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White P, Ranasinghe S, Chen J, Van de Looij Y, Sizonenko S, Prasad J, Berry M, Bennet L, Gunn A, Dean J. Comparative utility of MRI and EEG for early detection of cortical dysmaturation after postnatal systemic inflammation in the neonatal rat. Brain Behav Immun 2024; 121:104-118. [PMID: 39043347 DOI: 10.1016/j.bbi.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/10/2024] [Accepted: 07/20/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Exposure to postnatal systemic inflammation is associated with increased risk of brain injury in preterm infants, leading to impaired maturation of the cerebral cortex and adverse neurodevelopmental outcomes. However, the optimal method for identifying cortical dysmaturation is unclear. Herein, we compared the utility of electroencephalography (EEG), diffusion tensor imaging (DTI), and neurite orientation dispersion and density imaging (NODDI) at different recovery times after systemic inflammation in newborn rats. METHODS Sprague Dawley rat pups of both sexes received single-daily lipopolysaccharide (LPS; 0.3 mg/kg i.p.; n = 51) or saline (n = 55) injections on postnatal days (P)1, 2, and 3. A subset of these animals were implanted with EEG electrodes. Cortical EEG was recorded for 30 min from unanesthetized, unrestrained pups at P7, P14, and P21, and in separate groups, brain tissues were collected at these ages for ex-vivo MRI analysis (9.4 T) and Golgi-Cox staining (to assess neuronal morphology) in the motor cortex. RESULTS Postnatal inflammation was associated with reduced cortical pyramidal neuron arborization from P7, P14, and P21. These changes were associated with dysmature EEG features (e.g., persistence of delta waveforms, higher EEG amplitude, reduced spectral edge frequency) at P7 and P14, and higher EEG power in the theta and alpha ranges at P21. By contrast, there were no changes in cortical DTI or NODDI in LPS rats at P7 or P14, while there was an increase in cortical fractional anisotropy (FA) and decrease in orientation dispersion index (ODI) at P21. CONCLUSIONS EEG may be useful for identifying the early evolution of impaired cortical development after early life postnatal systemic inflammation, while DTI and NODDI seem to be more suited to assessing established cortical changes.
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Affiliation(s)
- Petra White
- University of Auckland, Auckland, New Zealand
| | | | - Joseph Chen
- University of Auckland, Auckland, New Zealand
| | - Yohan Van de Looij
- University of Geneva, Geneva, Switzerland; Lausanne Federal Polytechnic School, Lausanne, Switzerland
| | | | - Jaya Prasad
- University of Auckland, Auckland, New Zealand
| | - Mary Berry
- University of Otago, Wellington, New Zealand
| | | | | | - Justin Dean
- University of Auckland, Auckland, New Zealand.
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2
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Kellner P, Kwon J, Smith J, Pineda R. Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge. Am J Perinatol 2024; 41:561-568. [PMID: 34996118 PMCID: PMC11062498 DOI: 10.1055/a-1733-2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood. STUDY DESIGN This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic. RESULTS At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment. CONCLUSION Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU. KEY POINTS · There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..
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Affiliation(s)
- Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jenny Kwon
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
- Center for the Changing Family, University of Southern California, Los Angeles, California
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3
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Kelly SB, Dean JM, Zahra VA, Dudink I, Thiel A, Polglase GR, Miller SL, Hooper SB, Bennet L, Gunn AJ, Galinsky R. Progressive inflammation reduces high-frequency EEG activity and cortical dendritic arborisation in late gestation fetal sheep. J Neuroinflammation 2023; 20:124. [PMID: 37226206 DOI: 10.1186/s12974-023-02805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Antenatal infection/inflammation is associated with disturbances in neuronal connectivity, impaired cortical growth and poor neurodevelopmental outcomes. The pathophysiological substrate that underpins these changes is poorly understood. We tested the hypothesis that progressive inflammation in late gestation fetal sheep would alter cortical neuronal microstructure and neural function assessed using electroencephalogram band power analysis. METHODS Fetal sheep (0.85 of gestation) were surgically instrumented for continuous electroencephalogram (EEG) recording and randomly assigned to repeated saline (control; n = 9) or LPS (0 h = 300 ng, 24 h = 600 ng, 48 h = 1200 ng; n = 8) infusions to induce inflammation. Sheep were euthanised 4 days after the first LPS infusion for assessment of inflammatory gene expression, histopathology and neuronal dendritic morphology in the somatosensory cortex. RESULTS LPS infusions increased delta power between 8 and 50 h, with reduced beta power from 18 to 96 h (P < 0.05 vs. control). Basal dendritic length, numbers of dendritic terminals, dendritic arborisation and numbers of dendritic spines were reduced in LPS-exposed fetuses (P < 0.05 vs. control) within the somatosensory cortex. Numbers of microglia and interleukin (IL)-1β immunoreactivity were increased in LPS-exposed fetuses compared with controls (P < 0.05). There were no differences in total numbers of cortical NeuN + neurons or cortical area between the groups. CONCLUSIONS Exposure to antenatal infection/inflammation was associated with impaired dendritic arborisation, spine number and loss of high-frequency EEG activity, despite normal numbers of neurons, that may contribute to disturbed cortical development and connectivity.
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Affiliation(s)
- Sharmony B Kelly
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Justin M Dean
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Valerie A Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
| | - Ingrid Dudink
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Alison Thiel
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, VIC, 3168, Australia.
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.
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Wang J, Nichols ES, Mueller ME, de Vrijer B, Eagleson R, McKenzie CA, de Ribaupierre S, Duerden EG. Semi-automatic segmentation of the fetal brain from magnetic resonance imaging. Front Neurosci 2022; 16:1027084. [PMID: 36440277 PMCID: PMC9692018 DOI: 10.3389/fnins.2022.1027084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2023] Open
Abstract
Background Volumetric measurements of fetal brain maturation in the third trimester of pregnancy are key predictors of developmental outcomes. Improved understanding of fetal brain development trajectories may aid in identifying and clinically managing at-risk fetuses. Currently, fetal brain structures in magnetic resonance images (MRI) are often manually segmented, which requires both time and expertise. To facilitate the targeting and measurement of brain structures in the fetus, we compared the results of five segmentation methods applied to fetal brain MRI data to gold-standard manual tracings. Methods Adult women with singleton pregnancies (n = 21), of whom five were scanned twice, approximately 3 weeks apart, were recruited [26 total datasets, median gestational age (GA) = 34.8, IQR = 30.9-36.6]. T2-weighted single-shot fast spin echo images of the fetal brain were acquired on 1.5T and 3T MRI scanners. Images were first combined into a single 3D anatomical volume. Next, a trained tracer manually segmented the thalamus, cerebellum, and total cerebral volumes. The manual segmentations were compared with five automatic methods of segmentation available within Advanced Normalization Tools (ANTs) and FMRIB's Linear Image Registration Tool (FLIRT) toolboxes. The manual and automatic labels were compared using Dice similarity coefficients (DSCs). The DSC values were compared using Friedman's test for repeated measures. Results Comparing cerebellum and thalamus masks against the manually segmented masks, the median DSC values for ANTs and FLIRT were 0.72 [interquartile range (IQR) = 0.6-0.8] and 0.54 (IQR = 0.4-0.6), respectively. A Friedman's test indicated that the ANTs registration methods, primarily nonlinear methods, performed better than FLIRT (p < 0.001). Conclusion Deformable registration methods provided the most accurate results relative to manual segmentation. Overall, this semi-automatic subcortical segmentation method provides reliable performance to segment subcortical volumes in fetal MR images. This method reduces the costs of manual segmentation, facilitating the measurement of typical and atypical fetal brain development.
