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Katsuki S, Ushida T, Kidokoro H, Nakamura N, Iitani Y, Fuma K, Imai K, Nakano-Kobayashi T, Sato Y, Hayakawa M, Natsume J, Kajiyama H, Kotani T. Hypertensive disorders of pregnancy and alterations in brain metabolites in preterm infants: A multi-voxel proton MR spectroscopy study. Early Hum Dev 2021; 163:105479. [PMID: 34624700 DOI: 10.1016/j.earlhumdev.2021.105479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infants born to mothers with hypertensive disorders of pregnancy (HDP) have adverse neurodevelopmental consequences in later life. Magnetic resonance spectroscopy (MRS) is used to predict subsequent neurodevelopment in the field of perinatology. AIM We aimed to determine whether exposure to HDP in utero leads to alterations in brain metabolites in preterm infants using multi-voxel proton MRS at term-equivalent age. STUDY DESIGN Retrospective cohort study. SUBJECTS A total of 103 preterm infants born before 34 weeks of gestation at Nagoya University Hospital between 2010 and 2018 were eligible. Twenty-seven infants were born to mothers with HDP (HDP group), and 76 were born to mothers without HDP (non-HDP group). OUTCOME MEASURES The peak area ratios of N-acetylaspartate (NAA)/choline (Cho), NAA/creatine (Cr), and Cho/Cr were evaluated at 10 designated regions of interest (bilateral frontal lobes, basal ganglia, thalami, temporal lobes, and occipital lobes). RESULTS The peak area ratios of NAA/Cho and NAA/Cr in the bilateral thalami were significantly higher in the HDP group than in the non-HDP group after adjustment for covariates (postmenstrual age at MRS assessment and infant sex). No significant differences were observed in other regions. Preeclampsia, abnormal umbilical artery blood flow, and fetal growth restrictions were significantly associated with increased NAA/Cho and NAA/Cr ratios in the thalami. CONCLUSIONS Based on the evidence that NAA/Cho and NAA/Cr ratios constantly increase with postmenstrual age in normal brain development, exposure to maternal HDP in utero may accelerate brain maturation and increase neuronal activity in preterm infants.
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Affiliation(s)
- Satoru Katsuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Fuma
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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2
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Moss HG, Jenkins DD, Yazdani M, Brown TR. Identifying the translational complexity of magnetic resonance spectroscopy in neonates and infants. NMR IN BIOMEDICINE 2019; 32:e4089. [PMID: 30924565 PMCID: PMC6593752 DOI: 10.1002/nbm.4089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
Little attention has been paid to relating MRS outputs of vendor-supplied platforms to those from research software. This comparison is crucial to advance MRS as a clinical prognostic tool for disease or injury, recovery, and outcome. The work presented here investigates the agreement between metabolic ratios reported from vendor-provided and LCModel fitting algorithms using MRS data obtained on Siemens 3 T TIM Trio and 3 T Skyra MRI scanners in a total of 55 premature infants and term neonates with hypoxic ischemic encephalopathy (HIE). We compared peak area ratios in single voxels placed in basal ganglia (BG) and frontal white matter (WM) using standard PRESS (TE = 30 ms and 270 ms) and STEAM (TE = 20 ms) MRS sequences at multiple times after birth from 5 to 60 days. A total of 74 scans met quality standards for inclusion, reflecting a spectrum of neonatal disease and several months of early infant development. For the long TE PRESS sequence, N-acetylaspartate (NAA) and Choline (Cho) ratios to Creatine (Cr) correlated strongly between LCModel and vendor-supplied software in the BG. For shorter TEs, the ratios of NAA/Cr and Cho/Cr were more closely related using STEAM at TE = 20 ms in BG and WM, which was significantly better than using PRESS at TE = 30 ms in the BG of HIE infants. At short TEs, however, it is still unclear which MRS sequence, STEAM or PRESS, is superior and thus more work is required in this regard for translating research-generated MRS ratios to clinical diagnosis and prognostication, and unlocking the potential of MRS for in vivo metabolomics. MRS at both long and short TEs is desirable for standard metabolites such as NAA, Cho and Cr, along with important lower concentration metabolites such as myo-inositol and glutathione.
