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Aylward GP. Alterations in Preterm Brain Development: Relation to Developmental Assessment and Prediction. Am J Perinatol 2024; 41:826-830. [PMID: 37168010 DOI: 10.1055/s-0043-1768703] [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: 05/13/2023]
Abstract
Infants born extremely preterm are at risk for compromised cognitive and motor outcome. There are various possibilities as to why this occurs. The "two-hit" hypothesis consists of interrelated developmental disruptions and insults. Both specifically affect the transient subplate neuronal layer (SNL) and the early development of brain circuitry. The SNL, analogous to a switchboard, is critical in connecting cortical and lower brain centers and is highly susceptible to disruptions and insults, producing dysfunctional neural networks. Damage to the SNL provides the putative link between atypical early brain development and later cognitive and academic function that require complex neural circuitry. This, in turn, has major ramifications for developmental assessment and prediction. KEY POINTS: · Preterm brains are highly susceptible to disruptions and insults, this being the two-hit hypothesis.. · There is a variation in which low-grade stressors "sensitize" the infant increasing susceptibility to a second stressor-causing brain damage.. · Subplate neuronal layer damage compromises outcome by interfering with thalamocortical connections.. · Combining neuroimaging and developmental testing is the best way to gain insight into these processes.. · Atypical early brain development may not be evident until the network is mature and challenged..
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Affiliation(s)
- Glen P Aylward
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois
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Jang YH, Kim H, Lee JY, Ahn JH, Chung AW, Lee HJ. Altered development of structural MRI connectome hubs at near-term age in very and moderately preterm infants. Cereb Cortex 2022; 33:5507-5523. [PMID: 36408630 DOI: 10.1093/cercor/bhac438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract
Preterm infants may exhibit altered developmental patterns of the brain structural network by endogenous and exogenous stimuli, which are quantifiable through hub and modular network topologies that develop in the third trimester. Although preterm brain networks can compensate for white matter microstructural abnormalities of core connections, less is known about how the network developmental characteristics of preterm infants differ from those of full-term infants. We identified 13 hubs and 4 modules and revealed subtle differences in edgewise connectivity and local network properties between 134 preterm and 76 full-term infants, identifying specific developmental patterns of the brain structural network in preterm infants. The modules of preterm infants showed an imbalanced composition. The edgewise connectivity in preterm infants showed significantly decreased long- and short-range connections and local network properties in the dorsal superior frontal gyrus. In contrast, the fusiform gyrus and several nonhub regions showed significantly increased wiring of short-range connections and local network properties. Our results suggested that decreased local network in the frontal lobe and excessive development in the occipital lobe may contribute to the understanding of brain developmental deviances in preterm infants.
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Affiliation(s)
- Yong Hun Jang
- Hanyang University Graduate School of Biomedical Science and Engineering Department of Translational Medicine, , Seoul 04763 , Republic of Korea
| | - Hyuna Kim
- Hanyang University Graduate School of Biomedical Science and Engineering Department of Translational Medicine, , Seoul 04763 , Republic of Korea
| | - Joo Young Lee
- Hanyang University Graduate School of Biomedical Science and Engineering Department of Translational Medicine, , Seoul 04763 , Republic of Korea
| | - Ja-Hye Ahn
- Hanyang University College of Medicine Department of Pediatrics, Hanyang University Hospital, , Seoul 04763 , Republic of Korea
| | - Ai Wern Chung
- Harvard Medical School Fetal Neonatal-Neuroimaging and Developmental Science Center, Boston Children’s Hospital, , Boston, MA 02115 , USA
- Harvard Medical School Department of Pediatrics, Boston Children’s Hospital, , Boston, MA 02115 , USA
| | - Hyun Ju Lee
- Hanyang University College of Medicine Department of Pediatrics, Hanyang University Hospital, , Seoul 04763 , Republic of Korea
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Gomaa N, Konwar C, Gladish N, Au-Young SH, Guo T, Sheng M, Merrill SM, Kelly E, Chau V, Branson HM, Ly LG, Duerden EG, Grunau RE, Kobor MS, Miller SP. Association of Pediatric Buccal Epigenetic Age Acceleration With Adverse Neonatal Brain Growth and Neurodevelopmental Outcomes Among Children Born Very Preterm With a Neonatal Infection. JAMA Netw Open 2022; 5:e2239796. [PMID: 36322087 PMCID: PMC9631102 DOI: 10.1001/jamanetworkopen.2022.39796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Very preterm neonates (24-32 weeks' gestation) remain at a higher risk of morbidity and neurodevelopmental adversity throughout their lifespan. Because the extent of prematurity alone does not fully explain the risk of adverse neonatal brain growth or neurodevelopmental outcomes, there is a need for neonatal biomarkers to help estimate these risks in this population. OBJECTIVES To characterize the pediatric buccal epigenetic (PedBE) clock-a recently developed tool to measure biological aging-among very preterm neonates and to assess its association with the extent of prematurity, neonatal comorbidities, neonatal brain growth, and neurodevelopmental outcomes at 18 months of age. