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McDouall A, Zhou KQ, Davies A, Wassink G, Jones TLM, Bennet L, Gunn AJ, Davidson JO. Slow rewarming after hypothermia does not ameliorate white matter injury after hypoxia-ischemia in near-term fetal sheep. Pediatr Res 2024:10.1038/s41390-024-03332-y. [PMID: 39103629 DOI: 10.1038/s41390-024-03332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/10/2024] [Accepted: 05/18/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND The optimal rate to rewarm infants after therapeutic hypothermia is unclear. In this study we examined whether slow rewarming after 72 h of hypothermia would attenuate white matter injury. METHODS Near-term fetal sheep received sham occlusion (n = 8) or cerebral ischemia for 30 min, followed by normothermia (n = 7) or hypothermia from 3-72 h, with either spontaneous fast rewarming (n = 8) within 1 h, or slow rewarming at ~0.5 °C/h (n = 8) over 10 h. Fetuses were euthanized 7 days later. RESULTS Ischemia was associated with loss of total and mature oligodendrocytes, reduced expression of myelin proteins and induction of microglia and astrocytes, compared with sham controls (P < 0.05). Both hypothermia protocols were associated with a significant increase in numbers of total and mature oligodendrocytes, area fraction of myelin proteins and reduced numbers of microglia and astrocytes, compared with ischemia-normothermia (P < 0.05). There was no difference in the number of oligodendrocytes, microglia or astrocytes or expression of myelin proteins between fast and slow rewarming after hypothermia. CONCLUSION The rate of rewarming after a clinically relevant duration of hypothermia had no apparent effect on white matter protection by hypothermia after cerebral ischemia in near-term fetal sheep. IMPACT Persistent white matter injury is a major contributor to long-term disability after neonatal encephalopathy despite treatment with therapeutic hypothermia. The optimal rate to rewarm infants after therapeutic hypothermia is unclear; current protocols were developed on a precautionary basis. We now show that slow rewarming at 0.5 °C/h did not improve histological white matter injury compared with rapid spontaneous rewarming after a clinically established duration of hypothermia in near-term fetal sheep.
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Affiliation(s)
- Alice McDouall
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Kelly Q Zhou
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Anthony Davies
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Guido Wassink
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Timothy L M Jones
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- Department of Physiology, The University of Auckland, Auckland, New Zealand.
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Hung SC, Tu YF, Hunter SE, Guimaraes C. MRI predictors of long-term outcomes of neonatal hypoxic ischaemic encephalopathy: a primer for radiologists. Br J Radiol 2024; 97:1067-1077. [PMID: 38407350 DOI: 10.1093/bjr/tqae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
This review aims to serve as a foundational resource for general radiologists, enhancing their understanding of the role of Magnetic Resonance Imaging (MRI) in early prognostication for newborns diagnosed with hypoxic ischaemic encephalopathy (HIE). The article explores the application of MRI as a predictive instrument for determining long-term outcomes in newborns affected by HIE. With HIE constituting a leading cause of neonatal mortality and severe long-term neurodevelopmental impairments, early identification of prognostic indicators is crucial for timely intervention and optimal clinical management. We examine current literature and recent advancements to provide an in-depth overview of MRI predictors, encompassing brain injury patterns, injury scoring systems, spectroscopy, and diffusion imaging. The potential of these MRI biomarkers in predicting long-term neurodevelopmental outcomes and the probability of epilepsy is also discussed.
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Affiliation(s)
- Sheng-Che Hung
- Department of Radiology, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, United States
| | - Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Senyene E Hunter
- Department of Neurology, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599-7025, United States
| | - Carolina Guimaraes
- Department of Radiology, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, United States
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Kromm GH, Patankar H, Nagalotimath S, Wong H, Austin T. Socioemotional and Psychological Outcomes of Hypoxic-Ischemic Encephalopathy: A Systematic Review. Pediatrics 2024; 153:e2023063399. [PMID: 38440801 PMCID: PMC10979301 DOI: 10.1542/peds.2023-063399] [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] [Accepted: 01/05/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Therapeutic hypothermia has reduced the risk of death or major disability following perinatal hypoxic-ischemic encephalopathy (HIE); however, many children who experience perinatal HIE still go on to develop personal and behavioral challenges, which can be difficult for caregivers and a public health burden for society. Our objective with this review is to systematically identify and synthesize studies that evaluate associations between perinatal HIE and socioemotional or psychological outcomes. METHODS We screened all search-returned journal articles from Cochrane Library, Embase, Medline, PsycINFO, Scopus, and Web of Science from data inception through February 1, 2023. Keywords related to HIE (eg, neonatal encephalopathy, neonatal brain injury) and outcomes (eg, social*, emotion*, behav* problem, psycholog*, psychiatr*) were searched with a predefined search string. We included all observational human studies reporting socioemotional or psychological sequelae of term HIE. Study data were recorded on standardized sheets, and the Newcastle-Ottawa Scale was adapted to assess study quality. RESULTS We included 43 studies documenting 3244 HIE participants and 2132 comparison participants. We found statistically significant associations between HIE and social and emotional, behavioral, and psychological and psychiatric deficits throughout infancy, childhood, and adolescence (19 studies). The authors of the included studies also report nonsignificant findings (11 studies) and outcomes without statistical comparison (25 studies). CONCLUSIONS Perinatal HIE may be a risk factor for a range of socioemotional and psychological challenges in the short- and long-term. Routine screening, early intervention, and follow-up support may be particularly beneficial to this population.
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Affiliation(s)
| | | | | | - Hilary Wong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- NICU, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- NICU, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Parmentier CEJ, Kropman T, Groenendaal F, Lequin MH, de Vries LS, Benders MJNL, Alderliesten T. Cranial MRI beyond the Neonatal Period and Neurodevelopmental Outcomes in Neonatal Encephalopathy Due to Perinatal Asphyxia: A Systematic Review. J Clin Med 2023; 12:7526. [PMID: 38137594 PMCID: PMC10743759 DOI: 10.3390/jcm12247526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) including diffusion-weighted imaging within seven days after birth is widely used to obtain prognostic information in neonatal encephalopathy (NE) following perinatal asphyxia. Later MRI could be useful for infants without a neonatal MRI or in the case of clinical concerns during follow-up. Therefore, this review evaluates the association between cranial MRI beyond the neonatal period and neurodevelopmental outcomes following NE. METHODS A systematic literature search was performed using PubMed and Embase on cranial MRI between 2 and 24 months after birth and neurodevelopmental outcomes following NE due to perinatal asphyxia. Two independent researchers performed the study selection and risk of bias analysis. Results were separately described for MRI before and after 18 months. RESULTS Twelve studies were included (high-quality n = 2, moderate-quality n = 6, low-quality n = 4). All reported on MRI at 2-18 months: seven studies demonstrated a significant association between the pattern and/or severity of injury and overall neurodevelopmental outcomes and three showed a significant association with motor outcome. There were insufficient data on non-motor outcomes and the association between MRI at 18-24 months and neurodevelopmental outcomes. CONCLUSIONS Cranial MRI performed between 2 and 18 months after birth is associated with neurodevelopmental outcomes in NE following perinatal asphyxia. However, more data on the association with non-motor outcomes are needed.
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Affiliation(s)
- Corline E. J. Parmentier
- Department of Neonatology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
| | - Tobias Kropman
- Department of Neonatology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
| | - Maarten H. Lequin
- Department of Radiology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
| | - Linda S. de Vries
- Department of Neonatology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children’s Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, 3584 EA Utrecht, The Netherlands
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Labusek N, Ghari P, Mouloud Y, Köster C, Diesterbeck E, Hadamitzky M, Felderhoff-Müser U, Bendix I, Giebel B, Herz J. Hypothermia combined with extracellular vesicles from clonally expanded immortalized mesenchymal stromal cells improves neurodevelopmental impairment in neonatal hypoxic-ischemic brain injury. J Neuroinflammation 2023; 20:280. [PMID: 38012640 PMCID: PMC10680187 DOI: 10.1186/s12974-023-02961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Neonatal encephalopathy following hypoxia-ischemia (HI) is a leading cause of childhood death and morbidity. Hypothermia (HT), the only available but obligatory therapy is limited due to a short therapeutic window and limited efficacy. An adjuvant therapy overcoming limitations of HT is still missing. Mesenchymal stromal cell (MSC)-derived extracellular vesicles (EVs) have shown promising therapeutic effects in various brain injury models. Challenges associated with MSCs' heterogeneity and senescence can be mitigated by the use of EVs from clonally expanded immortalized MSCs (ciMSCs). In the present study, we hypothesized that intranasal ciMSC-EV delivery overcomes limitations of HT. METHODS Nine-day-old C57BL/6 mice were exposed to HI by occlusion of the right common carotid artery followed by 1 h hypoxia (10% oxygen). HT was initiated immediately after insult for 4 h. Control animals were kept at physiological body core temperatures. ciMSC-EVs or vehicle were administered intranasally 1, 3 and 5 days post HI/HT. Neuronal cell loss, inflammatory and regenerative responses were assessed via immunohistochemistry, western blot and real-time PCR 7 days after insult. Long-term neurodevelopmental outcome was evaluated by analyses of cognitive function, activity and anxiety-related behavior 5 weeks after HI/HT. RESULTS In contrast to HT monotherapy, the additional intranasal therapy with ciMSC-EVs prevented HI-induced cognitive deficits, hyperactivity and alterations of anxiety-related behavior at adolescence. This was preceded by reduction of striatal neuronal loss, decreased endothelial, microglia and astrocyte activation; reduced expression of pro-inflammatory and increased expression of anti-inflammatory cytokines. Furthermore, the combination of HT with intranasal ciMSC-EV delivery promoted regenerative and neurodevelopmental processes, including endothelial proliferation, neurotrophic growth factor expression and oligodendrocyte maturation, which were not altered by HT monotherapy. CONCLUSION Intranasal delivery of ciMSC-EVs represents a novel adjunct therapy, overcoming limitations of acute HT thereby offering new possibilities for improving long-term outcomes in neonates with HI-induced brain injury.
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Affiliation(s)
- Nicole Labusek
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Parnian Ghari
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Yanis Mouloud
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Köster
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Eva Diesterbeck
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Hadamitzky
- Institute for Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ivo Bendix
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Bernd Giebel
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Josephine Herz
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Bao J, Zhang X, Zhao X. MR imaging and outcome in neonatal HIBD models are correlated with sex: the value of diffusion tensor MR imaging and diffusion kurtosis MR imaging. Front Neurosci 2023; 17:1234049. [PMID: 37790588 PMCID: PMC10543095 DOI: 10.3389/fnins.2023.1234049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Objective Hypoxic-ischemic encephalopathy can lead to lifelong morbidity and premature death in full-term newborns. Here, we aimed to determine the efficacy of diffusion kurtosis (DK) [mean kurtosis (MK)] and diffusion tensor (DT) [fractional anisotropy (FA), mean diffusion (MD), axial diffusion (AD), and radial diffusion (RD)] parameters for the early diagnosis of early brain histopathological changes and the prediction of neurodegenerative events in a full-term neonatal hypoxic-ischemic brain injury (HIBD) rat model. Methods The HIBD model was generated in postnatal day 7 Sprague-Dawley rats to assess the changes in DK and DT parameters in 10 specific brain structural regions involving the gray matter, white matter, and limbic system during acute (12 h) and subacute (3 d and 5 d) phases after hypoxic ischemia (HI), which were validated against histology. Sensory and cognitive parameters were assessed by the open field, novel object recognition, elevated plus maze, and CatWalk tests. Results Repeated-measures ANOVA revealed that specific brain structures showed similar trends to the lesion, and the temporal pattern of MK was substantially more varied than DT parameters, particularly in the deep gray matter. The change rate of MK in the acute phase (12 h) was significantly higher than that of DT parameters. We noted a delayed pseudo-normalization for MK. Additionally, MD, AD, and RD showed more pronounced differences between males and females after HI compared to MK, which was confirmed in behavioral tests. HI females exhibited anxiolytic hyperactivity-like baseline behavior, while the memory ability of HI males was affected in the novel object recognition test. CatWalk assessments revealed chronic deficits in limb gait parameters, particularly the left front paw and right hind paw, as well as poorer performance in HI males than HI females. Conclusions Our results suggested that DK and DT parameters were complementary in the immature brain and provided great value in assessing early tissue microstructural changes and predicting long-term neurobehavioral deficits, highlighting their ability to detect both acute and long-term changes. Thus, the various diffusion coefficient parameters estimated by the DKI model are powerful tools for early HIBD diagnosis and prognosis assessment, thus providing an experimental and theoretical basis for clinical treatment.
