestation) and late (LP3; 34+0-35+6 weeks' gestation) preterm infants. Therefore, we aimed to investigate the effect of mild brain lesions on brain volumes in moderate-late preterm (MLPT4) infants and to compare brain volumes between MP and LP infants. METHODS From August 2017 to November 2019, eligible MLPT infants born at Isala Women and Children's Hospital were enrolled in a prospective cohort study (Brain Imaging in Moderate-late Preterm infants 'BIMP-study'). MRI was performed around term equivalent age (TEA5). MRI scans were assessed for (mild) brain lesions. T2-weighted images were used for automatic segmentation of eight brain structures. Linear regression analysis was performed to compare absolute and relative brain volumes between infants with and without mild brain lesions and between MP and LP infants. RESULTS 36 MP and 68 LP infants were included. In infants with mild brain lesions, intracranial volume (B = 27.4 cm3, p = 0.02), cerebrospinal fluid (B = 8.78 cm3, p = 0.01) and cerebellar volumes (B = 1.70 cm3, p = 0.03) were significantly larger compared to infants without mild brain lesions. After correction for weight and postmenstrual age at MRI, these volumes were no longer significantly different. LP infants had larger brain volumes than MP infants, but differences were not significant. Relative brain volumes showed no significant differences in both analyses. CONCLUSION Neither having mild brain lesions, nor being born moderate prematurely affected brain volumes at TEA in MLPT infants.
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14
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Dimitrova R, Arulkumaran S, Carney O, Chew A, Falconer S, Ciarrusta J, Wolfers T, Batalle D, Cordero-Grande L, Price AN, Teixeira RPAG, Hughes E, Egloff A, Hutter J, Makropoulos A, Robinson EC, Schuh A, Vecchiato K, Steinweg JK, Macleod R, Marquand AF, McAlonan G, Rutherford MA, Counsell SJ, Smith SM, Rueckert D, Hajnal JV, O’Muircheartaigh J, Edwards AD. Phenotyping the Preterm Brain: Characterizing Individual Deviations From Normative Volumetric Development in Two Large Infant Cohorts. Cereb Cortex 2021; 31:3665-3677. [PMID: 33822913 PMCID: PMC8258435 DOI: 10.1093/cercor/bhab039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022] Open
Abstract
The diverse cerebral consequences of preterm birth create significant challenges for understanding pathogenesis or predicting later outcome. Instead of focusing on describing effects common to the group, comparing individual infants against robust normative data offers a powerful alternative to study brain maturation. Here we used Gaussian process regression to create normative curves characterizing brain volumetric development in 274 term-born infants, modeling for age at scan and sex. We then compared 89 preterm infants scanned at term-equivalent age with these normative charts, relating individual deviations from typical volumetric development to perinatal risk factors and later neurocognitive scores. To test generalizability, we used a second independent dataset comprising of 253 preterm infants scanned using different acquisition parameters and scanner. We describe rapid, nonuniform brain growth during the neonatal period. In both preterm cohorts, cerebral atypicalities were widespread, often multiple, and varied highly between individuals. Deviations from normative development were associated with respiratory support, nutrition, birth weight, and later neurocognition, demonstrating their clinical relevance. Group-level understanding of the preterm brain disguises a large degree of individual differences. We provide a method and normative dataset that offer a more precise characterization of the cerebral consequences of preterm birth by profiling the individual neonatal brain.
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Affiliation(s)
- Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Judit Ciarrusta
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Thomas Wolfers
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen 6525EN, the Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen 6525EN, the Netherlands
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Biomedical Image Technologies, ETSI Telecomunicacion, Universidad Politecnica de Madrid and CIBER-BBN, Madrid 28040, Spain
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Rui P A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - Emma C Robinson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Johannes K Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Russell Macleod
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Andre F Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen 6525EN, the Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen 6525EN, the Netherlands
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Stephen M Smith
- Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
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15
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Relationship Between Early Functional and Structural Brain Developments and Brain Injury in Preterm Infants. THE CEREBELLUM 2021; 20:556-568. [PMID: 33532923 PMCID: PMC8360868 DOI: 10.1007/s12311-021-01232-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
Background Recent studies explored the relationship between early brain function and brain morphology, based on the hypothesis that increased brain activity can positively affect structural brain development and that excitatory neuronal activity stimulates myelination. Objective To investigate the relationship between maturational features from early and serial aEEGs after premature birth and MRI metrics characterizing structural brain development and injury, measured around 30weeks postmenstrual age (PMA) and at term. Moreover, we aimed to verify whether previously developed maturational EEG features are related with PMA. Design/Methods One hundred six extremely preterm infants received bedside aEEGs during the first 72h and weekly until week 5. 3T-MRIs were performed at 30weeks PMA and at term. Specific features were extracted to assess EEG maturation: (1) the spectral content, (2) the continuity [percentage of spontaneous activity transients (SAT%) and the interburst interval (IBI)], and (3) the complexity. Automatic MRI segmentation to assess volumes and MRI score was performed. The relationship between the maturational EEG features and MRI measures was investigated. Results Both SAT% and EEG complexity were correlated with PMA. IBI was inversely associated with PMA. Complexity features had a positive correlation with the cerebellar size at 30weeks, while event-based measures were related to the cerebellar size at term. Cerebellar width, cortical grey matter, and total brain volume at term were inversely correlated with the relative power in the higher frequency bands. Conclusions The continuity and complexity of the EEG steadily increase with increasing postnatal age. Increasing complexity and event-based features are associated with cerebellar size, a structure with enormous development during preterm life. Brain activity is important for later structural brain development. Supplementary Information The online version contains supplementary material available at 10.1007/s12311-021-01232-z.
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16
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Volpe J. Commentary - Cerebellar underdevelopment in the very preterm infant: Important and underestimated source of cognitive deficits. J Neonatal Perinatal Med 2021; 14:451-456. [PMID: 33967062 PMCID: PMC8673497 DOI: 10.3233/npm-210774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- J.J. Volpe
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, MA, USA
- Address for correspondence: Joseph J. Volpe, M.D., Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 221 Longwood Avenue, Room 343C, Boston, MA 02115 USA. Tel.: +1 617 525 4145; E-mail:
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17
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Mechanical Ventilation Duration, Brainstem Development, and Neurodevelopment in Children Born Preterm: A Prospective Cohort Study. J Pediatr 2020; 226:87-95.e3. [PMID: 32454115 DOI: 10.1016/j.jpeds.2020.05.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine, in children born preterm, the association of mechanical ventilation duration with brainstem development, white matter maturation, and neurodevelopmental outcomes at preschool age. STUDY DESIGN This prospective cohort study included 144 neonates born at <30 weeks of gestation (75 male, mean gestational age 27.1 weeks, SD 1.6) with regional brainstem volumes automatically segmented on magnetic resonance imaging at term-equivalent age (TEA). The white matter maturation was assessed by diffusion tensor imaging and tract-based spatial statistics. Neurodevelopmental outcomes were assessed at 4.5 years of age using the Movement Assessment Battery for Children, 2nd Edition, and the Wechsler Primary and Preschool Scale of Intelligence, 4th Edition, full-scale IQ. The association between the duration of mechanical ventilation and brainstem development was validated in an independent cohort of children born very preterm. RESULTS Each additional day of mechanical ventilation predicted lower motor scores (0.5-point decrease in the Movement Assessment Battery for Children, 2nd Edition, score by day of mechanical ventilation, 95% CI -0.6 to -0.3, P < .0001). Prolonged exposure to mechanical ventilation was associated with smaller pons and medulla volumes at TEA in 2 independent cohorts, along with widespread abnormalities in white matter maturation. Pons and medulla volumes at TEA predicted motor outcomes at 4.5 years of age. CONCLUSIONS In neonates born very preterm, prolonged mechanical ventilation is associated with impaired brainstem development, abnormal white matter maturation, and lower motor scores at preschool age. Further research is needed to better understand the neural pathological mechanisms involved.