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Affiliation(s)
- Jianan Wang
- Biomedical Engineering, Western University, London, ON, Canada
| | - Emily S. Nichols
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Megan E. Mueller
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Roy Eagleson
- Biomedical Engineering, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Charles A. McKenzie
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Biomedical Engineering, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Emma G. Duerden
- Biomedical Engineering, Western University, London, ON, Canada
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
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5
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Yates AG, Kislitsyna E, Alfonso Martin C, Zhang J, Sewell AL, Goikolea-Vives A, Cai V, Alkhader LF, Skaland A, Hammond B, Dimitrova R, Batalle D, Fernandes C, Edwards AD, Gressens P, Thornton C, Stolp HB. Montelukast reduces grey matter abnormalities and functional deficits in a mouse model of inflammation-induced encephalopathy of prematurity. J Neuroinflammation 2022; 19:265. [PMID: 36309753 PMCID: PMC9617353 DOI: 10.1186/s12974-022-02625-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
Encephalopathy of prematurity (EoP) affects approximately 30% of infants born < 32 weeks gestation and is highly associated with inflammation in the foetus. Here we evaluated the efficacy of montelukast, a cysteinyl leukotriene receptor antagonist widely used to treat asthma in children, to ameliorate peripheral and central inflammation, and subsequent grey matter neuropathology and behaviour deficits in a mouse model of EoP. Male CD-1 mice were treated with intraperitoneal (i.p.) saline or interleukin-1beta (IL-1β, 40 μg/kg, 5 μL/g body weight) from postnatal day (P)1-5 ± concomitant montelukast (1-30 mg/kg). Saline or montelukast treatment was continued for a further 5 days post-injury. Assessment of systemic and central inflammation and short-term neuropathology was performed from 4 h following treatment through to P10. Behavioural testing, MRI and neuropathological assessments were made on a second cohort of animals from P36 to 54. Montelukast was found to attenuate both peripheral and central inflammation, reducing the expression of pro-inflammatory molecules (IL-1β, IL-6, TNF) in the brain. Inflammation induced a reduction in parvalbumin-positive interneuron density in the cortex, which was normalised with high-dose montelukast. The lowest effective dose, 3 mg/kg, was able to improve anxiety and spatial learning deficits in this model of inflammatory injury, and alterations in cortical mean diffusivity were not present in animals that received this dose of montelukast. Repurposed montelukast administered early after preterm birth may, therefore, improve grey matter development and outcome in EoP.
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Affiliation(s)
- Abi G Yates
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elena Kislitsyna
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Carla Alfonso Martin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jiaying Zhang
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Amy L Sewell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ane Goikolea-Vives
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - Valerie Cai
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - Lama F Alkhader
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Aleksander Skaland
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Basil Hammond
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cathy Fernandes
- SGDP Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopment Disorders, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Claire Thornton
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK
| | - Helen B Stolp
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
- Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK.
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6
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Brain Development and Maternal Behavior in Relation to Cognitive and Language Outcomes in Preterm-Born Children. Biol Psychiatry 2022; 92:663-673. [PMID: 35599181 DOI: 10.1016/j.biopsych.2022.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children born very preterm (≤32 weeks gestational age) show poorer cognitive and language development compared with their term-born peers. The importance of supportive maternal responses to the child's cues for promoting neurodevelopment is well established. However, little is known about whether supportive maternal behavior can buffer the association of early brain dysmaturation with cognitive and language performance. METHODS Infants born very preterm (N = 226) were recruited from the neonatal intensive care unit for a prospective, observational cohort study. Chart review (e.g., size at birth, postnatal infection) was conducted from birth to discharge. Magnetic resonance imaging, including diffusion tensor imaging, was acquired at approximately 32 weeks postmenstrual age and again at term-equivalent age. Fractional anisotropy, a quantitative measure of brain maturation, was obtained from 11 bilateral regions of interest in the cortical gray matter. At 3 years (n = 187), neurodevelopmental testing (Bayley Scales of Infant and Toddler Development-III) was administered, and parent-child interaction was filmed. Maternal behavior was scored using the Emotional Availability Scale-IV. A total of 146 infants with neonatal brain imaging and follow-up data were included for analysis. Generalized estimating equations were used to examine whether maternal support interacted with mean fractional anisotropy values to predict Cognitive and Language scores at 3 years, accounting for confounding neonatal and maternal factors. RESULTS Higher maternal support significantly moderated cortical fractional anisotropy values at term-equivalent age to predict higher Cognitive (interaction term β = 2.01, p = .05) and Language (interaction term β = 1.85, p = .04) scores. CONCLUSIONS Findings suggest that supportive maternal behavior following early brain dysmaturation may provide an opportunity to promote optimal neurodevelopment in children born very preterm.
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7
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Romberg J, Wilke M, Allgaier C, Nägele T, Engel C, Poets CF, Franz A. MRI-based brain volumes of preterm infants at term: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:520-526. [PMID: 35078779 PMCID: PMC9411894 DOI: 10.1136/archdischild-2021-322846] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND MRI allows a detailed assessment of brain structures in preterm infants, outperforming cranial ultrasound. Neonatal MR-based brain volumes of preterm infants could serve as objective, quantitative and reproducible surrogate parameters of early brain development. To date, there are no reference values for preterm infants' brain volumes at term-equivalent age. OBJECTIVE Systematic review of the literature to determine reference ranges for MRI-based brain volumes of very preterm infants at term-equivalent age. METHODS PubMed Database was searched on 6 April 2020 for studies reporting MR-based brain volumes on representative unselected populations of very preterm and/or very low birthweight infants examined at term equivalent age (defined as 37-42 weeks mean postmenstrual age at MRI). Analyses were limited to volumetric parameters reported in >3 studies. Weighted mean volumes and SD were both calculated and simulated for each parameter. RESULTS An initial 367 publications were identified. Following application of exclusion criteria, 13 studies from eight countries were included for analysis, yielding four parameters. Weighted mean total brain volume was 379 mL (SD 72 mL; based on n=756). Cerebellar volume was 21 mL (6 mL; n=791), cortical grey matter volume 140 mL (47 mL; n=572) and weighted mean volume of unmyelinated white matter was 195 mL (38 mL; n=499). CONCLUSION This meta-analysis reports pooled data on several brain and cerebellar volumes which can serve as reference for future studies assessing MR-based volumetric parameters as a surrogate outcome for neurodevelopment and for the interpretation of individual or cohort MRI-based volumetric findings.
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Affiliation(s)
- Julia Romberg
- Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Marko Wilke
- Pediatric Neurology & Developmental Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Allgaier
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Nägele
- Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Corinna Engel
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Axel Franz
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
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8
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Li Z, Li H, Braimah A, Dillman JR, Parikh NA, He L. A novel Ontology-guided Attribute Partitioning ensemble learning model for early prediction of cognitive deficits using quantitative Structural MRI in very preterm infants. Neuroimage 2022; 260:119484. [PMID: 35850161 PMCID: PMC9483989 DOI: 10.1016/j.neuroimage.2022.119484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023] Open
Abstract
Structural magnetic resonance imaging studies have shown that brain anatomical abnormalities are associated with cognitive deficits in preterm infants. Brain maturation and geometric features can be used with machine learning models for predicting later neurodevelopmental deficits. However, traditional machine learning models would suffer from a large feature-to-instance ratio (i.e., a large number of features but a small number of instances/samples). Ensemble learning is a paradigm that strategically generates and integrates a library of machine learning classifiers and has been successfully used on a wide variety of predictive modeling problems to boost model performance. Attribute (i.e., feature) bagging method is the most commonly used feature partitioning scheme, which randomly and repeatedly draws feature subsets from the entire feature set. Although attribute bagging method can effectively reduce feature dimensionality to handle the large feature-to-instance ratio, it lacks consideration of domain knowledge and latent relationship among features. In this study, we proposed a novel Ontology-guided Attribute Partitioning (OAP) method to better draw feature subsets by considering the domain-specific relationship among features. With the better-partitioned feature subsets, we developed an ensemble learning framework, which is referred to as OAP-Ensemble Learning (OAP-EL). We applied the OAP-EL to predict cognitive deficits at 2 years of age using quantitative brain maturation and geometric features obtained at term equivalent age in very preterm infants. We demonstrated that the proposed OAP-EL approach significantly outperformed the peer ensemble learning and traditional machine learning approaches.
