1
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Song S, Zhu Z, Zhang K, Xiao M, Gao R, Li Q, Chen X, Mei H, Zeng L, Wei Y, Zhu Y, Nuer Y, Yang L, Li W, Li T, Ju R, Li Y, Jiang L, Chen C, Zhu L. Two risk assessment models for predicting white matter injury in extremely preterm infants. Pediatr Res 2024:10.1038/s41390-024-03402-1. [PMID: 39025934 DOI: 10.1038/s41390-024-03402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Extremely preterm infants (EPIs) are at high-risk of white matter injury (WMI), leading to long-term neurodevelopmental impairments. We aimed to develop nomograms for WMI. METHODS The study included patients from 31 provinces, spanning ten years. 6074 patients before 2018 were randomly divided into a training and internal validation group (7:3). The external validation group comprised 1492 patients from 2019. Predictors were identified using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression and nomograms were constructed. Models' performance was evaluated using receiver operating characteristic (ROC), decision curve analysis (DCA) and calibration curves. RESULTS The prenatal nomogram included multiple gestation, premature rupture of membranes (PROM), chorioamnionitis, prenatal glucocorticoids, hypertensive disorder complicating pregnancy (HDCP) and Apgar 1 min, with area under the curve (AUC) of 0.805, 0.816 and 0.799 in the training, internal validation and external validation group, respectively. Days of mechanical ventilation (MV), shock, patent ductus arteriosus (PDA) ligation, intraventricular hemorrhage (IVH) grade III-IV, septicemia, hypothermia and necrotizing enterocolitis (NEC) stage II-III were identified as postpartum predictors. The AUCs were 0.791, 0.813 and 0.823 in the three groups, respectively. DCA and calibration curves showed good clinical utility and consistency. CONCLUSION The two nomograms provide clinicians with precise and efficient tools for prediction of WMI. IMPACT This study is a large-sample multicenter study, spanning 10 years. The two nomograms are convenient for identifying high-risk infants early, allowing for reducing poor prognosis.
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Affiliation(s)
- Shuting Song
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhicheng Zhu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ke Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Mili Xiao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ruiwei Gao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Qingping Li
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Xiao Chen
- Department of Neonatology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Hua Mei
- Department of Neonatology, The Affiliated Hospital Inner Mongolia Medical University, Inner Mongolia, China
| | - Lingkong Zeng
- Department of Neonatology, Wuhan Woman and Children Medical Care Center, Hubei, China
| | - Yi Wei
- Department of Neonatology, Guilin Maternal and Child Health Hospital, Guangxi, China
| | - Yanpin Zhu
- Department of Neonatology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Ya Nuer
- Department of Neonatology, Xinjiang Uygur Autonomous Region People's Hospital, Xinjiang, China
| | - Ling Yang
- Department of Neonatology, Hainan Women and Children's Medical Center, Hainan, China
| | - Wen Li
- Department of Neonatology, Qilu Hospital of Shandong University, Shandong, China
| | - Ting Li
- Department of Neonatology, Hunan Maternal and Child Health Care Hospital, Hunan, China
| | - Rong Ju
- Department of Neonatology, Chengdu Woman's and Children's Center Hospital, Sichuan, China
| | - Yangfang Li
- Department of Neonatology, Kunming Children's Hospital, Yunnan, China
| | - Lian Jiang
- Department of Neonatology, Fourth Hospital of Hebei Medical University, Hebei, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Zhu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Horvath GA, Blau N, Ferreira CR. Clinical and biochemical footprints of inherited metabolic disease. V. Cerebral palsy phenotypes. Mol Genet Metab 2022; 137:445-448. [PMID: 33775522 PMCID: PMC10518079 DOI: 10.1016/j.ymgme.2021.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/14/2022]
Abstract
Cerebral palsy is the most common physical disability of childhood describing a heterogeneous group of neurodevelopmental disorders that cause activity limitation, but often are accompanied by disturbances of sensation, perception, cognition, communication and behavior, or by epilepsy. Inborn errors of metabolism have been reported in the literature as presenting with features of cerebral palsy. We reviewed and updated the list of metabolic disorders known to be associated with symptoms suggestive of cerebral palsy and found more than 150 relevant IEMs. This represents the fifth of a series of articles attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnosis according to system involvement.
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Affiliation(s)
- Gabriella A Horvath
- Department of Pediatrics, Division of Biochemical Genetics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
| | - Nenad Blau
- Division of Metabolism, University Children's Hospital Zürich, Zurich, Switzerland.
| | - Carlos R Ferreira
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
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3
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Cox CS, Juranek J, Kosmach S, Pedroza C, Thakur N, Dempsey A, Rennie K, Scott MC, Jackson M, Kumar A, Aertker B, Caplan H, Triolo F, Savitz SI. Autologous cellular therapy for cerebral palsy: a randomized, crossover trial. Brain Commun 2022; 4:fcac131. [PMID: 35702731 PMCID: PMC9188321 DOI: 10.1093/braincomms/fcac131] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
We examined an autologous mononuclear-cell-therapy-based approach to treat cerebral palsy using autologous umbilical cord blood or bone-marrow-derived mononuclear cells. The primary objective was to determine if autologous cells are safe to administer in children with cerebral palsy. The secondary objectives were to determine if there was improvement in motor function of patients 12 months after infusion using the Gross Motor Function Measure and to evaluate impact of treatment on corticospinal tract microstructure as determined by radial diffusivity measurement. This Phase 1/2a trial was a randomized, blinded, placebo-controlled, crossover study in children aged 2-10 years of age with cerebral palsy enrolled between November 2013 and November 2016. Participants were randomized to 2:1 treatment:placebo. Treatment was either autologous bone-marrow-derived mononuclear cells or autologous umbilical cord blood. All participants who enrolled and completed their baseline visit planned to return for follow-up visits at 6 months, 12 months and 24 months after the baseline visit. At the 12-month post-treatment visit, participants who originally received the placebo received either bone-marrow-derived mononuclear cell or umbilical cord blood treatment. Twenty participants were included; 7 initially randomized to placebo, and 13 randomized to treatment. Five participants randomized to placebo received bone-marrow-derived mononuclear cells, and 2 received umbilical cord blood at the 12-month visit. None of the participants experienced adverse events related to the stem cell infusion. Cell infusion at the doses used in our study did not dramatically alter motor function. We observed concordant bilateral changes in radial diffusivity in 10 of 15 cases where each corticospinal tract could be reconstructed in each hemisphere. In 60% of these cases (6/10), concordant decreases in bilateral corticospinal tract radial diffusivity occurred post-treatment. In addition, 100% of unilateral corticospinal tract cases (3/3) exhibited decreased corticospinal tract radial diffusivity post-treatment. In our discordant cases (n = 5), directionality of changes in corticospinal tract radial diffusivity appeared to coincide with handedness. There was a significant improvement in corticospinal tract radial diffusivity that appears related to handedness. Connectivity strength increased in either or both pathways (corticio-striatal and thalamo-cortical) in each participant at 12 months post-treatment. These data suggest that both stem cell infusions are safe. There may be an improvement in myelination in some groups of patients that correlate with small improvements in the Gross Motor Function Measure scales. A larger autologous cord blood trial is impractical at current rates of blood banking. Either increased private banking or matched units would be required to perform a larger-scale trial.
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Affiliation(s)
- Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Program in Pediatric Regenerative Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jenifer Juranek
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Program in Pediatric Regenerative Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Steven Kosmach
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Nivedita Thakur
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Allison Dempsey
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kimberly Rennie
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Department of Neuropsychology, NeuroBehavioral Health, Milwaukee, WI, USA
| | - Michael C. Scott
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Margaret Jackson
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Akshita Kumar
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Benjamin Aertker
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Henry Caplan
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Fabio Triolo
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Program in Pediatric Regenerative Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sean I. Savitz
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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4
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Yamagishi H, Osaka H, Toyokawa S, Kobayashi Y, Shimoizumi H. Survey on children with cerebral palsy in Tochigi Prefecture, Japan. Pediatr Int 2021; 63:951-957. [PMID: 33176036 DOI: 10.1111/ped.14536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/20/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of cerebral palsy (CP) is influenced by perinatal medicine and regional medical systems. We investigated the recent incidence of CP and the current problems of children with CP in living at home under an advanced perinatal medical system in Tochigi Prefecture, Japan. METHODS A clinical datasheet survey was performed among 13 hospitals and six rehabilitation facilities treating children with CP born in Tochigi Prefecture to estimate the incidence of CP among children born between 2009 and 2013. The severity of motor and intellectual impairment, presumed causal factors, complications, and provided medical interventions were investigated and compared between preterm and term-born children with CP. RESULTS The incidence of CP was 1.6 per 1000 live births. Shorter gestation period and lower birthweight were associated with a higher incidence of CP. Fifty-one percent of children with CP were non-ambulatory and 55% had severe to profound intellectual impairment. Episodes of neonatal asphyxia and periventricular leukomalacia were the most frequent causal factors; both were significantly more frequent in preterm than in term-born children. Approximately 30% of children with CP had respiratory disorders, dysphagia, or epilepsy; 62% received medical interventions, including medication, mechanical ventilation, oxygen therapy, tube feeding, and intraoral/intranasal suction. CONCLUSION We found the incidence of CP to be lower in comparison to previous Japanese studies. However, the motor and intellectual impairments were severe, and many children with CP and their families were burdened by daily medical care. Public support systems should be developed, as well as the perinatal medical system.