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Affiliation(s)
- Jieaoxue Bao
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Xiaoan Zhang
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
| | - Xin Zhao
- Department of Imaging, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou, China
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Kang OH, Jahn P, Eichhorn JG, Dresbach T, Müller A, Sabir H. Correlation of Different MRI Scoring Systems with Long-Term Cognitive Outcome in Cooled Asphyxiated Newborns. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1295. [PMID: 37628294 PMCID: PMC10453158 DOI: 10.3390/children10081295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
(1) Background: Cerebral MRI plays a significant role in assessing the extent of brain injury in neonates with neonatal encephalopathy after perinatal asphyxia. Over the last decades, several MRI scoring systems were developed to enhance the predictive accuracy of MRI. The aim of this study was to validate the correlation of four established MRI scoring systems with cognitive long-term outcomes in cooled asphyxiated newborns. (2) Methods: Forty neonates with neonatal encephalopathy treated with therapeutic hypothermia were included in this retrospective study. The MRI scans from the second week of life were scored using four existing MRI scoring systems (Barkovich, NICHD, Rutherford, and Weeke). The patients' outcome was assessed with the Bayley Scales of Infant Development (BSID-III) at the age of 2 years. To evaluate the correlation between the MRI scoring system with the cognitive scores of BSID-III, the correlation coefficient was calculated for each scoring system. (3) Results: All four MRI scoring systems showed a significant correlation with the cognitive scores of BSID-III. The strongest correlation was found between the Weeke Score (r2 = 0.43), followed by the Rutherford score (r2 = 0.39), the NICHD score (r2 = 0.22), and the Barkovich score (r2 = 0.17). (4) Conclusion: Our study confirms previously published results in an independent cohort and indicates that the Weeke and Rutherford scores have the strongest correlation with the cognitive score of BSID-III in cooled asphyxiated newborns.
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Affiliation(s)
- Ok-Hap Kang
- Children’s Hospital, Klinikum Leverkusen, 51375 Leverkusen, Germany; (O.-H.K.); (P.J.); (J.G.E.)
| | - Peter Jahn
- Children’s Hospital, Klinikum Leverkusen, 51375 Leverkusen, Germany; (O.-H.K.); (P.J.); (J.G.E.)
| | - Joachim G. Eichhorn
- Children’s Hospital, Klinikum Leverkusen, 51375 Leverkusen, Germany; (O.-H.K.); (P.J.); (J.G.E.)
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany; (T.D.); (A.M.)
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany; (T.D.); (A.M.)
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany; (T.D.); (A.M.)
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Onda K, Chavez-Valdez R, Graham EM, Everett AD, Northington FJ, Oishi K. Quantification of Diffusion Magnetic Resonance Imaging for Prognostic Prediction of Neonatal Hypoxic-Ischemic Encephalopathy. Dev Neurosci 2023; 46:55-68. [PMID: 37231858 PMCID: PMC10712961 DOI: 10.1159/000530938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/20/2023] [Indexed: 05/27/2023] Open
Abstract
Neonatal hypoxic-ischemic encephalopathy (HIE) is the leading cause of acquired neonatal brain injury with the risk of developing serious neurological sequelae and death. An accurate and robust prediction of short- and long-term outcomes may provide clinicians and families with fundamental evidence for their decision-making, the design of treatment strategies, and the discussion of developmental intervention plans after discharge. Diffusion tensor imaging (DTI) is one of the most powerful neuroimaging tools with which to predict the prognosis of neonatal HIE by providing microscopic features that cannot be assessed by conventional magnetic resonance imaging (MRI). DTI provides various scalar measures that represent the properties of the tissue, such as fractional anisotropy (FA) and mean diffusivity (MD). Since the characteristics of the diffusion of water molecules represented by these measures are affected by the microscopic cellular and extracellular environment, such as the orientation of structural components and cell density, they are often used to study the normal developmental trajectory of the brain and as indicators of various tissue damage, including HIE-related pathologies, such as cytotoxic edema, vascular edema, inflammation, cell death, and Wallerian degeneration. Previous studies have demonstrated widespread alteration in DTI measurements in severe cases of HIE and more localized changes in neonates with mild-to-moderate HIE. In an attempt to establish cutoff values to predict the occurrence of neurological sequelae, MD and FA measurements in the corpus callosum, thalamus, basal ganglia, corticospinal tract, and frontal white matter have proven to have an excellent ability to predict severe neurological outcomes. In addition, a recent study has suggested that a data-driven, unbiased approach using machine learning techniques on features obtained from whole-brain image quantification may accurately predict the prognosis of HIE, including for mild-to-moderate cases. Further efforts are needed to overcome current challenges, such as MRI infrastructure, diffusion modeling methods, and data harmonization for clinical application. In addition, external validation of predictive models is essential for clinical application of DTI to prognostication.
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Affiliation(s)
- Kengo Onda
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raul Chavez-Valdez
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ernest M. Graham
- Department of Gynecology & Obstetrics, Division of Maternal-Fetal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen D. Everett
- Department of Pediatrics, Division of Pediatric Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frances J. Northington
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenichi Oishi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Han Y, Wu P, Tian J, Chen H, Yang C. Diffusion kurtosis imaging and diffusion weighted imaging comparison in diagnosis of early hypoxic-ischemic brain edema. Eur J Med Res 2023; 28:159. [PMID: 37131227 PMCID: PMC10155297 DOI: 10.1186/s40001-023-01090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 03/05/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) refers to cerebral hypoxic-ischemic injury caused by asphyxia during perinatal period, which is one of the important causes of neonatal death and sequelae. Early and accurate diagnosis of HIE is of great significance for the prognostic evaluation of patients. The purpose of this study is to explore the efficacy of diffusion-kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) in the diagnosis of early HIE. METHODS Twenty Yorkshire newborn piglets (3-5 days) were randomly divided into control group and experimental group. DWI and DKI scanning were performed at timepoints of 3, 6, 9, 12, 16, and 24 h after hypoxic-ischemic exposure. At each timepoint, the parameter values obtained by each group scan were measured, and the lesion area of the apparent diffusion coefficient (ADC) map and mean diffusion coefficient (MDC) map were measured. (For better interpretation of this study, we replaced the description of MD with MDC). Then, we completely removed the brain for pathological examination, and observed the state of cells and mitochondria in the ADC/MDC matching area (the actual area of the lesion), and the mismatch area (the area around the lesion). RESULTS In the experimental group, the ADC and MDC values decreased with time, but the MDC decreased more significantly and the change rate was higher. Both MDC and ADC values changed rapidly from 3 to 12 h and slowly from 12 to 24 h. The MDC and ADC images showed obvious lesions at 3 h for the first time. At this time, the area of ADC lesions was larger than that of MDC. As the lesions developed, the area of ADC maps was always larger than that of the MDC maps within 24 h. By observing the microstructure of the tissues by light microscopy, we found that the ADC and MDC matching area in the experimental group showed swelling of neurons, infiltration of inflammatory cells, and local necrotic lesions. Consistent with the observation under light microscope, pathological changes were observed in the matching ADC and MDC regions under electron microscopy as well, including collapse of mitochondrial membrane, fracture of partial mitochondrial ridge, and emergence of autophagosomes. In the mismatching region, the above pathological changes were not observed in the corresponding region of the ADC map. CONCLUSIONS DKI's characteristic parameter MDC is better than ADC (parameter of DWI) to reflect the real area of the lesion. Therefore, DKI is superior to DWI in diagnosing early HIE.
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Affiliation(s)
- Yuxuan Han
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Peng Wu
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Juan Tian
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Honghai Chen
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
| | - Chao Yang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning Province China
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10
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Communication skills in children aged 6-8 years, without cerebral palsy cooled for neonatal hypoxic-ischemic encephalopathy. Sci Rep 2022; 12:17757. [PMID: 36272982 PMCID: PMC9588000 DOI: 10.1038/s41598-022-21723-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
We assessed communication skills of 48 children without cerebral palsy (CP) treated with therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) (cases) compared to 42 controls at early school-age and examined their association with white matter diffusion properties in both groups and 18-month Bayley-III developmental assessments in cases. Parents completed a Children's Communication Checklist (CCC-2) yielding a General Communication Composite (GCC), structural and pragmatic language scores and autistic-type behavior score. GCC ≤ 54 and thresholds of structural and pragmatic language score differences defined language impairment. Using tract-based spatial statistics (TBSS), fractional anisotropy (FA) was compared between 31 cases and 35 controls. Compared to controls, cases had lower GCC (p = 0.02), structural (p = 0.03) and pragmatic language score (p = 0.04) and higher language impairments (p = 0.03). GCC correlated with FA in the mid-body of the corpus callosum, the cingulum and the superior longitudinal fasciculus (p < 0.05) in cases. Bayley-III Language Composite correlated with GCC (r = 0.34, p = 0.017), structural (r = 0.34, p = 0.02) and pragmatic (r = 0.32, p = 0.03) language scores and autistic-type behaviors (r = 0.36, p = 0.01).
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11
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Cerebral injuries in neonatal encephalopathy treated with hypothermia: French LyTONEPAL cohort. Pediatr Res 2022; 92:880-887. [PMID: 34802036 DOI: 10.1038/s41390-021-01846-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/04/2021] [Accepted: 10/31/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypothermia is widely used for infants with hypoxic-ischemic neonatal encephalopathy but its impact remains poorly described at a population level. We aimed to describe brain imaging in infants born at ≥36 weeks' gestation, with moderate/severe encephalopathy treated with hypothermia. METHODS Descriptive analysis of brain MRI and discharge neurological examination for infants included in the French national multicentric prospective observational cohort LyTONEPAL. RESULTS Among 575 eligible infants, 479 (83.3%) with MRI before 12 days of life were included. MRI was normal for 48.2% (95% CI 43.7-52.8). Among infants with brain injuries, 62.5% (95% CI 56.2-68.5) had damage to more than one structure, 19.8% (95% CI 15.0-25.3) showed a pattern-associating injuries of basal ganglia/thalami (BGT), white matter (WM) and cortex. Overall, 68.4% (95% CI 62.0-74.3) of infants with normal MRI survived with a normal neurological examination. The rate of death was 15.4% (95% CI 12.3-19.0), predominantly for infants with the combined BGT, cortex, and/or WM injuries. CONCLUSIONS Among infants with neonatal encephalopathy treated with hypothermia, two-thirds of those with normal MRI survived with a normal neurological examination at discharge. When present, brain injuries often involved more than one structure. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT02676063). IMPACT In this multicentric cohort of infants with neonatal encephalopathy (LYTONEPAL) two-thirds survived with normal MRI and neurological examination at discharge. In total, 10% of newborns showed a pattern associating injuries of the basal ganglia-thalami, white matter, and cortex, which was correlated with a high risk of death at discharge. The evolution of MRI techniques and sequences in the era of hypothermia calls for a revisiting of imaging protocol in neonatal encephalopathy, especially for the timing. The neurological examination did not give evidence of brain injuries, thus questioning the reproducibility of the clinical exam or the neonatal brain functionality.
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Onda K, Catenaccio E, Chotiyanonta J, Chavez-Valdez R, Meoded A, Soares BP, Tekes A, Spahic H, Miller SC, Parker SJ, Parkinson C, Vaidya DM, Graham EM, Stafstrom CE, Everett AD, Northington FJ, Oishi K. Development of a composite diffusion tensor imaging score correlating with short-term neurological status in neonatal hypoxic-ischemic encephalopathy. Front Neurosci 2022; 16:931360. [PMID: 35983227 PMCID: PMC9379310 DOI: 10.3389/fnins.2022.931360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is the most common cause of neonatal acquired brain injury. Although conventional MRI may predict neurodevelopmental outcomes, accurate prognostication remains difficult. As diffusion tensor imaging (DTI) may provide an additional diagnostic and prognostic value over conventional MRI, we aimed to develop a composite DTI (cDTI) score to relate to short-term neurological function. Sixty prospective neonates treated with therapeutic hypothermia (TH) for HIE were evaluated with DTI, with a voxel size of 1 × 1 × 2 mm. Fractional anisotropy (FA) and mean diffusivity (MD) from 100 neuroanatomical regions (FA/MD *100 = 200 DTI parameters in total) were quantified using an atlas-based image parcellation technique. A least absolute shrinkage and selection operator (LASSO) regression was applied to the DTI parameters to generate the cDTI score. Time to full oral nutrition [short-term oral feeding (STO) score] was used as a measure of short-term neurological function and was correlated with extracted DTI features. Seventeen DTI parameters were selected with LASSO and built into the final unbiased regression model. The selected factors included FA or MD values of the limbic structures, the corticospinal tract, and the frontotemporal cortices. While the cDTI score strongly correlated with the STO score (rho = 0.83, p = 2.8 × 10-16), it only weakly correlated with the Sarnat score (rho = 0.27, p = 0.035) and moderately with the NICHD-NRN neuroimaging score (rho = 0.43, p = 6.6 × 10-04). In contrast to the cDTI score, the NICHD-NRN score only moderately correlated with the STO score (rho = 0.37, p = 0.0037). Using a mixed-model analysis, interleukin-10 at admission to the NICU (p = 1.5 × 10-13) and tau protein at the end of TH/rewarming (p = 0.036) and after rewarming (p = 0.0015) were significantly associated with higher cDTI scores, suggesting that high cDTI scores were related to the intensity of the early inflammatory response and the severity of neuronal impairment after TH. In conclusion, a data-driven unbiased approach was applied to identify anatomical structures associated with some aspects of neurological function of HIE neonates after cooling and to build a cDTI score, which was correlated with the severity of short-term neurological functions.
