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Xu F, Wang Y, Wang W, Liang W, Tang Y, Liu S. Preterm Birth Alters the Regional Development and Structural Covariance of Cerebellum at Term-Equivalent Age. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01691-0. [PMID: 38581612 DOI: 10.1007/s12311-024-01691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
Preterm birth is associated with increased risk for a spectrum of neurodevelopmental disabilities. The cerebellum is implicated in a wide range of cognitive functions extending beyond sensorimotor control and plays an increasingly recognized role in brain development. Morphometric studies based on volume analyses have revealed impaired cerebellar development in preterm infants. However, the structural covariance between the cerebellum and cerebral cortex has not been studied during the neonatal period, and the extent to which structural covariance is affected by preterm birth remains unknown. In this study, using the structural MR images of 52 preterm infants scanned at term-equivalent age and 312 full-term controls from the Developing Human Connectome Project, we compared volumetric growth, local cerebellum shape development and cerebello-cerebral structural covariance between the two groups. We found that although there was no significant difference in the overall volume measurements between preterm and full-term infants, the shape measurements were different. Compared with the control infants, preterm infants had significantly larger thickness in the vermis and lower thickness in the lateral portions of the bilateral cerebral hemispheres. The structural covariance between the cerebellum and frontal and parietal lobes was significantly greater in preterm infants than in full-term controls. The findings in this study suggested that cerebellar development and cerebello-cerebral structural covariance may be affected by premature birth.
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Affiliation(s)
- Feifei Xu
- Department of Anatomy and Neurobiology, Institute for Sectional Anatomy and Digital Human, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, Shandong, China
| | - Yu Wang
- Department of Anatomy and Neurobiology, Institute for Sectional Anatomy and Digital Human, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, Shandong, China
| | - Wenjun Wang
- Department of Anatomy and Neurobiology, Institute for Sectional Anatomy and Digital Human, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, Shandong, China
| | - Wenjia Liang
- Department of Anatomy and Neurobiology, Institute for Sectional Anatomy and Digital Human, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, Shandong, China
| | - Yuchun Tang
- Department of Anatomy and Neurobiology, Institute for Sectional Anatomy and Digital Human, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, Shandong, China
| | - Shuwei Liu
- Department of Anatomy and Neurobiology, Institute for Sectional Anatomy and Digital Human, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, Shandong, China.
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Gallagher K, Shaw C, Parisaei M, Marlow N, Aladangady N. Attitudes About Extremely Preterm Birth Among Obstetric and Neonatal Health Care Professionals in England: A Qualitative Study. JAMA Netw Open 2022; 5:e2241802. [PMID: 36374500 PMCID: PMC9664260 DOI: 10.1001/jamanetworkopen.2022.41802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Variation in attitudes between health care professionals involved in the counseling of parents facing extremely preterm birth (<24 wk gestational age) may lead to parental confusion and professional misalignment. Objective To explore the attitudes of health care professionals involved in the counseling of parents facing preterm birth on the treatment of extremely preterm infants. Design, Setting, and Participants This qualitative study used Q methods to explore the attitudes of neonatal nurses, neonatologists, midwives, and obstetricians involved in the care of extremely preterm infants in 4 UK National Health Service perinatal centers between February 10, 2020, and April 30, 2021. Each participating center had a tertiary level neonatal unit and maternity center. Individuals volunteered participation through choosing to complete the study following a presentation by researchers at each center. A link to the online Q study was emailed to all potential participants by local principal investigators. Participants ranked 53 statements about the treatment of extremely preterm infants in an online quasi-normal distribution grid from strongly agree (6) to strongly disagree (-6). Main Outcomes and Measures Distinguishing factors per professional group (representing different attitudes) identified through by-person factor analysis of Q sort-data were the primary outcome. Areas of shared agreement (consensus) between professional groups were also explored. Q sorts achieving a factor loading of greater than 0.46 (P < .01) on a given factor were included. Results In total, 155 health care professionals volunteered participation (128 [82.6%] women; mean [SD] age, 41.6 [10.2] years, mean [SD] experience, 14.1 [9.6] years). Four distinguishing factors were identified between neonatal nurses, 3 for midwives, 5 for neonatologists, and 4 for obstetricians. Analysis of factors within and between professional groups highlighted significant variation in attitudes of professionals toward parental engagement in decision-making, the perceived importance of potential disability in decision-making, and the use of medical technology. Areas of consensus highlighted that most professionals disagreed with statements suggesting disability equates to reduced quality of life. The statement suggesting the parents' decision was considered the most important when considering neonatal resuscitation was placed in the neutral (middistribution) position by all professionals. Conclusions and Relevance The findings of this qualitative study suggest that parental counseling at extremely low gestations is a complex scenario further complicated by the differences in attitudes within and between professional disciplines toward treatment approaches. The development of multidisciplinary training encompassing all professional groups may facilitate a more consistent and individualized approach toward parental engagement in decision-making.
