1
|
Lu J, Drobyshevsky A, Lu L, Yu Y, Caplan MS, Claud EC. Microbiota from Preterm Infants Who Develop Necrotizing Enterocolitis Drives the Neurodevelopment Impairment in a Humanized Mouse Model. Microorganisms 2023; 11:1131. [PMID: 37317106 PMCID: PMC10224461 DOI: 10.3390/microorganisms11051131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 06/16/2023] Open
Abstract
Necrotizing enterocolitis (NEC) is the leading basis for gastrointestinal morbidity and poses a significant risk for neurodevelopmental impairment (NDI) in preterm infants. Aberrant bacterial colonization preceding NEC contributes to the pathogenesis of NEC, and we have demonstrated that immature microbiota in preterm infants negatively impacts neurodevelopment and neurological outcomes. In this study, we tested the hypothesis that microbial communities before the onset of NEC drive NDI. Using our humanized gnotobiotic model in which human infant microbial samples were gavaged to pregnant germ-free C57BL/6J dams, we compared the effects of the microbiota from preterm infants who went on to develop NEC (MNEC) to the microbiota from healthy term infants (MTERM) on brain development and neurological outcomes in offspring mice. Immunohistochemical studies demonstrated that MNEC mice had significantly decreased occludin and ZO-1 expression compared to MTERM mice and increased ileal inflammation marked by the increased nuclear phospho-p65 of NFκB expression, revealing that microbial communities from patients who developed NEC had a negative effect on ileal barrier development and homeostasis. In open field and elevated plus maze tests, MNEC mice had worse mobility and were more anxious than MTERM mice. In cued fear conditioning tests, MNEC mice had worse contextual memory than MTERM mice. MRI revealed that MNEC mice had decreased myelination in major white and grey matter structures and lower fractional anisotropy values in white matter areas, demonstrating delayed brain maturation and organization. MNEC also altered the metabolic profiles, especially carnitine, phosphocholine, and bile acid analogs in the brain. Our data demonstrated numerous significant differences in gut maturity, brain metabolic profiles, brain maturation and organization, and behaviors between MTERM and MNEC mice. Our study suggests that the microbiome before the onset of NEC has negative impacts on brain development and neurological outcomes and can be a prospective target to improve long-term developmental outcomes.
Collapse
Affiliation(s)
- Jing Lu
- Department of Pediatrics, Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | | - Lei Lu
- Department of Pediatrics, Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Yueyue Yu
- Department of Pediatrics, Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Michael S. Caplan
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL 60202, USA
| | - Erika C. Claud
- Department of Pediatrics, Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
2
|
Torres Y, Celis C, Acurio J, Escudero C. Language Impairment in Children of Mothers with Gestational Diabetes, Preeclampsia, and Preterm Delivery: Current Hypothesis and Potential Underlying Mechanisms : Language Impartment and Pregnancy Complications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:245-267. [PMID: 37466777 DOI: 10.1007/978-3-031-32554-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Many conditions may impair or delay language development, including socioeconomic status, parent's education, or intrauterine environment. Accordingly, increasing evidence has described that pregnancy complications, including gestational diabetes mellitus (GDM), preeclampsia, and preterm delivery, are associated with the offspring's impaired neurodevelopment. Since language is one of the high brain functions, alterations in this function are another sign of neurodevelopment impairment. How these maternal conditions may generate language impairment has yet to be entirely understood. However, since language development requires adequate structural formation and function/connectivity of the brain, these processes must be affected by alterations in maternal conditions. However, the underlying mechanisms of these structural alterations are largely unknown. This manuscript critically analyzes the literature focused on the risk of developing language impairment in children of mothers with GDM, preeclampsia, and preterm delivery. Furthermore, we highlight potential underlying molecular mechanisms associated with these alterations, such as neuroinflammatory and metabolic and cerebrovascular alterations.
Collapse
Affiliation(s)
- Yesenia Torres
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Cristian Celis
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile
- Centro terapéutico , ABCfonoaudiologia, Santiago, Chile
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Science, Faculty of Sciences, Universidad of Bio Bio, Chillán, Chile.
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile.
| |
Collapse
|
3
|
Butera CD, Rhee C, Kelly CE, Dhollander T, Thompson DK, Wisnowski J, Molinini RM, Sargent B, Lepore N, Vorona G, Bessom D, Shall MS, Burnsed J, Stevenson RD, Brown S, Harper A, Hendricks-Muñoz KD, Dusing SC. Effect of a NICU to Home Physical Therapy Intervention on White Matter Trajectories, Motor Skills, and Problem-Solving Skills of Infants Born Very Preterm: A Case Series. J Pers Med 2022; 12:2024. [PMID: 36556244 PMCID: PMC9784100 DOI: 10.3390/jpm12122024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Infants born very preterm (VPT; ≤29 weeks of gestation) are at high risk of developmental disabilities and abnormalities in neural white matter characteristics. Early physical therapy interventions such as Supporting Play Exploration and Early Development Intervention (SPEEDI2) are associated with improvements in developmental outcomes. Six VPT infants were enrolled in a randomised clinical trial of SPEEDI2 during the transition from the neonatal intensive care unit to home over four time points. Magnetic resonance imaging scans and fixel-based analysis were performed, and fibre density (FD), fibre cross-section (FC), and fibre density and cross-section values (FDC) were computed. Changes in white matter microstructure and macrostructure were positively correlated with cognitive, motor, and motor-based problem solving over time on developmental assessments. In all infants, the greatest increase in FD, FC, and FDC occurred between Visit 1 and 2 (mean chronological age: 2.68-6.22 months), suggesting that this is a potential window of time to optimally support adaptive development. Results warrant further studies with larger groups to formally compare the impact of intervention and disparity on neurodevelopmental outcomes in infants born VPT.
Collapse
Affiliation(s)
- Christiana Dodd Butera
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Claire Rhee
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Claire E. Kelly
- Victorian Infant Brain Studies and Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3000, Australia
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Deanne K. Thompson
- Victorian Infant Brain Studies and Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jessica Wisnowski
- Departments of Radiology and Pediatrics (Neonatology), Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Rebecca M. Molinini
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Barbara Sargent
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
| | - Natasha Lepore
- CIBORG Laboratory, Department of Radiology, University of Southern California, Los Angeles, CA 90089, USA
- Departments of Pediatrics and Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Greg Vorona
- Department of Radiology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Dave Bessom
- Department of Radiology, Children’s Hospital of Richmond at VCU, Richmond, VA 23284, USA
| | - Mary S. Shall
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jennifer Burnsed
- Division of Neonatology, Departments of Pediatrics and Neurology, University of Virginia, Charlottesville, VA 22903, USA
| | - Richard D. Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Shaaron Brown
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Amy Harper
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Karen D. Hendricks-Muñoz
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA 23284, USA
| | - Stacey C. Dusing
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| |
Collapse
|
4
|
Mouka V, Drougia A, Xydis VG, Astrakas LG, Zikou AK, Kosta P, Andronikou S, Argyropoulou MI. Functional and structural connectivity of the brain in very preterm babies: relationship with gestational age and body and brain growth. Pediatr Radiol 2019; 49:1078-1084. [PMID: 31053875 DOI: 10.1007/s00247-019-04412-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/20/2019] [Accepted: 04/12/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Structural and functional changes of the brain have been reported in premature babies. OBJECTIVE To evaluate the relationship of functional and structural connectivity with gestational age, body growth and brain maturation in very preterm babies. MATERIALS AND METHODS We studied 18 very preterm babies (gestational age: mean ± standard deviation, 29.7±1.7 weeks). We examined functional connectivity by multivariate pattern analysis of resting-state functional MRI data. We assessed structural connectivity by analysis of diffusion tensor imaging data and probabilistic tractography. RESULTS The average functional connectivity of the medial orbitofrontal cortex with the rest of the brain was positively associated with gestational age (P<0.001). Fractional anisotropy of the right inferior fronto-occipital fasciculus was positively associated with head circumference at term-equivalent age. Structural connectivity of the inferior fronto-occipital fasciculus with the medial orbitofrontal cortex was positively associated with head circumference at term-equivalent age. Body weight at term-equivalent age was the only independent predictor of average structural connectivity of the medial orbitofrontal cortex with the rest of the brain (P=0.020). CONCLUSION Structural and functional connectivity of the medial orbitofrontal cortex with the rest of the brain depend on body growth and degree of prematurity, respectively.
Collapse
Affiliation(s)
- Vassiliki Mouka
- Medical School, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
| | - Aikaterini Drougia
- Neonatology Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Vasileios G Xydis
- Medical School, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
| | - Loukas G Astrakas
- Medical Physics, Medical School, University of Ioannina, Ioannina, Greece
| | - Anastasia K Zikou
- Medical School, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
| | - Paraskevi Kosta
- Medical School, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
| | | | - Maria I Argyropoulou
- Medical School, University Hospital of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece.
| |
Collapse
|
5
|
Jakab A, Ruegger C, Bucher HU, Makki M, Huppi PS, Tuura R, Hagmann C. Network based statistics reveals trophic and neuroprotective effect of early high dose erythropoetin on brain connectivity in very preterm infants. NEUROIMAGE-CLINICAL 2019; 22:101806. [PMID: 30991614 PMCID: PMC6451173 DOI: 10.1016/j.nicl.2019.101806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/18/2019] [Accepted: 03/30/2019] [Indexed: 01/17/2023]
Abstract
Periventricular white matter injury is common in very preterm infants and it is associated with long term neurodevelopmental impairments. While evidence supports the protective effects of erythropoetin (EPO) in preventing injury, we currently lack the complete understanding of how EPO affects the emergence and maturation of anatomical brain connectivity and function. In this case-control study, connectomic analysis based on diffusion MRI tractography was applied to evaluate the effect of early high-dose EPO in preterm infants. A whole brain, network-level analysis revealed a sub-network of anatomical brain connections in which connectivity strengths were significantly stronger in the EPO group. This distributed network comprised connections predominantly in the frontal and temporal lobe bilaterally, and the effect of EPO was focused on peripheral and feeder connections of the core structural connectivity network. EPO resulted in a globally increased clustering coefficient, higher global and average local efficiency, while higher strength and increased clustering was found for regions in the frontal lobe and cingulate gyrus. The connectivity network most affected by the EPO treatment showed a steeper increase graph theoretical measures with age compared to the placebo group. Our results demonstrate a weak but widespread effect of EPO on the structural connectivity network and a possible trophic effect of EPO reflected by increasing network segregation, predominantly in local connections. Erythropoietin (EPO) is a potential neuroprotective agent in very preterm infants. EPO leads to increased structural brain connectivity in fronto-temporal regions. Clustering coefficient, local and global efficiency increases after EPO treatment.