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Affiliation(s)
- Kengo Onda
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eva Catenaccio
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jill Chotiyanonta
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Raul Chavez-Valdez
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Bruno P. Soares
- Division of Neuroradiology, Department of Radiology, Larner College of Medicine at the University of Vermont, Burlington, VT, United States
| | - Aylin Tekes
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Pediatric Radiology and Pediatric Neuroradiology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Harisa Spahic
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sarah C. Miller
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Charlamaine Parkinson
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dhananjay M. Vaidya
- Department of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ernest M. Graham
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carl E. Stafstrom
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allen D. Everett
- Division of Pediatric Cardiology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Frances J. Northington
- Neuroscience Intensive Care Nursery Program, Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenichi Oishi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Hayakawa K, Tanda K, Nishimura A, Koshino S, Kizaki Z, Ohno K. Diffusion restriction in the corticospinal tract and the corpus callosum of term neonates with hypoxic-ischemic encephalopathy. Pediatr Radiol 2022; 52:1356-1369. [PMID: 35294621 DOI: 10.1007/s00247-022-05331-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 11/21/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diffusion-weighted imaging performed shortly after brain injury has been shown to facilitate visualization of acute corticospinal tract injury known as "pre-Wallerian degeneration." OBJECTIVE The aim of this study was to determine whether diffusion restriction in the corticospinal tract and corpus callosum occurs within the first 2 weeks after birth in neonates with neonatal hypoxic-ischemic encephalopathy. MATERIALS AND METHODS We enrolled a consecutive series of 66 infants diagnosed with hypoxic-ischemic encephalopathy who underwent MRI. We evaluated diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values to assess the presence of restricted diffusion in the corticospinal tract and corpus callosum. Next, we compared ADC values in the corticospinal tract and in the splenium and genu of the corpus callosum of infants with abnormal pattern on MRI with those of control infants, who showed a normal pattern on MRI. We attempted to follow all infants with hypoxic-ischemic encephalopathy until 18 months of age and assess them using a standardized neurologic examination. RESULTS After exclusions, we recruited 25 infants with abnormal MRI and 20 with normal MRI (controls). Among these 45 neonates, pre-Wallerian degeneration was visualized in the corticospinal tract in 10 neonates and in the corpus callosum in 12. The ADC values in the corticospinal tract in the first week were significantly lower than they were in the second week. Infants with pre-Wallerian degeneration in the corticospinal tract showed an unfavorable outcome. CONCLUSION Pre-Wallerian degeneration was visualized in the corticospinal tract and corpus callosum and was associated with extensive brain injury caused by hypoxic-ischemic encephalopathy. The changes in signal were observed to evolve over time within the first 2 weeks. The clinical outcome of infants having pre-Wallerian degeneration in the corticospinal tract was unfavorable.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan.
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Sachiko Koshino
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Zenro Kizaki
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Ohno
- Department of Diagnostic Radiology, Red Cross Kyoto Daiichi Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, 605-0981, Japan
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14
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Bobba PS, Weber CF, Mak A, Mozayan A, Malhotra A, Sheth KN, Taylor SN, Vossough A, Grant PE, Scheinost D, Constable RT, Ment LR, Payabvash S. Age-related topographic map of magnetic resonance diffusion metrics in neonatal brains. Hum Brain Mapp 2022; 43:4326-4334. [PMID: 35599634 PMCID: PMC9435001 DOI: 10.1002/hbm.25956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 01/15/2023] Open
Abstract
Accelerated maturation of brain parenchyma close to term-equivalent age leads to rapid changes in diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) metrics of neonatal brains, which can complicate the evaluation and interpretation of these scans. In this study, we characterized the topography of age-related evolution of diffusion metrics in neonatal brains. We included 565 neonates who had MRI between 0 and 3 months of age, with no structural or signal abnormality-including 162 who had DTI scans. We analyzed the age-related changes of apparent diffusion coefficient (ADC) values throughout brain and DTI metrics (fractional anisotropy [FA] and mean diffusivity [MD]) along white matter (WM) tracts. Rate of change in ADC, FA, and MD values across 5 mm cubic voxels was calculated. There was significant reduction of ADC and MD values and increase of FA with increasing gestational age (GA) throughout neonates' brain, with the highest temporal rates in subcortical WM, corticospinal tract, cerebellar WM, and vermis. GA at birth had significant effect on ADC values in convexity cortex and corpus callosum as well as FA/MD values in corpus callosum, after correcting for GA at scan. We developed online interactive atlases depicting age-specific normative values of ADC (ages 34-46 weeks), and FA/MD (35-41 weeks). Our results show a rapid decrease in diffusivity metrics of cerebral/cerebellar WM and vermis in the first few weeks of neonatal age, likely attributable to myelination. In addition, prematurity and low GA at birth may result in lasting delay in corpus callosum myelination and cerebral cortex cellularity.
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Affiliation(s)
- Pratheek S. Bobba
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Clara F. Weber
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA,Social Neuroscience Lab, Department of Psychiatry and PsychotherapyLübeck UniversityLübeckGermany
| | - Adrian Mak
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA,CLAIM ‐ Charité Lab for Artificial Intelligence in MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Ali Mozayan
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Ajay Malhotra
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Kevin N. Sheth
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA
| | - Sarah N. Taylor
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Arastoo Vossough
- Department of RadiologyChildren's Hospital of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Patricia Ellen Grant
- Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA,Department of Radiology, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Dustin Scheinost
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Robert Todd Constable
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Laura R. Ment
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA,Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
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15
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Neonatal encephalopathy prediction of poor outcome with diffusion-weighted imaging connectome and fixel-based analysis. Pediatr Res 2022; 91:1505-1515. [PMID: 33966055 PMCID: PMC9053106 DOI: 10.1038/s41390-021-01550-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Better biomarkers of eventual outcome are needed for neonatal encephalopathy. To identify the most potent neonatal imaging marker associated with 2-year outcomes, we retrospectively performed diffusion-weighted imaging connectome (DWIC) and fixel-based analysis (FBA) on magnetic resonance imaging (MRI) obtained in the first 4 weeks of life in term neonatal encephalopathy newborns. METHODS Diffusion tractography was available in 15 out of 24 babies with MRI, five each with normal, abnormal motor outcome, or death. All 15 except one underwent hypothermia as initial treatment. In abnormal motor and death groups, DWIC found 19 white matter pathways with severely disrupted fiber orientation distributions. RESULTS Using random forest classification, these disruptions predicted the follow-up outcomes with 89-99% accuracy. These pathways showed reduced integrity in abnormal motor and death vs. normal tone groups (p < 10-6). Using ranked supervised multi-view canonical correlation and depicting just three of the five dimensions of the analysis, the abnormal motor and death were clearly differentiated from each other and the normal tone group. CONCLUSIONS This study suggests that a machine-learning model for prediction using early DWIC and FBA could be a possible way of developing biomarkers in large MRI datasets having clinical outcomes. IMPACT Early connectome and FBA of clinically acquired DWI provide a new noninvasive imaging tool to predict the long-term motor outcomes after birth, based on the severity of white matter injury. Disrupted white matter connectivity as a novel neonatal marker achieves high accuracy of 89-99% to predict 2-year motor outcomes using conventional machine-learning classification. The proposed neonatal marker may allow better prognostication that is important to elucidate neural repair mechanisms and evaluate treatment modalities in neonatal encephalopathy.
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Beck J, Loron G, Ancel PY, Alison M, Hertz Pannier L, Vo Van P, Debillon T, Bednarek N. An Updated Overview of MRI Injuries in Neonatal Encephalopathy: LyTONEPAL Cohort. CHILDREN (BASEL, SWITZERLAND) 2022; 9:561. [PMID: 35455605 PMCID: PMC9032533 DOI: 10.3390/children9040561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic-ischemic events. The purpose of this study was to finely characterize brain injuries in this context. METHODS We provided a complete, descriptive analysis of the brain MRIs of infants included in the French national, multicentric cohort LyTONEPAL. RESULTS Among 794 eligible infants, 520 (65.5%) with MRI before 12 days of life, grade II or III encephalopathy and gestational age ≥36 weeks were included. Half of the population had a brain injury (52.4%); MRIs were acquired before 6 days of life among 247 (47.5%) newborns. The basal ganglia (BGT), white matter (WM) and cortex were the three predominant sites of injuries, affecting 33.8% (n = 171), 33.5% (n = 166) and 25.6% (n = 128) of participants, respectively. The thalamus and the periventricular WM were the predominant sublocations. The BGT, posterior limb internal capsule, brainstem and cortical injuries appeared more frequently in the early MRI group than in the late MRI group. CONCLUSION This study described an overview of brain injuries in hypoxic-ischemic neonatal encephalopathy. The basal ganglia with the thalamus and the WM with periventricular sublocation injuries were predominant. Comprehensive identification of brain injuries in the context of HIE may provide insight into the mechanism and time of occurrence.
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Affiliation(s)
- Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- EPOPé (Obstetrical Perinatal and Pediatric Epidemiology Research Team), CRESS (Centre of Research in Epidemiology and StatisticS), INSERM (Institut National de la Santé et de la Recherche Médicale), INRAE (Institut National de la Recherche Agronomique), Université de Paris, 75004 Paris, France;
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- CReSTIC EA (Centre de Recherche en Traitement du Signal Informatique) 3804, Université de Reims Champagne Ardenne, 51097 Reims, France
| | - Pierre-Yves Ancel
- EPOPé (Obstetrical Perinatal and Pediatric Epidemiology Research Team), CRESS (Centre of Research in Epidemiology and StatisticS), INSERM (Institut National de la Santé et de la Recherche Médicale), INRAE (Institut National de la Recherche Agronomique), Université de Paris, 75004 Paris, France;
- Assistance Publique—Hôpitaux de Paris, Clinical Investigation Center P1419, 75004 Paris, France
| | - Marianne Alison
- Service d’Imagerie Pédiatrique, Hôpital Robert Debré, APHP (Assistance Publique—Hôpitaux de Paris), 75019 Paris, France;
- Unit 1141 NeuroDiderot, Inserm, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives), Université Paris Cité, 75019 Paris, France;
| | - Lucie Hertz Pannier
- Unit 1141 NeuroDiderot, Inserm, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives), Université Paris Cité, 75019 Paris, France;
- UNIACT (Unité de Recherche en NeuroImagerie Applicative Clinique et Translationnelle), Neurospin, CEA (Commissariat à l’Énergie Atomique et aux Énergies Alternatives)-Saclay, 91191 Gif sur Yvette, France
| | - Philippe Vo Van
- Department of Neonatology, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Pinel, 69500 Bron, France;
| | - Thierry Debillon
- Neonatal Intensive Care Unit CHU (Centre Hospital-Universitaire) Grenoble Alpes, 38000 Grenoble, France;
- Grenoble INP (Institut d’Ingénierie et de Management), TIMC (Techniques de l’Ingénierie Médicale et de la Complexité)-IMAG (Informatique, Mathématiques et Applications, Grenoble), CNRS (Centre National de la Recherche Scientifique), University Grenoble Alpes, 38000 Grenoble, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (G.L.); (N.B.)
- CReSTIC EA (Centre de Recherche en Traitement du Signal Informatique) 3804, Université de Reims Champagne Ardenne, 51097 Reims, France
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Parmentier CEJ, de Vries LS, Groenendaal F. Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy. Diagnostics (Basel) 2022; 12:diagnostics12030645. [PMID: 35328199 PMCID: PMC8947468 DOI: 10.3390/diagnostics12030645] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 01/14/2023] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is a major cause of neurological sequelae in (near-)term newborns. Despite the use of therapeutic hypothermia, a significant number of newborns still experience impaired neurodevelopment. Neuroimaging is the standard of care in infants with HIE to determine the timing and nature of the injury, guide further treatment decisions, and predict neurodevelopmental outcomes. Cranial ultrasonography is a helpful noninvasive tool to assess the brain before initiation of hypothermia to look for abnormalities suggestive of HIE mimics or antenatal onset of injury. Magnetic resonance imaging (MRI) which includes diffusion-weighted imaging has, however, become the gold standard to assess brain injury in infants with HIE, and has an excellent prognostic utility. Magnetic resonance spectroscopy provides complementary metabolic information and has also been shown to be a reliable prognostic biomarker. Advanced imaging modalities, including diffusion tensor imaging and arterial spin labeling, are increasingly being used to gain further information about the etiology and prognosis of brain injury. Over the past decades, tremendous progress has been made in the field of neonatal neuroimaging. In this review, the main brain injury patterns of infants with HIE, the application of conventional and advanced MRI techniques in these newborns, and HIE mimics, will be described.
