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Batool M, Cai CL, Aranda JV, Hand I, Beharry KD. Early versus late caffeine and/or non-steroidal anti-inflammatory drugs (NSAIDS) for prevention of intermittent hypoxia-induced neuroinflammation in the neonatal rat. Int J Dev Neurosci 2024; 84:227-250. [PMID: 38459740 DOI: 10.1002/jdn.10321] [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: 10/24/2023] [Revised: 01/17/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024] Open
Abstract
Preterm infants often experience frequent intermittent hypoxia (IH) episodes which are associated with neuroinflammation. We tested the hypotheses that early caffeine and/or non-steroidal inflammatory drugs (NSAIDs) confer superior therapeutic benefits for protection against IH-induced neuroinflammation than late treatment. Newborn rats were exposed to IH or hyperoxia (50% O2) from birth (P0) to P14. For early treatment, the pups were administered: 1) daily caffeine (Caff) citrate (Cafcit, 20 mg/kg IP loading on P0, followed by 5 mg/kg from P1-P14); 2) ketorolac (Keto) topical ocular solution in both eyes from P0 to P14; 3) ibuprofen (Ibu, Neoprofen, 10 mg/kg loading dose on P0 followed by 5 mg/kg/day on P1 and P2); 4) Caff+Keto co-treatment; 5) Caff+Ibu co-treatment; or 6) equivalent volume saline (Sal). On P14, animals were placed in room air (RA) with no further treatment until P21. For late treatment, pups were exposed from P0 to P14, then placed in RA during which they received similar treatments from P15-P21 (Sal, Caff, and/or Keto), or P15-P17 (Ibu). RA controls were similarly treated. At P21, whole brains were assessed for histopathology, apoptosis, myelination, and biomarkers of inflammation. IH caused significant brain injury and hemorrhage, inflammation, reduced myelination, and apoptosis. Early treatment with Caff alone or in combination with NSAIDs conferred better neuroprotection against IH-induced damage than late treatment. Early postnatal treatment during a critical time of brain development, may be preferable for the prevention of IH-induced brain injury in preterm infants.
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Affiliation(s)
- Myra Batool
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Charles L Cai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jacob V Aranda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Ophthalmology, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ivan Hand
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York City Health & Hospitals/Kings County, Brooklyn, NY, USA
| | - Kay D Beharry
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Ophthalmology, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
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Van den Brande A, Bollen B, Boets B, Naulaers G, Ortibus E. Executive Function Assessment in 2-Year-Olds Born Preterm. Neuropediatrics 2024; 55:16-22. [PMID: 36720262 DOI: 10.1055/a-2023-9280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our objective was to investigate the executive function and its relationship with gestational age, sex, maternal education, and neurodevelopmental outcome at 2 years corrected age in children born preterm. METHOD Executive function was assessed by means of the Multisearch Multilocation Task (MSML), Reversed Categorization Task (RevCat), and Snack Delay Task (SDT). Infant and maternal characteristics were gathered from the child's record. The developmental outcome was measured by the Bayley Scales and a multidisciplinary risk evaluation for autism. RESULTS The executive function battery was completed by 97 children. The majority were able to successfully complete the MSML and SDT but failed RevCat. The lower the gestational age and the maternal education, the lower the executive function scores. Better cognition and motor function, as well as low autism risk, were associated with better executive function scores. Executive function was not related to sex. INTERPRETATION This cohort study provides evidence that it is feasible to assess executive function in 2-year-olds born preterm. Executive function is related to gestational age and maternal education and is positively correlated with behavioral outcome. Therefore, executive functions can be a valuable target for early intervention, resulting in improvements in neurodevelopmental outcomes in children born preterm.
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Affiliation(s)
- Astrid Van den Brande
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Bieke Bollen
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Bart Boets
- Leuven Autism Research consortium, KU Leuven, Leuven, Belgium
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Xiao J, Sun C, Chen R, Zhao Z, Wang G, Wu D. Reproducibility of Diffusion MRI-Based Tractography in the Fetal Brain. J Magn Reson Imaging 2024. [PMID: 38284561 DOI: 10.1002/jmri.29253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Tractography based on diffusion MRI (dMRI) is a useful tool to study white matter of the developing brain. However, its application in fetal brains is limited due to motion artifacts and low resolution of in utero dMRI, leading to reduced reliability, which was scarcely investigated in previous studies. PURPOSE To identify reliably traceable fibers in fetal brains and assess whether reproducibility varies with gestational age (GA) and varies between brain regions. STUDY TYPE Prospective cohort study. SUBJECTS A total of 44 healthy fetuses with GAs between 25 and 37 (31 ± 6). FIELD STRENGTH/SEQUENCE 3-T, diffusion-weighted echo-planar imaging sequence (2-5 repeated dMRI scans within the same session per subject). ASSESSMENT We fitted dMRI with constrained spherical deconvolution model and conducted tractography on eight fibers. We extracted volume, fractional anisotropy, and fiber count for each fiber and assessed the reproducibility of these metrics between repeated scans within each subject. Data were divided into two age-based subgroups (≤30 weeks, N = 28, and >30 weeks, N = 16) for further tests. STATISTICAL TESTS The reproducibility were compared between fibers by analysis of variance and two-sample t tests. Multiple comparisons were corrected by the false discovery rate (5% was accepted). RESULTS The reproducibility of the anterior thalamic radiation, inferior longitudinal fasciculus (ILF), genu of the corpus callosum (GCC), and body of the corpus callosum (BCC) significantly decreased with advancing GA (correlation coefficient = 0.525-0.823), as confirmed by group comparisons between fetuses in early GA (≤30 weeks) and late GA (>30 weeks) groups. Corticospinal tract, inferior fronto-occipital fasciculus, and GCC showed high reproducibility for fiber count (weighted dice average = 0.846 vs. 0.814), while BCC and ILF exhibited the lowest reproducibility in both age groups. DATA CONCLUSION The study indicates that the reliability of fetal brain tractography depends on GA and varies among different fibers. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jiaxin Xiao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Cong Sun
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruike Chen
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Guangbin Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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Drobyshevsky A, Synowiec S, Goussakov I, Fabres R, Lu J, Caplan M. Intestinal microbiota modulates neuroinflammatory response and brain injury after neonatal hypoxia-ischemia. Gut Microbes 2024; 16:2333808. [PMID: 38533575 PMCID: PMC10978030 DOI: 10.1080/19490976.2024.2333808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
Premature infants lack a normal intestinal microbial community and also at risk of perinatal hypoxic-ischemic (HI) brain injury, which is considered to be one of the major factors for motor, sensory, and cognitive deficits. We hypothesized that neonatal gut microbiota composition modulated the immune reaction and severity of neonatal H-I brain injury. Neonatal C57BL/6J mouse pups were exposed to H-I protocol consisting of permanent left carotid artery ligation, followed by 8% hypoxia for 60 min. Microbial manipulation groups included 1) antibiotic treatment, E18 (maternal) to P5; 2) antibiotic treatment E18 to P5 + E. coli gavage; 3) antibiotic treatment E18 to P5 + B. infantis gavage; and 4) saline to pups with dams getting fresh water. The extent of brain injury and recovery was measured on MRI. Edematous injury volume was significantly higher in E. coli group than that in B. infantis group and in fresh water group. Gene expression in brains of pro-inflammatory cytokines (IL1β, IL6, IL2, TNF-α and toll-like receptors 2-6) were elevated to a greater extent in the E. coli group at P10, no injury, and at P13, 72 hours after H-I relative to sham control and B. infantis groups. Significant effects of microbiome and brain injury and interaction of these factors were found in abundance of major phyla. The neuroinflammatory response and brain injury after neonatal hypoxia-ischemia are affected by intestinal microbiota, providing opportunities for therapeutic intervention through targeting the early colonization and development of the gut microbiota.
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Affiliation(s)
| | - Sylvia Synowiec
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Ivan Goussakov
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Rafael Fabres
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jing Lu
- Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael Caplan
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
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Lear BA, Lear CA, Dhillon SK, Davidson JO, Gunn AJ, Bennet L. Evolution of grey matter injury over 21 days after hypoxia-ischaemia in preterm fetal sheep. Exp Neurol 2023; 363:114376. [PMID: 36889575 DOI: 10.1016/j.expneurol.2023.114376] [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: 11/29/2022] [Revised: 02/05/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
Reduced grey matter volume in preterm infants is associated with later disability, but its time course and relationship with white matter injury are not well understood. We recently showed that moderate-severe hypoxia-ischaemia (HI) in preterm fetal sheep led to severe cystic injury 2-3 weeks later. In the same cohort we now show profound hippocampal neuronal loss from 3 days after HI. By contrast, reduction in cortical area and perimeter developed much more slowly, with maximum reduction at day 21. There was transient upregulation of cleaved caspase-3-positive apoptosis in the cortex at day 3 but no change in neuronal density or macroscopic injury of the cortex. Both microglia and astrocytes were transiently upregulated in the grey matter. EEG power was initially profoundly suppressed but partially recovered by 21 days of recovery, and final power was correlated with white matter area (p < 0.001, r2 = 0.75, F = 24.19), cortical area (p = 0.004, r2 = 0.44, F = 11.90) and hippocampi area (p = 0.049, r2 = 0.23, F = 4.58). In conclusion, the present study suggests that in preterm fetal sheep, hippocampal injury is established within a few days of acute HI, but impaired cortical growth develops slowly, in a similar time course to severe white matter injury.
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Affiliation(s)
- Benjamin A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Christopher A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Simerdeep K Dhillon
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.
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Morris EE, Miller NC, Haapala JL, Georgieff MK, Ramel SE. Preterm infant body composition, working memory, and temperament. Infant Behav Dev 2023; 70:101808. [PMID: 36610269 DOI: 10.1016/j.infbeh.2022.101808] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/06/2023]
Abstract
Altered body composition in preterm infants is associated with risks to cognitive development, but the effect specific to prefrontal cortex (PFC) development is unknown. We were interested in the impact of fat mass (FM) and fat free mass (FFM) gains out to 4 months corrected gestational age (CGA) on PFC development, as indexed by working memory and temperament. This is a prospective observational pilot study recruiting 100 preterm (<33 weeks gestation), appropriate for gestational age, and very low birth weight infants, of which 49 infants met inclusion criteria. Body composition was measured using air displacement plethysmography at hospital discharge and 4 months CGA. Questionnaire based temperament assessments were completed at 12 and 24 months CGA and a working memory assessment was completed at 24 months CGA. Associations between developmental tests and body composition obtained at term and 4 months were analyzed. Increased FM at discharge was associated with increased fear and decreased soothability at 12 months. Increased FM at 4 months was associated with increased activity level, increased distress from limitations at 12 months and decreased attentional shifting, decreased frustration, and decreased inhibitory control at 24 months. Increased FFM at 4 months was associated with increased activity level at 12 months and increased impulsivity and decreased low intensity pleasure at 24 months. In this exploratory pilot study, increased FM out to 4 months and increased FFM after discharge are associated with negative markers of infant temperament. Infant temperament may be sensitive to body composition status at least to 4 months CGA.
