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Tassinari ID, Zang J, Ribeiro NH, Martins BB, Tauffer JVM, Nunes RR, Sanches EF, Sizonenko S, Netto CA, Paz AH, de Fraga LS. Lactate administration causes long-term neuroprotective effects following neonatal hypoxia-ischemia. Exp Neurol 2024; 381:114929. [PMID: 39168170 DOI: 10.1016/j.expneurol.2024.114929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/17/2024] [Accepted: 08/16/2024] [Indexed: 08/23/2024]
Abstract
Neonatal hypoxia-ischemia (HI) is one of the main causes of mortality and long-term disabilities in newborns, and the only clinical approach to treat this condition is therapeutic hypothermia, which shows some limitations. Thus, putative neuroprotective agents have been tested in animal models of HI. Lactate is a preferential metabolic substrate of the neonatal brain and has already been shown to produce beneficial neuroprotective outcomes in neonatal animals exposed to HI. Here, we administered lactate as a treatment in neonatal rats previously exposed to HI and evaluated the impact of this treatment in adulthood. Seven-day-old (P7) male and female Wistar rats underwent permanent common right carotid occlusion combined with an exposition to a hypoxic atmosphere (8% oxygen) for 60 min. Animals were assigned to one of four experimental groups: HI, HI+LAC, SHAM, SHAM+LAC. Lactate was administered intraperitoneally 30 min and 2 h after hypoxia in HI+LAC and SHAM+LAC groups, whereas HI and SHAM groups received vehicle. Animals were tested in the behavioral tasks of negative geotaxis and righting reflex (P8), cylinder test (P24), and the modified neurological severity score was calculated (P25). Open field (OF), and novel object recognition (NOR) were evaluated in adulthood. Animals were killed at P60, and the brains were harvested and processed to evaluate the volume of brain injury. Our results showed that lactate administration reduced the volume of brain lesion and improved sensorimotor and cognitive behaviors in neonatal, juvenile, and adult life in HI animals from both sexes. Thus, lactate administration might be considered as a potential neuroprotective strategy for the treatment of neonatal HI, which is a prevalent disorder affecting newborns.
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Affiliation(s)
- Isadora D'Ávila Tassinari
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Janaína Zang
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Nícolas Heller Ribeiro
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil
| | - Bianca Büchele Martins
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil
| | - João Vitor Miotto Tauffer
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil
| | - Ricardo Ribeiro Nunes
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Eduardo Farias Sanches
- Division of Child Development and Growth, Department of Pediatrics, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Sizonenko
- Division of Child Development and Growth, Department of Pediatrics, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Carlos Alexandre Netto
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Departamento de Bioquímica, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil
| | - Ana Helena Paz
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Departamento de Ciências Morfológicas, Federal University of Rio Grande do Sul (UFRGS), Sarmento Leite, 500, Porto Alegre 90050-170, Brazil; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Luciano Stürmer de Fraga
- Departamento de Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2600, Porto Alegre 90035-003, Brazil; Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil.
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Huntingford SL, Boyd SM, McIntyre SJ, Goldsmith SC, Hunt RW, Badawi N. Long-Term Outcomes Following Hypoxic Ischemic Encephalopathy. Clin Perinatol 2024; 51:683-709. [PMID: 39095104 DOI: 10.1016/j.clp.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Hypoxic ischemic encephalopathy (HIE) is the most common cause of neonatal encephalopathy and results in significant morbidity and mortality. Long-term outcomes of the condition encompass impairments across all developmental domains. While therapeutic hypothermia (TH) has improved outcomes for term and late preterm infants with moderate to severe HIE, trials are ongoing to investigate the use of TH for infants with mild or preterm HIE. There is no evidence that adjuvant therapies in combination with TH improve long-term outcomes. Numerous trials of various adjuvant therapies are underway in the quest to further improve outcomes for infants with HIE.
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Affiliation(s)
- Simone L Huntingford
- Department of Paediatrics, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Newborn, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Stephanie M Boyd
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, New South Wales 2145, Australia; Faculty of Medicine and Health, University of Sydney, Campderdown, New South Wales 2006, Australia
| | - Sarah J McIntyre
- CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shona C Goldsmith
- CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rod W Hunt
- Department of Paediatrics, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Newborn, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, New South Wales 2145, Australia; CP Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Feng Y, Huang Z, Ma X, Zong X, Xu P, Lin HW, Zhang Q. Intermittent theta-burst stimulation alleviates hypoxia-ischemia-caused myelin damage and neurologic disability. Exp Neurol 2024; 378:114821. [PMID: 38782349 PMCID: PMC11214828 DOI: 10.1016/j.expneurol.2024.114821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/01/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
Neonatal hypoxia-ischemia (HI) results in behavioral deficits, characterized by neuronal injury and retarded myelin formation. To date, limited treatment methods are available to prevent or alleviate neurologic sequelae of HI. Intermittent theta-burst stimulation (iTBS), a non-invasive therapeutic procedure, is considered a promising therapeutic tool for treating some neurocognitive disorders and neuropsychiatric diseases. Hence, this study aims to investigate whether iTBS can prevent the negative behavioral manifestations of HI and explore the mechanisms for associations. We exposed postnatal day 10 Sprague-Dawley male and female rats to 2 h of hypoxia (6% O2) following right common carotid artery ligation, resulting in oligodendrocyte (OL) dysfunction, including reduced proliferation and differentiation of oligodendrocyte precursor cells (OPCs), decreased OL survival, and compromised myelin in the corpus callosum (CC) and hippocampal dentate gyrus (DG). These alterations were concomitant with cognitive dysfunction and depression-like behaviors. Crucially, early iTBS treatment (15 G, 190 s, seven days, initiated one day post-HI) significantly alleviated HI-caused myelin damage and mitigated the neurologic sequelae both in male and female rats. However, the late iTBS treatment (initiated 18 days after HI insult) could not significantly impact these behavioral deficits. In summary, our findings support that early iTBS treatment may be a promising strategy to improve HI-induced neurologic disability. The underlying mechanisms of iTBS treatment are associated with promoting the differentiation of OPCs and alleviating myelin damage.
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Affiliation(s)
- Yu Feng
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Highway, LA 71103, USA
| | - Zhihai Huang
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Highway, LA 71103, USA
| | - Xiaohui Ma
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Highway, LA 71103, USA
| | - Xuemei Zong
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Highway, LA 71103, USA
| | - Peisheng Xu
- Department of Drug Discovery and Biomedical Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, CLS609D, Columbia, SC 29208, USA
| | - Hung Wen Lin
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Highway, LA 71103, USA
| | - Quanguang Zhang
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, 1501 Kings Highway, LA 71103, USA.
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Mintoft A, Vallatos A, Robertson NJ. Mesenchymal Stromal Cell therapy for Hypoxic Ischemic Encephalopathy: Future directions for combination therapy with hypothermia and/or melatonin. Semin Perinatol 2024; 48:151929. [PMID: 38902120 DOI: 10.1016/j.semperi.2024.151929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Hypoxic ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and lifelong disability across the world. While therapeutic hypothermia (HT) is beneficial, it is only partially protective and adjuvant treatments that further improve outcomes are urgently needed. In high-income countries where HT is standard care, novel treatments are tested in conjunction with HT. Mesenchymal stromal cells (MSC) represent a paradigm shift in brain protection, uniquely adapting to the host cellular microenvironment. MSC have low immunogenicity and potent paracrine effects stimulating the host tissue repair and regeneration and reducing inflammation and apoptosis. Preclinical studies in perinatal brain injury suggest that MSC are beneficial after hypoxia-ischemia (HI) and most preclinical studies of MSC with HT show protection. Preclinical and early phase clinical trials have shown that allogenic administration of MSC to neonates with perinatal stroke and HIE is safe and feasible but further safety and efficacy studies of HT with MSC in these populations are needed. Combination therapies that target all stages of the evolution of injury after HI (eg HT, melatonin and MSC) show promise for improving outcomes in HIE.
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Affiliation(s)
- Alison Mintoft
- Institute for Women's Health, University College London, London, UK
| | - Antoine Vallatos
- School of Psychology and Neuroscience, University of Glasgow; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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Lee KS, Massaro A, Wintermark P, Soul J, Natarajan G, Dizon MLV, Mietzsch U, Mohammad K, Wu TW, Chandel A, Shenberger J, DiGeronimo R, Peeples ES, Hamrick S, Cardona VQ, Rao R. Practice Variations for Therapeutic Hypothermia in Neonates with Hypoxic-ischemic Encephalopathy: An International Survey. J Pediatr 2024; 274:114181. [PMID: 38950817 DOI: 10.1016/j.jpeds.2024.114181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To evaluate variations in management of therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) among international clinical sites and to identify areas for harmonization. STUDY DESIGN An electronic survey was sent to Children's Hospitals Neonatal Consortium site sponsors, Canadian Neonatal Network site investigators, members of the Newborn Brain Society, and American Academy of Pediatrics Neonatology chiefs. RESULTS One hundred five sites responded, with most from high-income regions (n = 95). Groupings were adapted from the United Nations regional groups: US (n = 52 sites); Canada (n = 20); Western Europe and other states excluding Canada and US Group (WEOG, n = 18); and non-WEOG (central and eastern Europe, Asia, Africa, Latin America, and Caribbean, n = 15). Regional variations were seen in the eligibility criteria for TH, such as the minimum gestational age, grading of HIE severity, use of electroencephalography, and the frequency of providing TH for mild HIE. Active TH during transport varied among regions and was less likely in smaller volume sites. Amplitude-integrated electroencephalogram and/or continuous electroencephalogram to determine eligibility for TH was used by most sites in WEOG and non-WEOG but infrequently by the US and Canada Groups. For sedation during TH, morphine was most frequently used as first choice but there was relatively high (33%) use of dexmedetomidine in the US Group. Timing of brain magnetic resonance imaging and neurodevelopmental follow-up were variable. Neurodevelopmental follow occurred earlier and more frequently, although for a shorter duration, in the non-WEOG. CONCLUSIONS We found significant variations in practices for TH for HIE across regions internationally. Future guidelines should incorporate resource availability in a global perspective.
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Affiliation(s)
- Kyong-Soon Lee
- Division of Neonatology, the Hospital for Sick Children, Department of Paediatrics, University of Toronto, Canada.
| | - An Massaro
- Division of Neonatology, Children's National Hospital, Department of Pediatrics, The George Washington School of Medicine, Washington, DC
| | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Janet Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Girija Natarajan
- Children's Hospital of Michigan/Wayne State University, Detroit, MI
| | - Maria L V Dizon
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Newborn Critical Care, University of Calgary, Cumming School of Medicine, Alberta Children's Hospital, Calgary, Canada
| | - Tai-Wei Wu
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Amit Chandel
- Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | | | - Robert DiGeronimo
- Division of Neonatology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Eric S Peeples
- Division of Neonatology, Department of Pediatrics, Children's Nebraska, University of Nebraska Medical Center, Omaha, NE
| | - Shannon Hamrick
- Emory University and Children's Healthcare of Atlanta, Atlanta GA
| | | | - Rakesh Rao
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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Shimochi S, Ihalainen J, Parikka V, Kudomi N, Tolvanen T, Hietanen A, Kokkomäki E, Johansson S, Tsuji M, Kanaya S, Yatkin E, Grönroos TJ, Iida H. Small animal PET with spontaneous inhalation of 15O-labelled oxygen gases: Longitudinal assessment of cerebral oxygen metabolism in a rat model of neonatal hypoxic-ischaemic encephalopathy. J Cereb Blood Flow Metab 2024; 44:1024-1038. [PMID: 38112197 PMCID: PMC11318403 DOI: 10.1177/0271678x231220691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/05/2023] [Accepted: 11/12/2023] [Indexed: 12/21/2023]
Abstract
Perinatal hypoxic-ischaemic encephalopathy (HIE) is the leading cause of irreversible brain damage resulting in serious neurological dysfunction among neonates. We evaluated the feasibility of positron emission tomography (PET) methodology with 15O-labelled gases without intravenous or tracheal cannulation for assessing temporal changes in cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) in a neonatal HIE rat model. Sequential PET scans with spontaneous inhalation of 15O-gases mixed with isoflurane were performed over 14 days after the hypoxic-ischaemic insult in HIE pups and age-matched controls. CBF and CMRO2 in the injured hemispheres of HIE pups remarkably decreased 2 days after the insult, gradually recovering over 14 days in line with their increase found in healthy controls according to their natural maturation process. The magnitude of hemispheric tissue loss histologically measured after the last PET scan was significantly correlated with the decreases in CBF and CMRO2.This fully non-invasive imaging strategy may be useful for monitoring damage progression in neonatal HIE and for evaluating potential therapeutic outcomes.