Collapse
Affiliation(s)
- A Jakab
- Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland.
| | - C Ruegger
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - H U Bucher
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Malek Makki
- Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - P S Huppi
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - R Tuura
- Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - C Hagmann
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland; Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
6
|
Plomgaard AM, Andersen AD, Petersen TH, van de Looij Y, Thymann T, Sangild PT, Thomsen C, Sizonenko SV, Greisen G. Structural brain maturation differs between preterm and term piglets, whereas brain activity does not. Acta Paediatr 2019; 108:637-644. [PMID: 30144173 DOI: 10.1111/apa.14556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/14/2018] [Accepted: 08/22/2018] [Indexed: 12/17/2022]
Abstract
AIM The aim of the study was to investigate whether amplitude-integrated electroencephalography (aEEG) and cerebral magnetic resonance imaging (MRI) in preterm piglets would provide measures of cerebral functional, microstructural and anatomical maturation, which might reflect the signs of functional brain immaturity, documented in preterm piglets. METHODS During July-October 2013 at the NEOMUNE Centre, Copenhagen University, Denmark, 31 preterm (90% gestation) and 10 term piglets underwent aEEG on days 1, 2, 4 and 11, and MRI on day 25. Physical activity levels were recorded. RESULTS Preterm showed delayed neonatal arousal and physical activity, relative to term piglets. Preterm piglets had lower growth rates and brain volume than term piglets, but aEEG patterns were similar. MRI mean diffusivity was also similar, but fractional anisotropy (FA) was lower in preterm piglets (p < 0.001). CONCLUSION Functional brain maturation, as assessed by aEEG, was relatively advanced in preterm piglets. Conversely, the low FA in the preterm piglets suggests that the white matter microstructure remains less mature in preterm compared to term piglets at postnatal day 25. The results might be utilised to define whether and how preterm piglets may contribute to preclinical models for brain development in preterm infants.
Collapse
Affiliation(s)
- A M Plomgaard
- Department of Neonatology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - A D Andersen
- Comparative Pediatrics and Nutrition; Department of Veterinary Clinical and Animal Science; Frederiksberg C Denmark
| | - T H Petersen
- Research Unit on Brain Injury Neurorehabilitation Copenhagen; Department of Neurorehabilitation; TBI Unit; Rigshospitalet; Copenhagen University Hospital; Hvidovre Denmark
| | - Y van de Looij
- Division of Child Development and Growth; University Children's Hospital Geneva; Geneva Switzerland
- Functional and Metabolic Imaging Laboratory; EPFL-SB-IPSB-LIFMET CH; Lausanne Switzerland
| | - T Thymann
- Comparative Pediatrics and Nutrition; Department of Veterinary Clinical and Animal Science; Frederiksberg C Denmark
| | - P T Sangild
- Comparative Pediatrics and Nutrition; Department of Veterinary Clinical and Animal Science; Frederiksberg C Denmark
| | - C Thomsen
- Department of Radiology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - S V Sizonenko
- Division of Child Development and Growth; University Children's Hospital Geneva; Geneva Switzerland
| | - G Greisen
- Department of Neonatology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
7
|
Reduced white matter fractional anisotropy mediates cortical thickening in adults born preterm with very low birthweight. Neuroimage 2019; 188:217-227. [DOI: 10.1016/j.neuroimage.2018.11.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022] Open
|
8
|
Loe IM, Adams JN, Feldman HM. Executive Function in Relation to White Matter in Preterm and Full Term Children. Front Pediatr 2019; 6:418. [PMID: 30697535 PMCID: PMC6341022 DOI: 10.3389/fped.2018.00418] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Executive function (EF) refers to cognitive abilities used to guide goal-directed behavior. Diffusion Tensor Imaging (DTI) provides quantitative characterization of white matter tracts in the brain. Children with preterm birth often have EF impairments and white matter injury. Aim: To examine the degree of association between EF scores and white matter fractional anisotropy (FA) as measured by DTI in children born preterm and term Study design: Cross-sectional study Subjects: Participants, 9-16 years of age, born preterm (n = 25; mean gestational age 28.6 weeks; mean birth weight 1,191 grams), and full term (n = 20) Outcome measures: White matter FA analyzed with Tract-Based Spatial Statistics, a technique that generates a skeleton representing the core of white matter tracts throughout the brain. Behavioral scores from EF tasks examining working memory, spatial memory capacity, and multiple skills from the Stockings of Cambridge. Results: The groups performed comparably on all tasks. In both groups, unfavorable working memory strategy scores were associated with lower FA. Other measures of EF were not associated with whole skeleton FA in either group in either direction. Conclusions: Strategy score on a spatial working memory task was associated with FA in preterm and full term children, suggesting common underlying neurobiology in both groups. Associations were found in frontal-parietal connections and other major tracts. Lack of associations between other EF tasks and FA may be due to variation in how children accomplish these EF tasks. Future research is required to fully understand the neurobiology of EF in children born preterm.
Collapse
Affiliation(s)
- Irene M. Loe
- Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Jenna N. Adams
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Heidi M. Feldman
- Department of Pediatrics, Stanford University, Stanford, CA, United States
| |
Collapse
|
9
|
Girault JB, Cornea E, Goldman BD, Knickmeyer RC, Styner M, Gilmore JH. White matter microstructural development and cognitive ability in the first 2 years of life. Hum Brain Mapp 2018; 40:1195-1210. [PMID: 30353962 DOI: 10.1002/hbm.24439] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 12/13/2022] Open
Abstract
White matter (WM) integrity has been related to cognitive ability in adults and children, but it remains largely unknown how WM maturation in early life supports emergent cognition. The associations between tract-based measures of fractional anisotropy (FA) and axial and radial diffusivity (AD, RD) shortly after birth, at age 1, and at age 2 and cognitive measures at 1 and 2 years were investigated in 447 healthy infants. We found that generally higher FA and lower AD and RD across many WM tracts in the first year of life were associated with better performance on measures of general cognitive ability, motor, language, and visual reception skills at ages 1 and 2, suggesting an important role for the overall organization, myelination, and microstructural properties of fiber pathways in emergent cognition. RD in particular was consistently related to ability, and protracted development of RD from ages 1 to 2 years in several tracts was associated with higher cognitive scores and better language performance, suggesting prolonged plasticity may confer cognitive benefits during the second year of life. However, we also found that cognition at age 2 was weakly associated with WM properties across infancy in comparison to child and demographic factors including gestational age and maternal education. Our findings suggest that early postnatal WM integrity across the brain is important for infant cognition, though its role in cognitive development should be considered alongside child and demographic factors.
Collapse
Affiliation(s)
- Jessica B Girault
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emil Cornea
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barbara D Goldman
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca C Knickmeyer
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Martin Styner
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
10
|
Lu J, Synowiec S, Lu L, Yu Y, Bretherick T, Takada S, Yarnykh V, Caplan J, Caplan M, Claud EC, Drobyshevsky A. Microbiota influence the development of the brain and behaviors in C57BL/6J mice. PLoS One 2018; 13:e0201829. [PMID: 30075011 PMCID: PMC6075787 DOI: 10.1371/journal.pone.0201829] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/23/2018] [Indexed: 12/22/2022] Open
Abstract
We investigated the contributions of commensal bacteria to brain structural maturation by magnetic resonance imaging and behavioral tests in four and 12 weeks old C57BL/6J specific pathogen free (SPF) and germ free (GF) mice. SPF mice had increased volumes and fractional anisotropy in major gray and white matter areas and higher levels of myelination in total brain, major white and grey matter structures at either four or 12 weeks of age, demonstrating better brain maturation and organization. In open field test, SPF mice had better mobility and were less anxious than GF at four weeks. In Morris water maze, SPF mice demonstrated better spatial and learning memory than GF mice at 12 weeks. In fear conditioning, SPF mice had better contextual memory than GF mice at 12 weeks. In three chamber social test, SPF mice demonstrated better social novelty than GF mice at 12 weeks. Our data demonstrate numerous significant differences in morphological brain organization and behaviors between SPF and GF mice. This suggests that commensal bacteria are necessary for normal morphological development and maturation in the grey and white matter of the brain regions with implications for behavioral outcomes such as locomotion and cognitive functions.
Collapse
Affiliation(s)
- Jing Lu
- Department of Pediatrics, Neonatology, Pritzker School of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Sylvia Synowiec
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, Illinois, United States of America
| | - Lei Lu
- Department of Pediatrics, Neonatology, Pritzker School of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Yueyue Yu
- Department of Pediatrics, Neonatology, Pritzker School of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Talitha Bretherick
- Laboratório de Neurogenética, Federal University of São Paulo, São Paulo, Brazil
| | - Silvia Takada
- Laboratório de Neurogenética, Federal University of São Paulo, São Paulo, Brazil
| | - Vasily Yarnykh
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Research Institute of Biology and Biophysics, Tomsk State University, Tomsk, Russian Federation
| | - Jack Caplan
- Department of Chemical Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois, United States of America
| | - Michael Caplan
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, Illinois, United States of America
| | - Erika C. Claud
- Department of Pediatrics, Neonatology, Pritzker School of Medicine, the University of Chicago, Chicago, Illinois, United States of America
- * E-mail: (AD); (ECC)
| | - Alexander Drobyshevsky
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, Illinois, United States of America
- * E-mail: (AD); (ECC)
| |
Collapse
|
11
|
Phillips AJ, Yeo RA, Caprihan A, Cannon DC, Patel S, Winter S, Steffen M, Campbell R, Wiedmeier S, Baker S, Gonzales S, Lowe J, Ohls RK. Neuroimaging in former preterm children who received erythropoiesis stimulating agents. Pediatr Res 2017; 82:685-690. [PMID: 28553989 PMCID: PMC5599329 DOI: 10.1038/pr.2017.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/10/2017] [Indexed: 01/31/2023]
Abstract
BackgroundIn premature children, erythropoiesis-stimulating agents (ESAs) may improve developmental outcome. It is not clear which of the several potential mechanisms are responsible for this improvement. High-resolution MRI and diffusion tensor imaging characterize brain structure and white matter organization, offering possible insight into the long-term effect of ESAs on brain development.MethodsMRI scans were performed at 3.5-4 years of age on former preterm infants treated with ESAs or placebo, and on healthy term controls. Mean cortical thickness, surface area, and fractional anisotropy (FA) were compared across study groups, and were correlated with general IQ measures.ResultsUnivariate analysis found no significant effect of ESAs on cortical thickness (P=0.366), surface area (P=0.940), or FA (P=0.150); however, there was a greater increase in FA among ESA-treated girls. Group analysis found significant correlations between FA and Full-Scale IQ (P=0.044) and Verbal IQ (P=0.036), although there was no significant relationship between Full-Scale IQ and FA among just the preterm children.ConclusionESA treatment may have a preferential effect on white matter development in girls, although factors other than just whole-brain FA are involved in mediating cognitive outcome.