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Affiliation(s)
- Katie Gallagher
- EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Chloe Shaw
- EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Maryam Parisaei
- Department of Obstetrics and Gynaecology, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
| | - Neil Marlow
- EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Narendra Aladangady
- Department of Neonatology, Homerton Healthcare NHS Foundation Trust, London, United Kingdom
- Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, QMUL, London, United Kingdom
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Rinat S, Mackay M, Synnes A, Holsti L, Zwicker JG. Early feeding behaviours of extremely preterm infants predict neurodevelopmental outcomes. Early Hum Dev 2022; 173:105647. [PMID: 36029558 DOI: 10.1016/j.earlhumdev.2022.105647] [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: 04/03/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infants born extremely preterm are at high risk for early feeding difficulties, as well as poor neurodevelopmental outcomes in childhood. Feeding, a complex motor skill, may be predictive of later neuromotor outcomes. AIMS To determine the relationship between feeding behaviours of extremely preterm-born infants (<28 weeks gestational age) at 4-months corrected age (CA) and neurodevelopmental outcomes at 4-5 years. STUDY DESIGN Retrospective cohort design with prospectively collected data. SUBJECTS Infants born extremely preterm from September 1999 - October 2013 [n = 412, mean gestational age 25.4 (1.3) weeks; mean birth weight 771 (168) grams]. Oral feeding was assessed at 4-months CA by an experienced occupational therapist; infants were classified as either having poor suck-swallow ('feeding difficulties') or no feeding difficulties. OUTCOME MEASURES Motor outcomes were assessed at 4-5 years using the Movement Assessment Battery for Children (MABC). Children were categorized as: (1) typical motor development (TMD; n = 214); (2) Developmental Coordination Disorder (DCD; n = 116); or (3) major neurodevelopmental disorder (MND; n = 82). RESULTS Feeding behaviour at 4-months CA predicted DCD (OR = 2.95, CI 1.13-7.68) and MND (OR = 3.67, CI 1.35-9.96) after controlling for confounders. Infants with feeding difficulties were more likely to be diagnosed with DCD (40 % of poor feeders) or MND (36 %) at 4-5 years, compared to infants without feeding issues. CONCLUSIONS Early feeding behaviours significantly predicted motor outcomes at 4-5 years. Infants born extremely preterm with early feeding difficulties should be identified as at high risk for poor motor outcomes later in childhood and screened for early diagnosis and intervention.
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Affiliation(s)
- Shie Rinat
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Margot Mackay
- Neonatal Follow-Up Program, BC Women's Hospital, Vancouver, Canada
| | - Anne Synnes
- Neonatal Follow-Up Program, BC Women's Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Brain, Behaviour, & Development Theme, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Liisa Holsti
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jill G Zwicker
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Brain, Behaviour, & Development Theme, BC Children's Hospital Research Institute, Vancouver, Canada; Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada.
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Jantzie L, Muthukumar S, Kitase Y, Vasan V, Fouda MA, Hamimi S, Burkhardt C, Burton VJ, Gerner G, Scafidi J, Ye X, Northington F, Robinson S. Infantile Cocktail of Erythropoietin and Melatonin Restores Gait in Adult Rats with Preterm Brain Injury. Dev Neurosci 2022; 44:266-276. [PMID: 35358965 PMCID: PMC10066804 DOI: 10.1159/000524394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of physical disability for children worldwide. Many infants and toddlers are not diagnosed with CP until they fail to achieve obvious motor milestones. Currently, there are no effective pharmacologic interventions available for infants and toddlers to substantially improve their trajectory of neurodevelopment. Because children with CP from preterm birth also exhibit a sustained immune system hyper-reactivity, we hypothesized that neuro-immunomodulation with a regimen of repurposed endogenous neurorestorative medications, erythropoietin (EPO) and melatonin (MLT), could improve this trajectory. Thus, we administered EPO + MLT to rats with CP during human infant-toddler equivalency to determine whether we could influence gait patterns in mature animals. After a prenatal injury on embryonic day 18 (E18) that mimics chorioamnionitis at ∼25 weeks human gestation, rat pups were born and raised with their dam. Beginning on postnatal day 15 (P15), equivalent to human infant ∼1 year, rats were randomized to receive either a regimen of EPO + MLT or vehicle (sterile saline) through P20. Gait was assessed in young adult rats at P30 using computerized digital gait analyses including videography on a treadmill. Results indicate that gait metrics of young adult rats treated with an infantile cocktail of EPO + MLT were restored compared to vehicle-treated rats (p < 0.05) and similar to sham controls. These results provide reassuring evidence that pharmacological interventions may be beneficial to infants and toddlers who are diagnosed with CP well after the traditional neonatal window of intervention.
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Affiliation(s)
- Lauren Jantzie
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Sankar Muthukumar
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuma Kitase
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vikram Vasan
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohammed A. Fouda
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah Hamimi
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Vera Joanna Burton
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Infant Neurodevelopment, Kennedy Krieger Institute, Baltimore, MD
| | - Gwendolyn Gerner
- Center for Infant Neurodevelopment, Kennedy Krieger Institute, Baltimore, MD
| | - Joseph Scafidi
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Infant Neurodevelopment, Kennedy Krieger Institute, Baltimore, MD
| | - Xiaobu Ye
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Frances Northington
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shenandoah Robinson
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Feasibility of a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age (Dance PREEMIE). Early Hum Dev 2021; 163:105482. [PMID: 34649192 DOI: 10.1016/j.earlhumdev.2021.105482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Physical activity (PA) participation provides opportunities for preschool-age children to improve motor skills. This is especially important for children born extremely preterm (EP) or extremely low birthweight (ELBW) who are at greater risk of motor impairment, and are participating less frequently in PA, compared with children born at term. There is limited evidence on improving PA participation for this population. METHODS This case series design study evaluated the feasibility of a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age (Dance PREEMIE), a community-based dance class intervention aiming to improve PA participation. Children born EP/ELBW with motor impairment were recruited at 3 years' corrected age. Dance teachers were recruited from community dance schools and provided with study-specific training. Intervention feasibility was assessed using; recruitment capability, class attendance, child involvement and enjoyment, teacher self-efficacy, and implementation fidelity. RESULTS Ten children and seven dance teachers were recruited. Most children (n = 7) attended >75% of classes. Children enjoyed the classes and were mostly 'somewhat-very' or 'very' involved. Teachers reported improved self-efficacy for teaching dance to children with motor impairment after attending the training day. CONCLUSION Further research is warranted to evaluate the efficacy of Dance PREEMIE in larger samples.
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