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18
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Hayward DA, Pomares F, Casey KF, Ismaylova E, Levesque M, Greenlaw K, Vitaro F, Brendgen M, Rénard F, Dionne G, Boivin M, Tremblay RE, Booij L. Birth weight is associated with adolescent brain development: A multimodal imaging study in monozygotic twins. Hum Brain Mapp 2020; 41:5228-5239. [PMID: 32881198 PMCID: PMC7670633 DOI: 10.1002/hbm.25188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 01/20/2023] Open
Abstract
Previous research has shown that the prenatal environment, commonly indexed by birth weight (BW), is a predictor of morphological brain development. We previously showed in monozygotic (MZ) twins associations between BW and brain morphology that were independent of genetics. In the present study, we employed a longitudinal MZ twin design to investigate whether variations in prenatal environment (as indexed by discordance in BW) are associated with resting‐state functional connectivity (rs‐FC) and with structural connectivity. We focused on the limbic and default mode networks (DMNs), which are key regions for emotion regulation and internally generated thoughts, respectively. One hundred and six healthy adolescent MZ twins (53 pairs; 42% male pairs) followed longitudinally from birth underwent a magnetic resonance imaging session at age 15. Graph theoretical analysis was applied to rs‐FC measures. TrackVis was used to determine track count as an indicator of structural connectivity strength. Lower BW twins had less efficient limbic network connectivity as compared to their higher BW co‐twin, driven by differences in the efficiency of the right hippocampus and right amygdala. Lower BW male twins had fewer tracks connecting the right hippocampus and right amygdala as compared to their higher BW male co‐twin. There were no associations between BW and the DMN. These findings highlight the possible role of unique prenatal environmental influences in the later development of efficient spontaneous limbic network connections within healthy individuals, irrespective of DNA sequence or shared environment.
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Affiliation(s)
- Dana A Hayward
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Florence Pomares
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Kevin F Casey
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Elmira Ismaylova
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | | | - Keelin Greenlaw
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Frank Vitaro
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,School of Psychoeducation, University of Montreal, Montreal, Canada
| | - Mara Brendgen
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
| | - Felix Rénard
- Grenoble Hospital, University of Grenoble, Grenoble, France
| | - Ginette Dionne
- Department of Psychology, University Laval, Quebec, Canada
| | - Michel Boivin
- Department of Psychology, University Laval, Quebec, Canada
| | - Richard E Tremblay
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology and Pediatrics, University of Montreal, Montreal, Canada.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Linda Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
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19
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Bin-Nun A, Kassirer Y, Mimouni FB, Shchors I, Hammerman C. Head Circumference Growth Is Enhanced by SMOFlipid in Preterm Neonates. Am J Perinatol 2020; 37:1130-1133. [PMID: 31167235 DOI: 10.1055/s-0039-1692390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Suboptimal fat intake during the early postnatal weeks significantly affects brain growth and maturation. Studies to date have focused on the quantity rather than the quality of fat intake. OBJECTIVE We hypothesized that early nutrition of premature neonates should also include optimization of the type of fat intake, and thus those receiving SMOFlipid, a balanced multicomponent lipid emulsion, would have improved head growth as measured by head circumference (HC) at discharge. STUDY DESIGN We retrospectively reviewed HC in infants weighing <1,500 g who were hospitalized for two or more weeks during a 20-month period, in which all preterm infants received fat as Lipofundin, and the following 20-month period, in which all such infants received SMOFlipid.Lipids were dosed up to 3 g/kg/day and reduced as enteral nutrition progressed. Parenteral fish oil (Omegaven) was permitted as rescue therapy during both periods. RESULTS Period 2 infants had better head growth (0.79 [0.69,0.90] vs. 0.75 [0.64,0.86] cm/week; p = 0.0158). More infants reached discharge with an HC of ≥50 percentile (51 vs. 31%; p = 0.0007), and fewer infants had an HC of ≤3 percentile (11 vs. 14%; p = 0.023). Median length of stay was reduced by more than 1 week.A multivariable regression was performed using the weekly increase in HC as the dependent variable, and the time epoch, birth weight, gestational age, hospitalization days, and gender as independent variables. Only the time epoch and days of hospitalization were significant (both p < 0.0001). CONCLUSION Our data offer preliminary evidence of improved brain growth in those receiving a balanced lipid emulsion as compared with a soybean oil emulsion.
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Affiliation(s)
- Alona Bin-Nun
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yair Kassirer
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Francis B Mimouni
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Tel Aviv, Israel
| | - Irina Shchors
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
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20
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van Beek PE, Claessens NHP, Makropoulos A, Groenendaal F, de Vries LS, Counsell SJ, Benders MJNL. Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm. J Pediatr 2020; 223:57-63.e5. [PMID: 32389719 DOI: 10.1016/j.jpeds.2020.04.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the effect of early life nutrition on structural brain development in 2 cohorts of extremely preterm infants, before and after the implementation of a nutrition regimen containing more protein and lipid. STUDY DESIGN We included 178 infants retrospectively (median gestational age, 26.6 weeks; IQR, 25.9-27.3), of whom 99 received the old nutrition regimen (cohort A, 2011-2013) and 79 the new nutrition regimen (cohort B, 2013-2015). Intake of protein, lipids, and calories was calculated for the first 28 postnatal days. Brain magnetic resonance imaging (MRI) was performed at 30 weeks postmenstrual age (IQR, 30.3-31.4) and term-equivalent age (IQR, 40.9-41.4). Volumes of 42 (left + right) brain structures were calculated. RESULTS Mean protein and caloric intake in cohort B (3.4 g/kg per day [P < .001] and 109 kcal/kg per day [P = .038]) was higher than in cohort A (2.7 g/kg per day; 104 kcal/kg per day). At 30 weeks, 22 regions were significantly larger in cohort B compared with cohort A, whereas at term-equivalent age, only the caudate nucleus was significantly larger in cohort B compared with cohort A. CONCLUSIONS An optimized nutrition protocol in the first 28 days of life is associated with temporarily improved early life brain volumes.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Science & Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands.