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Affiliation(s)
- Corline E. J. Parmentier
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
| | - Linda S. de Vries
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
- Department of Neonatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
- Correspondence:
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18
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Spencer APC, Brooks JCW, Masuda N, Byrne H, Lee-Kelland R, Jary S, Thoresen M, Goodfellow M, Cowan FM, Chakkarapani E. Motor function and white matter connectivity in children cooled for neonatal encephalopathy. Neuroimage Clin 2021; 32:102872. [PMID: 34749285 PMCID: PMC8578038 DOI: 10.1016/j.nicl.2021.102872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/13/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022]
Abstract
Therapeutic hypothermia reduces the incidence of severe motor disability, such as cerebral palsy, following neonatal hypoxic-ischaemic encephalopathy. However, cooled children without cerebral palsy at school-age demonstrate motor deficits and altered white matter connectivity. In this study, we used diffusion-weighted imaging to investigate the relationship between white matter connectivity and motor performance, measured using the Movement Assessment Battery for Children-2, in children aged 6-8 years treated with therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy at birth, who did not develop cerebral palsy (cases), and matched typically developing controls. Correlations between total motor scores and diffusion properties in major white matter tracts were assessed in 33 cases and 36 controls. In cases, significant correlations (FDR-corrected P < 0.05) were found in the anterior thalamic radiation bilaterally (left: r = 0.513; right: r = 0.488), the cingulate gyrus part of the left cingulum (r = 0.588), the hippocampal part of the left cingulum (r = 0.541), and the inferior fronto-occipital fasciculus bilaterally (left: r = 0.445; right: r = 0.494). No significant correlations were found in controls. We then constructed structural connectivity networks, for 22 cases and 32 controls, in which nodes represent brain regions and edges were determined by probabilistic tractography and weighted by fractional anisotropy. Analysis of whole-brain network metrics revealed correlations (FDR-corrected P < 0.05), in cases, between total motor scores and average node strength (r = 0.571), local efficiency (r = 0.664), global efficiency (r = 0.677), clustering coefficient (r = 0.608), and characteristic path length (r = -0.652). No significant correlations were found in controls. We then investigated edge-level association with motor function using the network-based statistic. This revealed subnetworks which exhibited group differences in the association between motor outcome and edge weights, for total motor scores (P = 0.0109) as well as for balance (P = 0.0245) and manual dexterity (P = 0.0233) domain scores. All three of these subnetworks comprised numerous frontal lobe regions known to be associated with motor function, including the superior frontal gyrus and middle frontal gyrus. The subnetwork associated with total motor scores was highly left-lateralised. These findings demonstrate an association between impaired motor function and brain organisation in school-age children treated with therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy.
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Affiliation(s)
- Arthur P C Spencer
- Clinical Research and Imaging Centre, University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C W Brooks
- Clinical Research and Imaging Centre, University of Bristol, Bristol, UK; School of Psychology, University of East Anglia, Norwich, UK
| | - Naoki Masuda
- Department of Mathematics, State University of New York at Buffalo, Buffalo, NY, USA; Computational and Data-Enabled Science and Engineering Program, State University of New York at Buffalo, Buffalo, NY, USA
| | - Hollie Byrne
- Clinical Research and Imaging Centre, University of Bristol, Bristol, UK; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Richard Lee-Kelland
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sally Jary
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marianne Thoresen
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marc Goodfellow
- Living Systems Institute, University of Exeter, Exeter, UK; Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, UK; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK; College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Frances M Cowan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Department of Paediatrics, Imperial College London, London, UK
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Neonatal Intensive Care Unit, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
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19
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Marlow N, Shankaran S, Rogers EE, Maitre NL, Smyser CD. Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101274. [PMID: 34330680 DOI: 10.1016/j.siny.2021.101274] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In randomized trials, therapeutic hypothermia (TH) is associated with reduced prevalence of the composite outcome mortality or neurodevelopmental morbidity in infants with neonatal encephalopathy (NE). Following systematic review, the reduction in prevalence of both mortality and infant neuromorbidity is clear. Among three trials reporting school age outcomes, the effects of NE and TH suggest that such benefit persists into middle childhood, but none of the major trials were powered to detect differences in these outcomes. Cognitive, educational and behavioural outcomes are all adversely affected by NE in children without moderate or severe neuromorbidity. High-quality longitudinal studies of neurocognitive and educational outcomes following NE in the era of TH, including studies incorporating multimodal neuroimaging assessments, are required to characterise deficits more precisely so that robust interventional targets may be developed, and resource planning can occur. Understanding the impact of NE on families and important educational, social, and behavioural outcomes in childhood is critical to attempts to optimise outcomes through interventions.
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Affiliation(s)
| | | | | | - Nathalie L Maitre
- Nationwide Children's Hospital, Columbus, OH, USA; Vanderbilt University, Nashville, TN, USA
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20
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Wisnowski JL, Wintermark P, Bonifacio SL, Smyser CD, Barkovich AJ, Edwards AD, de Vries LS, Inder TE, Chau V. Neuroimaging in the term newborn with neonatal encephalopathy. Semin Fetal Neonatal Med 2021; 26:101304. [PMID: 34736808 PMCID: PMC9135955 DOI: 10.1016/j.siny.2021.101304] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neuroimaging is widely used to aid in the diagnosis and clinical management of neonates with neonatal encephalopathy (NE). Yet, despite widespread use clinically, there are few published guidelines on neuroimaging for neonates with NE. This review outlines the primary patterns of brain injury associated with hypoxic-ischemic injury in neonates with NE and their frequency, associated neuropathological features, and risk factors. In addition, it provides an overview of neuroimaging methods, including the most widely used scoring systems used to characterize brain injury in these neonates and their utility as predictive biomarkers. Last, recommendations for neuroimaging in neonates with NE are presented.
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Affiliation(s)
- Jessica L. Wisnowski
- Departments of Radiology and Pediatrics (Neonatology), Children’s Hospital Los Angeles, 4650 Sunset Blvd. MS #81, Los Angeles CA 90027, USA
| | - Pia Wintermark
- Department of Pediatrics (Neonatology), McGill University/Montreal Children's Hospital, Division of Newborn Medicine, Research Institute of the McGill University Health Centre, 1001 boul. Décarie, Site Glen Block E, EM0.3244, Montréal, QC H4A 3J1, Canada.
| | - Sonia L. Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics (Neonatology), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA
| | - Christopher D. Smyser
- Departments of Neurology, Radiology, and Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St Louis, MO 63110-1093, USA
| | - A. James Barkovich
- Department of Radiology, UCSF Benioff Children’s Hospital, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - A. David Edwards
- Evelina London Children’s Hospital, Centre for Developing Brain, King’s College London, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Linda S. de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3584 EA, Utrecht, the Netherlands
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Vann Chau
- Department of Pediatrics (Neurology), The Hospital for Sick Children, University of Toronto, 555 University Avenue, Room 6513, Toronto, ON M5G 1X8, Canada.
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21
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Spencer APC, Byrne H, Lee-Kelland R, Jary S, Thoresen M, Cowan FM, Chakkarapani E, Brooks JCW. An Age-Specific Atlas for Delineation of White Matter Pathways in Children Aged 6-8 Years. Brain Connect 2021; 12:402-416. [PMID: 34210166 PMCID: PMC7612846 DOI: 10.1089/brain.2021.0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Diffusion MRI allows non-invasive assessment of white matter connectivity in typical development and of changes due to brain injury or pathology. Probabilistic white matter atlases allow diffusion metrics to be measured in specific white matter pathways, and are a critical component in spatial normalisation for group analysis. However, given the known developmental changes in white matter it may be sub-optimal to use an adult template when assessing data acquired from children. Methods By averaging subject-specific fibre bundles from 28 children aged from 6 to 8 years, we created an age-specific probabilistic white matter atlas for 12 major white matter tracts. Using both the newly developed and Johns Hopkins adult atlases, we compared the atlas to subject-specific fibre bundles in two independent validation cohorts, assessing accuracy in terms of volumetric overlap and measured diffusion metrics. Results Our age-specific atlas gave better overall performance than the adult atlas, achieving higher volumetric overlap with subject-specific fibre tracking and higher correlation of FA measurements with those measured from subject-specific fibre bundles. Specifically, estimates of FA values for cortico-spinal tract, uncinate fasciculus, forceps minor, cingulate gyrus part of the cingulum and anterior thalamic radiation were all significantly more accurate when estimated with an age-specific atlas. Discussion The age-specific atlas allows delineation of white matter tracts in children aged 6-8 years, without the need for tractography, more accurately than when normalising to an adult atlas. To our knowledge, this is the first publicly available probabilistic atlas of white matter tracts for this age group.
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Affiliation(s)
- Arthur P C Spencer
- Clinical Research and Imaging Centre, University of Bristol, Bristol, United Kingdom.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hollie Byrne
- Clinical Research and Imaging Centre, University of Bristol, Bristol, United Kingdom
| | - Richard Lee-Kelland
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sally Jary
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Marianne Thoresen
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Frances M Cowan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan C W Brooks
- Clinical Research and Imaging Centre, University of Bristol, Bristol, United Kingdom.,School of Psychology, University of East Anglia, Norwich, United Kingdom
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22
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Oleuropein Activates Neonatal Neocortical Proteasomes, but Proteasome Gene Targeting by AAV9 Is Variable in a Clinically Relevant Piglet Model of Brain Hypoxia-Ischemia and Hypothermia. Cells 2021; 10:cells10082120. [PMID: 34440889 PMCID: PMC8391411 DOI: 10.3390/cells10082120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 10/26/2022] Open
Abstract
Cerebral hypoxia-ischemia (HI) compromises the proteasome in a clinically relevant neonatal piglet model. Protecting and activating proteasomes could be an adjunct therapy to hypothermia. We investigated whether chymotrypsin-like proteasome activity differs regionally and developmentally in the neonatal brain. We also tested whether neonatal brain proteasomes can be modulated by oleuropein, an experimental pleiotropic neuroprotective drug, or by targeting a proteasome subunit gene using recombinant adeno-associated virus-9 (AAV). During post-HI hypothermia, we treated piglets with oleuropein, used AAV-short hairpin RNA (shRNA) to knock down proteasome activator 28γ (PA28γ), or enforced PA28γ using AAV-PA28γ with green fluorescent protein (GFP). Neonatal neocortex and subcortical white matter had greater proteasome activity than did liver and kidney. Neonatal white matter had higher proteasome activity than did juvenile white matter. Lower arterial pH 1 h after HI correlated with greater subsequent cortical proteasome activity. With increasing brain homogenate protein input into the assay, the initial proteasome activity increased only among shams, whereas HI increased total kinetic proteasome activity. OLE increased the initial neocortical proteasome activity after hypothermia. AAV drove GFP expression, and white matter PA28γ levels correlated with proteasome activity and subunit levels. However, AAV proteasome modulation varied. Thus, neonatal neocortical proteasomes can be pharmacologically activated. HI slows the initial proteasome performance, but then augments ongoing catalytic activity. AAV-mediated genetic manipulation in the piglet brain holds promise, though proteasome gene targeting requires further development.
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23
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Kushwah S, Kumar A, Verma A, Basu S, Kumar A. Comparison of fractional anisotropy and apparent diffusion coefficient among hypoxic ischemic encephalopathy stages 1, 2, and 3 and with nonasphyxiated newborns in 18 areas of brain. Indian J Radiol Imaging 2021; 27:447-456. [PMID: 29379241 PMCID: PMC5761173 DOI: 10.4103/ijri.ijri_384_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To determine the area and extent of injury in hypoxic encephalopathy stages by diffusion tensor imaging (DTI) using parameters apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values and their comparison with controls without any evidence of asphyxia. To correlate the outcome of hypoxia severity clinically and significant changes on DTI parameter. Materials and Methods DTI was done in 50 cases at median age of 12 and 20 controls at median age of 7 days. FA and apparent diffusion coefficient (ADC) were measured in several regions of interest (ROI). Continuous variables were analyzed using Student's t-test. Categorical variables were compared by Fisher's exact test. Comparison among multiple groups was done using analysis of variance (ANOVA) and post hoc Bonferroni test. Results Abnormalities were more easily and accurately determined in ROI with the help of FA and ADC values. When compared with controls FA values were significantly decreased and ADC values were significantly increased in cases, in ROI including both right and left side of thalamus, basal ganglia, posterior limb of internal capsule, cerebral peduncle, corticospinal tracts, frontal, parietal, temporal, occipital with P value < 0.05. The extent of injury was maximum in stage-III. There was no significant difference among males and females. Conclusion Compared to conventional magnetic resonance imaging (MRI), the evaluation of FA and ADC values using DTI can determine the extent and severity of injury in hypoxic encephalopathy. It can be used for early determination of brain injury in these patients.
