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Badawi N, Novak I, Morgan C, Crowle C. Early detection of cerebral palsy using general movements assessment and MRIs - a sensible way forward. Pediatr Res 2024; 95:1191-1192. [PMID: 38167645 DOI: 10.1038/s41390-023-03008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Nadia Badawi
- The Children's Hospital Westmead, Hawkesbury Rd, Westmead, NSW, 2145, Australia
- Cerebral Palsy Alliance Research Institute, PO Box 171, Allambie Heights, NSW, 2100, Australia
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, PO Box 171, Allambie Heights, NSW, 2100, Australia
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, PO Box 171, Allambie Heights, NSW, 2100, Australia
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia
| | - Cathryn Crowle
- The Children's Hospital Westmead, Hawkesbury Rd, Westmead, NSW, 2145, Australia.
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia.
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Steiner M, Schwarz H, Kasprian G, Rittenschober-Boehm J, Schmidbauer V, Fuiko R, Olischar M, Klebermass-Schrehof K, Berger A, Goeral K. Brain Biometry Reveals Impaired Brain Growth in Preterm Neonates with Intraventricular Hemorrhage. Neonatology 2023; 120:225-234. [PMID: 36805535 PMCID: PMC10906469 DOI: 10.1159/000528981] [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: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Preterm birth and cerebral hemorrhage have adverse effects on brain development. Alterations in regional brain size on magnetic resonance imaging (MRI) can be assessed using 2D biometrical analysis, an easily applicable technique showing good correlation with 3D brain volumes. METHODS This retrospective study included 74 preterm neonates with intraventricular hemorrhage (IVH) born <32+0 weeks of gestation between 2011 and 2019. Cerebral MRI was performed at term-equivalent age, and 2D measurement techniques were used for biometrical analysis and compared to normative data of two control groups. Finally, the correlation and association of brain parameters and patterns of impaired brain growth and outcome at 2 and 3 years of age were evaluated. RESULTS Interhemispheric distance (IHD), the 3rd ventricle, and lateral ventricles presented larger, in contrast, cerebral biparietal width (cBPW), fronto-occipital diameter (FOD), and the length of the corpus callosum were smaller in IVH patients compared to respective controls. The strongest correlations with outcome were observed for the parameters FOD, anteroposterior diameter of the vermis, transverse cerebellar diameter (tCD), corpus callosum, 3rd ventricle, and left ventricular index. Patients with the small FOD, small BPW, and increased IHD pattern reached overall lower outcome scores at follow-up. DISCUSSION Preterm neonates with IVH showed reduced total brain sizes and enlarged pericerebral spaces compared to neurologically healthy controls. Biometric analysis revealed that several 2D brain parameters as well as different patterns of impaired brain growth were associated with neurodevelopmental impairment in early childhood. These findings may support prediction of long-term outcome and parental counseling in patients with IVH.
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Affiliation(s)
- Mirjam Steiner
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hannah Schwarz
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Judith Rittenschober-Boehm
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Victor Schmidbauer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Bin-Nun A, Kasirer Y, Abu-Ata N, Rosenbaum D, Cytter-Kuint R, Hammerman C, Ben-David E. Detection of Global Brain Injury Using Point-of-Care Neonatal MRI Scanner. Neuropediatrics 2023. [PMID: 35977705 DOI: 10.1055/a-1926-2238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Conventional magnetic resonance imaging (MRI) neuroimaging of infants is complicated by the need to transport infants outside the neonatal intensive care unit (NICU), often to distant areas of the hospital. PRIMARY OBJECTIVE The main aim of this study was to evaluate and compare scoring of images from a novel 1T MRI, which enables neuroimaging within the NICU, with those from a conventional MRI. SECONDARY OBJECTIVE The second aim of this study was to document improved expediency, and thereby greater patient safety, as reflected by decreased transport time. MATERIALS AND METHODS Thirty premature infants (mean gestational age: 28.8 ± 2.1 weeks) were scanned consecutively on the novel 1T and 1.5T conventional scanners at term-equivalent age. Orthogonal T1- and T2-weighted images were acquired and reviewed. A global brain abnormality score (Kidokoro) was assigned independently to all images by two radiologists. Interrater agreement was evaluated using the kappa statistic and interscanner agreement was evaluated by Bland-Altman analysis. Transport time to and from both scanners was monitored and compared. RESULTS Weighted kappas were 0.77 (standard error of measurement [SEM] 0.08; confidence interval [CI]: 0.62-0.92) and 0.86 (SEM: 0.07; CI: 0.73-1), for the 1T and 1.5T scanners, respectively, reflecting substantial interrater agreement. Bland-Altman analysis showed excellent agreement between the two scanners.Transport time was 8 ± 6 minutes for the 1T MRI versus 46 ± 21 minutes for the conventional MRI (p < 0.00001). No adverse events were recorded during transport. Standard transport times will vary from institution to institution. CONCLUSIONS Kidokoro scores are similar when comparing images obtained from a 1T MRI with those of a conventional 1.5T MRI, reflecting comparable image quality. Transport time was significantly decreased using the 1T neonatal MRI.
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Affiliation(s)
- Alona Bin-Nun
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel
| | - Yair Kasirer
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nadeen Abu-Ata
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Debra Rosenbaum
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel
| | - Eliel Ben-David
- The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel.,Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
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4
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Amplitude-integrated EEG recorded at 32 weeks postconceptional age. Correlation with MRI at term. J Perinatol 2022; 42:880-884. [PMID: 35031690 DOI: 10.1038/s41372-021-01295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aims to establish the role of late aEEG (scored by Burdjalov) in predicting brain maturation as well as abnormalities evaluated at term equivalent age (TEA) by brain MRI. METHODS 91 infants born before 30 wks gestation underwent an aEEG monitoring at 32 wks postconceptional age (PCA). aEEG, was correlated with TEA MRI, scored by Kidokoro. RESULTS A significant correlation between the aEEG score and the MRI scores was found. The same results were obtained for the aEEG continuity score; cyclicity and bandwidth scores were associated with grey matter and cerebellar MRI items. Moreover, a correlation between aEEG and cEEG recorded both at 32 and 40 wks PCA, was found. CONCLUSIONS aEEG monitoring can be predictive of MRI findings at TEA, suggesting that it could be implemented as a useful tool to support ultrasound to help identify neonates who will benefit from early intervention services.
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5
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Cebeci B, Alderliesten T, Wijnen JP, van der Aa NE, Benders MJNL, de Vries LS, van den Hoogen A, Groenendaal F. Brain proton magnetic resonance spectroscopy and neurodevelopment after preterm birth: a systematic review. Pediatr Res 2022; 91:1322-1333. [PMID: 33953356 DOI: 10.1038/s41390-021-01539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (1H-MRS) is used to evaluate brain metabolites in asphyxiated term infants. The aim of this review is to assess associations between cerebral 1H-MRS and neurodevelopment after preterm birth. METHODS PubMed and Embase were searched to identify studies using 1H-MRS and preterm birth. Eligible studies for this review included 1H-MRS of the brain, gestational age ≤32 weeks, and neurodevelopment assessed at a corrected age (CA) of at least 12 months up to the age of 18 years. RESULTS Twenty papers evaluated 1H-MRS in preterm infants at an age between near-term and 18 years and neurodevelopment. 1H-MRS was performed in both white (WM) and gray matter (GM) in 12 of 20 studies. The main regions were frontal and parietal lobe for WM and basal ganglia for GM. N-acetylaspartate/choline (NAA/Cho) measured in WM and/or GM is the most common metabolite ratio associated with motor, language, and cognitive outcome at 18-24 months CA. CONCLUSIONS NAA/Cho in WM assessed at term-equivalent age was associated with motor, cognitive, and language outcome, and NAA/Cho in deep GM was associated with language outcome at 18-24 months CA. IMPACT In preterm born infants, brain metabolism assessed using 1H-MRS at term-equivalent age is associated with motor, cognitive, and language outcomes at 18-24 months. 1H-MRS at term-equivalent age in preterm born infants may be used as an early indication of brain development. Specific findings relating to NAA were most predictive of outcome.