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Affiliation(s)
- Hirokazu Yamagishi
- Department of Pediatrics, Jichi Medical University, Shimotsuke.,Department of Pediatrics, Nasu Institute for Developmental Disabilities, International University of Health and Welfare, Otawara
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Shimotsuke
| | - Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Shimoizumi
- Department of Pediatrics, Nasu Institute for Developmental Disabilities, International University of Health and Welfare, Otawara
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5
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Hollung SJ, Vik T, Andersen GL. The Challenge of Identifying Causal Pathways Leading to Cerebral Palsy. Pediatrics 2021; 147:peds.2020-033720. [PMID: 33602801 DOI: 10.1542/peds.2020-033720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro L Andersen
- Cerebral Palsy Registry of Norway, Vestfold Hospital Trust, Tønsberg, Norway; and
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6
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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7
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Alpay Savasan Z, Yilmaz A, Ugur Z, Aydas B, Bahado-Singh RO, Graham SF. Metabolomic Profiling of Cerebral Palsy Brain Tissue Reveals Novel Central Biomarkers and Biochemical Pathways Associated with the Disease: A Pilot Study. Metabolites 2019; 9:metabo9020027. [PMID: 30717353 PMCID: PMC6409919 DOI: 10.3390/metabo9020027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/17/2022] Open
Abstract
Cerebral palsy (CP) is one of the most common causes of motor disability in childhood, with complex and heterogeneous etiopathophysiology and clinical presentation. Understanding the metabolic processes associated with the disease may aid in the discovery of preventive measures and therapy. Tissue samples (caudate nucleus) were obtained from post-mortem CP cases (n = 9) and age- and gender-matched control subjects (n = 11). We employed a targeted metabolomics approach using both 1H NMR and direct injection liquid chromatography-tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 55 metabolites using 1H NMR and 186 using DI/LC-MS/MS. Among the 222 detected metabolites, 27 showed significant concentration changes between CP cases and controls. Glycerophospholipids and urea were the most commonly selected metabolites used to develop predictive models capable of discriminating between CP and controls. Metabolomics enrichment analysis identified folate, propanoate, and androgen/estrogen metabolism as the top three significantly perturbed pathways. We report for the first time the metabolomic profiling of post-mortem brain tissue from patients who died from cerebral palsy. These findings could help to further investigate the complex etiopathophysiology of CP while identifying predictive, central biomarkers of CP.
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Affiliation(s)
- Zeynep Alpay Savasan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Ali Yilmaz
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Zafer Ugur
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Buket Aydas
- Departments of Mathematics and Computer Sciences, Albion College, 611 E. Porter St., Albion, MI 49224, USA.
| | - Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Stewart F Graham
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
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8
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Nayeri UA, Buhimschi CS, Zhao G, Buhimschi IA, Bhandari V. Components of the antepartum, intrapartum, and postpartum exposome impact on distinct short-term adverse neonatal outcomes of premature infants: A prospective cohort study. PLoS One 2018; 13:e0207298. [PMID: 30517142 PMCID: PMC6281222 DOI: 10.1371/journal.pone.0207298] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
We aimed to test the hypothesis that determinants of the perinatal clinical exposome related to the underlying etiology of premature birth (PTB) impact differently on select neonatal outcomes. We conducted a prospective longitudinal study of 377 singleton preterm neonates [gestational age (GA) at birth: 23-34 weeks] separated into three distinct contemporaneous newborn cohorts: i) spontaneous PTB in the setting of intra-amniotic infection/inflammation (yes-IAI, n = 116); ii) spontaneous PTB in the absence of IAI (no-IAI, n = 130), and iii) iatrogenic PTB for preeclampsia (iPTB-PE, n = 131). Newborns (n = 372) were followed until death or discharge. Amniotic fluid defensins 1&2 and calgranulins A&C were used as biomarkers of IAI. An algorithm considering cord blood interleukin-6 (IL-6) and haptoglobin (Hp switch-on) was used to assess fetal exposure to IAI. Intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), early-onset neonatal (EONS) and late-onset (LOS) sepsis, death. Independent risk factors for adverse outcomes were: i) IVH (n = 53): histologic chorioamnionitis, GA, fetal growth restriction, male sex, Hp switch-on; ii) PVL (n = 11): cord blood IL-6; iii) NEC (n = 25), GA; iv) BPD (n = 53): ventilator support, need for surfactant, GA; v) ROP (n = 79): ventilator support, Hp switch-on, GA; vi) fetal and neonatal death (n = 31): GA, amniotic fluid IL-6; vii) suspect EONS (n = 92): GA, Hp switch-on; viii) LOS (n = 81): GA. Our findings are applicable to pregnancies delivered between 23 and 34 weeks' gestation in the setting of IAI and PE, and suggest that GA and inflammatory intrauterine environment play key roles in occurrence of IVH, PVL, ROP, death, EONS and LOS. Postnatal determinants seem to play major role in NEC and BPD.
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Affiliation(s)
- Unzila Ali Nayeri
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Catalin S. Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Guomao Zhao
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Irina A. Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
| | - Vineet Bhandari
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, School of Medicine, New Haven, Connecticut, United states of America
- Department of Pediatrics, Yale University, School of Medicine, New Haven, Connecticut, United states of America
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9
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PI3K-Akt-Wnt Pathway Is Implicated in Exercise-Induced Improvement of Short-term Memory in Cerebral Palsy Rats. Int Neurourol J 2018; 22:S156-164. [PMID: 30396265 PMCID: PMC6234731 DOI: 10.5213/inj.1836224.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/07/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Maternal lipopolysaccharide (LPS) injection induces neurodevelopmental disorders, such as cerebral palsy. Exercise activates phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) signaling pathway that enhances neurogenesis. Wnt ligands are also implicated in the hippocampal neurogenesis and synaptic plasticity. Glycogen synthase kinase-3β (GSK-3β) is a downstream molecule of Akt, and GSK-3β is known to modulate hippocampal neurogenesis negatively. METHODS Cerebral palsy was made by maternal LPS-injection. On the 5 weeks after birth, treadmill running was applied to the rat pups of the exercise groups, for 30 minutes, 5 times a week during 6 weeks. RESULTS Treadmill running alleviated short-term memory impairments of the cerebral palsy rat pups. Hippocampal cell proliferation was increased and hippocampal apoptosis was suppressed by treadmill running in the cerebral palsy rat pups. Hippocampal phosphorylated-PI3K/PI3K ratio, phosphorylated-Akt/Akt ratio, and Wnt expression were enhanced by treadmill running in the cerebral palsy rat pups. In contrast, hippocampal phosphorylated-GSK-3β/GSK-3β ratio and β-catenin expression were suppressed by treadmill running in the cerebral palsy rat pups. CONCLUSION The results of this study showed that short-term memory improvement due to treadmill running in cerebral palsy occurs via activation of the PI3K-Akt-Wnt pathway.
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10
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Decreasing prevalence and severity of cerebral palsy in Norway among children born 1999 to 2010 concomitant with improvements in perinatal health. Eur J Paediatr Neurol 2018; 22:814-821. [PMID: 29779984 DOI: 10.1016/j.ejpn.2018.05.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/16/2018] [Accepted: 05/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of our study was to explore if the prevalence and clinical characteristics of cerebral palsy (CP), concomitant with perinatal health indicators in the general population, remained unchanged for children born in Norway between 1999 and 2010. METHODS This national multi-register cohort study included 711 174 children recorded in the Medical Birth Registry of Norway. Among these, 707 916 were born alive, and 1664 had a validated diagnosis of CP recorded in the Cerebral Palsy Registry of Norway and/or the Norwegian Patient Registry. Prevalence per 1000 live births as a function of birth year was analyzed using logistic regression with fractional polynomials to allow for non-linear trends. Chi-square statistics were used to estimate trends in proportions of clinical characteristics. RESULTS The prevalence of CP in Norway decreased from 2.62 per 1000 live births in 1999 to 1.89 in 2010. The reduction was most evident among children with bilateral CP, in particular those with diplegia. During the study period, the proportions of children with severe motor impairments, epilepsy, intellectual impairment and reduced speech also decreased. At the same time, perinatal mortality has decreased in Norway, along with the proportion of women with preeclampsia, children born preterm or as a multiple. CONCLUSION We observed a significant decrease in the prevalence and severity of CP subtypes and associated impairments among children with CP in Norway. This coincided with improvements in perinatal health indicators in the general population. These improvements are most likely explained by advancements in obstetric and neonatal care.