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Affiliation(s)
- Zhiyuan Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Electronic Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Hailong Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Artificial Intelligence Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adebayo Braimah
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Artificial Intelligence Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lili He
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Artificial Intelligence Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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9
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Mueller M, Thompson B, Poppe T, Alsweiler J, Gamble G, Jiang Y, Leung M, Tottman AC, Wouldes T, Harding JE, Duerden EG. Amygdala subnuclei volumes, functional connectivity, and social–emotional outcomes in children born very preterm. Cereb Cortex Commun 2022; 3:tgac028. [PMID: 35990310 PMCID: PMC9383265 DOI: 10.1093/texcom/tgac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Children born very preterm can demonstrate social-cognitive impairments, which may result from limbic system dysfunction. Altered development of the subnuclei of the amygdala, stress-sensitive regions involved in emotional processing, may be key predictors of social-skill development. In a prospective cohort study, 7-year-old children born very preterm underwent neurodevelopmental testing and brain MRI. The Child Behavioral Checklist was used to assess social–emotional outcomes. Subnuclei volumes were extracted automatically from structural scans (n = 69) and functional connectivity (n = 66) was examined. General Linear Models were employed to examine the relationships between amygdala subnuclei volumes and functional connectivity values and social–emotional outcomes. Sex was a significant predictor of all social–emotional outcomes (P < 0.05), with boys having poorer social–emotional outcomes. Smaller right basal nuclei volumes (B = -0.043, P = 0.014), smaller right cortical volumes (B = -0.242, P = 0.02) and larger right central nuclei volumes (B = 0.85, P = 0.049) were associated with increased social problems. Decreased connectivity strength between thalamic and amygdala networks and smaller right basal volumes were significant predictors of greater social problems (both, P < 0.05), effects which were stronger in girls (P = 0.025). Dysregulated maturation of the amygdala subnuclei, along with altered connectivity strength in stress-sensitive regions, may reflect stress-induced dysfunction and can be predictive of social–emotional outcomes.
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Affiliation(s)
- Megan Mueller
- Applied Psychology , Faculty of Education, , London N6G 1G7 , Canada
- Western University , Faculty of Education, , London N6G 1G7 , Canada
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo , Waterloo , Canada
- Centre for Eye and Vision Research , 17W Science Park , Hong Kong
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Tanya Poppe
- Liggins Institute, University of Auckland , Auckland , New Zealand
- Centre for the Developing Brain, King’s College London , London , UK
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland , Auckland , New Zealand
| | - Greg Gamble
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Myra Leung
- Department of Paediatrics: Child and Youth Health, University of Auckland , Auckland , New Zealand
- Discipline of Optometry and Vision Science, University of Canberra , Canberra , Australia
| | - Anna C Tottman
- Liggins Institute, University of Auckland , Auckland , New Zealand
- Neonatal Services, Royal Women’s Hospital , Melbourne , Australia
| | - Trecia Wouldes
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Emma G Duerden
- Applied Psychology , Faculty of Education, , London N6G 1G7 , Canada
- Western University , Faculty of Education, , London N6G 1G7 , Canada
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10
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Selvanathan T, Guo T, Kwan E, Chau V, Brant R, Synnes AR, Grunau RE, Miller SP. Head circumference, total cerebral volume and neurodevelopment in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2022; 107:181-187. [PMID: 34261769 DOI: 10.1136/archdischild-2020-321397] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/25/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the association of head circumference (HC) <10th percentile at birth and discharge from the neonatal intensive care unit (NICU) with neurodevelopment in very preterm (24-32 weeks' gestational age) neonates, and to compare the association of HC and total cerebral volume (TCV) with neurodevelopmental outcomes. DESIGN In a prospective cohort, semiautomatically segmented TCV and manually segmented white matter injury (WMI) volumes were obtained. Multivariable regressions were used to study the association of HC and TCV with neurodevelopmental outcomes, accounting for birth gestational age, WMI and postnatal illness. SETTING Participants born in 2006-2013 at British Columbia Women's Hospital were recruited. PATIENTS 168 neonates had HC measurements at birth and discharge and MRI at term-equivalent age (TEA). 143 children were assessed at 4.5 years. MAIN OUTCOME MEASURES Motor, cognitive and language outcomes at 4.5 years were assessed using the Movement Assessment Battery for Children Second Edition (M-ABC) and Wechsler Preschool and Primary Scale of Intelligence Third Edition Full Scale IQ (FSIQ) and Verbal IQ (VIQ). RESULTS Small birth HC was associated with lower M-ABC and FSIQ scores. In children with small birth HC, small discharge HC was associated with lower M-ABC, FSIQ and VIQ scores, while normal HC at discharge was no longer associated with adverse outcomes. HC strongly correlated with TCV at TEA. TCV did not correlate with outcomes. CONCLUSIONS Small birth HC is associated with poorer neurodevelopment, independent of postnatal illness and WMI. Normalisation of HC during NICU care appears to moderate this risk.
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Affiliation(s)
- Thiviya Selvanathan
- Paediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Ting Guo
- Paediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Eddie Kwan
- Department of Pharmacy, University of British Columbia, Vancouver, British Columbia, Canada.,BC Women's Hospital and Health Centre and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Vann Chau
- Paediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Rollin Brant
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Anne R Synnes
- BC Women's Hospital and Health Centre and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Pediatrics (Neonatology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ruth E Grunau
- BC Women's Hospital and Health Centre and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Pediatrics (Neonatology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven P Miller
- Paediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada .,Paediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
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11
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Volpe J. Commentary - The late preterm infant: Vulnerable cerebral cortex and large burden of disability. J Neonatal Perinatal Med 2022; 15:1-5. [PMID: 34219675 PMCID: PMC8842754 DOI: 10.3233/npm-210803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- J.J. Volpe
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, MA, USA
- Address for correspondence: J.J. Volpe,
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12
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Dimitrova R, Pietsch M, Ciarrusta J, Fitzgibbon SP, Williams LZJ, Christiaens D, Cordero-Grande L, Batalle D, Makropoulos A, Schuh A, Price AN, Hutter J, Teixeira RP, Hughes E, Chew A, Falconer S, Carney O, Egloff A, Tournier JD, McAlonan G, Rutherford MA, Counsell SJ, Robinson EC, Hajnal JV, Rueckert D, Edwards AD, O'Muircheartaigh J. Preterm birth alters the development of cortical microstructure and morphology at term-equivalent age. Neuroimage 2021; 243:118488. [PMID: 34419595 PMCID: PMC8526870 DOI: 10.1016/j.neuroimage.2021.118488] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/16/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The dynamic nature and complexity of the cellular events that take place during the last trimester of pregnancy make the developing cortex particularly vulnerable to perturbations. Abrupt interruption to normal gestation can lead to significant deviations to many of these processes, resulting in atypical trajectory of cortical maturation in preterm birth survivors. METHODS We sought to first map typical cortical micro- and macrostructure development using invivo MRI in a large sample of healthy term-born infants scanned after birth (n = 259). Then we offer a comprehensive characterization of the cortical consequences of preterm birth in 76 preterm infants scanned at term-equivalent age (37-44 weeks postmenstrual age). We describe the group-average atypicality, the heterogeneity across individual preterm infants, and relate individual deviations from normative development to age at birth and neurodevelopment at 18 months. RESULTS In the term-born neonatal brain, we observed heterogeneous and regionally specific associations between age at scan and measures of cortical morphology and microstructure, including rapid surface expansion, greater cortical thickness, lower cortical anisotropy and higher neurite orientation dispersion. By term-equivalent age, preterm infants had on average increased cortical tissue water content and reduced neurite density index in the posterior parts of the cortex, and greater cortical thickness anteriorly compared to term-born infants. While individual preterm infants were more likely to show extreme deviations (over 3.1 standard deviations) from normative cortical maturation compared to term-born infants, these extreme deviations were highly variable and showed very little spatial overlap between individuals. Measures of regional cortical development were associated with age at birth, but not with neurodevelopment at 18 months. CONCLUSION We showed that preterm birth alters cortical micro- and macrostructural maturation near the time of full-term birth. Deviations from normative development were highly variable between individual preterm infants.
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Affiliation(s)
- Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Judit Ciarrusta
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sean P Fitzgibbon
- Centre for Functional MRI of the Brain (FMRIB), Welcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Logan Z J Williams
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Electrical Engineering, ESAT/PSI, KU Leuven, Belgium
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pag Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Emma C Robinson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Faculty of Informatics and Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom.