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Affiliation(s)
- Supriya Kushwah
- Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Ashok Kumar
- Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Sriparna Basu
- Department of Paediatrics, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Anaesthesia, KMC, Mangalore, Karnataka, India
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24
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Spencer APC, Brooks JCW, Masuda N, Byrne H, Lee-Kelland R, Jary S, Thoresen M, Tonks J, Goodfellow M, Cowan FM, Chakkarapani E. Disrupted brain connectivity in children treated with therapeutic hypothermia for neonatal encephalopathy. Neuroimage Clin 2021; 30:102582. [PMID: 33636541 PMCID: PMC7906894 DOI: 10.1016/j.nicl.2021.102582] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Therapeutic hypothermia following neonatal encephalopathy due to birth asphyxia reduces death and cerebral palsy. However, school-age children without cerebral palsy treated with therapeutic hypothermia for neonatal encephalopathy still have reduced performance on cognitive and motor tests, attention difficulties, slower reaction times and reduced visuo-spatial processing abilities compared to typically developing controls. We acquired diffusion-weighted imaging data from school-age children without cerebral palsy treated with therapeutic hypothermia for neonatal encephalopathy at birth, and a matched control group. Voxelwise analysis (33 cases, 36 controls) confirmed reduced fractional anisotropy in widespread areas of white matter in cases, particularly in the fornix, corpus callosum, anterior and posterior limbs of the internal capsule bilaterally and cingulum bilaterally. In structural brain networks constructed using probabilistic tractography (22 cases, 32 controls), graph-theoretic measures of strength, local and global efficiency, clustering coefficient and characteristic path length were found to correlate with IQ in cases but not controls. Network-based statistic analysis implicated brain regions involved in visuo-spatial processing and attention, aligning with previous behavioural findings. These included the precuneus, thalamus, left superior parietal gyrus and left inferior temporal gyrus. Our findings demonstrate that, despite the manifest successes of therapeutic hypothermia, brain development is impaired in these children.
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Affiliation(s)
- Arthur P C Spencer
- Clinical Research and Imaging Centre, University of Bristol, Bristol, United Kingdom
| | - Jonathan C W Brooks
- Clinical Research and Imaging Centre, University of Bristol, Bristol, United Kingdom; School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Naoki Masuda
- Department of Mathematics, State University of New York at Buffalo, Buffalo, NY, United States; Computational and Data-Enabled Science and Engineering Program, State University of New York at Buffalo, Buffalo, NY, United States
| | - Hollie Byrne
- Clinical Research and Imaging Centre, University of Bristol, Bristol, United Kingdom
| | - Richard Lee-Kelland
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sally Jary
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Marianne Thoresen
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - James Tonks
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; University of Exeter Medical School, Exeter, United Kingdom
| | - Marc Goodfellow
- Living Systems Institute, University of Exeter, Exeter, United Kingdom; Wellcome Trust Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter, United Kingdom; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom; College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - Frances M Cowan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Neonatal Intensive Care Unit, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
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25
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Longo D, Bottino F, Lucignani G, Scarciolla L, Pasquini L, Rossi Espagnet MC, Polito C, Figà-Talamanca L, Calbi G, Savarese I, Giliberti P, Napolitano A. DTI parameters in neonates with hypoxic-ischemic encephalopathy after total body hypothermia. J Matern Fetal Neonatal Med 2020; 35:4035-4042. [PMID: 33203279 DOI: 10.1080/14767058.2020.1846180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging provides means for discriminating different patterns of Hypoxic-ischemic encephalopathy (HIE) and may distinguish most severe cases from less severe but is unable to predict long-term outcome. Diffusion tensor imaging (DTI) offers information for a more complete characterization of HIE. The purpose of this study is to compare the modifications of DTI parameters in newborns one week and six months following total-body cooling to healthy controls. METHODS Forty-seven cooled newborns were studied with MRI, 20 underwent follow-up at 6 months. 12 healthy newborns and nine children at 6 months were enrolled as control groups (HC). Inferior Longitudinal Fasciculus (ILF), Corpus Callosum Fasciculus (CCF), Corticospinal Tract (CST), Optical Tract (OT), Optic Radiation (OR) were generated in all subjects. DTI parameters were evaluated in basal ganglia (BG), thalamus (TH) and tracks. Statistical analysis was performed with MANOVA. RESULTS In newborns HIE versus HC, there were significantly lower fractional anisotropy (FA) on OR and CST and higher axial diffusivity (AD), apparent diffusion coefficient (ADC) and radial diffusivity (RD) values on CST, BG and TH in HIE-N. At 6 months there were no significant grouping effects. The analysis showed a significant increase of FA, decrease of ADC, AD, RD after 6 months for HIE and HC. CONCLUSIONS We observed modifications of parameter values in HIE newborns vs HC; however normalization of values at 6 months suggests that changes of parameters cannot be considered early biomarkers for evaluation of therapeutic hypothermia in newborns with moderate HIE and normal conventional MRI.
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Affiliation(s)
- D Longo
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - F Bottino
- Medical Physics Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - G Lucignani
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Scarciolla
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Pasquini
- NESMOS, Neuroradiology Department, Sapienza University, Rome, Italy
| | - M C Rossi Espagnet
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.,NESMOS, Neuroradiology Department, Sapienza University, Rome, Italy
| | - C Polito
- Medical Physics Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Figà-Talamanca
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - G Calbi
- Anesthesiology Unit, DEA-ARCO, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - I Savarese
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - P Giliberti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - A Napolitano
- Medical Physics Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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26
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Dibble M, O'Dea MI, Hurley T, Byrne A, Colleran G, Molloy EJ, Bokde ALW. Diffusion tensor imaging in neonatal encephalopathy: a systematic review. Arch Dis Child Fetal Neonatal Ed 2020; 105:480-488. [PMID: 31822482 DOI: 10.1136/archdischild-2019-318025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Diffusion tensor imaging (DTI) during the first few days of life can be used to assess brain injury in neonates with neonatal encephalopathy (NE) for outcome prediction. The goal of this review was to identify specific white matter tracts of interest that can be quantified by DTI as being altered in neonates with this condition, and to investigate its potential prognostic ability. METHODS Searches of Medline and the Cochrane Database of Systematic Reviews were conducted to identify studies with diffusion data collected in term-born neonates with NE. RESULTS 19 studies were included which described restricted diffusion in encephalopathic neonates as compared with healthy controls, with the posterior limb of the internal capsule and the genu and splenium of the corpus callosum identified as particular regions of interest. Restricted diffusion was related to adverse outcomes in the studies that conducted a follow-up of these infants. CONCLUSIONS Obtaining diffusion measures in these key white matter tracts early in life before pseudonormalisation can occur can not only identify the extent of the damage but also can be used to examine the effectiveness of treatment and to predict neurodevelopmental outcome.
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Affiliation(s)
- Megan Dibble
- Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland .,Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
| | - Mary Isabel O'Dea
- Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
| | - Tim Hurley
- Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
| | - Angela Byrne
- Department of Radiology, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Gabrielle Colleran
- Department of Radiology, The National Maternity Hospital, Dublin, Ireland
| | - Eleanor J Molloy
- Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland.,Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Arun Lawrence Warren Bokde
- Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
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27
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Gosar D, Tretnjak V, Bregant T, Neubauer D, Derganc M. Reduced white-matter integrity and lower speed of information processing in adolescents with mild and moderate neonatal hypoxic-ischaemic encephalopathy. Eur J Paediatr Neurol 2020; 28:205-213. [PMID: 32665198 DOI: 10.1016/j.ejpn.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Studies have shown that adolescents with moderate hypoxic-ischaemic encephalopathy (HIE) may have specific cognitive deficits, especially reduced speed of information processing. The aim of our study was to confirm these earlier findings find out whether the degree of impairment in speed of information processing correlates with the degree of white-matter impairment as measured by diffusion tensor imaging (DTI). METHODS Thirty-three participants (mean age 18y 5mo, SD 12mo; 19 male) with mild or moderate HIE and 32 neurotypical adolescents (mean age 17y 10mo, SD 12mo, 18 male) completed a comprehensive neuropsychological battery measuring short-term memory, inhibition, speed of information processing, long-term visual and verbal memory. Fourteen participants also underwent structural MRI and DTI scans. RESULTS After controlling for age, gender and maternal education we found a significant effect of HIE on speed of information processing (F(2, 64) = 3.51, p < .037, η2 = 0.115), but not on other neuropsychological domains. Using tract-based spatial statistics we were also able to confirm a correlation between the degree of impairment in this cognitive domain and fractional anisotropy in several white-matter tracts. CONCLUSIONS The long-term cognitive outcome of moderate HIE includes reduced speed of information processing and is in part mediated by reduced integrity of major white-matter tracts.
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Affiliation(s)
- David Gosar
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia.
| | - Vali Tretnjak
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Tina Bregant
- Centre for Education and Rehabilitation of Physically Handicapped Children and Adolescents - CIRIUS Kamnik, Slovenia
| | - David Neubauer
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Metka Derganc
- University Medical Centre Ljubljana, Department of Paediatric Surgery and Intensive Care, Ljubljana, Slovenia
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28
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Aker K, Støen R, Eikenes L, Martinez-Biarge M, Nakken I, Håberg AK, Gibikote S, Thomas N. Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy in India (THIN study): a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2020; 105:405-411. [PMID: 31662328 PMCID: PMC7363785 DOI: 10.1136/archdischild-2019-317311] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/26/2019] [Accepted: 10/16/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the neuroprotective effect of therapeutic hypothermia (TH) induced by phase changing material (PCM) on MRI biomarkers in infants with hypoxic-ischaemic encephalopathy (HIE) in a low-resource setting. DESIGN Open-label randomised controlled trial. SETTING One neonatal intensive care unit in a tertiary care centre in India. PATIENTS 50 term/near-term infants admitted within 5 hours after birth with predefined physiological criteria and signs of moderate/severe HIE. INTERVENTIONS Standard care (n=25) or standard care plus 72 hours of hypothermia (33.5°C±0.5°C, n=25) induced by PCM. MAIN OUTCOME MEASURES Primary outcome was fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC) on neonatal diffusion tensor imaging analysed according to intention to treat. RESULTS Primary outcome was available for 22 infants (44%, 11 in each group). Diffusion tensor imaging showed significantly higher FA in the cooled than the non-cooled infants in left PLIC and several white matter tracts. After adjusting for sex, birth weight and gestational age, the mean difference in PLIC FA between groups was 0.026 (95% CI 0.004 to 0.048, p=0.023). Conventional MRI was available for 46 infants and demonstrated significantly less moderate/severe abnormalities in the cooled (n=2, 9%) than in the non-cooled (n=10, 43%) infants. There was no difference in adverse events between groups. CONCLUSIONS This study confirmed that TH induced by PCM reduced brain injury detected on MRI in infants with moderate HIE in a neonatal intensive care unit in India. Future research should focus on optimal supportive treatment during hypothermia rather than looking at efficacy of TH in low-resource settings. TRIAL REGISTRATION NUMBER CTRI/2013/05/003693.
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Affiliation(s)
- Karoline Aker
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway .,Department of Paediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Department of Paediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Ingeborg Nakken
- Norwegian Advisory Unit for Functional MRI, Department of Radiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asta Kristine Håberg
- Norwegian Advisory Unit for Functional MRI, Department of Radiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sridhar Gibikote
- Department of Radiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Ouwehand S, Smidt LCA, Dudink J, Benders MJNL, de Vries LS, Groenendaal F, van der Aa NE. Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis. Neonatology 2020; 117:411-427. [PMID: 32235122 DOI: 10.1159/000505519] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prediction of neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy remains an important challenge. Various studies have shown that the predictive ability of different modalities changed after the introduction of therapeutic hypothermia. This paper reviews the diagnostic test accuracy of the different modalities that are being used to predict neurodevelopmental outcomes following therapeutic hypothermia. METHODS A systematic literature search was performed using Embase and PubMed. Two reviewers independently included eligible studies and extracted data. The quality of the studies was assessed using the Quality in Prognosis Studies Tool. Meta-analyses were performed where possible. RESULTS Forty-seven articles and 3 conference abstracts were included, reporting on 3,072infants of whom 39% died or had an adverse neurodevelopmental outcome. A meta-analysis could be performed using 37 articles on (amplitude-integrated) electroencephalography (EEG), conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopy (1H-MRS). Amplitude-integrated EEG (aEEG) at 24 and 72 h showed similar high diagnostic OR, while aEEG at 6 h and EEG performed less, both due to a low specificity. For MRI, most studies reported scoring systems in which early (<8 days) MRI performed better than late (≥8 days) MRI. Injury to the posterior limb of the internal capsule on MRI or to the thalami on DWI were strong individual predictors, as was an increased lactate/N-acetylaspartate peak on 1H-MRS. CONCLUSIONS In the era of therapeutic hypothermia, the different modalities remain good predictors of neurodevelopmental outcome. However, timing should be taken into account. aEEG may initially be false positive and gets more reliable after 24 h. In contrast, MRI should be used during the first week, as its predictive value decreases afterwards.