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Algeri P, Callegari C, Bernasconi DP, Incerti M, Cozzolino S, Paterlini G, Mastrolia SA, Pellizzoni F, Vergani P. Neonatal hypoxia of the second twin after vaginal delivery of the first twin: what matters? . J Matern Fetal Neonatal Med 2018. [PMID: 29527962 DOI: 10.1080/14767058.2018.1451510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Optimal management of twin deliveries is controversial. We aimed to assess potential risk factors correlated to the development of hypoxia in the second twin after vaginal delivery of the first twin. Study design: This is a retrospective observational study including diamniotic twin pregnancies delivering at our Institution at 35 weeks of gestational age or more, weighing ≥1800 g. Hypoxia was defined as at least one of the following: Apgar score <5 at 10 minute, neonatal resuscitation for >10 minutes, neonatal acidosis (pH ≤7 and/or BE ≥12 mmol/L). Results: A number of 275 diamniotic twin pregnancies met the inclusion criteria and were divided within the following groups: (1) second twin not developing neonatal hypoxia (n = 265); and (2) second twin developing neonatal hypoxia (n = 10). The rate of second twins with neonatal hypoxia during the study period was 3.6% (10/275). Abnormal cardiotocography during the intertwin delivery interval, defined as ACOG category III, was significantly correlated to second twin hypoxia. Of interest, there was no significant difference in the intertwin delivery interval between the study groups. In addition, breech presentation of the second twin did not show to be a risk factor for neonatal hypoxia. None of the second twins developing neonatal hypoxia was reported to have encephalopathy (follow up of at least 24 months). At multivariate analysis, only abnormal cardiotocography was an independent risk factor for second twin hypoxia (OR 17.8, 95% CI 4.1-77.2). Conclusions: In our study, neonatal hypoxia was significantly correlated to abnormal cardiotocography, while intertwin delivery interval was not correlated to the development of this adverse neonatal outcome.
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Affiliation(s)
- Paola Algeri
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Clelia Callegari
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Davide Paolo Bernasconi
- b Department of Health Sciences , Center of Biostatistics for Clinical Epidemiology, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Maddalena Incerti
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Sabrina Cozzolino
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Giuseppe Paterlini
- c Neonatal Intensive Care Unit , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Salvatore Andrea Mastrolia
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Francesca Pellizzoni
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Patrizia Vergani
- a Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
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12
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Mohandas N, Bass-Stringer S, Maksimovic J, Crompton K, Loke YJ, Walstab J, Reid SM, Amor DJ, Reddihough D, Craig JM. Epigenome-wide analysis in newborn blood spots from monozygotic twins discordant for cerebral palsy reveals consistent regional differences in DNA methylation. Clin Epigenetics 2018; 10:25. [PMID: 29484035 PMCID: PMC5824607 DOI: 10.1186/s13148-018-0457-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral palsy (CP) is a clinical description for a group of motor disorders that are heterogeneous with respect to causes, symptoms and severity. A diagnosis of CP cannot usually be made at birth and in some cases may be delayed until 2–3 years of age. This limits opportunities for early intervention that could otherwise improve long-term outcomes. CP has been recorded in monozygotic twins discordant for the disorder, indicating a potential role of non-genetic factors such as intrauterine infection, hypoxia-ischaemia, haemorrhage and thrombosis. The aim of this exploratory study was to utilise the discordant monozygotic twin model to understand and measure epigenetic changes associated with the development of CP. Methods We performed a genome-wide analysis of DNA methylation using the Illumina Infinium Human Methylation 450 BeadChip array with DNA from newborn blood spots of 15 monozygotic twin pairs who later became discordant for CP. Quality control and data preprocessing were undertaken using the minfi R package. Differential methylation analysis was performed using the remove unwanted variation (RUVm) method, taking twin pairing into account in order to identify CP-specific differentially methylated probes (DMPs), and bumphunter was performed to identify differentially methylated regions (DMRs). Results We identified 33 top-ranked DMPs based on a nominal p value cut-off of p < 1 × 10−4 and two DMRs (p < 1 × 10−3) associated with CP. The top-ranked probes related to 25 genes including HNRNPL, RASSF5, CD3D and KALRN involved in immune signalling pathways, in addition to TBC1D24, FBXO9 and VIPR2 previously linked to epileptic encephalopathy. Gene ontology and pathway analysis of top-ranked DMP-associated genes revealed enrichment of inflammatory signalling pathways, regulation of cytokine secretion and regulation of leukocyte-mediated immunity. We also identified two top-ranked DMRs including one on chromosome 6 within the promoter region of LTA gene encoding tumour necrosis factor-beta (TNF-β), an important regulator of inflammation and brain development. The second was within the transcription start site of the LIME1 gene, which plays a key role in inflammatory pathways such as MAPK signalling. CP-specific differential DNA methylation within one of our two top DMRs was validated using an independent platform, MassArray EpiTyper. Conclusions Ours is the first epigenome-wide association study of CP in disease-discordant monozygotic twin pairs and suggests a potential role for immune dysfunction in this condition. Electronic supplementary material The online version of this article (10.1186/s13148-018-0457-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Namitha Mohandas
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia.,2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia
| | - Sebastian Bass-Stringer
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - Jovana Maksimovic
- 2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,Bioinformatics Group, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - Kylie Crompton
- 2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,4Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052 Australia.,5Neurodevelopment and Disability, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - Yuk J Loke
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - Janet Walstab
- 2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,4Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052 Australia
| | - Susan M Reid
- 2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,4Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052 Australia.,5Neurodevelopment and Disability, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - David J Amor
- 2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,4Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052 Australia.,5Neurodevelopment and Disability, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - Dinah Reddihough
- 2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,4Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052 Australia.,5Neurodevelopment and Disability, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia
| | - Jeffrey M Craig
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052 Australia.,2Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Victoria 3052 Australia.,6Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Victoria 3220 Australia
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Lee D, Pae C, Lee JD, Park ES, Cho SR, Um MH, Lee SK, Oh MK, Park HJ. Analysis of structure-function network decoupling in the brain systems of spastic diplegic cerebral palsy. Hum Brain Mapp 2017; 38:5292-5306. [PMID: 28731515 DOI: 10.1002/hbm.23738] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/08/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022] Open
Abstract
Manifestation of the functionalities from the structural brain network is becoming increasingly important to understand a brain disease. With the aim of investigating the differential structure-function couplings according to network systems, we investigated the structural and functional brain networks of patients with spastic diplegic cerebral palsy with periventricular leukomalacia compared to healthy controls. The structural and functional networks of the whole brain and motor system, constructed using deterministic and probabilistic tractography of diffusion tensor magnetic resonance images and Pearson and partial correlation analyses of resting-state functional magnetic resonance images, showed differential embedding of functional networks in the structural networks in patients. In the whole-brain network of patients, significantly reduced global network efficiency compared to healthy controls were found in the structural networks but not in the functional networks, resulting in reduced structural-functional coupling. On the contrary, the motor network of patients had a significantly lower functional network efficiency over the intact structural network and a lower structure-function coupling than the control group. This reduced coupling but reverse directionality in the whole-brain and motor networks of patients was prominent particularly between the probabilistic structural and partial correlation-based functional networks. Intact (or less deficient) functional network over impaired structural networks of the whole brain and highly impaired functional network topology over the intact structural motor network might subserve relatively preserved cognitions and impaired motor functions in cerebral palsy. This study suggests that the structure-function relationship, evaluated specifically using sparse functional connectivity, may reveal important clues to functional reorganization in cerebral palsy. Hum Brain Mapp 38:5292-5306, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dongha Lee
- Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal.,BK21 PLUS Project for Medical Science, Korea
| | - Chongwon Pae
- BK21 PLUS Project for Medical Science, Korea.,Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Doo Lee
- Department of Radiology and Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Eun Sook Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Hee Um
- BK21 PLUS Project for Medical Science, Korea
| | - Seung-Koo Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Maeng-Keun Oh
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Jeong Park
- BK21 PLUS Project for Medical Science, Korea.,Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Cognitive Science, Yonsei University, Seoul, Republic of Korea.,Center for Systems and Translational Brain Sciences, Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea
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14
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Meireles AL, Marques MR, Segabinazi E, Spindler C, Piazza FV, Salvalaggio GS, Augustin OA, Achaval M, Marcuzzo S. Association of environmental enrichment and locomotor stimulation in a rodent model of cerebral palsy: Insights of biological mechanisms. Brain Res Bull 2017; 128:58-67. [DOI: 10.1016/j.brainresbull.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/29/2016] [Accepted: 12/06/2016] [Indexed: 11/25/2022]
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15
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Eliasson AC, Holmström L, Aarne P, Nakeva von Mentzer C, Weiland AL, Sjöstrand L, Forssberg H, Tedroff K, Löwing K. Efficacy of the small step program in a randomised controlled trial for infants below age 12 months with clinical signs of CP; a study protocol. BMC Pediatr 2016; 16:175. [PMID: 27809886 PMCID: PMC5093986 DOI: 10.1186/s12887-016-0711-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 10/18/2016] [Indexed: 11/12/2022] Open
Abstract
Background Children with cerebral palsy (CP) have life-long motor disorders, and they are typically subjected to extensive treatment throughout their childhood. Despite this, there is a lack of evidence supporting the effectiveness of early interventions aiming at improving motor function, activity, and participation in daily life. The study will evaluate the effectiveness of the newly developed Small Step Program, which is introduced to children at risk of developing CP during their first year of life. The intervention is based upon theories of early learning-induced brain plasticity and comprises important components of evidence-based intervention approaches used with older children with CP. Method and design A two-group randomised control trial will be conducted. Invited infants at risk of developing CP due to a neonatal event affecting the brain will be randomised to either the Small Step Program or to usual care. They will be recruited from Astrid Lindgren Children’s Hospital at regular check-up and included at age 3–8 months. The Small Step Program was designed to provide individualized, goal directed, and intensive intervention focusing on hand use, mobility, and communication in the child’s own home environment and carried out by their parents who have been trained and coached by therapists. The primary endpoint will be approximately 35 weeks after the start of the intervention, and the secondary endpoint will be at 2 years of age. The primary outcome measure will be the Peabody Developmental Motor Scale (second edition). Secondary assessments will measure and describe the children’s general and specific development and brain pathology. In addition, the parents’ perspective of the program will be evaluated. General linear models will be used to compare outcomes between groups. Discussion This paper presents the background and rationale for developing the Small-Step Program and the design and protocol of a randomized controlled trial. The aim of the Small Step Program is to influence development by enabling children to function on a higher level than if not treated by the program and to evaluate whether the program will affect parent’s ability to cope with stress and anxiety related to having a child at risk of developing CP. Trial registration ClinicalTrials.gov Identifier NCT02166801. Registered June 12, 2014.