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Affiliation(s)
- Burcu Cebeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands.,Department of Neonatology, Health Sciences University, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands.
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D’Andrea CB, Kenley JK, Montez DF, Mirro AE, Miller RL, Earl EA, Koller JM, Sung S, Yacoub E, Elison JT, Fair DA, Dosenbach NU, Rogers CE, Smyser CD, Greene DJ. Real-time motion monitoring improves functional MRI data quality in infants. Dev Cogn Neurosci 2022; 55:101116. [PMID: 35636344 PMCID: PMC9157440 DOI: 10.1016/j.dcn.2022.101116] [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: 01/14/2022] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
Imaging the infant brain with MRI has improved our understanding of early neurodevelopment. However, head motion during MRI acquisition is detrimental to both functional and structural MRI scan quality. Though infants are typically scanned while asleep, they commonly exhibit motion during scanning causing data loss. Our group has shown that providing MRI technicians with real-time motion estimates via Framewise Integrated Real-Time MRI Monitoring (FIRMM) software helps obtain high-quality, low motion fMRI data. By estimating head motion in real time and displaying motion metrics to the MR technician during an fMRI scan, FIRMM can improve scanning efficiency. Here, we compared average framewise displacement (FD), a proxy for head motion, and the amount of usable fMRI data (FD ≤ 0.2 mm) in infants scanned with (n = 407) and without FIRMM (n = 295). Using a mixed-effects model, we found that the addition of FIRMM to current state-of-the-art infant scanning protocols significantly increased the amount of usable fMRI data acquired per infant, demonstrating its value for research and clinical infant neuroimaging. MRI studies of the infant brain are critical for studying early neurodevelopment. Head motion diminishes MRI data quality, which can adversely affect infant imaging. We show that real-time head motion monitoring improves fMRI scan quality in infants. Being able to monitor motion during fMRI acquisition improves scanning efficiency.
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Expert consensus on the clinical practice of neonatal brain magnetic resonance imaging. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:14-25. [PMID: 35177171 PMCID: PMC8802390 DOI: 10.7499/j.issn.1008-8830.2110018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
In recent years, magnetic resonance imaging (MRI) has been widely used in evaluating neonatal brain development, diagnosing neonatal brain injury, and predicting neurodevelopmental prognosis. Based on current research evidence and clinical experience in China and overseas, the Neonatologist Society of Chinese Medical Doctor Association has developed a consensus on the indications and standardized clinical process of neonatal brain MRI. The consensus has the following main points. (1) Brain MRI should be performed for neonates suspected of hypoxic-ischemic encephalopathy, intracranial infection, stroke and unexplained convulsions; brain MRI is not considered a routine in the management of preterm infants, but it should be performed for further evaluation when cranial ultrasound finds evidence of brain injury; as for extremely preterm or extremely low birth weight infants without abnormal ultrasound findings, it is recommended that they should undergo MRI examination at term equivalent age once. (2) Neonates should undergo MRI examination in a non-sedated state if possible. (3) During MRI examination, vital signs should be closely monitored to ensure safety; the necessity of MRI examination should be strictly evaluated for critically ill neonates, and magnetic resonance compatible incubator and ventilator can be used. (4) At present, 1.5 T or 3.0 T equipment can be used for neonatal brain MRI examination, and the special coil for the neonatal head should be used to improve signal-to-noise ratio; routine neonatal brain MRI sequences should at least include axial T1 weighted image (T1WI), axial T2 weighted imaging (T2WI), diffusion-weighted imaging, and sagittal T1WI or T2WI. (5) It is recommended to use a structured and graded reporting system, and reports by at least two reviewers and multi-center collaboration are recommended to increase the reliability of the report.
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8
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Spittle AJ, Thompson DK, Olsen JE, Kwong A, Treyvaud K. Predictors of long-term neurodevelopmental outcomes of children born extremely preterm. Semin Perinatol 2021; 45:151482. [PMID: 34456065 DOI: 10.1016/j.semperi.2021.151482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children born extremely preterm (<28 weeks' gestation) are at high risk of a range of adverse neurodevelopmental outcomes in later childhood compared with their peers born at term, including cognitive, motor, and behavioral difficulties. These difficulties can be associated with poorer academic achievement and health outcomes at school age. In this review, we discuss several predictors in the newborn period of early childhood neurodevelopmental outcomes including perinatal risk factors, neuroimaging findings and neurobehavioral assessments, along with social and environmental influences for children born extremely preterm. Given the complexity of predicting long-term outcomes in children born extremely preterm, we recommend multi-disciplinary teams in clinical practice to assist in determining an individual child's risk for adverse long-term outcomes and need for referral to targeted intervention, based upon their risk.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Physiotherapy and Newborn Services, The Royal Women's Hospital, Parkville, Australia.
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Physiotherapy and Newborn Services, The Royal Women's Hospital, Parkville, Australia
| | - Amanda Kwong
- Department of Physiotherapy, University of Melbourne, Parkville, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Physiotherapy and Newborn Services, The Royal Women's Hospital, Parkville, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
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9
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Abstract
While medical advancements have led to improved survival of extremely premature infants, children remain at risk for brain injury and neurodevelopmental impairment. Brain imaging can offer insight into an infant's acute and long-term outcome; however, counseling parents about the results and implications of brain imaging remains challenging. The purpose of this article is to review the current literature and describe the challenges associated with counseling families of premature infants on neuroimaging findings. We propose a framework to guide clinicians in counseling parents about brain imaging results, informed by best practices in other disciplines: (FIGURE): 1) Formulate a plan 2) Identify parental needs and values 3) Give information 4) Acknowledge Uncertainty 5) Recognize and Respond to emotions 6) Discuss Expectations and Establish follow-up.
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Affiliation(s)
- Sarah M Bernstein
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | | | - Monica E Lemmon
- Departments of Pediatrics and Population Health Sciences, Duke University Medical Center, Duke-Margolis Center for Health Policy, DUMC 3936, Durham, NC 27710, United States.
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10
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Inder TE, de Vries LS, Ferriero DM, Grant PE, Ment LR, Miller SP, Volpe JJ. Neuroimaging of the Preterm Brain: Review and Recommendations. J Pediatr 2021; 237:276-287.e4. [PMID: 34146549 DOI: 10.1016/j.jpeds.2021.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Donna M Ferriero
- Department of Neurology, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Francisco, San Francisco, CA; Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Laura R Ment
- Department of Pediatrics, Yale School of Medicine, New Haven, CT; Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Steven P Miller
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Joseph J Volpe
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary. CHILDREN-BASEL 2021; 8:children8030227. [PMID: 33809745 PMCID: PMC8002329 DOI: 10.3390/children8030227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
Advances in neuroimaging of the preterm infant have enhanced the ability to detect brain injury. This added information has been a blessing and a curse. Neuroimaging, particularly with magnetic resonance imaging, has provided greater insight into the patterns of injury and specific vulnerabilities. It has also provided a better understanding of the microscopic and functional impacts of subtle and significant injuries. While the ability to detect injury is important and irresistible, the evidence for how these injuries link to specific long-term outcomes is less clear. In addition, the impact on parents can be profound. This narrative summary will review the history and current state of brain imaging, focusing on magnetic resonance imaging in the preterm population and the current state of the evidence for how these patterns relate to long-term outcomes.