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted in 2 neonatal intensive care units of 2 hospitals in Toronto, Ontario, Canada. A total of 35 very preterm neonates (24-32 weeks' gestation) were recruited in 2017 and 2018, and neuroimaging was performed and buccal swab samples were acquired at 2 time points: the first in early life (median postmenstrual age, 32.9 weeks [IQR, 32.0-35.0 weeks]) and the second at term-equivalent age (TEA) at a median postmenstrual age of 43.0 weeks (IQR, 41.0-46.0 weeks). Follow-ups for neurodevelopmental assessments were completed in 2019 and 2020. All neonates in this cohort had at least 1 infection because they were originally enrolled to assess the association of neonatal infection with neurodevelopment. Neonates with congenital malformations, genetic syndromes, or congenital TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes and other agents) infection were excluded. EXPOSURES The extent of prematurity was measured by gestational age at birth and PedBE age difference. PedBE age was computed using DNA methylation obtained from 94 age-informative CpG (cytosine-phosphate-guanosine) sites. PedBE age difference (weeks) was calculated by subtracting PedBE age at each time point from the corresponding postmenstrual age. MAIN OUTCOMES AND MEASURES Total cerebral volumes and cerebral growth during the neonatal intensive care unit period were obtained from magnetic resonance imaging scans at 2 time points: approximately the first 2 weeks of life and at TEA. Bayley Scales of Infant and Toddler Development, Third Edition, were used to assess neurodevelopmental outcomes at 18 months. RESULTS Among 35 very preterm neonates (21 boys [60.0%]; median gestational age, 27.0 weeks [IQR, 25.9-29.9 weeks]; 23 [65.7%] born extremely preterm [<28 weeks' gestation]), extremely preterm neonates had an accelerated PedBE age compared with neonates born at a later gestational age (β = 9.0; 95% CI, 2.7-15.3; P = .01). An accelerated PedBE age was also associated with smaller cerebral volumes (β = -5356.8; 95% CI, -6899.3 to -2961.7; P = .01) and slower cerebral growth (β = -2651.5; 95% CI, -5301.2 to -1164.1; P = .04); these associations remained significant after adjusting for clinical neonatal factors. These findings were significant at TEA but not earlier in life. Similarly, an accelerated PedBE age at TEA was associated with lower cognitive (β = -0.4; 95% CI, -0.8 to -0.03; P = .04) and language (β = -0.6; 95% CI, -1.1 to -0.06; P = .02) scores at 18 months. CONCLUSIONS AND RELEVANCE This cohort study of very preterm neonates suggests that biological aging may be associated with impaired brain growth and neurodevelopmental outcomes. The associations between epigenetic aging and adverse neonatal brain health warrant further attention.
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Affiliation(s)
- Noha Gomaa
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chaini Konwar
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Gladish
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie H. Au-Young
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ting Guo
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Min Sheng
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah M. Merrill
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edmond Kelly
- Division of Neonatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vann Chau
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Helen M. Branson
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Linh G. Ly
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emma G. Duerden
- Faculty of Education, Western University, London, Ontario, Canada
| | - Ruth E. Grunau
- Division of Neonatology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Michael S. Kobor
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven P. Miller
- Neuroscience and Mental Health Program, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
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Bando N, Walton K, O'Connor DL, Janus M, Unger SL. Examination of school readiness and factors related to developmental vulnerability in children born very low birth weight. Child Care Health Dev 2022; 49:444-455. [PMID: 36070087 DOI: 10.1111/cch.13058] [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: 08/31/2021] [Revised: 08/02/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many children born very low birth weight (VLBW) experience school struggles with preparedness requiring adequate physical, social, behavioural, cognitive and communication skills. A global assessment of proficiency is necessary to identify those at risk in any such area and direct early intervention accordingly. Study objectives were to characterize developmental vulnerability and school readiness scores in these key domains in a sample of children born VLBW versus their provincial public school system peers and identify early-life infant and parent factors related to suboptimal school readiness. METHODS The Early Development Instrument teacher assessments of school readiness were collected for a Canadian VLBW sample (NCT02759809). Comparisons between children born VLBW and peers were made. Group differences between children born VLBW considered vulnerable (<10th percentile, not developmentally ready for learning) and not vulnerable were tested and linear regression explored associations between early-life factors and domain scores. RESULTS Of 77 available Early Development Instrument assessments, median (interquartile range) assessment age was 6.0 (5.7, 6.2) years, birth weight 950 (793, 1250) grammes and birth gestation 27.4 (25.6, 29.7) weeks. A higher proportion of children born VLBW versus peers exhibited vulnerability in Physical Health and Well-being (24.7% vs. 16.1%, p = 0.04), Communication Skills and General Knowledge (23.4% vs. 10.2%, p = 0.0001) and vulnerability in ≥2 domains (26.0% vs. 14.4%, p = 0.004). Children born VLBW classified as vulnerable versus not vulnerable had lower birth gestation and 5-min Apgar. Adjusted regression models found Apgar <7 associated with lower scores for Physical Health and Well-being (-0.86; 95%CI: -1.71, -0.00; p = 0.049), Social Competence (-1.77; 95%CI: -2.92, -0.62; p = 0.003), Emotional Maturity (-1.55; 95%CI: -2.43, -0.66; p = 0.0009) and Communication Skills and General Knowledge (-1.63; 95%CI: -3.19, -0.06; p = 0.04). CONCLUSIONS This VLBW sample exhibited poor school readiness in multiple domains. Identification of lower birth gestation and Apgar may assist targeted early interventions to mitigate vulnerability.