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Affiliation(s)
- Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Linda Holmström
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Päivikki Aarne
- Division of Speech and Language Pathology, Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ann-Louise Weiland
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Lena Sjöstrand
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Kristina Löwing
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
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16
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Hoon AH, Vasconcellos Faria A. Pathogenesis, neuroimaging and management in children with cerebral palsy born preterm. ACTA ACUST UNITED AC 2016; 16:302-12. [PMID: 25708073 DOI: 10.1002/ddrr.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/26/2011] [Indexed: 12/12/2022]
Abstract
With advances in obstetric and perinatal management, the incidence of intraventricular hemorrhage in premature infants has declined, while periventricular leukomalacia remains a significant concern. It is now known that brain injury in children born preterm also involves neuronal-axonal disease in supratentorial and infratentorial structures. The developing brain is especially vulnerable to white matter (WM) injury from 23 to 34 weeks gestation when blood vessels serving the periventricular WM are immature. Oligodendrocyte progenitors, which are beginning to form myelin during this time, are susceptible to attack from oxygen free radicals, glutamate, and inflammatory cytokines. Advances in imaging techniques such as diffusion tensor imaging provide a more complete picture of the location and extent of injury. Effective management of children born preterm with cerebral palsy is predicated on an understanding of sequential links from etiological antecedents to brain neuropathology as revealed with neuroimaging techniques to clinical phenotypes, toward focused interventions with measurable outcomes.
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Affiliation(s)
- Alexander H Hoon
- Johns Hopkins University School of Medicine, Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland.
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17
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Andersen EW, Leventer RJ, Reddihough DS, Davis MR, Ryan MM. Cerebral palsy is not a diagnosis: A case report of a novel atlastin-1 mutation. J Paediatr Child Health 2016; 52:669-71. [PMID: 27333849 DOI: 10.1111/jpc.13200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Erik W Andersen
- Children's Neurosciences Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Richard J Leventer
- Children's Neurosciences Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
| | - Dinah S Reddihough
- Department of Developmental Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
| | - Mark R Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Monique M Ryan
- Children's Neurosciences Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
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18
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Srivastava IN, Shperdheja J, Baybis M, Ferguson T, Crino PB. mTOR pathway inhibition prevents neuroinflammation and neuronal death in a mouse model of cerebral palsy. Neurobiol Dis 2015; 85:144-154. [PMID: 26459113 DOI: 10.1016/j.nbd.2015.10.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/23/2015] [Accepted: 10/08/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Mammalian target of rapamycin (mTOR) pathway signaling governs cellular responses to hypoxia and inflammation including induction of autophagy and cell survival. Cerebral palsy (CP) is a neurodevelopmental disorder linked to hypoxic and inflammatory brain injury however, a role for mTOR modulation in CP has not been investigated. We hypothesized that mTOR pathway inhibition would diminish inflammation and prevent neuronal death in a mouse model of CP. METHODS Mouse pups (P6) were subjected to hypoxia-ischemia and lipopolysaccharide-induced inflammation (HIL), a model of CP causing neuronal injury within the hippocampus, periventricular white matter, and neocortex. mTOR pathway inhibition was achieved with rapamycin (an mTOR inhibitor; 5mg/kg) or PF-4708671 (an inhibitor of the downstream p70S6kinase, S6K, 75 mg/kg) immediately following HIL, and then for 3 subsequent days. Phospho-activation of the mTOR effectors p70S6kinase and ribosomal S6 protein and expression of hypoxia inducible factor 1 (HIF-1α) were assayed. Neuronal cell death was defined with Fluoro-Jade C (FJC) and autophagy was measured using Beclin-1 and LC3II expression. Iba-1 labeled, activated microglia were quantified. RESULTS Neuronal death, enhanced HIF-1α expression, and numerous Iba-1 labeled, activated microglia were evident at 24 and 48 h following HIL. Basal mTOR signaling, as evidenced by phosphorylated-S6 and -S6K levels, was unchanged by HIL. Rapamycin or PF-4,708,671 treatment significantly reduced mTOR signaling, neuronal death, HIF-1α expression, and microglial activation, coincident with enhanced expression of Beclin-1 and LC3II, markers of autophagy induction. CONCLUSIONS mTOR pathway inhibition prevented neuronal death and diminished neuroinflammation in this model of CP. Persistent mTOR signaling following HIL suggests a failure of autophagy induction, which may contribute to neuronal death in CP. These results suggest that mTOR signaling may be a novel therapeutic target to reduce neuronal cell death in CP.
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Affiliation(s)
- Isha N Srivastava
- Shriners Hospitals Pediatric Research Center, Temple University School of Medicine, Philadelphia, PA 19140, United States
| | - Jona Shperdheja
- Shriners Hospitals Pediatric Research Center, Temple University School of Medicine, Philadelphia, PA 19140, United States
| | - Marianna Baybis
- Shriners Hospitals Pediatric Research Center, Temple University School of Medicine, Philadelphia, PA 19140, United States
| | - Tanya Ferguson
- Shriners Hospitals Pediatric Research Center, Temple University School of Medicine, Philadelphia, PA 19140, United States
| | - Peter B Crino
- Shriners Hospitals Pediatric Research Center, Temple University School of Medicine, Philadelphia, PA 19140, United States.
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Fate at 2 years of children with risk of developmental disorders followed by the network Grandir en Languedoc Roussillon: Effect of isolated or associated motor development disorders. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cao J, Khan B, Hervey N, Tian F, Delgado MR, Clegg NJ, Smith L, Roberts H, Tulchin-Francis K, Shierk A, Shagman L, MacFarlane D, Liu H, Alexandrakis G. Evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy based on functional near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:046009. [PMID: 25900145 PMCID: PMC4479242 DOI: 10.1117/1.jbo.20.4.046009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/30/2015] [Indexed: 05/04/2023]
Abstract
Sensorimotor cortex plasticity induced by constraint-induced movement therapy (CIMT) in six children (10.2±2.1 years old) with hemiplegic cerebral palsy was assessed by functional near-infrared spectroscopy (fNIRS). The activation laterality index and time-to-peak/duration during a finger-tapping task and the resting-state functional connectivity were quantified before, immediately after, and 6 months after CIMT. These fNIRS-based metrics were used to help explain changes in clinical scores of manual performance obtained concurrently with imaging time points. Five age-matched healthy children (9.8±1.3 years old) were also imaged to provide comparative activation metrics for normal controls. Interestingly, the activation time-to-peak/duration for all sensorimotor centers displayed significant normalization immediately after CIMT that persisted 6 months later. In contrast to this improved localized activation response, the laterality index and resting-state connectivity metrics that depended on communication between sensorimotor centers improved immediately after CIMT, but relapsed 6 months later. In addition, for the subjects measured in this work, there was either a trade-off between improving unimanual versus bimanual performance when sensorimotor activation patterns normalized after CIMT, or an improvement occurred in both unimanual and bimanual performance but at the cost of very abnormal plastic changes in sensorimotor activity.
