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Geva S, Hoskote A, Saini M, Clark CA, Banks T, Chong WKK, Baldeweg T, de Haan M, Vargha-Khadem F. Cognitive outcome and its neural correlates after cardiorespiratory arrest in childhood. Dev Sci 2024:e13501. [PMID: 38558493 DOI: 10.1111/desc.13501] [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: 07/20/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Hypoxia-ischaemia (HI) can result in structural brain abnormalities, which in turn can lead to behavioural deficits in various cognitive and motor domains, in both adult and paediatric populations. Cardiorespiratory arrest (CA) is a major cause of hypoxia-ischaemia in adults, but it is relatively rare in infants and children. While the effects of adult CA on brain and cognition have been widely studied, to date, there are no studies examining the neurodevelopmental outcome of children who suffered CA early in life. Here, we studied the long-term outcome of 28 children who suffered early CA (i.e., before age 16). They were compared to a group of control participants (n = 28) matched for age, sex and socio-economic status. The patient group had impairments in the domains of memory, language and academic attainment (measured using standardised tests). Individual scores within the impaired range were most commonly found within the memory domain (79%), followed by academic attainment (50%), and language (36%). The patient group also had reduced whole brain grey matter volume, and reduced volume and fractional anisotropy of the white matter. In addition, lower performance on memory tests was correlated with bilaterally reduced volume of the hippocampi, thalami, and striatum, while lower attainment scores were correlated with bilateral reduction of fractional anisotropy in the superior cerebellar peduncle, the main output tract of the cerebellum. We conclude that patients who suffered early CA are at risk of developing specific cognitive deficits associated with structural brain abnormalities. RESEARCH HIGHLIGHTS: Our data shed light on the long-term outcome and associated neural mechanisms after paediatric hypoxia-ischaemia as a result of cardiorespiratory arrest. Patients had impaired scores on memory, language and academic attainment. Memory impairments were associated with smaller hippocampi, thalami, and striatum. Lower academic attainment correlated with reduced fractional anisotropy of the superior cerebellar peduncle.
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Affiliation(s)
- Sharon Geva
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Aparna Hoskote
- Heart and Lung Division, Institute of Cardiovascular Science, Great Ormond Street Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Maneet Saini
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher A Clark
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Tina Banks
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - W K Kling Chong
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Torsten Baldeweg
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Michelle de Haan
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Faraneh Vargha-Khadem
- Department of Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Neuropsychology Service, Great Ormond Street Hospital, London, United Kingdom of Great Britain and Northern Ireland
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Yimenicioglu S, Kaya TB, Yıldırım E, Arayıcı S, Bildirici Y, Ekici A. The factors affecting neurodevelopmental outcomes in HIE. Acta Neurol Belg 2023; 123:1903-1909. [PMID: 36352199 DOI: 10.1007/s13760-022-02126-5] [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: 05/27/2022] [Accepted: 10/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hypoxic ischemic encephalopathy (HIE) has different neurological outcomes. AIM We wanted to see if there was any developmental delay in neonates with hypoxia ischemic encephalopathy who were given therapeutic hypothermia. STUDY DESIGN Retrospective cohort study. METHODS The Denver developmental screening test II (DDST-II) was performed to newborns who had been applied to therapeutic hypothermia. RESULTS There were 69 male and 36 female newborns. The mean 1-min and 5-min Apgar scores were 4.72 ± 2.51 and 7.03 ± 2.017, respectively. The mean pH and mean base excess were 6.92 ± 0.1 and -18.05 ± 5.72, respectively. The most common risk factors were meconium staining (17.1%). There were 67 patients with Stage I, 20 with Stage II, and 18 with Stage III. Diffusion restriction was seen in 13 patients. 28 patients had seizures. In aEEG, 12 patients had burst suppression. Three (2.9%) infants died during hospitalization. 19 patients missed follow-up appointments. Thirteen patients had abnormal development according to DDST-II. Seven patients had gross motor function delays and were diagnosed with cerebral palsy. Three had language skill delays, but two of them had speech disorders after two years of age. Two had delayed milestones. Two had delays in fine motor skills but did not have any sequels after two years of age. A significant difference was found between seizures and the severity of Sarnat stage, intubation in the delivery room with developmental delay. Apgar scores were significantly lower in patients with CP. CONCLUSION We should closely follow-up neonates who had low Apgar scores, seizures, a high Sarnat stage, were intubated in the delivery room.