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12
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An assessment of prevalence and expenditure associated with discharge brain MRI in preterm infants. PLoS One 2021; 16:e0247857. [PMID: 33667251 PMCID: PMC7935297 DOI: 10.1371/journal.pone.0247857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/15/2021] [Indexed: 11/28/2022] Open
Abstract
To assess national expenditure associated with preterm-infant brain MRI and potential impact of reduction per Choosing Wisely campaign 2015 recommendation to “avoid routine screening term-equivalent or discharge brain MRIs in preterm-infants”. Cross-sectional U.S. trend data from the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) database (2006, 2009, 2012, 2016) was used to estimate overall national expenditure associated with brain MRI among infants with gestational age (GA) ≤36 weeks, and also when classified as ‘not indicated’ (NI-MRI) i.e., equivalent to routine use without clinical indications and regarded as low-value service (LVS). Associated cost was determined by querying CMS-database for physician-fee-schedules to find the highest global procedure-cost per cycle, then adjusting for inflation. Sensitivity-analyses were conducted to account for additional clinical charges associated with NI-MRI. 3,768 (0.26%) of 1,472,236 preterm-infants had brain MRI across all cycles (inflation-adjusted total $3,690,088). Overall proportion of brain MRIs increased across 2006–2012 from 0.25%-0.33% but decreased in 2016 to 0.16% (P<0.001). Inflation-adjusted overall expenditure by cycle was: 2006, $1,299,130 (95% CI: $987,505, $1,610,755); 2009, $1,194,208 (95% CI: $873,487, $1,516,154); 2012, $931,836 (95% CI: $666,114, $1,197,156); and 2016, $264,648 (95% CI: $172,061, $357,280). Prevalence for NI-MRI in 2006, 2009, 2012 and 2016 was 86% (n = 809), 88% (n = 940), 89% (n = 1028) and 50% (n = 299), respectively; and 70% were in infants 35–36 weeks GA. NI-MRI prevalence was not different over time by payer-type (Medicaid, private), sex or race/ethnicity (white, black, Hispanic); larger hospital size was significantly associated across 2006–2012 but this declined for all sizes in 2016, with most decline in larger hospitals (P for interaction <0.05). NI-MRI expenditure sensitivity-analysis with addition of cycle median total-admission-charge to inflation-adjusted CMS-fee was $1,190,919/$518,343, for 2012/2016 cycles respectively. National MRI prevalence in preterm infants (both overall and LVS) and associated expenditure decreased substantially post recommendation; however, annual savings are modest and unlikely to be >$1.2 million.
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Tacchino C, Impagliazzo M, Maggi E, Bertamino M, Blanchi I, Campone F, Durand P, Fato M, Giannoni P, Iandolo R, Izzo M, Morasso P, Moretti P, Ramenghi L, Shima K, Shimatani K, Tsuji T, Uccella S, Zanardi N, Casadio M. Spontaneous movements in the newborns: a tool of quantitative video analysis of preterm babies. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105838. [PMID: 33421664 DOI: 10.1016/j.cmpb.2020.105838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The number of preterm babies is steadily growing world-wide and these neonates are at risk of neuro-motor-cognitive deficits. The observation of spontaneous movements in the first three months of age is known to predict such risk. However, the analysis by specifically trained physiotherapists is not suited for the clinical routine, motivating the development of simple computerized video analysis systems, integrated with a well-structured Biobank to make available for preterm babies a growing service with diagnostic, prognostic and epidemiological purposes. METHODS MIMAS (Markerless Infant Movement Analysis System) is a simple, low-cost system of video analysis of spontaneous movements of newborns in their natural environment, based on a single standard RGB camera, without markers attached to the body. The original videos are transformed into binarized sequences highlighting the silhouette of the baby, in order to minimize the illumination effects and increase the robustness of the analysis; such sequences are then coded by a large set of parameters (39) related to the spatial and spectral changes of the silhouette. The parameter vectors of each baby were stored in the Biobank together with related clinical information. RESULTS The preliminary test of the system was carried out at the Gaslini Pediatric Hospital in Genoa, where 46 preterm (PT) and 21 full-term (FT) babies (as controls) were recorded at birth (T0) and 8-12 weeks thereafter (T1). A simple statistical analysis of the data showed that the coded parameters are sensitive to the degree of maturation of the newborns (comparing T0 with T1, for both PT and FT babies), and to the conditions at birth (PT vs. FT at T0), whereas this difference tends to vanish at T1. Moreover, the coding method seems also able to detect the few 'abnormal' preterm babies in the PT populations that were analyzed as specific case studies. CONCLUSIONS Preliminary results motivate the adoption of this tool in clinical practice allowing for a systematic accumulation of cases in the Biobank, thus for improving the accuracy of data analysis performed by MIMAS and ultimately allowing the adoption of data mining techniques.
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Affiliation(s)
- Chiara Tacchino
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | | | - Erika Maggi
- DIBRIS dept., University of Genoa, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Isa Blanchi
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Francesca Campone
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Paola Durand
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Marco Fato
- DIBRIS dept., University of Genoa, Genoa, Italy
| | | | - Riccardo Iandolo
- DIBRIS dept., University of Genoa, Genoa, Italy; RBCS dept., Italian Institute of Technology, Genoa, Italy
| | - Massimiliano Izzo
- DIBRIS dept., University of Genoa, Genoa, Italy; Oxford e-Research Centre, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Pietro Morasso
- DIBRIS dept., University of Genoa, Genoa, Italy; RBCS dept., Italian Institute of Technology, Genoa, Italy
| | - Paolo Moretti
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Luca Ramenghi
- Intensive Therapy and Neonatal Pathology, Gaslini Pediatric Hospital, Genoa, Italy
| | - Keisuke Shima
- Faculty of Engineering, Yokohama National University, Yokohama, Japan
| | - Koji Shimatani
- Dept. of Physical Therapy, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Toshio Tsuji
- Dept. of System Cybernetics, Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Sara Uccella
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | | | - Maura Casadio
- DIBRIS dept., University of Genoa, Genoa, Italy; RBCS dept., Italian Institute of Technology, Genoa, Italy.
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14
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Abstract
Neuroimaging of the preterm infant is a common assessment performed in the NICU. Timely and focused studies can be used for diagnostic, therapeutic, and prognostic information. However, significant variability exists among neonatal units as to which modalities are used and when imaging studies are obtained. Appropriate timing and selection of neuroimaging studies can help identify neonates with brain injury who may require therapeutic intervention or who may be at risk for neurodevelopmental impairment. This clinical report reviews the different modalities of imaging broadly available to the clinician. Evidence-based indications for each modality, optimal timing of examinations, and prognostic value are discussed.
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Affiliation(s)
- Ivan L Hand
- Department of Pediatrics, New York City Health + Hospitals/Kings County, State University of New York Downstate Medical Center, Brooklyn, New York;
| | - Renée A Shellhaas
- Pediatric Neurology Division, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Sarah S Milla
- Departments of Radiology and Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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15
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Guillot M, Chau V, Lemyre B. L’imagerie cérébrale systématique du nouveau-né prématuré. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Résumé
L’imagerie cérébrale systématique pour déceler les lésions touchant les nouveau-nés prématurés est utilisée pour prédire le pronostic à long terme et déterminer les complications susceptibles de nécessiter une intervention. Même si l’imagerie par résonance magnétique peut être indiquée dans des situations particulières, l’échographie cérébrale est la technique la plus utilisée et demeure la meilleure modalité d’imagerie systématique en raison de sa portabilité et de sa facilité d’accès. L’échographie cérébrale systématique est recommandée pour tous les nouveau-nés venus au monde à 31+6 semaines d’âge gestationnel ou auparavant. Chez les nouveau-nés prématurés venus au monde entre 32+0 et 36+6 semaines d’âge gestationnel l’échographie cérébrale systématique n’est recommandée qu’en présence de facteurs de risque d’hémorragie intracrânienne ou d’ischémie. Il est conseillé d’obtenir une imagerie cérébrale de quatre à sept jours après la naissance pour déceler la plupart des hémorragies de la matrice germinale et des hémorragies intraventriculaires. Il est recommandé de reprendre l’imagerie entre quatre et six semaines de vie pour déceler les lésions de la substance blanche. Chez les nouveau-nés prématurés venus au monde avant 26 semaines d’âge gestationnel, il est recommandé de reprendre l’échographie cérébrale à l’âge équivalant au terme.