Collapse
Affiliation(s)
- Authors: John Phillips
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico,Mind Research Network, Albuquerque, New Mexico
| | - Ronald A. Yeo
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | | | - Daniel C Cannon
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Shrena Patel
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Sarah Winter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Michael Steffen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico
| | - Susan Wiedmeier
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | | | - Jean Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Robin K. Ohls
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
12
|
Travis KE, Ben-Shachar M, Myall NJ, Feldman HM. Variations in the neurobiology of reading in children and adolescents born full term and preterm. Neuroimage Clin 2016; 11:555-565. [PMID: 27158588 PMCID: PMC4845391 DOI: 10.1016/j.nicl.2016.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 01/18/2023]
Abstract
Diffusion properties of white matter tracts have been associated with individual differences in reading. Individuals born preterm are at risk of injury to white matter. In this study we compared the associations between diffusion properties of white matter and reading skills in children and adolescents born full term and preterm. 45 participants, aged 9-17 years, included 26 preterms (born < 36 weeks' gestation) and 19 full-terms. Tract fractional anisotropy (FA) profiles were generated for five bilateral white matter tracts previously associated with reading: anterior superior longitudinal fasciculus (aSLF), arcuate fasciculus (Arc), corticospinal tract (CST), uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF). Mean scores on reading for the two groups were in the normal range and were not statistically different. In both groups, FA was associated with measures of single word reading and comprehension in the aSLF, AF, CST, and UF. However, correlations were negative in the full term group and positive in the preterm group. These results demonstrate variations in the neurobiology of reading in children born full term and preterm despite comparable reading skills. Findings suggest that efficient information exchange required for strong reading abilities may be accomplished via a different balance of neurobiological mechanisms in different groups of readers.
Collapse
Affiliation(s)
- Katherine E Travis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Michal Ben-Shachar
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel; Department of English Literature and Linguistics, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Nathaniel J Myall
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Heidi M Feldman
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, United States.
| |
Collapse
|
13
|
Sølsnes AE, Sripada K, Yendiki A, Bjuland KJ, Østgård HF, Aanes S, Grunewaldt KH, Løhaugen GC, Eikenes L, Håberg AK, Rimol LM, Skranes J. Limited microstructural and connectivity deficits despite subcortical volume reductions in school-aged children born preterm with very low birth weight. Neuroimage 2015; 130:24-34. [PMID: 26712340 DOI: 10.1016/j.neuroimage.2015.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/24/2015] [Accepted: 12/16/2015] [Indexed: 12/14/2022] Open
Abstract
Preterm birth and very low birth weight (VLBW, ≤1500 g) are worldwide problems that burden survivors with lifelong cognitive, psychological, and physical challenges. In this multimodal structural magnetic resonance imaging (MRI) and diffusion MRI (dMRI) study, we investigated differences in subcortical brain volumes and white matter tract properties in children born preterm with VLBW compared to term-born controls (mean age=8 years). Subcortical brain structure volumes and cortical thickness estimates were obtained, and fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were generated for 18 white matter tracts. We also assessed structural relationships between white matter tracts and cortical thickness of the tract endpoints. Compared to controls, the VLBW group had reduced volumes of thalamus, globus pallidus, corpus callosum, cerebral white matter, ventral diencephalon, and brain stem, while the ventricular system was larger in VLBW subjects, after controlling for age, sex, IQ, and estimated total intracranial volume. For the dMRI parameters, group differences were not significant at the whole-tract level, though pointwise analysis found shorter segments affected in forceps minor and left superior longitudinal fasciculus - temporal bundle. IQ did not correlate with subcortical volumes or dMRI measures in the VLBW group. While the deviations in subcortical volumes were substantial, there were few differences in dMRI measures between the two groups, which may reflect the influence of advances in perinatal care on white matter development.
Collapse
Affiliation(s)
- Anne Elisabeth Sølsnes
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kam Sripada
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anastasia Yendiki
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Knut Jørgen Bjuland
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Furre Østgård
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Synne Aanes
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristine Hermansen Grunewaldt
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olav's Hospital, Trondheim, Norway
| | - Gro C Løhaugen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asta K Håberg
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Medical Imaging, St. Olav's Hospital, Trondheim, Norway
| | - Lars M Rimol
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Skranes
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| |
Collapse
|
14
|
Travis KE, Adams JN, Ben-Shachar M, Feldman HM. Decreased and Increased Anisotropy along Major Cerebral White Matter Tracts in Preterm Children and Adolescents. PLoS One 2015; 10:e0142860. [PMID: 26560745 PMCID: PMC4641645 DOI: 10.1371/journal.pone.0142860] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/26/2015] [Indexed: 12/15/2022] Open
Abstract
Premature birth is highly prevalent and associated with neurodevelopmental delays and disorders. Adverse outcomes, particularly in children born before 32 weeks of gestation, have been attributed in large part to white matter injuries, often found in periventricular regions using conventional imaging. To date, tractography studies of white matter pathways in children and adolescents born preterm have evaluated only a limited number of tracts simultaneously. The current study compares diffusion properties along 18 major cerebral white matter pathways in children and adolescents born preterm (n = 27) and full term (n = 19), using diffusion magnetic resonance imaging and tractography. We found that compared to the full term group, the preterm group had significantly decreased FA in segments of the bilateral uncinate fasciculus and anterior segments of the right inferior fronto-occipital fasciculus. Additionally, the preterm group had significantly increased FA in segments of the right and left anterior thalamic radiations, posterior segments of the right inferior fronto-occipital fasciculus, and the right and left inferior longitudinal fasciculus. Increased FA in the preterm group was generally associated with decreased radial diffusivity. These findings indicate that prematurity-related white matter differences in later childhood and adolescence do not affect all tracts in the periventricular zone and can involve both decreased and increased FA. Differences in the patterns of radial diffusivity and axial diffusivity suggest that the tissue properties underlying group FA differences may vary within and across white matter tracts. Distinctive diffusion properties may relate to variations in the timing of injury in the neonatal period, extent of white matter dysmaturity and/or compensatory processes in childhood.
Collapse
Affiliation(s)
- Katherine E. Travis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, 94303, United States of America
| | - Jenna N. Adams
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, 94303, United States of America
| | - Michal Ben-Shachar
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, 5290002, Israel
- Department of English Literature and Linguistics, Bar Ilan University, Ramat Gan, 5290002, Israel
| | - Heidi M. Feldman
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, 94303, United States of America
| |
Collapse
|
15
|
Abstract
The human brain rapidly develops during the final weeks of gestation and in the first two years following birth. Diffusion tensor imaging (DTI) is a unique in vivo imaging technique that allows three-dimensional visualization of the white matter anatomy in the brain. It has been considered to be a valuable tool for studying brain development in early life. In this review, we first introduce the DTI technique. We then review DTI findings on white matter development at the fetal stage and in infancy as well as DTI applications for understanding neurocognitive development and brain abnormalities in preterm infants. Finally, we discuss limitations of DTI and potential valuable imaging techniques for studying white matter myelination.
Collapse
Affiliation(s)
- Anqi Qiu
- Department of Biomedical Engineering and Clinical Imaging Research Center, National University of Singapore, 117576 Singapore;
| | | | | |
Collapse
|
16
|
Chu C, Lagercrantz H, Forssberg H, Nagy Z. Investigating the use of support vector machine classification on structural brain images of preterm-born teenagers as a biological marker. PLoS One 2015; 10:e0123108. [PMID: 25837791 PMCID: PMC4383582 DOI: 10.1371/journal.pone.0123108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/27/2015] [Indexed: 12/03/2022] Open
Abstract
Preterm birth has been shown to induce an altered developmental trajectory of brain structure and function. With the aid support vector machine (SVM) classification methods we aimed to investigate whether MRI data, collected in adolescence, could be used to predict whether an individual had been born preterm or at term. To this end we collected T1-weighted anatomical MRI data from 143 individuals (69 controls, mean age 14.6y). The inclusion criteria for those born preterm were birth weight ≤ 1500g and gestational age < 37w. A linear SVM was trained on the grey matter segment of MR images in two different ways. First, all the individuals were used for training and classification was performed by the leave-one-out method, yielding 93% correct classification (sensitivity = 0.905, specificity = 0.942). Separately, a random half of the available data were used for training twice and each time the other, unseen, half of the data was classified, resulting 86% and 91% accurate classifications. Both gestational age (R = -0.24, p<0.04) and birth weight (R = -0.51, p < 0.001) correlated with the distance to decision boundary within the group of individuals born preterm. Statistically significant correlations were also found between IQ (R = -0.30, p < 0.001) and the distance to decision boundary. Those born small for gestational age did not form a separate subgroup in these analyses. The high rate of correct classification by the SVM motivates further investigation. The long-term goal is to automatically and non-invasively predict the outcome of preterm-born individuals on an individual basis using as early a scan as possible.
Collapse
Affiliation(s)
- Carlton Chu
- DeepMind Technologies Ltd., London, United Kingdom
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
| | - Hugo Lagercrantz
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Zoltan Nagy
- Laboratory for Social and Neural Systems Research, University of Zurich, Zurich, Switzerland
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
| |
Collapse
|
17
|
Hart AR, Smith MF, Whitby EH, Alladi S, Wilkinson S, Paley MN, Griffiths PD. Diffusion-weighted imaging and magnetic resonance proton spectroscopy following preterm birth. Clin Radiol 2014; 69:870-9. [PMID: 24935906 DOI: 10.1016/j.crad.2014.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
AIM To study the associations between magnetic resonance proton spectroscopy (MRS) data and apparent diffusion coefficients (ADC) from the preterm brain with developmental outcome at 18 months corrected age and clinical variables. MATERIALS AND METHODS A prospective observational cohort study of 67 infants born before 35 weeks gestational age who received both magnetic resonance imaging of the brain between 37 and 44 weeks corrected gestational age and developmental assessment around 18 months corrected age. RESULTS No relationships were found between ADC values and MRS results or outcome. MRS ratios involving N-acetyl aspartate (NAA) from the posterior white matter were associated with "severe" and "moderate to severe" difficulties, and fine motor scores were significantly lower in participants with a visible lactate doublet in the posterior white matter. The presence of a patent ductus arteriosus (PDA) was the only clinical factor related to NAA ratios. CONCLUSION Altered NAA levels in the posterior white matter may reflect subtle white matter injury associated with neuro-developmental difficulties, which may be related to a PDA. Further work is needed to assess the longer-term neuro-developmental implications of these findings, and to study the effect of PDAs on developmental outcome in later childhood/adolescence.