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21
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Nassar R, Kaczkurkin AN, Xia CH, Sotiras A, Pehlivanova M, Moore TM, Garcia de La Garza A, Roalf DR, Rosen AFG, Lorch SA, Ruparel K, Shinohara RT, Davatzikos C, Gur RC, Gur RE, Satterthwaite TD. Gestational Age is Dimensionally Associated with Structural Brain Network Abnormalities Across Development. Cereb Cortex 2020; 29:2102-2114. [PMID: 29688290 DOI: 10.1093/cercor/bhy091] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/02/2018] [Indexed: 02/06/2023] Open
Abstract
Prematurity is associated with diverse developmental abnormalities, yet few studies relate cognitive and neurostructural deficits to a dimensional measure of prematurity. Leveraging a large sample of children, adolescents, and young adults (age 8-22 years) studied as part of the Philadelphia Neurodevelopmental Cohort, we examined how variation in gestational age impacted cognition and brain structure later in development. Participants included 72 preterm youth born before 37 weeks' gestation and 206 youth who were born at term (37 weeks or later). Using a previously-validated factor analysis, cognitive performance was assessed in three domains: (1) executive function and complex reasoning, (2) social cognition, and (3) episodic memory. All participants completed T1-weighted neuroimaging at 3 T to measure brain volume. Structural covariance networks were delineated using non-negative matrix factorization, an advanced multivariate analysis technique. Lower gestational age was associated with both deficits in executive function and reduced volume within 11 of 26 structural covariance networks, which included orbitofrontal, temporal, and parietal cortices as well as subcortical regions including the hippocampus. Notably, the relationship between lower gestational age and executive dysfunction was accounted for in part by structural network deficits. Together, these findings emphasize the durable impact of prematurity on cognition and brain structure, which persists across development.
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Affiliation(s)
- Rula Nassar
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Antonia N Kaczkurkin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cedric Huchuan Xia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Aristeidis Sotiras
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angel Garcia de La Garza
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adon F G Rosen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott A Lorch
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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22
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Fleiss B, Gressens P, Stolp HB. Cortical Gray Matter Injury in Encephalopathy of Prematurity: Link to Neurodevelopmental Disorders. Front Neurol 2020; 11:575. [PMID: 32765390 PMCID: PMC7381224 DOI: 10.3389/fneur.2020.00575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Preterm-born infants frequently suffer from an array of neurological damage, collectively termed encephalopathy of prematurity (EoP). They also have an increased risk of presenting with a neurodevelopmental disorder (e.g., autism spectrum disorder; attention deficit hyperactivity disorder) later in life. It is hypothesized that it is the gray matter injury to the cortex, in addition to white matter injury, in EoP that is responsible for the altered behavior and cognition in these individuals. However, although it is established that gray matter injury occurs in infants following preterm birth, the exact nature of these changes is not fully elucidated. Here we will review the current state of knowledge in this field, amalgamating data from both clinical and preclinical studies. This will be placed in the context of normal processes of developmental biology and the known pathophysiology of neurodevelopmental disorders. Novel diagnostic and therapeutic tactics required integration of this information so that in the future we can combine mechanism-based approaches with patient stratification to ensure the most efficacious and cost-effective clinical practice.
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Affiliation(s)
- Bobbi Fleiss
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Pierre Gressens
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Helen B. Stolp
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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23
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Tataranno ML, Gui L, Hellström-Westas L, Toet M, Groenendaal F, Claessens NHP, Schuurmans J, Fellman V, Sävman K, de Vries LS, Huppi P, Benders MJNL. Morphine affects brain activity and volumes in preterms: An observational multi-center study. Early Hum Dev 2020; 144:104970. [PMID: 32276190 DOI: 10.1016/j.earlhumdev.2020.104970] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We hypothesized that morphine has a depressing effect on early brain activity, assessed using quantitative aEEG/EEG parameter and depressed activity will be associated with brain volumes at term in extremely preterm infants. STUDY DESIGN 174 preterm infants were enrolled in 3 European tertiary NICUs (mean GA:26 ± 1wks) and monitored during the first 72 h after birth with continuous 2 channel aEEG. Six epochs of aEEG recordings were selected and minimum amplitude of aEEG (min aEEG), percentage of time amplitude <5 μV (% of time < 5 μV), spontaneous activity transients (SATrate) and interSAT interval (ISI) were calculated. For infants receiving morphine, the cumulative morphine dosage was calculated. In a subgroup of 58 infants, good quality MRI at term equivalent age (TEA) and the cumulative morphine dose until TEA were available. The effects of morphine administration and cumulative dose on aEEG/EEG measures and on brain volumes were investigated. RESULTS Morphine administration had a significant effect on all quantitative aEEG/EEG measures, causing depression of early brain activity [longer ISI (β 2.900), reduced SAT rate (β -1.386), decreased min aEEG (β -0.782), and increased % of time < 5 μV (β 14.802)] in all epochs. A significant effect of GA and postnatal age on aEEG/EEG measures was observed. Cumulative morphine dose until TEA had a significant negative effect on total brain volume (TBV) (β -8.066) and cerebellar volume (β -1.080). CONCLUSIONS Administration of sedative drugs should be considered when interpreting aEEG/EEG together with the negative dose dependent morphine impact on brain development.
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Affiliation(s)
- M L Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - L Gui
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - L Hellström-Westas
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - N H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - J Schuurmans
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - V Fellman
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Skåne University Hospital, Lund, Sweden
| | - K Sävman
- Department of Pediatrics, Perinatal Center, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - L S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - P Huppi
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - M J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
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24
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Kozhemiako N, Nunes AS, Vakorin VA, Chau CMY, Moiseev A, Ribary U, Grunau RE, Doesburg SM. Sex differences in brain connectivity and male vulnerability in very preterm children. Hum Brain Mapp 2019; 41:388-400. [PMID: 31587465 PMCID: PMC7267928 DOI: 10.1002/hbm.24809] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/13/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022] Open
Abstract
Evidence indicates better cognitive and behavioral outcomes for females born very preterm (≤32 weeks gestation) compared to males, but the neurophysiology underlying this apparent resiliency of the female brain remains poorly understood. Here we test the hypothesis that very preterm males express more pronounced connectivity alterations as a reflection of higher male vulnerability. Resting state MEG recordings, neonatal and psychometric data were collected from 100 children at age 8 years: very preterm boys (n = 27), very preterm girls (n = 34), full‐term boys (n = 15) and full‐term girls (n = 24). Neuromagnetic source dynamics were reconstructed from 76 cortical brain regions. Functional connectivity was estimated using inter‐regional phase‐synchronization. We performed a series of multivariate analyses to test for differences across groups as well as to explore relationships between deviations in functional connectivity and psychometric scores and neonatal factors for very preterm children. Very preterm boys displayed significantly higher (p < .001) absolute deviation from average connectivity of same‐sex full‐term group, compared to very preterm girls versus full‐term girls. In the connectivity comparison between very preterm and full‐term groups separately for boys and girls, significant group differences (p < .05) were observed for boys, but not girls. Sex differences in connectivity (p < .01) were observed in very preterm children but not in full‐term groups. Our findings indicate that very preterm boys have greater alterations in resting neurophysiological network communication than girls. Such uneven brain communication disruption in very preterm boys and girls suggests that stronger connectivity alterations might contribute to male vulnerability in long‐term behavioral and cognitive outcome.