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Affiliation(s)
- Jianwei Cao
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Bilal Khan
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Nathan Hervey
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Fenghua Tian
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Mauricio R. Delgado
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
- University of Texas Southwestern Medical Center at Dallas, Department of Neurology, Dallas, Texas 75235, United States
| | - Nancy J. Clegg
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Linsley Smith
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Heather Roberts
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Kirsten Tulchin-Francis
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Angela Shierk
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Laura Shagman
- University of Texas at Dallas, Department of Electrical Engineering, Richardson, Texas 75080, United States
| | - Duncan MacFarlane
- University of Texas at Dallas, Department of Electrical Engineering, Richardson, Texas 75080, United States
| | - Hanli Liu
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - George Alexandrakis
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
- Address all correspondence to: George Alexandrakis, E-mail:
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Potential neuroprotective strategies for perinatal infection and inflammation. Int J Dev Neurosci 2015; 45:44-54. [DOI: 10.1016/j.ijdevneu.2015.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 01/17/2023] Open
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Bunata R, Icenogle K. Cerebral palsy of the elbow and forearm. J Hand Surg Am 2014; 39:1425-32. [PMID: 24969499 DOI: 10.1016/j.jhsa.2013.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 02/02/2023]
Abstract
Management of elbow and forearm involvement in cerebral palsy has evolved over the last 3 decades with a better understanding of its neuropathophysiology, improved outcome measures, and evolving therapy protocols. Current nonoperative and surgical treatment methods are discussed. The use of standard function measuring instruments and encouragement of the participation in research will hopefully result in more accurate outcome information and, thereby, refine our techniques and rehabilitation methods.
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Affiliation(s)
- Robert Bunata
- University of North Texas Health Science Center/Cook Children's Hospital; and the University of North Texas Health Science Center, Tarrant County Affiliated Orthopedic Residency Program, Fort Worth, TX.
| | - Kurt Icenogle
- University of North Texas Health Science Center/Cook Children's Hospital; and the University of North Texas Health Science Center, Tarrant County Affiliated Orthopedic Residency Program, Fort Worth, TX
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Tupikowski K, Biały A, Dembowski J, Złotkiewicz M, Guziński M, Kołodziej AK, Zdrojowy R. Kidney angiomyolipoma in pregnancy. Cent European J Urol 2014; 66:434-6. [PMID: 24757536 PMCID: PMC3992443 DOI: 10.5173/ceju.2013.04.art11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/12/2013] [Accepted: 11/06/2013] [Indexed: 11/22/2022] Open
Abstract
Neoplasms are rare in pregnant women, however they are always a challenging diagnostic and curative problem. We present a case of a benign kidney tumor (angiomyolipoma) imitating nephroblastoma on magnetic resonance diagnosed in pregnancy. Cesarean section was performed in 29. gestotic week followed immediately by right radical nephrectomy.
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Affiliation(s)
- Krzysztof Tupikowski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Aleksander Biały
- Department of Urology and Oncological Urology, University Clinical Hospital in Wrocław, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Monika Złotkiewicz
- Department of Urology and Oncological Urology, University Clinical Hospital in Wrocław, Wrocław, Poland
| | - Maciej Guziński
- Department of General Radiology, Inerventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland
| | - Anna Karina Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
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Abstract
OBJECTIVE To investigate the link between infection-related risk factors for cerebral palsy subtypes in children born at term. METHODS A case-control study was performed in a population-based series of children with cerebral palsy born at term (n=309) matched with a control group (n=618). The cases were divided into cerebral palsy subtypes: spastic hemiplegia, spastic diplegia, spastic tetraplegia, and dyskinetic cerebral palsy. All forms of spastic cerebral palsy were also analyzed together. All records were examined for maternal and neonatal signs of infection. Univariate and adjusted analyses were performed. RESULTS Infection-related risk factors were shown to be independent risk factors for spastic cerebral palsy in the adjusted analyses. This was especially pronounced in the subgroup with spastic hemiplegia in which bacterial growth in urine during pregnancy (n=11 [7.5%], odds ratio [OR] 4.7, 95% confidence interval [CI] 1.5-15.2), any infectious disease during pregnancy (n=57 [39.0%], OR 2.9, 95% CI 1.7-4.8), severe infection during pregnancy (n=12 [8.2%], OR 15.4, 95% CI 3.0-78.1), antibiotic therapy once during pregnancy (n=33 [22.6%], OR 6.3, 95% CI 3.0-15.2) as well as several times during pregnancy (n=9 [6.2%], OR 15.6, 95% CI 1.8-134.2) constituted strong independent risk factors. However, only neonatal infection (n=11 [9.1%], OR 14.7, 95% CI 1.7-126.5) was independently significantly associated with an increased risk of spastic diplegia and tetraplegia. CONCLUSIONS Infection-related factors are strong independent risk factors for the subgroup with spastic hemiplegia in children with cerebral palsy born at term. The finding is less pronounced in the subgroups with spastic diplegia or tetraplegia. LEVEL OF EVIDENCE II.
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Chaturvedi SK, Rai Y, Chourasia A, Goel P, Paliwal VK, Garg RK, Rathore RKS, Pandey CM, Gupta RK. Comparative assessment of therapeutic response to physiotherapy with or without botulinum toxin injection using diffusion tensor tractography and clinical scores in term diplegic cerebral palsy children. Brain Dev 2013; 35:647-53. [PMID: 23165172 DOI: 10.1016/j.braindev.2012.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/20/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
The present study was to compare the effects of combined therapy [botulinum (BTX) plus physiotherapy] with physiotherapy alone using diffusion tensor imaging (DTI) derived fractional anisotropy (FA) values of motor and sensory fiber bundles and clinical grade of the disability to see the value of BTX in term children with spastic diplegic cerebral palsy (CP). Clinically diagnosed 36 children participated in the study. All these children were born at term, and had no history of seizures. The study was randomly categorized into two groups: group I (n=18) - physiotherapy alone and group II (n=18) - physiotherapy plus BTX injection. Quantitative diffusion tensor tractography on all these children was performed on motor and sensory fiber bundles on baseline as well as after 6months of therapy. Motor function and clinical grades were also measured by gross motor function measures (GMFM) scale on both occasions. We observed significant change in FA value in motor and sensory fiber bundle as well as in GMFM scores at 6months compared to baseline study in both the groups. However, delta change and relative delta change in FA values of sensory and motor fiber bundle as well as GMFM score between group I and group II was statistically insignificant. We conclude that addition of BTX to physiotherapy regimen does not influence the outcome at 6months with similar insult in children with term diplegic spastic CP. This information may influence management of diplegic CP especially in developing countries, where BTX is beyond the reach of these children.
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Affiliation(s)
- Saurabh K Chaturvedi
- Magnetic Resonance Section, Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Park HJ, Kim CH, Park ES, Park B, Oh SR, Oh MK, Park CI, Lee JD. Increased GABA-A Receptor Binding and Reduced Connectivity at the Motor Cortex in Children with Hemiplegic Cerebral Palsy: A Multimodal Investigation Using 18F-Fluoroflumazenil PET, Immunohistochemistry, and MR Imaging. J Nucl Med 2013; 54:1263-9. [DOI: 10.2967/jnumed.112.117358] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Koy A, Hellmich M, Pauls KAM, Marks W, Lin JP, Fricke O, Timmermann L. Effects of deep brain stimulation in dyskinetic cerebral palsy: A meta-analysis. Mov Disord 2013; 28:647-54. [DOI: 10.1002/mds.25339] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology; University of Cologne; Germany
| | | | - Warren Marks
- Department of Pediatric Neurology; Cook Children's Medical Center; Fort Worth; Texas; United States of America
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Pediatric Neuroscience; Guy's & St Thomas' Hospitals Foundation Trust & King's College Hospital Foundation Trust, King's Health Partners; London; United Kingdom
| | - Oliver Fricke
- Department of Pediatric Neurology; University Hospital; Cologne; Germany
| | - Lars Timmermann
- Department of Neurology; University Hospital Cologne; Germany
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Affiliation(s)
- Nadia Badawi
- Macquarie Group Foundation, Cerebral Palsy Institute, University of Notre Dame, Sydney, New South Wales, Australia.