Collapse
Affiliation(s)
- A R Hart
- Department of Paediatric Neurology and Child Development, Ryegate Children's Centre, Sheffield Children's Hospital NHS Foundation Trust, Tapton Crescent Road, Sheffield S10 5DD, UK.
| | - M F Smith
- Department of Neonatology, Jessop Wing, Sheffield Teaching Hospitals NHS, Foundation Trust, Tree Root Walk, Sheffield S10 2SF, UK
| | - E H Whitby
- Academic Unit of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - S Alladi
- Department of Paediatric Neurology and Child Development, Ryegate Children's Centre, Sheffield Children's Hospital NHS Foundation Trust, Tapton Crescent Road, Sheffield S10 5DD, UK
| | - S Wilkinson
- Department of Neonatology, Jessop Wing, Sheffield Teaching Hospitals NHS, Foundation Trust, Tree Root Walk, Sheffield S10 2SF, UK
| | - M N Paley
- Academic Unit of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - P D Griffiths
- Academic Unit of Radiology, University of Sheffield, Floor C, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| |
Collapse
|
18
|
Skiöld B, Alexandrou G, Padilla N, Blennow M, Vollmer B, Adén U. Sex differences in outcome and associations with neonatal brain morphology in extremely preterm children. J Pediatr 2014; 164:1012-8. [PMID: 24530122 DOI: 10.1016/j.jpeds.2013.12.051] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 11/18/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate sex differences in neurologic and developmental outcomes in extremely preterm (EPT) children and explore associations with neonatal brain morphology. STUDY DESIGN A population-based cohort of infants born at <27 weeks gestation underwent magnetic resonance imaging (MRI) at term equivalent age (n = 107). Voxel-based morphometry (n = 27) and tract-based spatial statistics (n = 29) were performed in infants with normal MRI findings. Neurologic and developmental assessment (using the Bayley Scales of Infant and Toddler Development-Third Edition [BSITD-III]) was performed at 30 months corrected age (n = 91). RESULTS EPT boys had lower mean cognitive composite scores (P = .03) and lower mean language composite scores (P = .04) compared with EPT girls. Rates of cerebral palsy were similar in the 2 sexes. No perinatal factor explained the variance in outcomes. Visual inspection of T1- and T2-weighted MRI images found that delayed myelination was found more frequently in boys, whereas cerebellar abnormalities were more common in girls. In the subgroup of children with normal MRI findings (n = 27), boys had poorer cognitive function (P = .015) and language function (P = .008), despite larger volumes of cerebellar tissue (P = .029). In boys, cerebellar volume was positively correlated with BSITD-III cognitive and motor scores (P = .04 for both). In girls, white matter volume (P = .02) and cortical gray matter volume (P = .03) were positively correlated with BSITD-III language score. At the regional level, significant correlations with outcomes were found only in girls. CONCLUSION Cognitive and language outcomes at age 30 months were poorer in boys. Sex-related differences were observed on neonatal structural MRI, including differences in the patterns of correlations between brain volumes and developmental scores at both global and regional levels.
Collapse
Affiliation(s)
- Béatrice Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska Institutet, Stockholm, Sweden.
| | - Georgios Alexandrou
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nelly Padilla
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Blennow
- Department of Neonatology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Vollmer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Adén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
MRI of animal models of developmental disorders and translation to human imaging. Curr Opin Neurol 2014; 27:157-67. [DOI: 10.1097/wco.0000000000000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
de Kieviet JF, Pouwels PJW, Lafeber HN, Vermeulen RJ, van Elburg RM, Oosterlaan J. A crucial role of altered fractional anisotropy in motor problems of very preterm children. Eur J Paediatr Neurol 2014; 18:126-33. [PMID: 24119780 DOI: 10.1016/j.ejpn.2013.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/22/2013] [Accepted: 09/14/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Very preterm children (<32 weeks of gestation) are characterized by impaired white matter development as measured by fractional anisotropy (FA). This study investigates whether altered FA values underpin the widespread motor impairments and higher incidence of developmental coordination disorder (DCD) in very preterm children at school-age. METHODS Thirty very preterm born children (mean (SD) age of 8.6 (0.3) years) and 47 term born controls (mean [SD] age 8.7 [0.5] years) participated. Motor development was measured using the Movement Assessment Battery for Children. A score below the 15th percentile was used as a research diagnosis of DCD. FA values, as measure of white matter abnormalities, were determined for 18 major white matter tracts, obtained using probabilistic diffusion tensor tractography. RESULTS Large-sized reductions in FA of the cingulum hippocampal tract right (d = 0.75, p = .003) and left (d = 0.76, p = .001), corticospinal tract right (d = 0.56, p = .02) and left (d = 0.65, p = .009), forceps major (d = 1.04, p < .001) and minor (d = 0.54, p = .02) were present in very preterms, in particular with a research diagnosis of DCD. Reduced FA values moderately to strongly related to motor impairments. A ROC curve for average FA, as calculated from tracts that significantly discriminated between very preterm children with and without a research diagnosis of DCD, showed an area under curve of 0.87 (95% CI 0.74-1.00, p = .001). CONCLUSIONS This study provides clear evidence that reduced FA values are strongly underpinning motor impairment and DCD in very preterm children at school-age. In addition, outcomes demonstrate that altered white matter FA values can potentially be used to discriminate between very preterm children at risk for motor impairments, although future studies are warranted.
Collapse
Affiliation(s)
- Jorrit F de Kieviet
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Petra J W Pouwels
- VU University Medical Center, Department of Physics and Medical Technology, Amsterdam, The Netherlands
| | - Harrie N Lafeber
- VU University Medical Center, Department of Paediatrics, Amsterdam, The Netherlands
| | - R Jeroen Vermeulen
- VU University Medical Center, Department of Paediatric Neurology, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Ruurd M van Elburg
- VU University Medical Center, Department of Paediatrics, Amsterdam, The Netherlands; Danone Research Centre for Specialized Nutrition, Wageningen, The Netherlands
| | - Jaap Oosterlaan
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| |
Collapse
|
21
|
Shim SY, Jeong HJ, Son DW, Chung M, Park S, Cho ZH. Serial diffusion tensor images during infancy and their relationship to neuromotor outcomes in preterm infants. Neonatology 2014; 106:348-54. [PMID: 25278285 DOI: 10.1159/000363218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Even preterm infants with normal magnetic resonance imaging (MRI) results are at greater risk for neuromotor dysfunction. OBJECTIVES Our aim was to compare serial diffusion tensor imaging (DTI) data from preterm infants without apparent brain abnormalities on magnetic resonance imaging with those from term controls and to investigate the white matter (WM) region associated with neuromotor outcomes. METHODS We obtained serial DTIs from 21 preterm infants at term-equivalent age (TEA) and 1 year of corrected age. As controls, 15 term neonates and 20 newly recruited term infants aged 1 year underwent DTI. Preterm and term infants at 1 year of age were assessed with the Bayley Scales of Infant Development, second edition. Tract-based spatial statistics and regions of interest were used for analysis. RESULTS At TEA, the entire WM development was delayed in the preterm infants compared with the term controls, but at 1 year of age, the WM development, except for that of the corpus callosum (CC), had reached the development level of the term controls. The psychomotor developmental index was positively correlated with the fractional anisotropy (FA) in the CC (particularly in the body and splenium) at 1 year of age after correcting for gestational age, chronic lung disease, and postnatal infection. CONCLUSIONS The CC of the preterm infants was consistently underdeveloped compared with that of the term controls. The FA in the CC, particularly in the body and splenium at 1 year of age, well reflected the degree of motor function in infants without apparent brain abnormalities.
Collapse
Affiliation(s)
- So-Yeon Shim
- Division of Neonatology, Ewha Womans University, School of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
22
|
Thompson DK, Lee KJ, Egan GF, Warfield SK, Doyle LW, Anderson PJ, Inder TE. Regional white matter microstructure in very preterm infants: predictors and 7 year outcomes. Cortex 2013; 52:60-74. [PMID: 24405815 DOI: 10.1016/j.cortex.2013.11.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/18/2013] [Accepted: 11/27/2013] [Indexed: 02/01/2023]
Abstract
The aims of this study were to investigate regional white matter microstructural differences between very preterm (VPT) (<30 weeks' gestational age and/or <1250 g) and full term (FT) (≥37 weeks' gestational age) infants at term corrected age with diffusion tensor imaging, and to explore perinatal predictors of diffusion measures, and the relationship between regional diffusion measures and neurodevelopmental outcomes at age 7 years in VPT children. Mean (MD) (p = .003), axial (AD) (p = .008), and radial diffusivity (RD) (p = .003) in total white matter were increased in VPT compared with FT infants, with similar fractional anisotropy (FA) in the two groups. There was little evidence that group-wise differences were specific to any of the 8 regions studied for each hemisphere. Perinatal white matter abnormality and intraventricular hemorrhage (grade III or IV) were associated with increased diffusivity in the white matter of VPT infants. Higher white matter diffusivity measures of the inferior occipital and cerebellar region at term-equivalent age were associated with increased risk of impairments in motor and executive function at 7 years in VPT children, but there was little evidence for associations with IQ or memory impairment. In conclusion, myelination is likely disrupted or delayed in VPT infants, especially those with perinatal brain abnormality (BA). Altered diffusivity at term-equivalent age helps explain impaired functioning at 7 years. This study defines the nature of microstructural alterations in VPT infant white matter, assists in understanding the associated risk factors, and is the first study to reveal an important link between inferior occipital and cerebellar white matter disorganization in infancy, and executive and motor functioning 7 years later.
Collapse
Affiliation(s)
- Deanne K Thompson
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Carlton, Vic, Australia.
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Carlton, Vic, Australia
| | - Gary F Egan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Carlton, Vic, Australia; Monash Biomedical Imaging, Monash University, Clayton, Vic, Australia
| | - Simon K Warfield
- Department of Radiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Carlton, Vic, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Carlton, Vic, Australia
| | - Terrie E Inder
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Department of Pediatrics, St Louis Children's Hospital, Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|
23
|
Duerden EG, Card D, Lax ID, Donner EJ, Taylor MJ. Alterations in frontostriatal pathways in children born very preterm. Dev Med Child Neurol 2013; 55:952-8. [PMID: 23859594 DOI: 10.1111/dmcn.12198] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/30/2022]
Abstract
AIM Children born very preterm (<32wks' gestation) are at risk of white matter injury, particularly in frontostriatal pathways that mediate executive functioning. However, it is unclear whether very preterm children without evidence of neonatal brain injury manifest long-term white matter microstructural differences once they reach school age and if this is related to cognitive impairments. METHOD Twenty school-aged children born very preterm (11 males, nine females; mean age 8y 6mo, standard error [SE] 1.68mo, range 7y 7mo-9y 6mo; gestational age range 24-30wks, mean gestational age 26.9wks, SE 0.4wk; birthweight 988 g, SE 46 g, range 570-1424 g) without evidence of neonatal brain injury, and 20 sex- and age-matched term-born children (mean age 8y 4.8mo, SE 1.92mo; range 7y 2mo-9y-10.8mo) underwent neurodevelopmental assessment and diffusion tensor imaging. RESULTS Fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated within all white matter pathways and within frontostriatal projections. Children born preterm had decreased fractional anisotropy in the territories of the left external capsule, superior longitudinal fasciculus, uncinate fasciculus, and inferior fronto-occipital fasciculus. Measures of intelligence were negatively correlated with frontostriatal fractional anisotropy only in males born preterm. INTERPRETATION Results indicate that very preterm-born children exhibit white matter disturbances that persist into middle childhood, with potential sex differences in the association between these white matter alterations and cognitive function.
