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Wintermark P, Lapointe A, Steinhorn R, Rampakakis E, Burhenne J, Meid AD, Bajraktari-Sylejmani G, Khairy M, Altit G, Adamo MT, Poccia A, Gilbert G, Saint-Martin C, Toffoli D, Vachon J, Hailu E, Colin P, Haefeli WE. Feasibility and Safety of Sildenafil to Repair Brain Injury Secondary to Birth Asphyxia (SANE-01): A Randomized, Double-blind, Placebo-controlled Phase Ib Clinical Trial. J Pediatr 2024; 266:113879. [PMID: 38142044 DOI: 10.1016/j.jpeds.2023.113879] [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: 10/05/2023] [Revised: 11/21/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To test feasibility and safety of administering sildenafil in neonates with neonatal encephalopathy (NE), developing brain injury despite therapeutic hypothermia (TH). STUDY DESIGN We performed a randomized, double-blind, placebo-controlled phase Ib clinical trial between 2016 and 2019 in neonates with moderate or severe NE, displaying brain injury on day-2 magnetic resonance imaging (MRI) despite TH. Neonates were randomized (2:1) to 7-day sildenafil or placebo (2 mg/kg/dose enterally every 12 hours, 14 doses). Outcomes included feasibility and safety (primary outcomes), pharmacokinetics (secondary), and day-30 neuroimaging and 18-month neurodevelopment assessments (exploratory). RESULTS Of the 24 enrolled neonates, 8 were randomized to sildenafil and 3 to placebo. A mild decrease in blood pressure was reported in 2 of the 8 neonates after initial dose, but not with subsequent doses. Sildenafil plasma steady-state concentration was rapidly reached, but decreased after TH discontinuation. Twelve percent of neonates (1/8) neonates died in the sildenafil group and 0% (0/3) in the placebo group. Among surviving neonates, partial recovery of injury, fewer cystic lesions, and less brain volume loss on day-30 magnetic resonance imaging were noted in 71% (5/7) of the sildenafil group and in 0% (0/3) of the placebo group. The rate of death or survival to 18 months with severe neurodevelopmental impairment was 57% (4/7) in the sildenafil group and 100% (3/3) in the placebo group. CONCLUSIONS Sildenafil was safe and well-absorbed in neonates with NE treated with TH. Optimal dosing needs to be established. Evaluation of a larger number of neonates through subsequent phases II and III trials is required to establish efficacy. CLINICAL TRIAL REGISTRATION ClinicalTrials.govNCT02812433.
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Affiliation(s)
- Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada.
| | - Anie Lapointe
- Department of Neonatology, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Robin Steinhorn
- Department of Pediatrics, University of California San Diego, and Rady Children's Hospital, San Diego, CA
| | | | - Jürgen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gzona Bajraktari-Sylejmani
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - May Khairy
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Gabriel Altit
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Marie-Therese Adamo
- Pharmacy Department, McGill University Health Center, Montreal, Québec, Canada
| | - Alishia Poccia
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare, Mississauga, Ontario, Canada
| | | | - Daniela Toffoli
- Department of Ophthalmology, McGill University, Montreal, Québec, Canada
| | - Julie Vachon
- Member of the Ordre des Psychologues du Quebec, Montreal, Québec, Canada
| | - Elizabeth Hailu
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Patrick Colin
- Patrick Colin Consultant Inc, Montreal, Québec, Canada
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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2
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Handlogten K. Pediatric regional anesthesiology: a narrative review and update on outcome-based advances. Int Anesthesiol Clin 2024; 62:69-78. [PMID: 38063039 DOI: 10.1097/aia.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Kathryn Handlogten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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3
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Mike JK, White Y, Hutchings RS, Vento C, Ha J, Iranmahboub A, Manzoor H, Gunewardena A, Cheah C, Wang A, Goudy BD, Lakshminrusimha S, Long-Boyle J, Fineman JR, Ferriero DM, Maltepe E. Effect of Clemastine on Neurophysiological Outcomes in an Ovine Model of Neonatal Hypoxic-Ischemic Encephalopathy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1728. [PMID: 38002819 PMCID: PMC10670092 DOI: 10.3390/children10111728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
Originally approved by the U.S. Food and Drug Administration (FDA) for its antihistamine properties, clemastine can also promote white matter integrity and has shown promise in the treatment of demyelinating diseases such as multiple sclerosis. Here, we conducted an in-depth analysis of the feasibility, safety, and neuroprotective efficacy of clemastine administration in near-term lambs (n = 25, 141-143 days) following a global ischemic insult induced via an umbilical cord occlusion (UCO) model. Lambs were randomly assigned to receive clemastine or placebo postnatally, and outcomes were assessed over a six-day period. Clemastine administration was well tolerated. While treated lambs demonstrated improvements in inflammatory scores, their neurodevelopmental outcomes were unchanged.