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Affiliation(s)
- Sabine Ouwehand
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisanne C A Smidt
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands, .,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Merhar SL, Gozdas E, Tkach JA, Parikh NA, Kline-Fath BM, He L, Yuan W, Altaye M, Leach JL, Holland SK. Neonatal Functional and Structural Connectivity Are Associated with Cerebral Palsy at Two Years of Age. Am J Perinatol 2020; 37:137-145. [PMID: 30919395 PMCID: PMC8103821 DOI: 10.1055/s-0039-1683874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The accuracy of structural magnetic resonance imaging (MRI) to predict later cerebral palsy (CP) in newborns with perinatal brain injury is variable. Diffusion tensor imaging (DTI) and task-based functional MRI (fMRI) show promise as predictive tools. We hypothesized that infants who later developed CP would have reduced structural and functional connectivity as compared with those without CP. STUDY DESIGN We performed DTI and fMRI using a passive motor task at 40 to 48 weeks' postmenstrual age in 12 infants with perinatal brain injury. CP was diagnosed at age 2 using a standardized examination. RESULTS Five infants had CP at 2 years of age, and seven did not have CP. Tract-based spatial statistics showed a widespread reduction of fractional anisotropy (FA) in almost all white matter tracts in the CP group. Using the median FA value in the corticospinal tracts as a cutoff, FA was 100% sensitive and 86% specific to predict CP compared with a sensitivity of 60 to 80% and a specificity of 71% for structural MRI. During fMRI, the CP group had reduced functional connectivity from the right supplemental motor area as compared with the non-CP group. CONCLUSION DTI and fMRI obtained soon after birth are potential biomarkers to predict CP in newborns with perinatal brain injury.
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Affiliation(s)
- Stephanie L. Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,University of Cincinnati Department of Pediatrics, Cincinnati OH
| | - Elveda Gozdas
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Jean A. Tkach
- Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Nehal A. Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,University of Cincinnati Department of Pediatrics, Cincinnati OH
| | - Beth M. Kline-Fath
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Lili He
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - James L. Leach
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
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Santos PT, O'Brien CE, Chen MW, Hopkins CD, Adams S, Kulikowicz E, Singh R, Koehler RC, Martin LJ, Lee JK. Proteasome Biology Is Compromised in White Matter After Asphyxic Cardiac Arrest in Neonatal Piglets. J Am Heart Assoc 2019; 7:e009415. [PMID: 30371275 PMCID: PMC6474957 DOI: 10.1161/jaha.118.009415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Neurological deficits in hypoxic‐ischemic encephalopathy, even with therapeutic hypothermia, are partially attributed to white matter injury. We theorized that proteasome insufficiency contributes to white matter injury. Methods and Results Neonatal piglets received hypoxia‐ischemia (HI) or sham procedure with normothermia, hypothermia, or hypothermia+rewarming. Some received a proteasome activator drug (oleuropein) or white matter–targeted, virus‐mediated proteasome knockdown. We measured myelin oligodendrocyte glycoprotein, proteasome subunit 20S (P20S), proteasome activity, and carbonylated and ubiquitinated protein levels in white matter and cerebral cortex. HI reduced myelin oligodendrocyte glycoprotein levels regardless of temperature, and myelin oligodendrocyte glycoprotein loss was associated with increased ubiquitinated and carbonylated protein levels. Ubiquitinated and carbonyl‐damaged proteins increased in white matter 29 hours after HI during hypothermia to exceed levels at 6 to 20 hours. In cortex, ubiquitinated proteins decreased. Ubiquitinated and carbonylated protein accumulation coincided with lower P20S levels in white matter; P20S levels also decreased in cerebral cortex. However, proteasome activity in white matter lagged behind that in cortex 29 hours after HI during hypothermia. Systemic oleuropein enhanced white matter P20S and protected the myelin, whereas proteasome knockdown exacerbated myelin oligodendrocyte glycoprotein loss and ubiquitinated protein accumulation after HI. At the cellular level, temperature and HI interactively affected macroglial P20S enrichment in subcortical white matter. Rewarming alone increased macroglial P20S immunoreactivity, but this increase was blocked by HI. Conclusions Oxidized and ubiquitinated proteins accumulate with HI‐induced white matter injury. Proteasome insufficiency may drive this injury. Hypothermia did not prevent myelin damage, protect the proteasome, or preserve oxidized and ubiquitinated protein clearance after HI.
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Affiliation(s)
- Polan T Santos
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - Caitlin E O'Brien
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - May W Chen
- 2 Division of Neonatology Department of Pediatrics Johns Hopkins University Baltimore MD
| | - C Danielle Hopkins
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - Shawn Adams
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - Ewa Kulikowicz
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - Rashmi Singh
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - Raymond C Koehler
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
| | - Lee J Martin
- 3 Department of Pathology Johns Hopkins University Baltimore MD
| | - Jennifer K Lee
- 1 Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore MD
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Salas J, Reddy N, Carson KA, Northington FJ, Huisman TA. Ultrasound Predicts White Matter Integrity after Hypothermia Therapy in Neonatal Hypoxic-Ischemic Injury. J Neuroimaging 2019; 29:743-749. [PMID: 31206969 PMCID: PMC6814495 DOI: 10.1111/jon.12644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypoxic-ischemic injury (HII) is a major cause of neonatal death and neurodevelopmental disability. Head ultrasounds (HUS) in neonates with HII often show enhanced gray/white matter differentiation. We assessed the significance of this finding in predicting white matter structural integrity measured by diffusion tensor imaging (DTI) in neonates with HII. METHODS We performed a quantitative region of interest-based analysis of white and gray matter echogenicity within the cingulate gyrus on pre- and posthypothermia HUS. We also completed a quantitative analysis of fractional anisotropy (FA) and mean (MD), axial (AD), and radial (RD) diffusivity within the bilateral anterior and posterior centrum semiovale (CSO) on posthypothermia brain magnetic resonance imaging. For HUS studies, we calculated a white-to-gray matter echogenicity ratio (WGR) and subsequently correlated it to DTI measurements. RESULTS Forty-two term neonates with HII who underwent hypothermia therapy were included. Significant correlation was found between prehypothermia WGR and MD, AD, and RD values in the left anterior CSO (r = .38-.40, P = .02). Prehypothermia WGR also correlated with the following: MD and RD in the right anterior CSO (r = .35-.36, P = .04), MD and AD in the right posterior CSO (r = .32-.45, P = .008-.03), and AD in the left posterior CSO (r = .47, P = .005). No significant correlation was found either between prehypothermia WGR and FA values in the bilateral anterior and posterior CSO or between posthypothermia WGR and all DTI scalars in the bilateral anterior and posterior CSO. CONCLUSIONS Prehypothermia HUS WGR may predict posthypothermia white matter structural integrity and is potentially an early and easily obtainable biomarker of severity in neonatal HII.
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Affiliation(s)
- Jacqueline Salas
- Division of Neonatology, Department of Pediatrics, New-York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA,Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine
| | - Nihaal Reddy
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn A. Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frances J. Northington
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine
| | - Thierry A.G.M. Huisman
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gerner GJ, Newman EI, Burton VJ, Roman B, Cristofalo EA, Leppert M, Johnston MV, Northington FJ, Huisman TA, Poretti A. Correlation Between White Matter Injury Identified by Neonatal Diffusion Tensor Imaging and Neurodevelopmental Outcomes Following Term Neonatal Asphyxia and Therapeutic Hypothermia: An Exploratory Pilot Study. J Child Neurol 2019; 34:556-566. [PMID: 31070085 PMCID: PMC7318916 DOI: 10.1177/0883073819841717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes. METHOD Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars. RESULTS Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months. CONCLUSION Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.
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Affiliation(s)
- Gwendolyn J. Gerner
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Eric I. Newman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science
| | - V. Joanna Burton
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Brenton Roman
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD USA
| | - Elizabeth A. Cristofalo
- Frederick Memorial Hospital, Department of Neonatology, Frederick, MD, USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Mary Leppert
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Michael V. Johnston
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD USA
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Frances J. Northington
- Department of Perinatal-Neonatal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Thierry A.G.M. Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Andrea Poretti
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD USA
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science
- Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
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Azzopardi D, Chew AT, Deierl A, Huertas A, Robertson NJ, Tusor N, Edwards AD. Prospective qualification of early cerebral biomarkers in a randomised trial of treatment with xenon combined with moderate hypothermia after birth asphyxia. EBioMedicine 2019; 47:484-491. [PMID: 31451436 PMCID: PMC6796501 DOI: 10.1016/j.ebiom.2019.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The TOBY-Xe proof of concept randomised trial found no effect of xenon combined with hypothermia after birth asphyxia on the lactate to N-acetyl aspartate ratio (Lac/NAA) in the thalamus and fractional anisotropy (FA) in white matter tracts measured within 15 days of birth. To confirm that these biomarkers are qualified to predict long-term outcome after neural rescue therapy we assessed surviving participants at 2-3 years of age. METHODS Of the 92 infants in TOBY-Xe, one was omitted from the study, 69 survived and we assessed 62 participants, 32 in the hypothermia and xenon and 30 in the hypothermia only groups. We examined the relation between Lac/NAA and FA and the scores of the Bayley Scales of Infant and Toddler Development III and calculated their predictive accuracy for moderate or severe disability or death. RESULTS Fifteen of 62 participants (24%) developed moderate/severe disability, and 22/92 (24%) died. The Lac/NAA ratio (difference in medians 0.628, 95% CI -0.392 to 4.684) and FA (difference in means -0.055, 95% CI -0.033 to -0.077) differed significantly between participants with or without moderate or severe disability or death and were significantly related with development scores in both groups. Adverse outcomes were correctly identified in 95.65% of cases by Lac/NAA and 78.79% by FA, with adequate mean calibration of the model. INTERPRETATION The results confirm the qualification of the cerebral magnetic resonance biomarkers employed in the TOBY-Xe study as predictors of outcome after neuroprotective therapy. FUND: The Centre for the Developing Brain, King's College London, UK.
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Affiliation(s)
- Denis Azzopardi
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King's College London, UK.
| | - Andrew T Chew
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King's College London, UK
| | - Aniko Deierl
- Neonatal Department, Imperial College Healthcare NHS Trust, London, UK
| | - Angela Huertas
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Nora Tusor
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King's College London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King's College London, UK
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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36
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Salas J, Reddy N, Orru E, Carson KA, Chavez-Valdez R, Burton VJ, Stafstrom CE, Northington FJ, Huisman TAGM. The Role of Diffusion Tensor Imaging in Detecting Hippocampal Injury Following Neonatal Hypoxic-Ischemic Encephalopathy. J Neuroimaging 2018; 29:252-259. [PMID: 30325083 DOI: 10.1111/jon.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/12/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Neonatal hypoxic-ischemic injury of the brain and resultant encephalopathy (HIE) leads to major developmental impairments by school age. Conventional/anatomical MRI often fails to detect hippocampal injury in mild cases. We hypothesize that diffusion tensor imaging (DTI) has greater sensitivity for identifying subtle hippocampal injury. METHODS We retrospectively analyzed DTI data collected from a cohort of neonates with HIE and controls. Conventional MRI sequences were classified qualitatively according to severity using a modified Barkovich scale. Using multivariate linear regression, we compared hippocampal DTI scalars of HIE patients and controls. Spearman correlation was used to test the association of DTI scalars in the hippocampal and thalamic regions. A multiple regression analysis tested the association of the DTI scalars with short-term outcomes. RESULTS Fifty-five neonates with HIE (42% males) and 13 controls (54% males) were included. Hippocampal DTI scalars were similar between HIE and control groups, even when restricting the HIE group to those with moderate-to-severe injury (8 subjects). DTI scalars of the thalamus were significantly lower in the moderate-to-severely affected patients compared to controls (right fractional anisotropy [FA] .148 vs. .182, P = .01; left FA .147 vs. .181, P = .03). Hippocampal and thalamic DTI scalars were correlated (P < .001). Hippocampal DTI scalars were not associated with short-term outcomes. CONCLUSIONS Quantitative DTI analysis of the hippocampus in neonates following HIE is a feasible technique to examine neuronal injury. Although DTI scalars were useful in identifying thalamic injury in our cohort, hippocampal DTI analysis did not provide additional information regarding hippocampal injury following HIE.