Collapse
Affiliation(s)
- Emma G Duerden
- Diagnostic Imaging, Research Institute, Hospital for Sick Children, Toronto, ON, Canada; Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, Toronto, ON, Canada; Neurology, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
24
|
Pandit AS, Ball G, Edwards AD, Counsell SJ. Diffusion magnetic resonance imaging in preterm brain injury. Neuroradiology 2013; 55 Suppl 2:65-95. [PMID: 23942765 DOI: 10.1007/s00234-013-1242-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/09/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION White matter injury and abnormal maturation are thought to be major contributors to the neurodevelopmental disabilities observed in children and adolescents who were born preterm. Early detection of abnormal white matter maturation is important in the design of preventive, protective, and rehabilitative strategies for the management of the preterm infant. Diffusion-weighted magnetic resonance imaging (d-MRI) has become a valuable tool in assessing white matter maturation and injury in survivors of preterm birth. In this review, we aim to (1) describe the basic concepts of d-MRI; (2) evaluate the methods that are currently used to analyse d-MRI; (3) discuss neuroimaging correlates of preterm brain injury observed at term corrected age; during infancy, adolescence and in early adulthood; and (4) explore the relationship between d-MRI measures and subsequent neurodevelopmental performance. METHODS References for this review were identified through searches of PubMed and Google Scholar before March 2013. RESULTS The impact of premature birth on cerebral white matter can be observed from term-equivalent age through to adulthood. Disruptions to white matter development, identified by d-MRI, are related to diminished performance in functional domains including motor performance, cognition and behaviour in early childhood and in later life. CONCLUSION d-MRI is an effective tool for investigating preterm white matter injury. With advances in image acquisition and analysis approaches, d-MRI has the potential to be a biomarker of subsequent outcome and to evaluate efficacy of clinical interventions in this population.
Collapse
Affiliation(s)
- Anand S Pandit
- Centre for the Developing Brain, Department of Perinatal Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, First Floor, South Wing, St Thomas' Hospital, London, UK
| | | | | | | |
Collapse
|
25
|
Aeby A, De Tiège X, Creuzil M, David P, Balériaux D, Van Overmeire B, Metens T, Van Bogaert P. Language development at 2years is correlated to brain microstructure in the left superior temporal gyrus at term equivalent age: A diffusion tensor imaging study. Neuroimage 2013; 78:145-51. [DOI: 10.1016/j.neuroimage.2013.03.076] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/18/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022] Open
|
26
|
Pavlova MA, Krägeloh-Mann I. Limitations on the developing preterm brain: impact of periventricular white matter lesions on brain connectivity and cognition. ACTA ACUST UNITED AC 2013; 136:998-1011. [PMID: 23550112 DOI: 10.1093/brain/aws334] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Brain lesions to the white matter in peritrigonal regions, periventricular leukomalacia, in children who were born prematurely represent an important model for studying limitations on brain development. The lesional pattern is of early origin and bilateral, that constrains the compensatory potential of the brain. We suggest that (i) topography and severity of periventricular lesions may have a long-term predictive value for cognitive and social capabilities in preterm birth survivors; and (ii) periventricular lesions may impact cognitive and social functions by affecting brain connectivity, and thereby, the dissociable neural networks underpinning these functions. A further pathway to explore is the relationship between cerebral palsy and cognitive outcome. Restrictions caused by motor disability may affect active exploration of surrounding and social participation that may in turn differentially impinge on cognitive development and social cognition. As an outline for future research, we underscore sex differences, as the sex of a preterm newborn may shape the mechanisms by which the developing brain is affected.
Collapse
Affiliation(s)
- Marina A Pavlova
- Department of Paediatric Neurology and Developmental Medicine, Children's Hospital, Medical School, Eberhard Karls University of Tübingen, Hoppe-Seyler-Strasse 1, 72076 Tübingen, Germany.
| | | |
Collapse
|
27
|
de Kieviet JF, Vuijk PJ, van den Berg A, Lafeber HN, Oosterlaan J, van Elburg RM. Glutamine effects on brain growth in very preterm children in the first year of life. Clin Nutr 2013; 33:69-74. [PMID: 23582234 DOI: 10.1016/j.clnu.2013.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIMS Glutamine supplementation in the neonatal period has been associated with increased brain structure volumes at school-age in very preterm children. The aim of this study was to clarify the emergence and specificity of differences in brain structure volumes, using growth trajectories of head circumference, weight, and length. METHODS Sixty-five very preterm (<32 weeks gestation) children, who originally took part in a randomized controlled trial on glutamine supplementation, participated. Head circumference, weight, and length, were measured at the neonatal intensive care unit, and at routine follow-up assessments at the outpatient clinic and well baby clinics. Magnetic Resonance Imaging was used to determine brain structure volumes at school-age. Growth trajectories were investigated using multilevel modeling analyses. RESULTS Head circumference in the first year of life was positively associated with white matter volume and grey matter volume (range r = 0.55-0.81, all p < 0.002) at school-age. Furthermore, neonatal glutamine supplementation was associated with increased head circumference growth (p = 0.008) in the first year of life, but not with increased growth in weight (p = 0.44) and length (p = 0.73). CONCLUSIONS This study indicates a specific increase in head circumference growth in very preterm children that received neonatal glutamine supplementation, and suggests that group differences in brain structure volumes at school-age may have emerged during the first year of life.
Collapse
Affiliation(s)
- Jorrit F de Kieviet
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Pieter J Vuijk
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Anemone van den Berg
- University Medical Center Utrecht, Department of Paediatric Gastroenterology, Utrecht, The Netherlands.
| | - Harrie N Lafeber
- VU University Medical Center, Department of Paediatrics, Amsterdam, The Netherlands.
| | - Jaap Oosterlaan
- VU University Amsterdam, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Ruurd M van Elburg
- VU University Medical Center, Department of Paediatrics, Amsterdam, The Netherlands; Danone Research Centre for Specialized Nutrition, Wageningen, The Netherlands.
| |
Collapse
|
28
|
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that provides quantitative characterization of white matter tracts in the brain. This study used DTI to examine the degree of association between parent-rated scores of attention, internalizing behaviors including anxiety symptoms, and externalizing behaviors and white matter fractional anisotropy (FA) in children born preterm. METHODS Participants were aged 9 to 16 years; 25 were born at <36 weeks of gestation (mean = 28.6 wk, birth weight = 1191 g) and 20 were full term. The authors analyzed the results using Tract-Based Spatial Statistics, a technique that generates a skeleton representing the core of white matter tracts throughout the brain. The authors examined the correlations between behavior scores and FA of (1) the whole skeleton and (2) the specific regions of interest. RESULTS In preterm children, scores on attention and internalizing behavior scales were each associated with whole skeleton FA and several regions of interest; unfavorable scores were consistently associated with lower FA. Externalizing behaviors were not associated with whole skeleton FA, but significant associations were found within a few regions of interest. The network of significant regions for attention and internalizing symptoms was widely distributed and overlapping. In full-term children, no associations of FA and behavior were significant. CONCLUSIONS Attention and internalizing behaviors in preterm children were associated with FA in a widely distributed overlapping network of white matter tracts, suggesting common underlying neurobiology. DTI contributes to understanding individual differences in attention and behavior characteristics in children born preterm.
Collapse
Affiliation(s)
- Irene M Loe
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA.
| | | | | |
Collapse
|
29
|
Pandit AS, Robinson E, Aljabar P, Ball G, Gousias IS, Wang Z, Hajnal JV, Rueckert D, Counsell SJ, Montana G, Edwards AD. Whole-brain mapping of structural connectivity in infants reveals altered connection strength associated with growth and preterm birth. ACTA ACUST UNITED AC 2013; 24:2324-33. [PMID: 23547135 DOI: 10.1093/cercor/bht086] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cerebral white-matter injury is common in preterm-born infants and is associated with neurocognitive impairments. Identifying the pattern of connectivity changes in the brain following premature birth may provide a more comprehensive understanding of the neurobiology underlying these impairments. Here, we characterize whole-brain, macrostructural connectivity following preterm delivery and explore the influence of age and prematurity using a data-driven, nonsubjective analysis of diffusion magnetic resonance imaging data. T1- and T2-weighted and -diffusion MRI were obtained between 11 and 31 months postconceptional age in 49 infants, born between 25 and 35 weeks postconception. An optimized processing pipeline, combining anatomical, and tissue segmentations with probabilistic diffusion tractography, was used to map mean tract anisotropy. White-matter tracts where connection strength was related to age of delivery or imaging were identified using sparse-penalized regression and stability selection. Older children had stronger connections in tracts predominantly involving frontal lobe structures. Increasing prematurity at birth was related to widespread reductions in connection strength in tracts involving all cortical lobes and several subcortical structures. This nonsubjective approach to mapping whole-brain connectivity detected hypothesized changes in the strength of intracerebral connections during development and widespread reductions in connectivity strength associated with premature birth.
Collapse
Affiliation(s)
- A S Pandit
- Centre for the Developing Brain, King's College London, London SE1 7EH, UK, Institute of Clinical Sciences
| | - E Robinson
- FMRIB, University of Oxford, Oxford OX3 9DU, UK
| | - P Aljabar
- Centre for the Developing Brain, King's College London, London SE1 7EH, UK
| | - G Ball
- Centre for the Developing Brain, King's College London, London SE1 7EH, UK
| | | | - Z Wang
- Statistics Section, Department of Mathematics
| | - J V Hajnal
- Centre for the Developing Brain, King's College London, London SE1 7EH, UK
| | - D Rueckert
- Biomedical Image Analysis Group, Department of Computing
| | - S J Counsell
- Centre for the Developing Brain, King's College London, London SE1 7EH, UK
| | - G Montana
- Statistics Section, Department of Mathematics
| | - A D Edwards
- Centre for the Developing Brain, King's College London, London SE1 7EH, UK, Department of Bioengineering, Imperial College London, London SW7 2AZ, UK and
| |
Collapse
|
30
|
Feldman HM, Lee ES, Yeatman JD, Yeom KW. Language and reading skills in school-aged children and adolescents born preterm are associated with white matter properties on diffusion tensor imaging. Neuropsychologia 2012; 50:3348-62. [PMID: 23088817 DOI: 10.1016/j.neuropsychologia.2012.10.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
Children born preterm are at risk for deficits in language and reading. They are also at risk for injury to the white matter of the brain. The goal of this study was to determine whether performance in language and reading skills would be associated with white matter properties in children born preterm and full-term. Children born before 36 weeks gestation (n=23, mean±SD age 12.5±2.0 years, gestational age 28.7±2.5 weeks, birth weight 1184±431 g) and controls born after 37 weeks gestation (n=19, 13.1±2.1 years, 39.3±1.0 weeks, 3178±413 g) underwent a battery of language and reading tests. Diffusion tensor imaging (DTI) scans were processed using tract-based spatial statistics to generate a core white matter skeleton that was anatomically comparable across participants. Fractional anisotropy (FA) was the diffusion property used in analyses. In the full-term group, no regions of the whole FA-skeleton were associated with language and reading. In the preterm group, regions of the FA-skeleton were significantly associated with verbal IQ, linguistic processing speed, syntactic comprehension, and decoding. Combined, the regions formed a composite map of 22 clusters on 15 tracts in both hemispheres and in the ventral and dorsal streams. ROI analyses in the preterm group found that several of these regions also showed positive associations with receptive vocabulary, verbal memory, and reading comprehension. Some of the same regions showed weak negative correlations within the full-term group. Exploratory multiple regression in the preterm group found that specific white matter pathways were related to different aspects of language processing and reading, accounting for 27-44% of the variance. The findings suggest that higher performance in language and reading in a group of preterm but not full-term children is associated with higher fractional anisotropy of a bilateral and distributed white matter network.