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Affiliation(s)
- Saeka Shimochi
- Turku PET Centre, University of Turku, Turku, Finland
- MediCity Research Laboratory, University of Turku, Turku, Finland
- Nara Institute of Science and Technology, Ikoma City, Japan
| | - Jukka Ihalainen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Accelerator Laboratory, Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Vilhelmiina Parikka
- Turku PET Centre, University of Turku, Turku, Finland
- MediCity Research Laboratory, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Nobuyuki Kudomi
- Department of Medical Physics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Ari Hietanen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Esa Kokkomäki
- Turku PET Centre, University of Turku, Turku, Finland
| | - Stefan Johansson
- Accelerator Laboratory, Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Masahiro Tsuji
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | | | - Emrah Yatkin
- Central Animal Laboratory, University of Turku, Turku, Finland
| | - Tove J Grönroos
- Turku PET Centre, University of Turku, Turku, Finland
- MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Hidehiro Iida
- Turku PET Centre, University of Turku, Turku, Finland
- Nara Institute of Science and Technology, Ikoma City, Japan
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Kromm GH, Patankar H, Nagalotimath S, Wong H, Austin T. Socioemotional and Psychological Outcomes of Hypoxic-Ischemic Encephalopathy: A Systematic Review. Pediatrics 2024; 153:e2023063399. [PMID: 38440801 PMCID: PMC10979301 DOI: 10.1542/peds.2023-063399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Therapeutic hypothermia has reduced the risk of death or major disability following perinatal hypoxic-ischemic encephalopathy (HIE); however, many children who experience perinatal HIE still go on to develop personal and behavioral challenges, which can be difficult for caregivers and a public health burden for society. Our objective with this review is to systematically identify and synthesize studies that evaluate associations between perinatal HIE and socioemotional or psychological outcomes. METHODS We screened all search-returned journal articles from Cochrane Library, Embase, Medline, PsycINFO, Scopus, and Web of Science from data inception through February 1, 2023. Keywords related to HIE (eg, neonatal encephalopathy, neonatal brain injury) and outcomes (eg, social*, emotion*, behav* problem, psycholog*, psychiatr*) were searched with a predefined search string. We included all observational human studies reporting socioemotional or psychological sequelae of term HIE. Study data were recorded on standardized sheets, and the Newcastle-Ottawa Scale was adapted to assess study quality. RESULTS We included 43 studies documenting 3244 HIE participants and 2132 comparison participants. We found statistically significant associations between HIE and social and emotional, behavioral, and psychological and psychiatric deficits throughout infancy, childhood, and adolescence (19 studies). The authors of the included studies also report nonsignificant findings (11 studies) and outcomes without statistical comparison (25 studies). CONCLUSIONS Perinatal HIE may be a risk factor for a range of socioemotional and psychological challenges in the short- and long-term. Routine screening, early intervention, and follow-up support may be particularly beneficial to this population.
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Affiliation(s)
| | | | | | - Hilary Wong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- NICU, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- NICU, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Kim CF, Carreon CK, James KE, Bates SV, Mueller SB, Boyd TK, Roberts DJ. Gross and Histologic Placental Abnormalities Associated With Neonatal Hypoxic-Ischemic Encephalopathy. Pediatr Dev Pathol 2024; 27:123-131. [PMID: 37749054 DOI: 10.1177/10935266231195166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To elucidate particular placental pathology findings that are associated with hypoxic ischemic encephalopathy (HIE) and determine which patterns are associated with adverse fetal/neonatal outcomes. STUDY DESIGN Multi-institutional retrospective case-control study of newborns with HIE (2002-2022) and controls. Four perinatal pathologists performed gross and histologic evaluation of placentas of cases and controls. RESULTS A total of 265 placentas of neonates with HIE and 122 controls were examined. Infants with HIE were more likely to have anatomic umbilical cord abnormalities (19.7% vs 7.4%, P = .003), fetal inflammatory response in the setting of amniotic fluid infection (27.7% vs 13.9%, P = .004), and fetal vascular malperfusion (30.6% vs 9.0%, P = <.001) versus controls. Fetal vascular malperfusion with maternal vascular malperfusion was more common in those who died of disease (P = .01). CONCLUSION Placental pathology examination of neonates with HIE may improve our understanding of this disorder and its adverse outcomes.
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Affiliation(s)
- Charlotte F Kim
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, TX, USA
| | - Chrystalle Katte Carreon
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Kaitlyn E James
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Sara V Bates
- Department of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah B Mueller
- Department of Pathology, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, TX, USA
| | - Drucilla J Roberts
- Department of Pathology, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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9
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Marques KL, Rodrigues V, Balduci CTN, Montes GC, Barradas PC, Cunha-Rodrigues MC. Emerging therapeutic strategies in hypoxic-ischemic encephalopathy: a focus on cognitive outcomes. Front Pharmacol 2024; 15:1347529. [PMID: 38469401 PMCID: PMC10925695 DOI: 10.3389/fphar.2024.1347529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
Perinatal hypoxia-ischemia represents a significant risk to CNS development, leading to high mortality rates, diverse damages, and persistent neurological deficits. Despite advances in neonatal medicine in recent decades, the incidence of HIE remains substantial. Motor deficits can manifest early, while cognitive impairments may be diagnosed later, emphasizing the need for extended follow-up. This review aims to explore potential candidates for therapeutic interventions for hypoxic-ischemic encephalopathy (HIE), with a focus on cognitive deficits. We searched randomized clinical trials (RCT) that tested drug treatments for HIE and evaluated cognitive outcomes. The results included studies on erythropoietin, melatonin, magnesium sulfate, topiramate, and a combination of vitamin C and ibuprofen. Although there are several indications of the efficacy of these drugs among animal models, considering neuroprotective properties, the RCTs failed to provide complete effectiveness in the context of cognitive impairments derived from HIE. More robust RCTs are still needed to advance our knowledge and to establish standardized treatments for HIE.
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Affiliation(s)
- Kethely L. Marques
- Laboratory of Neurobiology, Pharmacology and Psychobiology Department, Roberto Alcantara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Victor Rodrigues
- Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cassiana T. N. Balduci
- Laboratory of Neurobiology, Pharmacology and Psychobiology Department, Roberto Alcantara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rare Diseases Sales Force, Daiichi Sankyo Brazil, São Paulo, Brazil
| | - Guilherme C. Montes
- Laboratory of Neurobiology, Pharmacology and Psychobiology Department, Roberto Alcantara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Penha C. Barradas
- Laboratory of Neurobiology, Pharmacology and Psychobiology Department, Roberto Alcantara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marta C. Cunha-Rodrigues
- Laboratory of Neurobiology, Pharmacology and Psychobiology Department, Roberto Alcantara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Dave AM, Porter NA, Korade Z, Peeples ES. Effects of Neonatal Hypoxic-Ischemic Injury on Brain Sterol Synthesis and Metabolism. Neuropediatrics 2024; 55:23-31. [PMID: 37871611 DOI: 10.1055/s-0043-1776286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Neonatal hypoxic-ischemic brain injury (HIBI) results from disruptions to blood supply and oxygen in the perinatal brain. The goal of this study was to measure brain sterol metabolites and plasma oxysterols after injury in a neonatal HIBI mouse model to assess for potential therapeutic targets in the brain biochemistry as well as potential circulating diagnostic biomarkers. METHODS Postnatal day 9 CD1-IGS mouse pups were randomized to HIBI induced by carotid artery ligation followed by 30 minutes at 8% oxygen or to sham surgery and normoxia. Brain tissue was collected for sterol analysis by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Plasma was collected for oxysterol analysis by LC-MS/MS. RESULTS There were minimal changes in brain sterol concentrations in the first 72 hours after HIBI. In severely injured brains, there was a significant increase in desmosterol, 7-DHC, 8-DHC, and cholesterol 24 hours after injury in the ipsilateral tissue. Lanosterol, 24-dehydrolathosterol, and 14-dehydrozymostenol decreased in plasma 24 hours after injury. Severe neonatal HIBI was associated with increased cholesterol and sterol precursors in the cortex at 24 hours after injury. CONCLUSIONS Differences in plasma oxysterols were seen at 24 hours but were not present at 30 minutes after injury, suggesting that these sterol intermediates would be of little value as early diagnostic biomarkers.
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Affiliation(s)
- Amanda M Dave
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, United States
- Child Health Research Institute, Omaha, Nebraska, United States
| | - Ned A Porter
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee, United States
| | - Zeljka Korade
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Child Health Research Institute, Omaha, Nebraska, United States
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, United States
- Child Health Research Institute, Omaha, Nebraska, United States
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11
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Tepe T, Satar M, Ozdemir M, Yildizdas HY, Ozlü F, Erdogan S, Toyran T, Akillioglu K, Köse S, Avci C. Long-term effect of indomethacin on a rat model of neonatal hypoxia ischemic encephalopathy through behavioral tests. Int J Dev Neurosci 2024; 84:22-34. [PMID: 37842754 DOI: 10.1002/jdn.10305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/09/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Many medical experts prescribe indomethacin because of its anti-inflammatory, analgesic, tocolytic, and duct closure effects. This article presents an evaluation of the enduring impact of indomethacin on neonatal rats with hypoxic-ischemic (HI) insults, employing behavioral tests as a method of assessment. METHODS The experiment was conducted on male Wistar-Albino rats weighing 10 to 15 g, aged between seven and 10 days. The rats were divided into three groups using a random allocation method as follows: hypoxic ischemic encephalopathy (HIE) group, HIE treated with indomethacin group (INDO), and Sham group. A left common carotid artery ligation and hypoxia model was applied in both the HIE and INDO groups. The INDO group was treated with 4 mg/kg intraperitoneal indomethacin every 24 h for 3 days, while the Sham and HIE groups were given dimethylsulfoxide (DMSO). After 72 h, five rats from each group were sacrificed and brain tissue samples were stained with 2,3,5-Triphenyltetrazolium chloride (TCC) for infarct-volume measurement. Seven rats from each group were taken to the behavioral laboratory in the sixth postnatal week (PND42) and six from each group were sacrificed for the Evans blue (EB) experiment for blood-brain barrier (BBB) integrity evaluation. The open field (OF) test and Morris water maze (MWM) tests were performed. After behavioral tests, brain tissue were obtained and stained with TCC to assess the infarct volume. RESULTS The significant increase in the time spent in the central area and the frequency of crossing to the center in the INDO group compared with the HIE group indicated that indomethacin decreased anxiety-like behavior (p < 0.001, p < 0.05). However, the MWM test revealed that indomethacin did not positively affect learning and memory performance (p > 0.05). Additionally, indomethacin significantly reduced infarct volume and neuropathological grading in adolescence (p < 0.05), although not statistically significant in the early period. Moreover, the EB experiment demonstrated that indomethacin effectively increased BBB integrity (p < 0.05). CONCLUSIONS In this study, we have shown for the first time that indomethacin treatment can reduce levels of anxiety-like behavior and enhance levels of exploratory behavior in a neonatal rat model with HIE. It is necessary to determine whether nonsteroidal anti-inflammatory agents, such as indomethacin, should be used for adjuvant therapy in newborns with HIE.
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Affiliation(s)
- Tugay Tepe
- Department of Pediatrics, Division of Neonatology, Cukurova University Faculty of Medicine, Adana, Turkey
- Department of Physiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mehmet Satar
- Department of Pediatrics, Division of Neonatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mustafa Ozdemir
- Department of Pediatrics, Division of Neonatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hacer Yapicioglu Yildizdas
- Department of Pediatrics, Division of Neonatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ferda Ozlü
- Department of Pediatrics, Division of Neonatology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Seyda Erdogan
- Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Tugba Toyran
- Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Kübra Akillioglu
- Department of Physiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Seda Köse
- Department of Physiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Cagri Avci
- Department of Virology, Cukurova University Faculty of Veterinary Medicine, Adana, Turkey
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12
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Daidone C, Carper S. Differential Diagnosis and Interdisciplinary Workup of a Pediatric Patient With an Unknown Immune Condition: Chronic Respiratory Distress Secondary to Viral Illness and Developmental Consequences. Cureus 2024; 16:e53109. [PMID: 38414706 PMCID: PMC10898650 DOI: 10.7759/cureus.53109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
We present a case of a three-year-old African American male, born at term, who initially presented with bronchiolitis at six months and has since experienced recurrent episodes of respiratory distress and hospitalizations. The patient also has severe eczema, developmental delays, and recurrent viral illnesses. Despite thorough evaluations from various specialists, such as pulmonology, allergy, and gastroenterology, the underlying cause remained elusive. The differential diagnosis for this case is as follows: severe persistent asthma with a possible link to genetic mutations such as CDHR3, hyper-IgE syndrome, atypical presentation of Wiskott-Aldrich syndrome, and severe gastroesophageal reflux disease (GERD) with aspiration pneumonitis. This patient's chronic condition has contributed to several developmental consequences, including failure to gain weight and possible hypoxic encephalopathy, leading to delays in cognitive and motor milestones and speech delays. Aggressive medical management, especially long-term systemic steroids, raises concerns about future complications. Through this case, we highlight the importance of thorough workups and an interdisciplinary approach to diagnosing and managing an unknown immune condition, as well as consistent pediatric primary care follow-up to assess development and coordinate necessary support. Here, we aim to address a gap in research on the unique presentations of pediatric respiratory distress symptoms by formulating a comprehensive differential diagnosis and exploring the various ways that chronic respiratory illness can contribute to developmental deficits such as speech and cognitive delays in pediatric patients. This study calls for further research into genetic contributions to asthma, diverse presentations of GERD, prevention of viral illnesses, alternative treatments minimizing steroid use, and an understanding of the impact of chronic respiratory distress on cognitive and language development in children. Thorough workups and interdisciplinary approaches are essential for effective diagnosis and management.