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Affiliation(s)
- Jacqueline Salas
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, The Charlotte R. Bloomberg Children's Center, Baltimore, MD.,Neuro-Intensive Care Nursery Group, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Nihaal Reddy
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emanuele Orru
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn A Carson
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Raul Chavez-Valdez
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, The Charlotte R. Bloomberg Children's Center, Baltimore, MD.,Neuro-Intensive Care Nursery Group, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Vera Joanna Burton
- Neuro-Intensive Care Nursery Group, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Carl E Stafstrom
- Neuro-Intensive Care Nursery Group, The Johns Hopkins School of Medicine, Baltimore, MD.,Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Frances J Northington
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, The Charlotte R. Bloomberg Children's Center, Baltimore, MD.,Neuro-Intensive Care Nursery Group, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.,Neuro-Intensive Care Nursery Group, The Johns Hopkins School of Medicine, Baltimore, MD
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Abstract
Predicting neurodevelopmental outcomes in high-risk neonates remains challenging despite advances in neonatal care. Early and accurate characterization of infants at risk for neurodevelopmental delays is necessary to best identify those who may benefit from existing early interventions and novel therapies that become available. Although neuroimaging is a promising biomarker in the prediction of neurodevelopmental outcomes in high-risk infants, it requires additional resources and expertise. Despite many advances in neonatal neuroimaging, there remain limitations in relating early neuroimaging findings with long-term outcomes; further studies are necessary to determine the optimal protocols to best identify high-risk patients and improve neurodevelopmental outcome prediction.
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Kline-Fath BM, Horn PS, Yuan W, Merhar S, Venkatesan C, Thomas CW, Schapiro MB. Conventional MRI scan and DTI imaging show more severe brain injury in neonates with hypoxic-ischemic encephalopathy and seizures. Early Hum Dev 2018; 122:8-14. [PMID: 29803998 DOI: 10.1016/j.earlhumdev.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neonates with hypoxic-ischemic encephalopathy (HIE) and seizures have poorer outcome for undetermined reasons. AIMS Our aim was to determine if brain imaging was more abnormal in neonates with HIE and electrographically confirmed seizures and whether this was impacted by seizure burden. STUDY DESIGN Single center retrospective review. SUBJECTS Forty-eight term neonates with HIE (with and without seizures) underwent MRI brain scans before age 14 days between the years 2008 and 2013. OUTCOME MEASURES Images were rated using a MRI injury score and fractional anisotropy (FA) values were extracted from diffusion tensor imaging (DTI). RESULTS The seizure group (n = 25) had significantly more injury within white matter, basal ganglia, posterior limb of internal capsule, and watershed areas compared to the group without seizures (n = 23). The severity of injury in all measured areas increased with increasing seizure severity. The seizure group also had lower FA values in posterior limb of the internal capsule and the splenium of corpus callosum. CONCLUSIONS Neonates with HIE and seizures had more brain injury that occurred in areas typically affected by HIE and was greater with higher seizure burden. Seizures may be a marker of more severe brain injury or seizures themselves may amplify brain damage from HIE.
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Affiliation(s)
- Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Weihong Yuan
- Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, USA
| | - Stephanie Merhar
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Charu Venkatesan
- Division of Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Cameron W Thomas
- Division of Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Mark B Schapiro
- Division of Neurology, Cincinnati Children's Hospital Medical Center, USA.
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Carrasco M, Perin J, Jennings JM, Parkinson C, Gilmore MM, Chavez-Valdez R, Massaro AN, Koehler RC, Northington FJ, Tekes A, Lee JK. Cerebral Autoregulation and Conventional and Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy. Pediatr Neurol 2018; 82:36-43. [PMID: 29622488 PMCID: PMC5960435 DOI: 10.1016/j.pediatrneurol.2018.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deviation of mean arterial blood pressure (MAP) from the range that optimizes cerebral autoregulatory vasoreactivity (optimal MAP) could increase neurological injury from hypoxic-ischemic encephalopathy (HIE). We tested whether a global magnetic resonance imaging (MRI) brain injury score and regional diffusion tensor imaging (DTI) are associated with optimal MAP in neonates with HIE. METHODS Twenty-five neonates cooled for HIE were monitored with the hemoglobin volume index. In this observational study, we identified optimal MAP and measured brain injury by qualitative and quantitative MRIs with the Neonatal Research Network (NRN) score and DTI mean diffusivity scalars. Optimal MAP and blood pressure were compared with brain injury. RESULTS Neonates with blood pressure measurements within optimal MAP during rewarming had less brain injury by NRN score (P = 0.040). Longer duration of MAP within optimal MAP during hypothermia correlated with higher mean diffusivity in the anterior centrum semiovale (P = 0.008) and pons (P = 0.002). Blood pressure deviation below optimal MAP was associated with lower mean diffusivity in cerebellar white matter (P = 0.033). Higher optimal MAP values related to lower mean diffusivity in the basal ganglia (P = 0.021), the thalamus (P = 0.006), the posterior limb of the internal capsule (P = 0.018), the posterior centrum semiovale (P = 0.035), and the cerebellar white matter (P = 0.008). Optimal MAP values were not associated with the NRN score. CONCLUSIONS The NRN score and the regional mean diffusivity scalars detected injury with mean arterial blood pressure deviations from the optimal MAP. Higher optimal MAP and lower mean diffusivity may be related because of cytotoxic edema and limited vasodilatory reserve at low MAP in injured brain. DTI detected injury with elevated optimal MAP better than the NRN score.
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Affiliation(s)
- Melisa Carrasco
- Department of Neurology, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jamie Perin
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jacky M. Jennings
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charlamaine Parkinson
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maureen M. Gilmore
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Raul Chavez-Valdez
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - An N. Massaro
- Department of Pediatrics, Children’s National Medical Center, George Washington University School of Medicine, Washington, District of Columbia
| | - Raymond C. Koehler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frances J. Northington
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aylin Tekes
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Department of Radiology, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer K. Lee
- Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
The purpose of this study was to compare diffusion tensor metrics in normal age-matched neonates with survivors of hypoxic–ischemic encephalopathy (HIE) and extracorporeal membrane oxygenation (ECMO). Thirty-five normal, 27 HIE, and 13 ECMO infants underwent MRI at 3 T. Neurodevelopmental assessments were performed. Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) of the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, anterior commissure, genu corpus callosum and splenium of the corpus callosum, anterior and posterior limb of the internal capsule, superior longitudinal fasciculus, and the centrum semiovale were analyzed with tract-based spatial statistics modified for use in neonates. Linear regression analysis was performed, and 95% confidence intervals were created for age effects on the tensor metrics with the control patients. Two-sample t-test was done to determine whether there was a difference in the tensor metrics between the normal and patient cohort. There was a statistically significant age effect on the FA and RD in the selected regions of the brain (F<0.05) and a group difference in the FA and RD between the normal and the HIE group (P<0.05). The group difference in the FA and RD between the normal and ECMO groups was seen in the anterior commissure, genu corpus callosum, right inferior longitudinal fasciculus, fronto-occipital fasciculus, centrum semiovale, and superior longitudinal fasciculus (P<0.05). Patients who were outside the 95% confidence intervals of the FA, AD, and RD overlapped with those with abnormalities clinically and on the conventional MRI. In conclusion, diffusion tensor imaging can play a significant role in detecting infants with early indications of hypoxic–ischemic brain injury.
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Makropoulos A, Counsell SJ, Rueckert D. A review on automatic fetal and neonatal brain MRI segmentation. Neuroimage 2018; 170:231-248. [DOI: 10.1016/j.neuroimage.2017.06.074] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/06/2017] [Accepted: 06/26/2017] [Indexed: 01/18/2023] Open
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O'Connor CM, Ryan CA, Boylan GB, Murray DM. The ability of early serial developmental assessment to predict outcome at 5years following neonatal hypoxic-ischaemic encephalopathy. Early Hum Dev 2017; 110:1-8. [PMID: 28433953 DOI: 10.1016/j.earlhumdev.2017.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neurodevelopmental difficulties in children following hypoxic-ischaemic encephalopathy (HIE) may not emerge until school age. AIMS To evaluate the value and stability of early serial developmental assessments in predicting long-term outcome. STUDY DESIGN Prospective study of infants with neonatal HIE and early continuous EEG at birth. SUBJECTS Term infants with HIE were recruited at birth. Development was measured at 6, 12 and 24months using the Revised Griffiths' Scales (GMDS-R). OUTCOME MEASURES Intellectual abilities at age five were measured using the Wechsler Preschool & Primary Scale of Intelligence (WPPSI-IIIUK) and the 'numbers' subtest from the Children's Memory Scale. Overall five-year outcome was also reported. RESULTS IQ outcome was available in forty-seven surviving children (28 male, 19 female: mean (SD) age 64.0(5.7) months. Mean processing speed (p=0.01) and short-term verbal memory (p=0.005) were below the norm. Global development (GDQ) at 6, 12 and 24months correlated (p<0.01) with five-year global, verbal and performance IQ with improved correlation over time. Normal GDQ throughout early childhood predicted normal IQ at 5years (24month AUROC value=0.941, p=0.001). An abnormal early GDQ score at any stage in the first 24months had excellent negative predictive values, superior to those for neonatal Sarnat and EEG grading. CONCLUSIONS Normal early development predicts normal 5year IQ with prediction increasing over time. Repeated measurement is warranted due to instability of findings across the first two years. Follow-up for children with abnormal early development is warranted given high sensitivity for school-age global abnormal outcome.
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Affiliation(s)
- Catherine M O'Connor
- Department of Paediatrics and Child Health, University College Cork, Clinical Investigations Unit, Cork University Hospital, Wilton, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre), Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, Cork, Ireland; Neonatal Brain Research Group, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - C Anthony Ryan
- Department of Paediatrics and Child Health, University College Cork, Clinical Investigations Unit, Cork University Hospital, Wilton, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre), Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, University College Cork, Clinical Investigations Unit, Cork University Hospital, Wilton, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre), Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, Cork, Ireland; Neonatal Brain Research Group, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Deirdre M Murray
- Department of Paediatrics and Child Health, University College Cork, Clinical Investigations Unit, Cork University Hospital, Wilton, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre), Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, Cork, Ireland; Neonatal Brain Research Group, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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McAdams RM, Fleiss B, Traudt C, Schwendimann L, Snyder JM, Haynes RL, Natarajan N, Gressens P, Juul SE. Long-Term Neuropathological Changes Associated with Cerebral Palsy in a Nonhuman Primate Model of Hypoxic-Ischemic Encephalopathy. Dev Neurosci 2017; 39:124-140. [PMID: 28486224 DOI: 10.1159/000470903] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/13/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common motor disability in childhood, with a worldwide prevalence of 1.5-4/1,000 live births. Hypoxic-ischemic encephalopathy (HIE) contributes to the burden of CP, but the long-term neuropathological findings of this association remain limited. METHODOLOGY Thirty-four term Macaca nemestrina macaques were included in this long-term neuropathological study: 9 control animals delivered by cesarean section and 25 animals with perinatal asphyxia delivered by cesarean section after 15-18 min of umbilical cord occlusion (UCO). UCO animals were randomized to saline (n = 11), therapeutic hypothermia (TH; n = 6), or TH + erythropoietin (Epo; n = 8). Epo was given on days 1, 2, 3, and 7. Animals had serial developmental assessments and underwent magnetic resonance imaging with diffusion tensor imaging at 9 months of age followed by necropsy. Histology and immunohistochemical (IHC) staining of brain and brainstem sections were performed. RESULTS All UCO animals demonstrated and met the standard diagnostic criteria for human neonates with moderate-to-severe HIE. Four animals developed moderate-to-severe CP (3 UCO and 1 UCO + TH), 9 had mild CP (2 UCO, 3 UCO + TH, 3 UCO + TH + Epo, and 1 control), and 2 UCO animals died. None of the animals treated with TH + Epo died, had moderate-to-severe CP, or demonstrated signs of long-term neuropathological toxicity. Compared to animals grouped together as having no CP (no-CP; controls and mild CP only), animals with CP (moderate and severe) demonstrated decreased fractional anisotropy of multiple white-matter tracts including the corpus callosum and internal capsule, when using Tract-Based Spatial Statistics (TBSS). Animals with CP had decreased staining for cortical neurons and increased brainstem glial scarring compared to animals without CP. The cerebellar cell density of the internal granular layer and white matter was decreased in CP animals compared to that in control animals without CP. CONCLUSIONS/SIGNIFICANCE In this nonhuman primate HIE model, animals treated with TH + Epo had less brain pathology noted on TBSS and IHC staining, which supports the long-term safety of TH + Epo in the setting of HIE. Animals that developed CP showed white-matter changes noted on TBSS, subtle histopathological changes in both the white and gray matter, and brainstem injury that correlated with CP severity. This HIE model may lend itself to further study of the relationship between brainstem injury and CP.
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Affiliation(s)
- Ryan M McAdams
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
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Abstract
Hypoxic-ischemic encephalopathy is associated with a high risk of morbidity and mortality in the neonatal period. Long-term neurodevelopmental disability is also frequent in survivors. Conventional MRI defines typical patterns of injury that reflect specific pathophysiologic mechanisms. Advanced magnetic resonance techniques now provide unique perspectives on neonatal brain metabolism, microstructure, and connectivity. The application of these imaging techniques has revealed that brain injury commonly occurs at or near the time of birth and evolves over the first weeks of life. Amplitude-integrated electroencephalogram and near-infrared spectroscopy are increasingly used as bedside tools in neonatal intensive care units to monitor brain function.