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Affiliation(s)
- Erin E Morris
- Division of Neonatology, University of Minnesota, Minneapolis, MN, USA.
| | - Neely C Miller
- Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Michael K Georgieff
- Division of Neonatology, University of Minnesota, Minneapolis, MN, USA; Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN, USA
| | - Sara E Ramel
- Division of Neonatology, University of Minnesota, Minneapolis, MN, USA; Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN, USA
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Sadeghpour Heravi F, Hu H. Bifidobacterium: Host-Microbiome Interaction and Mechanism of Action in Preventing Common Gut-Microbiota-Associated Complications in Preterm Infants: A Narrative Review. Nutrients 2023; 15:nu15030709. [PMID: 36771414 PMCID: PMC9919561 DOI: 10.3390/nu15030709] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The development and health of infants are intertwined with the protective and regulatory functions of different microorganisms in the gut known as the gut microbiota. Preterm infants born with an imbalanced gut microbiota are at substantial risk of several diseases including inflammatory intestinal diseases, necrotizing enterocolitis, late-onset sepsis, neurodevelopmental disorders, and allergies which can potentially persist throughout adulthood. In this review, we have evaluated the role of Bifidobacterium as commonly used probiotics in the development of gut microbiota and prevention of common diseases in preterm infants which is not fully understood yet. The application of Bifidobacterium as a therapeutical approach in the re-programming of the gut microbiota in preterm infants, the mechanisms of host-microbiome interaction, and the mechanism of action of this bacterium have also been investigated, aiming to provide new insights and opportunities in microbiome-targeted interventions in personalized medicine.
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Affiliation(s)
- Fatemah Sadeghpour Heravi
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence: (F.S.H.); (H.H.)
| | - Honghua Hu
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
- Innovation Center of Translational Pharmacy, Jinhua Institute of Zhejiang University, Jinhua 321016, China
- Correspondence: (F.S.H.); (H.H.)
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Trousson C, Toumazi A, Bourmaud A, Biran V, Baud O. Neurocognitive outcomes at age 5 years after prophylactic hydrocortisone in infants born extremely preterm. Dev Med Child Neurol 2022. [PMID: 36417367 DOI: 10.1111/dmcn.15470] [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: 06/02/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
AIM To assess the 5-year neurocognitive outcomes of children born extremely preterm exposed to prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia. METHOD This was a prespecified secondary analysis of the PREMILOC clinical trial (trial registration: EudraCT no. 2007-002041-20, NCT00623740). The primary outcome was full-scale IQ based on the Wechsler Preschool and Primary Scale of Intelligence. RESULTS Among 109 surviving children recruited at the Robert Debré Children's Hospital, Paris, outcome data were available for 42 out of 56 infants (75%) in the group treated with hydrocortisone and 41 out of 53 (77%) in the placebo group. Mean scores were not significantly different between the two groups on full-scale IQ (hydrocortisone: 91.9 [SD = 13.9], placebo: 86.3 [SD = 15.4]; mean difference = 5.7, 95% confidence interval [CI] = -1.0 to 12.3, p = 0.10); however, working memory and retention ability were significantly better in the group treated with hydrocortisone. In a multivariate logistic regression including potential confounding variables, hydrocortisone treatment was significantly associated with a greater chance to survive at 5 years of age with a full-scale IQ equal to or greater than 90 compared to placebo (adjusted odds ratio = 4.26, 95% CI = 1.47-12.36, p = 0.008). INTERPRETATION This exploratory analysis provides reassuring data regarding the long-term neurodevelopmental safety of prophylactic hydrocortisone in infants born extremely preterm.
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Affiliation(s)
- Clémence Trousson
- Assistance Publique-Hôpitaux de Paris, Neonatal Intensive Care Unit, Robert Debré Children's Hospital, Paris, France
| | - Artemis Toumazi
- Assistance Publique-Hôpitaux de Paris, Unit of Clinical Epidemiology, Robert Debré Children's Hospital, University of Paris, Institut National de la Santé et de la Recherche Médicale U1123 and CIC-EC 1426, Paris, France
| | - Aurélie Bourmaud
- Assistance Publique-Hôpitaux de Paris, Unit of Clinical Epidemiology, Robert Debré Children's Hospital, University of Paris, Institut National de la Santé et de la Recherche Médicale U1123 and CIC-EC 1426, Paris, France
| | - Valérie Biran
- Assistance Publique-Hôpitaux de Paris, Neonatal Intensive Care Unit, Robert Debré Children's Hospital, Paris, France.,Institut National de la Santé et de la Recherche Médicale U1141, University of Paris, Paris, France
| | - Olivier Baud
- Institut National de la Santé et de la Recherche Médicale U1141, University of Paris, Paris, France.,Division of Neonatology and Pediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
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Brain MRI findings of prelingually deaf children and cochlear implant outcome: Preliminary results. Int J Pediatr Otorhinolaryngol 2022; 162:111302. [PMID: 36122419 DOI: 10.1016/j.ijporl.2022.111302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the incidence of brain abnormalities in a cohort of prelingually deaf children and whether these abnormalities can impact the hearing outcomes of patients eligible for cochlear implantation (CI). METHODS We performed a retrospective review of consecutive medical charts of prelingually deaf children under 12 years of age who underwent brain magnetic resonance imaging (MRI) during their preoperative workup for CI surgery. We used the category of auditory performance (CAP) test and the speech intelligibility rating (SIR) test to assess the hearing and speech performance of the children, respectively. RESULTS The MRIs of 285 patients, 174 boys and 111 girls with a mean age of 36.4 (±16) months, were evaluated for this study. We identified 31 patients with abnormal findings (10.88%): (17/31) (54.8%) had MRI brain abnormalities, (9/31) (29%) had inner ear anomalies, and (5/31) (16.1%) had both inner ear and brain abnormalities. The most frequent inner ear anomaly was an enlarged vestibular aqueduct, while white matter lesions were the most common brain abnormality. The CAP and SIR mean score of patients with inner ear anomalies was slightly, but not significantly, higher than those of patients with brain abnormalities. CONCLUSION CAP and SIR scores were not significantly different in children with brain abnormalities than inner ear anomalies. These patients can still benefit from CI to improve their overall hearing and speech performance.
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Romberg J, Wilke M, Allgaier C, Nägele T, Engel C, Poets CF, Franz A. MRI-based brain volumes of preterm infants at term: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:520-526. [PMID: 35078779 PMCID: PMC9411894 DOI: 10.1136/archdischild-2021-322846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND MRI allows a detailed assessment of brain structures in preterm infants, outperforming cranial ultrasound. Neonatal MR-based brain volumes of preterm infants could serve as objective, quantitative and reproducible surrogate parameters of early brain development. To date, there are no reference values for preterm infants' brain volumes at term-equivalent age. OBJECTIVE Systematic review of the literature to determine reference ranges for MRI-based brain volumes of very preterm infants at term-equivalent age. METHODS PubMed Database was searched on 6 April 2020 for studies reporting MR-based brain volumes on representative unselected populations of very preterm and/or very low birthweight infants examined at term equivalent age (defined as 37-42 weeks mean postmenstrual age at MRI). Analyses were limited to volumetric parameters reported in >3 studies. Weighted mean volumes and SD were both calculated and simulated for each parameter. RESULTS An initial 367 publications were identified. Following application of exclusion criteria, 13 studies from eight countries were included for analysis, yielding four parameters. Weighted mean total brain volume was 379 mL (SD 72 mL; based on n=756). Cerebellar volume was 21 mL (6 mL; n=791), cortical grey matter volume 140 mL (47 mL; n=572) and weighted mean volume of unmyelinated white matter was 195 mL (38 mL; n=499). CONCLUSION This meta-analysis reports pooled data on several brain and cerebellar volumes which can serve as reference for future studies assessing MR-based volumetric parameters as a surrogate outcome for neurodevelopment and for the interpretation of individual or cohort MRI-based volumetric findings.
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Affiliation(s)
- Julia Romberg
- Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Marko Wilke
- Pediatric Neurology & Developmental Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Allgaier
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Nägele
- Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Corinna Engel
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Axel Franz
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
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Lowe JR, DiDomenico J, Stephen JM, Roberts MH, Rodriguez DE, Bakhireva LN. Early developmental trajectory of children with prenatal alcohol and opioid exposure. Pediatr Res 2022:10.1038/s41390-022-02252-z. [PMID: 35948606 PMCID: PMC9911560 DOI: 10.1038/s41390-022-02252-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND With significant increases in opioid use/misuse and persistent high prevalence of prenatal alcohol exposure (PAE), identifying infants at risk for long-term developmental sequelae due to these exposures remains an urgent need. This study reports on developmental outcomes in young children from a prospective cohort, ENRICH-1, which recruited pregnant women and followed up maternal-infant pairs. METHODS Subjects were assigned to four study groups based on prenatal use of medications for opioid use disorder (MOUD), PAE, MOUD+PAE, and unexposed controls (UC). Mixed effects modeling was used to evaluate changes in the Bayley Scales of Infant Development-III (BSID-III) Cognitive, Language, and Motor scores between 6 and 20 months. RESULTS There was a significant three-way interaction (MOUD-by-PAE-by-Time) with respect to the BSID-III Cognitive (p = 0.045) and Motor (p = 0.033) scales. Significant changes between the two evaluations were observed for MOUD group in Cognitive and Language scores; for PAE group in Cognitive, Language, and Motor scores, and for MOUD+PAE group in Language scores after adjusting for child sex and family socio-economic status. The developmental scores for the UC remained stable. CONCLUSION Observed decline in neurodevelopmental scores during the first 2 years of life emphasizes the importance of a longitudinal approach when evaluating children with prenatal polysubstance exposure. IMPACT BSID-III scores were stable during the first 2 years of life for unexposed children. BSID-III scores declined for children with prenatal exposures to alcohol and/or opioids. Standard developmental tests may not be sensitive enough during the first year of life. Findings emphasize the need for repeated evaluations of children who are at high risk.
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Affiliation(s)
- Jean R Lowe
- Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Julia M Stephen
- The Mind Research Network, a Division of the Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Dominique E Rodriguez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
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Illapani VSP, Edmondson DA, Cecil KM, Altaye M, Kumar M, Harpster K, Parikh NA. Magnetic resonance spectroscopy brain metabolites at term and 3-year neurodevelopmental outcomes in very preterm infants. Pediatr Res 2022; 92:299-306. [PMID: 33654289 PMCID: PMC8410891 DOI: 10.1038/s41390-021-01434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Noninvasive advanced neuroimaging and neurochemical assessment can identify subtle abnormalities and predict neurodevelopmental impairments. Our objective was to quantify white matter metabolite levels and evaluate their relationship with neurodevelopmental outcomes at age 3 years. METHODS Our study evaluated a longitudinal prospective cohort of very premature infants (<32 weeks gestational age) with single-voxel proton magnetic resonance spectroscopy from the centrum semiovale performed at term-equivalent age and standardized cognitive, verbal, and motor assessments at 3 years corrected age. We separately examined metabolite ratios in the left and right centrum semiovale. We also conducted an exploratory interaction analysis for high/low socioeconomic status (SES) to evaluate the relationship between metabolites and neurodevelopmental outcomes, after adjusting for confounders. RESULTS We found significant relationships between choline/creatine levels in the left and right centrum semiovale and motor development scores. Exploratory interaction analyses revealed that, for infants with low SES, there was a negative association between choline/creatine in the left centrum semiovale and motor assessment scores at age 3 years. CONCLUSIONS Brain metabolites from the centrum semiovale at term-equivalent age were associated with motor outcomes for very preterm infants at 3 years corrected age. This effect may be most pronounced for infants with low SES. IMPACT Motor development at 3 years corrected age for very preterm infants is inversely associated with choline neurochemistry within the centrum semiovale on magnetic resonance spectroscopy at term-equivalent age, especially in infants with low socioeconomic status. No prior studies have studied metabolites in the centrum semiovale to predict neurodevelopmental outcomes at 3 years corrected age based on high/low socioeconomic status. For very preterm infants with lower socioeconomic status, higher choline-to-creatine ratio in central white matter is associated with worse neurodevelopmental outcomes.