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Morokuma S, Fukushima K, Otera Y, Yumoto Y, Tsukimori K, Ochiai M, Hara T, Wake N. Ultrasound evaluation of fetal brain dysfunction based on behavioral patterns. Brain Dev 2013; 35:61-7. [PMID: 22321861 DOI: 10.1016/j.braindev.2012.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/13/2012] [Accepted: 01/14/2012] [Indexed: 10/14/2022]
Abstract
To identify fetuses at high risk of poor neurological outcomes using a novel ultrasound evaluation system. We assessed an ultrasound evaluation system based on our previous findings, consisting of screening for decreased or lack of fetal movements, abnormal patterns of fetal heart rate, congenital CNS malformations, polyhydramnios of unknown cause, and a "brief ultrasound evaluation" of fetal brain functions, including movement of extremities, breathing movements, ultradian rhythm, REM period, and NREM period. We then assessed the correlation between fetal brain functions and neurological outcomes in infancy (MR, CP, and low Developmental Quotient). During screening, we prospectively evaluated 4978 fetuses receiving prenatal and intrapartum management between January 2000 and December 2009 in our hospital that were later delivered between 32 and 41 weeks' gestation and identified 93 cases as suspicious for impairment. Of the 93 fetuses, 26 underwent the second step of brief ultrasound examination at 35-40 weeks' gestation. Our findings revealed that this method was adequately sensitive (80%) and specific (88%) in identifying neurological impairment. We concluded that this method was mainly useful in the clinical setting for establishing the first indication for fetal CNS examination for functional impairment, rendering it suitable for clinical application.
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Affiliation(s)
- Seiichi Morokuma
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
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The influence of spatial working memory on ipsilateral remembered proprioceptive matching in adults with cerebral palsy. Exp Brain Res 2012; 223:259-69. [DOI: 10.1007/s00221-012-3256-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 08/31/2012] [Indexed: 11/24/2022]
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Abstract
Cerebral palsy is caused by injury or developmental disturbances to the immature brain and leads to substantial motor, cognitive, and learning deficits. In addition to developmental disruption associated with the initial insult to the immature brain, injury processes can persist for many months or years. We suggest that these tertiary mechanisms of damage might include persistent inflammation and epigenetic changes. We propose that these processes are implicit in prevention of endogenous repair and regeneration and predispose patients to development of future cognitive dysfunction and sensitisation to further injury. We suggest that treatment of tertiary mechanisms of damage might be possible by various means, including preventing the repressive effects of microglia and astrocyte over-activation, recapitulating developmentally permissive epigenetic conditions, and using cell therapies to stimulate repair and regeneration Recognition of tertiary mechanisms of damage might be the first step in a complex translational task to tailor safe and effective therapies that can be used to treat the already developmentally disrupted brain long after an insult.
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Genetic [corrected] insights into the causes and classification of [corrected] cerebral palsies. Lancet Neurol 2012; 11:283-92. [PMID: 22261432 DOI: 10.1016/s1474-4422(11)70287-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cerebral palsy-the most common physical disability of childhood-is a clinical diagnosis encompassing a heterogeneous group of neurodevelopmental disorders that cause impairments of movement and posture that persist throughout life. Despite being commonly attributed to a range of environmental factors, particularly birth asphyxia, the specific cause of cerebral palsy remains unknown in most individuals. A growing body of evidence suggests that cerebral palsy is probably caused by multiple genetic factors, similar to other neurodevelopmental disorders such as autism and intellectual disability. Recent advances in next-generation sequencing technologies have made possible rapid and cost-effective sequencing of the entire human genome. Novel cerebral palsy genes will probably be identified as more researchers and clinicians use this approach to study individuals with undiagnosed neurological disorders. As our knowledge of the underlying pathophysiological mechanisms of cerebral palsy increases, so will the possibility of developing genomically guided therapeutic interventions.
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The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study. Eur J Paediatr Neurol 2012; 16:56-63. [PMID: 22104566 DOI: 10.1016/j.ejpn.2011.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 09/17/2011] [Accepted: 10/23/2011] [Indexed: 11/21/2022]
Abstract
AIMS To examine the effects of multiple risk factors on cerebral palsy (CP). MATERIALS/METHODS For 176,591 Norwegian infants born 1996-98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry. RESULTS In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity (p < 0.001 vs. term), and 5% had five or more (p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term (p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction. CONCLUSIONS The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.
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Costantine MM, Drever N. Antenatal Exposure to Magnesium Sulfate and Neuroprotection in Preterm Infants. Obstet Gynecol Clin North Am 2011; 38:351-66, xi. [DOI: 10.1016/j.ogc.2011.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sukhov A, Wu Y, Xing G, Smith LH, Gilbert WM. Risk factors associated with cerebral palsy in preterm infants. J Matern Fetal Neonatal Med 2011; 25:53-7. [DOI: 10.3109/14767058.2011.564689] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Braga LW, Borigato EVM, Speck-Martins CE, Imamura EU, Gorges AMP, Izumi AP, Dantas RC, Nunes LGN. Apolipoprotein E genotype and cerebral palsy. Dev Med Child Neurol 2010; 52:666-71. [PMID: 20002130 DOI: 10.1111/j.1469-8749.2009.03465.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Apolipoprotein E (APOE, protein; [ApoE, gene]) is a lipid transport protein abundantly present in brain cells. We investigated whether the APOE genotype is associated with cerebral palsy (CP) and whether patients with CP with comorbid conditions and more severe neurological deficits are likely to have a particular genotype. METHOD In a cross-sectional study, 243 individuals with spastic CP (135 males, 108 females; mean age at data collection 11 year ([SD 6y 7mo], 34% with hemiplegia, 37% with diplegia, 29% with triplegia/tetraplegia; 44% with mild motor involvement), 31% with moderate motor involvement, 25% with severe motor involvement, were compared with healthy individuals matched by age, race, and sex to analyse the association between APOE genotype and the incidence of CP. Associations between the APOE genotype and the incidence of comorbidities and neurological deficits were studied in the group with CP. RESULTS The APOE epsilon2epsilon3 genotype was significantly more prevalent in the group with CP (11%) than the comparison group (5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.01-7.66). The presence of the epsilon2 allele raised the probability of having CP (OR 3.2; 95% CI 1.27-8.27). The presence of ApoE epsilon4 was not significantly different among groups. No relation was found between APOE genotype and severity of neurological deficit or distribution of motor involvement. Four patients with CP presented the epsilon4epsilon4 genotype, and all exhibited epilepsy and microcephaly. Eleven of 12 individuals with CP and macrocephaly carried the epsilon3epsilon3 genotype. INTERPRETATION A higher prevalence of the APOE epsilon2 genotype was found among those with CP. The association of microcephaly and epilepsy with the epsilon4epsilon4 genotype and the association of macrocephaly with epsilon3 demand further investigation.
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Affiliation(s)
- Lucia W Braga
- Neuropsychology Department, SARAH Network of Rehabilitation Hospitals, SMHS Quadra 501 CJ. A Trreo, Brasilia DF, Brazil.
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Himpens E, Oostra A, Franki I, Vansteelandt S, Vanhaesebrouck P, den Broeck CV. Predictability of cerebral palsy in a high-risk NICU population. Early Hum Dev 2010; 86:413-7. [PMID: 20542648 DOI: 10.1016/j.earlhumdev.2010.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 05/17/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
Abstract
AIM This study aims to create a predictive model for the assessment of the individual risk of developing cerebral palsy in a large cohort of selected high-risk infants. PATIENTS AND METHODS 1099 NICU-admitted high-risk infants were assessed up to the corrected age of at least 12 months. CP was categorized relative to subtype, distribution and severity. Several perinatal characteristics (gender, gestational age, multiple gestation, small for gestational age, perinatal asphyxia and duration of mechanical ventilation), besides neonatal cerebral ultrasound data were used in the logistic regression model for the risk of CP. RESULTS Perinatal asphyxia, mechanical ventilation>7 days, white matter disease except for transient echodensities<7 days, intraventricular haemorrhage grades III and IV, cerebral infarction and deep grey matter lesions were recognized as independent predictors for the development of CP. 95% of all children with CP were correctly identified at or above the cut-off value of 4.5% probability of CP development. Higher gestational age, perinatal asphyxia and deep grey matter lesion are independent predictors for non-spastic versus spastic CP (OR=1.1, 3.6, and 7.5, respectively). Independent risk factors for prediction of unilateral versus bilateral spastic CP are higher gestational age, cerebral infarction and parenchymal haemorrhagic infarction (OR=1.2, 31, and 17.6, respectively). Perinatal asphyxia is the only significant variable retained for the prediction of severe CP versus mild or moderate CP. CONCLUSION The presented model based on perinatal characteristics and neonatal US-detected brain injuries is a useful tool in identifying specific infants at risk for developing CP.