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Affiliation(s)
- Nicole Bando
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn Walton
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Magdalena Janus
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sharon L Unger
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada.,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Barnes-Davis ME, Williamson BJ, Merhar SL, Nagaraj UD, Parikh NA, Kadis DS. Extracallosal Structural Connectivity Is Positively Associated With Language Performance in Well-Performing Children Born Extremely Preterm. Front Pediatr 2022; 10:821121. [PMID: 35372163 PMCID: PMC8971711 DOI: 10.3389/fped.2022.821121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
Children born extremely preterm (<28 weeks gestation) are at risk for language delay or disorders. Decreased structural connectivity in preterm children has been associated with poor language outcome. Previously, we used multimodal imaging techniques to demonstrate that increased functional connectivity during a stories listening task was positively associated with language scores for preterm children. This functional connectivity was supported by extracallosal structural hyperconnectivity when compared to term-born children. Here, we attempt to validate this finding in a distinct cohort of well-performing extremely preterm children (EPT, n = 16) vs. term comparisons (TC, n = 28) and also compare this to structural connectivity in a group of extremely preterm children with a history of language delay or disorder (EPT-HLD, n = 8). All participants are 4-6 years of age. We perform q-space diffeomorphic reconstruction and functionally-constrained structural connectometry (based on fMRI activation), including a novel extension enabling between-groups comparisons with non-parametric ANOVA. There were no significant differences between groups in age, sex, race, ethnicity, parental education, family income, or language scores. For EPT, tracks positively associated with language scores included the bilateral posterior inferior fronto-occipital fasciculi and bilateral cerebellar peduncles and additional cerebellar white matter. Quantitative anisotropy in these pathways accounted for 55% of the variance in standardized language scores for the EPT group specifically. Future work will expand this cohort and follow longitudinally to investigate the impact of environmental factors on developing language networks and resiliency in the preterm brain.
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Affiliation(s)
- Maria E Barnes-Davis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Brady J Williamson
- Department of Radiology, University of Cincinnati, Cincinnati, OH, United States
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Usha D Nagaraj
- Department of Radiology, University of Cincinnati, Cincinnati, OH, United States
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Darren S Kadis
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
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Savenko IV, Garbaruk ES, Boboshko MY. [Psychoacoustic methods in diagnosis of central auditory processing disorders in prematurely born children]. Vestn Otorinolaringol 2020; 85:11-17. [PMID: 32628376 DOI: 10.17116/otorino20208503111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The presence of numerous perinatal risk factors and comorbid pathology in prematurely born children, even in the absence of peripheral auditory deficit, can lead to disruptions in the processes of higher nervous sound information processing with the formation of central auditory disorders. OBJECTIVE Audiological assessment of the functional state of auditory system central parts in prematurely born children. MATERIAL AND METHODS The study involved 54 deeply premature born infants, which were divided into 3 groups depending on age (6-7, 8-9, and 10-11 years), 18 subjects in each group, and 70 healthy, term-born children of the corresponding age. In addition to the traditional audiological examination, all children underwent an assessment of functional state of the central parts of auditory system through a pause detection test (Random Gap Detection Test, RGDT); the perception of fast rhythmic sequences of stimuli, monaural low excess speech testing, binaural interaction test in alternating binaural speech format (ABS ), dichotic presentation of pairs of single digits, single digits and monosyllables, two-digit numerals, Russian matrix phrasal test in noise (RUMatrix) were studied. RESULTS Prematurely born infants of all age groups were significantly worse compared to control group (p<0.01) while having RGDT, a test for assessing the perception of fast rhythmic sequences of stimuli and dichotic binaural integration tests. Monaural intelligibility of monosyllabic words in silence in children of all three groups did not differ from normal values, but it suffered from contralateral use of noise interference in children aged 6-7. According to the RUMatrix test, legibility of phrases in noise was impaired in 65% of subjects. Test results in the ABS format revealed a significant violation of speech intelligibility (p<0.01) only in children of the younger age group. CONCLUSION In prematurely born children, there is a dysfunction of the central parts of the auditory system, which is multilevel in nature, partially leveling as children grow older. Moreover, the processes of temporary processing of acoustic information suffer to the greatest extent, not being compensated up to adolescence.
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Affiliation(s)
- I V Savenko
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - E S Garbaruk
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.,Saint Petersburg State Pediatric Medical University of the Ministry of Health of Russia, Saint Petersburg, Russia
| | - M Yu Boboshko
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.,Mechnikov North-Western State Medical University of the Ministry of Health of Russia, Saint Petersburg, Russia
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Fernandez-Baizan C, Alcántara-Canabal L, Solis G, Mendez M. The association between perinatal and neonatal variables and neuropsychological development in very and extremely low-birth-weight preterm children at the beginning of primary school. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 10:348-358. [DOI: 10.1080/21622965.2019.1709464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Cristina Fernandez-Baizan
- Neuroscience Institute of Principado de Asturias (INEUROPA), Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Leticia Alcántara-Canabal
- Neuroscience Institute of Principado de Asturias (INEUROPA), Oviedo, Spain
- Primary Care Center, Paulino Prieto, Sanitary Area IV, Oviedo, Spain
| | - Gonzalo Solis
- Neuroscience Institute of Principado de Asturias (INEUROPA), Oviedo, Spain
- Pediatric Clinic Area, Neonatology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Marta Mendez
- Neuroscience Institute of Principado de Asturias (INEUROPA), Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
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Preterm birth subtypes, placental pathology findings, and risk of neurodevelopmental disabilities during childhood. Placenta 2019; 83:17-25. [PMID: 31477202 DOI: 10.1016/j.placenta.2019.06.374] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Preterm birth (PTB) and in-utero inflammation are recognized risk factors of neurodevelopmental disabilities (NDDs); however, their combined role in NDDs is unknown. We examined the independent and joint association of PTB and placental histological findings with the childhood risk of NDDs (overall and by subgroups including autism spectrum disorder (ASD) and ADHD). METHODS We analyzed data from the Boston Birth Cohort, where mother-infant pairs were enrolled at birth and followed from birth onwards. Birth outcomes, placental pathology and NDDs were obtained from electronic medical records. Placental pathology was categorized using a standardized classification system proposed by the Amsterdam Placental Workshop Group. RESULTS PTB (all, including spontaneous, medically indicated) was an independent risk factor for NDDs. Placental histological chorioamnionitis (CA) and PTB additively increased the odds of NDDs (aOR: 2.16, 95% CI: 1.37, 3.39), as well as ADHD (aOR: 2.75, 95% CI: 1.55, 4.90), other developmental disabilities (aOR: 1.96, 95% CI: 1.18, 3.25) and possibly ASD (aOR: 2.31, 95% CI: 0.99, 5.39). The above associations were more pronounced in spontaneous than medically indicated PTB. PTB alone in the absence of CA only had a moderate association with ASD and ADHD. Placental maternal vascular malperfusion alone or in combination with PTB was not associated with the risk of NDDs. DISCUSSION Our study provided new insights on PTB and NDDs by further considering preterm subtypes and placental histology. We revealed that children of spontaneous PTB along with histological CA were at the highest risk for a spectrum of NDDs.