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Affiliation(s)
- Camryn Daidone
- Research, Edward Via College of Osteopathic Medicine, Shreveport, USA
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13
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Malan R, Van Der Linde J, Kritzinger A, Graham MA, Krüger E, Kollapen K, Lockhat Z. Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:893-902. [PMID: 36444930 DOI: 10.1080/17549507.2022.2147217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe the evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy (HIE) during hospitalisation. METHOD A longitudinal cohort study was used. Twenty-nine participants (median age 39.0 weeks [IQR = 2.0 weeks]) with mild (n = 7), moderate (n = 19) and severe (n = 3) HIE were included. Clinical swallowing and feeding assessments were conducted at introduction of oral feeds and at discharge using the Neonatal Feeding Assessment Scale (NFAS). Videofluoroscopic swallow studies (VFSS) supplemented the NFAS before discharge. RESULT Approximately two thirds of participants showed symptoms of oropharyngeal dysphagia (OPD) during initial NFAS and VFSS. Significantly fewer OPD symptoms occurred at discharge NFAS (p = 0.004). Endurance during non-nutritive sucking (p < 0.001) and nutritive sucking (p < 0.001) significantly improved. Nine participants (31.0%) demonstrated penetration or aspiration. Most aspiration events were silent (60%). Instrumental assessment identified pharyngeal phase dysphagia more effectively than bedside evaluation. High proportions of participants displayed OPD symptoms regardless of HIE severity. The correlation between OPD severity and the length of hospitalisation (p = 0.052) was not significant. CONCLUSION All grades of HIE should be considered for early intervention by speech-language pathologists before discharge. Findings may be valuable to neonatal feeding teams.
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Affiliation(s)
- Roxanne Malan
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Jeannie Van Der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Alta Kritzinger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marien A Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Kumeshnie Kollapen
- Department of Radiology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Zarina Lockhat
- Department of Radiology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
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14
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Xu Y, Xu J, Chen L, Su W, Zhu Q, Tong G. Protective mechanisms of quercetin in neonatal rat brain injury induced by hypoxic-ischemic brain damage (HIBD). Food Sci Nutr 2023; 11:7649-7663. [PMID: 38107093 PMCID: PMC10724619 DOI: 10.1002/fsn3.3684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 12/19/2023] Open
Abstract
Neonatal hypoxic-ischemic brain damage (HIBD) is a leading cause of infant mortality worldwide. This study explored whether quercetin (Que) exerts neuroprotective effects in a rat model of HIBD. A total of 36 seven-day-old Sprague-Dawley rats were divided into control, Que, HI, and HI + Que groups. The Rice method was used to establish HIBD in HI and HI + Que rats, which were treated with hypoxia (oxygen concentration of 8%) for 2 h after ligation of the left common carotid artery. The rats in the HI + Que group were intraperitoneally injected with Que (30 mg/kg) 1 h before hypoxia, and the rats in the Que group were only injected with the same amount of Que. Brain tissues were harvested 24 h postoperation and assessed by hematoxylin and eosin staining, 2,3,5-triphenyltetrazolium chloride staining, and terminal deoxynucleotidyl transferase dUTP nick-end labeling assay; relative gene and protein levels were evaluated by RT-qPCR, IHC, or western blot (WB) assay. Brain tissue morphologies were characterized by transmission electron microscopy (TEM); LC3B protein levels were assessed by immunofluorescence staining. Escape latencies and platform crossing times were significantly improved (p < .05) in HI + Que groups; infarct volume significantly decreased (p < .001), whereas the numbers of autophagic bodies and apoptotic cells increased and decreased, respectively. Meanwhile, NLRX1, ATG7, and Beclin1 expressions were significantly upregulated, and mTOR and TIM23 expressions, LC3B protein level, and LC 3II/LC 3I ratio were significantly downregulated. Que exerted neuroprotective effects in a rat model of HIBD by regulating NLRX1 and autophagy.
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Affiliation(s)
- Yan‐hong Xu
- Anhui Provincial Children's HospitalHefeiChina
| | - Jin‐bo Xu
- Anhui Provincial Children's HospitalHefeiChina
| | - Lu‐lu Chen
- Anhui Provincial Children's HospitalHefeiChina
| | - Wei Su
- Anhui Provincial Children's HospitalHefeiChina
| | - Qing Zhu
- Anhui Provincial Children's HospitalHefeiChina
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Hedstrom A, Nyonyintono J, Mubiri P, Namakula Mirembe H, Magnusson B, Nakakande J, MacGuffie M, Nsubuga M, Waiswa P, Nambuya H, Batra M. Outborn newborns drive birth asphyxia mortality rates-An 8 year analysis at a rural level two nursery in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002261. [PMID: 37939037 PMCID: PMC10631647 DOI: 10.1371/journal.pgph.0002261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
Birth asphyxia is a leading cause of global neonatal mortality. Most cases occur in low- and middle- income countries and contribute to half of neonatal deaths in Uganda. Improved understanding of the risk factors associated with mortality among these patients is needed. We performed a retrospective cohort study of a clinical database and report maternal demographics, clinical characteristics and outcomes from neonates with birth asphyxia at a Ugandan level two unit from 2014 through 2021. "Inborn" patients were born at the hospital studied and "outborn" were born at another facility or home and then admitted to the hospital studied. Doctors assigned the patient's primary diagnosis at death or discharge. We performed a Poisson model regression of factors associated with mortality among patients with asphyxia. The study included 1,565 patients with birth asphyxia and the proportion who were outborn rose from 26% to 71% over eight years. Mortality in asphyxiated patients increased over the same period from 9% to 27%. Factors independently associated with increased death included outborn birth location (ARR 2.1, p<0.001), admission in the year 2020 (ARR 2.4, p<0.05) and admission respiratory rate below 30bpm (RR 3.9, p<0.001), oxygen saturation <90% (ARR 2.0, p<0.001) and blood sugar >8.3 mmol/L (RR 1.7, p<0.05). Conversely, a respiratory rate >60bpm was protective against death (ARR 0.6, p<0.05). Increased birth asphyxia mortality at this referral unit was associated with increasing admission of outborn patients. Patients born at another facility and transferred face unique challenges. Increased capacity building at lower-level birth facilities could include improved staffing, training and equipment for labor monitoring and newborn resuscitation as well as training on the timely identification of newborns with birth asphyxia and resources for transfer. These changes may reduce incidence of birth asphyxia, improve outcomes among birth asphyxia patients and help meet global targets for newborn mortality.
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Affiliation(s)
- Anna Hedstrom
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Paul Mubiri
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Brooke Magnusson
- Adara Development, Edmonds, Washington, United States of America
| | | | - Molly MacGuffie
- Adara Development, Edmonds, Washington, United States of America
| | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
| | - Harriet Nambuya
- Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Maneesh Batra
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, United States of America
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Cawley P, Padormo F, Cromb D, Almalbis J, Marenzana M, Teixeira R, Uus A, O’Muircheartaigh J, Williams SC, Counsell SJ, Arichi T, Rutherford MA, Hajnal JV, Edwards AD. Development of neonatal-specific sequences for portable ultralow field magnetic resonance brain imaging: a prospective, single-centre, cohort study. EClinicalMedicine 2023; 65:102253. [PMID: 38106560 PMCID: PMC10725077 DOI: 10.1016/j.eclinm.2023.102253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background Magnetic Resonance (MR) imaging is key for investigation of suspected newborn brain abnormalities. Access is limited in low-resource settings and challenging in infants needing intensive care. Portable ultralow field (ULF) MRI is showing promise in bedside adult brain imaging. Use in infants and children has been limited as brain-tissue composition differences necessitate sequence modification. The aim of this study was to develop neonatal-specific ULF structural sequences and test these across a range of gestational maturities and pathologies to inform future validation studies. Methods Prospective cohort study within a UK neonatal specialist referral centre. Infants undergoing 3T MRI were recruited for paired ULF (64mT) portable MRI by convenience sampling from the neonatal unit and post-natal ward. Key inclusion criteria: 1) Infants with risk or suspicion of brain abnormality, or 2) preterm and term infants without suspicion of major genetic, chromosomal or neurological abnormality. Exclusions: presence of contra-indication for MR scanning. ULF sequence parameters were optimised for neonatal brain-tissues by iterative and explorative design. Neuroanatomic and pathologic features were compared by unblinded review, informing optimisation of subsequent sequence generations in a step-wise manner. Main outcome: visual identification of healthy and abnormal brain tissues/structures. ULF MR spectroscopy, diffusion, susceptibility weighted imaging, arteriography, and venography require pre-clinical technical development and have not been tested. Findings Between September 23, 2021 and October 25, 2022, 102 paired scans were acquired in 87 infants; 1.17 paired scans per infant. Median age 9 days, median postmenstrual age 40+2 weeks (range: 31+3-53+4). Infants had a range of intensive care requirements. No adverse events observed. Optimised ULF sequences can visualise key neuroanatomy and brain abnormalities. In finalised neonatal sequences: T2w imaging distinguished grey and white matter (7/7 infants), ventricles (7/7), pituitary tissue (5/7), corpus callosum (7/7) and optic nerves (7/7). Signal congruence was seen within the posterior limb of the internal capsule in 10/11 infants on finalised T1w scans. In addition, brain abnormalities visualised on ULF optimised sequences have similar MR signal patterns to 3T imaging, including injury secondary to infarction (6/6 infants on T2w scans), hypoxia-ischaemia (abnormal signal in basal ganglia, thalami and white matter 2/2 infants on T2w scans, cortical highlighting 1/1 infant on T1w scan), and congenital malformations: polymicrogyria 3/3, absent corpus callosum 2/2, and vermian hypoplasia 3/3 infants on T2w scans. Sequences are susceptible to motion corruption, noise, and ULF artefact. Non-identified pathologies were small or subtle. Interpretation On unblinded review, optimised portable MR can provide sufficient contrast, signal, and resolution for neuroanatomical identification and detection of a range of clinically important abnormalities. Blinded validation studies are now warranted. Funding The Bill and Melinda Gates Foundation, the MRC, the Wellcome/EPSRC Centre for Medical Engineering, the MRC Centre for Neurodevelopmental Disorders, and the National Institute for Health Research (NIHR) Biomedical Research Centres based at Guy's and St Thomas' and South London & Maudsley NHS Foundation Trusts and King's College London.
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Affiliation(s)
- Paul Cawley
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| | - Francesco Padormo
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Medical Physics, Guy’s & St. Thomas' NHS Foundation Trust, London, UK
- Hyperfine, Inc., 351 New Whitfield St., Guilford, Connecticut 06437, USA
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Jennifer Almalbis
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Massimo Marenzana
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Rui Teixeira
- Hyperfine, Inc., 351 New Whitfield St., Guilford, Connecticut 06437, USA
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Steven C.R. Williams
- Centre for Neuroimaging Sciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Mary A. Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| | - Joseph V. Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - A. David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
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Von Adamovich GMG, Bastos Torres JAG, Vianna FS, Barradas PC, Alves de Oliveira BF, Villela NR, De Rodrigues MCC, Montes GC. Evaluation of Pain Prevalence in Children Who Experienced Perinatal Hypoxia-Ischemia Events: Characteristics and Associations With Sociodemographic Factors. Cureus 2023; 15:e46359. [PMID: 37920623 PMCID: PMC10619469 DOI: 10.7759/cureus.46359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Pain in children who suffer from hypoxia-ischemia (HI) events is still not widely studied. Hypoxia-ischemia is characterized by the momentary or permanent cessation of blood flow and, consequently, of oxygen supply, becoming the main cause of encephalopathy in children. Hyperalgesia was identified in animals undergoing prenatal hypoxia-ischemia by researchers from the Universidade do Estado do Rio de Janeiro (UERJ). Premature and asphyxiated newborns have been admitted to the neonatal intensive care unit (NICU) of Pedro Ernesto University Hospital (HUPE) in Brazil and are monitored by the Outpatient Follow-up of High-Risk Newborns Project (SARAR), but no pain assessment was performed. OBJECTIVE To assess pain in children born in high-risk situations, such as prematurity and perinatal asphyxia, with higher chances of perinatal HI, discharged from the NICU/HUPE, and followed by SARAR. METHODOLOGY The study was approved by the HUPE Research Ethics Committee. The epidemiological, descriptive, cross-sectional study started in 2021 and finished in 2023, with the application of the pain assessment tool or instrument adapted from the Lübeck Pain-Screening Questionnaire to the caregivers and with the collection of growth and development data. The population consisted of asphyxiated infants born with a gestational age greater than 35 weeks and submitted to the Therapeutic Hypothermia protocol and premature infants discharged from the NICU between two (gestational age 1 (GA1)) and 12 years old. For most of them, pain prevalence was assessed according to its frequency and intensity, as were sociodemographic variables of the child and mother, neural alterations, and the Children's Developmental Scale (DENVER II). The percentage differences between the evaluated factors and the presence of pain were performed using Fisher's exact test and medians using the non-parametric Wilcoxon rank-sum test, both appropriate for the small sample of children. Significance levels of 10% were considered for trends and 5% for statistically significant differences. RESULTS Of the 86 children included in our search, 26 (30%) were born with a gestational age greater than 35 weeks and diagnosed with perinatal asphyxia (hereinafter referred to as the asphyxiation group), and 60 (70%) were premature. Pain was reported by 22 (25%) children, of whom 54.4% reported moderate or severe pain. The head and abdomen were the most reported sites (36%). Differences were observed in the percentage distribution of pain between asphyxiates and premature infants (11% vs. 32%; p-value 0.061 on the Fisher test) and between females and males (34% vs. 17%; p-value 0.085 on the Fisher test). Black and Brown children had higher median pain scale values than White children (p-value < 0.027, Wilcoxon rank sum test). CONCLUSION There is a higher prevalence of pain in girls, in the head, in premature infants, and greater intensity among Black and Brown children. Therefore, knowing the pain profile can help improve their quality of life by offering treatments.