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Affiliation(s)
- Jana Krystofova Mike
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Yasmine White
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Rachel S. Hutchings
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Christian Vento
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Janica Ha
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Ariana Iranmahboub
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Hadiya Manzoor
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Anya Gunewardena
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Cheryl Cheah
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
| | - Aijun Wang
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95817, USA;
| | - Brian D. Goudy
- Department of Pediatrics, University of California Davis, Davis, CA 95817, USA (S.L.)
| | | | - Janel Long-Boyle
- School of Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA
- Initiative for Pediatric Drug and Device Development, San Francisco, CA 94143, USA
| | - Jeffrey R. Fineman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
- Initiative for Pediatric Drug and Device Development, San Francisco, CA 94143, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Emin Maltepe
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA (R.S.H.); (A.I.); (C.C.); (D.M.F.)
- Initiative for Pediatric Drug and Device Development, San Francisco, CA 94143, USA
- Department of Biomedical Sciences, University of California San Francisco, San Francisco, CA 94143, USA
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Viaene AN, Nelson EJ, Santi M. Perinatal hypoxic-ischemic brain injury: What's behind the "ribbon effect"? J Neuropathol Exp Neurol 2023; 82:865-875. [PMID: 37595577 DOI: 10.1093/jnen/nlad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
Ribbon effect describes a perceived macroscopic color reversal of the gray and white matter, characterized by a pale cortex and diffusely dusky underlying white matter. This finding is thought to be unique to the perinatal period and indicative of hypoxic-ischemic injury. However, the clinical and microscopic correlates of this macroscopic finding have not been clearly defined. A 21-year retrospective study of autopsies was performed. Ribbon effect was seen in 190 subjects, ages 20 weeks gestation to 9.5 months adjusted age. Clinical associations and radiographic findings were similar in ribbon effect cases and controls. A variety of histologic findings were observed including acute neuronal injury, diffuse white matter gliosis, and white matter necrosis. Only white matter vascular congestion was significantly correlated to the macroscopic severity of ribbon effect; the severity of white matter injury and acute neuronal injury were not significantly correlated to ribbon effect. While hypoxic-ischemic changes were present in nearly all cases of ribbon effect, the location, severity, and chronicity of these changes varied considerably, and similar findings were observed in controls. The presence of ribbon effect therefore does not predict microscopic findings apart from vascular congestion, highlighting the importance of microscopic examination in perinatal brain autopsies.
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Affiliation(s)
- Angela N Viaene
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ernest J Nelson
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Berger L, Holshouser B, Nichols JG, Pivonka-Jones J, Ashwal S, Bartnik-Olson B. White Matter Metabolite Ratios Predict Cognitive Outcome in Pediatric Traumatic Brain Injury. Metabolites 2023; 13:778. [PMID: 37512485 PMCID: PMC10385309 DOI: 10.3390/metabo13070778] [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: 04/29/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023] Open
Abstract
The prognostic ability of global white matter and gray matter metabolite ratios following pediatric traumatic brain injury (TBI) and their relationship to 12-month neuropsychological assessments of intelligence quotient (IQ), attention, and memory is presented. Three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) in pediatric subjects with complicated mild (cMild), moderate, and severe TBI was acquired acutely (6-18 days) and 12 months post-injury and compared to age-matched typically developing adolescents. A global linear regression model, co-registering MRSI metabolite maps with 3D high-resolution magnetic resonance images, was used to identify longitudinal white matter and gray matter metabolite ratio changes. Acutely, gray matter NAA/Cr, white matter NAA/Cr, and white matter NAA/Cho ratios were significantly lower in TBI groups compared to controls. Gray matter NAA/Cho was reduced only in the severe TBI group. At 12 months, all metabolite ratios normalized to control levels in each of the TBI groups. Acute gray matter and white matter NAA ratios were significantly correlated to 12-month assessments of IQ, attention, and memory. These findings suggest that whole brain gray matter and white matter metabolite ratios reflect longitudinal changes in neuronal metabolism following TBI, which can be used to predict neuropsychological outcomes in pediatric subjects.