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Moore LJS, Allegrante JP, Palma M, Lewin J, Carlson MG. Assessment of Quality of Life Needs of Children With Mild Hemiplegic Cerebral Palsy. CHILDRENS HEALTH CARE 2010. [DOI: 10.1080/02739611003679980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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HOON ALEXANDERH, STASHINKO ELAINEE, NAGAE LIDIAM, LIN DORISDM, KELLER JENNIFER, BASTIAN AMY, CAMPBELL MICHELLEL, LEVEY ERIC, MORI SUSUMU, JOHNSTON MICHAELV. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Dev Med Child Neurol 2009; 51:697-704. [PMID: 19416315 PMCID: PMC2908264 DOI: 10.1111/j.1469-8749.2009.03306.x] [Citation(s) in RCA: 229] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Cerebral palsy (CP) is frequently linked to white matter injury in children born preterm. Diffusion tensor imaging (DTI) is a powerful technique providing precise identification of white matter microstructure. We investigated the relationship between DTI-observed thalamocortical (posterior thalamic radiation) injury, motor (corticospinal tract) injury, and sensorimotor function. METHOD Twenty-eight children born preterm (16 males, 12 females; mean age 5y 10mo, SD 2y 6mo, range 16mo-13y; mean gestational age at birth 28wks, SD 2.7wks, range 23-34wks) were included in this case-control study. Twenty-one children had spastic diplegia, four had spastic quadriplegia, two had hemiplegia, and one had ataxic/hypotonic CP; 15 of the participants walked independently. Normative comparison data were obtained from 35 healthy age-matched children born at term (19 males, 16 females; mean age 5y 9mo, SD 4y 4mo, range 15mo-15y). Two-dimensional DTI color maps were created to evaluate 26 central white matter tracts, which were graded by a neuroradiologist masked to clinical status. Quantitative measures of touch, proprioception, strength (dynamometer), and spasticity (modified Ashworth scale) were obtained from a subset of participants. RESULTS All 28 participants with CP had periventricular white-matter injury on magnetic resonance imaging. Using DTI color maps, there was more severe injury in the posterior thalamic radiation pathways than in the descending corticospinal tracts. Posterior thalamic radiation injury correlated with reduced contralateral touch threshold, proprioception, and motor severity, whereas corticospinal tract injury did not correlate with motor or sensory outcome measures. INTERPRETATION These findings extend previous research demonstrating that CP in preterm children reflects disruption of thalamocortical connections as well as descending corticospinal pathways.
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Affiliation(s)
- ALEXANDER H HOON
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - ELAINE E STASHINKO
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - LIDIA M NAGAE
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - DORIS DM LIN
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - JENNIFER KELLER
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, USA
| | - AMY BASTIAN
- Motion Analyses Laboratory, Kennedy Krieger Institute, Baltimore, MD, USA
| | - MICHELLE L CAMPBELL
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - ERIC LEVEY
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - SUSUMU MORI
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - MICHAEL V JOHNSTON
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA, Departments of Neurology, Pediatrics, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Vimercati A, Scioscia M, Nardelli C, Panella E, Laforgia N, Decosmo L, Selvaggi LE. Are active labour and mode of delivery still a challenge for extremely low birth weight infants? Experience at a tertiary care hospital. Eur J Obstet Gynecol Reprod Biol 2009; 145:154-7. [DOI: 10.1016/j.ejogrb.2009.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/12/2009] [Accepted: 04/21/2009] [Indexed: 11/17/2022]
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Using proteomics in perinatal and neonatal sepsis: hopes and challenges for the future. Curr Opin Infect Dis 2009; 22:235-43. [PMID: 19395960 DOI: 10.1097/qco.0b013e32832a5963] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Particularities of the fetal immune response to infection cause a heightened inflammatory state that acts synergistically with microbial insult to induce damage. Proteomics offers the opportunity for detecting fetuses at risk of sepsis and neurological injury. RECENT FINDINGS Molecular tools (16S-rRNA) demonstrate that the diversity of microbial agents of intra-amniotic infection exceeds what is suspected clinically or is documented by cultures. The resulting inflammatory process has the potential to damage the fetus in utero. Stepwise algorithms (mass restricted score) have been developed to extract proteomic profiles characteristic of amniotic fluid inflammation. The mass restricted score includes four proteomic biomarkers: defensin-2, defensin-1, S100A12, and S100A8 proteins. Other amniotic fluid biomarkers relevant for preterm birth are S100A9 and insulin-like growth factor-binding protein 1. S100A12 - ligand for the receptor of advanced glycation end products - has the strongest association with histological chorioamnionitis and funisitis. Presence of S100A12 and S100A8 in amniotic fluid is predictive of early-onset neonatal sepsis and poor neurodevelopmental outcome. SUMMARY Presence of amniotic fluid proteomic biomarkers of inflammation is associated with increased inflammatory status of the fetus at birth. Future challenges are to find biomarkers that provide insight into molecular mechanisms of chronic fetal and neonatal cellular damage and to identify candidates for early neuroprotection strategies.
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Berger A, Witt A, Haiden N, Kaider A, Klebermasz K, Fuiko R, Langgartner M, Pollak A. Intrauterine infection with Ureaplasma species is associated with adverse neuromotor outcome at 1 and 2 years adjusted age in preterm infants. J Perinat Med 2009; 37:72-8. [PMID: 18976044 DOI: 10.1515/jpm.2009.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate the association between the presence of bacterial pathogens in the amniotic cavity at the time of preterm delivery and neuromotor outcome at two years adjusted age in preterm infants born at < or =33 weeks' gestation. METHODS The cohort included 114 preterm infants, born at 23-33 weeks' gestation to mothers with amniotic cavity cultures taken during cesarean delivery who were subsequently evaluated at 24.0+/-1.1 months corrected age with the Bayley Scales of Infant Development II and a standardized neurologic examination. RESULTS A group of 67 infants with negative amniotic cavity cultures was compared to 47 infants with positive amniotic cavity cultures (Ureaplasma urealyticum (Uu) in 32 cases and other bacteria in 15 cases). Patients with positive amniotic cavity cultures had a significantly higher risk for an adverse psychomotor development index (PDI) score (OR 3.1, CI 1.3-7.1), an abnormal neurologic outcome (OR 4.8, CI 1.7-13.8), and a higher probability for diagnosis of cerebral palsy (OR 4.8, CI 1.4-16.4) at two years compared to patients with negative culture results. Isolation of Uu at birth was associated with a particular adverse outcome of preterm infants. CONCLUSIONS Isolation of pathogens from the amniotic cavity at birth is significantly associated with abnormal PDI and adverse neuromotor outcome in preterm infants, irrespective of gestational age and birthweight.
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Affiliation(s)
- Angelika Berger
- Department of Pediatrics, Medical University Vienna, Austria.
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Buhimschi CS, Dulay AT, Abdel-Razeq S, Zhao G, Lee S, Hodgson EJ, Bhandari V, Buhimschi IA. Fetal inflammatory response in women with proteomic biomarkers characteristic of intra-amniotic inflammation and preterm birth. BJOG 2009; 116:257-67. [PMID: 18947340 PMCID: PMC3791329 DOI: 10.1111/j.1471-0528.2008.01925.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the relationship between presence of amniotic fluid (AF) biomarkers characteristic of inflammation (defensins 2 and 1 and calgranulins C and A) and fetal inflammatory status at birth. DESIGN Prospective observational cohort. SETTING Tertiary referral University hospital. POPULATION One hundred and thirty-two consecutive mothers (gestational age, median [interquartile range]: 29.6 [24.1-33.1] weeks) who had a clinically indicated amniocentesis to rule out infection and their newborns. METHODS Intra-amniotic inflammation was diagnosed by mass spectrometry surface-enhanced-laser-desorption-ionization time of flight (SELDI-TOF). The AF proteomic fingerprint (mass-restricted [MR] score) ranges from 0-4 (none to all biomarkers present). The intensity of intra-amniotic inflammation was graded based on the number of proteomic biomarkers: MR score 0: 'no' inflammation, MR score 1-2: 'minimal' inflammation and MR score 3-4: 'severe' inflammation. At birth, cord blood was obtained for all women. Severity of histological chorioamnionitis and early-onset neonatal sepsis (EONS) was based on established histological and haematological criteria. Interleukin-6 (IL-6) levels were measured by sensitive immunoassays. The cord blood-to-AF IL-6 ratio was used as an indicator of the differential inflammatory response in the fetal versus the AF compartment. MAIN OUTCOME MEASURES To relate proteomic biomarkers of intra-amniotic infection to cord blood IL-6 and to use the latter as the primary marker of fetal inflammatory response. RESULTS Women with intra-amniotic inflammation delivered at an earlier gestational age (analysis of variance, P<0.001) and had higher AF IL-6 levels (P<0.001). At birth, neonates of women with severe intra-amniotic inflammation had higher cord blood IL-6 levels (P=0.002) and a higher frequency of EONS (P=0.002). EONS was characterised by significantly elevated cord blood IL-6 levels (P<0.001). Of the 39 neonates delivered by mothers with minimal intra-amniotic inflammation, 15 (39%) neonates had umbilical cord blood IL-6 levels above the mean for the group and 2 neonates had confirmed sepsis. The severity of the neutrophilic infiltrate in the chorionic plate (P<0.001), choriodecidua (P=0.002), umbilical cord (P<0.001) but not in the amnion (P>0.05) was an independent predictor of the cord blood-to-AF IL-6 ratio. Relationships were maintained following correction for gestational age, birthweight, amniocentesis-to-delivery interval, caesarean delivery, status of the membranes, race, MR score and antibiotics and steroid exposure. CONCLUSIONS We provide evidence that presence of proteomic biomarkers characteristic of inflammation in the AF is associated with an increased inflammatory status of the fetus at birth. Neonates mount an increased inflammatory status and have positive blood cultures even in the context of minimal intra-amniotic inflammation.