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Affiliation(s)
- Mireille Guillot
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Vann Chau
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Brigitte Lemyre
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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16
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Guillot M, Chau V, Lemyre B. Routine imaging of the preterm neonatal brain. Paediatr Child Health 2020; 25:249-262. [PMID: 32549742 DOI: 10.1093/pch/pxaa033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/23/2019] [Indexed: 01/08/2023] Open
Abstract
Routine brain imaging to detect injuries affecting preterm infants is used to predict long-term outcomes and identify complications that might necessitate an intervention. Although magnetic resonance imaging may be indicated in some specific cases, head ultrasound is the most widely used technique and, because of portability and ease of access, is the best modality for routine imaging. Routine head ultrasound examination is recommended for all infants born at or before 31+6 weeks gestation. For preterm neonates born between 32+0 to 36+6 weeks gestation, routine head ultrasound is recommended only in presence of risk factors for intracranial hemorrhage or ischemia. Brain imaging in the first 7 to 14 days postbirth is advised to detect most germinal matrix and intraventricular hemorrhages. Repeat imaging at 4 to 6 weeks of age is recommended to detect white matter injury.
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Affiliation(s)
- Mireille Guillot
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Vann Chau
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Brigitte Lemyre
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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17
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Agut T, Alarcon A, Cabañas F, Bartocci M, Martinez-Biarge M, Horsch S. Preterm white matter injury: ultrasound diagnosis and classification. Pediatr Res 2020; 87:37-49. [PMID: 32218534 PMCID: PMC7098888 DOI: 10.1038/s41390-020-0781-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential neuroimaging in preterm infants, and is reliable for the diagnosis of cystic periventricular leukomalacia. Although magnetic resonance imaging is superior to CUS in detecting the diffuse and more subtle forms of WMI that prevail in very premature infants surviving nowadays, recent improvement in the quality of neonatal CUS imaging has broadened the spectrum of preterm white matter abnormalities that can be detected with this technique. We propose a structured CUS assessment of WMI of prematurity that seeks to account for both cystic and non-cystic changes, as well as signs of white matter loss and impaired brain growth and maturation, at or near term equivalent age. This novel assessment system aims to improve disease description in both routine clinical practice and clinical research. Whether this systematic assessment will improve prediction of outcome in preterm infants with WMI still needs to be evaluated in prospective studies.
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Affiliation(s)
- Thais Agut
- Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - Ana Alarcon
- 0000 0001 0663 8628grid.411160.3Department of Neonatology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Fernando Cabañas
- 0000 0000 8970 9163grid.81821.32Department of Neonatology, Quironsalud Madrid University Hospital and Biomedical Research Foundation, La Paz University Hospital Madrid, Madrid, Spain
| | - Marco Bartocci
- Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Miriam Martinez-Biarge
- 0000 0001 2113 8111grid.7445.2Department of Paediatrics, Imperial College London, London, UK
| | - Sandra Horsch
- 0000 0000 8778 9382grid.491869.bDepartment of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany ,0000 0004 1937 0626grid.4714.6Department Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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18
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Functional Connectome of the Fetal Brain. J Neurosci 2019; 39:9716-9724. [PMID: 31685648 PMCID: PMC6891066 DOI: 10.1523/jneurosci.2891-18.2019] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 01/05/2023] Open
Abstract
Large-scale functional connectome formation and reorganization is apparent in the second trimester of pregnancy, making it a crucial and vulnerable time window in connectome development. Here we identified which architectural principles of functional connectome organization are initiated before birth, and contrast those with topological characteristics observed in the mature adult brain. A sample of 105 pregnant women participated in human fetal resting-state fMRI studies (fetal gestational age between 20 and 40 weeks). Connectome analysis was used to analyze weighted network characteristics of fetal macroscale brain wiring. We identified efficient network attributes, common functional modules, and high overlap between the fetal and adult brain network. Our results indicate that key features of the functional connectome are present in the second and third trimesters of pregnancy. Understanding the organizational principles of fetal connectome organization may bring opportunities to develop markers for early detection of alterations of brain function.SIGNIFICANCE STATEMENT The fetal to neonatal period is well known as a critical stage in brain development. Rapid neurodevelopmental processes establish key functional neural circuits of the human brain. Prenatal risk factors may interfere with early trajectories of connectome formation and thereby shape future health outcomes. Recent advances in MRI have made it possible to examine fetal brain functional connectivity. In this study, we evaluate the network topography of normative functional network development during connectome genesis in utero Understanding the developmental trajectory of brain connectivity provides a basis for understanding how the prenatal period shapes future brain function and disease dysfunction.
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19
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Chung HU, Kim BH, Lee JY, Lee J, Xie Z, Ibler EM, Lee K, Banks A, Jeong JY, Kim J, Ogle C, Grande D, Yu Y, Jang H, Assem P, Ryu D, Kwak JW, Namkoong M, Park JB, Lee Y, Kim DH, Ryu A, Jeong J, You K, Ji B, Liu Z, Huo Q, Feng X, Deng Y, Xu Y, Jang KI, Kim J, Zhang Y, Ghaffari R, Rand CM, Schau M, Hamvas A, Weese-Mayer DE, Huang Y, Lee SM, Lee CH, Shanbhag NR, Paller AS, Xu S, Rogers JA. Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care. Science 2019; 363:363/6430/eaau0780. [PMID: 30819934 PMCID: PMC6510306 DOI: 10.1126/science.aau0780] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/04/2019] [Indexed: 12/25/2022]
Abstract
Existing vital signmonitoring systems in the neonatal intensive care unit (NICU) requiremultiple wires connected to rigid sensors with strongly adherent interfaces to the skin.We introduce a pair of ultrathin, soft, skin-like electronic devices whose coordinated, wireless operation reproduces the functionality of these traditional technologies but bypasses their intrinsic limitations.The enabling advances in engineering science include designs that support wireless, battery-free operation; real-time, in-sensor data analytics; time-synchronized, continuous data streaming; soft mechanics and gentle adhesive interfaces to the skin; and compatibility with visual inspection and with medical imaging techniques used in the NICU. Preliminary studies on neonates admitted to operating NICUs demonstrate performance comparable to the most advanced clinical-standard monitoring systems.