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Pregnolato S, Chakkarapani E, Isles AR, Luyt K. Glutamate Transport and Preterm Brain Injury. Front Physiol 2019; 10:417. [PMID: 31068830 PMCID: PMC6491644 DOI: 10.3389/fphys.2019.00417] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Preterm birth complications are the leading cause of child death worldwide and a top global health priority. Among the survivors, the risk of life-long disabilities is high, including cerebral palsy and impairment of movement, cognition, and behavior. Understanding the molecular mechanisms of preterm brain injuries is at the core of future healthcare improvements. Glutamate excitotoxicity is a key mechanism in preterm brain injury, whereby the accumulation of extracellular glutamate damages the delicate immature oligodendrocytes and neurons, leading to the typical patterns of injury seen in the periventricular white matter. Glutamate excitotoxicity is thought to be induced by an interaction between environmental triggers of injury in the perinatal period, particularly cerebral hypoxia-ischemia and infection/inflammation, and developmental and genetic vulnerabilities. To avoid extracellular build-up of glutamate, the brain relies on rapid uptake by sodium-dependent glutamate transporters. Astrocytic excitatory amino acid transporter 2 (EAAT2) is responsible for up to 95% of glutamate clearance, and several lines of evidence suggest that it is essential for brain functioning. While in the adult EAAT2 is predominantly expressed by astrocytes, EAAT2 is transiently upregulated in the immature oligodendrocytes and selected neuronal populations during mid-late gestation, at the peak time for preterm brain injury. This developmental upregulation may interact with perinatal hypoxia-ischemia and infection/inflammation and contribute to the selective vulnerability of the immature oligodendrocytes and neurons in the preterm brain. Disruption of EAAT2 may involve not only altered expression but also impaired function with reversal of transport direction. Importantly, elevated EAAT2 levels have been found in the reactive astrocytes and macrophages of human infant post-mortem brains with severe white matter injury (cystic periventricular leukomalacia), potentially suggesting an adaptive mechanism against excitotoxicity. Interestingly, EAAT2 is suppressed in animal models of acute hypoxic-ischemic brain injury at term, pointing to an important and complex role in newborn brain injuries. Enhancement of EAAT2 expression and transport function is gathering attention as a potential therapeutic approach for a variety of adult disorders and awaits exploration in the context of the preterm brain injuries.
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Affiliation(s)
- Silvia Pregnolato
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elavazhagan Chakkarapani
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anthony R Isles
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Karen Luyt
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Alcántara-Canabal L, Fernández-Baizán C, Solís-Sánchez G, Arias JL, Méndez M. [Identification of behavioural and emotional problems in premature children in the primary care setting]. Aten Primaria 2019; 52:104-111. [PMID: 30638698 PMCID: PMC7025995 DOI: 10.1016/j.aprim.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/26/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Objetivos Evidenciar la utilidad, para su uso por el pediatra de atención primaria, del cuestionario BASC (Behavior Assessment System for Children) para la detección precoz de los problemas psicológicos y comportamentales en los prematuros. Diseño Estudio transversal y descriptivo. Emplazamiento Centro de atención primaria (Área Sanitaria IV del Principado de Asturias) y centro hospitalario (Hospital Universitario Central de Asturias), España. Participantes Padres de 87 niños prematuros con peso menor de 1.500 g al nacimiento y de 43 controles nacidos a término, ambos grupos con edad de 5 a 7 años. Mediciones principales Se aplicó el cuestionario BASC (versión para padres). Resultados Los niños prematuros presentan diferencias respecto a los controles, muestran mayores niveles de inatención (Z = −4,125; p < 0,001), ansiedad (Z = −2,801; p = 0,005) e interiorización de conductas (Z = −2,148; p = 0,032), conductas que son más evidentes a los 5 años. Los niños prematuros presentan mayores niveles de hiperactividad (Z = −2,082; p = 0,037) y problemas de conducta (Z = −2.354; p = 0,019) que las niñas, que destacan en problemas de atención (Z = −2.345; p = 0,019). Conclusiones El BASC permite la detección y diagnóstico precoz en atención primaria de los problemas de conducta y emocionales de los niños prematuros.
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Affiliation(s)
| | - Cristina Fernández-Baizán
- Departamento de Psicología, Instituto de Neurociencias del Principado de Asturias (INEUROPA), Universidad de Oviedo, Oviedo (Asturias), España
| | - Gonzalo Solís-Sánchez
- Área de Gestión Clínica de Pediatría, Neonatología, Hospital Universitario Central de Asturias, Oviedo (Asturias), España
| | - Jorge L Arias
- Departamento de Psicología, Instituto de Neurociencias del Principado de Asturias (INEUROPA), Universidad de Oviedo, Oviedo (Asturias), España
| | - Marta Méndez
- Departamento de Psicología, Instituto de Neurociencias del Principado de Asturias (INEUROPA), Universidad de Oviedo, Oviedo (Asturias), España
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Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury. J Perinatol 2018; 38:1431-1443. [PMID: 30166622 PMCID: PMC6215507 DOI: 10.1038/s41372-018-0209-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes. The goal of this review is to describe the distinct and often overlapping types of brain injury in the preterm neonate, with a focus on neonatal hydrocephalus, and to connect injury on imaging to neurodevelopmental outcome risk. Head ultrasound and magnetic resonance imaging findings are described separately. The current state of the literature is imprecise and we end the review with recommendations for future radiologic and neurodevelopmental research.