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Affiliation(s)
- Sevgi Yimenicioglu
- Department of Pediatric Neurology, Health Ministry Eskisehir City Hospital, Eskisehir, Turkey.
| | - Tugba Barsan Kaya
- Department of Neonatal Intensive Care Unit, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey
| | - Egemen Yıldırım
- Department of Neonatal Intensive Care Unit, Health Ministry Eskisehir City Hospital, Eskişehir, Turkey
| | - Sema Arayıcı
- Department of Neonatal Intensive Care Unit, Akdeniz University Hospital, Antalya, Turkey
| | - Yaşar Bildirici
- Department of Pediatrics, Health Ministry Eskisehir City Hospital, Eskisehir, Turkey
| | - Arzu Ekici
- Department of Pediatric Neurology, Health Ministry Bursa Yüksek İhtisas Eğitim Araştirma Hastahanesi, Bursa, Turkey
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Malan R, Van der Linde J, Kritzinger A, Graham MA, Krüger E. Evolution of Feeding and Developmental Outcomes in Infants With Moderate Hypoxic-Ischemic Encephalopathy: A Pilot Study. Neonatal Netw 2023; 42:264-275. [PMID: 37657810 DOI: 10.1891/nn-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 09/03/2023]
Abstract
The purpose of the study was to describe the evolution of outcomes among full-term infants with moderate hypoxic-ischemic encephalopathy (HIE); from their early swallowing and feeding abilities during hospitalization, to their later developmental outcomes at 6 and 12 months. Four participants with moderate HIE were recruited. Early feeding and swallowing were assessed using the Neonatal Feeding Assessment Scale and video fluoroscopic swallow studies. Developmental assessments were conducted at 6 and 12 months using the Rossetti Infant-Toddler Language Scale and Vineland-3 Scale. All participants displayed atypical outcomes throughout the study, including oropharyngeal dysphagia initially during hospitalization. All participants were discharged on oral feeds but some breastfeeding difficulties persisted. Variable but pervasive developmental delays were found among all participants at 6 and 12 months. This study emphasizes the need for consistent early intervention from the neonatal period onward, for all infants with moderate HIE. Future studies should use larger cohorts, longer follow-up, and correlational designs.
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Mota-Rojas D, Villanueva-García D, Solimano A, Muns R, Ibarra-Ríos D, Mota-Reyes A. Pathophysiology of Perinatal Asphyxia in Humans and Animal Models. Biomedicines 2022; 10:biomedicines10020347. [PMID: 35203556 PMCID: PMC8961792 DOI: 10.3390/biomedicines10020347] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Perinatal asphyxia is caused by lack of oxygen delivery (hypoxia) to end organs due to an hypoxemic or ischemic insult occurring in temporal proximity to labor (peripartum) or delivery (intrapartum). Hypoxic–ischemic encephalopathy is the clinical manifestation of hypoxic injury to the brain and is usually graded as mild, moderate, or severe. The search for useful biomarkers to precisely predict the severity of lesions in perinatal asphyxia and hypoxic–ischemic encephalopathy (HIE) is a field of increasing interest. As pathophysiology is not fully comprehended, the gold standard for treatment remains an active area of research. Hypothermia has proven to be an effective neuroprotective strategy and has been implemented in clinical routine. Current studies are exploring various add-on therapies, including erythropoietin, xenon, topiramate, melatonin, and stem cells. This review aims to perform an updated integration of the pathophysiological processes after perinatal asphyxia in humans and animal models to allow us to answer some questions and provide an interim update on progress in this field.
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Affiliation(s)
- Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, Universidad Autónoma Metropolitana (UAM), Mexico City 04960, Mexico
- Correspondence: (D.M.-R.); (D.V.-G.)
| | - Dina Villanueva-García
- Division of Neonatology, National Institute of Health Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
- Correspondence: (D.M.-R.); (D.V.-G.)
| | - Alfonso Solimano
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
| | - Ramon Muns
- Livestock Production Sciences Unit, Agri-Food and Biosciences Institute, Hillsborough BT26 6DR, UK;
| | - Daniel Ibarra-Ríos
- Division of Neonatology, National Institute of Health Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Andrea Mota-Reyes
- School of Medicine and Health Sciences, TecSalud, Instituto Tecnológico y de Estudios Superiores de Monterrey (ITESM), Monterrey 64849, Mexico;
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Sheikh A, Meng X, Liu J, Mikhailova A, Kao JPY, McQuillen PS, Kanold PO. Neonatal Hypoxia-Ischemia Causes Functional Circuit Changes in Subplate Neurons. Cereb Cortex 2020; 29:765-776. [PMID: 29365081 DOI: 10.1093/cercor/bhx358] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/21/2017] [Indexed: 01/16/2023] Open
Abstract
Neonatal hypoxia-ischemia (HI) in the preterm human results in damage to subcortical developing white matter and cognitive impairments. Subplate neurons (SPNs) are among the first-born cortical neurons and are necessary for normal cerebral development. While moderate or severe HI at P1 in rats leads to SPN loss, it is unclear if HI, esp. forms not associated with overt cell loss lead to altered SPN circuits. Thus, we used two HI models with different severities in P1 rats. Cauterization of the common carotid artery (CCA) causes a largely transient and thus milder ischemia (HI-Caut) while CCA ligation causes more severe ischemia (HI-Lig). While HI-Lig caused subplate damage, HI-Caut did not cause overt histological damage on the light microscopic level. We used laser-scanning photostimulation (LSPS) in acute thalamocortical slices of auditory cortex during P5-10 to study the functional connectivity of SPNs. Both HI categories resulted in hyperconnectivity of excitatory and inhibitory circuits to SPNs. Thus, alterations on the circuit level are present in the absence of cell loss. Our results show that SPN circuits are uniquely susceptible to HI. Given the key developmental role of SPNs, our results suggest that altered SPN circuits might underlie the abnormal development of cortical function after HI.