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Affiliation(s)
- Ha Uk Chung
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL 60208, USA
| | - Bong Hoon Kim
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jungyup Lee
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Zhaoqian Xie
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Erin M Ibler
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Center for Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - KunHyuck Lee
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Anthony Banks
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Loomis Laboratory of Physics, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Ji Yoon Jeong
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jongwon Kim
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Mechanical Engineering, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Christopher Ogle
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Dominic Grande
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Yongjoon Yu
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Hokyung Jang
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Pourya Assem
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Dennis Ryu
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Jean Won Kwak
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Myeong Namkoong
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jun Bin Park
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Yechan Lee
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Do Hoon Kim
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Arin Ryu
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Jaeseok Jeong
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Kevin You
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Bowen Ji
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zhuangjian Liu
- Institute of High Performance Computing, A*Star, 138632 Singapore
| | - Qingze Huo
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Xue Feng
- Applied Mechanics Laboratory, Department of Engineering Mechanics, Center for Mechanics and Materials, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Yujun Deng
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA.,State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yeshou Xu
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA.,Key Laboratory of C&PC Structures of the Ministry of Education, Southeast University, Nanjing 2100096, China
| | - Kyung-In Jang
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
| | - Jeonghyun Kim
- Department of Electronics Convergence Engineering, Kwangwoon University, Seoul 01897, Republic of Korea
| | - Yihui Zhang
- Applied Mechanics Laboratory, Department of Engineering Mechanics, Center for Mechanics and Materials, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Roozbeh Ghaffari
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Casey M Rand
- Center for Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Molly Schau
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Aaron Hamvas
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Debra E Weese-Mayer
- Center for Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Yonggang Huang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Seung Min Lee
- Department of Energy Electronics Convergence, Kookmin University, Seoul 02707, Republic of Korea
| | - Chi Hwan Lee
- Weldon School of Biomedical Engineering, School of Mechanical Engineering, Center for Implantable Devices, and Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, USA
| | - Naresh R Shanbhag
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Amy S Paller
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA. .,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Shuai Xu
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA. .,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John A Rogers
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA. .,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Chemistry, Northwestern University, Evanston, IL 60208, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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20
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Proper timing for the evaluation of neonatal brain white matter development: a diffusion tensor imaging study. Eur Radiol 2018; 29:1527-1537. [DOI: 10.1007/s00330-018-5665-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
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21
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Affiliation(s)
- Mandy Brown Belfort
- 1 Neonatologist, Brigham and Women's Hospital , Boston, Massachusetts.,2 Assistant Professor of Pediatrics, Harvard Medical School , Boston, Massachusetts
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22
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El Ters NM, Vesoulis ZA, Liao SM, Smyser CD, Mathur AM. Term-equivalent functional brain maturational measures predict neurodevelopmental outcomes in premature infants. Early Hum Dev 2018; 119:68-72. [PMID: 29579560 PMCID: PMC6190680 DOI: 10.1016/j.earlhumdev.2018.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Term equivalent age (TEA) brain MRI identifies preterm infants at risk for adverse neurodevelopmental outcomes. But some infants may experience neurodevelopmental impairments even in the absence of neuroimaging abnormalities. OBJECTIVE Evaluate the association of TEA amplitude-integrated EEG (aEEG) measures with neurodevelopmental outcomes at 24-36 months corrected age. METHODS We performed aEEG recordings and brain MRI at TEA (mean post-menstrual age of 39 (±2) weeks in a cohort of 60 preterm infants born at a mean gestational age of 26 (±2) weeks. Forty-four infants underwent Bayley Scales of Infant Development, 3rd Edition (BSID-III) testing at 24-36 months corrected age. Developmental delay was defined by a score greater than one standard deviation below the mean (<85) in any domain. An ROC curve was constructed and a value of SEF90 < 9.2, yielded the highest sensitivity and specificity for moderate/severe brain injury on MRI. The association between aEEG measures and neurodevelopmental outcomes was assessed using odds ratio, then adjusted for confounding variables using logistic regression. RESULTS Infants with developmental delay in any domain had significantly lower values of SEF90. Absent cyclicity was more prevalent in infants with cognitive and motor delay. Both left and right SEF90 < 9.2 were associated with motor delay (OR left: 4.7(1.2-18.3), p = 0.02, OR right: 7.9 (1.8-34.5), p < 0.01). Left SEF90 and right SEF90 were associated with cognitive delay and language delay respectively. Absent cyclicity was associated with motor and cognitive delay (OR for motor delay: 5.8 (1.3-25.1), p = 0.01; OR for cognitive delay: 16.8 (3.1-91.8), p < 0.01). These associations remained significant after correcting for social risk index score and confounding variables. CONCLUSIONS aEEG may be used at TEA as a new tool for risk stratification of infants at higher risk of poor neurodevelopmental outcomes. Therefore, a larger study is needed to validate these results in premature infants at low and high risk of brain injury.
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Affiliation(s)
- Nathalie M El Ters
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Steve M Liao
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Amit M Mathur
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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23
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Bolk J, Padilla N, Forsman L, Broström L, Hellgren K, Åden U. Visual-motor integration and fine motor skills at 6½ years of age and associations with neonatal brain volumes in children born extremely preterm in Sweden: a population-based cohort study. BMJ Open 2018; 8:e020478. [PMID: 29455171 PMCID: PMC5855250 DOI: 10.1136/bmjopen-2017-020478] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This exploratory study aimed to investigate associations between neonatal brain volumes and visual-motor integration (VMI) and fine motor skills in children born extremely preterm (EPT) when they reached 6½ years of age. SETTING Prospective population-based cohort study in Stockholm, Sweden, during 3 years. PARTICIPANTS All children born before gestational age, 27 weeks, during 2004-2007 in Stockholm, without major morbidities and impairments, and who underwent MRI at term-equivalent age. MAIN OUTCOME MEASURES Brain volumes were calculated using morphometric analyses in regions known to be involved in VMI and fine motor functions. VMI was assessed with The Beery-Buktenica Developmental Test of Visual-Motor Integration-sixth edition and fine motor skills were assessed with the manual dexterity subtest from the Movement Assessment Battery for Children-second edition, at 6½ years. Associations between the brain volumes and VMI and fine motor skills were evaluated using partial correlation, adjusted for total cerebral parenchyma and sex. RESULTS Out of 107 children born at gestational age <27 weeks, 83 were assessed at 6½ years and 66/83 were without major brain lesions or cerebral palsy and included in the analyses. A representative subsample underwent morphometric analyses: automatic segmentation (n=34) and atlas-based segmentation (n=26). The precentral gyrus was associated with both VMI (r=0.54, P=0.007) and fine motor skills (r=0.54, P=0.01). Associations were also seen between fine motor skills and the volume of the cerebellum (r=0.42, P=0.02), brainstem (r=0.47, P=0.008) and grey matter (r=-0.38, P=0.04). CONCLUSIONS Neonatal brain volumes in areas known to be involved in VMI and fine motor skills were associated with scores for these two functions when children born EPT without major brain lesions or cerebral palsy were evaluated at 6½ years of age. Establishing clear associations between early brain volume alterations and later VMI and/or fine motor skills could make early interventions possible.
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Affiliation(s)
- Jenny Bolk
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Sachs’s Children and Youth Hospital, Stockholm, Sweden
| | - Nelly Padilla
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Lea Forsman
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Lina Broström
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Hellgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Neuropediatric Department, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Åden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Neonatal Unit, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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24
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Affiliation(s)
- Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
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25
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Herzmann C, Zubiaurre-Elorza L, Wild CJ, Linke AC, Han VK, Lee DSC, Cusack R. Using Functional Magnetic Resonance Imaging to Detect Preserved Function in a Preterm Infant with Brain Injury. J Pediatr 2017; 189:213-217.e1. [PMID: 28735979 DOI: 10.1016/j.jpeds.2017.06.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/15/2017] [Accepted: 06/26/2017] [Indexed: 02/07/2023]
Abstract
We studied developmental plasticity using functional magnetic resonance imaging (fMRI) in a preterm infant with brain injury on structural MRI. fMRI showed preserved brain function and subsequent neurodevelopment was within the normal range. Multimodal neuroimaging including fMRI can improve understanding of neural plasticity after preterm birth and brain injury.
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Affiliation(s)
| | | | - Conor J Wild
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Annika C Linke
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Victor K Han
- Children's Health Research Institute, London, Ontario, Canada
| | - David S C Lee
- Children's Health Research Institute, London, Ontario, Canada; Pediatrics, Western University, London, Ontario, Canada
| | - Rhodri Cusack
- Brain and Mind Institute, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
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26
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Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
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Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
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27
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Impact of brain injury on functional measures of amplitude-integrated EEG at term equivalent age in premature infants. J Perinatol 2017; 37:947-952. [PMID: 28492522 PMCID: PMC5578901 DOI: 10.1038/jp.2017.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the association between qualitative and quantitative amplitude-integrated EEG (aEEG) measures at term equivalent age (TEA) and brain injury on magnetic resonance imaging (MRI) in preterm infants. STUDY DESIGN A cohort of premature infants born at <30 weeks of gestation and with moderate-to-severe MRI injury on a TEA MRI scan was identified. A contemporaneous group of gestational age-matched control infants also born at <30 weeks of gestation with none/mild injury on MRI was also recruited. Quantitative aEEG measures, including maximum and minimum amplitudes, bandwidth span and spectral edge frequency (SEF90), were calculated using an offline software package. The aEEG recordings were qualitatively scored using the Burdjalov system. MRI scans, performed on the same day as aEEG, occurred at a mean postmenstrual age of 38.0 (range 37 to 42) weeks and were scored for abnormality in a blinded manner using an established MRI scoring system. RESULTS Twenty-eight (46.7%) infants had a normal MRI or mild brain abnormality, while 32 (53.3%) infants had moderate-to-severe brain abnormality. Univariate regression analysis demonstrated an association between severity of brain abnormality and quantitative measures of left and right SEF90 and bandwidth span (β=-0.38, -0.40 and 0.30, respectively) and qualitative measures of cyclicity, continuity and total Burdjalov score (β=-0.10, -0.14 and -0.12, respectively). After correcting for confounding variables, the relationship between MRI abnormality score and aEEG measures of SEF90, bandwidth span and Burdjalov score remained significant. CONCLUSION Brain abnormalities on MRI at TEA in premature infants are associated with abnormalities on term aEEG measures, suggesting that anatomical brain injury may contribute to delay in functional brain maturation as assessed using aEEG.