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Affiliation(s)
- Nataliia Kozhemiako
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Adonay S Nunes
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vasily A Vakorin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, British Columbia, Canada.,Fraser Health, British Columbia Health Authority, Surrey, British Columbia, Canada
| | - Cecil M Y Chau
- Pediatrics Department, University of British Columbia, Vancouver, British Columbia, Canada.,B.C. Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Alexander Moiseev
- Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Urs Ribary
- Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, British Columbia, Canada.,B.C. Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ruth E Grunau
- Pediatrics Department, University of British Columbia, Vancouver, British Columbia, Canada.,B.C. Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sam M Doesburg
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, British Columbia, Canada
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25
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Bouyssi-Kobar M, De Asis-Cruz J, Murnick J, Chang T, Limperopoulos C. Altered Functional Brain Network Integration, Segregation, and Modularity in Infants Born Very Preterm at Term-Equivalent Age. J Pediatr 2019; 213:13-21.e1. [PMID: 31358292 PMCID: PMC6765421 DOI: 10.1016/j.jpeds.2019.06.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the functional network organization of the brain in infants born very preterm at term-equivalent age and to relate network alterations to known clinical risk factors for poor neurologic outcomes in prematurity. STUDY DESIGN Resting-state functional magnetic resonance imaging data from 66 infants born very preterm (gestational age <32 weeks and birth weight <1500 g) and 66 healthy neonates born at full term, acquired as part of a prospective, cross-sectional study, were compared at term age using graph theory. Features of resting-state networks, including integration, segregation, and modularity, were derived from correlated hemodynamic activity arising from 93 cortical and subcortical regions of interest and compared between groups. RESULTS Despite preserved small-world topology and modular organization, resting-state networks of infants born very preterm at term-equivalent age were less segregated and less integrated than those of infants born full term. Chronic respiratory illness (ie, bronchopulmonary dysplasia and the length of oxygen support) was associated with decreased global efficiency and increased path lengths (P < .05). In both cohorts, 4 functional modules with similar composition were observed (parietal/temporal, frontal, subcortical/limbic, and occipital). The density of connections in 3 of the 4 modules was decreased in the very preterm network (P < .01); however, in the occipital/visual cortex module, connectivity was increased in infants born very preterm relative to control infants (P < .0001). CONCLUSIONS Early exposure to the ex utero environment is associated with altered resting-state network functional organization in infants born very preterm at term-equivalent age, likely reflecting disrupted brain maturational processes.
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Affiliation(s)
- Marine Bouyssi-Kobar
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC,Institute for Biomedical Sciences, George Washington University, Washington, DC
| | - Josepheen De Asis-Cruz
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC
| | - Jonathan Murnick
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC
| | - Taeun Chang
- Department of Neurology, Children’s National Health System, Washington, DC
| | - Catherine Limperopoulos
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
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26
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Hortensius LM, van Elburg RM, Nijboer CH, Benders MJNL, de Theije CGM. Postnatal Nutrition to Improve Brain Development in the Preterm Infant: A Systematic Review From Bench to Bedside. Front Physiol 2019; 10:961. [PMID: 31404162 PMCID: PMC6677108 DOI: 10.3389/fphys.2019.00961] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Preterm infants are at high risk for Encephalopathy of Prematurity and successive adverse neurodevelopmental outcome. Adequate nutrition is crucial for healthy brain development. Maternal breast milk is first choice of post-natal enteral nutrition for preterm infants. However, breast milk contains insufficient nutrient quantities to meet the greater nutritional needs of preterm infants, meaning that supplementation is recommended. Aim: To provide an overview of current literature on potential nutritional interventions for improvement of neurodevelopmental outcome in preterm infants, by taking a bench to bedside approach from pre-clinical models of neonatal brain injury to randomized controlled clinical trials (RCTs) in preterm infants. Methods: Separate clinical and pre-clinical searches were performed in Medline and Embase for English written papers published between 08/2008 and 08/2018 that studied a single nutritional component. Papers were included if one of the following components was studied: lipids, carbohydrates, proteins, vitamins, minerals, probiotics, prebiotics, oligosaccharides, fatty acids, or amino acids, with brain injury, brain development or neurodevelopmental outcome as outcome measure in preterm infants (gestational age <32 weeks and/or birth weight <1,500 g) or in animal models of neonatal brain injury. Results: In total, 2,671 pre-clinical studies and 852 RCTs were screened, of which 24 pre-clinical and 22 RCTs were included in this review. In these trials supplementation with amino acids and protein, lipids, probiotics (only clinical), prebiotics (only clinical), vitamins, and minerals was studied. All included pre-clinical studies show positive effect of supplementation on brain injury and/or neurodevelopment. Although some nutrients, such as glutamine, show promising short term outcome in clinical studies, no evident long term effect of any supplemented nutrient was found. Main limitations were inclusion of studies no older than 10 years at time of search and studies that focused on single nutritional components only. Conclusion: Even though many pre-clinical trials demonstrate promising effects of different nutritional interventions on reducing brain injury and/or improving neurodevelopmental outcome, these positive effects have so far not evidently been demonstrated in RCTs. More clinically relevant animal models and long term follow up after clinical trials are needed to move novel nutritional therapies from bench to bedside of preterm infants.