Collapse
Affiliation(s)
- Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine, CA 94304, USA.
| | | | | | | |
Collapse
|
31
|
Iwata S, Nakamura T, Hizume E, Kihara H, Takashima S, Matsuishi T, Iwata O. Qualitative brain MRI at term and cognitive outcomes at 9 years after very preterm birth. Pediatrics 2012; 129:e1138-47. [PMID: 22529280 DOI: 10.1542/peds.2011-1735] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A prospective study was performed to assess the relationship between the appearance of cerebral MRI at term and the cognitive functioning at 9 years old in very preterm born infants. METHODS Seventy-six very preterm born infants (birth weight <1500 g or gestational age ≤32 weeks) obtained cerebral MRI at term-equivalent period, which was assessed by using established composite scores for the white and gray matter; cognitive outcomes at 9 years old were assessed in 60 subjects by using Wechsler Intelligence Scale for Children, Third Edition. RESULTS Mildly low scores on the different IQ indices (<85) were observed in 23.3% (verbal IQ), 41.7% (performance IQ), and 30.0% (full-scale IQ) of the cohort, whereas moderately low scores (<70) were noted in 3.3% (verbal IQ), 11.7% (performance IQ), and 11.7% (full-scale IQ); cerebral palsy was diagnosed in 10.0%, whereas special assistance at school was required in 56.7%. Abnormal white matter appearances predicted mildly low verbal, performance, and full-scale IQs; moderately low performance and full-scale IQs; cerebral palsy; and the requirement for special assistance at school. Abnormal white matter appearances predicted mild cognitive impairment even after the adjustment for known clinical risk factors. In contrast, abnormal gray matter appearances did not predict any of the outcome measures. CONCLUSIONS In a cohort of very preterm born infants, abnormal white matter appearance on term MRI showed consistent associations with cognitive impairments at 9 years old, further supporting the benefit of obtaining term MRI for very preterm born infants.
Collapse
Affiliation(s)
- Sachiko Iwata
- Centre for Developmental & Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011 Japan
| | | | | | | | | | | | | |
Collapse
|
32
|
de Kieviet JF, Zoetebier L, van Elburg RM, Vermeulen RJ, Oosterlaan J. Brain development of very preterm and very low-birthweight children in childhood and adolescence: a meta-analysis. Dev Med Child Neurol 2012; 54:313-23. [PMID: 22283622 DOI: 10.1111/j.1469-8749.2011.04216.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this article was to clarify the impact and consequences of very preterm birth (born <32wks of gestation) and/or very low birthweight ([VLBW], weighing <1500g) on brain volume development throughout childhood and adolescence. METHOD The computerized databases PubMed, Web of Knowledge, and EMBASE were searched for studies that reported volumetric outcomes during childhood or adolescence using magnetic resonance imaging and included a term-born comparison group. Fifteen studies were identified, encompassing 818 very preterm/VLBW children and 450 term-born peers. Average reductions in the total brain volume, white matter volume, grey matter volume, and in the size of the cerebellum, hippocampus, and corpus callosum were investigated using meta-analytic methods. RESULTS Very preterm/VLBW children were found to have a significantly smaller total brain volume than the comparison group (d=-0.58; 95% confidence interval [CI] -0.43 to -0.73; p<0.001), smaller white matter volume (d=-0.53; CI -0.40 to -0.67; p<0.001), smaller grey matter volume (d=-0.62; CI -0.48 to -0.76; p<0.001), smaller cerebellum (d=-0.74; CI -0.56 to -0.92; p<0.001), smaller hippocampus (d=-0.47; CI -0.26 to -0.69; p<0.001), and smaller corpus callosum (d=-0.71; CI -0.34 to -1.07; p<0.001). Reductions have been associated with decreased general cognitive functioning, and no relations with age at assessment were found. INTERPRETATION Very preterm/VLBW birth is associated with an overall reduction in brain volume, which becomes evident in equally sized reductions in white and grey matter volumes, as well as in volumes of diverse brain structures throughout childhood and adolescence.
Collapse
Affiliation(s)
- Jorrit F de Kieviet
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | | | | | | | | |
Collapse
|
33
|
Cigarette smoking and white matter microstructure in schizophrenia. Psychiatry Res 2012; 201:152-8. [PMID: 22386966 PMCID: PMC3319200 DOI: 10.1016/j.pscychresns.2011.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 08/10/2011] [Accepted: 08/19/2011] [Indexed: 11/22/2022]
Abstract
The majority of patients with schizophrenia smoke cigarettes. Both nicotine use and schizophrenia have been associated with alterations in brain white matter microstructure as measured by diffusion tensor imaging (DTI). The purpose of this study was to examine fractional anisotropy (FA) in smoking and non-smoking patients with schizophrenia and in healthy volunteers. A total of 43 patients (28 smoking and 15 non-smoking) with schizophrenia and 40 healthy, non-smoking participants underwent DTI. Mean FA was calculated in four global regions of interest (ROIs) (whole brain, cerebellum, brainstem, and total cortical) as well as in four regional ROIs (frontal, temporal, parietal and occipital lobes). The non-smoking patient group had a significantly higher intellectual quotient (IQ) compared with the patients who smoked, and our results varied according to whether IQ was included as a covariate. Without IQ correction, significant between-group effects for FA were found in four ROIs: total brain, total cortical, frontal lobe and the occipital lobe. In all cases the FA was lower among the smoking patient group, and highest in the control group. Smoking patients differed significantly from non-smoking patients in the frontal lobe ROI. However, these differences were no longer significant after IQ correction. FA differences between non-smoking patients and controls were not significant. Among smoking and non-smoking patients with schizophrenia but not healthy controls, FA was correlated with IQ. In conclusion, group effects of smoking on FA in schizophrenia might be mediated by IQ. Further, low FA in specific brain areas may be a neural marker for complex pathophysiology and risk for diverse problems such as schizophrenia, low IQ, and nicotine addiction.
Collapse
|
34
|
Burnett AC, Anderson PJ, Cheong J, Doyle LW, Davey CG, Wood SJ. Prevalence of psychiatric diagnoses in preterm and full-term children, adolescents and young adults: a meta-analysis. Psychol Med 2011; 41:2463-2474. [PMID: 21733218 DOI: 10.1017/s003329171100081x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Preterm (PT) birth and low birth weight (LBW) are high-prevalence events that are associated with adverse outcomes in the longer term, with vulnerability increasing as maturity at birth decreases. Psychiatric symptomatology appears heightened in PT/LBW survivors, though there are some discordant findings from studies using questionnaire measures, particularly with respect to anxiety and depressive symptoms. METHOD This article synthesises findings from research using clinical psychiatric diagnostic criteria in PT/LBW individuals aged 10-25 years compared with term-born peers. Key outcomes of interest were the rates of individuals receiving any psychiatric diagnosis and the number of diagnoses of anxiety or depressive disorders. RESULTS A literature search for studies reporting prevalence of 'any diagnosis' yielded five studies that met inclusion criteria, with a total of 565 PT/LBW and 533 control individuals. Also, five studies were found that reported rates of anxiety/depression (692 PT/LBW and 605 control individuals). The risk of these outcomes was increased for PT/LBW individuals compared with controls [any diagnosis: odds ratio (OR) 3.66, 95% confidence interval (CI) 2.57-5.21; anxiety or depressive disorder: OR 2.86, 95% CI 1.73-4.73]. CONCLUSIONS The studies reviewed here indicate that, in addition to monitoring and management of medical and cognitive sequelae, the psychological well-being of PT/LBW individuals should be a key part of ongoing care.
Collapse
Affiliation(s)
- A C Burnett
- Department of Psychology, The University of Melbourne, VIC, Australia.
| | | | | | | | | | | |
Collapse
|
35
|
Allin MPG, Kontis D, Walshe M, Wyatt J, Barker GJ, Kanaan RAA, McGuire P, Rifkin L, Murray RM, Nosarti C. White matter and cognition in adults who were born preterm. PLoS One 2011; 6:e24525. [PMID: 22022357 PMCID: PMC3192037 DOI: 10.1371/journal.pone.0024525] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/12/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Individuals born very preterm (before 33 weeks of gestation, VPT) are at risk of damage to developing white matter, which may affect later cognition and behaviour. METHODS We used diffusion tensor MRI (DT-MRI) to assess white matter microstructure (fractional anisotropy; FA) in 80 VPT and 41 term-born individuals (mean age 19.1 years, range 17-22, and 18.5 years, range 17-22 years, respectively). VPT individuals were part of a 1982-1984 birth cohort which had been followed up since birth; term individuals were recruited by local press advertisement. General intellectual function, executive function and memory were assessed. RESULTS The VPT group had reduced FA in four clusters, and increased FA in four clusters relative to the Term group, involving several association tracts of both hemispheres. Clusters of increased FA were associated with more severe neonatal brain injury in the VPT group. Clusters of reduced FA were associated with lower birth weight and perinatal hypoxia, and with reduced adult cognitive performance in the VPT group only. CONCLUSIONS Alterations of white matter microstructure persist into adulthood in VPT individuals and are associated with cognitive function.
Collapse
Affiliation(s)
- Matthew P G Allin
- King's Health Partners, King's College London, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Hart A, Whitby E, Wilkinson S, Alladi S, Paley M, Smith M. Neuro-developmental outcome at 18 months in premature infants with diffuse excessive high signal intensity on MR imaging of the brain. Pediatr Radiol 2011; 41:1284-92. [PMID: 21681616 DOI: 10.1007/s00247-011-2155-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/01/2011] [Accepted: 03/28/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diffuse excessive high signal intensity (DEHSI) may represent damage to the white matter in preterm infants, but may be best studied alongside quantitative markers. Limited published data exists on its neuro-developmental implications. OBJECTIVE The purpose of this study was to assess whether preterm children with DEHSI at term-corrected age have abnormal neuro-developmental outcome. MATERIALS AND METHODS This was a prospective observational study of 67 preterm infants with MRI of the brain around term-equivalent age, including diffusion-weighted imaging (DWI). Images were reported as being normal, overtly abnormal or to show DEHSI. A single observer placed six regions of interest in the periventricular white matter and calculated the apparent diffusion coefficients (ADC). DEHSI was defined as (1) high signal on T2-weighted images alone, (2) high signal with raised ADC values or (3) raised ADC values independent of visual appearances. The neuro-development was assessed around 18 months' corrected age using the Bayley Scales of Infant and Toddler Development (3rd Edition). Standard t tests compared outcome scores between imaging groups. RESULTS No statistically significant difference in neuro-developmental outcome scores was seen between participants with normal MRI and DEHSI, regardless of which definition was used. CONCLUSION Preterm children with DEHSI have similar neuro-developmental outcome to those with normal brain MRI, even if the definition includes objective markers alongside visual appearances.