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13
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Ferrer-Oliveras R, Mendoza M, Capote S, Pratcorona L, Esteve-Valverde E, Cabero-Roura L, Alijotas-Reig J. Immunological and physiopathological approach of COVID-19 in pregnancy. Arch Gynecol Obstet 2021; 304:39-57. [PMID: 33945026 PMCID: PMC8093597 DOI: 10.1007/s00404-021-06061-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
Coronavirus disease-2019 (COVID-19) related to Coronavirus-2 (SARS-CoV-2) is a worldwide health concern. Despite the majority of patients will evolve asymptomatic or mild-moderate upper respiratory tract infections, 20% will develop severe disease. Based on current pathogenetic knowledge, a severe COVID-19 form is mainly a hyperinflammatory, immune-mediated disorder, triggered by a viral infection. Due to their particular immunological features, pregnant women are supposed to be particularly susceptible to complicate by intracellular infections as well as immunological disturbances. As an example, immune-thrombosis has been identified as a common immune-mediated and pathogenic phenomenon both in COVID-19, in obstetric diseases and in COVID-19 pregnant women. According to extensive published clinical data, is rationale to expect an interference with the normal development of pregnancy in selected SARS-CoV-2-infected cases, mainly during third trimester.This manuscript provides insights of research to elucidate the potential harmful responses to SARS-CoV-2 and /or other coronavirus infections, as well as bidirectional interactions between COVID-19 and pregnancy to improve their respective management.
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Affiliation(s)
- Raquel Ferrer-Oliveras
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain.
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Sira Capote
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
| | - Laia Pratcorona
- Department of Obstetrics, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Enrique Esteve-Valverde
- Department of Internal Medicine, Althaia Network Health. Manresa, Barcelona, Spain
- Universitat Central de Catalunya, Barcelona, Catalonia, Spain
| | - Lluis Cabero-Roura
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
- Prof. Emeritus of Obsterics and Gynaecology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit. Department of Internal Medicine-1, Vall d' Hebron University Hospital, Barcelona, Spain.
- Systemic Autoimmune Research Unit, Vall d'Hebron Reseacrh Institute, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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14
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Prasad JD, Gunn KC, Davidson JO, Galinsky R, Graham SE, Berry MJ, Bennet L, Gunn AJ, Dean JM. Anti-Inflammatory Therapies for Treatment of Inflammation-Related Preterm Brain Injury. Int J Mol Sci 2021; 22:4008. [PMID: 33924540 PMCID: PMC8069827 DOI: 10.3390/ijms22084008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of preterm brain injury, there are no established neuroprotective strategies to prevent or alleviate mild-to-moderate inflammation-related brain injury. Perinatal infection and inflammation have been shown to trigger acute neuroinflammation, including proinflammatory cytokine release and gliosis, which are associated with acute and chronic disturbances in brain cell survival and maturation. These findings suggest the hypothesis that the inhibition of peripheral immune responses following infection or nonspecific inflammation may be a therapeutic strategy to reduce the associated brain injury and neurobehavioral deficits. This review provides an overview of the neonatal immunity, neuroinflammation, and mechanisms of inflammation-related brain injury in preterm infants and explores the safety and efficacy of anti-inflammatory agents as potentially neurotherapeutics.
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Affiliation(s)
- Jaya D. Prasad
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Katherine C. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Joanne O. Davidson
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia;
| | - Scott E. Graham
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Mary J. Berry
- Department of Pediatrics and Health Care, University of Otago, Dunedin 9016, New Zealand;
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Alistair J. Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
| | - Justin M. Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1010, New Zealand; (J.D.P.); (K.C.G.); (J.O.D.); (L.B.); (A.J.G.)
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15
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Story L, Davidson A, Patkee P, Fleiss B, Kyriakopoulou V, Colford K, Sankaran S, Seed P, Jones A, Hutter J, Shennan A, Rutherford M. Brain volumetry in fetuses that deliver very preterm: An MRI pilot study. NEUROIMAGE-CLINICAL 2021; 30:102650. [PMID: 33838546 PMCID: PMC8045030 DOI: 10.1016/j.nicl.2021.102650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
Fetuses that subsequently deliver very preterm have a reduction in cortical and extra cerebrospinal fluid volumes. If such alterations commence antenatally this suggests a role for earlier administration of neuroprotective agents.
Background Infants born preterm are at increased risk of neurological complications resulting in significant morbidity and mortality. The exact mechanism and the impact of antenatal factors has not been fully elucidated, although antenatal infection/inflammation has been implicated in both the aetiology of preterm birth and subsequent neurological sequelae. It is therefore hypothesized that processes driving preterm birth are affecting brain development in utero. This study aims to compare MRI derived regional brain volumes in fetuses that deliver < 32 weeks with fetuses that subsequently deliver at term. Methods Women at high risk of preterm birth, with gestation 19.4–32 weeks were recruited prospectively. A control group was obtained from existing study datasets. Fetal MRI was performed on a 1.5 T or 3 T MRI scanner: T2-weighted images were obtained of the fetal brain. 3D brain volumetric datsets were produced using slice to volume reconstruction and regional segmentations were produced using multi-atlas approaches for supratentorial brain tissue, lateral ventricles, cerebellum cerebral cortex and extra-cerebrospinal fluid (eCSF). Statistical comparison of control and high-risk for preterm delivery fetuses was performed by creating normal ranges for each parameter from the control datasets and then calculating gestation adjusted z scores. Groups were compared using t-tests. Results Fetal image datasets from 24 pregnancies with delivery < 32 weeks and 87 control pregnancies that delivered > 37 weeks were included. Median gestation at MRI of the preterm group was 26.8 weeks (range 19.4–31.4) and control group 26.2 weeks (range 21.7–31.9). No difference was found in supra-tentorial brain volume, ventricular volume or cerebellar volume but the eCSF and cerebral cortex volumes were smaller in fetuses that delivered preterm (p < 0.001 in both cases). Conclusion Fetuses that deliver preterm have a reduction in cortical and eCSF volumes. This is a novel finding and needs further investigation. If alterations in brain development are commencing antenatally in fetuses that subsequently deliver preterm, this may present a window for in utero therapy in the future.
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Affiliation(s)
- Lisa Story
- Department of Women and Children's Health, King's College London, UK.
| | - Alice Davidson
- Centre for the Developing Brain, King's College London, London, UK
| | - Prachi Patkee
- Centre for the Developing Brain, King's College London, London, UK
| | - Bobbi Fleiss
- Centre for the Developing Brain, King's College London, London, UK; School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, VIC, Australia; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
| | | | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, UK; Centre for Medical Engineering, King's College London, London, UK
| | | | - Paul Seed
- Department of Women and Children's Health, King's College London, UK
| | - Alice Jones
- Centre for the Developing Brain, King's College London, London, UK; Queen Mary University Medical School, UK
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, UK; School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, VIC, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, UK
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16
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Quon JL, Jin MC, Seekins J, Yeom KW. Harnessing the potential of artificial neural networks for pediatric patient management. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Beltrán-Arzate K, Hodson K, Tes HK, Bowyer SAH, Ratliff HC, Abraham MM, Johnson E, Harris M, Jaekel J. Contextual risk and psychosocial profiles of opioid-using mothers: A mixed-methods study. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211060624. [PMID: 34818934 PMCID: PMC8628311 DOI: 10.1177/17455065211060624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is an increase in cases of mothers using opioids during pregnancy in the United States but research investigating mothers' psychosocial environments along with individual variability among this high-risk group of women is scarce. METHODS This mixed-methods study aims to examine the complex interplay of contextual risks and experiences of opioid-using mothers. A sample of 50 opioid-using biological mothers of infants diagnosed with neonatal opioid withdrawal syndrome (NOWS) were studied using a set of standardized and open-ended questions, along with medical records extraction. RESULTS A high-risk subgroup of 36 mothers was identified using cluster analysis, characterized by a distinct profile of psychosocial risk. Thematic content analysis revealed four themes: (1) barriers to communication and mistrust of health professionals, (2) limitations of access to health care and the amplification of disadvantages related to COVID-19, (3) lifelong consequences of adverse childhood experiences (ACEs), and (4) intimate partner violence and its influence on drug use. CONCLUSION Our findings highlight important information toward health services provision for opioid-using women of childbearing age. Efforts to reduce opioid usage in mothers need to consider psychosocial and contextual risks.