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Affiliation(s)
- Aminah Sheikh
- Department of Biology, University of Maryland, College Park, MD, USA.,Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA
| | - Xiangying Meng
- Department of Biology, University of Maryland, College Park, MD, USA
| | - Ji Liu
- Department of Biology, University of Maryland, College Park, MD, USA
| | - Alexandra Mikhailova
- Departments of Pediatrics and Neurology, University of California, San Francisco, CA, USA
| | - Joseph P Y Kao
- Center for Biomedical Engineering and Technology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick S McQuillen
- Departments of Pediatrics and Neurology, University of California, San Francisco, CA, USA
| | - Patrick O Kanold
- Department of Biology, University of Maryland, College Park, MD, USA.,Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA
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Doran SJ, Jandzinski M, Patrizz A, Trammel C, Sharmeen R, Mamun AA, Capozzi LA, Venna VR, Liu F, McCullough LD. Deficits in ultrasonic vocalization development and production following neonatal hypoxic ischemic insult. Behav Brain Res 2019; 369:111931. [PMID: 31047922 DOI: 10.1016/j.bbr.2019.111931] [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: 03/07/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
Neonatal hypoxic ischemia encephalopathy (HIE) leads to major deficits in language development. While clinically there is a known correlation in the degree of HIE injury and subsequent language disability, there are no treatments beyond speech and language therapy; therefore, experimental studies with a HIE animal model to test new interventions and therapeutics are warranted. Neonatal rodents normally ultrasonically vocalize at postnatal day 7 (PND 7) to PND 14 in response to removal from their mothers. At 6-8 weeks of age juvenile male rodents ultrasonically vocalize in response to exposure to a mature female mouse. Changes in ultrasonic vocalization (USV) production after neonatal brain injury, such ashypoxic ischemia (HI), have not been studied. This study examines the acute and long-term ultrasonic vocalization ability of mice after HI at PND 10. Pups were subjected to HI, sham, or naïve conditions; where in HI and sham surgeries the right common carotid artery was exposed, in the HI this artery was double ligated. The HI and sham pups were then exposed to60minof hypoxia. Naïve pups did not undergo surgery and were subjected to60minof room air. At 3 days following surgery, HI and sham pups vocalize less than nonsurgical naïve controls; yet "juvenile" mice of 6-8 weeks old that underwent HI at PND 10 vocalize less than sham and naïve mice. We conclude that HI injury has significant impact on later adult vocalization.
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Affiliation(s)
- Sarah J Doran
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Mike Jandzinski
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Anthony Patrizz
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States; Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, United States
| | - Cassandra Trammel
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Romana Sharmeen
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, United States
| | - Abdullah A Mamun
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, United States
| | - Lori A Capozzi
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Venugopal Reddy Venna
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States; Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, United States
| | - Fudong Liu
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States; Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, United States
| | - Louise D McCullough
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT 06030, United States; Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, United States.
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Adhikari S, Rao KS. Neurodevelopmental outcome of term infants with perinatal asphyxia with hypoxic ischemic encephalopathy stage II. Brain Dev 2017; 39:107-111. [PMID: 27697304 DOI: 10.1016/j.braindev.2016.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Perinatal asphyxia with hypoxic ischemic encephalopathy (HIE) causes significant mortality and morbidity in developing countries. There is limited information about long term neurodevelopmental outcome of infants with neonatal encephalopathy. METHODS Term infants with the diagnosis of perinatal asphyxia were followed up in neurodevelopmental clinics of Manipal Teaching hospital, Nepal. Study design was prospective mixed longitudinal study. Prematurity, major congenital malformations, other intracranial pathology, birth weight <2500g and chromosomal abnormalities were excluded. After consent and enrollment their detailed perinatal history, Apgar score, resuscitation measures and outcome parameters were recorded on a predesigned proforma. Developmental assessment was done with Denver Developmental Screening Tool 2nd edition (DDST 2) at the age of 3months, 6months, 9months, 1year, 18months and 2years. RESULTS Total 187 assessments done in the age group of 3months to 2years among HIE stage 2 patients. Impaired hearing and vision was noted in 5.3% while language delay was observed in 19.2% of infants. Abnormal tone and deep tendon reflexes were noted in 46.2% infants at 3months. Abnormal tone and reflexes were noted only in 18.8% and 9.4% respectively at the age of 2years. Overall, gross motor delay was noted in 55(29.4%) of patient, 34(18.2%) showed fine motor delay and 17.1% social delay. Seizures were persistent in 15.6% patients at 2years age. CONCLUSION Infants affected with HIE have delay in all sectors of developmental milestones. Motor abnormalities are common and tend to improve with advancing age.
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Affiliation(s)
- Sudhir Adhikari
- Department of Pediatrics, Manipal College of Medical Sciences, Pokhara, Nepal.
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