Collapse
Affiliation(s)
- Anthony Hart
- Department of Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
Over the last 50 years in the United States a rising preterm birth rate, a progressive decrease in preterm mortality, and a lowering of the limit of viability have made preterm birth a significant public health problem. Neuromaturation, the functional development of the central nervous system (CNS), is a dynamic process that promotes and shapes CNS structural development. This article reviews preterm outcomes, recognizing that multiple factors influence neuromaturation and lead to a range of neurodevelopmental disabilities, dysfunctions, and altered CNS processing. Ways to protect preterm infants and support their growth and development in and beyond intensive care are examined.
Collapse
Affiliation(s)
- Marilee C Allen
- Division of Neonatology, Department of Pediatrics, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
38
|
Lind A, Parkkola R, Lehtonen L, Munck P, Maunu J, Lapinleimu H, Haataja L. Associations between regional brain volumes at term-equivalent age and development at 2 years of age in preterm children. Pediatr Radiol 2011; 41:953-61. [PMID: 21534004 DOI: 10.1007/s00247-011-2071-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 11/25/2010] [Accepted: 11/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Altered brain volumes and associations between volumes and developmental outcomes have been reported in prematurely born children. OBJECTIVES To assess which regional brain volumes are different in very low birth weight (VLBW) children without neurodevelopmental impairments ([NDI] cerebral palsy, hearing loss, blindness and significantly delayed cognitive performance) compared with VLBW children with NDI, and to evaluate the association between regional brain volumes at term-equivalent age and cognitive development and neurological performance at a corrected age of 2 years. MATERIALS AND METHODS The study group consisted of a regional cohort of 164 VLBW children, divided into one group of children without NDI (n = 148) and one group of children with NDI (n = 16). Brain (MRI) was performed at term-equivalent age, from which brain volumes were manually analysed. Cognitive development was assessed with the Bayley Scales of Infant Development II (BSID-II), and neurological performance with the Hammersmith Infant Neurological Examination at the corrected age of 2 years. RESULTS The volumes of total brain tissue, cerebrum, frontal lobes, basal ganglia and thalami, and cerebellum were significantly smaller, and the volume of the ventricles significantly larger, in the children with NDI than in those without NDI. Even in children without NDI, a smaller cerebellar volume was significantly correlated with poor neurological performance at 2 years of corrected age. CONCLUSION Volumetric analysis at brain MRI can provide an additional parameter for early prediction of outcome in VLBW children.
Collapse
Affiliation(s)
- Annika Lind
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Processing speed mediates executive function difficulties in very preterm children in middle childhood. J Int Neuropsychol Soc 2011; 17:445-54. [PMID: 21439114 DOI: 10.1017/s1355617711000373] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Executive function and attention difficulties are reported in very preterm (VPT) children at school entry, but it is unclear if these remain at later ages and/or if these difficulties are mediated by more basic functions, such as processing speed. Processing speed has been shown to underlie academic and behavioral problems in VPT children in middle childhood (Mulder, Pitchford, & Marlow, 2010, 2011), so may also underpin executive function and attention difficulties. We investigated this by comparing VPT (gestational age <31 weeks; N = 56) to term children (N = 22) aged 9-10 years on a comprehensive battery of executive function and attention tasks from the Test of Everyday Attention for Children (Manly, Robertson, Anderson, & Nimmo-Smith, 1999) and NEPSY (Korkman, Kirk, & Kemp, 1998). Selective and sustained attention, inhibition, working memory, shifting, verbal fluency, planning, and processing speed were examined. Group differences favoring term children were shown on most executive function tasks (i.e., inhibition, working memory, verbal fluency, and shifting), all of which were mediated by slow processing speed in the VPT group, except response inhibition. Seemingly, processing speed is an important determinant underpinning many neuropsychological deficits seen in VPT children in middle childhood.
Collapse
|
40
|
Lee ES, Yeatman JD, Luna B, Feldman HM. Specific language and reading skills in school-aged children and adolescents are associated with prematurity after controlling for IQ. Neuropsychologia 2011; 49:906-913. [PMID: 21195100 PMCID: PMC3078177 DOI: 10.1016/j.neuropsychologia.2010.12.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 11/13/2010] [Accepted: 12/22/2010] [Indexed: 11/20/2022]
Abstract
Although studies of long-term outcomes of children born preterm consistently show low intelligence quotient (IQ) and visual-motor impairment, studies of their performance in language and reading have found inconsistent results. In this study, we examined which specific language and reading skills were associated with prematurity independent of the effects of gender, socioeconomic status (SES), and IQ. Participants from two study sites (N=100) included 9-16-year old children born before 36 weeks gestation and weighing less than 2500 grams (preterm group, n=65) compared to children born at 37 weeks gestation or more (full-term group, n=35). Children born preterm had significantly lower scores than full-term controls on Performance IQ, Verbal IQ, receptive and expressive language skills, syntactic comprehension, linguistic processing speed, verbal memory, decoding, and reading comprehension but not on receptive vocabulary. Using MANCOVA, we found that SES, IQ, and prematurity all contributed to the variance in scores on a set of six non-overlapping measures of language and reading. Simple regression analyses found that after controlling for SES and Performance IQ, the degree of prematurity as measured by gestational age group was a significant predictor of linguistic processing speed, β=-.27, p<.05, R(2)=.07, verbal memory, β=.31, p<.05, R(2)=.09, and reading comprehension, β=.28, p<.05, R(2)=.08, but not of receptive vocabulary, syntactic comprehension, or decoding. The language and reading domains where prematurity had a direct effect can be classified as fluid as opposed to crystallized functions and should be monitored in school-aged children and adolescents born preterm.
Collapse
Affiliation(s)
- Eliana S Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Jason D Yeatman
- Department of Psychology, Stanford University, Stanford, CA 94305, United States
| | - Beatriz Luna
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi M Feldman
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States.
| |
Collapse
|
41
|
McCauley SR, Wilde EA, Bigler ED, Chu Z, Yallampalli R, Oni MB, Wu TC, Ramos MA, Pedroza C, Vásquez AC, Hunter JV, Levin HS. Diffusion tensor imaging of incentive effects in prospective memory after pediatric traumatic brain injury. J Neurotrauma 2011; 28:503-16. [PMID: 21250917 DOI: 10.1089/neu.2010.1555] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Few studies exist investigating the brain-behavior relations of event-based prospective memory (EB-PM) impairments following traumatic brain injury (TBI). To address this, children with moderate-to-severe TBI performed an EB-PM test with two motivational enhancement conditions and underwent concurrent diffusion tensor imaging (DTI) at 3 months post-injury. Children with orthopedic injuries (OI; n=37) or moderate-to-severe TBI (n=40) were contrasted. Significant group differences were found for fractional anisotropy (FA) and apparent diffusion coefficient for orbitofrontal white matter (WM), cingulum bundles, and uncinate fasciculi. The FA of these WM structures in children with TBI significantly correlated with EB-PM performance in the high, but not the low motivation condition. Regression analyses within the TBI group indicated that the FA of the left cingulum bundle (p=0.003), left orbitofrontal WM (p<0.02), and left (p<0.02) and right (p<0.008) uncinate fasciculi significantly predicted EB-PM performance in the high motivation condition. We infer that the cingulum bundles, orbitofrontal WM, and uncinate fasciculi are important WM structures mediating motivation-based EB-PM responses following moderate-to-severe TBI in children.
Collapse
Affiliation(s)
- Stephen R McCauley
- Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and University of Texas-Houston Medical School, Houston, Texas, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Lubsen J, Vohr B, Myers E, Hampson M, Lacadie C, Schneider KC, Katz KH, Constable RT, Ment LR. Microstructural and functional connectivity in the developing preterm brain. Semin Perinatol 2011; 35:34-43. [PMID: 21255705 PMCID: PMC3063450 DOI: 10.1053/j.semperi.2010.10.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Prematurely born children are at increased risk for cognitive deficits, but the neurobiological basis of these findings remains poorly understood. Because variations in neural circuitry may influence performance on cognitive tasks, recent investigations have explored the impact of preterm birth on connectivity in the developing brain. Diffusion tensor imaging studies demonstrate widespread alterations in fractional anisotropy, a measure of axonal integrity and microstructural connectivity, throughout the developing preterm brain. Functional connectivity studies report that preterm neonates, children and adolescents exhibit alterations in both resting state and task-based connectivity when compared with term control subjects. Taken together, these data suggest that neurodevelopmental impairment following preterm birth may represent a disease of neural connectivity.
Collapse
Affiliation(s)
- Julia Lubsen
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Betty Vohr
- Department of Pediatrics, Warren Alpert Brown Medical School, Providence, R.I
| | - Eliza Myers
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Michelle Hampson
- Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT
| | - Cheryl Lacadie
- Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT
| | - Karen C. Schneider
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Karol H. Katz
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - R. Todd Constable
- Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT
| | - Laura R. Ment
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT,Department of Neurology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
43
|
Taylor HG, Filipek PA, Juranek J, Bangert B, Minich N, Hack M. Brain Volumes in Adolescents With Very Low Birth Weight: Effects on Brain Structure and Associations With Neuropsychological Outcomes. Dev Neuropsychol 2011; 36:96-117. [PMID: 21253993 DOI: 10.1080/87565641.2011.540544] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
44
|
Mullen KM, Vohr BR, Katz KH, Schneider KC, Lacadie C, Hampson M, Makuch RW, Reiss AL, Constable RT, Ment LR. Preterm birth results in alterations in neural connectivity at age 16 years. Neuroimage 2010; 54:2563-70. [PMID: 21073965 DOI: 10.1016/j.neuroimage.2010.11.019] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 10/28/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022] Open
Abstract
Very low birth weight preterm (PT) children are at high risk for brain injury. Employing diffusion tensor imaging (DTI), we tested the hypothesis that PT adolescents would demonstrate microstructural white matter disorganization relative to term controls at 16 years of age. Forty-four PT subjects (600-1250 g birth weight) without neonatal brain injury and 41 term controls were evaluated at age 16 years with DTI, the Wechsler Intelligence Scale for Children-III (WISC), the Peabody Picture Vocabulary Test-Revised (PPVT), and the Comprehensive Test of Phonological Processing (CTOPP). PT subjects scored lower than term subjects on WISC full scale (p=0.003), verbal (p=0.043), and performance IQ tests (p=0.001), as well as CTOPP phonological awareness (p=0.004), but scored comparably to term subjects on PPVT and CTOPP Rapid Naming tests. PT subjects had lower fractional anisotropy (FA) values in multiple regions including bilateral uncinate fasciculi (left: p=0.01; right: p=0.004), bilateral external capsules (left: p<0.001; right: p<0.001), the splenium of the corpus callosum (p=0.008), and white matter serving the inferior frontal gyrus bilaterally (left: p<0.001; right: p=0.011). FA values in both the left and right uncinate fasciculi correlated with PPVT scores (a semantic language task) in the PT subjects (left: r=0.314, p=0.038; right: r=0.336, p=0.026). FA values in the left and right arcuate fasciculi correlated with CTOPP Rapid Naming scores (a phonologic task) in the PT subjects (left: r=0.424, p=0.004; right: r=0.301, p=0.047). These data support for the first time that dual pathways underlying language function are present in PT adolescents. The striking bilateral dorsal correlations for the PT group suggest that prematurely born subjects rely more heavily on the right hemisphere than typically developing adults for performance of phonological language tasks. These findings may represent either a delay in maturation or the engagement of alternative neural pathways for language in the developing PT brain.