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Affiliation(s)
- Karina Beltrán-Arzate
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Kevin Hodson
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Haley K Tes
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Sarah-Anne H Bowyer
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Hollis C Ratliff
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Michael M Abraham
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Elizabeth Johnson
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Malinda Harris
- Department of Neonatology, East Tennessee Children’s Hospital, Knoxville, TN, USA
| | - Julia Jaekel
- Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
- Department of Psychology, University of Oulu, Oulu, Finland
- Department of Psychology, University of Warwick, Coventry, UK
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18
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Chen J, Fang Z, Zhang G, Ling L, Li G, Zhang H, Wang L. Automatic brain extraction from 3D fetal MR image with deep learning-based multi-step framework. Comput Med Imaging Graph 2020; 88:101848. [PMID: 33385932 DOI: 10.1016/j.compmedimag.2020.101848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Brain extraction is a fundamental prerequisite step in neuroimage analysis for fetus. Due to surrounding maternal tissues and unpredictable movement, brain extraction from fetal Magnetic Resonance (MR) images is a challenging task. In this paper, we propose a novel deep learning-based multi-step framework for brain extraction from 3D fetal MR images. In the first step, a global localization network is applied to estimate probability maps for brain candidates. Connected-component labeling algorithm is applied to eliminate small erroneous components and accurately locate the candidate brain area. In the second step, a local refinement network is implemented in the brain candidate area to obtain fine-grained probability maps. Final extraction results are derived by a fusion network with the two cascaded probability maps obtained from previous two steps. Experimental results demonstrate that our proposed method has superior performance compared with existing deep learning-based methods.
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Affiliation(s)
- Jian Chen
- School of Electronic, Electrical Engineering and Physics, Fujian University of Technology, Fuzhou, Fujian, 350118, China.
| | - Zhenghan Fang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, NC, 27517, USA
| | - Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
| | - Lei Ling
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
| | - Gang Li
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, NC, 27517, USA
| | - He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
| | - Li Wang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, NC, 27517, USA.
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Galinsky R, van de Looij Y, Mitchell N, Dean JM, Dhillon SK, Yamaguchi K, Lear CA, Wassink G, Davidson JO, Nott F, Zahra VA, Kelly SB, King VJ, Sizonenko SV, Bennet L, Gunn AJ. Magnetic Resonance Imaging Correlates of White Matter Gliosis and Injury in Preterm Fetal Sheep Exposed to Progressive Systemic Inflammation. Int J Mol Sci 2020; 21:ijms21238891. [PMID: 33255257 PMCID: PMC7727662 DOI: 10.3390/ijms21238891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022] Open
Abstract
Progressive fetal infection/inflammation is strongly associated with neural injury after preterm birth. We aimed to test the hypotheses that progressively developing fetal inflammation leads to neuroinflammation and impaired white matter development and that the histopathological changes can be detected using high-field diffusion tensor magnetic resonance imaging (MRI). Chronically instrumented preterm fetal sheep at 0.7 of gestation were randomly assigned to receive intravenous saline (control; n = 6) or a progressive infusion of lipopolysaccharide (LPS, 200 ng intravenous over 24 h then doubled every 24 h for 5 days to induce fetal inflammation, n = 7). Sheep were killed 10 days after starting the infusions, for histology and high-field diffusion tensor MRI. Progressive LPS infusion was associated with increased circulating interleukin (IL)-6 concentrations and moderate increases in carotid artery perfusion and the frequency of electroencephalogram (EEG) activity (p < 0.05 vs. control). In the periventricular white matter, fractional anisotropy (FA) was increased, and orientation dispersion index (ODI) was reduced (p < 0.05 vs. control for both). Histologically, in the same brain region, LPS infusion increased microglial activation and astrocyte numbers and reduced the total number of oligodendrocytes with no change in myelination or numbers of immature/mature oligodendrocytes. Numbers of astrocytes in the periventricular white matter were correlated with increased FA and reduced ODI signal intensities. Astrocyte coherence was associated with increased FA. Moderate astrogliosis, but not loss of total oligodendrocytes, after progressive fetal inflammation can be detected with high-field diffusion tensor MRI.
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Affiliation(s)
- Robert Galinsky
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia; (F.N.); (V.A.Z.); (S.B.K.)
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria 3800, Australia
| | - Yohan van de Looij
- Division of Child Development & Growth, Department of Pediatrics, Gynaecology & Obstetrics, School of Medicine, University of Geneva, 1015 Geneva, Switzerland; (Y.v.d.L.); (S.V.S.)
| | - Natasha Mitchell
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Justin M. Dean
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Simerdeep K. Dhillon
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Kyohei Yamaguchi
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Christopher A. Lear
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Guido Wassink
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Joanne O. Davidson
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Fraser Nott
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia; (F.N.); (V.A.Z.); (S.B.K.)
| | - Valerie A. Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia; (F.N.); (V.A.Z.); (S.B.K.)
| | - Sharmony B. Kelly
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia; (F.N.); (V.A.Z.); (S.B.K.)
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria 3800, Australia
| | - Victoria J. King
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Stéphane V. Sizonenko
- Division of Child Development & Growth, Department of Pediatrics, Gynaecology & Obstetrics, School of Medicine, University of Geneva, 1015 Geneva, Switzerland; (Y.v.d.L.); (S.V.S.)
| | - Laura Bennet
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
| | - Alistair J. Gunn
- Department of Physiology, University of Auckland, Auckland 1023, New Zealand; (R.G.); (N.M.); (J.M.D.); (S.K.D.); (K.Y.); (C.A.L.); (G.W.); (J.O.D.); (V.J.K.); (L.B.)
- Correspondence:
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20
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Automated brain morphometric biomarkers from MRI at term predict motor development in very preterm infants. NEUROIMAGE-CLINICAL 2020; 28:102475. [PMID: 33395969 PMCID: PMC7649646 DOI: 10.1016/j.nicl.2020.102475] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
Nearly 1/3 of very preterm (VPT) infants develop motor impairments later in life. Better early biomarkers are needed for risk-stratification and early intervention. We used MRI morphometrics at term to predict 2-year motor ability in VPT infants. Inner cortical curvature at term is a novel biomarker of early motor aptitude. In regression models, morphometrics explained nearly 50% of motor score variance.
Very preterm infants are at high risk for motor impairments. Early interventions can improve outcomes in this cohort, but they would be most effective if clinicians could accurately identify the highest-risk infants early. A number of biomarkers for motor development exist, but currently none are sufficiently accurate for early risk-stratification. We prospectively enrolled very preterm (gestational age ≤31 weeks) infants from four level-III NICUs. Structural brain MRI was performed at term-equivalent age. We used a established pipeline to automatically derive brain volumetrics and cortical morphometrics – cortical surface area, sulcal depth, gyrification index, and inner cortical curvature – from structural MRI. We related these objective measures to Bayley-III motor scores (overall, gross, and fine) at two-years corrected age. Lasso regression identified the three best predictive biomarkers for each motor scale from our initial feature set. In multivariable regression, we assessed the independent value of these brain biomarkers, over-and-above known predictors of motor development, to predict motor scores. 75 very preterm infants had high-quality T2-weighted MRI and completed Bayley-III motor testing. All three motor scores were positively associated with regional cortical surface area and subcortical volumes and negatively associated with cortical curvature throughout the majority of brain regions. In multivariable regression modeling, thalamic volume, curvature of the temporal lobe, and curvature of the insula were significant predictors of overall motor development on the Bayley-III, independent of known predictors. Objective brain morphometric biomarkers at term show promise in predicting motor development in very preterm infants.