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Affiliation(s)
| | | | - Felipe S Vianna
- Internal Medicine, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | - Penha C Barradas
- Pharmacology and Psychobiology, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | - Beatriz F Alves de Oliveira
- Epidemiology and Public Health, Fiocruz Regional Office of Piauí, National School of Public Health, Oswaldo Cruz Foundation, Piauí, BRA
| | - Nivaldo R Villela
- Anesthesiology, Pain Medicine, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | | | - Guilherme C Montes
- Pharmacology and Psycobiology, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
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Deng W, Anastasopoulos S, deRegnier RA, Pouppirt N, Barlow AK, Patrick C, O’Brien MK, Babula S, Sukal-Moulton T, Peyton C, Morgan C, Rogers JA, Lieber RL, Jayaraman A. Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay. PLoS One 2023; 18:e0291408. [PMID: 37725613 PMCID: PMC10508609 DOI: 10.1371/journal.pone.0291408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). METHODS We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.
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Affiliation(s)
- Weiyang Deng
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | | | - Raye-Ann deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Pouppirt
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ann K. Barlow
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Megan K. O’Brien
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
| | - Sarah Babula
- Pathways.org, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John A. Rogers
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Jessie Brown Jr., Hines V.A. Medical Center, Hines, Illinois, United States of America
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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19
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Song D, Narasimhan SR, Huang A, Jegatheesan P. Increased newborn NICU admission for evaluation of hypoxic-ischemic encephalopathy during COVID-19 pandemic in a public hospital. Front Pediatr 2023; 11:1206137. [PMID: 37456571 PMCID: PMC10338929 DOI: 10.3389/fped.2023.1206137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Background Prenatal and perinatal care of pregnant mothers has been adversely affected during the COVID-19 pandemic. Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal death and long-term neurological disabilities. Therapeutic hypothermia is effective for neonatal HIE. This study evaluated the effect of the pandemic on neonatal HIE. Methods This retrospective single-center study compared neonatal HIE evaluation and hypothermia treatment between pre-COVID-19 pandemic (1 January 2018-31 December 2019) and COVID-19 pandemic (1 January 2020-31 December 2021) periods. Infants with abnormal neurological examination and or significant metabolic acidosis were admitted to NICU for evaluation of HIE and therapeutic hypothermia. Demographics, NICU admission and interventions, and neonatal outcomes were compared between infants born during the two periods using χ2, t-test, and Wilcoxon rank-sum test as appropriate. Statistical Process Control charts show the yearly proportion of infants evaluated for HIE and those treated with therapeutic hypothermia. Results From the pre-pandemic to the pandemic period, the proportion of infants that met HIE screening criteria increased from 13% to 16% (p < 0.0001), the proportion of infants admitted to NICU for HIE evaluation increased from 1% to 1.4% (p = 0.02), and the maternal hypertension rates of the admitted infants increased from 30% to 55% (p = 0.006). There was no difference in the proportions of the infants diagnosed with HIE (0.7% vs. 0.9%, p = 0.3) or treated with therapeutic hypothermia (0.2% vs. 0.3%, p = 0.3) between the two periods. There were no differences in the HIE severity and outcomes of the infants treated with therapeutic hypothermia between the two periods. Conclusion During the COVID-19 pandemic, we observed a significant increase in NICU admission for HIE evaluation. While we did not find significant increases in neonatal HIE and the need for therapeutic hypothermia, larger studies are needed for a comprehensive assessment of the impact of the COVID-19 pandemic on neonatal HIE.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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20
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Tang Z, Mahmoodi S, Darekar A, Vollmer B. Automatic veins analysis of susceptibility weighted image in hypoxic-ischaemic encephalopathy. Magn Reson Imaging 2023; 98:83-96. [PMID: 36669595 DOI: 10.1016/j.mri.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/27/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to evaluate venous vascular structure and distribution as prognostic indicators of developmental outcomes for infants with neonatal hypoxic-ischaemic encephalopathy (HIE) by detecting and analysing ridges representing vessels on susceptibility-weighted magnetic resonance images (SWIs). METHODS Forty-two infants with neonatal HIE underwent SWI in the neonatal period and neurodevelopmental assessment at age 2 years. Normalised histograms of the width, intensity, length and Hessian eigenvalues extracted from the ridge analysis of each patient's SWI are applied as feature vectors to feed into supervised classifiers such as the kNN and random forest (RF) classifiers to predict their neurodevelopmental outcomes. Here we also propose a supervised classifier for automatic prognosis of automated detection of SWI signs of HIE. Our classifier proposed in this paper demonstrates a superior performance in HIE prognosis for the datasets associated with cognitive and motor outcomes and it also enables to determination of brain regions which have been affected by hypoxia-ischaemia by extracting appropriate features from SWI images. RESULTS The feature vectors containing width, intensity, length, and eigenvalue show a promising classification accuracy of 78.67% ± 2.58Linear regression, polynomial regression, and support vector regression (SVR) models predicted outcomes and the lower mean relative errors (MRE) for motor and cognitive outcomes are 0.088 ± 0.073 and 0.101 ± 0.11 respectively. CONCLUSION The features derived from the vascular ridges improve the prognostic value of SWI in HIE. Our findings suggest that it is possible to predict neurological, motor, and cognitive outcomes by numerical analysis of neonatal SW images and to identify brain regions on SWI affected by hypoxia-ischaemia.
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Affiliation(s)
- Zhen Tang
- School of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK.
| | - Sasan Mahmoodi
- School of Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK.
| | - Angela Darekar
- Department of Medical Physics, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Brigitte Vollmer
- Clinical Neurosciences,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, SO17 1BJ, UK; University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, UK.
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21
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Pinto CR, Duarte JV, Marques C, Vicente IN, Paiva C, Éloi J, Pereira DJ, Correia BR, Castelo-Branco M, Oliveira G. The role of early functional neuroimaging in predicting neurodevelopmental outcomes in neonatal encephalopathy. Eur J Pediatr 2023; 182:1191-1200. [PMID: 36607412 PMCID: PMC10023620 DOI: 10.1007/s00431-022-04778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
Reliably assessing the early neurodevelopmental outcomes in infants with neonatal encephalopathy (NE) is of utmost importance to advise parents and implement early and personalized interventions. We aimed to evaluate the accuracy of neuroimaging modalities, including functional magnetic resonance imaging (fMRI) in predicting neurodevelopmental outcomes in NE. Eighteen newborns with NE due to presumed perinatal asphyxia (PA) were included in the study, 16 of whom underwent therapeutic hypothermia. Structural magnetic resonance imaging (MRI), and fMRI during passive visual, auditory, and sensorimotor stimulation were acquired between the 10th and 14th day of age. Clinical follow-up protocol included visual and auditory evoked potentials and a detailed neurodevelopmental evaluation at 12 and 18 months of age. Infants were divided according to sensory and neurodevelopmental outcome: severe, moderate disability, or normal. Structural MRI findings were the best predictor of severe disability with an AUC close to 1.0. There were no good predictors to discriminate between moderate disability versus normal outcome. Nevertheless, structural MRI measures showed a significant correlation with the scores of neurodevelopmental assessments. During sensorimotor stimulation, the fMRI signal in the right hemisphere had an AUC of 0.9 to predict absence of cerebral palsy (CP). fMRI measures during auditory and visual stimulation did not predict sensorineural hearing loss or cerebral visual impairment. CONCLUSION In addition to structural MRI, fMRI with sensorimotor stimulation may open the gate to improve the knowledge of neurodevelopmental/motor prognosis if proven in a larger cohort of newborns with NE. WHAT IS KNOWN • Establishing an early, accurate neurodevelopmental prognosis in neonatal encephalopathy remains challenging. • Although structural MRI has a central role in neonatal encephalopathy, advanced MRI modalities are gradually being explored to optimize neurodevelopmental outcome knowledge. WHAT IS NEW • Newborns who later developed cerebral palsy had a trend towards lower fMRI measures in the right sensorimotor area during sensorimotor stimulation. • These preliminary fMRI results may improve future early delineation of motor prognosis in neonatal encephalopathy.
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Affiliation(s)
- Carla R Pinto
- Pediatric Intensive Care Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Avenida Afonso Romão, Coimbra, 3000-602, Portugal.
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.
| | - João V Duarte
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carla Marques
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês N Vicente
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Paiva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Éloi
- Otorhinolaryngology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela J Pereira
- Neuroradiology Unit, Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bárbara R Correia
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Quantitative Methods, Information and Management Systems Department, Coimbra Business School, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Guiomar Oliveira
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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22
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Variations in care of neonates during therapeutic hypothermia: call for care practice bundle implementation. Pediatr Res 2023:10.1038/s41390-022-02453-6. [PMID: 36624286 DOI: 10.1038/s41390-022-02453-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Therapeutic hypothermia (TH) is the gold-standard treatment for moderate and severe neonatal encephalopathy (NE). Care during TH has implications for long-term outcomes. Outcome variability exists among neonatal intensive care units (NICUs) in Canada, but care variations are not understood well. This study examines variations in care practices for neonates with NE treated with TH in NICUs across Canada. METHODS A non-anonymous, web-based questionnaire was emailed to tertiary NICUs in Canada providing TH for NE to assess care practices during the first days of life and neurodevelopmental follow-up. RESULTS Ninety-two percent (24/26) responded. Centres followed national guidelines regarding the use of the modified Sarnat score to assess the initial severity of NE, the need to initiate TH within the first 6 h of birth, and the importance of follow-up. However, other practices varied, including ventilation mode, definition/treatment of hypotension, routine echocardiography, use of sedation, use of electroencephalogram (EEG), MRI timing, placental analysis, and follow-up duration. CONCLUSIONS NICUs across Canada follow available national guidelines, but variations exist in practices for managing NE during TH. Development and implementation of a consensus-based care bundle for neonates during TH may reduce practice variability and improve outcomes. IMPACT This survey describes the current HIE care practices and variation among tertiary centres in Canada. Variations exist in the care of neonates with NE treated with TH in NICUs across Canada. This paper Identifies areas of variation that are not discussed in detail in the national guidelines and will help to set up quality improvement initiatives. Elucidating the variation in care practices calls for the creation and implementation of a national, consensus-based care bundle, with the objective to improve the outcomes of these critically ill neonates.
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Serrenho I, Cardoso CM, Grãos M, Dinis A, Manadas B, Baltazar G. Hypothermia Does Not Boost the Neuroprotection Promoted by Umbilical Cord Blood Cells in a Neonatal Hypoxia-Ischemia Rat Model. Int J Mol Sci 2022; 24:ijms24010257. [PMID: 36613698 PMCID: PMC9820288 DOI: 10.3390/ijms24010257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of death and long-term disability in the perinatal period. Currently, therapeutic hypothermia is the standard of care for this condition with modest efficacy and strict enrollment criteria. Therapy with umbilical cord blood cells (UCBC) has come forward as a strong candidate for the treatment of neonatal HIE, but no preclinical studies have yet compared the action of UCBC combined with hypothermia (HT) with the action of each therapy by itself. Thus, to evaluate the potential of each therapeutic approach, a hypoxic-ischemic brain lesion was induced in postnatal day ten rat pups; two hours later, HT was applied for 4 h; and 24, 48, and 72 h post-injury, UCBC were administered intravenously. The neonatal hypoxic-ischemic injury led to a brain lesion involving about 48% of the left hemisphere that was not improved by HT (36%) or UCBC alone (28%), but only with the combined therapies (25%; p = 0.0294). Moreover, a decrease in glial reactivity and improved functional outcomes were observed in both groups treated with UCBC. Overall, these results support UCBC as a successful therapeutic approach for HIE, even when treatment with therapeutic hypothermia is not possible.
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Affiliation(s)
- Inês Serrenho
- Health Sciences Research Center (CICS-UBI), University of Beira Interior, 6201-506 Covilhã, Portugal
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | | | - Mário Grãos
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Biocant, Technology Transfer Association, 3060-197 Cantanhede, Portugal
- Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
| | - Alexandra Dinis
- Pediatric Intensive Care Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Bruno Manadas
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Institute for Interdisciplinary Research, University of Coimbra (IIIUC), 3030-789 Coimbra, Portugal
- Correspondence: (B.M.); (G.B.)
| | - Graça Baltazar
- Health Sciences Research Center (CICS-UBI), University of Beira Interior, 6201-506 Covilhã, Portugal
- Faculty of Health Sciences, University of Beira Interior, 6201-506 Covilhã, Portugal
- Correspondence: (B.M.); (G.B.)