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Affiliation(s)
- C S Buhimschi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.
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Antenatal Antecedents and the Impact of Obstetric Care in the Etiology of Cerebral Palsy. Clin Obstet Gynecol 2008; 51:775-86. [DOI: 10.1097/grf.0b013e3181870994] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Accardo PJ, Hoon AH. The challenge of cerebral palsy classification: the ELGAN study. J Pediatr 2008; 153:451-2. [PMID: 18847614 DOI: 10.1016/j.jpeds.2008.05.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 05/21/2008] [Indexed: 11/29/2022]
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Kramer MR, Hogue CR. Place matters: variation in the black/white very preterm birth rate across U.S. metropolitan areas, 2002-2004. Public Health Rep 2008; 123:576-85. [PMID: 18828412 PMCID: PMC2496930 DOI: 10.1177/003335490812300507] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We reported on the distribution of very preterm (VPT) birth rates by race across metropolitan statistical areas (MSAs). METHODS Rates of singleton VPT birth for non-Hispanic white, non-Hispanic black, and Hispanic women were calculated with National Center for Health Statistics 2002-2004 natality files for infants in 168 MSAs. Subanalysis included stratification by parity, age, smoking, maternal education, metropolitan size, region, proportion of MSA that was black, proportion of black population living below the poverty line, and indices of residential segregation. RESULTS The mean metropolitan-level VPT birth rate was 12.3, 34.8, and 15.7 per 1,000 live births for white, black, and Hispanic women, respectively. There was virtually no overlap in the white and black distributions. The variation in mean risk across cities was three times greater for black women compared with white women. The threefold disparity in mean rate, and two- to threefold increased variation as indicated by standard deviation, was maintained in all subanalyses. CONCLUSION Compared with white women, black women have three times the mean VPT birth risk, as well as three times the variance in city-level rates. The racial disparity in VPT birth rates was composed of characteristics that were constant across MSAs, as well as factors that varied by MSA. The increased sensitivity to place for black women was unexplained by measured maternal and metropolitan factors. Understanding determinants of differences in both the mean risk and the variation of risk among black and white women may contribute to reducing the disparity in risk between races.
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Affiliation(s)
- Michael R Kramer
- Women and Children's Center, Department of Epidemiology, Rollins School of Public Health, Emory University, Room 257-C, 1518 Clifton Rd., Atlanta, GA 30322, USA.
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Abstract
Extreme prematurity confers about a 100-fold increase in the risk of cerebral palsy (CP), relative to birth at term gestation. Although CP is primarily a disorder of movement, many children with this disorder have other impairments which may affect their quality of life and life expectancy. Epidemiologic and clinical studies of cerebral palsy have benefited from recent efforts to develop greater uniformity of definition and classification. Particularly noteworthy is the development of the Gross Motor Function Classification System, which is a reliable and valid measure used with increasing frequency in observational and experimental studies. Also of great importance are efforts to quantify reliably the quality of life for children with cerebral palsy, thereby providing a target for medical and community interventions that aim to increase participation and well-being among affected children. During the late 1970s and early 1980s, the rate of CP actually rose, presumably as a result of increased survival of especially vulnerable infants who otherwise would have died. In developed countries over the past two decades (late 1980s to present), CP rates have been either stable or decreasing. Although considerable effort is being directed at prevention, the only perinatal interventions for which there is strong evidence of a beneficial effect on both mortality and the risk of CP is antenatal treatment of the mother with glucocorticoid.
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Affiliation(s)
- Michael O'Shea
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Nagae LM, Hoon AH, Stashinko E, Lin D, Zhang W, Levey E, Wakana S, Jiang H, Leite CC, Lucato LT, van Zijl PCM, Johnston MV, Mori S. Diffusion tensor imaging in children with periventricular leukomalacia: variability of injuries to white matter tracts. AJNR Am J Neuroradiol 2007; 28:1213-22. [PMID: 17698519 PMCID: PMC7977654 DOI: 10.3174/ajnr.a0534] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging shows evidence of brain injury and/or maldevelopment in 70%-90% of children with cerebral palsy (CP), though its capability to identify specific white matter tract injury is limited. The great variability of white matter lesions in CP already demonstrated by postmortem studies is thought to be one of the reasons why response to treatment is so variable. Our hypothesis is that diffusion tensor imaging (DTI) is a suitable technique to provide in vivo characterization of specific white matter tract lesions in children with CP associated with periventricular leukomalacia (PVL). MATERIALS AND METHODS In this study, 24 children with CP associated with PVL and 35 healthy controls were evaluated with DTI. Criteria for identification of 26 white matter tracts on the basis of 2D DTI color-coded maps were established, and a qualitative scoring system, based on visual inspection of the tracts in comparison with age-matched controls, was used to grade the severity of abnormalities. An ordinal grading system (0=normal, 1=abnormal, 2=severely abnormal or absent) was used to score each white matter tract. RESULTS There was marked variability in white matter injury pattern in patients with PVL, with the most frequent injury to the retrolenticular part of the internal capsule, posterior thalamic radiation, superior corona radiata, and commissural fibers. CONCLUSION DTI is a suitable technique for in vivo assessment of specific white matter lesions in patients with PVL and, thus, a potentially valuable diagnostic tool. The tract-specific evaluation revealed a family of tracts that are highly susceptible in PVL, important information that can potentially be used to tailor treatment options in the future.
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Affiliation(s)
- L M Nagae
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USAand Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Ma Y, Krikun G, Abrahams VM, Mor G, Guller S. Cell type-specific expression and function of toll-like receptors 2 and 4 in human placenta: implications in fetal infection. Placenta 2007; 28:1024-31. [PMID: 17588655 PMCID: PMC2064901 DOI: 10.1016/j.placenta.2007.05.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/26/2007] [Accepted: 05/07/2007] [Indexed: 02/03/2023]
Abstract
Placental infection is associated with adverse fetal outcomes. Toll-like receptors (TLRs) are critical regulators of the innate immune response based on their ability to recognize and respond to pathogen-associated molecular patterns expressed by microbes. To date, cell-type specific expression and regulation of TLR function in human term placenta remains largely unelucidated. The goal of the current study was to examine the in vivo and in vitro patterns of TLR expression and function in major cell types of term placenta. Immunohistochemical analysis of terminal and stem villi localized TLR-2, which recognizes peptidoglycan (PG) from Gram-positive bacteria, to endothelial cells and macrophages, and to a lesser extent to syncytiotrophoblast (SCTs) and fibroblasts (FIBs). Staining for TLR-4, the receptor for Gram-negative bacterial lipopolysaccharide (LPS), was most prominent in SCTs and endothelial cells. Results from Western blotting, conventional, and quantitative PCR (qRTPCR) analyses using protein and mRNA isolated from cultures of SCTs and myofibroblasts (mFIBs) revealed that SCTs expressed TLR-2 and TLR-4, whereas mFIBs expressed only TLR-4. In addition, qRTPCR showed that LPS treatment increased TLR-2 expression in SCTs, indicating that infection with Gram-negative bacteria may enhance innate immune responses in placenta toward a broad range of microorganisms. In addition, treatment with LPS increased IL-8 levels in both SCTs and mFIBs, whereas PG treatment only stimulated IL-8 levels in SCTs. Our results indicate that there exist cell type-specific patterns of TLR function in placenta which likely regulate innate immune response at the maternal-fetal interface.
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Affiliation(s)
- Y Ma
- Department of Obstetrics/Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street-339 FMB, PO Box 208063, New Haven, CT 06520-8063, USA
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