Collapse
Affiliation(s)
- Katherine M Mullen
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06511, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Eikenes L, Løhaugen GC, Brubakk AM, Skranes J, Håberg AK. Young adults born preterm with very low birth weight demonstrate widespread white matter alterations on brain DTI. Neuroimage 2010; 54:1774-85. [PMID: 20965255 DOI: 10.1016/j.neuroimage.2010.10.037] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 09/27/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022] Open
Abstract
Preterm birth with very low birth weight (VLBW, ≤1500 g) is connected to reduced white matter (WM) integrity in childhood and adolescence. These changes in WM are correlated to motor, sensory and neuropsychological impairments. CNS myelination continues into the early twenties, but the consequences of this for WM integrity in VLBWs have not been explored. DTI and tract based spatial statistics (TBSS) was carried out to test for voxelwise differences in fractional anisotropy (FA), eigenvalues and mean diffusivity (MD) between a preterm VLBW group (n=49) and a control group born at term (n=59) at 18-22 years of age. TBSS was also used to explore the relationship between perinatal clinical data and general cognitive ability (total IQ), respectively, and the DTI metrics (FA and MD), with gender and age as a confounder. In the VLBW group several major WM tracts particularly in the posterior region had significantly reduced FA caused by an increase in the two lowest eigenvalues. MD was significantly increased in the VLBWs in 50% of the same regions as the FA changes, but encompassing also more peripheral WM. In the VLBW group, FA was found to correlate positively with birth weight and negatively with number of days in intensive care and on mechanical ventilator, particularly in the corpus callosum. FA was found to correlate positively with total IQ in the young preterm adults. In the controls there was no correlation between FA and total IQ. Our results indicate that the neurologic sequelae of preterm birth with VLBW are a lifelong condition inducing structural and functional impairments also in adulthood in VLBW survivors. The greatest risk of having reduced WM integrity in adulthood was found in the most immature VLBW neonates requiring mechanical ventilation and long-term intensive care.
Collapse
Affiliation(s)
- Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | | | |
Collapse
|
46
|
Okumura A, Hayakawa M, Oshiro M, Hayakawa F, Shimizu T, Watanabe K. Nutritional state, maturational delay on electroencephalogram, and developmental outcome in extremely low birth weight infants. Brain Dev 2010; 32:613-8. [PMID: 19819655 DOI: 10.1016/j.braindev.2009.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 09/11/2009] [Accepted: 09/13/2009] [Indexed: 11/17/2022]
Abstract
The aim of this study is to clarify the relation among developmental outcome, nutritional state during the neonatal period, maturational electroencephalographic changes. Thirteen extremely low birth weight infants who completed 6- or 9-year follow-up were a subject of this study. Undernutrition was defined as enteral feeding below 100mL/kg/day at 3 weeks of age. Dysmature patterns were defined as the persistence of EEG patterns 2 weeks or more immature for post-conceptional age. IQ was examined at 6 and 9 years of age. Body height and weight, and head circumference at 6 years of age were stratified by the percentile grades. Full and verbal IQ was significantly lower in infants with undernutrition than those with normal nutrition. Among infants with undernutrition, those with persistent dysmature patterns tended to have lower full and performance IQ than those without persistent dysmature patterns. Head circumference was 50 percentile or larger in all infants with normal nutrition, whereas it was below 50 percentile in six of eight infants with undernutrition. Extremely low birth weight infants with undernutrition had worse neurodevelopmental outcome at 6 or 9 years of age than those with normal nutrition. Among infants with undernutrition, developmental outcome was relatively worse in those with persistent dysmature patterns than those without.
Collapse
Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Juntendo University, School of Medicine, Bunkyo-ku, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
47
|
Appearances of diffuse excessive high signal intensity (DEHSI) on MR imaging following preterm birth. Pediatr Radiol 2010; 40:1390-6. [PMID: 20333509 DOI: 10.1007/s00247-010-1633-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/06/2010] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependent on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters. OBJECTIVE To assess the subjectivity of DEHSI on conventional and ultrafast T2-weighted MR imaging following preterm birth. MATERIALS AND METHODS An observational study of 40 preterm infants who had MR imaging of the brain around term-equivalent age, including conventional fast spin-echo (FSE) and ultrafast single-shot fast spin-echo (SSFSE) T2-weighted sequences in the axial plane. Images were anonymised and scored twice by four observers for the presence of DEHSI. Inter- and intra-observer agreement were calculated. RESULTS Sixty-five percent of conventional and 100% of the ultrafast images were of diagnostic quality. DEHSI was noted in between 0% and 69.2% of conventional images and 27.5-90% of the ultrafast images. Inter- and intra-observer agreement ranged from none to moderate. CONCLUSION The visual appearances of DEHSI on conventional FSE and ultrafast SSFSE T2-W images are highly subjective, limiting its clinical application.
Collapse
|
48
|
Oni MB, Wilde EA, Bigler ED, McCauley SR, Wu TC, Yallampalli R, Chu Z, Li X, Hunter JV, Vasquez AC, Levin HS. Diffusion tensor imaging analysis of frontal lobes in pediatric traumatic brain injury. J Child Neurol 2010; 25:976-84. [PMID: 20332386 PMCID: PMC3227397 DOI: 10.1177/0883073809356034] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined the use of diffusion tensor imaging in detecting white matter changes in the frontal lobes following pediatric traumatic brain injury. A total of 46 children (ages 8-16 years) with moderate to severe traumatic brain injury and 47 children with orthopedic injury underwent 1.5 Tesla magnetic resonance imaging (MRI) at 3 months postinjury. Conventional MRI studies were obtained along with diffusion tensor imaging. Diffusion tensor imaging metrics, including fractional anisotropy, apparent diffusion coefficient, and radial diffusivity, were compared between the groups. Significant group differences were identified, implicating frontal white matter alterations in the injury group that were predictive of later Glasgow Outcome Scale ratings; however, focal lesions were not related to the Glasgow Outcome Scale ratings. Injury severity was also significantly associated with diffusion tensor imaging metrics. Diffusion tensor imaging holds great promise as an index of white matter integrity in traumatic brain injury and as a potential biomarker reflective of outcome.
Collapse
Affiliation(s)
| | - Elisabeth A. Wilde
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas,Department of Radiology, Baylor College of Medicine, Houston, Texas,Department of Neurology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Erin D. Bigler
- Department of Psychology, Brigham Young University, Provo, Utah,Department of Neuroscience, Brigham Young University, Provo, Utah,The Brain Institute, University of Utah, Salt Lake City, Utah
| | - Stephen R. McCauley
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas,Department of Pediatrics-Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Trevor C. Wu
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Ragini Yallampalli
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Zili Chu
- Department of Radiology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Xiaoqi Li
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Ana C. Vasquez
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Harvey S. Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
49
|
Hart AR, Whitby EH, Clark SJ, Paley MNJ, Smith MF. Diffusion-weighted imaging of cerebral white matter and the cerebellum following preterm birth. Dev Med Child Neurol 2010; 52:652-9. [PMID: 20132141 DOI: 10.1111/j.1469-8749.2009.03590.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM The aim of this study was to determine if apparent diffusion coefficients (ADCs) generated with diffusion-weighted imaging of cerebral white matter and the cerebellum are affected by white matter damage. METHOD Seventy-two preterm infants (32 males, 40 females; mean gestational age at birth 30.3 wks, SD 3.0 wks; mean birthweight 1458g, SD 534g) underwent magnetic resonance imaging of the brain around term-equivalent age and were categorized into three groups: normal, overt abnormality, and diffuse excessive high signal intensity (DEHSI). ADC values were calculated from cerebral white matter, cerebellar hemispheres, and cerebellar midline, and were compared between groups. Regression analysis identified clinical parameters correlated with ADC values. RESULTS Imaging was normal in 27 infants, and revealed overt abnormalities in 14 and DEHSI in 31. ADC values did not differ between groups. ADC values from cerebral white matter were negatively correlated with the number of episodes of postnatal sepsis (p=0.002). ADC values from cerebellar hemispheres (p=0.007) and cerebellar midline (p=0.036) correlated with gestational age at birth. INTERPRETATION ADC values from white matter are not altered in preterm infants with DEHSI but are negatively correlated with the number of episodes of postnatal sepsis. ADC values in the cerebellum are not altered by white matter damage, but are affected by preterm birth itself.
Collapse
Affiliation(s)
- Anthony R Hart
- Department of Neonatology, Sheffield Teaching Hospital NHS Foundation Trust, Tree Root Walk, Sheffield, UK.
| | | | | | | | | |
Collapse
|
50
|
Abstract
Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that allows for the visualization and characterization of the white matter tracts of the brain in vivo. DTI does not assess white matter directly. Rather, it capitalizes on the fact that diffusion is isotropic (equal in all directions) in cerebral spinal fluid and cell bodies but anisotropic (greater in one direction than the other directions) in axons that comprise white matter. It provides quantitative information about the degree and direction of water diffusion within individual units of volume within the magnetic resonance image, and by inference, about the integrity of white matter. Measures from DTI can be applied throughout the brain or to regions of interest. Fiber tract reconstruction, or tractography, creates continuous 3-dimensional tracts by sequentially piecing together estimates of fiber orientation from the direction of diffusion within individual volume units. DTI has increased our understanding of white matter structure and function. DTI shows nonlinear growth of white matter tracts from childhood to adulthood. Delayed maturation of the white matter in the frontal lobes may explain the continued growth of cognitive control into adulthood. Relative to good readers, adults and children who are poor readers have evidence of white matter differences in a specific region of the temporo-parietal lobe, implicating differences in connections among brain regions as a factor in reading disorder. Measures from DTI changed in poor readers who improved their reading skills after intense remediation. DTI documents injury to white matter tracts after prematurity. Measures indicative of white matter injury are associated with motor and cognitive impairment in children born prematurely. Further research on DTI is necessary before it can become a routine clinical procedure.
Collapse
|