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Affiliation(s)
- Lisa M. Hortensius
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ruurd M. van Elburg
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Cora H. Nijboer
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Caroline G. M. de Theije
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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27
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Pecheva D, Tournier JD, Pietsch M, Christiaens D, Batalle D, Alexander DC, Hajnal JV, Edwards AD, Zhang H, Counsell SJ. Fixel-based analysis of the preterm brain: Disentangling bundle-specific white matter microstructural and macrostructural changes in relation to clinical risk factors. Neuroimage Clin 2019; 23:101820. [PMID: 30991305 PMCID: PMC6462822 DOI: 10.1016/j.nicl.2019.101820] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 12/13/2022]
Abstract
Diffusion MRI (dMRI) studies using the tensor model have identified abnormal white matter development associated with perinatal risk factors in preterm infants studied at term equivalent age (TEA). However, this model is an oversimplification of the underlying neuroanatomy. Fixel-based analysis (FBA) is a novel quantitative framework, which identifies microstructural and macrostructural changes in individual fibre populations within voxels containing crossing fibres. The aim of this study was to apply FBA to investigate the relationship between fixel-based measures of apparent fibre density (FD), fibre bundle cross-section (FC), and fibre density and cross-section (FDC) and perinatal risk factors in preterm infants at TEA. We studied 50 infants (28 male) born at 24.0-32.9 (median 30.4) weeks gestational age (GA) and imaged at 38.6-47.1 (median 42.1) weeks postmenstrual age (PMA). dMRI data were acquired in non-collinear directions with b-value 2500 s/mm2 on a 3 Tesla system sited on the neonatal intensive care unit. FBA was performed to assess the relationship between FD, FC, FDC and PMA at scan, GA at birth, days on mechanical ventilation, days on total parenteral nutrition (TPN), birthweight z-score, and sex. FBA reveals fibre population-specific alterations in FD, FC and FDC associated with clinical risk factors. FD was positively correlated with GA at birth and was negatively correlated with number of days requiring ventilation. FC was positively correlated with GA at birth, birthweight z-scores and was higher in males. FC was negatively correlated with number of days on ventilation and days on TPN. FDC was positively correlated with GA at birth and birthweight z-scores, negatively correlated with days on ventilation and days on TPN and higher in males. We demonstrate that these relationships are fibre-specific even within regions of crossing fibres. These results show that aberrant white matter development involves both microstructural changes and macrostructural alterations.
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Affiliation(s)
- Diliana Pecheva
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King''s College London, UK
| | - Daniel C Alexander
- Department of Computer Science and Centre for Medical Image Computing, University College London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK.
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Zhang C, Adeli E, Wu Z, Li G, Lin W, Shen D. Infant Brain Development Prediction With Latent Partial Multi-View Representation Learning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:909-918. [PMID: 30307859 PMCID: PMC6450718 DOI: 10.1109/tmi.2018.2874964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The early postnatal period witnesses rapid and dynamic brain development. However, the relationship between brain anatomical structure and cognitive ability is still unknown. Currently, there is no explicit model to characterize this relationship in the literature. In this paper, we explore this relationship by investigating the mapping between morphological features of the cerebral cortex and cognitive scores. To this end, we introduce a multi-view multi-task learning approach to intuitively explore complementary information from different time-points and handle the missing data issue in longitudinal studies simultaneously. Accordingly, we establish a novel model, latent partial multi-view representation learning. Our approach regards data from different time-points as different views and constructs a latent representation to capture the complementary information from incomplete time-points. The latent representation explores the complementarity across different time-points and improves the accuracy of prediction. The minimization problem is solved by the alternating direction method of multipliers. Experimental results on both synthetic and real data validate the effectiveness of our proposed algorithm.
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Affiliation(s)
- Changqing Zhang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, North Carolina, USA and College of Intelligence and Computing, Tianjin University, Tianjin, China, ()
| | - Ehsan Adeli
- Department of Psychiatry and Behavioral Sciences, Stanford University, California, USA, ()
| | - Zhengwang Wu
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, North Carolina, USA, ()
| | - Gang Li
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, North Carolina, USA, ()
| | - Weili Lin
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, North Carolina, USA, ()
| | - Dinggang Shen
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, North Carolina, USA, and also with Department of Brain and Cognitive Engineering, Korea University, Seoul 02841, Republic of Korea, ()
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Claessens NHP, Khalili N, Isgum I, Ter Heide H, Steenhuis TJ, Turk E, Jansen NJG, de Vries LS, Breur JMPJ, de Heus R, Benders MJNL. Brain and CSF Volumes in Fetuses and Neonates with Antenatal Diagnosis of Critical Congenital Heart Disease: A Longitudinal MRI Study. AJNR Am J Neuroradiol 2019; 40:885-891. [PMID: 30923087 DOI: 10.3174/ajnr.a6021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Fetuses and neonates with critical congenital heart disease are at risk of delayed brain development and neurodevelopmental impairments. Our aim was to investigate the association between fetal and neonatal brain volumes and neonatal brain injury in a longitudinally scanned cohort with an antenatal diagnosis of critical congenital heart disease and to relate fetal and neonatal brain volumes to postmenstrual age and type of congenital heart disease. MATERIALS AND METHODS This was a prospective, longitudinal study including 61 neonates with critical congenital heart disease undergoing surgery with cardiopulmonary bypass <30 days after birth and MR imaging of the brain; antenatally (33 weeks postmenstrual age), neonatal preoperatively (first week), and postoperatively (7 days postoperatively). Twenty-six had 3 MR imaging scans; 61 had at least 1 fetal and/or neonatal MR imaging scan. Volumes (cubic centimeters) were calculated for total brain volume, unmyelinated white matter, cortical gray matter, cerebellum, extracerebral CSF, and ventricular CSF. MR images were reviewed for ischemic brain injury. RESULTS Total fetal brain volume, cortical gray matter, and unmyelinated white matter positively correlated with preoperative neonatal total brain volume, cortical gray matter, and unmyelinated white matter (r = 0.5-0.58); fetal ventricular CSF and extracerebral CSF correlated with neonatal ventricular CSF and extracerebral CSF (r = 0.64 and 0.82). Fetal cortical gray matter, unmyelinated white matter, and the cerebellum were negatively correlated with neonatal ischemic injury (r = -0.46 to -0.41); fetal extracerebral CSF and ventricular CSF were positively correlated with neonatal ischemic injury (r = 0.40 and 0.23). Unmyelinated white matter:total brain volume ratio decreased with increasing postmenstrual age, with a parallel increase of cortical gray matter:total brain volume and cerebellum:total brain volume. Fetal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios decreased with increasing postmenstrual age; however, neonatal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios increased with postmenstrual age. CONCLUSIONS This study reveals that fetal brain volumes relate to neonatal brain volumes in critical congenital heart disease, with a negative correlation between fetal brain volumes and neonatal ischemic injury. Fetal brain imaging has the potential to provide early neurologic biomarkers.
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Affiliation(s)
- N H P Claessens
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.) .,Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.).,Pediatric Intensive Care (N.H.P.C., N.J.G.J.)
| | - N Khalili
- Image Sciences Institute (N.K., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - I Isgum
- Image Sciences Institute (N.K., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Ter Heide
- Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.)
| | - T J Steenhuis
- Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.)
| | - E Turk
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.)
| | - N J G Jansen
- Pediatric Intensive Care (N.H.P.C., N.J.G.J.).,Department of Pediatrics (N.J.G.J.), Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - L S de Vries
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.)
| | - J M P J Breur
- Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.)
| | - R de Heus
- Obstetrics (R.d.H.), Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - M J N L Benders
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.)