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Affiliation(s)
| | - David A. Edmondson
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kim M. Cecil
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Manoj Kumar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, INDIA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nehal A. Parikh
- Division of Neonatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Corresponding author’s contact information: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, (513) 636-7584 (Business), (513) 803-0969 (Fax),
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Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070969. [PMID: 35883953 PMCID: PMC9320519 DOI: 10.3390/children9070969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Point-of-care human milk analysis is now feasible in the neonatal intensive care unit (NICU) and allows accurate measurement of macronutrient delivery. Higher macronutrient intakes over this period may promote brain growth and development. In a prospective, observational study of 55 infants born at <32 weeks’ gestation, we used a mid-infrared spectroscopy-based human milk analyzer to measure the macronutrient content in repeated samples of human milk over the NICU hospitalization. We calculated daily nutrient intakes from unfortified milk and assigned infants to quintiles based on median intakes over the hospitalization. Infants underwent brain magnetic resonance imaging at term equivalent age to quantify total and regional brain volumes and fractional anisotropy of white matter tracts. Infants in the highest quintile of energy intake from milk, as compared with the lower four quintiles, had larger total brain volume (31 cc, 95% confidence interval [CI]: 5, 56), cortical gray matter (15 cc, 95%CI: 1, 30), and white matter volume (23 cc, 95%CI: 12, 33). Higher protein intake was associated with larger total brain (36 cc, 95%CI: 7, 65), cortical gray matter (22 cc, 95%CI: 6, 38) and deep gray matter (1 cc, 95%CI: 0.1, 3) volumes. These findings suggest innovative strategies to close nutrient delivery gaps in the NICU may promote brain growth for preterm infants.
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Visuospatial working memory of children and adults born very preterm and/or very low birth weight. Pediatr Res 2022; 91:1436-1444. [PMID: 34923577 DOI: 10.1038/s41390-021-01869-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND This paper examines the visuospatial working memory (WM) performance of children and adults born very preterm (VPT) and/or very low birth weight (VLBW) relative to their full-term (FT)-born peers. Of interest was the nature and severity of observed impairments, as well associations with educational/occupational functioning at each age point. METHODS Participants were drawn from two prospective cohort studies: (1) a regional cohort of 110 VPT (<32 weeks' gestation and <1500 g) and 113 FT born children assessed at age 12 years; (2) a national cohort of 229 VLBW (<1500 g) and 100 FT born adults assessed at age 28 years. Visuospatial WM was assessed using a four-span/difficulty-level computerized task. RESULTS Both children and adults born VPT/VLBW had poorer visuospatial WM than FT controls, with their performance less accurate, slower (correct trials), and less efficient with increasing task difficulty (Cohen's d = 0.27-0.51; p < 0.05). Adults had better visuospatial WM than children, but between-group differences were highly similar across ages, before and after adjustment for confounding social background and individual factors. Poorer WM was associated with lower levels of educational and occupational/socioeconomic achievement. CONCLUSIONS Visuospatial WM difficulties persist into adulthood raising concerns for the longer-term cognitive and adaptive functioning of VPT survivors. IMPACT Both children and adults born very preterm have poorer visuospatial working memory than their term-born peers. They are less accurate, take longer to respond correctly and are less efficient, with test performance declining with increasing cognitive demand. Similar differences in visuospatial working memory are observed between VPT/VLBW and full-term individuals during both childhood and adulthood, with these differences remaining even after covariate adjustment. Individuals with poorer visuospatial working memory have lower levels of educational achievement and occupational/socioeconomic success. Visuospatial working memory difficulties persist into adulthood and appear to continue to impact everyday functioning and life-course opportunities.
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Cebeci B, Alderliesten T, Wijnen JP, van der Aa NE, Benders MJNL, de Vries LS, van den Hoogen A, Groenendaal F. Brain proton magnetic resonance spectroscopy and neurodevelopment after preterm birth: a systematic review. Pediatr Res 2022; 91:1322-1333. [PMID: 33953356 DOI: 10.1038/s41390-021-01539-x] [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: 08/04/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (1H-MRS) is used to evaluate brain metabolites in asphyxiated term infants. The aim of this review is to assess associations between cerebral 1H-MRS and neurodevelopment after preterm birth. METHODS PubMed and Embase were searched to identify studies using 1H-MRS and preterm birth. Eligible studies for this review included 1H-MRS of the brain, gestational age ≤32 weeks, and neurodevelopment assessed at a corrected age (CA) of at least 12 months up to the age of 18 years. RESULTS Twenty papers evaluated 1H-MRS in preterm infants at an age between near-term and 18 years and neurodevelopment. 1H-MRS was performed in both white (WM) and gray matter (GM) in 12 of 20 studies. The main regions were frontal and parietal lobe for WM and basal ganglia for GM. N-acetylaspartate/choline (NAA/Cho) measured in WM and/or GM is the most common metabolite ratio associated with motor, language, and cognitive outcome at 18-24 months CA. CONCLUSIONS NAA/Cho in WM assessed at term-equivalent age was associated with motor, cognitive, and language outcome, and NAA/Cho in deep GM was associated with language outcome at 18-24 months CA. IMPACT In preterm born infants, brain metabolism assessed using 1H-MRS at term-equivalent age is associated with motor, cognitive, and language outcomes at 18-24 months. 1H-MRS at term-equivalent age in preterm born infants may be used as an early indication of brain development. Specific findings relating to NAA were most predictive of outcome.
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Affiliation(s)
- Burcu Cebeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands.,Department of Neonatology, Health Sciences University, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands.
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Lu J, Lu L, Yu Y, Oliphant K, Drobyshevsky A, Claud EC. Early preterm infant microbiome impacts adult learning. Sci Rep 2022; 12:3310. [PMID: 35228616 PMCID: PMC8885646 DOI: 10.1038/s41598-022-07245-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/10/2022] [Indexed: 12/14/2022] Open
Abstract
Interventions to mitigate long-term neurodevelopmental deficits such as memory and learning impairment in preterm infants are warranted. Manipulation of the gut microbiome affects host behaviors. In this study we determined whether early maturation of the infant microbiome is associated with neurodevelopment outcomes. Germ free mice colonized at birth with human preterm infant microbiomes from infants of advancing post menstrual age (PMA) demonstrated an increase in bacterial diversity and a shift in dominance of taxa mimicking the human preterm microbiome development pattern. These characteristics along with changes in a number of metabolites as the microbiome matured influenced associative learning and memory but not locomotor ability, anxiety-like behaviors, or social interaction in adult mice. As a regulator of learning and memory, brain glial cell-derived neurotrophic factor increased with advancing PMA and was also associated with better performance in associative learning and memory in adult mice. We conclude that maturation of the microbiome in early life of preterm infants primes adult associative memory and learning ability. Our findings suggest a critical window of early intervention to affect maturation of the preterm infant microbiome and ultimately improve neurodevelopmental outcomes.
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Affiliation(s)
- Jing Lu
- Department of Pediatrics, Pritzker School of Medicine/Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Lei Lu
- Department of Pediatrics, Pritzker School of Medicine/Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Yueyue Yu
- Department of Pediatrics, Pritzker School of Medicine/Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Kaitlyn Oliphant
- Department of Pediatrics, Pritzker School of Medicine/Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Alexander Drobyshevsky
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, 60202, USA
| | - Erika C Claud
- Department of Pediatrics, Pritzker School of Medicine/Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA.
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Marques A, Santos ME. Oral language of school-aged children born pretermaturely: a population-based analysis from Madeira Island, Portugal. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.74670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Premature birth and low birth weight are very important factors in neurodevelopment. Current research in this population focuses on children born prematurely, with no underlying complications in the post-natal period, who are likely to develop specific disorders with their language development and consequently with their learning capabilities too. This study aims to analyse the oral language skills of prematurely born children in comparison to their school-aged peers. The children were assessed in the respective schools, 27 preterm children (16 under 32 weeks and 11 with 32 or more weeks of gestation) and 49 term paired by gender, age, and school year. Tests including simple and complex structures for assessing semantics, morphosyntax, and phonology were used, as well as a test of verbal memory. Preterm born children, regardless of their prematurity grade, showed significantly lower results than their peers, and more than a half of them, 52%, presented low scores in all language tests simultaneously, showing an important language deficit. In contrast, in the term born children group only 14% showed low scores simultaneously in all tests. Verbal memory ability proved to be lower than that of their term peers, regardless of the gestational age and birth weight of preterm children. As a result of this analysis we consider that the evaluation of the linguistic development of these children, even in cases of moderate to late prematurity, should be monitored in order to identify earlier the existence of deficits and prevent psychosocial and learning problems.
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18
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Mayock DE, Gogcu S, Puia-Dumitrescu M, Shaw DWW, Wright JN, Comstock BA, Heagerty PJ, Juul SE. Association between Term Equivalent Brain Magnetic Resonance Imaging and 2-Year Outcomes in Extremely Preterm Infants: A Report from the Preterm Erythropoietin Neuroprotection Trial Cohort. J Pediatr 2021; 239:117-125.e6. [PMID: 34454953 PMCID: PMC9052881 DOI: 10.1016/j.jpeds.2021.08.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the term equivalent brain magnetic resonance imaging (MRI) findings between erythropoietin (Epo) treated and placebo control groups in infants 240/7-276/7 weeks of gestational age and to assess the associations between MRI findings and neurodevelopmental outcomes at 2 years corrected age. STUDY DESIGN The association between brain abnormality scores and Bayley Scales of Infant Development, Third Edition at 2 years corrected age was explored in a subset of infants enrolled in the Preterm Erythropoietin Neuroprotection Trial. Potential risk factors for neurodevelopmental outcomes such as treatment assignment, recruitment site, gestational age, inpatient complications, and treatments were examined using generalized estimating equation models. RESULTS One hundred ten infants were assigned to Epo and 110 to placebo groups. 27% of MRI scans were rated as normal, and 60%, 10%, and 2% were rated as having mild, moderate, or severe abnormality. Brain abnormality scores did not significantly differ between the treatment groups. Factors that increased the risk of higher brain injury scores included intubation; bronchopulmonary dysplasia; retinopathy of prematurity; opioid, benzodiazepine, or antibiotic treatment >7 days; and periventricular leukomalacia or severe intraventricular hemorrhage diagnosed on cranial ultrasound. Increased global brain abnormality and white matter injury scores at term equivalent were associated with reductions in cognitive, motor, and language abilities at 2 years of corrected age. CONCLUSIONS Evidence of brain injury on brain MRIs obtained at term equivalent correlated with adverse neurodevelopmental outcomes as assessed by the Bayley Scales of Infant and Toddler Development, Third Edition at 2 years corrected age. Early Epo treatment had no effect on the MRI brain injury scores compared with the placebo group.