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12
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Luu TM, Nuyt AM. Cognitive trajectories from infancy to early adulthood in the EPICure cohort: time to refocus research on how to break the 'natural limits' of brain plasticity. Arch Dis Child Fetal Neonatal Ed 2018; 103:F399-F400. [PMID: 29208665 DOI: 10.1136/archdischild-2017-314003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/23/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Thuy Mai Luu
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics and Research Centre, Montreal, Quebec, Canada
| | - Anne-Monique Nuyt
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics and Research Centre, Montreal, Quebec, Canada
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13
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Coq JO, Delcour M, Ogawa Y, Peyronnet J, Castets F, Turle-Lorenzo N, Montel V, Bodineau L, Cardot P, Brocard C, Liabeuf S, Bastide B, Canu MH, Tsuji M, Cayetanot F. Mild Intrauterine Hypoperfusion Leads to Lumbar and Cortical Hyperexcitability, Spasticity, and Muscle Dysfunctions in Rats: Implications for Prematurity. Front Neurol 2018; 9:423. [PMID: 29973904 PMCID: PMC6020763 DOI: 10.3389/fneur.2018.00423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/22/2018] [Indexed: 12/22/2022] Open
Abstract
Intrauterine ischemia-hypoxia is detrimental to the developing brain and leads to white matter injury (WMI), encephalopathy of prematurity (EP), and often to cerebral palsy (CP), but the related pathophysiological mechanisms remain unclear. In prior studies, we used mild intrauterine hypoperfusion (MIUH) in rats to successfully reproduce the diversity of clinical signs of EP, and some CP symptoms. Briefly, MIUH led to inflammatory processes, diffuse gray and WMI, minor locomotor deficits, musculoskeletal pathologies, neuroanatomical and functional disorganization of the primary somatosensory and motor cortices, delayed sensorimotor reflexes, spontaneous hyperactivity, deficits in sensory information processing, memory and learning impairments. In the present study, we investigated the early and long-lasting mechanisms of pathophysiology that may be responsible for the various symptoms induced by MIUH. We found early hyperreflexia, spasticity and reduced expression of KCC2 (a chloride cotransporter that regulates chloride homeostasis and cell excitability). Adult MIUH rats exhibited changes in muscle contractile properties and phenotype, enduring hyperreflexia and spasticity, as well as hyperexcitability in the sensorimotor cortex. Taken together, these results show that reduced expression of KCC2, lumbar hyperreflexia, spasticity, altered properties of the soleus muscle, as well as cortical hyperexcitability may likely interplay into a self-perpetuating cycle, leading to the emergence, and persistence of neurodevelopmental disorders (NDD) in EP and CP, such as sensorimotor impairments, and probably hyperactivity, attention, and learning disorders.
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Affiliation(s)
- Jacques-Olivier Coq
- Centre National de la Recherche Scientifique, Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Université, Marseille, France.,Centre National de la Recherche Scientifique, Neurosciences Intégratives et Adaptatives, UMR 7260, Aix Marseille Université, Marseille, France
| | - Maxime Delcour
- Centre National de la Recherche Scientifique, Neurosciences Intégratives et Adaptatives, UMR 7260, Aix Marseille Université, Marseille, France
| | - Yuko Ogawa
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Julie Peyronnet
- Centre National de la Recherche Scientifique, Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Université, Marseille, France
| | - Francis Castets
- Centre National de la Recherche Scientifique, Institut de Biologie du Développement de Marseille, UMR 7288, Aix-Marseille Université, Marseille, France
| | - Nathalie Turle-Lorenzo
- FR 3512 Fédération 3C, Aix Marseille Université - Centre National de la Recherche Scientifique, Marseille, France
| | - Valérie Montel
- EA 7369 ≪Activité Physique, Muscle et Santé≫ - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Lille, France
| | - Laurence Bodineau
- Institut National de la Santé et de la Recherche Médicale, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Phillipe Cardot
- Institut National de la Santé et de la Recherche Médicale, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Cécile Brocard
- Centre National de la Recherche Scientifique, Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Université, Marseille, France
| | - Sylvie Liabeuf
- Centre National de la Recherche Scientifique, Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Université, Marseille, France
| | - Bruno Bastide
- EA 7369 ≪Activité Physique, Muscle et Santé≫ - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Lille, France
| | - Marie-Hélène Canu
- EA 7369 ≪Activité Physique, Muscle et Santé≫ - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Université de Lille, Lille, France
| | - Masahiro Tsuji
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Florence Cayetanot
- Centre National de la Recherche Scientifique, Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Université, Marseille, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
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14
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Buddington RK, Chizhikov VV, Iskusnykh IY, Sable HJ, Sable JJ, Holloway ZR, Blumenfeld Katzir T, van der Merwe M, Yakimkova T, Buddington KK, Lifshitz Y, Tessler S, Gilbert A. A Phosphatidylserine Source of Docosahexanoic Acid Improves Neurodevelopment and Survival of Preterm Pigs. Nutrients 2018; 10:E637. [PMID: 29783637 PMCID: PMC5986516 DOI: 10.3390/nu10050637] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022] Open
Abstract
The amount, composition, and sources of nutrition support provided to preterm infants is critical for normal growth and development, and particularly for structural and functional neurodevelopment. Although omega-3 long chain polyunsaturated fatty acids (LC-PUFA), and particularly docosahexanoic acid (DHA), are considered of particular importance, results from clinical trials with preterm infants have been inconclusive because of ethical limitations and confounding variables. A translational large animal model is needed to understand the structural and functional responses to DHA. Neurodevelopment of preterm pigs was evaluated in response to feeding formulas to term-equivalent age supplemented with DHA attached to phosphatidylserine (PS-DHA) or sunflower oil as the placebo. Newborn term pigs were used as a control for normal in utero neurodevelopment. Supplementing formula with PS-DHA increased weight of the brain, and particularly the cerebellum, at term-equivalent age compared with placebo preterm pigs (P's < 0.10 and 0.05 respectively), with a higher degree of myelination in all regions of the brain examined (all p < 0.06). Brains of pigs provided PS-DHA were similar in weight to newborn term pigs. Event-related brain potentials and performance in a novel object recognition test indicated the PS-DHA supplement accelerated development of sensory pathways and recognition memory compared with placebo preterm pigs. The PS-DHA did not increase weight gain, but was associated with higher survival. The benefits of PS-DHA include improving neurodevelopment and possibly improvement of survival, and justify further studies to define dose-response relations, compare benefits associated with other sources of DHA, and understand the mechanisms underlying the benefits and influences on the development of other tissues and organ systems.