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Abstract
Despite the advances in neonatal intensive care, the preterm brain remains vulnerable to white matter injury (WMI) and disruption of normal brain development (i.e., dysmaturation). Compared to severe cystic WMI encountered in the past decades, contemporary cohorts of preterm neonates experience milder WMIs. More than destructive lesions, disruption of the normal developmental trajectory of cellular elements of the white and the gray matter occurs. In the acute phase, in response to hypoxia-ischemia and/or infection and inflammation, multifocal areas of necrosis within the periventricular white matter involve all cellular elements. Later, chronic WMI is characterized by diffuse WMI with aberrant regeneration of oligodendrocytes, which fail to mature to myelinating oligodendrocytes, leading to myelination disturbances. Complete neuronal degeneration classically accompanies necrotic white matter lesions, while altered neurogenesis, represented by a reduction of the dendritic arbor and synapse formation, is observed in response to diffuse WMI. Neuroimaging studies now provide more insight in assessing both injury and dysmaturation of both gray and white matter. Preterm brain injury remains an important cause of neurodevelopmental disabilities, which are still observed in up to 50% of the preterm survivors and take the form of a complex combination of motor, cognitive, and behavioral concerns.
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Affiliation(s)
- Juliane Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Steven P Miller
- Division of Neurology and Centre for Brain and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.
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Longitudinal study of neonatal brain tissue volumes in preterm infants and their ability to predict neurodevelopmental outcome. Neuroimage 2019; 185:728-741. [DOI: 10.1016/j.neuroimage.2018.06.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/08/2018] [Accepted: 06/09/2018] [Indexed: 12/13/2022] Open
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Kaczkurkin AN, Raznahan A, Satterthwaite TD. Sex differences in the developing brain: insights from multimodal neuroimaging. Neuropsychopharmacology 2019; 44:71-85. [PMID: 29930385 PMCID: PMC6235840 DOI: 10.1038/s41386-018-0111-z] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
Youth (including both childhood and adolescence) is a period when the brain undergoes dramatic remodeling and is also a time when neuropsychiatric conditions often emerge. Many of these illnesses have substantial sex differences in prevalence, suggesting that sex differences in brain development may underlie differential risk for psychiatric symptoms between males and females. Substantial evidence documents sex differences in brain structure and function in adults, and accumulating data suggests that these sex differences may be present or emerge during development. Here we review the evidence for sex differences in brain structure, white matter organization, and perfusion during development. We then use these normative differences as a framework to understand sex differences in brain development associated with psychopathology. In particular, we focus on sex differences in the brain as they relate to anxiety, depression, psychosis, and attention-deficit/hyperactivity symptoms. Finally, we highlight existing limitations, gaps in knowledge, and fertile avenues for future research.
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Affiliation(s)
- Antonia N Kaczkurkin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Armin Raznahan
- Developmental Neurogenomics Unit, National Institute of Mental Health, Bethesda, MD, 20814, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Matthews LG, Walsh BH, Knutsen C, Neil JJ, Smyser CD, Rogers CE, Inder TE. Brain growth in the NICU: critical periods of tissue-specific expansion. Pediatr Res 2018; 83:976-981. [PMID: 29320484 PMCID: PMC6054136 DOI: 10.1038/pr.2018.4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/31/2017] [Indexed: 11/09/2022]
Abstract
ObjectiveTo examine, using serial magnetic resonance imaging (MRI), total and tissue-specific brain growth in very-preterm (VPT) infants during the period that coincides with the early and late stages of the third trimester.MethodsStructural MRI scans were collected from two prospective cohorts of VPT infants (≤30 weeks of gestation). A total of 51 MRI scans from 18 VPT subjects were available for volumetric analysis. Brain tissue was classified into cerebrospinal fluid, cortical gray matter, myelinated and unmyelinated white matter, deep nuclear gray matter, and cerebellum. Nine infants had sufficient serial scans to allow comparison of tissue growth during the periods corresponding to the early and late stages of the third trimester.ResultsTissue-specific differences in ex utero brain growth trajectories were observed in the period corresponding to the third trimester. Most notably, there was a marked increase in cortical gray matter expansion from 34 to 40 weeks of postmenstrual age, emphasizing this critical period of brain development.ConclusionUtilizing serial MRI to document early brain development in VPT infants, this study documents regional differences in brain growth trajectories ex utero during the period corresponding to the first and second half of the third trimester, providing novel insight into the maturational vulnerability of the rapidly expanding cortical gray matter in the NICU.
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Affiliation(s)
- Lillian G. Matthews
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian H. Walsh
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clare Knutsen
- Department of Pediatrics, Washington University, Saint Louis, Missouri
| | - Jeffrey J. Neil
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher D. Smyser
- Department of Pediatrics, Washington University, Saint Louis, Missouri
- Department of Neurology, Washington University, Saint Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Cynthia E. Rogers
- Department of Pediatrics, Washington University, Saint Louis, Missouri
- Department of Psychiatry, Washington University, Saint Louis, Missouri
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Benavente-Fernández I, Rodríguez-Zafra E, León-Martínez J, Jiménez-Gómez G, Ruiz-González E, Fernández-Colina RC, Lechuga-Sancho AM, Lubián-López SP. Normal Cerebellar Growth by Using Three-dimensional US in the Preterm Infant from Birth to Term-corrected Age. Radiology 2018; 288:254-261. [PMID: 29613844 DOI: 10.1148/radiol.2018171956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To establish cross-sectional and longitudinal reference values for cerebellar size in preterm infants with normal neuroimaging findings and normal 2-year neurodevelopmental outcome by using cranial ultrasonography (US). Materials and Methods This prospective study consecutively enrolled preterm infants admitted to a neonatal intensive care unit from June 2011 to June 2014 with a birth weight of less than or equal to 1500 g and/or gestational age (GA) of less than or equal to 32 weeks. They underwent weekly cranial US from birth to term-equivalent age and magnetic resonance (MR) imaging at term-equivalent age. The infants underwent neurodevelopmental assessments at age 2 years with Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III). Patients with adverse outcomes (death or abnormal neuroimaging findings and/or BSID-III score of <85) were excluded. The following measurements were performed: vermis height, craniocaudal diameter, superior width, inferior width, vermis area, and transcerebellar diameter. Statistical analyses were conducted by using multilevel analyses. Results A total of 137 infants with a mean GA at birth of 29.4 weeks (range, 25-32 weeks) were included. Transcerebellar diameter increased by 1.04 mm per week on average; vermis height and craniocaudal diameter increased by 0.55 mm and 0.59 mm, respectively. Superior vermian width increased by an average of 0.45 mm, whereas inferior vermian width increased by an average of 0.51 mm per week. Vermis area was found to increase by 0.22 cm2 per week on average. The sex effect was significant (female lower than male) for vermis height (P < .05), craniocaudal diameter (P < .05), inferior vermian width (P <. 05), and vermis area (P <. 05). Conclusion Cross-sectional and longitudinal reference values were established for cerebellar growth in preterm infants, which may be included in routine cranial US.