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Affiliation(s)
- Dennis E. Mayock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Jason N. Wright
- Department of Radiology, University of Washington, Seattle, WA
| | | | | | - Sandra E. Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA
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Niño SA, Vázquez-Hernández N, Arevalo-Villalobos J, Chi-Ahumada E, Martín-Amaya-Barajas FL, Díaz-Cintra S, Martel-Gallegos G, González-Burgos I, Jiménez-Capdeville ME. Cortical Synaptic Reorganization Under Chronic Arsenic Exposure. Neurotox Res 2021; 39:1970-1980. [PMID: 34533753 DOI: 10.1007/s12640-021-00409-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022]
Abstract
There is solid epidemiological evidence that arsenic exposure leads to cognitive impairment, while experimental work supports the hypothesis that it also contributes to neurodegeneration. Energy deficit, oxidative stress, demyelination, and defective neurotransmission are demonstrated arsenic effects, but it remains unclear whether synaptic structure is also affected. Employing both a triple-transgenic Alzheimer's disease model and Wistar rats, the cortical microstructure and synapses were analyzed under chronic arsenic exposure. Male animals were studied at 2 and 4 months of age, after exposure to 3 ppm sodium arsenite in drinking water during gestation, lactation, and postnatal development. Through nuclear magnetic resonance, diffusion-weighted images were acquired and anisotropy (integrity; FA) and apparent diffusion coefficient (dispersion degree; ADC) metrics were derived. Postsynaptic density protein and synaptophysin were analyzed by means of immunoblot and immunohistochemistry, while dendritic spine density and morphology of cortical pyramidal neurons were quantified after Golgi staining. A structural reorganization of the cortex was evidenced through high-ADC and low-FA values in the exposed group. Similar changes in synaptic protein levels in the 2 models suggest a decreased synaptic connectivity at 4 months of age. An abnormal dendritic arborization was observed at 4 months of age, after increased spine density at 2 months. These findings demonstrate alterations of cortical synaptic connectivity and microstructure associated to arsenic exposure appearing in young rodents and adults, and these subtle and non-adaptive plastic changes in dendritic spines and in synaptic markers may further progress to the degeneration observed at older ages.
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Affiliation(s)
- Sandra A Niño
- Departamento de Bioquímica, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Nallely Vázquez-Hernández
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, IMSS. Guadalajara, Jalisco, Mexico
| | - Jaime Arevalo-Villalobos
- Facultad de Agronomía y Veterinaria, Universidad Autónoma de San Luis Potosí, Soledad de Graciano Sánchez, San Luis Potosí, Mexico
| | - Erika Chi-Ahumada
- Departamento de Bioquímica, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Sofía Díaz-Cintra
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Guadalupe Martel-Gallegos
- Laboratorio de Biomedicina, Unidad Académica Multidisciplinaria Zona Media, Universidad Autónoma de San Luis Potosí, Rio Verde, San Luis Potosí, Mexico
| | - Ignacio González-Burgos
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, IMSS. Guadalajara, Jalisco, Mexico
| | - María E Jiménez-Capdeville
- Departamento de Bioquímica, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
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Walczak-Kozłowska T, Chrzan-Dętkoś M, Harciarek M. Heterogeneity of the attentional system's efficiency among very prematurely born pre-schoolers. Child Neuropsychol 2021; 28:120-142. [PMID: 34348594 DOI: 10.1080/09297049.2021.1961702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Very preterm birth increases the risk of ADHD as well as other neurodevelopmental disorders. Deficits within the attentional system were previously signaled in preterm children; however, studies lacked in consideration of an intragroup differentiation. Thus, this study aimed to verify whether deficits in the attentional mechanisms are inter-individually differentiated among very prematurely born children and if so, which biomedical and non-biomedical factors are associated with the profile of deficits within the attentional system. We tested the efficiency of attentional processes among 5-year-old children with the Attention Network Task - Child Version. The results have indicated that 26% of very preterm children presented with the suboptimal functioning of the attentional system (more than 1 SD below mean score of full-term children in attentional alerting and orienting), whereas 74% were characterized by the normal efficiency of attention. The profile of attentional deficits observed among very preterm preschoolers was associated with significantly lower birth weight and decreased family living standard. Very prematurely born children are thus a relatively heterogeneous group in terms of the efficiency of attentional system and deficits apply to only some of those children. Early developmental support aimed at enhancing attentional functioning should be addressed to children with lower birth weight in the first place.
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Affiliation(s)
- Tamara Walczak-Kozłowska
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Magdalena Chrzan-Dętkoś
- Division of Developmental Psychology and Psychopathology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Michał Harciarek
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
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Sandoval CC, Gaspardo CM, Linhares MBM. The impact of preterm birth on the executive functioning of preschool children: A systematic review. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:873-890. [PMID: 33984255 DOI: 10.1080/21622965.2021.1915145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper presents a systematic review of the impact of preterm childbirth on the later executive functioning of preschool-aged children. A systematic search for studies published between 2014 and 2019 was performed using the following keywords: executive funct* AND preterm AND child. The methodological quality of the reports was examined using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Thirty-two studies were reviewed and scored at least 67% on the methodological quality assessment. In comparison to children born full-term, preschool children born preterm exhibit executive functioning deficits in the dimensions of the global index, inhibitory control, cognitive flexibility, working memory, and planning/executive functioning. These findings are independent of the degree of prematurity at birth. Since executive functioning has many complex components, future studies should assess the dimensions of executive functioning separately in preschool-aged children born preterm, rather than as a single measure.
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Affiliation(s)
- Carolina Cruvinel Sandoval
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Cláudia Maria Gaspardo
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Maria Beatriz Martins Linhares
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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Development of human white matter pathways in utero over the second and third trimester. Proc Natl Acad Sci U S A 2021; 118:2023598118. [PMID: 33972435 PMCID: PMC8157930 DOI: 10.1073/pnas.2023598118] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During the second and third trimesters of human gestation, rapid neurodevelopment is underpinned by fundamental processes including neuronal migration, cellular organization, cortical layering, and myelination. In this time, white matter growth and maturation lay the foundation for an efficient network of structural connections. Detailed knowledge about this developmental trajectory in the healthy human fetal brain is limited, in part, due to the inherent challenges of acquiring high-quality MRI data from this population. Here, we use state-of-the-art high-resolution multishell motion-corrected diffusion-weighted MRI (dMRI), collected as part of the developing Human Connectome Project (dHCP), to characterize the in utero maturation of white matter microstructure in 113 fetuses aged 22 to 37 wk gestation. We define five major white matter bundles and characterize their microstructural features using both traditional diffusion tensor and multishell multitissue models. We found unique maturational trends in thalamocortical fibers compared with association tracts and identified different maturational trends within specific sections of the corpus callosum. While linear maturational increases in fractional anisotropy were seen in the splenium of the corpus callosum, complex nonlinear trends were seen in the majority of other white matter tracts, with an initial decrease in fractional anisotropy in early gestation followed by a later increase. The latter is of particular interest as it differs markedly from the trends previously described in ex utero preterm infants, suggesting that this normative fetal data can provide significant insights into the abnormalities in connectivity which underlie the neurodevelopmental impairments associated with preterm birth.
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Structural Changes in the Cortico-Ponto-Cerebellar Axis at Birth are Associated with Abnormal Neurological Outcomes in Childhood. Clin Neuroradiol 2021; 31:1005-1020. [PMID: 33944956 DOI: 10.1007/s00062-021-01017-1] [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: 09/02/2020] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
White matter lesions in hypoxic-ischemic encephalopathy (HIE) are considered to be the important substrate of frequent neurological consequences in preterm infants. The aim of the study was to analyze volumes and tractographic parameters of the cortico-ponto-cerebellar axis to assess alterations in the periventricular fiber system and crossroads, corticopontine and corticospinal pathways and prospective transsynaptic changes of the cerebellum.Term infants (control), premature infants without (normotypic) and with perinatal HIE (HIE) underwent brain magnetic resonance imaging at term-equivalent age (TEA) and at 2 years. Cerebrum, cerebellum, brainstem divisions and ventrodorsal compartments volumetric analysis were performed, as well as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of corticopontine, corticospinal pathways and middle cerebellar peduncles. Amiel-Tison scale at TEA and the Hempel test at 2 years were assessed.Cerebellum, brainstem and its compartments volumes were decreased in normotypic and HIE groups at TEA, while at 2 years volumes were significantly reduced in the HIE group, accompanied by decreased volume and FA and increased ADC of corticopontine and corticospinal pathways. Negative association of the brainstem, cerebellum, mesencephalon, pons, corticopontine volumes and corticospinal pathway FA at TEA with the neurological score at 2 years. Cerebellum and pons volumes presented as potential prognostic indicators of neurological outcomes.Our findings agree that these pathways, as a part of the periventricular fiber system and crossroads, exhibit lesion-induced reaction and vulnerability in HIE. Structural differences between normotypic and HIE group at the 2 years suggest a different developmental structural plasticity.
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Prasad JD, Gunn KC, Davidson JO, Galinsky R, Graham SE, Berry MJ, Bennet L, Gunn AJ, Dean JM. Anti-Inflammatory Therapies for Treatment of Inflammation-Related Preterm Brain Injury. Int J Mol Sci 2021; 22:4008. [PMID: 33924540 PMCID: PMC8069827 DOI: 10.3390/ijms22084008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of preterm brain injury, there are no established neuroprotective strategies to prevent or alleviate mild-to-moderate inflammation-related brain injury. Perinatal infection and inflammation have been shown to trigger acute neuroinflammation, including proinflammatory cytokine release and gliosis, which are associated with acute and chronic disturbances in brain cell survival and maturation. These findings suggest the hypothesis that the inhibition of peripheral immune responses following infection or nonspecific inflammation may be a therapeutic strategy to reduce the associated brain injury and neurobehavioral deficits. This review provides an overview of the neonatal immunity, neuroinflammation, and mechanisms of inflammation-related brain injury in preterm infants and explores the safety and efficacy of anti-inflammatory agents as potentially neurotherapeutics.
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Affiliation(s)
- Jaya D. Prasad
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Katherine C. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Joanne O. Davidson
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia;
| | - Scott E. Graham
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Mary J. Berry
- Department of Pediatrics and Health Care, University of Otago, Dunedin 9016, New Zealand;
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Alistair J. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Justin M. Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
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25
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Glasgow MJ, Edlin R, Harding JE. Cost burden and net monetary benefit loss of neonatal hypoglycaemia. BMC Health Serv Res 2021; 21:121. [PMID: 33546675 PMCID: PMC7863541 DOI: 10.1186/s12913-021-06098-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/18/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neonatal hypoglycaemia is a common but treatable metabolic disorder that affects newborn infants and which, if not identified and treated adequately, may result in neurological sequelae that persist for the lifetime of the patient. The long-term financial and quality-of-life burden of neonatal hypoglycaemia has not been previously examined. METHODS We assessed the postnatal hospital and long-term costs associated with neonatal hypoglycaemia over 80 year and 18 year time horizons, using a health-system perspective and assessing impact on quality of life using quality-adjusted life year (QALYs). A decision analytic model was used to represent key outcomes in the presence and absence of neonatal hypoglycaemia. RESULTS The chance of developing one of the outcomes of neonatal hypoglycaemia in our model (cerebral palsy, learning disabilities, seizures, vision disorders) was 24.03% in subjects who experienced neonatal hypoglycaemia and 3.56% in those who do did not. Over an 80 year time horizon a subject who experienced neonatal hypoglycaemia had a combined hospital and post-discharge cost of NZ$72,000 due to the outcomes modelled, which is NZ$66,000 greater than a subject without neonatal hypoglycaemia. The net monetary benefit lost due to neonatal hypoglycaemia, using a value per QALY of NZ$43,000, is NZ$180,000 over an 80 year time horizon. CONCLUSIONS Even under the most conservative of estimates, neonatal hypoglycaemia contributes a significant financial burden to the health system both during childhood and over a lifetime. The combination of direct costs and loss of quality of life due to neonatal hypoglycaemia means that this condition warrants further research to focus on prevention and effective treatment.
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Affiliation(s)
- Matthew J Glasgow
- Liggins Institute, University of Auckland, Private Bag 92019, Grafton, Auckland, 1142, New Zealand
| | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Private Bag 92019, Grafton, Auckland, 1142, New Zealand.