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21
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Kline JE, Illapani VSP, He L, Altaye M, Logan JW, Parikh NA. Early cortical maturation predicts neurodevelopment in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2020; 105:460-465. [PMID: 31704737 PMCID: PMC7205568 DOI: 10.1136/archdischild-2019-317466] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the ability of four objectively defined, cortical maturation features-surface area, gyrification index, sulcal depth and curvature-from structural MRI at term-equivalent age (TEA) to independently predict cognitive and language development at 2 years corrected age in very preterm (VPT) infants. DESIGN Population-based, prospective cohort study. Structural brain MRI was performed at term, between 40 and 44 weeks postmenstrual age and processed using the developing Human Connectome Project pipeline. SETTING Multicentre study comprising four regional level III neonatal intensive care units in the Columbus, Ohio region. PATIENTS 110 VPT infants (gestational age (GA) ≤ 31 weeks). MAIN OUTCOME MEASURES Cognitive and language scores at 2 years corrected age on the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS Of the 94 VPT infants with high-quality T2-weighted MRI scans, 75 infants (80%) returned for Bayley-III testing. Cortical surface area was positively correlated with cognitive and language scores in nearly every brain region. Curvature of the inner cortex was negatively correlated with Bayley scores in the frontal, parietal and temporal lobes. In multivariable regression models, adjusting for GA, sex, socioeconomic status, and injury score on MRI, regional measures of surface area and curvature independently explained more than one-third of the variance in cognitive and language scores at 2 years corrected age in our cohort. CONCLUSIONS We identified increased cortical curvature at TEA as a new prognostic biomarker of adverse neurodevelopment in very premature infants. When combined with cortical surface area, it enhanced prediction of cognitive and language development. Larger studies are needed to externally validate our findings.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA,Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - John Wells Logan
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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22
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Fleiss B, Gressens P, Stolp HB. Cortical Gray Matter Injury in Encephalopathy of Prematurity: Link to Neurodevelopmental Disorders. Front Neurol 2020; 11:575. [PMID: 32765390 PMCID: PMC7381224 DOI: 10.3389/fneur.2020.00575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Preterm-born infants frequently suffer from an array of neurological damage, collectively termed encephalopathy of prematurity (EoP). They also have an increased risk of presenting with a neurodevelopmental disorder (e.g., autism spectrum disorder; attention deficit hyperactivity disorder) later in life. It is hypothesized that it is the gray matter injury to the cortex, in addition to white matter injury, in EoP that is responsible for the altered behavior and cognition in these individuals. However, although it is established that gray matter injury occurs in infants following preterm birth, the exact nature of these changes is not fully elucidated. Here we will review the current state of knowledge in this field, amalgamating data from both clinical and preclinical studies. This will be placed in the context of normal processes of developmental biology and the known pathophysiology of neurodevelopmental disorders. Novel diagnostic and therapeutic tactics required integration of this information so that in the future we can combine mechanism-based approaches with patient stratification to ensure the most efficacious and cost-effective clinical practice.
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Affiliation(s)
- Bobbi Fleiss
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Pierre Gressens
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- PremUP, Paris, France
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Helen B. Stolp
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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23
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Galinsky R, Dhillon SK, Dean JM, Davidson JO, Lear CA, Wassink G, Nott F, Kelly SB, Fraser M, Yuill C, Bennet L, Gunn AJ. Tumor necrosis factor inhibition attenuates white matter gliosis after systemic inflammation in preterm fetal sheep. J Neuroinflammation 2020; 17:92. [PMID: 32293473 PMCID: PMC7087378 DOI: 10.1186/s12974-020-01769-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background Increased circulating levels of tumor necrosis factor (TNF) are associated with greater risk of impaired neurodevelopment after preterm birth. In this study, we tested the hypothesis that systemic TNF inhibition, using the soluble TNF receptor Etanercept, would attenuate neuroinflammation in preterm fetal sheep exposed to lipopolysaccharide (LPS). Methods Chronically instrumented preterm fetal sheep at 0.7 of gestation were randomly assigned to receive saline (control; n = 7), LPS infusion (100 ng/kg i.v. over 24 h then 250 ng/kg/24 h for 96 h plus 1 μg LPS boluses at 48, 72, and 96 h, to induce inflammation; n = 8) or LPS plus two i.v. infusions of Etanercept (2 doses, 5 mg/kg infused over 30 min, 48 h apart) started immediately before LPS-exposure (n = 8). Sheep were killed 10 days after starting infusions, for histology. Results LPS boluses were associated with increased circulating TNF, interleukin (IL)-6 and IL-10, electroencephalogram (EEG) suppression, hypotension, tachycardia, and increased carotid artery perfusion (P < 0.05 vs. control). In the periventricular and intragyral white matter, LPS exposure increased gliosis, TNF-positive cells, total oligodendrocytes, and cell proliferation (P < 0.05 vs control), but did not affect myelin expression or numbers of neurons in the cortex and subcortical regions. Etanercept delayed the rise in circulating IL-6, prolonged the increase in IL-10 (P < 0.05 vs. LPS), and attenuated EEG suppression, hypotension, and tachycardia after LPS boluses. Histologically, Etanercept normalized LPS-induced gliosis, and increase in TNF-positive cells, proliferation, and total oligodendrocytes. Conclusion TNF inhibition markedly attenuated white matter gliosis but did not affect mature oligodendrocytes after prolonged systemic inflammation in preterm fetal sheep. Further studies of long-term brain maturation are now needed.
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Affiliation(s)
- Robert Galinsky
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Simerdeep K Dhillon
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Justin M Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Joanne O Davidson
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Christopher A Lear
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Guido Wassink
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Fraser Nott
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Sharmony B Kelly
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Mhoyra Fraser
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Caroline Yuill
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand
| | - Alistair Jan Gunn
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Private bag 92019, Auckland, 1023, New Zealand.
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24
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Patkee PA, Baburamani AA, Kyriakopoulou V, Davidson A, Avini E, Dimitrova R, Allsop J, Hughes E, Kangas J, McAlonan G, Rutherford MA. Early alterations in cortical and cerebellar regional brain growth in Down Syndrome: An in vivo fetal and neonatal MRI assessment. Neuroimage Clin 2020; 25:102139. [PMID: 31887718 DOI: 10.1101/683656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/15/2019] [Accepted: 12/21/2019] [Indexed: 05/22/2023]
Abstract
Down Syndrome (DS) is the most frequent genetic cause of intellectual disability with a wide spectrum of neurodevelopmental outcomes. At present, the relationship between structural brain morphology and the spectrum of cognitive phenotypes in DS, is not well understood. This study aimed to quantify the development of the fetal and neonatal brain in DS participants, with and without a congenital cardiac defect compared with a control population using dedicated, optimised and motion-corrected in vivo magnetic resonance imaging (MRI). We detected deviations in development and altered regional brain growth in the fetus with DS from 21 weeks' gestation, when compared to age-matched controls. Reduced cerebellar volume was apparent in the second trimester with significant alteration in cortical growth becoming evident during the third trimester. Developmental abnormalities in the cortex and cerebellum are likely substrates for later neurocognitive impairment, and ongoing studies will allow us to confirm the role of antenatal MRI as an early biomarker for subsequent cognitive ability in DS. In the era of rapidly developing technologies, we believe that the results of this study will assist counselling for prospective parents.
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Affiliation(s)
- Prachi A Patkee
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Ana A Baburamani
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Vanessa Kyriakopoulou
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Alice Davidson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Elhaam Avini
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom; Department of Forensic and Neurodevelopmental Science, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom
| | - Joanna Allsop
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Johanna Kangas
- Department of Forensic and Neurodevelopmental Science, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom.
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25
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Patkee PA, Baburamani AA, Kyriakopoulou V, Davidson A, Avini E, Dimitrova R, Allsop J, Hughes E, Kangas J, McAlonan G, Rutherford MA. Early alterations in cortical and cerebellar regional brain growth in Down Syndrome: An in vivo fetal and neonatal MRI assessment. Neuroimage Clin 2019; 25:102139. [PMID: 31887718 PMCID: PMC6938981 DOI: 10.1016/j.nicl.2019.102139] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/15/2019] [Accepted: 12/21/2019] [Indexed: 11/25/2022]
Abstract
Down Syndrome (DS) is the most frequent genetic cause of intellectual disability with a wide spectrum of neurodevelopmental outcomes. At present, the relationship between structural brain morphology and the spectrum of cognitive phenotypes in DS, is not well understood. This study aimed to quantify the development of the fetal and neonatal brain in DS participants, with and without a congenital cardiac defect compared with a control population using dedicated, optimised and motion-corrected in vivo magnetic resonance imaging (MRI). We detected deviations in development and altered regional brain growth in the fetus with DS from 21 weeks' gestation, when compared to age-matched controls. Reduced cerebellar volume was apparent in the second trimester with significant alteration in cortical growth becoming evident during the third trimester. Developmental abnormalities in the cortex and cerebellum are likely substrates for later neurocognitive impairment, and ongoing studies will allow us to confirm the role of antenatal MRI as an early biomarker for subsequent cognitive ability in DS. In the era of rapidly developing technologies, we believe that the results of this study will assist counselling for prospective parents.