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24
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Robertsson Grossmann K, Eriksson Westblad M, Blennow M, Lindström K. Outcome at early school age and adolescence after hypothermia-treated hypoxic-ischaemic encephalopathy: an observational, population-based study. Arch Dis Child Fetal Neonatal Ed 2022; 108:295-301. [PMID: 36600485 PMCID: PMC10176399 DOI: 10.1136/archdischild-2022-324418] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We aimed to describe long-term outcomes following hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). DESIGN Prospective, population-based observational study. SETTING Tertiary level neonatal intensive care units and neonatal outpatient clinic, Karolinska University Hospital, Stockholm, Sweden. PATIENTS Sixty-six infants treated with TH due to HIE between 2007 and 2009. INTERVENTIONS At 6-8 years and 10-12 years of age, children were assessed using a standardised neurological examination, the Movement Assessment Battery for Children, Second Edition (MABC-2) and the Wechsler Intelligence Scales for Children IV/V. Parents completed the Five-to-Fifteen (FTF) questionnaire. MAIN OUTCOME MEASURES Adverse outcome among survivors was defined as cerebral palsy (CP), epilepsy, hearing or visual impairment, full-scale IQ (FSIQ) below 85, attention deficit disorder with/without hyperactivity, autism spectrum disorder or developmental coordination disorder. RESULTS Mortality was 12%. Seventeen per cent of survivors developed CP. Mean FSIQ was normal in children without major neuromotor impairment. Assessment in early adolescence revealed emerging deficits in 26% of children with a previously favourable outcome. The proportion of children exhibiting executive difficulties increased from 7% to 19%. This was reflected also by a significantly increased proportion of children with an FTF score >90th percentile compared with norms in early adolescence. The proportion of children with an MABC-2 score ≤5th percentile was also significantly increased compared with norms. CONCLUSIONS Survivors without major neuromotor impairment have normal intelligence. The incidence of executive difficulties appears to be increased in this patient population. More subtle difficulties may go undetected at early school-age.
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Affiliation(s)
- Katarina Robertsson Grossmann
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden .,Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Mimmi Eriksson Westblad
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden.,Medical Unit of Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Blennow
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Lindström
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Child Neurology, Karolinska University Hospital, Stockholm, Sweden
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Children, Adolescents, and Young Adults with Borderline Intellectual Functioning: Etiological, Neurophysiological, and Mri Findings in a Cohort of 651 Patients. Neurol Int 2022; 14:1007-1017. [PMID: 36548185 PMCID: PMC9785934 DOI: 10.3390/neurolint14040080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
This retrospective chart review study explored the etiology, use, and yield of the etiological investigations of 651 children and adolescents diagnosed with borderline intellectual functioning (BIF). Neurological, neurodevelopmental, or neuropsychiatric comorbidities were frequent, and in 23%, the BIF diagnosis evolved into an intellectual disability (ID) by the time of discharge. A primary etiological cause was found in 37.6%, the most prevalent causes being pre- or perinatal conditions, genetic syndromes/chromosomal abnormalities, fetal exposure to maternal substance use, cerebral dysgenesis, and neurological diseases. In total, 79.1% of patients went through one or more investigations during their follow-up. The best etiologic yield leading to a diagnosis in this study population was with exome sequencing, a specific gene panel, microarrays, electroneuromyography, and brain magnetic resonance imaging (MRI). Etiological investigations were performed more frequently among those children receiving an ID diagnosis. Yet, there was no statistically significant difference in the proportion of abnormal findings between the BIF and ID groups. This may mean that the current strategy for determining the need for etiological investigations or current means to gain an etiology is still indecisive. Considering that BIF is defined to include individuals performing between normal cognitive functioning and mild ID, this implies that the prevalence would be anywhere between 7 and 14%. Thus, it could be argued whether in-depth etiological investigations may be justified in cases other than ID in this age group of children over five. With these children and adolescents, the clinicians have to discern between those with a normal variation and those having major difficulties in adaptive behavior affecting everyday life in order to specify and prescribe the rehabilitation or other measures needed. We advocate for a targeted etiological search after careful history-taking and neurological examination. National guidelines that take into account the severity of developmental delay are warranted.
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Challenges and Neuropsychological Functioning in Children and Adolescents with Borderline Intellectual Functioning. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121847. [PMID: 36553291 PMCID: PMC9777449 DOI: 10.3390/children9121847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
This retrospective chart review study sought to explore neuropsychological profiles, neuropsychiatric and psychiatric comorbidity, changes in diagnoses, support at daycare and school, medication use, psychiatric referrals, and progression into further education in a cohort of participants with borderline intellectual functioning (BIF). Additionally, developmental factors connected to BIF were studied. Delays in language and gross motor development were the initial reasons for the parents to seek health care. Comorbid neuropsychiatric and psychiatric diagnoses were frequent, a total of 41% of participants were referred to psychiatric services, and 45% used medication. Educational support was needed by 92% of the study participants. The majority of those graduating elementary school continued their studies at ordinary or special vocational schools. The risk of dropping out during secondary studies appeared to increase. The results in most of the neuropsychological subdomains declined over time, and 23% of the participants were later diagnosed with an intellectual disability (ID). The early developmental signs pointing towards BIF and the need for prompt support were a delay in language and motor development, difficulties in executive function, a delay in learning the activities of daily living among children under school age, and difficulties in reading and arithmetic skills and abstract reasoning at school age. It is important to follow up and support individuals with BIF as their risk for being left behind in the society is increased. Also, it would be important to repeat the neuropsychological testing of cognitive and adaptive functions before graduating elementary school as to capture those who meet the ID criteria.
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27
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Neonatal hypoxia ischemia redistributes L1 cell adhesion molecule into rat cerebellar lipid rafts. Pediatr Res 2022; 92:1325-1331. [PMID: 35152267 PMCID: PMC9372221 DOI: 10.1038/s41390-022-01974-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is a devastating disease with lifelong disabilities. Hypothermia is currently the only treatment. At term, the neonatal cerebellum may be particularly vulnerable to the effects of HIE. At this time, many developmental processes depend on lipid raft function. These microdomains of the plasma membrane are critical for cellular signaling and axon extension. We hypothesized that HIE alters the protein content of lipid rafts in the cerebellum. METHODS Postnatal day (PN) 10 animals, considered human term equivalent, underwent hypoxic-ischemic (HI) injury by a right carotid artery ligation followed by hypoxia. For some animals, LPS was administered on PN7, and hypothermia (HT) was conducted for 4 h post-hypoxia. Lipid rafts were isolated from the right and left cerebella. The percent of total L1 cell adhesion molecule in lipid rafts was determined 4 and 72 h after hypoxia. RESULTS No sex differences were found. HI alone caused significant increases in the percent of L1 in lipid rafts which persisted until 72 h in the right but not the left cerebellum. A small but significant effect of LPS was detected in the left cerebellum 72 h after HI. Hypothermia had no effect. CONCLUSIONS Lipid rafts may be a new target for interventions of HIE. IMPACT This article investigates the effect of neonatal exposure to hypoxic-ischemic encephalopathy (HIE) on the distribution of membrane proteins in the cerebellum. This article explores the effectiveness of hypothermia as a prevention for the harmful effects of HIE on membrane protein distribution. This article shows an area of potential detriment secondary to HIE that persists with current treatments, and explores ideas for new treatments.
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Tarkowska A, Furmaga-Jabłońska W, Bogucki J, Kocki J, Pluta R. Hypothermia after Perinatal Asphyxia Does Not Affect Genes Responsible for Amyloid Production in Neonatal Peripheral Lymphocytes. J Clin Med 2022; 11:3263. [PMID: 35743334 PMCID: PMC9225259 DOI: 10.3390/jcm11123263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, the expression of the genes of the amyloid protein precursor, β-secretase, presenilin 1 and 2 by RT-PCR in the lymphocytes of newborns after perinatal asphyxia and perinatal asphyxia treated with hypothermia was analyzed at the age of 15-21 days. The relative quantification of Alzheimer's-disease-related genes was first performed by comparing the peripheral lymphocytes of non-asphyxia control versus those with asphyxia or asphyxia with hypothermia. In the newborns who had perinatal asphyxia, the peripheral lymphocytes presented a decreased expression of the amyloid protein precursor and β-secretase genes. On the other hand, the expression of the presenilin 1 and 2 genes increased in the studied group. The expression of the studied genes in the asphyxia group treated with hypothermia had an identical pattern of changes that were not statistically significant to the asphyxia group. This suggests that the expression of the genes involved in the metabolism of the amyloid protein precursor in the peripheral lymphocytes may be a biomarker of progressive pathological processes in the brain after asphyxia that are not affected by hypothermia. These are the first data in the world showing the role of hypothermia in the gene changes associated with Alzheimer's disease in the peripheral lymphocytes of newborns after asphyxia.
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Affiliation(s)
- Agata Tarkowska
- Department of Neonate and Infant Pathology, Medical University of Lublin, 20-093 Lublin, Poland; (A.T.); (W.F.-J.)
| | - Wanda Furmaga-Jabłońska
- Department of Neonate and Infant Pathology, Medical University of Lublin, 20-093 Lublin, Poland; (A.T.); (W.F.-J.)
| | - Jacek Bogucki
- Department of Organic Chemistry, Faculty of Pharmacy, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland;
| | - Ryszard Pluta
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
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Pregnolato S, Sabir H, Luyt K, Rienecker KDA, Isles AR, Chakkarapani E. Regulation of glutamate transport and neuroinflammation in a term newborn rat model of hypoxic–ischaemic brain injury. Brain Neurosci Adv 2022; 6:23982128221097568. [PMID: 35615059 PMCID: PMC9125068 DOI: 10.1177/23982128221097568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
In the newborn brain, moderate-severe hypoxia–ischaemia induces glutamate excitotoxicity and inflammation, possibly via dysregulation of candidate astrocytic glutamate transporter ( Glt1) and pro-inflammatory cytokines (e.g. Tnfα, Il1β, Il6). Epigenetic mechanisms may mediate dysregulation. Hypotheses: (1) hypoxia–ischaemia dysregulates mRNA expression of these candidate genes; (2) expression changes in Glt1 are mediated by DNA methylation changes; and (3) methylation values in brain and blood are correlated. Seven-day-old rat pups ( n = 42) were assigned to nine groups based on treatment (for each timepoint: naïve ( n = 3), sham ( n = 3), hypoxia–ischaemia ( n = 8) and timepoint for tissue collection (6, 12 and 24 h post-hypoxia). Moderate hypoxic–ischemic brain injury was induced via ligation of the left common carotid artery followed by 100 min hypoxia (8% O2, 36°C). mRNA was quantified in cortex and hippocampus for the candidate genes, myelin ( Mbp), astrocytic ( Gfap) and neuronal ( Map2) markers (qPCR). DNA methylation was measured for Glt1 in cortex and blood (bisulphite pyrosequencing). Hypoxia–ischaemia induced pro-inflammatory cytokine upregulation in both brain regions at 6 h. This was accompanied by gene expression changes potentially indicating onset of astrogliosis and myelin injury. There were no significant changes in expression or promoter DNA methylation of Glt1. This pilot study supports accumulating evidence that hypoxia–ischaemia causes neuroinflammation in the newborn brain and prioritises further expression and DNA methylation analyses focusing on this pathway. Epigenetic blood biomarkers may facilitate identification of high-risk newborns at birth, maximising chances of neuroprotective interventions.
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Affiliation(s)
- Silvia Pregnolato
- Department of Neonatal Neurology, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University of Bonn, Bonn, Germany
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg Essen, Essen, Germany
| | - Karen Luyt
- Department of Neonatal Neurology, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kira DA Rienecker
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Anthony R Isles
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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30
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Cristancho AG, Gadra EC, Samba IM, Zhao C, Ouyang M, Magnitsky S, Huang H, Viaene AN, Anderson SA, Marsh ED. Deficits in Seizure Threshold and Other Behaviors in Adult Mice without Gross Neuroanatomic Injury after Late Gestation Transient Prenatal Hypoxia. Dev Neurosci 2022; 44:246-265. [PMID: 35279653 PMCID: PMC9464267 DOI: 10.1159/000524045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Intrauterine hypoxia is a common cause of brain injury in children resulting in a broad spectrum of long-term neurodevelopmental sequela, including life-long disabilities that can occur even in the absence of severe neuroanatomic damage. Postnatal hypoxia-ischemia rodent models are commonly used to understand the effects of ischemia and transient hypoxia on the developing brain. Postnatal models, however, have some limitations. First, they do not test the impact of placental pathologies on outcomes from hypoxia. Second, they primarily recapitulate severe injury because they provoke substantial cell death, which is not seen in children with mild hypoxic injury. Lastly, they do not model preterm hypoxic injury. Prenatal models of hypoxia in mice may allow us to address some of these limitations to expand our understanding of developmental brain injury. The published rodent models of prenatal hypoxia employ multiple days of hypoxic exposure or complicated surgical procedures, making these models challenging to perform consistently in mice. Furthermore, large animal models suggest that transient prenatal hypoxia without ischemia is sufficient to lead to significant functional impairment to the developing brain. However, these large animal studies are resource-intensive and not readily amenable to mechanistic molecular studies. Therefore, here we characterized the effect of late gestation (embryonic day 17.5) transient prenatal hypoxia (5% inspired oxygen) on long-term anatomical and neurodevelopmental outcomes in mice. Late gestation transient prenatal hypoxia increased hypoxia-inducible factor 1 alpha protein levels (a marker of hypoxic exposure) in the fetal brain. Hypoxia exposure predisposed animals to decreased weight at postnatal day 2, which normalized by day 8. However, hypoxia did not affect gestational age at birth, litter size at birth, or pup survival. No differences in fetal brain cell death or long-term gray or white matter changes resulted from hypoxia. Animals exposed to prenatal hypoxia did have several long-term functional consequences, including sex-dichotomous changes. Hypoxia exposure was associated with a decreased seizure threshold and abnormalities in hindlimb strength and repetitive behaviors in males and females. Males exposed to hypoxia had increased anxiety-related deficits, whereas females had deficits in social interaction. Neither sex developed any motor or visual learning deficits. This study demonstrates that late gestation transient prenatal hypoxia in mice is a simple, clinically relevant paradigm for studying putative environmental and genetic modulators of the long-term effects of hypoxia on the developing brain.