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26
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Bradford A, Hernandez M, Kearney E, Theriault L, Lim YP, Stonestreet BS, Threlkeld SW. Effects of Juvenile or Adolescent Working Memory Experience and Inter-Alpha Inhibitor Protein Treatment after Neonatal Hypoxia-Ischemia. Brain Sci 2020; 10:E999. [PMID: 33348631 PMCID: PMC7765798 DOI: 10.3390/brainsci10120999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
Hypoxic-Ischemic (HI) brain injury in the neonate contributes to life-long cognitive impairment. Early diagnosis and therapeutic interventions are critical but limited. We previously reported in a rat model of HI two interventional approaches that improve cognitive and sensory function: administration of Inter-alpha Inhibitor Proteins (IAIPs) and early experience in an eight-arm radial water maze (RWM) task. Here, we expanded these studies to examine the combined effects of IAIPs and multiple weeks of RWM assessment beginning with juvenile or adolescent rats to evaluate optimal age windows for behavioral interventions. Subjects were divided into treatment groups; HI with vehicle, sham surgery with vehicle, and HI with IAIPs, and received either juvenile (P31 initiation) or adolescent (P52 initiation) RWM testing, followed by adult retesting. Error rates on the RWM decreased across weeks for all conditions. Whereas, HI injury impaired global performance as compared to shams. IAIP-treated HI subjects tested as juveniles made fewer errors as compared to their untreated HI counterparts. The juvenile group made significantly fewer errors on moderate demand trials and showed improved retention as compared to the adolescent group during the first week of adult retesting. Together, results support and extend our previous findings that combining behavioral and anti-inflammatory interventions in the presence of HI improves subsequent learning performance. Results further indicate sensitive periods for behavioral interventions to improve cognitive outcomes. Specifically, early life cognitive experience can improve long-term learning performance even in the presence of HI injury. Results from this study provide insight into typical brain development and the impact of developmentally targeted therapeutics and task-specific experience on subsequent cognitive processing.
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Affiliation(s)
- Aaron Bradford
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Miranda Hernandez
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Elaine Kearney
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Luke Theriault
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Yow-Pin Lim
- ProThera Biologics, Inc., 349 Eddy Street, Providence, RI 02903, USA;
- Department of Pathology and Laboratory Medicine, The Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Barbara S. Stonestreet
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA;
| | - Steven W. Threlkeld
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
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27
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Fernandez-Baizan C, Caunedo-Jimenez M, Martinez JA, Arias JL, Mendez M, Solis G. Development of visuospatial memory in preterm infants: A new paradigm to assess short-term and working memory. Child Neuropsychol 2020; 27:296-316. [PMID: 33191857 DOI: 10.1080/09297049.2020.1847264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Preterm infants have a higher risk of showing visuospatial memory impairment, the function that allows to encode and remember visual and spatial information. It has been studied in late childhood in preterm children. Studies on visuospatial memory throughout the first 2 years of life are still scarce. Behavior, temperament, and overall cognition could be altered in preterm children affecting memory performance. Therefore, the main aim of this study was to evaluate short-term and visuospatial working memory performance in a preterm sample followed longitudinally at 12, 15, 18, and 22 months (N = 15), and compare their performance with that of full-term children (N = 65). The secondary aim was to analyze the course of mnesic development in preterm infants and relate their memory performance to other cognitive abilities and behavioral tendencies. Assessment included previously published tasks and an experimental paradigm. Results showed that preterm children scored lower than full-term children on visuospatial short-term and working memory at 12 and 22 months of age, although these results varied depending on the memory test used. Preterm children's memory results showed that these skills improve in this population between the first and second year of life. Finally, memory performance was directly associated with the level of cognitive development and the presence of proactive behaviors, while being inversely correlated with the presence of disruptive behaviors and a difficult temperamental style. These preliminary findings suggest that it is possible to detect visuospatial memory difficulties in the preterm population before the age of two.
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Affiliation(s)
- C Fernandez-Baizan
- Neuroscience Institute of Principado de Asturias (INEUROPA), University of Oviedo, Oviedo, Spain.,Department of Psychology, University of Oviedo, Oviedo, Spain
| | - M Caunedo-Jimenez
- Pediatric Clinic Area, Neonatology, University Central Hospital of Asturias, Oviedo, Spain
| | - J A Martinez
- Neuroscience Institute of Principado de Asturias (INEUROPA), University of Oviedo, Oviedo, Spain.,Department of Electronic Technology, University of Oviedo, Gijón, Spain
| | - J L Arias
- Neuroscience Institute of Principado de Asturias (INEUROPA), University of Oviedo, Oviedo, Spain.,Department of Psychology, University of Oviedo, Oviedo, Spain
| | - M Mendez
- Neuroscience Institute of Principado de Asturias (INEUROPA), University of Oviedo, Oviedo, Spain.,Department of Psychology, University of Oviedo, Oviedo, Spain
| | - G Solis
- Neuroscience Institute of Principado de Asturias (INEUROPA), University of Oviedo, Oviedo, Spain.,Pediatric Clinic Area, Neonatology, University Central Hospital of Asturias, Oviedo, Spain
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28
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MHlthMgt MJG, Edlin R, Harding JE. Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants. J Pediatr 2020; 226:80-86.e1. [PMID: 32634402 PMCID: PMC7779688 DOI: 10.1016/j.jpeds.2020.06.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the long-term costs and impact on quality of life of using prophylactic dextrose gel in patients at increased risk of developing neonatal hypoglycemia. STUDY DESIGN A cost-utility analysis was performed from the perspective of the health system, using a decision tree to model the long-term clinical outcomes of neonatal hypoglycemia, including cerebral palsy, epilepsy, vision disturbances, and learning disabilities, in patients at increased risk of neonatal hypoglycemia who received prophylactic dextrose gel vs standard care. Model parameters including likelihoods of hypoglycemia and admission to a neonatal intensive care unit, were based on the pre-Hypoglycemia Prevention with Oral Dextrose Study. Estimations of the likelihood of long-term condition(s), and their costs, were based on review of published literature. RESULTS Patients who received prophylactic dextrose gel incurred costs to the health system of around US $14 000 over an 18-year time horizon, accruing 11.25 quality-adjusted life-years, whereas those who did not receive prophylactic treatment incurred cost of around $16 000 and experienced a utility of 11.10 quality-adjusted life-years. CONCLUSIONS A prophylactic strategy of using dextrose gel in infants at increased risk of neonatal hypoglycemia is likely to be cost effective compared with standard care, to reduce the direct costs to the health system over an 18-year time horizon, and improve quality of life.
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Affiliation(s)
| | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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29
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Kelly CE, Thompson DK, Spittle AJ, Chen J, Seal ML, Anderson PJ, Doyle LW, Cheong JL. Regional brain volumes, microstructure and neurodevelopment in moderate-late preterm children. Arch Dis Child Fetal Neonatal Ed 2020; 105:593-599. [PMID: 32132139 DOI: 10.1136/archdischild-2019-317941] [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: 07/22/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore whether regional brain volume and white matter microstructure at term-equivalent age (TEA) are associated with development at 2 years of age in children born moderate-late preterm (MLPT). STUDY DESIGN A cohort of MLPT infants had brain MRI at approximately TEA (38-44 weeks' postmenstrual age) and had a developmental assessment (Bayley Scales of Infant and Toddler Development and Infant Toddler Social Emotional Assessment) at 2 years' corrected age. Relationships between cortical grey matter and white matter volumes and 2-year developmental outcomes were explored using voxel-based morphometry. Relationships between diffusion tensor measures of white matter microstructure (fractional anisotropy (FA) and axial (AD), radial (RD) and mean (MD) diffusivities) and 2-year developmental outcomes were explored using tract-based spatial statistics. RESULTS 189 MLPT children had data from at least one MRI modality (volumetric or diffusion) and data for at least one developmental domain. Larger cortical grey and white matter volumes in many brain regions, and higher FA and lower AD, RD and MD in several major white matter regions, were associated with better cognitive and language scores. There was little evidence that cortical grey matter and white matter volumes and white matter microstructure were associated with motor and behavioural outcomes. CONCLUSIONS Regional cortical grey matter and white matter volumes and white matter microstructure are associated with cognitive and language development at 2 years of age in MLPT children. Thus, early alterations to brain volumes and microstructure may contribute to some of the developmental deficits described in MLPT children.
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Affiliation(s)
- Claire E Kelly
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia .,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeanie Ly Cheong
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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30
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Ng IHX, Bonthrone AF, Kelly CJ, Cordero-Grande L, Hughes EJ, Price AN, Hutter J, Victor S, Schuh A, Rueckert D, Hajnal JV, Simpson J, Edwards AD, Rutherford MA, Batalle D, Counsell SJ. Investigating altered brain development in infants with congenital heart disease using tensor-based morphometry. Sci Rep 2020; 10:14909. [PMID: 32913193 PMCID: PMC7483731 DOI: 10.1038/s41598-020-72009-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance (MR) imaging studies have demonstrated reduced global and regional brain volumes in infants with congenital heart disease (CHD). This study aimed to provide a more detailed evaluation of altered structural brain development in newborn infants with CHD compared to healthy controls using tensor-based morphometry (TBM). We compared brain development in 64 infants with CHD to 192 age- and sex-matched healthy controls. T2-weighted MR images obtained prior to surgery were analysed to compare voxel-wise differences in structure across the whole brain between groups. Cerebral oxygen delivery (CDO2) was measured in infants with CHD (n = 49) using phase contrast MR imaging and the relationship between CDO2 and voxel-wise brain structure was assessed using TBM. After correcting for global scaling differences, clusters of significant volume reduction in infants with CHD were demonstrated bilaterally within the basal ganglia, thalami, corpus callosum, occipital, temporal, parietal and frontal lobes, and right hippocampus (p < 0.025 after family-wise error correction). Clusters of significant volume expansion in infants with CHD were identified in cerebrospinal fluid spaces (p < 0.025). After correcting for global brain size, there was no significant association between voxel-wise brain structure and CDO2. This study localizes abnormal brain development in infants with CHD, identifying areas of particular vulnerability.
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Affiliation(s)
- Isabel H X Ng
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Emer J Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
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Alison M, Tilea B, Toumazi A, Biran V, Mohamed D, Alberti C, Bourmaud A, Baud O. Prophylactic hydrocortisone in extremely preterm infants and brain MRI abnormality. Arch Dis Child Fetal Neonatal Ed 2020; 105:520-525. [PMID: 31980445 DOI: 10.1136/archdischild-2019-317720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether early low-dose hydrocortisone treatment in extremely preterm infants is associated with brain damage assessed by MRI at term equivalent of age (TEA). PATIENTS AND OUTCOMES This is a predefined secondary analysis of brain abnormalities, observed by MRI at TEA, of patients randomly assigned to receive either placebo or hydrocortisone in the PREMILOC trial. Outcomes were based on brain abnormalities graded according to Kidokoro scores. RESULTS Among 412 survivors at TEA, 300 MRIs were performed and 295 were suitable for analysis. Kidokoro scoring was completed for 119/148 and 110/147 MRIs in the hydrocortisone and placebo groups, respectively. The distribution of the Kidokoro white matter (WM) subscore and other subscores was not significantly different between the two groups. There was, however, a significant association between a higher overall Kidokoro score and hydrocortisone treatment (5.84 (SD 3.51) for hydrocortisone and 4.98 (SD 2.52) for placebo; mean difference, 0.86; 95% CI 0.06 to 1.66; p=0.04). However, hydrocortisone was not statistically associated with moderate-to-severe brain lesions (Kidokoro overall score ≥6) in a multivariate logistic regression model accounting for potential confounding variables (adjusted OR (95% CI) 1.27 (0.75 to 2.14), p=0.38). Bronchopulmonary dysplasia at 36 weeks postmenstrual age significantly predicted both WM damage (adjusted OR (95% CI) 2.70 (1.03 to 7.14), p=0.04) and global brain damage (adjusted OR (95% CI) 2.18 (1.19 to 3.99), p=0.01). CONCLUSIONS Early hydrocortisone exposure in extremely preterm infants is not statistically associated with either WM brain damage or overall moderate-to-severe brain lesions when adjusted for other neonatal variables. TRIAL REGISTRATION NUMBER EudraCT number 2007-002041-20, NCT00623740.