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Affiliation(s)
- Isabel Benavente-Fernández
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Enrique Rodríguez-Zafra
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Jesús León-Martínez
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Gema Jiménez-Gómez
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Estefanía Ruiz-González
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Rosalía Campuzano Fernández-Colina
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Alfonso M Lechuga-Sancho
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
| | - Simón P Lubián-López
- From the Neonatology Unit (I.B.F., E.R.G., S.P.L.L.) and Research Unit (G.J.G., A.M.L.S.), University Hospital Puerta del Mar, Avda. Ana de Viya 21, Cádiz 11009, Spain; Nene Foundation (Neonatal Neurology Research Group), Madrid, Spain (I.B.F., S.P.L.L.); Department of Pediatrics, Faculty of Medicine, University of Cádiz, Cádiz, Spain (E.R.Z., J.L.M.); and Early Intervention, Health and Social Policies, Regional Government of Andalusia, Seville, Spain (R.C.F.C.)
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Changes in brain morphology and microstructure in relation to early brain activity in extremely preterm infants. Pediatr Res 2018; 83:834-842. [PMID: 29244803 DOI: 10.1038/pr.2017.314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/27/2017] [Indexed: 01/18/2023]
Abstract
Background and ObjectiveTo investigate the relation of early brain activity with structural (growth of the cortex and cerebellum) and white matter microstructural brain development.MethodsA total of 33 preterm neonates (gestational age 26±1 weeks) without major brain abnormalities were continuously monitored with electroencephalography during the first 48 h of life. Rate of spontaneous activity transients per minute (SAT rate) and inter-SAT interval (ISI) in seconds per minute were calculated. Infants underwent brain magnetic resonance imaging ∼30 (mean 30.5; min: 29.3-max: 32.0) and 40 (41.1; 40.0-41.8) weeks of postmenstrual age. Increase in cerebellar volume, cortical gray matter volume, gyrification index, fractional anisotropy (FA) of posterior limb of the internal capsule, and corpus callosum (CC) were measured.ResultsSAT rate was positively associated with cerebellar growth (P=0.01), volumetric growth of the cortex (P=0.027), increase in gyrification (P=0.043), and increase in FA of the CC (P=0.037). ISI was negatively associated with cerebellar growth (P=0.002).ConclusionsIncreased early brain activity is associated with cerebellar and cortical growth structures with rapid development during preterm life. Higher brain activity is related to FA microstructural changes in the CC, a region responsible for interhemispheric connections. This study underlines the importance of brain activity for microstructural brain development.
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Drost FJ, Keunen K, Moeskops P, Claessens NHP, van Kalken F, Išgum I, Voskuil-Kerkhof ESM, Groenendaal F, de Vries LS, Benders MJNL, Termote JUM. Severe retinopathy of prematurity is associated with reduced cerebellar and brainstem volumes at term and neurodevelopmental deficits at 2 years. Pediatr Res 2018; 83:818-824. [PMID: 29320482 DOI: 10.1038/pr.2018.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/24/2017] [Indexed: 11/09/2022]
Abstract
BackgroundTo evaluate the association between severe retinopathy of prematurity (ROP), measures of brain morphology at term-equivalent age (TEA), and neurodevelopmental outcome.MethodsEighteen infants with severe ROP (median gestational age (GA) 25.3 (range 24.6-25.9 weeks) were included in this retrospective case-control study. Each infant was matched to two extremely preterm control infants (n=36) by GA, birth weight, sex, and brain injury. T2-weighted images were obtained on a 3 T magnetic resonance imaging (MRI) at TEA. Brain volumes were computed using an automatic segmentation method. In addition, cortical folding metrics were extracted. Neurodevelopment was formally assessed at the ages of 15 and 24 months.ResultsInfants with severe ROP had smaller cerebellar volumes (21.4±3.2 vs. 23.1±2.6 ml; P=0.04) and brainstem volumes (5.4±0.5 ml vs. 5.8±0.5 ml; P=0.01) compared with matched control infants. Furthermore, ROP patients showed a significantly lower development quotient (Griffiths Mental Development Scales) at the age of 15 months (93±15 vs. 102±10; P=0.01) and lower fine motor scores (10±3 vs. 12±2; P=0.02) on Bayley Scales (Third Edition) at the age of 24 months.ConclusionSevere ROP was associated with smaller volumes of the cerebellum and brainstem and with poorer early neurodevelopmental outcome. Follow-up through childhood is needed to evaluate the long-term consequences of our findings.
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Affiliation(s)
- Femke J Drost
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Kristin Keunen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Pim Moeskops
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Femke van Kalken
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | | | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jacqueline U M Termote
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Makropoulos A, Counsell SJ, Rueckert D. A review on automatic fetal and neonatal brain MRI segmentation. Neuroimage 2018; 170:231-248. [DOI: 10.1016/j.neuroimage.2017.06.074] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/06/2017] [Accepted: 06/26/2017] [Indexed: 01/18/2023] Open
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Schneider J, Fischer Fumeaux CJ, Duerden EG, Guo T, Foong J, Graz MB, Hagmann P, Chakravarty MM, Hüppi PS, Beauport L, Truttmann AC, Miller SP. Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates. Pediatrics 2018; 141:peds.2017-2169. [PMID: 29440285 DOI: 10.1542/peds.2017-2169] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes. METHODS Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected. RESULTS Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months' corrected age. CONCLUSIONS In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness.
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Affiliation(s)
- Juliane Schneider
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada.,Department of Woman-Mother-Child, Clinic of Neonatology and
| | | | - Emma G Duerden
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Ting Guo
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Justin Foong
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | - Patric Hagmann
- Department of Radiology, Clinic of Neuroradiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute, Montreal, Canada.,Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada; and
| | - Petra S Hüppi
- Division of Development and Growth, Department of Paediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Lydie Beauport
- Department of Woman-Mother-Child, Clinic of Neonatology and
| | | | - Steven P Miller
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada;
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Effects of early nutrition and growth on brain volumes, white matter microstructure, and neurodevelopmental outcome in preterm newborns. Pediatr Res 2018; 83:102-110. [PMID: 28915232 DOI: 10.1038/pr.2017.227] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/08/2017] [Indexed: 01/31/2023]
Abstract
BackgroundThis study aimed to investigate the effect of nutrition and growth during the first 4 weeks after birth on cerebral volumes and white matter maturation at term equivalent age (TEA) and on neurodevelopmental outcome at 2 years' corrected age (CA), in preterm infants.MethodsOne hundred thirty-one infants born at a gestational age (GA) <31 weeks with magnetic resonance imaging (MRI) at TEA were studied. Cortical gray matter (CGM) volumes, basal ganglia and thalami (BGT) volumes, cerebellar volumes, and total brain volume (TBV) were computed. Fractional anisotropy (FA) in the posterior limb of internal capsule (PLIC) was obtained. Cognitive and motor scores were assessed at 2 years' CA.ResultsCumulative fat and enteral intakes were positively related to larger cerebellar and BGT volumes. Weight gain was associated with larger cerebellar, BGT, and CGM volume. Cumulative fat and caloric intake, and enteral intakes were positively associated with FA in the PLIC. Cumulative protein intake was positively associated with higher cognitive and motor scores (all P<0.05).ConclusionOur study demonstrated a positive association between nutrition, weight gain, and brain volumes. Moreover, we found a positive relationship between nutrition, white matter maturation at TEA, and neurodevelopment in infancy. These findings emphasize the importance of growth and nutrition with a balanced protein, fat, and caloric content for brain development.