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Affiliation(s)
- Ana G. Cristancho
- Division of Child Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Elyse C. Gadra
- Department of Child and Adolescent Psychiatry and Behavioral Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - Ima M. Samba
- Division of Child Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - Chenying Zhao
- Radiology Research, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, U.S.A
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Minhui Ouyang
- Radiology Research, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, U.S.A
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, U.S.A
| | - Sergey Magnitsky
- Radiology Research, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, U.S.A
| | - Hao Huang
- Radiology Research, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, U.S.A
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, U.S.A
| | - Angela N. Viaene
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A. and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Stewart A. Anderson
- Department of Child and Adolescent Psychiatry and Behavioral Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Eric D. Marsh
- Division of Child Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, U.S.A
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
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31
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Chen X, Zhang J, Wu Y, Tucker R, Baird GL, Domonoske R, Barrios-Anderson A, Lim YP, Bath K, Walsh EG, Stonestreet BS. Inter-alpha Inhibitor Proteins Ameliorate Brain Injury and Improve Behavioral Outcomes in a Sex-Dependent Manner After Exposure to Neonatal Hypoxia Ischemia in Newborn and Young Adult Rats. Neurotherapeutics 2022; 19:528-549. [PMID: 35290609 PMCID: PMC9226254 DOI: 10.1007/s13311-022-01217-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 12/16/2022] Open
Abstract
Hypoxic-ischemic (HI) brain injury is a major contributor to neurodevelopmental morbidities. Inter-alpha inhibitor proteins (IAIPs) have neuroprotective effects on HI-related brain injury in neonatal rats. However, the effects of treatment with IAIPs on sequential behavioral, MRI, and histopathological abnormalities in the young adult brain after treatment with IAIPs in neonates remain to be determined. The objective of this study was to examine the neuroprotective effects of IAIPs at different neurodevelopmental stages from newborn to young adults after exposure of neonates to HI injury. IAIPs were given as 11-sequential 30-mg/kg doses to postnatal (P) day 7-21 rats after right common carotid artery ligation and exposure to 90 min of 8% oxygen. The resulting brain edema and injury were examined by T2-weighted magnetic resonance imaging (MRI) and cresyl violet staining, respectively. The mean T2 values of the ipsilateral hemisphere from MRI slices 6 to 10 were reduced in IAIP-treated HI males + females on P8, P9, and P10 and females on P8, P9, P10, and P14. IAIP treatment reduced hemispheric volume atrophy by 44.5 ± 29.7% in adult male + female P42 rats and improved general locomotor abilities measured by the righting reflex over time at P7.5, P8, and P9 in males + females and males and muscle strength/endurance measured by wire hang on P16 in males + females and females. IAIPs provided beneficial effects during the learning phase of the Morris water maze with females exhibiting beneficial effects. IAIPs confer neuroprotection from HI-related brain injury in neonates and even in adult rats and beneficial MRI and behavioral benefits in a sex-dependent manner.
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Affiliation(s)
- Xiaodi Chen
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Jiyong Zhang
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Yuqi Wu
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Richard Tucker
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Grayson L Baird
- Department of Diagnostic Imaging, Biostatistics Core Lifespan Hospital System, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rose Domonoske
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Adriel Barrios-Anderson
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA
| | - Yow-Pin Lim
- ProThera Biologics, Inc, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin Bath
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical College, New York, NY, USA
| | - Edward G Walsh
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Barbara S Stonestreet
- Department of Pediatrics, Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Women &101 Dudley Street, Providence, RI, 02905-2499, USA.
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32
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Magai DN, Koot HM, Newton CR, Abubakar A. Long-Term Mental Health and Quality of Life Outcomes of Neonatal Insults in Kilifi, Kenya. Child Psychiatry Hum Dev 2022; 53:212-222. [PMID: 33452950 PMCID: PMC8924086 DOI: 10.1007/s10578-020-01079-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
We examined the mental health and quality of life (QoL) outcomes and their correlates of school-aged survivors of neonatal jaundice (NNJ), hypoxic-ischemic encephalopathy (HIE), and a comparison group. The Child Behavior Checklist and the Pediatric Quality of Life Inventory were administered to assess the mental health and QoL of 375 children (134 with NNJ, 107 with HIE, and 134 comparison group) aged 6 to 12 years [Median age 9 (interquartile range 7 to 11)]. The results showed that survivors of NNJ and HIE have mental health problems and QoL similar to the comparison group. Maternal mental health was the predominant covariate of mental health and QoL in survivors of NNJ and HIE. This result could indicate that mothers with mental health problems are more likely to have children with mental health issues, but also that caring for children with these adversities may affect mental health well-being of the caregivers. There is a need for early mental health screening and psychosocial intervention for caregivers and their children to enhance both their mental health and QoL.
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Affiliation(s)
- Dorcas N Magai
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya.
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Charles R Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Erdi-Krausz G, Rocha R, Brown A, Myneni A, Lennartsson F, Romsauerova A, Cianfaglione R, Edmonds CJ, Vollmer B. Neonatal hypoxic-ischaemic encephalopathy: Motor impairment beyond cerebral palsy. Eur J Paediatr Neurol 2021; 35:74-81. [PMID: 34666231 DOI: 10.1016/j.ejpn.2021.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/21/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research investigating neuromotor function in the absence of cerebral palsy (CP) for children who had neonatal HIE is limited. AIMS To investigate school-age neurological and neuromotor function, and correlations with attention, neonatal Magnetic Resonance Imaging (MRI), and neuromotor assessments at toddler age. METHODS Twenty-seven children with neonatal HIE without CP who underwent hypothermia treatment and a comparison group of 20 children were assessed at age 5-7 years for Minor Neurological Dysfunction (MND; simplified Touwen), motor skills (Movement Assessment Battery for Children-2; MABC-2), parental concern over motor function (MABC Checklist), general cognition (Wechsler Preschool and Primary Scale of Intelligence-IV, WPPSI), and attention (DuPaul ADHD Rating Scale). Neurological examination and motor development, using Bayley-3 scales, at age 24-months was extracted from the clinical database. Clinical neonatal MRI was assessed for hypoxic-ischaemic injury. RESULTS In the HIE group, MND was more prevalent (p = 0.026) and M-ABC performance (total score p = 0.006; balance subtest p = 0.008) was worse; parents were more concerned about children's motor function (p = 0.011). HIE group inattention scores were higher (p = 0.032), which correlated with lower MABC-2 scores (rs = -0.590, p = 0.004). Neurological examination at 24-months correlated with MND (rs = 0.437, p = 0.033); Bayley-3 motor scores did not correlate with M-ABC-2 scores (rs = 368, p = 0.133). Neonatal MRI findings were not associated with school-age MND (rs = 0.140, p = 0.523) or MABC-2 (rs = 0.300, p = 0.165). CONCLUSIONS Children with neonatal HIE, without CP, treated with hypothermia may be more likely to develop MND and motor difficulties than typically developing peers. Inattention may contribute to motor performance. In the absence of CP, neonatal MRI and toddler age assessment of motor development have limited predictive value for school-age outcome. Since this was an exploratory study with a small sample size, findings should be confirmed by a definite larger study.
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Affiliation(s)
- Gergo Erdi-Krausz
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Ruben Rocha
- Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Alice Brown
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Archana Myneni
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Finn Lennartsson
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Andrea Romsauerova
- Neuroradiology Department, University Hospital of Southampton NHS Foundation Trust, UK
| | - Rina Cianfaglione
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| | - Caroline J Edmonds
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; School of Psychology, University of East London, London, UK
| | - Brigitte Vollmer
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Neonatal and Paediatric Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Wintermark P, Mohammad K, Bonifacio SL. Proposing a care practice bundle for neonatal encephalopathy during therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101303. [PMID: 34711527 DOI: 10.1016/j.siny.2021.101303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neonates with neonatal encephalopathy (NE) often present with multi-organ dysfunction that requires multidisciplinary specialized management. Care of the neonate with NE is thus complex with interaction between the brain and various organ systems. Illness severity during the first days of birth, and not only during the initial hypoxia-ischemia event, is a significant predictor of adverse outcomes in neonates with NE treated with therapeutic hypothermia (TH). We thus propose a care practice bundle dedicated to support the injured neonatal brain that is based on the current best evidence for each organ system. The impact of using such bundle on outcomes in NE remains to be demonstrated.
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Affiliation(s)
- Pia Wintermark
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Neonatology, University of Calgary, 28 Oki Drive NW, T3B 6A8, Calgary, AB, Canada.
| | - Sonia L Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Road, Suite 315, 94304, Palo Alto, CA, USA.
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- Newborn Brain Society, PO Box 200783, Roxbury Crossing, 02120, MA, USA
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35
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Marlow N, Shankaran S, Rogers EE, Maitre NL, Smyser CD. Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101274. [PMID: 34330680 DOI: 10.1016/j.siny.2021.101274] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In randomized trials, therapeutic hypothermia (TH) is associated with reduced prevalence of the composite outcome mortality or neurodevelopmental morbidity in infants with neonatal encephalopathy (NE). Following systematic review, the reduction in prevalence of both mortality and infant neuromorbidity is clear. Among three trials reporting school age outcomes, the effects of NE and TH suggest that such benefit persists into middle childhood, but none of the major trials were powered to detect differences in these outcomes. Cognitive, educational and behavioural outcomes are all adversely affected by NE in children without moderate or severe neuromorbidity. High-quality longitudinal studies of neurocognitive and educational outcomes following NE in the era of TH, including studies incorporating multimodal neuroimaging assessments, are required to characterise deficits more precisely so that robust interventional targets may be developed, and resource planning can occur. Understanding the impact of NE on families and important educational, social, and behavioural outcomes in childhood is critical to attempts to optimise outcomes through interventions.
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Affiliation(s)
| | | | | | - Nathalie L Maitre
- Nationwide Children's Hospital, Columbus, OH, USA; Vanderbilt University, Nashville, TN, USA
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Edmonds CJ, Cianfaglione R, Cornforth C, Vollmer B. Children with neonatal Hypoxic Ischaemic Encephalopathy (HIE) treated with therapeutic hypothermia are not as school ready as their peers. Acta Paediatr 2021; 110:2756-2765. [PMID: 34160861 DOI: 10.1111/apa.16002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/12/2023]
Abstract
AIM We aimed to determine whether children with neonatal Hypoxic Ischaemic Encephalopathy (HIE) treated with therapeutic hypothermia (TH) differ from their peers on measures of fine motor skills, executive function, language and general cognitive abilities, factors that are important for school readiness. METHODS We compared school readiness in 31children with HIE treated with TH (without Cerebral Palsy; mean age 5 years 4 months) with 20 typically developing children without HIE (mean age 5 years 6 months). RESULTS Children with HIE scored significantly lower than typically developing children on fine motor skills, executive functions, memory and language. CONCLUSION While general cognitive abilities and attainment were in the normal range, our findings suggest those scores mask specific underlying difficulties identified by more focussed assessments. Children with HIE treated with TH may not be as 'school ready' as their typically developing classmates and may benefit from long-term follow-up until starting school.
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Affiliation(s)
- Caroline J Edmonds
- School of Psychology University of East London London UK
- Clinical and Experimental Sciences Faculty of Medicine Southampton General Hospital University of Southampton Southampton UK
| | - Rina Cianfaglione
- Clinical and Experimental Sciences Faculty of Medicine Southampton General Hospital University of Southampton Southampton UK
| | - Christine Cornforth
- Harris Wellbeing of Women Research Centre Liverpool Women's Hospital University of Liverpool Liverpool UK
| | - Brigitte Vollmer
- Clinical and Experimental Sciences Faculty of Medicine Southampton General Hospital University of Southampton Southampton UK
- Paediatric and Neonatal Neurology Southampton Children’s Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
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37
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Peng X, Wang J, Peng J, Jiang H, Le K. Resveratrol Improves Synaptic Plasticity in Hypoxic-Ischemic Brain Injury in Neonatal Mice via Alleviating SIRT1/NF-κB Signaling-Mediated Neuroinflammation. J Mol Neurosci 2021; 72:113-125. [PMID: 34549339 DOI: 10.1007/s12031-021-01908-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Neonatal hypoxic-ischemic encephalopathy (HIE) is an obstinate disease that troubles neonatologists. At present, cognitive impairment after HIE has received increasing attention. Synaptic plasticity determines the development of cognitive function, so it is urgent to develop new drugs that can improve HIE-induced cognitive impairment. Hypoxia-ischemia (HI)-induced neuroinflammation affects synaptic plasticity. As a SIRT1 agonist, resveratrol has a powerful anti-inflammatory effect, but whether it has an effect on impaired synaptic plasticity in HIE and the potential mechanism remain unclear. In the present study, resveratrol was used to intervene in hypoxic-ischemic brain injury (HIBI) mice, and the effects on hippocampal synaptic plasticity and further mechanisms were explored through performing neurobehavioral, morphological observations, Golgi sliver staining, western blotting, and quantitative real-time polymerase chain reaction experiments. We first found that resveratrol improves HI-induced long-term cognitive and memory deficits, and then we found that resveratrol reduces hippocampal neuronal damage and increases dendritic spine density and the expression of synaptic proteins. Finally, we found that this effect may be exerted by regulating the neuroinflammatory response mediated by the SIRT1/NF-κB axis. This study provides a new theoretical basis for resveratrol to prevent long-term neurological dysfunction following HIBI.