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Affiliation(s)
| | - Victor V Chizhikov
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Igor Y Iskusnykh
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Helen J Sable
- Department of Psychology, University of Memphis, Memphis, TN 38152, USA.
| | - Jeffrey J Sable
- Department of Behavioral Sciences, Christian Brothers University, Memphis, TN 38104, USA.
| | - Zade R Holloway
- Department of Psychology, University of Memphis, Memphis, TN 38152, USA.
| | | | | | - Taisiya Yakimkova
- School of Health Studies, University of Memphis, Memphis, TN 38152, USA.
| | - Karyl K Buddington
- Department of Biological Sciences, University of Memphis, Memphis, TN 38152, USA.
| | - Yael Lifshitz
- Enzymotec, Sagi 2000 Industrial Park, Migdal HaEmeq 23106, Israel.
| | - Shoshi Tessler
- Enzymotec, Sagi 2000 Industrial Park, Migdal HaEmeq 23106, Israel.
| | - Ariel Gilbert
- Enzymotec, Sagi 2000 Industrial Park, Migdal HaEmeq 23106, Israel.
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15
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Are Anesthesia and Surgery during Infancy Associated with Decreased White Matter Integrity and Volume during Childhood? Anesthesiology 2017; 127:788-799. [DOI: 10.1097/aln.0000000000001808] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Anesthetics have neurotoxic effects in neonatal animals. Relevant human evidence is limited. We sought such evidence in a structural neuroimaging study.
Methods
Two groups of children underwent structural magnetic resonance imaging: patients who, during infancy, had one of four operations commonly performed in otherwise healthy children and comparable, nonexposed control subjects. Total and regional brain tissue composition and volume, as well as regional indicators of white matter integrity (fractional anisotropy and mean diffusivity), were analyzed.
Results
Analyses included 17 patients, without potential confounding central nervous system problems or risk factors, who had general anesthesia and surgery during infancy and 17 control subjects (age ranges, 12.3 to 15.2 yr and 12.6 to 15.1 yr, respectively). Whole brain white matter volume, as a percentage of total intracranial volume, was lower for the exposed than the nonexposed group, 37.3 ± 0.4% and 38.9 ± 0.4% (least squares mean ± SE), respectively, a difference of 1.5 percentage points (95% CI, 0.3 to 2.8; P = 0.016). Corresponding decreases were statistically significant for parietal and occipital lobes, infratentorium, and brainstem separately. White matter integrity was lower for the exposed than the nonexposed group in superior cerebellar peduncle, cerebral peduncle, external capsule, cingulum (cingulate gyrus), and fornix (cres) and/or stria terminalis. The groups did not differ in total intracranial, gray matter, and cerebrospinal fluid volumes.
Conclusions
Children who had anesthesia and surgery during infancy showed broadly distributed, decreased white matter integrity and volume. Although the findings may be related to anesthesia and surgery during infancy, other explanations are possible.
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16
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D'Agata AL, Sanders MR, Grasso DJ, Young EE, Cong X, Mcgrath JM. UNPACKING THE BURDEN OF CARE FOR INFANTS IN THE NICU. Infant Ment Health J 2017; 38:306-317. [PMID: 28236329 DOI: 10.1002/imhj.21636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Infants who begin early life in the medicalized environment of the neonatal intensive care unit (NICU) experience disruption to numerous fundamental expectancies. In the NICU, infants are exposed to chronic, extreme stressors that include painful medical procedures and parental separation. Due to their preverbal stage of development, infants are unable to fully express these experiences, and linking these experiences to long-term outcomes has been difficult. This clinical article proposes the terminology Infant Medical Trauma in the NICU (IMTN) to describe the infant experience. Following a discussion of the NICU as an adverse childhood event, the article has three sections: (a) the unique and critical factors that define the newborn period, (b) a review of the IMTN conceptual model, and (c) recommendations for supportive neuroprotective strategies to moderate the intensity of adverse NICU infant experiences.