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Affiliation(s)
- Hunter G. Moss
- Department of RadiologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Dorothea D. Jenkins
- Department of PediatricsMedical University of South CarolinaCharlestonSouth Carolina
| | - Milad Yazdani
- Department of RadiologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Truman R. Brown
- Department of RadiologyMedical University of South CarolinaCharlestonSouth Carolina
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Abstract
Examination of the placenta provides a unique opportunity to explore and understand the intrauterine environment, as well as providing a record of events that may be associated with adverse pregnancy outcomes, one of the most devastating of which is central nervous system (CNS) injury. A number of placental lesions have been described in association with various forms of neurologic injury. They can be divided into four major categories: sentinel events, inflammatory lesions, vascular lesions, and "biomarker" lesions, which are not themselves causative, but are often found in association with other lesions that are causative. The purpose of this review is to outline these placental lesions and summarize the types of CNS injury that have been described in association with each. Finally, one of the most important of all risk factors for CNS injury is the finding of multiple independent placental lesions. The effects of these lesions may be synergistic, particularly when metachronous, with an earlier lesion leaving the CNS more vulnerable to the effects of a later lesion.
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Affiliation(s)
- Sanjita Ravishankar
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Raymond W Redline
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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Thomason ME, Hect J, Waller R, Manning JH, Stacks AM, Beeghly M, Boeve JL, Wong K, van den Heuvel MI, Hernandez-Andrade E, Hassan SS, Romero R. Prenatal neural origins of infant motor development: Associations between fetal brain and infant motor development. Dev Psychopathol 2018; 30:763-772. [PMID: 30068433 PMCID: PMC6261435 DOI: 10.1017/s095457941800072x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Functional circuits of the human brain emerge and change dramatically over the second half of gestation. It is possible that variation in neural functional system connectivity in utero predicts individual differences in infant behavioral development, but this possibility has yet to be examined. The current study examines the association between fetal sensorimotor brain system functional connectivity and infant postnatal motor ability. Resting-state functional connectivity data was obtained in 96 healthy human fetuses during the second and third trimesters of pregnancy. Infant motor ability was measured 7 months after birth using the Bayley Scales of Infant Development. Increased connectivity between the emerging motor network and regions of the prefrontal cortex, temporal lobes, posterior cingulate, and supplementary motor regions was observed in infants that showed more mature motor functions. In addition, females demonstrated stronger fetal-brain to infant-behavior associations. These observations extend prior longitudinal research back into prenatal brain development and raise exciting new ideas about the advent of risk and the ontogeny of early sex differences.
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Enguix V, Ding Y, Lodygensky GA. Recent advances in preclinical and clinical multimodal MR in the newborn brain. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 292:149-154. [PMID: 29731237 DOI: 10.1016/j.jmr.2018.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 05/20/2023]
Abstract
Aside from injury identification, MRI of the newborn brain has given us insight into cortical and white matter development, identified windows of vulnerabilities, enabled the introduction of therapeutic hypothermia which has become the standard of care in neonatal asphyxia, and is fostering leapfrogging discoveries in the field of neuro-genetics. This article reviews the main advances in recent years in newborn brain imaging both in preclinical and clinical research.
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Affiliation(s)
- Vicente Enguix
- Department of Pediatrics, University of Montréal, Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Yang Ding
- Department of Pediatrics, University of Montréal, Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Gregory A Lodygensky
- Department of Pediatrics, University of Montréal, Research Center, CHU Sainte-Justine, Montréal, Québec, Canada; Department of Pharmacology and Physiology, Université de Montréal, Montréal, Québec, Canada.