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Affiliation(s)
- Xin Peng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China.,Department of Otolaryngology, Jiangxi Province Children's Hospital, No.122 Yangming Road, Nanchang, Jiangxi Province, 330006, China
| | - Jun Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Juan Peng
- Department of Rehabilitation Medicine, PingXiang No.2 People's Hospital, No. 89 Pingan South Avenue, Danjiang Street, PingXiang, Jiangxi Province, 337000, China
| | - Hongqun Jiang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China
| | - Kai Le
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Nanchang, Jiangxi Province, 330006, China.
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Long-Term Outcomes of Perinatal Hypoxia and Asphyxia at an Early School Age. MEDICINA-LITHUANIA 2021; 57:medicina57090988. [PMID: 34577911 PMCID: PMC8466311 DOI: 10.3390/medicina57090988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8–9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8–9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105(15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level.
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Gailus B, Naundorf H, Welzel L, Johne M, Römermann K, Kaila K, Löscher W. Long-term outcome in a noninvasive rat model of birth asphyxia with neonatal seizures: Cognitive impairment, anxiety, epilepsy, and structural brain alterations. Epilepsia 2021; 62:2826-2844. [PMID: 34458992 DOI: 10.1111/epi.17050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Birth asphyxia is a major cause of hypoxic-ischemic encephalopathy (HIE) in neonates and often associated with mortality, neonatal seizures, brain damage, and later life motor, cognitive, and behavioral impairments and epilepsy. Preclinical studies on rodent models are needed to develop more effective therapies for preventing HIE and its consequences. Thus far, the most popular rodent models have used either exposure of intact animals to hypoxia-only, or a combination of hypoxia and carotid occlusion, for the induction of neonatal seizures and adverse outcomes. However, such models lack systemic hypercapnia, which is a fundamental constituent of birth asphyxia with major effects on neuronal excitability. Here, we use a recently developed noninvasive rat model of birth asphyxia with subsequent neonatal seizures to study later life adverse outcome. METHODS Intermittent asphyxia was induced for 30 min by exposing male and female postnatal day 11 rat pups to three 7 + 3-min cycles of 9% and 5% O2 at constant 20% CO2 . All pups exhibited convulsive seizures after asphyxia. A set of behavioral tests were performed systematically over 14 months following asphyxia, that is, a large part of the rat's life span. Video-electroencephalographic (EEG) monitoring was used to determine whether asphyxia led to the development of epilepsy. Finally, structural brain alterations were examined. RESULTS The animals showed impaired spatial learning and memory and increased anxiety when tested at an age of 3-14 months. Video-EEG at ~10 months showed an abundance of spontaneous seizures, which was paralleled by neurodegeneration in the hippocampus and thalamus, and by aberrant mossy fiber sprouting. SIGNIFICANCE The present model of birth asphyxia recapitulates several of the later life consequences associated with human HIE. This model thus allows evaluation of the efficacy of novel therapies designed to prevent HIE and seizures following asphyxia, and of how such therapies might alleviate long-term adverse consequences.
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Affiliation(s)
- Björn Gailus
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Hannah Naundorf
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Lisa Welzel
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
| | - Marie Johne
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Kerstin Römermann
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
| | - Kai Kaila
- Molecular and Integrative Biosciences, University of Helsinki, Helsinki, Finland.,Neuroscience Center (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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Abstract
Neonatal encephalopathy due to perinatal hypoxia-ischemia (hypoxic-ischemic encephalopathy [HIE]) occurs at a rate of 1 to 3 per 1000 live births. Therapeutic hypothermia is the standard of care and the only currently available therapy to reduce the risk of death or disability in newborns with moderate to severe HIE. Hypothermia therapy needs to be initiated within 6 hours after birth in order to provide the best chance for neuroprotection. All pediatricians and delivery room attendants should be trained to recognize encephalopathy and understand the eligibility criteria for treatment. The modified Sarnat examination is the most frequently used tool to assess the degree of encephalopathy and has six categories, each of which can have mild, moderate, severe abnormalities. Apart from historical and biochemical criteria, a neonate must have 3 of 6 categories scored in the moderate or severe range in order to qualify for hypothermia as was done in the randomized trials. Whether an infant qualifies or there is concern that an infant might have HIE, transfer to a center that can perform treatment should be initiated immediately. Hypothermia significantly reduces the risk of death or moderate to severe impairments at 2 years and at school age. On average, only 7 neonates need to be treated for one neonate to benefit. Although easy in concept, implementation of hypothermia does require expertise and should be carried out under the guidance of a neonatologist. If infants are passively cooled prior to transport, core temperature needs to be closely monitored with a target of 33.5°C ± 0.5°C. Maintenance of homeostasis is important in order to prevent conditions that may result in additional brain injury. Seizures are common in neonates with HIE, but electrographic seizures are rare in the first few hours after birth if the insult occurred during labor and delivery. Prophylactic antiepileptic drugs should not be administered. Brain monitoring in the form of electroencephalogram (EEG) and or amplitude-integrated EEG should be implemented as soon as possible to help with prognosis and to accurately diagnose seizures.
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Affiliation(s)
- Sonia Lomeli Bonifacio
- NeuroNICU, Division of Neonatal and Developmental Medicine, 750 Welch Road, Suite 315, Palo Alto, CA, USA.
| | - Shandee Hutson
- Department of Neonatology, NICN, Sharp Mary Birch Hospital for Women and Newborns, 8555 Aero Drive #104, San Diego, CA 92123, USA
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Ezenwa BN, Olorunfemi G, Fajolu I, Adeniyi T, Oleolo-Ayodeji K, Kene-Udemezue B, Olamijulo JA, Ezeaka C. Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study. PLoS One 2021; 16:e0250633. [PMID: 33901237 PMCID: PMC8075215 DOI: 10.1371/journal.pone.0250633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Globally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria. Objective We assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital. Methods A temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software. Results The median age of the newborns at admission was 26.5 (10–53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03). Conclusion The case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.
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Affiliation(s)
- Beatrice Nkolika Ezenwa
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- * E-mail:
| | - Gbenga Olorunfemi
- Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Iretiola Fajolu
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Toyin Adeniyi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Joseph A. Olamijulo
- Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinyere Ezeaka
- Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
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Penny TR, Pham Y, Sutherland AE, Smith MJ, Lee J, Jenkin G, Fahey MC, Miller SL, McDonald CA. Optimization of behavioral testing in a long-term rat model of hypoxic ischemic brain injury. Behav Brain Res 2021; 409:113322. [PMID: 33901432 DOI: 10.1016/j.bbr.2021.113322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hypoxic ischemic (HI) brain injury is a significant cause of childhood neurological deficits. Preclinical rodent models are often used to study these deficits; however, no preclinical study has determined which behavioral tests are most appropriate for long-term follow up after neonatal HI. METHODS HI brain injury was induced in postnatal day (PND) 10 rat pups using the Rice-Vannucci method of unilateral carotid artery ligation. Rats underwent long-term behavioral testing to assess motor and cognitive outcomes between PND11-50. Behavioral scores were transformed into Z-scores and combined to create composite behavioral scores. RESULTS HI rats showed a significant deficit in three out of eight behavioral tests: negative geotaxis analysis, the cylinder test and the novel object recognition test. These individual test outcomes were transformed into Z-scores and combined to create a composite Z-score. This composite z-score showed that HI rats had a significantly increased behavioral burden over the course of the experiment. CONCLUSION In this study we have identified tests that highlight specific cognitive and motor deficits in a rat model of neonatal HI. Due to the high variability in this model of neonatal HI brain injury, significant impairment is not always observed in individual behavioral tests, but by combining outcomes from these individual tests, long-term behavioral burden can be measured.
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Affiliation(s)
- Tayla R Penny
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Yen Pham
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Amy E Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Madeleine J Smith
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Joohyung Lee
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Courtney A McDonald
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
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Pereira-Figueiredo D, Nascimento AA, Cunha-Rodrigues MC, Brito R, Calaza KC. Caffeine and Its Neuroprotective Role in Ischemic Events: A Mechanism Dependent on Adenosine Receptors. Cell Mol Neurobiol 2021; 42:1693-1725. [PMID: 33730305 DOI: 10.1007/s10571-021-01077-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Ischemia is characterized by a transient, insufficient, or permanent interruption of blood flow to a tissue, which leads to an inadequate glucose and oxygen supply. The nervous tissue is highly active, and it closely depends on glucose and oxygen to satisfy its metabolic demand. Therefore, ischemic conditions promote cell death and lead to a secondary wave of cell damage that progressively spreads to the neighborhood areas, called penumbra. Brain ischemia is one of the main causes of deaths and summed with retinal ischemia comprises one of the principal reasons of disability. Although several studies have been performed to investigate the mechanisms of damage to find protective/preventive interventions, an effective treatment does not exist yet. Adenosine is a well-described neuromodulator in the central nervous system (CNS), and acts through four subtypes of G-protein-coupled receptors. Adenosine receptors, especially A1 and A2A receptors, are the main targets of caffeine in daily consumption doses. Accordingly, caffeine has been greatly studied in the context of CNS pathologies. In fact, adenosine system, as well as caffeine, is involved in neuroprotection effects in different pathological situations. Therefore, the present review focuses on the role of adenosine/caffeine in CNS, brain and retina, ischemic events.
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Affiliation(s)
- D Pereira-Figueiredo
- Neurobiology of the Retina Laboratory, Biomedical Sciences Program, Biomedical Institute, Fluminense Federal University, Niterói, RJ, Brazil
| | - A A Nascimento
- Neurobiology of the Retina Laboratory, Program of Neurosciences, Institute of Biology, Fluminense Federal University, Niterói, RJ, Brazil
| | - M C Cunha-Rodrigues
- Neurobiology of the Retina Laboratory, Program of Neurosciences, Institute of Biology, Fluminense Federal University, Niterói, RJ, Brazil
| | - R Brito
- Laboratory of Neuronal Physiology and Pathology, Cellular and Molecular Biology Department, Institute of Biology, Fluminense Federal University, Niterói, RJ, Brazil
| | - K C Calaza
- Neurobiology of the Retina Laboratory, Biomedical Sciences Program, Biomedical Institute, Fluminense Federal University, Niterói, RJ, Brazil. .,Neurobiology of the Retina Laboratory, Program of Neurosciences, Institute of Biology, Fluminense Federal University, Niterói, RJ, Brazil. .,Neurobiology Department, Biology Institute of Fluminense Federal University, Niteroi, RJ, Brazil.
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Annink KV, de Vries LS, Groenendaal F, Eijsermans RMJC, Mocking M, van Schooneveld MMJ, Dudink J, van Straaten HLM, Benders MJNL, Lequin M, van der Aa NE. Mammillary body atrophy and other MRI correlates of school-age outcome following neonatal hypoxic-ischemic encephalopathy. Sci Rep 2021; 11:5017. [PMID: 33658541 PMCID: PMC7930036 DOI: 10.1038/s41598-021-83982-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
The mammillary bodies (MB) and hippocampi are important for memory function and are often affected following neonatal hypoxic ischemic encephalopathy (HIE). The aim of this study was to assess neurodevelopmental outcome in 10-year-old children with HIE with and without therapeutic hypothermia. Additional aims were to assess the associations between MB atrophy, brain volumes (including the hippocampi), white matter microstructure and neurodevelopmental outcome at school-age. Ten-year-old children with HIE were included, who were treated with therapeutic hypothermia (n = 22) or would have qualified but were born before this became standard of care (n = 28). Children completed a neuropsychological and motor assessment and MRI. Mammillary bodies were scored as normal or atrophic at 10 years. Brain volumes were segmented on childhood MRI and DTI scans were analysed using tract-based spatial statistics. Children with HIE suffered from neurocognitive and memory problems at school-age, irrespective of hypothermia. Hippocampal volumes and MB atrophy were associated with total and performance IQ, processing speed and episodic memory in both groups. Normal MB and larger hippocampi were positively associated with global fractional anisotropy. In conclusion, injury to the MB and hippocampi was associated with neurocognition and memory at school-age in HIE and might be an early biomarker for neurocognitive and memory problems.
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Affiliation(s)
- Kim V Annink
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | | | - Manouk Mocking
- Department of Paediatric Psychology and Social Work, UMC Utrecht, Utrecht, The Netherlands
| | | | - Jeroen Dudink
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | | | - Manon J N L Benders
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | - Maarten Lequin
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands.