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41
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Procedural pain and oral glucose in preterm neonates: brain development and sex-specific effects. Pain 2017; 159:515-525. [DOI: 10.1097/j.pain.0000000000001123] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Barnett ML, Tusor N, Ball G, Chew A, Falconer S, Aljabar P, Kimpton JA, Kennea N, Rutherford M, David Edwards A, Counsell SJ. Exploring the multiple-hit hypothesis of preterm white matter damage using diffusion MRI. NEUROIMAGE-CLINICAL 2017; 17:596-606. [PMID: 29234596 PMCID: PMC5716951 DOI: 10.1016/j.nicl.2017.11.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 10/25/2017] [Accepted: 11/18/2017] [Indexed: 12/14/2022]
Abstract
Background Preterm infants are at high risk of diffuse white matter injury and adverse neurodevelopmental outcome. The multiple hit hypothesis suggests that the risk of white matter injury increases with cumulative exposure to multiple perinatal risk factors. Our aim was to test this hypothesis in a large cohort of preterm infants using diffusion weighted magnetic resonance imaging (dMRI). Methods We studied 491 infants (52% male) without focal destructive brain lesions born at < 34 weeks, who underwent structural and dMRI at a specialist Neonatal Imaging Centre. The median (range) gestational age (GA) at birth was 30+ 1 (23+ 2–33+ 5) weeks and median postmenstrual age at scan was 42+ 1 (38–45) weeks. dMRI data were analyzed using tract based spatial statistics and the relationship between dMRI measures in white matter and individual perinatal risk factors was assessed. We tested the hypothesis that increased exposure to perinatal risk factors was associated with lower fractional anisotropy (FA), and higher radial, axial and mean diffusivity (RD, AD, MD) in white matter. Neurodevelopmental performance was investigated using the Bayley Scales of Infant and Toddler Development, Third Edition (BSITD-III) in a subset of 381 infants at 20 months corrected age. We tested the hypothesis that lower FA and higher RD, AD and MD in white matter were associated with poorer neurodevelopmental performance. Results Identified risk factors for diffuse white matter injury were lower GA at birth, fetal growth restriction, increased number of days requiring ventilation and parenteral nutrition, necrotizing enterocolitis and male sex. Clinical chorioamnionitis and patent ductus arteriosus were not associated with white matter injury. Multivariate analysis demonstrated that fetal growth restriction, increased number of days requiring ventilation and parenteral nutrition were independently associated with lower FA values. Exposure to cumulative risk factors was associated with reduced white matter FA and FA values at term equivalent age were associated with subsequent neurodevelopmental performance. Conclusion This study suggests multiple perinatal risk factors have an independent association with diffuse white matter injury at term equivalent age and exposure to multiple perinatal risk factors exacerbates dMRI defined, clinically significant white matter injury. Our findings support the multiple hit hypothesis for preterm white matter injury. White matter injury was assessed in 491 preterm infants at term equivalent age. Aberrant white matter development was associated with several perinatal factors. Our findings support the multiple hit hypothesis for preterm brain injury.
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Affiliation(s)
- Madeleine L Barnett
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Nora Tusor
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Gareth Ball
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Andrew Chew
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Shona Falconer
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Paul Aljabar
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Jessica A Kimpton
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Nigel Kennea
- St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, UK.
| | - Mary Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE1 7EH, UK.
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Claessens NHP, Kelly CJ, Counsell SJ, Benders MJNL. Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease. Dev Med Child Neurol 2017; 59:894-902. [PMID: 28542743 DOI: 10.1111/dmcn.13461] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
This review integrates data on brain dysmaturation and acquired brain injury using fetal and neonatal magnetic resonance imaging (MRI), including the contribution of cardiovascular physiology to differences in brain development, and the relationship between brain abnormalities and subsequent neurological impairments in infants with congenital heart disease (CHD). The antenatal and neonatal period are critical for optimal brain development; the developing brain is particularly vulnerable to haemodynamic disturbances during this time. Altered cerebral perfusion and decreased cerebral oxygen delivery in the antenatal period can affect functional and structural brain development, while postnatal haemodynamic fluctuations may cause additional injury. In critical CHD, brain dysmaturation and acquired brain injury result from a combination of underlying cardiovascular pathology and surgery performed in the neonatal period. MRI findings in infants with CHD can be used to evaluate potential clinical risk factors for brain abnormalities, and aid prediction of functional outcomes at an early stage. In addition, information on timing of brain dysmaturation and acquired brain injury in CHD has the potential to be used when developing strategies to optimize neurodevelopment.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christopher J Kelly
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Fischer HS, Reibel NJ, Bührer C, Dame C. Prophylactic Early Erythropoietin for Neuroprotection in Preterm Infants: A Meta-analysis. Pediatrics 2017; 139:peds.2016-4317. [PMID: 28557760 DOI: 10.1542/peds.2016-4317] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Recombinant human erythropoietin (rhEPO) is a promising pharmacological agent for neuroprotection in neonates. OBJECTIVE To investigate whether prophylactic rhEPO administration in very preterm infants improves neurodevelopmental outcomes in a meta-analysis of randomized controlled trials (RCTs). DATA SOURCES Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched in December 2016 and complemented by other sources. STUDY SELECTION RCTs investigating the use of rhEPO in preterm infants versus a control group were selected if they were published in a peer-reviewed journal and reported neurodevelopmental outcomes at 18 to 24 months' corrected age. DATA EXTRACTION Data extraction and analysis followed the standard methods of the Cochrane Neonatal Review Group. The primary outcome was the number of infants with a Mental Developmental Index (MDI) <70 on the Bayley Scales of Infant Development. Secondary outcomes included a Psychomotor Development Index <70, cerebral palsy, visual impairment, and hearing impairment. RESULTS Four RCTs, comprising 1133 infants, were included in the meta-analysis. Prophylactic rhEPO administration reduced the incidence of children with an MDI <70, with an odds ratio (95% confidence interval) of 0.51 (0.31-0.81), P < .005. The number needed to treat was 14. There was no statistically significant effect on any secondary outcome. CONCLUSIONS Prophylactic rhEPO improved the cognitive development of very preterm infants, as assessed by the MDI at a corrected age of 18 to 24 months, without affecting other neurodevelopmental outcomes. Current and future RCTs should investigate optimal dosing and timing of prophylactic rhEPO and plan for long-term neurodevelopmental follow-up.
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Affiliation(s)
- Hendrik S Fischer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Nora J Reibel
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - Christof Dame
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
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