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6
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Gomez-Lopez N, Romero R, Xu Y, Leng Y, Garcia-Flores V, Miller D, Jacques SM, Hassan SS, Faro J, Alsamsam A, Alhousseini A, Gomez-Roberts H, Panaitescu B, Yeo L, Maymon E. Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin? Am J Obstet Gynecol 2017; 217:693.e1-693.e16. [PMID: 28964823 PMCID: PMC5878926 DOI: 10.1016/j.ajog.2017.09.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/12/2017] [Accepted: 09/18/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neutrophils are the most abundant white blood cells found in the amniotic cavity of women with intraamniotic infection and/or inflammation. The current belief is that these neutrophils are of fetal origin. However, abundant neutrophils have been found in the amniotic fluid of women with a severe acute maternal inflammatory response but without a severe fetal inflammatory response in the placenta, suggesting that these innate immune cells can also be of maternal origin or a mixture of both fetal and maternal neutrophils. OBJECTIVE We sought to investigate the origin of amniotic fluid neutrophils from women with intraamniotic infection and/or inflammation and to correlate these findings with acute histologic maternal and fetal inflammatory responses in the placenta. STUDY DESIGN Amniotic fluid was collected from 15 women with suspected intraamniotic infection and/or inflammation (positive microbiological cultures and/or interleukin-6 concentrations ≥2.6 ng/mL). Amniotic fluid neutrophils were purified by fluorescence-activated cell sorting, DNA was extracted, and DNA fingerprinting was performed. DNA fingerprinting was also performed in the umbilical cord and maternal blood DNA. Fluorescence in situ hybridization was assayed in women with male neonates. Blinded placental histopathological evaluations were conducted. RESULTS First, DNA fingerprinting revealed that 43% (6/14) of women who underwent a single amniocentesis had mostly fetal neutrophils in the amniotic fluid. Second, DNA fingerprinting showed that 36% (5/14) of the women who underwent a single amniocentesis had predominantly maternal neutrophils in the amniotic fluid. Third, DNA fingerprinting indicated that 21% (3/14) of the women who underwent a single amniocentesis had an evident mixture of fetal and maternal neutrophils in the amniotic fluid. Fourth, DNA fingerprinting revealed that a woman who underwent 2 amniocenteses (patient 15) had fetal neutrophils first, and as infection progressed, abundant maternal neutrophils invaded the amniotic cavity. Fifth, fluorescence in situ hybridization confirmed DNA fingerprinting results by showing that both fetal and maternal neutrophils were present in the amniotic fluid. Sixth, most of the women who had predominantly amniotic fluid neutrophils of fetal origin at the time of collection delivered extremely preterm neonates (71% [5/7]). Seventh, all of the women who had predominantly amniotic fluid neutrophils of maternal origin at the time of collection delivered term or late preterm neonates (100% [6/6]). Eighth, 2 of the women who had an evident mixture of fetal and maternal neutrophils in the amniotic fluid at the time of collection delivered extremely preterm neonates (67% [2/3]), and the third woman delivered a term neonate (33% [1/3]). Finally, most of the women included in this study presented acute maternal and fetal inflammatory responses in the placenta (87% [13/15]). CONCLUSION Amniotic fluid neutrophils can be either predominantly of fetal or maternal origin, or a mixture of both fetal and maternal origin, in women with intraamniotic infection and/or inflammation. The findings herein provide evidence that both fetal and maternal neutrophils can invade the amniotic cavity, suggesting that both the fetus and the mother participate in the host defense mechanisms against intraamniotic infection.
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Affiliation(s)
- Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Immunology, Microbiology, and Biochemistry, Wayne State University School of Medicine, Detroit, MI.