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Affiliation(s)
- Prachi A Patkee
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Ana A Baburamani
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Vanessa Kyriakopoulou
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Alice Davidson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Elhaam Avini
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom; Department of Forensic and Neurodevelopmental Science, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom
| | - Joanna Allsop
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom
| | - Johanna Kangas
- Department of Forensic and Neurodevelopmental Science, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AB, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas's Hospital, London, SE1 7EH, United Kingdom.
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26
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Kline JE, Illapani VSP, He L, Altaye M, Parikh NA. Retinopathy of Prematurity and Bronchopulmonary Dysplasia are Independent Antecedents of Cortical Maturational Abnormalities in Very Preterm Infants. Sci Rep 2019; 9:19679. [PMID: 31873183 PMCID: PMC6928014 DOI: 10.1038/s41598-019-56298-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023] Open
Abstract
Very preterm (VPT) infants are at high-risk for neurodevelopmental impairments, however there are few validated biomarkers at term-equivalent age that accurately measure abnormal brain development and predict future impairments. Our objectives were to quantify and contrast cortical features between full-term and VPT infants at term and to associate two key antecedent risk factors, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), with cortical maturational changes in VPT infants. We prospectively enrolled a population-based cohort of 110 VPT infants (gestational age ≤31 weeks) and 51 healthy full-term infants (gestational age 38-42 weeks). Structural brain MRI was performed at term. 94 VPT infants and 46 full-term infants with high-quality T2-weighted MRI were analyzed. As compared to full-term infants, VPT infants exhibited significant global cortical maturational abnormalities, including reduced surface area (-5.9%) and gyrification (-6.7%) and increased curvature (5.9%). In multivariable regression controlled for important covariates, BPD was significantly negatively correlated with lobar and global cortical surface area and ROP was significantly negatively correlated with lobar and global sulcal depth in VPT infants. Our cohort of VPT infants exhibited widespread cortical maturation abnormalities by term-equivalent age that were in part anteceded by two of the most potent neonatal diseases, BPD and ROP.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Divison of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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27
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A Comparison of the effects of preterm birth and institutional deprivation on child temperament. Dev Psychopathol 2019; 32:1524-1533. [PMID: 31711549 DOI: 10.1017/s0954579419001457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Both preterm birth and early institutional deprivation are associated with neurodevelopmental impairment-with both shared and distinctive features. To explore shared underlying mechanisms, this study directly compared the effects of these putative risk factors on temperament profiles in six-year-olds: Children born very preterm (<32 weeks gestation) or at very low birthweight (<1500 g) from the Bavarian Longitudinal Study (n = 299); and children who experienced >6 months of deprivation in Romanian institutions from the English and Romanian Adoptees Study (n = 101). The former were compared with 311 healthy term born controls and the latter with 52 nondeprived adoptees. At 6 years, temperament was assessed via parent reports across 5 dimensions: effortful control, activity, shyness, emotionality, and sociability. Very preterm/very low birthweight and postinstitutionalized children showed similarly aberrant profiles in terms of lower effortful control, preterm = -0.50, 95% CI [-0.67, -0.33]; postinstitutionalized = -0.48, 95% CI [-0.82, -0.14], compared with their respective controls. Additionally, postinstitutionalized children showed higher activity, whereas very preterm/very low birthweight children showed lower shyness. Preterm birth and early institutionalization are similarly associated with poorer effortful control, which might contribute to long-term vulnerability. More research is needed to examine temperamental processes as common mediators of negative long-term outcomes following early adversity.
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Kelly CJ, Hughes EJ, Rutherford MA, Counsell SJ. Advances in neonatal MRI of the brain: from research to practice. Arch Dis Child Educ Pract Ed 2019; 104:106-110. [PMID: 29563140 DOI: 10.1136/archdischild-2018-314778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Christopher J Kelly
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Emer J Hughes
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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29
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Longitudinal study of neonatal brain tissue volumes in preterm infants and their ability to predict neurodevelopmental outcome. Neuroimage 2019; 185:728-741. [DOI: 10.1016/j.neuroimage.2018.06.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/08/2018] [Accepted: 06/09/2018] [Indexed: 12/13/2022] Open
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30
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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31
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Sripada K, Bjuland KJ, Sølsnes AE, Håberg AK, Grunewaldt KH, Løhaugen GC, Rimol LM, Skranes J. Trajectories of brain development in school-age children born preterm with very low birth weight. Sci Rep 2018; 8:15553. [PMID: 30349084 PMCID: PMC6197262 DOI: 10.1038/s41598-018-33530-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/27/2018] [Indexed: 12/29/2022] Open
Abstract
Preterm birth (gestational age < 37 weeks) with very low birth weight (VLBW, birth weight ≤ 1500 g) is associated with lifelong cognitive deficits, including in executive function, and persistent alterations in cortical and subcortical structures. However, it remains unclear whether “catch-up” growth is possible in the preterm/VLBW brain. Longitudinal structural MRI was conducted with children born preterm with VLBW (n = 41) and term-born peers participating in the Norwegian Mother and Child Cohort Study (MoBa) (n = 128) at two timepoints in early school age (mean ages 8.0 and 9.3 years). Images were analyzed with the FreeSurfer 5.3.0 longitudinal stream to assess differences in development of cortical thickness, surface area, and brain structure volumes, as well as associations with executive function development (NEPSY Statue and WMS-III Spatial Span scores) and perinatal health markers. No longitudinal group × time effects in cortical thickness, surface area, or subcortical volumes were seen, indicating similar brain growth trajectories in the groups over an approximately 16-month period in middle childhood. Higher IQ scores within the VLBW group were associated with greater surface area in left parieto-occipital and inferior temporal regions. Among VLBW preterm-born children, cortical surface area was smaller across the cortical mantle, and cortical thickness was thicker occipitally and frontally and thinner in lateral parietal and posterior temporal areas. Smaller volumes of corpus callosum, right globus pallidus, and right thalamus persisted in the VLBW group from timepoint 1 to 2. VLBW children had on average IQ 1 SD below term-born MoBa peers and significantly worse scores on WMS-III Spatial Span. Executive function scores did not show differential associations with morphometry between groups cross-sectionally or longitudinally. This study investigated divergent or “catch-up” growth in terms of cortical thickness, surface area, and volumes of subcortical gray matter structures and corpus callosum in children born preterm/VLBW and did not find group × time interactions. Greater surface area at mean age 9.3 in left parieto-occipital and inferior temporal cortex was associated with higher IQ in the VLBW group. These results suggest that preterm VLBW children may have altered cognitive networks, yet have structural growth trajectories that appear generally similar to their term-born peers in this early school age window.