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Affiliation(s)
- Luke Berger
- School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Barbara Holshouser
- Department of Radiology, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Joy G Nichols
- Department of Pediatrics, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Jamie Pivonka-Jones
- Department of Pediatrics, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Stephen Ashwal
- Department of Pediatrics, Loma Linda University Health, Loma Linda, CA 92354, USA
- Division of Child Neurology, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University Health, Loma Linda, CA 92354, USA
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6
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Brossard-Racine M, Rampakakis E, Tardif CL, Gilbert G, White A, Luu TM, Gallagher A, Pinchefsky E, Montreuil T, Simard MN, Wintermark P. Long-term consequences of neonatal encephalopathy in the hypothermia era: protocol for a follow-up cohort study at 9 years of age. BMJ Open 2023; 13:e073063. [PMID: 37055215 PMCID: PMC10106079 DOI: 10.1136/bmjopen-2023-073063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Therapeutic hypothermia (TH) became the standard of care treatment for neonates with moderate and severe neonatal encephalopathy (NE) in most industrialized countries about 10 years ago. Although TH is effective in reducing mortality and the incidence of severe developmental disabilities, the recent literature converges in reporting frequent cognitive and behavioural difficulties at school entry in children with NE-TH. Although these challenges are deemed minor compared with cerebral palsy and intellectual disability, their impacts on a child's self-determination and family's well-being are quite significant. Therefore, the nature and extent of these difficulties need to be comprehensively described so that appropriate care can be offered. METHODS AND ANALYSIS The current study will be the largest follow-up study of neonates with NE treated with TH to characterize their developmental outcomes and associated brain structural profiles at 9 years of age. Specifically, we will compare executive function, attention, social cognition, behaviour, anxiety, self-esteem, peer problems, brain volume, cortical features, white matter microstructure and myelination between children with NE-TH and matched peers without NE. Associations of perinatal risk factors and structural brain integrity with cognitive, behavioural and psycho-emotional deficits will be evaluated to inform about the potential aggravating and protective factors associated with function. ETHICS AND DISSEMINATION This study is supported by the Canadian Institute of Health Research (202203PJT-480065-CHI-CFAC-168509), and received approval from the Pediatric Ethical Review Board of the McGill University Health Center (MP-37-2023-9320). The study findings will be disseminated in scientific journals and conferences and presented to parental associations and healthcare providers to inform best practices. TRIAL REGISTRATION NUMBER NCT05756296.
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Affiliation(s)
- Marie Brossard-Racine
- Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Angela White
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Anne Gallagher
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Elana Pinchefsky
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Tina Montreuil
- Department of Psychiatry, McGill University Montreal, Montreal, Quebec, Canada
- Department of Educational and Counselling Psychology, McGill University Montreal, Montreal, Quebec, Canada
| | - Marie-Noelle Simard
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Pia Wintermark
- Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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7
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Jia F, Liao Y, Li X, Ye Z, Li P, Zhou X, Li Q, Wang S, Ning G, Qu H. Preliminary Study on Quantitative Assessment of the Fetal Brain Using MOLLI T1 Mapping Sequence. J Magn Reson Imaging 2022; 56:1505-1512. [PMID: 35394092 DOI: 10.1002/jmri.28195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Prenatal quantitative evaluation of myelin is important. However, few techniques are suitable for the quantitative evaluation of fetal myelination. PURPOSE To optimize a modified Look-Locker inversion recovery (MOLLI) T1 mapping sequence for fetal brain development study. STUDY TYPE Prospective observational preliminary cohort study. POPULATION A total of 71 women with normal fetuses divided into mid-pregnancy (gestational age 24-28 weeks, N = 25) and late pregnancy (gestational age > 28 weeks, N = 46) groups. FIELD STRENGTH/SEQUENCE A 3 T/MOLLI sequence. ASSESSMENT