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28
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Belfort MB, Ehrenkranz RA. Neurodevelopmental outcomes and nutritional strategies in very low birth weight infants. Semin Fetal Neonatal Med 2017; 22:42-48. [PMID: 27692935 DOI: 10.1016/j.siny.2016.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The developing brain of the very low birth weight (VLBW) infant is highly sensitive to effects of the nutritional milieu during the neonatal hospitalization and after discharge. Strategies to optimize nutritional care play an important role in reducing long-term neurodevelopmental morbidities in this population. Currently available interventions to ensure that the unique nutrient requirements of the VLBW infant are met include various dietary fortification strategies and parenteral nutrition. In this article, we review evidence regarding nutritional strategies and their beneficial effects on neurodevelopment in VLBW infants. We also highlight gaps in current knowledge and areas of current investigation that hold promise for improving nutritional care and long-term outcomes.
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Affiliation(s)
- Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Richard A Ehrenkranz
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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29
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Bruno CJ, Bengani S, Gomes WA, Brewer M, Vega M, Xie X, Kim M, Fuloria M. MRI Differences Associated with Intrauterine Growth Restriction in Preterm Infants. Neonatology 2017; 111:317-323. [PMID: 28076856 DOI: 10.1159/000453576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at risk for neurodevelopmental impairment. Intrauterine growth restriction (IUGR) further increases this risk. Brain imaging studies are often utilized at or near term-equivalent age to determine later prognosis. OBJECTIVE To evaluate the association between intrauterine growth and regional brain volume on MRI scans performed in preterm infants at or near term-equivalent age. METHODS This is a retrospective case-control study of 24 infants born at gestational age ≤30 weeks and cared for in a large, inner-city, academic neonatal intensive-care unit from 2012 to 2013. Each IUGR infant was matched with 1-2 appropriate for gestational age (AGA) infants who served as controls. Predischarge MRI scans routinely obtained at ≥36 weeks' adjusted age were analyzed for regional brain volumetric differences. We examined the association between IUGR and thalamic, basal ganglion, and cerebellar brain volumes in these preterm infants. RESULTS Compared to AGA infants, IUGR infants had a smaller thalamus (7.88 vs. 5.87 mL, p = 0.001) and basal ganglion (8.87 vs. 6.92 mL, p = 0.002) volumes. There was no difference in cerebellar volumes between the two study groups. Linear regression analyses revealed similar trends in the associations between IUGR and brain volumes after adjusting for sex, gestational age at birth, and postconceptual age and weight at MRI. CONCLUSIONS Thalamus and basal ganglion volumes are reduced in growth-restricted preterm infants. These differences may preferentially impact neurodevelopmental outcomes. Further research is needed to explore these relationships.
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Affiliation(s)
- Christie J Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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30
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Mongerson CRL, Jennings RW, Borsook D, Becerra L, Bajic D. Resting-State Functional Connectivity in the Infant Brain: Methods, Pitfalls, and Potentiality. Front Pediatr 2017; 5:159. [PMID: 28856131 PMCID: PMC5557740 DOI: 10.3389/fped.2017.00159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/04/2017] [Indexed: 11/02/2022] Open
Abstract
Early brain development is characterized by rapid growth and perpetual reconfiguration, driven by a dynamic milieu of heterogeneous processes. Postnatal brain plasticity is associated with increased vulnerability to environmental stimuli. However, little is known regarding the ontogeny and temporal manifestations of inter- and intra-regional functional connectivity that comprise functional brain networks. Resting-state functional magnetic resonance imaging (rs-fMRI) has emerged as a promising non-invasive neuroinvestigative tool, measuring spontaneous fluctuations in blood oxygen level dependent (BOLD) signal at rest that reflect baseline neuronal activity. Over the past decade, its application has expanded to infant populations providing unprecedented insight into functional organization of the developing brain, as well as early biomarkers of abnormal states. However, many methodological issues of rs-fMRI analysis need to be resolved prior to standardization of the technique to infant populations. As a primary goal, this methodological manuscript will (1) present a robust methodological protocol to extract and assess resting-state networks in early infancy using independent component analysis (ICA), such that investigators without previous knowledge in the field can implement the analysis and reliably obtain viable results consistent with previous literature; (2) review the current methodological challenges and ethical considerations associated with emerging field of infant rs-fMRI analysis; and (3) discuss the significance of rs-fMRI application in infants for future investigations of neurodevelopment in the context of early life stressors and pathological processes. The overarching goal is to catalyze efforts toward development of robust, infant-specific acquisition, and preprocessing pipelines, as well as promote greater transparency by researchers regarding methods used.
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Affiliation(s)
- Chandler R L Mongerson
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States.,Department of Surgery, Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Lino Becerra
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Dusica Bajic
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States.,Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
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31
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Clinical impact of term-equivalent magnetic resonance imaging in extremely low-birth-weight infants at a regional NICU. J Perinatol 2016; 36:985-989. [PMID: 27467565 DOI: 10.1038/jp.2016.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/20/2016] [Accepted: 06/03/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the clinical impact of routine term-equivalent magnetic resonance imaging (TE-MRI) for extremely low-birth-weight infants at a regional neonatal intensive care unit. STUDY DESIGN This is a single-center retrospective study evaluating preterm survivors who underwent TE-MRI. MRI abnormalities were compared between infants with and without cranial ultrasonography (CUS) abnormalities. Cost analysis comparing imaging modalities was also performed. RESULTS TE-MRI use increased from 17% in 2006 to 76% in 2010. MRI detected new findings in nearly half of infants, whether or not they had known ultrasound abnormalities. MRI detected more cerebellar (18% vs 6%, P=0.04) and moderate white matter injury (12% vs 7%, P<0.001), and altered simulated neurological prognosis across developmental domains. The cost of TE-MRI was $1600, which was comparable to serial CUSs. CONCLUSION TE-MRI detects new abnormalities and impacts developmental prognosis in the extremely low birth weight, which supports its use despite the added financial cost.
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32
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Smyser CD, Tam EWY, Chang T, Soul JS, Miller SP, Glass HC. Fellowship Training in the Emerging Fields of Fetal-Neonatal Neurology and Neonatal Neurocritical Care. Pediatr Neurol 2016; 63:39-44.e3. [PMID: 27473650 DOI: 10.1016/j.pediatrneurol.2016.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal neurocritical care is a growing and rapidly evolving medical subspecialty, with increasing numbers of dedicated multidisciplinary clinical, educational, and research programs established at academic institutions. The growth of these programs has provided trainees in neurology, neonatology, and pediatrics with increased exposure to the field, sparking interest in dedicated fellowship training in fetal-neonatal neurology. OBJECTIVES To meet this rising demand, increasing numbers of training programs are being established to provide trainees with the requisite knowledge and skills to independently deliver care for infants with neurological injury or impairment from the fetal care center and neonatal intensive care unit to the outpatient clinic. This article provides an initial framework for standardization of training across these programs. RESULTS Recommendations include goals and objectives for training in the field; core areas where clinical competency must be demonstrated; training activities and neuroimaging and neurodiagnostic modalities which require proficiency; and programmatic requirements necessary to support a comprehensive and well-rounded training program. CONCLUSIONS With consistent implementation, the proposed model has the potential to establish recognized standards of professional excellence for training in the field, provide a pathway toward Accreditation Council for Graduate Medical Education certification for program graduates, and lead to continued improvements in medical and neurological care provided to patients in the neonatal intensive care unit.