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Yi Xu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Yaozhu Leng
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Valeria Garcia-Flores
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Derek Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Suzanne M Jacques
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Hutzel Women's Hospital, Wayne State University School of Medicine, Detroit, MI
| | - Sonia S Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Jonathan Faro
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Adham Alsamsam
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Ali Alhousseini
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Hunter Gomez-Roberts
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Eli Maymon
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
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7
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Niwa T, Suzuki K, Sugiyama N, Imai Y. Regional volumetric assessment of the brain in moderately preterm infants (30-35 gestational weeks) scanned at term-equivalent age on magnetic resonance imaging. Early Hum Dev 2017; 111:36-41. [PMID: 28575725 DOI: 10.1016/j.earlhumdev.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Early volume analyses of the infantile brain may help predict neurodevelopmental outcome. However, brain volumes are not well understood in moderately preterm infants at term-equivalent age (TEA). AIM This study retrospectively investigated the relationship between regional brain volumes and infant gestational age (GA) at birth in moderately preterm infants (30-35weeks' GA) on magnetic resonance imaging (MRI) at TEA. METHODS Forty infants scanned at TEA were enrolled. Regional brain volumes were estimated by manual segmentation on MRI, and their relationship with GA at birth was assessed. RESULTS The regional volumes of the cerebral hemispheres and deep gray matter were larger (Spearman ρ=0.40, P=0.01, and Spearman ρ=0.48, P<0.01, respectively), and volumes of the lateral ventricles were smaller (Spearman ρ=-0.32, P=0.04) in infants born at a later GA. The volumes of the cerebral hemispheres of the infants born at 30weeks' GA were significantly smaller than those born at 33 and 35weeks' GA (P<0.05). No associations were found between the volume of the cerebellum and brainstem, and GA at birth (Spearman ρ=0.24, P=0.13, and Spearman ρ=0.24, P=0.14, respectively). CONCLUSIONS The volumes of the cerebral hemispheres at TEA may be smaller in infants born at 30weeks' GA, whereas those of the cerebellum and brainstem may not be correlated with GA among moderately preterm infants.
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Affiliation(s)
- Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, Isehara, Japan.
| | - Keiji Suzuki
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Nobuyoshi Sugiyama
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine, Isehara, Japan
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8
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Sijens PE, Wischniowsky K, Ter Horst HJ. The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia. Magn Reson Imaging 2017; 42:82-87. [PMID: 28619605 DOI: 10.1016/j.mri.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by 1H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome. METHODS At the age of 6.0±1.8days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30months the Bayley Scale of Infant Development-III was performed. RESULTS Infants that died had lower gray matter NAA levels than infants that survived (P=0.005). In surviving infants (28 of 35) there was a trend of negative correlation between gray matter choline levels and gross motor outcome (r=-0.45). In the white matter, choline correlated negatively with fine motor skills (r=-0.40), and creatine positively with gross motor skills (r=0.58, P=0.02). There was no relationship between lactate levels and outcome. CONCLUSION MRS of asphyxiated neonates treated by therapeutic hypothermia can serve as predictor of outcome. Unlike previously reported associations in untreated asphyxiates, lactate levels had no relationship with outcome, which indicates that one of the working mechanisms of therapeutic hypothermia is reduction of the metabolic rate.
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Affiliation(s)
- Paul E Sijens
- Department of Radiology, Division of Neonatology, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713 GZ, The Netherlands.
| | - Katharina Wischniowsky
- Department of Pediatrics, Division of Neonatology, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713 GZ, The Netherlands
| | - Hendrik J Ter Horst
- Department of Pediatrics, Division of Neonatology, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9713 GZ, The Netherlands
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9
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Alahmari DM, Skiöld B, Barton SK, Nitsos I, McDonald C, Miller SL, Zahra V, Galinsky R, Wu Q, Farrell MJ, Moss TJ, Hooper SB, Pearson JT, Polglase GR. Diffusion Tensor Imaging Colour Mapping Threshold for Identification of Ventilation-Induced Brain Injury after Intrauterine Inflammation in Preterm Lambs. Front Pediatr 2017; 5:70. [PMID: 28424764 PMCID: PMC5380678 DOI: 10.3389/fped.2017.00070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/20/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study is to examine whether advanced magnetic resonance imaging (MRI) techniques can detect early brain injury caused by intrauterine inflammation and inappropriate initial respiratory support in preterm lambs. HYPOTHESIS Neuropathology caused by intrauterine inflammation is exacerbated by mechanical ventilation at birth and is detectable with advanced MRI techniques. METHODS Pregnant ewes received intra-amniotic lipopolysaccharide (LPS) 7 days prior to delivery at ~125 days of gestation (85% of gestation), whereupon lambs were delivered and randomised to receive an injurious (LPS + INJ, n = 6) or protective (LPS + PROT, n = 6) ventilation strategy. MRI of the brain was conducted 90 min after preterm delivery, using structural, diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) techniques. A colour map threshold technique was utilised to compare distributions of low diffusivity voxels in the brains of LPS-exposed lambs with those not exposed to LPS (PROT, n = 7 PROT and INJ, n = 10). RESULTS No overt cerebral injury was identified on structural MRI images of any lamb. However, on DTI, axial diffusivity, radial diffusivity, and mean diffusivity values were lower and significantly more heterogeneous in specific brain regions of lambs in the LPS + INJ group compared to the LPS + PROT group. Colour mapping revealed lower diffusivity in the thalamus, periventricular white matter, internal capsule, and frontal white matter in the LPS + INJ group compared to LPS + PROT group. The MRS peak area ratios of lactate, relative to those for the metabolites creatine, choline, and N-acetylaspartate, were not different between LPS-exposed groups. Lambs exposed to LPS had lower diffusivity within the white matter regions assessed than non-LPS-treated control lambs. CONCLUSION DTI colour map threshold techniques detected early brain injury in preterm lambs exposed to intrauterine inflammation and detected differences between injurious and protective ventilation strategies. DTI mapping approaches are potentially useful for early detection of subtle brain injury in premature infants.