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Liu F, Shao M, Xu F, Rong F. Inhibition of NOD1 Attenuates Neonatal Hypoxia-Ischemia Induced Long-Term Cognitive Impairments in Mice Through Modulation of Autophagy-Related Proteins. Neuropsychiatr Dis Treat 2021; 17:2659-2669. [PMID: 34421301 PMCID: PMC8373312 DOI: 10.2147/ndt.s314884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Autophagy is implicated in neonatal hypoxia-ischemia (HI) induced cognitive impairment. The nucleotide-oligomerizing domain-1 (NOD1), a protein involved in inflammatory responses, has been shown to activate autophagy to promote progression of other diseases. We aimed to investigate whether and how NOD1 is involved in HI-induced brain injury using an HI mouse model. METHODS We induced HI in neonatal mice and examined levels of NOD1 and genes associated with autophagy. We then inhibited NOD1 by intracerebroventricular injection of si-NOD1 following HI induction and tested the effects on autophagy, inflammatory responses and long-term behavioral outcomes through Morris water maze and open field tests. RESULTS We found that HI induction significantly elevated mRNA levels of NOD1 (3.54 folds change) and autophagy-related genes including Atg5 (3.89 folds change) and Beclin-1 (3.34 folds change). NOD1 inhibition following HI induction suppressed autophagy signaling as well as HI induced proinflammatory cytokine production. Importantly, NOD1 inhibition after HI improved long-term cognitive function, without impacting exploratory and locomotor activities. CONCLUSION We show here that NOD1 is involved in the pathogenesis of HI-induced brain injury through modulation of autophagy-related proteins and inflammatory responses. Our findings suggest that NOD1 may be a potent target for developing therapeutic strategies for treating HI-induced brain injury.
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Affiliation(s)
- Fang Liu
- Department of Child Health Care, Zibo Central Hospital, Zibo, 255000, Shandong, People's Republic of China
| | - Mingyu Shao
- Department of Child Health Care, Zibo Central Hospital, Zibo, 255000, Shandong, People's Republic of China
| | - Feng Xu
- Department of Pediatrics, Zibo Central Hospital, Zibo, 255000, Shandong, People's Republic of China
| | - Fang Rong
- The Community Clinic of Overseas Chinese Town, Zibo Central Hospital, North Gate of Zhongrun Overseas Chinese Town, Zibo, 255000, Shandong, People's Republic of China
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Rodriguez J, Li T, Xu Y, Sun Y, Zhu C. Role of apoptosis-inducing factor in perinatal hypoxic-ischemic brain injury. Neural Regen Res 2021; 16:205-213. [PMID: 32859765 PMCID: PMC7896227 DOI: 10.4103/1673-5374.290875] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Perinatal complications, such as asphyxia, can cause brain injuries that are often associated with subsequent neurological deficits, such as cerebral palsy or mental retardation. The mechanisms of perinatal brain injury are not fully understood, but mitochondria play a prominent role not only due to their central function in metabolism but also because many proteins with apoptosis-related functions are located in the mitochondrion. Among these proteins, apoptosis-inducing factor has already been shown to be an important factor involved in neuronal cell death upon hypoxia-ischemia, but a better understanding of the mechanisms behind these processes is required for the development of more effective treatments during the early stages of perinatal brain injury. In this review, we focus on the molecular mechanisms of hypoxic-ischemic encephalopathy, specifically on the importance of apoptosis-inducing factor. The relevance of apoptosis-inducing factor is based not only because it participates in the caspase-independent apoptotic pathway but also because it plays a crucial role in mitochondrial energetic functionality, especially with regard to the maintenance of electron transport during oxidative phosphorylation and in oxidative stress, acting as a free radical scavenger. We also discuss all the different apoptosis-inducing factor isoforms discovered, focusing especially on apoptosis-inducing factor 2, which is only expressed in the brain and the functions of which are starting now to be clarified. Finally, we summarized the interaction of apoptosis-inducing factor with several proteins that are crucial for both apoptosis-inducing factor functions (pro-survival and pro-apoptotic) and that are highly important in order to develop promising therapeutic targets for improving outcomes after perinatal brain injury.
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Affiliation(s)
- Juan Rodriguez
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tao Li
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yiran Xu
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yanyan Sun
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anatomy, School of Basic Medical Science, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Changlian Zhu
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Bradford A, Hernandez M, Kearney E, Theriault L, Lim YP, Stonestreet BS, Threlkeld SW. Effects of Juvenile or Adolescent Working Memory Experience and Inter-Alpha Inhibitor Protein Treatment after Neonatal Hypoxia-Ischemia. Brain Sci 2020; 10:E999. [PMID: 33348631 PMCID: PMC7765798 DOI: 10.3390/brainsci10120999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
Hypoxic-Ischemic (HI) brain injury in the neonate contributes to life-long cognitive impairment. Early diagnosis and therapeutic interventions are critical but limited. We previously reported in a rat model of HI two interventional approaches that improve cognitive and sensory function: administration of Inter-alpha Inhibitor Proteins (IAIPs) and early experience in an eight-arm radial water maze (RWM) task. Here, we expanded these studies to examine the combined effects of IAIPs and multiple weeks of RWM assessment beginning with juvenile or adolescent rats to evaluate optimal age windows for behavioral interventions. Subjects were divided into treatment groups; HI with vehicle, sham surgery with vehicle, and HI with IAIPs, and received either juvenile (P31 initiation) or adolescent (P52 initiation) RWM testing, followed by adult retesting. Error rates on the RWM decreased across weeks for all conditions. Whereas, HI injury impaired global performance as compared to shams. IAIP-treated HI subjects tested as juveniles made fewer errors as compared to their untreated HI counterparts. The juvenile group made significantly fewer errors on moderate demand trials and showed improved retention as compared to the adolescent group during the first week of adult retesting. Together, results support and extend our previous findings that combining behavioral and anti-inflammatory interventions in the presence of HI improves subsequent learning performance. Results further indicate sensitive periods for behavioral interventions to improve cognitive outcomes. Specifically, early life cognitive experience can improve long-term learning performance even in the presence of HI injury. Results from this study provide insight into typical brain development and the impact of developmentally targeted therapeutics and task-specific experience on subsequent cognitive processing.
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Affiliation(s)
- Aaron Bradford
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Miranda Hernandez
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Elaine Kearney
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Luke Theriault
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
| | - Yow-Pin Lim
- ProThera Biologics, Inc., 349 Eddy Street, Providence, RI 02903, USA;
- Department of Pathology and Laboratory Medicine, The Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Barbara S. Stonestreet
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA;
| | - Steven W. Threlkeld
- Neuroscience Program, School of Health Sciences, Regis College, 235 Wellesley Street, Weston, MA 02493, USA; (A.B.); (M.H.); (E.K.); (L.T.)
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48
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Gosar D, Tretnjak V, Bregant T, Neubauer D, Derganc M. Reduced white-matter integrity and lower speed of information processing in adolescents with mild and moderate neonatal hypoxic-ischaemic encephalopathy. Eur J Paediatr Neurol 2020; 28:205-213. [PMID: 32665198 DOI: 10.1016/j.ejpn.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Studies have shown that adolescents with moderate hypoxic-ischaemic encephalopathy (HIE) may have specific cognitive deficits, especially reduced speed of information processing. The aim of our study was to confirm these earlier findings find out whether the degree of impairment in speed of information processing correlates with the degree of white-matter impairment as measured by diffusion tensor imaging (DTI). METHODS Thirty-three participants (mean age 18y 5mo, SD 12mo; 19 male) with mild or moderate HIE and 32 neurotypical adolescents (mean age 17y 10mo, SD 12mo, 18 male) completed a comprehensive neuropsychological battery measuring short-term memory, inhibition, speed of information processing, long-term visual and verbal memory. Fourteen participants also underwent structural MRI and DTI scans. RESULTS After controlling for age, gender and maternal education we found a significant effect of HIE on speed of information processing (F(2, 64) = 3.51, p < .037, η2 = 0.115), but not on other neuropsychological domains. Using tract-based spatial statistics we were also able to confirm a correlation between the degree of impairment in this cognitive domain and fractional anisotropy in several white-matter tracts. CONCLUSIONS The long-term cognitive outcome of moderate HIE includes reduced speed of information processing and is in part mediated by reduced integrity of major white-matter tracts.
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Affiliation(s)
- David Gosar
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia.
| | - Vali Tretnjak
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Tina Bregant
- Centre for Education and Rehabilitation of Physically Handicapped Children and Adolescents - CIRIUS Kamnik, Slovenia
| | - David Neubauer
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Metka Derganc
- University Medical Centre Ljubljana, Department of Paediatric Surgery and Intensive Care, Ljubljana, Slovenia
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Maxwell JR, Zimmerman AJ, Pavlik N, Newville JC, Carlin K, Robinson S, Brigman JL, Northington FJ, Jantzie LL. Neonatal Hypoxic-Ischemic Encephalopathy Yields Permanent Deficits in Learning Acquisition: A Preclinical Touchscreen Assessment. Front Pediatr 2020; 8:289. [PMID: 32582593 PMCID: PMC7291343 DOI: 10.3389/fped.2020.00289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
Neonatal hypoxic-ischemic encephalopathy (HIE) remains a common problem world-wide for infants born at term. The impact of HIE on long-term outcomes, especially into adulthood, is not well-described. To facilitate identification of biobehavioral biomarkers utilizing a translational platform, we sought to investigate the impact of HIE on executive function and cognitive outcomes into adulthood utilizing a murine model of HIE. HIE mice (unilateral common carotid artery occlusion to induce ischemia, followed by hypoxia with a FiO2 of 0.08 for 45 min) and control mice were tested on discrimination and reversal touchscreen tasks (using their noses) shown to be sensitive to loss of basal ganglia or cortical function, respectively. We hypothesized that the HIE injury would result in deficits in reversal learning, revealing complex cognitive and executive functioning impairments. Following HIE, mice had a mild discrimination impairment as measured by incorrect responses but were able to learn the paradigm to similar levels as controls. During reversal, HIE mice required significantly more total trials, errors and correction trials across the paradigm. Analysis of specific stages showed that reversal impairments in HIE were driven by significant increases in all measured parameters during the late learning, striatal-mediated portion of the task. Together, these results support the concept that HIE occurring during the neonatal period results in abnormal neurodevelopment that persists into adulthood, which can impact efficient associated learning. Further, these data show that utilization of an established model of HIE coupled with touchscreen learning provides valuable information for screening therapeutic interventions that could mitigate these deficits to improve the long-term outcomes of this vulnerable population.
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Affiliation(s)
- Jessie R. Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Amber J. Zimmerman
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Nathaniel Pavlik
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Jessie C. Newville
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Katherine Carlin
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan L. Brigman
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
| | - Frances J. Northington
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lauren L. Jantzie
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Kennedy Krieger Institute, Baltimore, MD, United States
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50
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Huang J, Lu W, Doycheva DM, Gamdzyk M, Hu X, Liu R, Zhang JH, Tang J. IRE1α inhibition attenuates neuronal pyroptosis via miR-125/NLRP1 pathway in a neonatal hypoxic-ischemic encephalopathy rat model. J Neuroinflammation 2020; 17:152. [PMID: 32375838 PMCID: PMC7203836 DOI: 10.1186/s12974-020-01796-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inhibition of inositol-requiring enzyme-1 alpha (IRE1α), one of the sensor signaling proteins associated with endoplasmic reticulum (ER) stress, has been shown to alleviate brain injury and improve neurological behavior in a neonatal hypoxic-ischemic encephalopathy (HIE) rat model. However, there is no information about the role of IRE1α inhibitor as well as its molecular mechanisms in preventing neuronal pyroptosis induced by NLRP1 (NOD-, LRR- and pyrin domain-containing 1) inflammasome. In the present study, we hypothesized that IRE1α can degrade microRNA-125-b-2-3p (miR-125-b-2-3p) and activate NLRP1/caspased-1 pathway, and subsequently promote neuronal pyroptosis in HIE rat model. METHODS Ten-day old unsexed rat pups were subjected to hypoxia-ischemia (HI) injury, and the inhibitor of IRE1α, STF083010, was administered intranasally at 1 h after HI induction. AntimiR-125 or NLRP1 activation CRISPR was administered by intracerebroventricular (i.c.v) injection at 24 h before HI induction. Immunofluorescence staining, western blot analysis, reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR), brain infarct volume measurement, neurological function tests, and Fluoro-Jade C staining were performed. RESULTS Endogenous phosphorylated IRE1α (p-IRE1α), NLRP1, cleaved caspase-1, interleukin-1β (IL-1β), and interleukin-18 (IL-18) were increased and miR-125-b-2-3p was decreased in HIE rat model. STF083010 administration significantly upregulated the expression of miR-125-b-2-3p, reduced the infarct volume, improved neurobehavioral outcomes and downregulated the protein expression of NLRP1, cleaved caspase-1, IL-1β and IL-18. The protective effects of STF083010 were reversed by antimiR-125 or NLRP1 activation CRISPR. CONCLUSIONS IRE1α inhibitor, STF083010, reduced neuronal pyroptosis at least in part via miR-125/NLRP1/caspase-1 signaling pathway after HI.
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Affiliation(s)
- Juan Huang
- Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
| | - Weitian Lu
- Institute of Neuroscience, Chongqing Medical University, Chongqing, 400016, China
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
| | - Desislava Met Doycheva
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
| | - Marcin Gamdzyk
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
| | - Xiao Hu
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Rui Liu
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA
- Department of Anesthesiology, Loma Linda University, Loma Linda, CA, 92350, USA
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Jiping Tang
- Department of Physiology and Pharmacology, Loma Linda University, Risley Hall, 11041 Campus St, Loma Linda, CA, 92350, USA.
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