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Affiliation(s)
- Christopher D Smyser
- Department of Neurology, Washington University, St. Louis, Missouri; Department of Pediatrics, Washington University, St. Louis, Missouri; Department of Radiology, Washington University, St. Louis, Missouri.
| | - Emily W Y Tam
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
| | - Taeun Chang
- Department of Neurology, Children's National Health System, Washington, DC
| | - Janet S Soul
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Steven P Miller
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
| | - Hannah C Glass
- Department of Neurology, Benioff Children's Hospital, University of California, San Francisco, California; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, Benioff Children's Hospital, University of California, San Francisco, California
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33
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McKenna MC, Scafidi S, Robertson CL. Metabolic Alterations in Developing Brain After Injury: Knowns and Unknowns. Neurochem Res 2015; 40:2527-43. [PMID: 26148530 PMCID: PMC4961252 DOI: 10.1007/s11064-015-1600-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/10/2015] [Accepted: 05/02/2015] [Indexed: 12/21/2022]
Abstract
Brain development is a highly orchestrated complex process. The developing brain utilizes many substrates including glucose, ketone bodies, lactate, fatty acids and amino acids for energy, cell division and the biosynthesis of nucleotides, proteins and lipids. Metabolism is crucial to provide energy for all cellular processes required for brain development and function including ATP formation, synaptogenesis, synthesis, release and uptake of neurotransmitters, maintaining ionic gradients and redox status, and myelination. The rapidly growing population of infants and children with neurodevelopmental and cognitive impairments and life-long disability resulting from developmental brain injury is a significant public health concern. Brain injury in infants and children can have devastating effects because the injury is superimposed on the high metabolic demands of the developing brain. Acute injury in the pediatric brain can derail, halt or lead to dysregulation of the complex and highly regulated normal developmental processes. This paper provides a brief review of metabolism in developing brain and alterations found clinically and in animal models of developmental brain injury. The metabolic changes observed in three major categories of injury that can result in life-long cognitive and neurological disabilities, including neonatal hypoxia-ischemia, pediatric traumatic brain injury, and brain injury secondary to prematurity are reviewed.
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Affiliation(s)
- Mary C McKenna
- Department of Pediatrics and Program in Neuroscience, University of Maryland School of Medicine, 655 W. Baltimore St., Room 13-019, Baltimore, MD, 21201, USA.
| | - Susanna Scafidi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtney L Robertson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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34
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McKenna MC, Scafidi S, Robertson CL. Metabolic Alterations in Developing Brain After Injury: Knowns and Unknowns. Neurochem Res 2015. [PMID: 26148530 DOI: 10.1007/s11064‐015‐1600‐7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Brain development is a highly orchestrated complex process. The developing brain utilizes many substrates including glucose, ketone bodies, lactate, fatty acids and amino acids for energy, cell division and the biosynthesis of nucleotides, proteins and lipids. Metabolism is crucial to provide energy for all cellular processes required for brain development and function including ATP formation, synaptogenesis, synthesis, release and uptake of neurotransmitters, maintaining ionic gradients and redox status, and myelination. The rapidly growing population of infants and children with neurodevelopmental and cognitive impairments and life-long disability resulting from developmental brain injury is a significant public health concern. Brain injury in infants and children can have devastating effects because the injury is superimposed on the high metabolic demands of the developing brain. Acute injury in the pediatric brain can derail, halt or lead to dysregulation of the complex and highly regulated normal developmental processes. This paper provides a brief review of metabolism in developing brain and alterations found clinically and in animal models of developmental brain injury. The metabolic changes observed in three major categories of injury that can result in life-long cognitive and neurological disabilities, including neonatal hypoxia-ischemia, pediatric traumatic brain injury, and brain injury secondary to prematurity are reviewed.
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Affiliation(s)
- Mary C McKenna
- Department of Pediatrics and Program in Neuroscience, University of Maryland School of Medicine, 655 W. Baltimore St., Room 13-019, Baltimore, MD, 21201, USA.
| | - Susanna Scafidi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtney L Robertson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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35
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Wu J, Awate SP, Licht DJ, Clouchoux C, du Plessis AJ, Avants BB, Vossough A, Gee JC, Limperopoulos C. Assessment of MRI-Based Automated Fetal Cerebral Cortical Folding Measures in Prediction of Gestational Age in the Third Trimester. AJNR Am J Neuroradiol 2015; 36:1369-74. [PMID: 26045578 DOI: 10.3174/ajnr.a4357] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/20/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Traditional methods of dating a pregnancy based on history or sonographic assessment have a large variation in the third trimester. We aimed to assess the ability of various quantitative measures of brain cortical folding on MR imaging in determining fetal gestational age in the third trimester. MATERIALS AND METHODS We evaluated 8 different quantitative cortical folding measures to predict gestational age in 33 healthy fetuses by using T2-weighted fetal MR imaging. We compared the accuracy of the prediction of gestational age by these cortical folding measures with the accuracy of prediction by brain volume measurement and by a previously reported semiquantitative visual scale of brain maturity. Regression models were constructed, and measurement biases and variances were determined via a cross-validation procedure. RESULTS The cortical folding measures are accurate in the estimation and prediction of gestational age (mean of the absolute error, 0.43 ± 0.45 weeks) and perform better than (P = .024) brain volume (mean of the absolute error, 0.72 ± 0.61 weeks) or sonography measures (SDs approximately 1.5 weeks, as reported in literature). Prediction accuracy is comparable with that of the semiquantitative visual assessment score (mean, 0.57 ± 0.41 weeks). CONCLUSIONS Quantitative cortical folding measures such as global average curvedness can be an accurate and reliable estimator of gestational age and brain maturity for healthy fetuses in the third trimester and have the potential to be an indicator of brain-growth delays for at-risk fetuses and preterm neonates.
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Affiliation(s)
- J Wu
- From the Department of Radiology (J.W., B.B.A., A.V., J.C.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S P Awate
- Department of Computer Science and Engineering (S.P.A.), Indian Institute of Technology Bombay, Mumbai, India
| | - D J Licht
- Neurovascular Imaging Lab (D.J.L.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C Clouchoux
- Advanced Pediatric Brain Imaging Research Laboratory (C.C., C.L.), Children's National Medical Center, Washington, DC Departments of Neurology, Radiology, and Pediatrics (C.C., A.J.d.P., C.L.), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - A J du Plessis
- Departments of Neurology, Radiology, and Pediatrics (C.C., A.J.d.P., C.L.), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - B B Avants
- From the Department of Radiology (J.W., B.B.A., A.V., J.C.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Vossough
- From the Department of Radiology (J.W., B.B.A., A.V., J.C.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J C Gee
- From the Department of Radiology (J.W., B.B.A., A.V., J.C.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - C Limperopoulos
- Advanced Pediatric Brain Imaging Research Laboratory (C.C., C.L.), Children's National Medical Center, Washington, DC Departments of Neurology, Radiology, and Pediatrics (C.C., A.J.d.P., C.L.), George Washington University School of Medicine and Health Sciences, Washington, DC
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36
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Anderson PJ, Cheong JLY, Thompson DK. The predictive validity of neonatal MRI for neurodevelopmental outcome in very preterm children. Semin Perinatol 2015; 39:147-58. [PMID: 25724792 DOI: 10.1053/j.semperi.2015.01.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Very preterm children are at a high risk for neurodevelopmental impairments, but there is variability in the pattern and severity of outcome. Neonatal magnetic resonance imaging (MRI) enhances the capacity to detect brain injury and altered brain development and assists in the prediction of high-risk children who warrant surveillance and early intervention. This review describes the application of conventional and advanced MRI with very preterm neonates, specifically focusing on the relationship between neonatal MRI findings and later neurodevelopmental outcome. Research demonstrates that conventional MRI is strongly associated with neurodevelopmental outcome in childhood. Further studies are needed to examine the role of advanced MRI techniques in predicting outcome in very preterm children, but early research findings are promising. In conclusion, neonatal MRI is predictive of later neurodevelopment but is dependent on appropriately trained specialists and should be interpreted in conjunction with other clinical and social information.