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Affiliation(s)
- Dhafer M Alahmari
- Department of Medical Imaging and Radiation Sciences, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Beatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Samantha K Barton
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Ilias Nitsos
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Courtney McDonald
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology and Paediatrics, Monash University, Clayton, VIC, Australia
| | - Valerie Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Physiology, University of Auckland, Grafton, New Zealand
| | - Qizhu Wu
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Michael John Farrell
- Department of Medical Imaging and Radiation Sciences, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Timothy J Moss
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology and Paediatrics, Monash University, Clayton, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology and Paediatrics, Monash University, Clayton, VIC, Australia
| | - James T Pearson
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,Department of Physiology, Monash University, Clayton, VIC, Australia.,Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology and Paediatrics, Monash University, Clayton, VIC, Australia
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10
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Shehee L, Coker-Bolt P, Barbour A, Moss H, Brown T, Jenkins D. Predicting motor outcomes with 3 month prone hip angles in premature infants. J Pediatr Rehabil Med 2016; 9:231-6. [PMID: 27612083 DOI: 10.3233/prm-160384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study used kinematic analysis to identify a reliable and rapid assessment method for abnormal patterns of motor development in preterm infants. METHODS In a retrospective analysis, we examined video of n= 35 preterm infants at 3mo corrected age (CA) who had concurrent Test of Infant Motor Performance (TIMP) scores. Hyperflexion at the hip produces common gait anomalies seen in children with CP, therefore we analyzed hip angle in the prone head lift position at 3 months CA. Magnetic Resonance Spectroscopy (MRS) was performed at term equivalent (n= 23) and Bayley-III neurodevelopmental tests were performed at 1 year (n= 28). We correlated hip angles with TIMP and Bayley-III scores, and MRS neuronal metabolites. RESULTS Hip angle positively correlated with TIMP at 3 months (r= 0.642, p≤ 0.001), but not with Bayley-III at 1 year (r= 0.122, p= 0.529). Hip angle correlated negatively with myo-inositol (mI) ratios in frontal white matter tracts (mI/Cr r= -0.520, p= 0.011). CONCLUSIONS These results suggest prone hip angle may be a quantitative proxy for the 42-item TIMP at 3 months, and that hypertonicity in the hip flexor musculature is a manifestation of white matter metabolic abnormalities (elevated mI ratios) that may indicate occult white matter injury.
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Affiliation(s)
| | - Patty Coker-Bolt
- Division of Occupational Therapy, College of Health Professions, Charleston, SC, USA
| | - Andrew Barbour
- Division of Occupational Therapy, College of Health Professions, Charleston, SC, USA
| | - Hunter Moss
- Department of Radiology and Radiological Sciences and the Center for Advanced Imaging Research, MUSC, Charleston, SC, USA
| | - Truman Brown
- Department of Radiology and Radiological Sciences and the Center for Advanced Imaging Research, MUSC, Charleston, SC, USA
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