T1 values were measured in pedunculus cerebri, basal ganglia, thalamus, posterior limb of the internal capsule, temporal white matter, occipital white matter, frontal white matter, and parietal white matter by two radiologists (11 and 16 years of experience, respectively). STATISTICAL TESTS The Kruskal-Wallis test was used for reginal comparison. For each region of interest (ROI), differences in T1 values between the mid and late pregnancy groups were assessed by the Mann Whitney U test. Pearson correlation coefficients (r) were used to evaluate the correlations between T1 values and gestational age for each ROI. Intraobserver and interobserver agreement was determined by the intraclass correlation coefficient (ICC). A P value <0.05 was considered statistically significant. RESULTS Interobserver and intraobserver agreements of T1 were good for all ROIs (all ICCs > 0.700). There were significant differences in T1 values between lobal white matter and deep regions, respectively. Significant T1 values differences were found between middle and late pregnancy groups in pedunculus cerebri, basal ganglion, thalamus, posterior limb of the internal capsule, temporal, and occipital white matter. The T1 values showed significantly negative correlations with gestational weeks in pedunculus cerebri (r = -0.80), basal ganglion (r = -0.60), thalamus (r = -0.68), and posterior limb of the internal capsule (r = -0.77). DATA CONCLUSION The T1 values of fetal brain may be assessed using the MOLLI sequence and may reflect the myelination. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Fenglin Jia
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Liao
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xuesheng Li
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhijun Ye
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Pei Li
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiaoyue Zhou
- MR Collaborations, Siemens Healthineers, Shanghai, People's Republic of China
| | - Qing Li
- MR Collaborations, Siemens Healthineers, Shanghai, People's Republic of China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Shanghai, People's Republic of China
| | - Gang Ning
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Haibo Qu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Cai Y, Zhang X, Wu X, Liu H, Qi L, Liu X. The value of umbilical artery blood gas analysis in the diagnosis and prognosis evaluation of fetal distress. Am J Transl Res 2022; 14:4821-4829. [PMID: 35958451 PMCID: PMC9360831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
To explore the diagnostic specificity and clinical application of neonatal umbilical cord blood gas analysis in the prognosis of fetal distress, and to provide theoretical basis for neonatal rescue. Clinical data of a total of 240 singleton pregnant women and their neonates who delivered in the Obstetrics Department of our hospital from January 2021 to December 2021 were retrospectively analyzed. The pregnant women and their newborns were divided into an acute group (acute fetal distress), a chronic group (chronic fetal distress) and a control group (no fetus distress), with 80 cases in each. The umbilical artery blood gas analysis values including power of hydrogen (PH), partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate radical (HCO3 -), buffer excess (BE) and the Apgar score, as well as the neonatal asphyxia outcome after birth were recorded. There were statistically significant differences in fetal condition, PH and BE between newborns with asphyxia and normal newborns (P<0.05). The incidence of neonatal distress was 1.25% in the control group and 19.38% in the fetal distress group (including acute and chronic groups). Logistic regression analysis found that fetal distress was a risk factor for neonatal asphyxia (Odds Ratio (OR)=11.064, P=0.012). The specificity and sensitivity of neonatal cord blood gas analysis in diagnosing neonatal asphyxia were 95.69% and 80.65%, respectively. The specificity of Apgar score in the diagnosis of neonatal asphyxia was 94.74%, and the sensitivity was 70.97%. The rate of neonatal asphyxia in the chronic fetal distress group (26.25%) was higher than that in the acute fetal distress group (12.5%). The proportion of neonatal severe asphyxia in the chronic fetal distress group (66.67%) was higher than that in the acute group (20%). The PH and BE levels in the chronic fetal distress group were lower than those in the control group and acute fetal distress group (P<0.05). Cord blood gas analysis can help to improve the accuracy of fetal distress diagnosis. Cord blood gas is closely related to neonatal prognosis. Compared with acute fetal distress, chronic fetal distress is more likely to lead to neonatal acidosis and asphyxia.