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Affiliation(s)
- Stephanie L Merhar
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, ML 7009, Cincinnati, OH 45229, USA.
| | - Vann Chau
- Division of Neurology (Pediatrics), The Hospital for Sick Children, University of Toronto and Neuroscience & Mental Health Research Institute, 555 University Avenue, Room 6536B, Hill Wing, Toronto, Ontario M5G 1X8, Canada
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45
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McAdams RM, Juul SE. Neonatal Encephalopathy: Update on Therapeutic Hypothermia and Other Novel Therapeutics. Clin Perinatol 2016; 43:485-500. [PMID: 27524449 PMCID: PMC4987711 DOI: 10.1016/j.clp.2016.04.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neonatal encephalopathy (NE) is a major cause of neonatal mortality and morbidity. Therapeutic hypothermia (TH) is standard treatment for newborns at 36 weeks of gestation or greater with intrapartum hypoxia-related NE. Term and late preterm infants with moderate to severe encephalopathy show improved survival and neurodevelopmental outcomes at 18 months of age after TH. TH can increase survival without increasing major disability, rates of an IQ less than 70, or cerebral palsy. Neonates with severe NE remain at risk of death or severe neurodevelopmental impairment. This review discusses the evidence supporting TH for term or near term neonates with NE.
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Zhang F, Liu C, Qian L, Hou H, Guo Z. Diffusion Tensor Imaging of White Matter Injury Caused by Prematurity-Induced Hypoxic-Ischemic Brain Damage. Med Sci Monit 2016; 22:2167-74. [PMID: 27338673 PMCID: PMC4933547 DOI: 10.12659/msm.896471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background This investigation aimed to evaluate changes in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of white matter injury (WMI) in preterm neonates with hypoxic-ischemic encephalopathy (HIE) using diffusion tension imaging (DTI). Material/Methods Thirty-eight neonates less than 37 weeks of gestation with leukoencephalopathy (as observation group) and 38 full-term infants with no leukoencephalopathy (as control group) were selected from the Neonatal Care Center in Taian Central Hospital from January 2012 to December 2013. A DTI scan was obtained within 1 week after birth. Results In the observation group, on both sides the ADC values in regions of interest (ROI) of white matter, lesions were greater and FA values were lower than in the control group. ADC and FA values in genu and splenum of corpus callosum were statistically different between the mild and severe injury groups (p<0.05). Conclusions This study demonstrates that DTI provides sensitive detection and early diagnosis of WMI in brains of premature infants with HIE.
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Affiliation(s)
- Fuyong Zhang
- , Taian City Central Hospital, Taian, Shandong, China (mainland)
| | - Chunli Liu
- , Taian City Central Hospital, Taian, Shandong, China (mainland)
| | - Linlin Qian
- , Taian City Central Hospital, Taian, Shandong, China (mainland)
| | - Haifeng Hou
- , Taishan Medical University, Taian, Shandong, China (mainland)
| | - Zhengyi Guo
- , Taian City Central Hospital, Taian, Shandong, China (mainland)
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Azzopardi D, Robertson NJ, Bainbridge A, Cady E, Charles-Edwards G, Deierl A, Fagiolo G, Franks NP, Griffiths J, Hajnal J, Juszczak E, Kapetanakis B, Linsell L, Maze M, Omar O, Strohm B, Tusor N, Edwards AD. Moderate hypothermia within 6 h of birth plus inhaled xenon versus moderate hypothermia alone after birth asphyxia (TOBY-Xe): a proof-of-concept, open-label, randomised controlled trial. Lancet Neurol 2015; 15:145-153. [PMID: 26708675 PMCID: PMC4710577 DOI: 10.1016/s1474-4422(15)00347-6] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/03/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
Abstract
Background Moderate cooling after birth asphyxia is associated with substantial reductions in death and disability, but additional therapies might provide further benefit. We assessed whether the addition of xenon gas, a promising novel therapy, after the initiation of hypothermia for birth asphyxia would result in further improvement. Methods Total Body hypothermia plus Xenon (TOBY-Xe) was a proof-of-concept, randomised, open-label, parallel-group trial done at four intensive-care neonatal units in the UK. Eligible infants were 36–43 weeks of gestational age, had signs of moderate to severe encephalopathy and moderately or severely abnormal background activity for at least 30 min or seizures as shown by amplitude-integrated EEG (aEEG), and had one of the following: Apgar score of 5 or less 10 min after birth, continued need for resuscitation 10 min after birth, or acidosis within 1 h of birth. Participants were allocated in a 1:1 ratio by use of a secure web-based computer-generated randomisation sequence within 12 h of birth to cooling to a rectal temperature of 33·5°C for 72 h (standard treatment) or to cooling in combination with 30% inhaled xenon for 24 h started immediately after randomisation. The primary outcomes were reduction in lactate to N-acetyl aspartate ratio in the thalamus and in preserved fractional anisotropy in the posterior limb of the internal capsule, measured with magnetic resonance spectroscopy and MRI, respectively, within 15 days of birth. The investigator assessing these outcomes was masked to allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00934700, and with ISRCTN, as ISRCTN08886155. Findings The study was done from Jan 31, 2012, to Sept 30, 2014. We enrolled 92 infants, 46 of whom were randomly assigned to cooling only and 46 to xenon plus cooling. 37 infants in the cooling only group and 41 in the cooling plus xenon group underwent magnetic resonance assessments and were included in the analysis of the primary outcomes. We noted no significant differences in lactate to N-acetyl aspartate ratio in the thalamus (geometric mean ratio 1·09, 95% CI 0·90 to 1·32) or fractional anisotropy (mean difference −0·01, 95% CI −0·03 to 0·02) in the posterior limb of the internal capsule between the two groups. Nine infants died in the cooling group and 11 in the xenon group. Two adverse events were reported in the xenon group: subcutaneous fat necrosis and transient desaturation during the MRI. No serious adverse events were recorded. Interpretation Administration of xenon within the delayed timeframe used in this trial is feasible and apparently safe, but is unlikely to enhance the neuroprotective effect of cooling after birth asphyxia. Funding UK Medical Research Council.
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Affiliation(s)
- Denis Azzopardi
- Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK.
| | | | | | - Ernest Cady
- Faculty of Engineering Science, University College London, London, UK
| | | | - Aniko Deierl
- Division of Neonatology, Imperial College Healthcare NHS Trust, London, UK
| | - Gianlorenzo Fagiolo
- Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK
| | - Nicholas P Franks
- Faculty of Natural Sciences, Department of Life Sciences, Imperial College London, London, UK
| | - James Griffiths
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Joseph Hajnal
- Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Basil Kapetanakis
- Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mervyn Maze
- Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Omar Omar
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brenda Strohm
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nora Tusor
- Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences and Bioengineering, King's College London, London, UK
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Lally PJ, Pauliah S, Montaldo P, Chaban B, Oliveira V, Bainbridge A, Soe A, Pattnayak S, Clarke P, Satodia P, Harigopal S, Abernethy LJ, Turner MA, Huertas-Ceballos A, Shankaran S, Thayyil S. Magnetic Resonance Biomarkers in Neonatal Encephalopathy (MARBLE): a prospective multicountry study. BMJ Open 2015; 5:e008912. [PMID: 26423856 PMCID: PMC4593140 DOI: 10.1136/bmjopen-2015-008912] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite cooling, adverse outcomes are seen in up to half of the surviving infants after neonatal encephalopathy. A number of novel adjunct drug therapies with cooling have been shown to be highly neuroprotective in animal studies, and are currently awaiting clinical translation. Rigorous evaluation of these therapies in phase II trials using surrogate MR biomarkers may speed up their bench to bedside translation. A recent systematic review of single-centre studies has suggested that MR spectroscopy biomarkers offer the best promise; however, the prognostic accuracy of these biomarkers in cooled encephalopathic babies in a multicentre setting using different MR scan makers is not known. METHODS AND ANALYSIS The MR scanners (3 T; Philips, Siemens, GE) in all the participating sites will be harmonised using phantom experiments and healthy adult volunteers before the start of the study. We will then recruit 180 encephalopathic infants treated with whole body cooling from the participating centres. MRI and spectroscopy will be performed within 2 weeks of birth. Neurodevelopmental outcomes will be assessed at 18-24 months of age. Agreement between MR cerebral biomarkers and neurodevelopmental outcome will be reported. The sample size is calculated using the 'rule of 10', generally used to calculate the sample size requirements for developing prognostic models. Considering 9 parameters, we require 9×10 adverse events, which suggest that a total sample size of 180 is required. ETHICS AND DISSEMINATION Human Research Ethics Committee approvals have been received from Brent Research Ethics Committee (London), and from Imperial College London (Sponsor). We will submit the results of the study to relevant journals and offer national and international presentations. TRIAL REGISTRATION NUMBER Clinical Trials.gov Number: NCT01309711.
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Affiliation(s)
- Peter J Lally
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Shreela Pauliah
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Badr Chaban
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Vania Oliveira
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Alan Bainbridge
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
- University College Hospital, London, UK
| | - Aung Soe
- Medway NHS Foundation Trust, Kent, UK
| | | | - Paul Clarke
- Department of Neonatology, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
| | - Prakash Satodia
- Department of Neonatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Mark A Turner
- Liverpool Womens Hospital and Alderhey Hospital, Liverpool, UK
| | | | - Seetha Shankaran
- Department of Neonatology, Children's Hospital of Michigan, Michigan, UK
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
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Rennie JM, Kendall GS. Advanced magnetic resonance techniques provide more accurate prognostic information than conventional imaging. Dev Med Child Neurol 2015; 57:403-4. [PMID: 25640201 DOI: 10.1111/dmcn.12680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MASSARO ANN, EVANGELOU IORDANIS, FATEMI ALI, VEZINA GILBERT, MCCARTER ROBERT, GLASS PENNY, LIMPEROPOULOS CATHERINE. White matter tract integrity and developmental outcome in newborn infants with hypoxic-ischemic encephalopathy treated with hypothermia. Dev Med Child Neurol 2015; 57:441-8. [PMID: 25492527 PMCID: PMC4543365 DOI: 10.1111/dmcn.12646] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 12/01/2022]
Abstract
AIM To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging (DTI) measures relate to developmental outcome in encephalopathic newborn infants after therapeutic hypothermia. METHOD Encephalopathic newborn infants enrolled in a longitudinal study underwent DTI after hypothermia. Parametric maps were generated for fractional anisotropy, mean, radial, and axial diffusivity. CC and CST were segmented by DTI-based tractography. Multiple regression models were used to examine the association of DTI measures with Bayley-II Mental (MDI) and Psychomotor Developmental Index (PDI) at 15 months and 21 months of age. RESULTS Fifty-two infants (males n=32, females n=20) underwent DTI at median age of 8 days. Two were excluded because of poor magnetic resonance imaging quality. Outcomes were assessed in 42/50 (84%) children at 15 months and 35/50 (70%) at 21 months. Lower CC and CST fractional anisotropy were associated with lower MDI and PDI respectively, even after controlling for gestational age, birth weight, sex, and socio-economic status. There was also a direct relationship between CC axial diffusivity and MDI, while CST radial diffusivity was inversely related to PDI. INTERPRETATION In encephalopathic newborn infants, impaired microstructural organization of the CC and CST predicts poorer cognitive and motor performance respectively. Tractography provides a reliable method for early assessment of perinatal brain injury.
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Affiliation(s)
- ANN MASSARO
- Department of Neonatology, Children’s National Medical Center, Washington, DC,Department of Pediatrics, The George Washington University School of Medicine, Washington, DC
| | - IORDANIS EVANGELOU
- Department of Diagnostic Imaging and Radiology, Children’s National Medical Center, Washington, DC,Department of Radiology, The George Washington University School of Medicine, Washington, DC
| | - ALI FATEMI
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - GILBERT VEZINA
- Department of Diagnostic Imaging and Radiology, Children’s National Medical Center, Washington, DC,Department of Pediatrics, The George Washington University School of Medicine, Washington, DC,Department of Radiology, The George Washington University School of Medicine, Washington, DC
| | - ROBERT MCCARTER
- Department of Biostatistics & Informatics, Children’s National Medical Center, Washington, DC,Department of Pediatrics, The George Washington University School of Medicine, Washington, DC,Department of Epidemiology & Biostatistics, The George Washington University School of Medicine, Washington, DC, USA
| | - PENNY GLASS
- Department of Psychiatry & Behavioral Sciences, Children’s National Medical Center, Washington, DC,Department of Pediatrics, The George Washington University School of Medicine, Washington, DC
| | - CATHERINE LIMPEROPOULOS
- Department of Diagnostic Imaging and Radiology, Children’s National Medical Center, Washington, DC,Department of Pediatrics, The George Washington University School of Medicine, Washington, DC
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