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Affiliation(s)
- Marianne Alison
- Pediatric Radiology, Hôpital Universitaire Robert Debré, Paris, France
| | - Bogdana Tilea
- Pediatric Radiology, Hôpital Universitaire Robert Debré, Paris, France
| | - Artemis Toumazi
- Pediatric Radiology, Hôpital Universitaire Robert Debré, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Hopital Universitaire Robert Debre, Paris, Île-de-France, France.,Inserm U1141, University of Paris, Paris, France
| | - Damir Mohamed
- Centre d'Investigation Clinique-Epidémiologie Clinique, Hopital Universitaire Robert Debre, Paris, France
| | - Corinne Alberti
- Centre d'Investigation Clinique-Epidémiologie Clinique, Hopital Universitaire Robert Debre, Paris, France
| | - Aurélie Bourmaud
- Pediatric Radiology, Hôpital Universitaire Robert Debré, Paris, France
| | - Olivier Baud
- Inserm U1141, University of Paris, Paris, France .,DFEA, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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32
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Kline JE, Illapani VSP, He L, Altaye M, Parikh NA. Retinopathy of Prematurity and Bronchopulmonary Dysplasia are Independent Antecedents of Cortical Maturational Abnormalities in Very Preterm Infants. Sci Rep 2019; 9:19679. [PMID: 31873183 PMCID: PMC6928014 DOI: 10.1038/s41598-019-56298-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023] Open
Abstract
Very preterm (VPT) infants are at high-risk for neurodevelopmental impairments, however there are few validated biomarkers at term-equivalent age that accurately measure abnormal brain development and predict future impairments. Our objectives were to quantify and contrast cortical features between full-term and VPT infants at term and to associate two key antecedent risk factors, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), with cortical maturational changes in VPT infants. We prospectively enrolled a population-based cohort of 110 VPT infants (gestational age ≤31 weeks) and 51 healthy full-term infants (gestational age 38-42 weeks). Structural brain MRI was performed at term. 94 VPT infants and 46 full-term infants with high-quality T2-weighted MRI were analyzed. As compared to full-term infants, VPT infants exhibited significant global cortical maturational abnormalities, including reduced surface area (-5.9%) and gyrification (-6.7%) and increased curvature (5.9%). In multivariable regression controlled for important covariates, BPD was significantly negatively correlated with lobar and global cortical surface area and ROP was significantly negatively correlated with lobar and global sulcal depth in VPT infants. Our cohort of VPT infants exhibited widespread cortical maturation abnormalities by term-equivalent age that were in part anteceded by two of the most potent neonatal diseases, BPD and ROP.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Divison of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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33
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Sato J, Mossad SI, Wong SM, Hunt BAE, Dunkley BT, Urbain C, Taylor MJ. Spectral slowing is associated with working memory performance in children born very preterm. Sci Rep 2019; 9:15757. [PMID: 31673006 PMCID: PMC6823447 DOI: 10.1038/s41598-019-52219-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/13/2019] [Indexed: 11/20/2022] Open
Abstract
Children born very preterm (VPT) often demonstrate selective difficulties in working memory (WM), which may underlie academic difficulties observed in this population. Despite this, few studies have investigated the functional networks underlying WM in young children born VPT, a period when cognitive deficits become apparent. Using magnetoencephalography, we examined the networks underlying the maintenance of visual information in 6-year-old VPT (n = 15) and full-term (FT; n = 20) children. Although task performance was similar, VPT children engaged different oscillatory mechanisms during WM maintenance. Within the FT group, we observed higher mean whole-brain connectivity in the alpha-band during the retention (i.e. maintenance) interval associated with correct compared to incorrect responses. VPT children showed reduced whole-brain alpha synchrony, and a different network organization with fewer connections. In the theta-band, VPT children demonstrated a slight increase in whole-brain connectivity during WM maintenance, and engaged similar network hubs as FT children in the alpha-band, including the left dorsolateral prefrontal cortex and superior temporal gyrus. These findings suggest that VPT children rely on the theta-band to support similar task performance. Altered oscillatory mechanisms may reflect a less mature pattern of functional recruitment underlying WM in VPT children, which may affect the processing in complex ecological situations.
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Affiliation(s)
- Julie Sato
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada. .,Department of Psychology, University of Toronto, Toronto, Canada. .,Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada.
| | - Sarah I Mossad
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada.,Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Simeon M Wong
- Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Benjamin A E Hunt
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Benjamin T Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Charline Urbain
- UR2NF - Neuropsychology and Functional Neuroimaging Research Group at Center for Research in Cognition and Neurosciences (CRCN) and ULB Neurosciences Institute (UNI), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Margot J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada.,Neuroscience & Mental Health Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
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34
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Cormack BE, Harding JE, Miller SP, Bloomfield FH. The Influence of Early Nutrition on Brain Growth and Neurodevelopment in Extremely Preterm Babies: A Narrative Review. Nutrients 2019; 11:E2029. [PMID: 31480225 PMCID: PMC6770288 DOI: 10.3390/nu11092029] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022] Open
Abstract
Extremely preterm babies are at increased risk of less than optimal neurodevelopment compared with their term-born counterparts. Optimising nutrition is a promising avenue to mitigate the adverse neurodevelopmental consequences of preterm birth. In this narrative review, we summarize current knowledge on how nutrition, and in particular, protein intake, affects neurodevelopment in extremely preterm babies. Observational studies consistently report that higher intravenous and enteral protein intakes are associated with improved growth and possibly neurodevelopment, but differences in methodologies and combinations of intravenous and enteral nutrition strategies make it difficult to determine the effects of each intervention. Unfortunately, there are few randomized controlled trials of nutrition in this population conducted to determine neurodevelopmental outcomes. Substantial variation in reporting of trials, both of nutritional intakes and of outcomes, limits conclusions from meta-analyses. Future studies to determine the effects of nutritional intakes in extremely preterm babies need to be adequately powered to assess neurodevelopmental outcomes separately in boys and girls, and designed to address the many potential confounders which may have clouded research findings to date. The development of minimal reporting sets and core outcome sets for nutrition research will aid future meta-analyses.
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Affiliation(s)
- Barbara E Cormack
- Starship Child Health, Auckland City Hospital, Auckland 1023, New Zealand
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Steven P Miller
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON M5S, Canada
| | - Frank H Bloomfield
- Starship Child Health, Auckland City Hospital, Auckland 1023, New Zealand.
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
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35
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Berndt M, Bäuml JG, Menegaux A, Meng C, Daamen M, Baumann N, Zimmer C, Boecker H, Bartmann P, Wolke D, Sorg C. Impaired structural connectivity between dorsal attention network and pulvinar mediates the impact of premature birth on adult visual-spatial abilities. Hum Brain Mapp 2019; 40:4058-4071. [PMID: 31179600 DOI: 10.1002/hbm.24685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022] Open
Abstract
The dorsal attention network (DAN), including frontal eye fields and posterior parietal cortices, and its link with the posterior thalamus, contribute to visual-spatial abilities. Very premature birth impairs both visual-spatial abilities and cortico-thalamic structural connectivity. We hypothesized that impaired structural DAN-pulvinar connectivity mediates the effect of very premature birth on adult visual-spatial abilities. Seventy very premature (median age 26.6 years) and 57 mature born adults (median age 26.6 years) were assessed with cognitive tests and diffusion tensor imaging. Perceptual organization (PO) index of the Wechsler Adult Intelligence Scale-III was used as a proxy for visual-spatial abilities, and connection probability maps in the thalamus, derived from probabilistic tractography from the DAN, were used as a proxy for DAN-thalamic connectivity. Premature born adults showed decreases in both PO-index and connection probability from DAN into the pulvinar, with both changes being positively correlated. Moreover, path analysis revealed that DAN-pulvinar connectivity mediates the relationship between very premature birth and PO-index. Results provide evidence for long-term effects of very premature birth on structural DAN-pulvinar connectivity, mediating the effect of prematurity on adult visual-spatial impairments. Data suggest DAN-pulvinar connectivity as a specific target of prognostic and diagnostic procedures for visual-spatial abilities after premature birth.
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Affiliation(s)
- Maria Berndt
- Department of Neuroradiology, Technische Universität München, School of Medicine, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, School of Medicine, Munich, Germany
| | - Josef G Bäuml
- Department of Neuroradiology, Technische Universität München, School of Medicine, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, School of Medicine, Munich, Germany
| | - Aurore Menegaux
- Department of Neuroradiology, Technische Universität München, School of Medicine, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, School of Medicine, Munich, Germany.,Department of Psychology, General and Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.,Graduate School of Systemic Neurosciences GSN, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Chun Meng
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, School of Medicine, Munich, Germany.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Marcel Daamen
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany.,Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, UK
| | - Claus Zimmer
- Department of Neuroradiology, Technische Universität München, School of Medicine, Munich, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Christian Sorg
- Department of Neuroradiology, Technische Universität München, School of Medicine, Munich, Germany.,TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, School of Medicine, Munich, Germany.,Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München
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36
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Cree BAC, Niu J, Hoi KK, Zhao C, Caganap SD, Henry RG, Dao DQ, Zollinger DR, Mei F, Shen YAA, Franklin RJM, Ullian EM, Xiao L, Chan JR, Fancy SPJ. Clemastine rescues myelination defects and promotes functional recovery in hypoxic brain injury. Brain 2019; 141:85-98. [PMID: 29244098 DOI: 10.1093/brain/awx312] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/14/2017] [Indexed: 11/14/2022] Open
Abstract
Hypoxia can injure brain white matter tracts, comprised of axons and myelinating oligodendrocytes, leading to cerebral palsy in neonates and delayed post-hypoxic leukoencephalopathy (DPHL) in adults. In these conditions, white matter injury can be followed by myelin regeneration, but myelination often fails and is a significant contributor to fixed demyelinated lesions, with ensuing permanent neurological injury. Non-myelinating oligodendrocyte precursor cells are often found in lesions in plentiful numbers, but fail to mature, suggesting oligodendrocyte precursor cell differentiation arrest as a critical contributor to failed myelination in hypoxia. We report a case of an adult patient who developed the rare condition DPHL and made a nearly complete recovery in the setting of treatment with clemastine, a widely available antihistamine that in preclinical models promotes oligodendrocyte precursor cell differentiation. This suggested possible therapeutic benefit in the more clinically prevalent hypoxic injury of newborns, and we demonstrate in murine neonatal hypoxic injury that clemastine dramatically promotes oligodendrocyte precursor cell differentiation, myelination, and improves functional recovery. We show that its effect in hypoxia is oligodendroglial specific via an effect on the M1 muscarinic receptor on oligodendrocyte precursor cells. We propose clemastine as a potential therapy for hypoxic brain injuries associated with white matter injury and oligodendrocyte precursor cell maturation arrest.