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Affiliation(s)
- Yu Cai
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zunyi Medical University (Zunyi First People's Hospital) Zunyi 563000, Guizhou, China
| | - Xiaojuan Zhang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zunyi Medical University (Zunyi First People's Hospital) Zunyi 563000, Guizhou, China
| | - Xiaozhi Wu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zunyi Medical University (Zunyi First People's Hospital) Zunyi 563000, Guizhou, China
| | - Honglan Liu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zunyi Medical University (Zunyi First People's Hospital) Zunyi 563000, Guizhou, China
| | - Lianfeng Qi
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zunyi Medical University (Zunyi First People's Hospital) Zunyi 563000, Guizhou, China
| | - Xiaoyun Liu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Zunyi Medical University (Zunyi First People's Hospital) Zunyi 563000, Guizhou, China
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9
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Zhao X, Zhang C, Zhang B, Yan J, Wang K, Zhu Z, Zhang X. The Value of Diffusion Kurtosis Imaging in Detecting Delayed Brain Development of Premature Infants. Front Neurol 2021; 12:789254. [PMID: 34966352 PMCID: PMC8710729 DOI: 10.3389/fneur.2021.789254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Preterm infants are at high risk of the adverse neurodevelopmental outcomes. Our aim is to explore the value of diffusion kurtosis imaging (DKI) in diagnosing brain developmental disorders in premature infants. Materials and Methods: A total of 52 subjects were included in this study, including 26 premature infants as the preterm group, and 26 full-term infants as the control group. Routine MRI and DKI examinations were performed. Mean kurtosis (MK), radial kurtosis (RK), fractional anisotropy (FA), and mean diffusivity (MD) values were measured in the brain regions including posterior limbs of the internal capsule (PLIC), anterior limb of internal capsule (ALIC), parietal white matter (PWM), frontal white matter (FWM), thalamus (TH), caudate nucleus (CN), and genu of the corpus callosum (GCC). The chi-squared test, t-test, Spearman's correlation analysis, and receiver operating characteristic curve were used for data analyses. Results: In the premature infant group, the MK and RK values of PLIA, ALIC, and PWM were lower than those in the control group (p < 0.05). The FA values of PWM, FWM, and TH were also lower than those of the control group (p < 0.05). The area under curves of MK in PLIC and ALIC, MD in PWM, and FA in FWM were 0.813, 0.802, 0.842, and 0.867 (p < 0.05). In the thalamus and CN, the correlations between MK, RK values, and postmenstrual age (PMA) were higher than those between FA, MD values, and PMA. Conclusion: Diffusion kurtosis imaging can be used as an effective tool in detecting brain developmental disorders in premature infants.
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Affiliation(s)
- Xin Zhao
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunxiang Zhang
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bohao Zhang
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Kaiyu Wang
- MRI Research, GE Healthcare, Beijing, China
| | | | - Xiaoan Zhang
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wisnowski JL, Wintermark P, Bonifacio SL, Smyser CD, Barkovich AJ, Edwards AD, de Vries LS, Inder TE, Chau V. Neuroimaging in the term newborn with neonatal encephalopathy. Semin Fetal Neonatal Med 2021; 26:101304. [PMID: 34736808 PMCID: PMC9135955 DOI: 10.1016/j.siny.2021.101304] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neuroimaging is widely used to aid in the diagnosis and clinical management of neonates with neonatal encephalopathy (NE). Yet, despite widespread use clinically, there are few published guidelines on neuroimaging for neonates with NE. This review outlines the primary patterns of brain injury associated with hypoxic-ischemic injury in neonates with NE and their frequency, associated neuropathological features, and risk factors. In addition, it provides an overview of neuroimaging methods, including the most widely used scoring systems used to characterize brain injury in these neonates and their utility as predictive biomarkers. Last, recommendations for neuroimaging in neonates with NE are presented.
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Affiliation(s)
- Jessica L. Wisnowski
- Departments of Radiology and Pediatrics (Neonatology), Children’s Hospital Los Angeles, 4650 Sunset Blvd. MS #81, Los Angeles CA 90027, USA
| | - Pia Wintermark
- Department of Pediatrics (Neonatology), McGill University/Montreal Children's Hospital, Division of Newborn Medicine, Research Institute of the McGill University Health Centre, 1001 boul. Décarie, Site Glen Block E, EM0.3244, Montréal, QC H4A 3J1, Canada.
| | - Sonia L. Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics (Neonatology), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA
| | - Christopher D. Smyser
- Departments of Neurology, Radiology, and Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St Louis, MO 63110-1093, USA
| | - A. James Barkovich
- Department of Radiology, UCSF Benioff Children’s Hospital, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - A. David Edwards
- Evelina London Children’s Hospital, Centre for Developing Brain, King’s College London, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Linda S. de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3584 EA, Utrecht, the Netherlands
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Vann Chau
- Department of Pediatrics (Neurology), The Hospital for Sick Children, University of Toronto, 555 University Avenue, Room 6513, Toronto, ON M5G 1X8, Canada.
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