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Affiliation(s)
- Peter J Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Neonatal Services, Royal Women׳s Hospital, Melbourne, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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37
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Malik SJ, Beqiri A, Price AN, Teixeira JN, Hand JW, Hajnal JV. Specific absorption rate in neonates undergoing magnetic resonance procedures at 1.5 T and 3 T. NMR IN BIOMEDICINE 2015; 28:344-52. [PMID: 25594939 PMCID: PMC5053241 DOI: 10.1002/nbm.3256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/01/2014] [Accepted: 12/09/2014] [Indexed: 05/24/2023]
Abstract
MRI is finding increased clinical use in neonatal populations; the extent to which electromagnetic models used for quantification of specific absorption rate (SAR) by commercial MRI scanners accurately reflect this alternative scenario is unclear. This study investigates how SAR predictions relating to adults can be related to neonates under differing conditions when imaged using 1.5 T and 3 T MRI scanners. Electromagnetic simulations were produced in neonatal subjects of different sizes and positions within a generic MRI body transmit device operating at both 64 MHz and 128 MHz, corresponding to 1.5 T and 3 T MRI scanners, respectively. An adult model was also simulated, as was a spherical salt-water phantom, which was also used in a calorimetry experiment. The SAR in neonatal subjects was found to be less than that experienced in an adult in all scenarios; however, the overestimation factor was variable. For example a 3 T body scan resulting in local 10 g SAR of 10.1 W kg(-1) in an adult would deposit 2.6 W kg(-1) in a neonate: an approximately fourfold difference. The SAR experienced by neonatal subjects undergoing MRI is lower than that in adults in equivalent situations. If the safety of such procedures is assessed using adult-appropriate models then the result is a conservative estimate.
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Affiliation(s)
- Shaihan J Malik
- Centre for the Developing Brain and Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
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Di Martino A, Fair DA, Kelly C, Satterthwaite TD, Castellanos FX, Thomason ME, Craddock RC, Luna B, Leventhal BL, Zuo XN, Milham MP. Unraveling the miswired connectome: a developmental perspective. Neuron 2015; 83:1335-53. [PMID: 25233316 DOI: 10.1016/j.neuron.2014.08.050] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/29/2022]
Abstract
The vast majority of mental illnesses can be conceptualized as developmental disorders of neural interactions within the connectome, or developmental miswiring. The recent maturation of pediatric in vivo brain imaging is bringing the identification of clinically meaningful brain-based biomarkers of developmental disorders within reach. Even more auspicious is the ability to study the evolving connectome throughout life, beginning in utero, which promises to move the field from topological phenomenology to etiological nosology. Here, we scope advances in pediatric imaging of the brain connectome as the field faces the challenge of unraveling developmental miswiring. We highlight promises while also providing a pragmatic review of the many obstacles ahead that must be overcome to significantly impact public health.
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Affiliation(s)
- Adriana Di Martino
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, New York, NY 10016, USA
| | - Damien A Fair
- Behavioral Neuroscience and Psychiatry Departments and Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR 97329, USA
| | - Clare Kelly
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, New York, NY 10016, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - F Xavier Castellanos
- Department of Child and Adolescent Psychiatry, Child Study Center at NYU Langone Medical Center, New York, NY 10016, USA; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Moriah E Thomason
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI 48202, USA; Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - R Cameron Craddock
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, NY 10022, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Bennett L Leventhal
- Department of Psychiatry, Langley Porter Psychiatric Institute, University of California San Francisco, San Francisco, CA 94143, USA
| | - Xi-Nian Zuo
- Key Laboratory of Behavioral Science and Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Faculty of Psychology, Southwest University, Beibei, Chongqing 100101, China
| | - Michael P Milham
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, NY 10022, USA.
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39
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Giampietri M, Bartalena L, Guzzetta A, Boldrini A, Ghirri P. New techniques in the study of the brain development in newborn. Front Hum Neurosci 2015; 8:1069. [PMID: 25653608 PMCID: PMC4299644 DOI: 10.3389/fnhum.2014.01069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/23/2014] [Indexed: 01/29/2023] Open
Affiliation(s)
- Matteo Giampietri
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, S. Chiara Hospital, University of Pisa , Pisa , Italy
| | - Laura Bartalena
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, S. Chiara Hospital, University of Pisa , Pisa , Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Stella Maris Scientific Institute , Pisa , Italy
| | - Antonio Boldrini
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, S. Chiara Hospital, University of Pisa , Pisa , Italy
| | - Paolo Ghirri
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, S. Chiara Hospital, University of Pisa , Pisa , Italy
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40
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Affiliation(s)
- Eric C Eichenwald
- Department of Pediatrics, University of Texas Medical School, Houston, Texas
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41
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Dean DC, Dirks H, O’Muircheartaigh J, Walker L, Jerskey BA, Lehman K, Han M, Waskiewicz N, Deoni SCL. Pediatric neuroimaging using magnetic resonance imaging during non-sedated sleep. Pediatr Radiol 2014; 44:64-72. [PMID: 23917588 PMCID: PMC3889986 DOI: 10.1007/s00247-013-2752-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/30/2013] [Accepted: 06/24/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Etiological studies of many neurological and psychiatric disorders are increasingly turning toward longitudinal investigations of infant brain development in order to discern predisposing structural and/or functional differences prior to the onset of overt clinical symptoms. While MRI provides a noninvasive window into the developing brain, MRI of infants and toddlers is challenging due to the modality's extreme motion sensitivity and children's difficulty in remaining still during image acquisition. OBJECTIVE Here, we outline a broad research protocol for successful MRI of children under 4 years of age during natural, non-sedated sleep. MATERIALS AND METHODS All children were imaged during natural, non-sedated sleep. Active and passive measures to reduce acoustic noise were implemented to reduce the likelihood of the children waking up during acquisition. Foam cushions and vacuum immobilizers were used to limit intra-scan motion artifacts. RESULTS More than 380 MRI datasets have been successfully acquired from 220 children younger than 4 years of age within the past 39 months. Implemented measures permitted children to remain asleep for the duration of the scan and allowed the data to be acquired with an overall 97% success rate. CONCLUSION The proposed method greatly advances current pediatric imaging techniques and may be readily implemented in other research and clinical settings to facilitate and further improve pediatric neuroimaging.
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Affiliation(s)
- Douglas C. Dean
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
| | - Holly Dirks
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
| | - Jonathan O’Muircheartaigh
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA ,Department of NeuroImaging Sciences, King’s College London, Institute of Psychiatry, Delaware Crespigny Park, London, UK
| | - Lindsay Walker
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
| | - Beth A. Jerskey
- Department of Human Behaviour and Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Katie Lehman
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
| | - Michelle Han
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
| | - Nicole Waskiewicz
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
| | - Sean C. L. Deoni
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI 02912 USA
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42
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Setänen S, Haataja L, Parkkola R, Lind A, Lehtonen L. Predictive value of neonatal brain MRI on the neurodevelopmental outcome of preterm infants by 5 years of age. Acta Paediatr 2013; 102:492-7. [PMID: 23398524 DOI: 10.1111/apa.12191] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/30/2013] [Accepted: 02/04/2013] [Indexed: 11/27/2022]
Abstract
AIM To study the prognostic value of MRI in preterm infants at term equivalent age for cognitive development at 5 years of age. METHODS A total of 217 very low birth weight/very low gestational age infants who all received brain MRI at term equivalent age were categorized into 4 groups based on the brain MRI findings. Cognitive development was assessed at 5 years of chronological age by using a short form of Wechsler Preschool and Primary Scale of Intelligence - Revised. This information was combined with neurosensory diagnoses by 2 years of corrected age. RESULTS Of all infants 31 (17.0%) had Full Scale Intelligence Quotient (FSIQ) <85, 14 (6.5%) had cerebral palsy and 4 (1.8%) had severe hearing impairment. A total of 41 (22.0%) infants had some neurodevelopmental impairment at 5 years of age. Considering cognitive outcome (FSIQ <85), the positive predictive value of several major MRI pathologies was 43.8%, and the negative predictive value of normal finding or minor pathologies was 92.0% and 85.7%, respectively. CONCLUSION The MRI of the brain at term equivalent age may be valuable in predicting neurodevelopmental outcome in preterm infants by 5 years of age. The findings should always be interpreted alongside the clinical information of the infant. Furthermore, MRI should not replace a long-term clinical follow-up for very preterm infants.
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Affiliation(s)
- Sirkku Setänen
- Department of Pediatric Neurology, Turku University Hospital, Turku, Finland.
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