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Affiliation(s)
- Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Jianqin Niu
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA 94158, USA.,Department of Histology and Embryology, Collaborative Innovation Center for Brain Research, Third Military Medical University, Chongqing 400038, China
| | - Kimberly K Hoi
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Chao Zhao
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Scott D Caganap
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Roland G Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Dang Q Dao
- Department of Ophthalmology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Daniel R Zollinger
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Feng Mei
- Department of Histology and Embryology, Collaborative Innovation Center for Brain Research, Third Military Medical University, Chongqing 400038, China
| | - Yun-An A Shen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Robin J M Franklin
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Erik M Ullian
- Department of Ophthalmology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Lan Xiao
- Department of Histology and Embryology, Collaborative Innovation Center for Brain Research, Third Military Medical University, Chongqing 400038, China
| | - Jonah R Chan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Stephen P J Fancy
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA 94158, USA.,Department of Pediatrics, University of California at San Francisco, San Francisco, CA 94158, USA.,Division of Neonatology, University of California at San Francisco, San Francisco, CA 94158, USA.,Newborn Brain Research Institute, University of California at San Francisco, San Francisco, CA 94158, USA
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37
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Everts R, Schöne CG, Mürner-Lavanchy I, Steinlin M. Development of executive functions from childhood to adolescence in very preterm-born individuals - A longitudinal study. Early Hum Dev 2019; 129:45-51. [PMID: 30639465 DOI: 10.1016/j.earlhumdev.2018.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
Preterm-born individuals are at risk for poorer executive functions. Longitudinal studies investigating whether preterm-born individuals present persistent cognitive deficits, or a transient delay of development are scarce. We assessed developmental trajectories of executive functions (inhibition, working memory, cognitive flexibility) in 29 very preterm-born individuals (<32 weeks' gestation) and 25 term-born controls longitudinally over two time points, namely in childhood (7-12 years of age, TP1) and adolescence (13-16 years of age, TP2). Individual changes in executive functions were examined using relative difference scores (TP2 - TP1) / TP1). There was a significantly stronger improvement of inhibition (U = 477, p = .024) and cognitive flexibility (U = 312, p = .029) between childhood and adolescence in very preterm-born individuals than in term-born controls. Preterm-born individuals improved their performance in the domain of cognitive flexibility significantly more often (76%) between childhood and adolescence than controls (31%, χ2 = 8.6, p = .003). Controls worsened significantly more often (36%) in the domain of inhibition than the preterm group (14%, χ2 = 4.8, p = .028). Results indicate that healthy preterm-born individuals show prolonged development of executive functions throughout childhood up into adolescence.
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Affiliation(s)
- Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Corina G Schöne
- Institute of Psychology, University of Bern, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Switzerland
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38
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Abstract
Late preterm infants (born at 340/7-366/7 weeks gestation) have been found to have increased morbidity and mortality compared to full term infants. Research has also been done to explore longer-term neurodevelopmental outcomes. This review details neurodevelopmental outcomes from birth to adulthood for late preterm infants. Outcome studies indicate that they are at increased risk of developmental disability, school failure, behavior problems, social and medical disabilities, and death. Many questions still remain regarding late preterm infant neurodevelopmental outcomes and future research should be done into this topic. Given the high prevalence of late preterm births, even small differences in abilities, special education, and length of education may have broader consequences.
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39
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Loe IM, Adams JN, Feldman HM. Executive Function in Relation to White Matter in Preterm and Full Term Children. Front Pediatr 2019; 6:418. [PMID: 30697535 PMCID: PMC6341022 DOI: 10.3389/fped.2018.00418] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Executive function (EF) refers to cognitive abilities used to guide goal-directed behavior. Diffusion Tensor Imaging (DTI) provides quantitative characterization of white matter tracts in the brain. Children with preterm birth often have EF impairments and white matter injury. Aim: To examine the degree of association between EF scores and white matter fractional anisotropy (FA) as measured by DTI in children born preterm and term Study design: Cross-sectional study Subjects: Participants, 9-16 years of age, born preterm (n = 25; mean gestational age 28.6 weeks; mean birth weight 1,191 grams), and full term (n = 20) Outcome measures: White matter FA analyzed with Tract-Based Spatial Statistics, a technique that generates a skeleton representing the core of white matter tracts throughout the brain. Behavioral scores from EF tasks examining working memory, spatial memory capacity, and multiple skills from the Stockings of Cambridge. Results: The groups performed comparably on all tasks. In both groups, unfavorable working memory strategy scores were associated with lower FA. Other measures of EF were not associated with whole skeleton FA in either group in either direction. Conclusions: Strategy score on a spatial working memory task was associated with FA in preterm and full term children, suggesting common underlying neurobiology in both groups. Associations were found in frontal-parietal connections and other major tracts. Lack of associations between other EF tasks and FA may be due to variation in how children accomplish these EF tasks. Future research is required to fully understand the neurobiology of EF in children born preterm.
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Affiliation(s)
- Irene M. Loe
- Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Jenna N. Adams
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Heidi M. Feldman
- Department of Pediatrics, Stanford University, Stanford, CA, United States
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40
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Longitudinal study of neonatal brain tissue volumes in preterm infants and their ability to predict neurodevelopmental outcome. Neuroimage 2019; 185:728-741. [DOI: 10.1016/j.neuroimage.2018.06.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/08/2018] [Accepted: 06/09/2018] [Indexed: 12/13/2022] Open
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41
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Lu J, Claud EC. Connection between gut microbiome and brain development in preterm infants. Dev Psychobiol 2018; 61:739-751. [PMID: 30460694 DOI: 10.1002/dev.21806] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/30/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
Dysbiosis of the gut microbiome in preterm infants predisposes the neonate to various major morbidities including neonatal necrotizing enterocolitis and sepsis in the neonatal intensive care unit, and adverse neurological outcomes later in life. There are parallel early developmental windows for the gut microbiota and the nervous system during prenatal to postnatal of life. Therefore, preterm infants represent a unique population in which optimization of initial colonization and microbiota development can affect brain development and enhance neurological outcomes. In this review, we will first discuss the factors affecting the assembly of neonatal gut microbiota and the contribution of dysbiosis in preterm infants to neuroinflammation and neurodevelopmental disorders. We then will discuss the emerging pathways connecting the gut microbiome and brain development. Further we will discuss the significance of current models for alteration of the gut microbiome (including humanized gnotobiotic models and exposure to antibiotics) to brain development and functions. Understanding the role of early optimization of the microbiome in brain development is of paramount importance for developing microbiome-targeted therapies and protecting infants from prematurity-related neurodevelopmental diseases.
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Affiliation(s)
- Jing Lu
- Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Erika C Claud
- Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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42
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Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury. J Perinatol 2018; 38:1431-1443. [PMID: 30166622 PMCID: PMC6215507 DOI: 10.1038/s41372-018-0209-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes. The goal of this review is to describe the distinct and often overlapping types of brain injury in the preterm neonate, with a focus on neonatal hydrocephalus, and to connect injury on imaging to neurodevelopmental outcome risk. Head ultrasound and magnetic resonance imaging findings are described separately. The current state of the literature is imprecise and we end the review with recommendations for future radiologic and neurodevelopmental research.
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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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44
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Feng EC, Jiang L. Effects of leptin on neurocognitive and motor functions in juvenile rats in a preterm brain damage model. Mol Med Rep 2018; 18:4095-4102. [PMID: 30106108 DOI: 10.3892/mmr.2018.9389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 06/12/2018] [Indexed: 11/05/2022] Open
Abstract
Preterm infants face lifelong disabilities, including learning disorders, as well as visual, auditory and behavioral problems. Recent studies have demonstrated that leptin, an adipocytokine encoded by a gene associated with obesity and expressed in adipose tissue, affects neurocognitive and motor function; however, the mechanisms of brain damage in preterm infants are unclear. In the present study, the neuroprotective effects of leptin in a rat model of preterm hypoxic‑ischemic brain damage were investigated. Rats (2‑days‑old) were subjected to brain damage (ligation of the common carotid artery followed by exposure to 6% oxygen for 2 h) and treated with vehicle (control) or leptin. Spatial memory was analyzed in the present study using the Morris water maze test 19 days following ligation. Over the 24‑day post‑surgical observation period, capture‑resistance test, forelimb suspension and open field tests were conducted to evaluate motor function and anxiety‑associated behavior. Treatment with leptin did not affect survival rate or body weight. Treatment with leptin increased the number of platform crossings in rats with premature brain damage in the Morris water maze test, which was used to assess spatial memory. Multivariate analysis revealed that leptin reduced the latency to finding the platform location, independent of gender and weight. In the capture‑resistance, forelimb suspension and open field tests, there were no differences between animals administered leptin and the sham group. Collectively, the results of the present study suggested that leptin may alleviate spatial memory impairment resulting from premature brain damage, independent of gender or weight. These results may improve understanding of the neuroprotective effects exhibited by leptin in infants with preterm brain damage.
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Affiliation(s)
- Er-Cui Feng
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, P.R. China
| | - Li Jiang
- Department of Pediatrics, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, P.R. China
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45
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Hodel AS. Rapid Infant Prefrontal Cortex Development and Sensitivity to Early Environmental Experience. DEVELOPMENTAL REVIEW 2018; 48:113-144. [PMID: 30270962 PMCID: PMC6157748 DOI: 10.1016/j.dr.2018.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Over the last fifteen years, the emerging field of developmental cognitive neuroscience has described the relatively late development of prefrontal cortex in children and the relation between gradual structural changes and children's protracted development of prefrontal-dependent skills. Widespread recognition by the broader scientific community of the extended development of prefrontal cortex has led to the overwhelming perception of prefrontal cortex as a "late developing" region of the brain. However, despite its supposedly protracted development, multiple lines of research have converged to suggest that prefrontal cortex development may be particularly susceptible to individual differences in children's early environments. Recent studies demonstrate that the impacts of early adverse environments on prefrontal cortex are present very early in development: within the first year of life. This review provides a comprehensive overview of new neuroimaging evidence demonstrating that prefrontal cortex should be characterized as a "rapidly developing" region of the brain, discusses the converging impacts of early adversity on prefrontal circuits, and presents potential mechanisms via which adverse environments shape both concurrent and long-term measures of prefrontal cortex development. Given that environmentally-induced disparities are present in prefrontal cortex development within the first year of life, translational work in intervention and/or prevention science should focus on intervening early in development to take advantages of this early period of rapid prefrontal development and heightened plasticity.
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46
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Gresch LD, Marchman VA, Loi EC, Fernald A, Feldman HM. Nonword Repetition and Language Outcomes in Young Children Born Preterm. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1203-1215. [PMID: 29800357 PMCID: PMC6195080 DOI: 10.1044/2018_jslhr-l-17-0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/12/2017] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
Purpose The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills. Method Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures. Results More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance. Conclusions These findings suggest that phonological short-term memory is an important skill underlying language development in both children born PT and FT. These findings have relevance to clinical practice in assessing children born PT.