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Affiliation(s)
- Amy L D'Agata
- University of Connecticut, Storrs, and University of South Florida
| | - Marilyn R Sanders
- Connecticut Children's Medical Center, Hartford and University of Connecticut, Farmington
| | | | - Erin E Young
- University of Connecticut, Storrs, and University of Connecticut, Farmington
| | | | - Jacqueline M Mcgrath
- University of Connecticut, Storrs, and Connecticut Children's Medical Center, Hartford
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17
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Dix LML, van Bel F, Lemmers PMA. Monitoring Cerebral Oxygenation in Neonates: An Update. Front Pediatr 2017; 5:46. [PMID: 28352624 PMCID: PMC5348638 DOI: 10.3389/fped.2017.00046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
Cerebral oxygenation is not always reflected by systemic arterial oxygenation. Therefore, regional cerebral oxygen saturation (rScO2) monitoring with near-infrared spectroscopy (NIRS) is of added value in neonatal intensive care. rScO2 represents oxygen supply to the brain, while cerebral fractional tissue oxygen extraction, which is the ratio between rScO2 and systemic arterial oxygen saturation, reflects cerebral oxygen utilization. The balance between oxygen supply and utilization provides insight in neonatal cerebral (patho-)physiology. This review highlights the potential and limitations of cerebral oxygenation monitoring with NIRS in the neonatal intensive care unit.
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Affiliation(s)
- Laura Marie Louise Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands
| | - Petra Maria Anna Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands
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18
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Bennet L, Fyfe KL, Yiallourou SR, Merk H, Wong FY, Horne RSC. Discrimination of sleep states using continuous cerebral bedside monitoring (amplitude-integrated electroencephalography) compared to polysomnography in infants. Acta Paediatr 2016; 105:e582-e587. [PMID: 27659907 DOI: 10.1111/apa.13602] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/15/2016] [Accepted: 09/20/2016] [Indexed: 01/22/2023]
Abstract
AIM Limited two-channel electroencephalography (EEG) and amplitude-integrated EEG (aEEG) monitorings are being increasingly used; however, these measurements have not been compared with polysomnographic monitoring, the gold standard for determining infant sleep states. We aimed to determine the accuracy of two-channel EEG and aEEG recordings in defining sleep states and wakefulness in term infants compared to polysomnographic monitoring. METHODS Sleep was assessed in eight healthy term born infants (mean: 34 ± 3 days), using simultaneous polysomnography (Compumedics S-Series) and a two-channel EEG monitor (Brainz BRM2). EEG intensity, 90% spectral edge frequency (SEF), aEEG amplitude frequency bands were analysed in 30-second epochs during quiet sleep, active sleep and awake as determined by polysomnography. RESULTS BRM2-recorded EEG accurately identified quiet sleep from active sleep for EEG intensity (p = 0.003), SEF (p = 0.001) and aEEG amplitude (p = 0.003) and quiet sleep from awake, but not active sleep from awake. Frequency band analysis showed that wake could be identified by changes in absolute power (p = 0.015) and frequency as a percentage of total power (p = 0.03). CONCLUSION We demonstrate that limited two-channel EEG monitoring can distinguish quiet sleep from active sleep and may be suitable for investigating the development of sleep in infants in the neonatal intensive care setting.
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Affiliation(s)
- Laura Bennet
- Department of Physiology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Karinna L. Fyfe
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Stephanie R. Yiallourou
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Henriette Merk
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
| | - Flora Y. Wong
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Rosemary S. C. Horne
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
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19
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Kelly CE, Thompson DK, Chen J, Leemans A, Adamson CL, Inder TE, Cheong JLY, Doyle LW, Anderson PJ. Axon density and axon orientation dispersion in children born preterm. Hum Brain Mapp 2016; 37:3080-102. [PMID: 27133221 DOI: 10.1002/hbm.23227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/12/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Very preterm birth (VPT, <32 weeks' gestation) is associated with altered white matter fractional anisotropy (FA), the biological basis of which is uncertain but may relate to changes in axon density and/or dispersion, which can be measured using Neurite Orientation Dispersion and Density Imaging (NODDI). This study aimed to compare whole brain white matter FA, axon dispersion, and axon density between VPT children and controls (born ≥37 weeks' gestation), and to investigate associations with perinatal factors and neurodevelopmental outcomes. METHODS FA, neurite dispersion, and neurite density were estimated from multishell diffusion magnetic resonance images for 145 VPT and 33 control 7-year-olds. Diffusion values were compared between groups and correlated with perinatal factors (gestational age, birthweight, and neonatal brain abnormalities) and neurodevelopmental outcomes (IQ, motor, academic, and behavioral outcomes) using Tract-Based Spatial Statistics. RESULTS Compared with controls, VPT children had lower FA and higher axon dispersion within many major white matter fiber tracts. Neonatal brain abnormalities predicted lower FA and higher axon dispersion in many major tracts in VPT children. Lower FA, higher axon dispersion, and lower axon density in various tracts correlated with poorer neurodevelopmental outcomes in VPT children. CONCLUSIONS FA and NODDI measures distinguished VPT children from controls and were associated with neonatal brain abnormalities and neurodevelopmental outcomes. This study provides a more detailed and biologically meaningful interpretation of white matter microstructure changes associated with prematurity. Hum Brain Mapp 37:3080-3102, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Claire E Kelly
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jian Chen
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Jeanie L Y Cheong
- Murdoch Childrens Research Institute, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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20
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Coq JO, Delcour M, Massicotte VS, Baud O, Barbe MF. Prenatal ischemia deteriorates white matter, brain organization, and function: implications for prematurity and cerebral palsy. Dev Med Child Neurol 2016; 58 Suppl 4:7-11. [PMID: 27027601 PMCID: PMC4817365 DOI: 10.1111/dmcn.13040] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 12/16/2022]
Abstract
Cerebral palsy (CP) describes a group of neurodevelopmental disorders of posture and movement that are frequently associated with sensory, behavioral, and cognitive impairments. The clinical picture of CP has changed with improved neonatal care over the past few decades, resulting in higher survival rates of infants born very preterm. Children born preterm seem particularly vulnerable to perinatal hypoxia-ischemia insults at birth. Animal models of CP are crucial for elucidating underlying mechanisms and for development of strategies of neuroprotection and remediation. Most animal models of CP are based on hypoxia-ischemia around the time of birth. In this review, we focus on alterations of brain organization and functions, especially sensorimotor changes, induced by prenatal ischemia in rodents and rabbits, and relate these alterations to neurodevelopmental disorders found in preterm children. We also discuss recent literature that addresses the relationship between neural and myelin plasticity, as well as possible contributions of white matter injury to the emergence of brain dysfunctions induced by prenatal ischemia.
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Affiliation(s)
- Jacques-Olivier Coq
- CNRS-Aix-Marseille Université, Neurosciences Intégratives et Adaptatives, Marseille,CNRS-Aix-Marseille Université, Institut de Neurosciences de la Timone (INT), Marseille, France
| | - Maxime Delcour
- CNRS-Aix-Marseille Université, Neurosciences Intégratives et Adaptatives, Marseille
| | - Vicky S Massicotte
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Olivier Baud
- Université Paris, Faculté de Médecine Denis Diderot, Paris,Hôpital Robert-Debré, Paris, France
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
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21
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Finn D, Boylan GB, Ryan CA, Dempsey EM. Enhanced Monitoring of the Preterm Infant during Stabilization in the Delivery Room. Front Pediatr 2016; 4:30. [PMID: 27066463 PMCID: PMC4814766 DOI: 10.3389/fped.2016.00030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/18/2016] [Indexed: 11/13/2022] Open
Abstract
Monitoring of preterm infants in the delivery room (DR) remains limited. Current guidelines suggest that pulse oximetry should be available for all preterm infant deliveries, and that if intubated a colorimetric carbon dioxide detector should provide verification of correct endotracheal tube placement. These two methods of assessment represent the extent of objective monitoring of the newborn commonly performed in the DR. Monitoring non-invasive ventilation effectiveness (either by capnography or respiratory function monitoring) and cerebral oxygenation (near-infrared spectroscopy) is becoming more common within research settings. In this article, we will review the different modalities available for cardiorespiratory and neuromonitoring in the DR and assess the current evidence base on their feasibility, strengths, and limitations during preterm stabilization.
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Affiliation(s)
- Daragh Finn
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - C Anthony Ryan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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22
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Kenosi M, Naulaers G, Ryan CA, Dempsey EM. Current research suggests that the future looks brighter for cerebral oxygenation monitoring in preterm infants. Acta Paediatr 2015; 104:225-31. [PMID: 25557591 DOI: 10.1111/apa.12906] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/02/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED Brain injuries remain a significant problem for preterm infants, despite extensive physiological monitoring. Near infrared spectroscopy (NIRS) monitoring in the neonatal intensive care unit has to date remained limited to research activities. CONCLUSION This review highlights the increasing clinical application of NIRS in delivery suites and neonatal units. Four randomised controlled trials incorporating NIRS monitoring suggest that the future may indeed be brighter for this technology in the care of very preterm infants.
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Affiliation(s)
- M Kenosi
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Wilton Cork Ireland
- Irish Centre for Fetal and Transitional Neonatal Research (INFANT); University College Cork; Cork Ireland
| | - G Naulaers
- Katholieke Universiteit Leuven; Leuven Belgium
| | - CA Ryan
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Wilton Cork Ireland
- Irish Centre for Fetal and Transitional Neonatal Research (INFANT); University College Cork; Cork Ireland
| | - EM Dempsey
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Wilton Cork Ireland
- Irish Centre for Fetal and Transitional Neonatal Research (INFANT); University College Cork; Cork Ireland
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23
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Petrova A, Mehta R. Alteration in regional tissue oxygenation of preterm infants during placement in the semi-upright seating position. Sci Rep 2015; 5:8343. [PMID: 25661986 PMCID: PMC4321184 DOI: 10.1038/srep08343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/15/2015] [Indexed: 01/30/2023] Open
Abstract
We investigated whether the cerebral (rSO2-C %) and renal (rSO2-R %) tissue oxygenation of preterm infants is altered by repositioning from the supine to semi-upright position for pre-discharge car seat testing. Near-infrared spectroscopy was used to measure rSO2-C and rSO2-R, which were recorded simultaneously with vital signs in 15 preterm infants for 30 minutes in supine, 60 minutes in the semi-upright (at 45 degrees in a car seat), and 30 minutes in the post-semi-upright (supine) position. Changes in rSO2-C and SO2-R were mostly within 1 Standard Deviation (SD) of baseline mean levels in the supine position. Decrease in rSO2-C and rSO2-R (more than 1SD below baseline mean) was recorded in 26.7% and 6.6% of infants respectively, which persisted even after adjustment for variation in heart and respiratory rate, and pulse oximeter measured oxygen saturation (P, 0.0001). Re-positioning the infants from the car seat to supine position was associated with normalization of the rSO2-C. Alteration in rSO2-C and rSO2-R in a car seat was independent from the gestational and post-conception age, weight and presence of anemia. We concluded that approximately one-third of preterm infants show minor reduction of cerebral tissue oxygenation in the semi-upright (car seat) position.
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Affiliation(s)
- Anna Petrova
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Rajeev Mehta
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
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Schmitz J, Pichler G, Schwaberger B, Urlesberger B, Baik N, Binder C. Feasibility of long-term cerebral and peripheral regional tissue oxygen saturation measurements. Physiol Meas 2014; 35:1349-55. [DOI: 10.1088/0967-3334/35/7/1349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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