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Affiliation(s)
- Lisa D. Gresch
- Department of Pediatrics, Stanford University School of Medicine, CA
| | | | - Elizabeth C. Loi
- Department of Pediatrics, Stanford University School of Medicine, CA
| | - Anne Fernald
- Department of Psychology, Stanford University, CA
| | - Heidi M. Feldman
- Department of Pediatrics, Stanford University School of Medicine, CA
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47
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Lu J, Lu L, Yu Y, Cluette-Brown J, Martin CR, Claud EC. Effects of Intestinal Microbiota on Brain Development in Humanized Gnotobiotic Mice. Sci Rep 2018; 8:5443. [PMID: 29615691 PMCID: PMC5882882 DOI: 10.1038/s41598-018-23692-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/19/2018] [Indexed: 12/23/2022] Open
Abstract
Poor growth in the Neonatal Intensive Care Unit is associated with an increased risk for poor neurodevelopmental outcomes for preterm infants, however the mechanism is unclear. The microbiome has increasingly been recognized as a modifiable environmental factor to influence host development. Here we explore the hypothesis that the microbiome influences both growth phenotype and brain development. A germ free mouse transfaunation model was used to examine the effects of preterm infant microbiotas known to induce either high growth or low growth phenotypes on postnatal brain development. The microbiome which induced the low growth phenotype was associated with decreases in the neuronal markers NeuN and neurofilament-L as well as the myelination marker MBP when compared to the microbiome associated with the high growth phenotype. Additionally, poor growth phenotype-associated microbiota was associated with increased neuroinflammation marked by increased Nos1, as well as alteration in IGF-1 pathway including decreased circulating and brain IGF-1, decreased circulating IGFBP3, and increased Igfbp3 brain mRNA expression. This study suggests that growth-associated microbiota can influence early neuron and oligodendrocyte development and that this effect may be mediated by effects on neuroinflammation and circulating IGF-1.
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Affiliation(s)
- Jing Lu
- The University of Chicago, Pritzker School of Medicine, Department of Pediatrics, Chicago, IL, 60637, USA
| | - Lei Lu
- The University of Chicago, Pritzker School of Medicine, Department of Pediatrics, Chicago, IL, 60637, USA
| | - Yueyue Yu
- The University of Chicago, Pritzker School of Medicine, Department of Pediatrics, Chicago, IL, 60637, USA
| | - Joanne Cluette-Brown
- Beth Israel Deaconess Medical Center, Division of Gastroenterology, Boston, MA, 02215, USA
| | - Camilia R Martin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Neonatology and Division of Translational Research, Boston, MA, 02215, USA
| | - Erika C Claud
- The University of Chicago, Pritzker School of Medicine, Department of Pediatrics, Chicago, IL, 60637, USA.
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48
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Chen D, Dixon BJ, Doycheva DM, Li B, Zhang Y, Hu Q, He Y, Guo Z, Nowrangi D, Flores J, Filippov V, Zhang JH, Tang J. IRE1α inhibition decreased TXNIP/NLRP3 inflammasome activation through miR-17-5p after neonatal hypoxic-ischemic brain injury in rats. J Neuroinflammation 2018; 15:32. [PMID: 29394934 PMCID: PMC5797348 DOI: 10.1186/s12974-018-1077-9] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/22/2018] [Indexed: 12/18/2022] Open
Abstract
Background The endoplasmic reticulum (ER) is responsible for the control of correct protein folding and protein function which is crucial for cell survival. However, under pathological conditions, such as hypoxia–ischemia (HI), there is an accumulation of unfolded proteins thereby triggering the unfolded protein response (UPR) and causing ER stress which is associated with activation of several stress sensor signaling pathways, one of them being the inositol requiring enzyme-1 alpha (IRE1α) signaling pathway. The UPR is regarded as a potential contributor to neuronal cell death and inflammation after HI. In the present study, we sought to investigate whether microRNA-17 (miR-17), a potential IRE1α ribonuclease (RNase) substrate, arbitrates downregulation of thioredoxin-interacting protein (TXNIP) and consequent NLRP3 inflammasome activation in the immature brain after HI injury and whether inhibition of IRE1α may attenuate inflammation via miR-17/TXNIP regulation. Methods Postnatal day 10 rat pups (n = 287) were subjected to unilateral carotid artery ligation followed by 2.5 h of hypoxia (8% O2). STF-083010, an IRE1α RNase inhibitor, was intranasally delivered at 1 h post-HI or followed by an additional one administration per day for 2 days. MiR-17-5p mimic or anti-miR-17-5p inhibitor was injected intracerebroventricularly at 48 h before HI. Infarct volume and body weight were used to evaluate the short-term effects while brain weight, gross and microscopic brain tissue morphologies, and neurobehavioral tests were conducted for the long-term evaluation. Western blots, immunofluorescence staining, reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR), and co-immunoprecipitation (Co-IP) were used for mechanism studies. Results Endogenous phosphorylated IRE1α expression was significantly increased after HI. Intranasal administration of STF-083010 alleviated brain injury and improved neurological behavior. MiR-17-5p expression was reduced after HI, and this decrease was attenuated by STF-083010 treatment. MiR-17-5p mimic administration ameliorated TXNIP expression, NLRP3 inflammasome activation, caspase-1 cleavage, and IL-1β production, as well as brain infarct volume. Conversely, anti-miR-17-5p inhibitor reversed IRE1α inhibition-induced decrease in TXNIP expression and inflammasome activation, as well as exacerbated brain injury after HI. Conclusions IRE1a-induced UPR pathway may contribute to inflammatory activation and brain injury following neonatal HI. IRE1a activation, through decay of miR-17-5p, elevated TXNIP expression to activate NLRP3 inflammasome and aggravated brain damage. Electronic supplementary material The online version of this article (10.1186/s12974-018-1077-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Di Chen
- Cerebrovascular Diseases Laboratory, Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
| | - Brandon J Dixon
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Desislava M Doycheva
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Bo Li
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Yang Zhang
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Qin Hu
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Yue He
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Zongduo Guo
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Derek Nowrangi
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Jerry Flores
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Valery Filippov
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - John H Zhang
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.,Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Jiping Tang
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.
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49
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Su X, Yuan H, Cui H, Zhu H, Yun X, Tang W, Chen J, Luan Z. Effect of T helper cell 1/T helper cell 2 balance and nuclear factor-κB on white matter injury in premature neonates. Mol Med Rep 2018; 17:5552-5556. [PMID: 29393452 DOI: 10.3892/mmr.2018.8511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/08/2017] [Indexed: 11/06/2022] Open
Abstract
Incidence of white matter injury (WMI), which is featured as softening of white matter tissues, has recently increased. Previous studies have demonstrated a close correlation between T helper cell 1 and T helper cell 2 (Th1/Th2) imbalance and nuclear factor‑κB (NF‑κB) with brain disease. Their role in premature WMI, however, remains to be illustrated. Serum samples were collected from 60 premature WMI neonates, plus another control group of 60 premature babies without WMI. Patients were further divided into mild, moderate and severe WMI groups. Reverse transcription quantitative polymerase chain reaction was used to test mRNA expression levels of Th1/Th2 cytokines, including interleukin 2 (IL)‑2, tumor necrosis factor‑α (TNF‑α), IL‑4, IL‑10 and nuclear factor (NF)‑κB, whilst their serum levels were measured by ELISA. Their correlation with disease occurrence and progression were further analysed, to illustrate the effect of Th1/Th2 balance and NF‑κB on pathology of premature WMI. Serum levels of IL‑4 and IL‑10 were significantly decreased in premature WMI babies, whilst IL‑2, TNF‑α and NF‑κB were upregulated (P<0.05 vs. control group). With aggravated disease, IL‑4 and IL‑10 expression was further decreased while IL‑2, TNF‑α and NF‑κB were increased (P<0.05 vs. mild WMI group). Th1 cytokines IL‑2 and TNF‑α and NF‑κB were negatively correlated with Th2 cytokines IL‑4 and IL‑10. Disease severity was positively correlated with IL‑2, TNF‑α and NF‑κB expression, and was negatively correlated with IL‑4 and IL‑10 (P<0.05). Th1/Th2 imbalance and NF‑κB upregulation were observed in WMI pathogenesis, with elevated secretion of Th1 cytokines and decreased Th2 cytokines, suggesting that Th1/Th2 imbalance and NF‑κB upregulation may be a potential indicator for the early diagnosis and treatment of WMI pathogenesis and progression.
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Affiliation(s)
- Xuewen Su
- Department of Paediatrics, Inner Mongolia People's Hospital, Huhehot, Inner Mongolia 010017, P.R. China
| | - Haifeng Yuan
- Department of Paediatrics, Inner Mongolia People's Hospital, Huhehot, Inner Mongolia 010017, P.R. China
| | - Hongwei Cui
- Department of Paediatrics, Clinical Medical Research Center, Affiliated Hospital of Inner Mongolia Medical University, Huhehot, Inner Mongolia 010010, P.R. China
| | - Hua Zhu
- Department of Paediatrics, Inner Mongolia People's Hospital, Huhehot, Inner Mongolia 010017, P.R. China
| | - Xia Yun
- Department of Paediatrics, Inner Mongolia People's Hospital, Huhehot, Inner Mongolia 010017, P.R. China
| | - Wenyan Tang
- Department of Paediatrics, Affiliated Navy General Hospital of Southern Medical University, Haidian, Beijing 100048, P.R. China
| | - Junlong Chen
- Department of Paediatrics, Inner Mongolia People's Hospital, Huhehot, Inner Mongolia 010017, P.R. China
| | - Zu Luan
- Department of Paediatrics, An Hui Provincial Hospital, Hefei, Anhui 230001, P.R. China
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50
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Olsen A, Dennis EL, Evensen KAI, Husby Hollund IM, Løhaugen GCC, Thompson PM, Brubakk AM, Eikenes L, Håberg AK. Preterm birth leads to hyper-reactive cognitive control processing and poor white matter organization in adulthood. Neuroimage 2017; 167:419-428. [PMID: 29191480 PMCID: PMC6625518 DOI: 10.1016/j.neuroimage.2017.11.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/08/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022] Open
Abstract
Individuals born preterm with very low birth weight (VLBW; birth weight ≤ 1500 g) are at high risk for perinatal brain injuries and deviant brain development, leading to increased chances of later cognitive, emotional, and behavioral problems. Here we investigated the neuronal underpinnings of both reactive and proactive cognitive control processes in adults with VLBW. We included 32 adults born preterm with VLBW (before 37th week of gestation) and 32 term-born controls (birth weight ≥10th percentile for gestational age) between 22 and 24 years of age that have been followed prospectively since birth. Participants performed a well-validated Not-X continuous performance test (CPT) adapted for use in a mixed block- and event-related fMRI protocol. BOLD fMRI and DTI data was acquired on a 3T scanner. Performance on the Not-X CPT was highly similar between groups. However, the VLBW group demonstrated hyper-reactive cognitive control processing and disrupted white matter organization. The hyper-reactive brain activation signature in VLBW adults was associated with lower gestational age, lower fluid intelligence score, and anxiety problems. Automated Multi-Atlas Tract Extraction (AutoMATE) analyses revealed that this disruption of normal brain function was accompanied by poorer white matter organization in the anterior thalamic radiation and the cingulum, as reflected in both reduced fractional anisotropy and increased mean diffusivity. These findings show that the preterm behavioral phenotype is associated with predominantly reactive-, rather than proactive cognitive control processing, as well as white matter abnormalities, that may underlie common difficulties that many preterm born individuals experience in everyday life.
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Affiliation(s)
- Alexander Olsen
- Department of Psychology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Emily L Dennis
- Imaging Genetics Center, Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Kari Anne I Evensen
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physiotherapy, Trondheim Municipality, Trondheim, Norway
| | - Ingrid Marie Husby Hollund
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Paul M Thompson
- Imaging Genetics Center, Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Ann-Mari Brubakk
- Department of Laboratory Medicine, Children's and Women's Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asta K Håberg
- Department of Neuromedicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Medical Imaging, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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