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Affiliation(s)
- K Sripada
- Department of Clinical & Molecular Medicine, Norwegian University of Science & Technology, Trondheim, Norway.
| | - K J Bjuland
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - A E Sølsnes
- Department of Clinical & Molecular Medicine, Norwegian University of Science & Technology, Trondheim, Norway
| | - A K Håberg
- Department of Neuromedicine & Movement Science, Norwegian University of Science & Technology, Trondheim, Norway.,Department of Radiology & Nuclear Medicine, St. Olav's Hospital, Trondheim, Norway
| | - K H Grunewaldt
- Department of Clinical & Molecular Medicine, Norwegian University of Science & Technology, Trondheim, Norway.,Department of Pediatrics, St. Olav's Hospital, Trondheim, Norway
| | - G C Løhaugen
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - L M Rimol
- Department of Radiology & Nuclear Medicine, St. Olav's Hospital, Trondheim, Norway.,Department of Circulation & Medical Imaging, Norwegian University of Science & Technology, Trondheim, Norway
| | - J Skranes
- Department of Clinical & Molecular Medicine, Norwegian University of Science & Technology, Trondheim, Norway.,Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
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32
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Zhao T, Mishra V, Jeon T, Ouyang M, Peng Q, Chalak L, Wisnowski JL, Heyne R, Rollins N, Shu N, Huang H. Structural network maturation of the preterm human brain. Neuroimage 2018; 185:699-710. [PMID: 29913282 DOI: 10.1016/j.neuroimage.2018.06.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
During the 3rd trimester, large-scale neural circuits are formed in the human brain, resulting in a highly efficient and segregated connectome at birth. Despite recent findings identifying important preterm human brain network properties such as rich-club organization, how the structural network develops differentially across brain regions and among different types of connections in this period is not yet known. Here, using high resolution diffusion MRI of 77 preterm-born and full-term neonates scanned at 31.9-41.7 postmenstrual weeks (PMW), we constructed structural connectivity matrices and performed graph-theory-based analyses. Faster increases of nodal efficiency were mainly located at the brain hubs distributed in primary sensorimotor regions, superior-middle frontal, and precuneus regions during 31.9-41.7PMW. Higher rates of edge strength increases were found in the rich-club and within-module connections, compared to other connections. The edge strength of short-range connections increased faster than that of long-range connections. Nodal efficiencies of the hubs predicted individual postmenstrual ages more accurately than those of non-hubs. Collectively, these findings revealed more rapid efficiency increases of the hub and rich-club connections as well as higher developmental rates of edge strength in short-range and within-module connections. These jointly underlie network segregation and differentiated emergence of brain functions.
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Affiliation(s)
- Tengda Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China
| | - Virendra Mishra
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Tina Jeon
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Minhui Ouyang
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Qinmu Peng
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Lina Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Jessica Lee Wisnowski
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States; Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, Chile
| | - Roy Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Nancy Rollins
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, 19104, United States
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China.
| | - Hao Huang
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States; Radiology Research, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, 19104, United States.
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33
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Bennet L, Walker DW, Horne RSC. Waking up too early - the consequences of preterm birth on sleep development. J Physiol 2018; 596:5687-5708. [PMID: 29691876 DOI: 10.1113/jp274950] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022] Open
Abstract
Good quality sleep of sufficient duration is vital for optimal physiological function and our health. Sleep deprivation is associated with impaired neurocognitive function and emotional control, and increases the risk for cardiometabolic diseases, obesity and cancer. Sleep develops during fetal life with the emergence of a recognisable pattern of sleep states in the preterm fetus associated with the development, maturation and connectivity within neural networks in the brain. Despite the physiological importance of sleep, surprisingly little is known about how sleep develops in individuals born preterm. Globally, an estimated 15 million babies are born preterm (<37 weeks gestation) each year, and these babies are at significant risk of neural injury and impaired brain development. This review discusses how sleep develops during fetal and neonatal life, how preterm birth impacts on sleep development to adulthood, and the factors which may contribute to impaired brain and sleep development, leading to altered neurocognitive, behavioural and motor capabilities in the infant and child. Going forward, the challenge is to identify specific risk factors for impaired sleep development in preterm babies to allow for the design of interventions that will improve the quality and quantity of sleep throughout life.
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Affiliation(s)
- Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia
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Batalle D, O'Muircheartaigh J, Makropoulos A, Kelly CJ, Dimitrova R, Hughes EJ, Hajnal JV, Zhang H, Alexander DC, Edwards AD, Counsell SJ. Different patterns of cortical maturation before and after 38 weeks gestational age demonstrated by diffusion MRI in vivo. Neuroimage 2018; 185:764-775. [PMID: 29802969 PMCID: PMC6299264 DOI: 10.1016/j.neuroimage.2018.05.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 04/19/2018] [Accepted: 05/18/2018] [Indexed: 12/17/2022] Open
Abstract
Human cortical development during the third trimester is characterised by macro- and microstructural changes which are reflected in alterations in diffusion MRI (dMRI) measures, with significant decreases in cortical mean diffusivity (MD) and fractional anisotropy (FA). This has been interpreted as reflecting increased cellular density and dendritic arborisation. However, the fall in FA stops abruptly at 38 weeks post-menstrual age (PMA), and then tends to plateau, while MD continues to fall, suggesting a more complex picture and raising the hypothesis that after this age development is dominated by continuing increase in neural and organelle density rather than alterations in the geometry of dendritic trees. To test this, we used neurite orientation dispersion and density imaging (NODDI), acquiring multi-shell, high angular resolution dMRI and measures of cortical volume and mean curvature in 99 preterm infants scanned between 25 and 47 weeks PMA. We predicted that increased neurite and organelle density would be reflected in increases in neurite density index (NDI), while a relatively unchanging geometrical structure would be associated with constant orientation dispersion index (ODI). As dendritic arborisation is likely to be one of the drivers of gyrification, we also predicted that measures of cortical volume and curvature would correlate with ODI and show slower growth after 38 weeks. We observed a decrease of MD throughout the period, while cortical FA decreased from 25 to 38 weeks PMA and then increased. ODI increased up to 38 weeks and then plateaued, while NDI rose after 38 weeks. The evolution of ODI correlated with cortical volume and curvature. Regional analysis of cortical microstructure revealed a heterogenous pattern with increases in FA and NDI after 38 weeks confined to primary motor and sensory regions. These results support the interpretation that cortical development between 25 and 38 weeks PMA shows a predominant increase in dendritic arborisation and neurite growth, while between 38 and 47 weeks PMA it is dominated by increasing cellular and organelle density. DTI and NODDI cortical measures between 25 and 47 weeks GA Early cortical changes consistent with dendritic arborisation and neurite growth After 38 weeks cortical changes consistent with increasing cellular density Cortical curvature evolves in parallel with dendritic arborisation
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Affiliation(s)
- Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences & Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, London, United Kingdom
| | | | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences & Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, London, United Kingdom
| | - Emer J Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom
| | - Hui Zhang
- Department of Computer Science & Centre for Medical Image Computing, University College London, United Kingdom
| | - Daniel C Alexander
- Department of Computer Science & Centre for Medical Image Computing, University College London, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom.
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, SE1 7EH, London, United Kingdom
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35
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Matthews LG, Walsh BH, Knutsen C, Neil JJ, Smyser CD, Rogers CE, Inder TE. Brain growth in the NICU: critical periods of tissue-specific expansion. Pediatr Res 2018; 83:976-981. [PMID: 29320484 PMCID: PMC6054136 DOI: 10.1038/pr.2018.4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/31/2017] [Indexed: 11/09/2022]
Abstract
ObjectiveTo examine, using serial magnetic resonance imaging (MRI), total and tissue-specific brain growth in very-preterm (VPT) infants during the period that coincides with the early and late stages of the third trimester.MethodsStructural MRI scans were collected from two prospective cohorts of VPT infants (≤30 weeks of gestation). A total of 51 MRI scans from 18 VPT subjects were available for volumetric analysis. Brain tissue was classified into cerebrospinal fluid, cortical gray matter, myelinated and unmyelinated white matter, deep nuclear gray matter, and cerebellum. Nine infants had sufficient serial scans to allow comparison of tissue growth during the periods corresponding to the early and late stages of the third trimester.ResultsTissue-specific differences in ex utero brain growth trajectories were observed in the period corresponding to the third trimester. Most notably, there was a marked increase in cortical gray matter expansion from 34 to 40 weeks of postmenstrual age, emphasizing this critical period of brain development.ConclusionUtilizing serial MRI to document early brain development in VPT infants, this study documents regional differences in brain growth trajectories ex utero during the period corresponding to the first and second half of the third trimester, providing novel insight into the maturational vulnerability of the rapidly expanding cortical gray matter in the NICU.
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Affiliation(s)
- Lillian G. Matthews
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian H. Walsh
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clare Knutsen
- Department of Pediatrics, Washington University, Saint Louis, Missouri
| | - Jeffrey J. Neil
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher D. Smyser
- Department of Pediatrics, Washington University, Saint Louis, Missouri
- Department of Neurology, Washington University, Saint Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Cynthia E. Rogers
- Department of Pediatrics, Washington University, Saint Louis, Missouri
- Department of Psychiatry, Washington University, Saint Louis, Missouri
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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36
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Makropoulos A, Counsell SJ, Rueckert D. A review on automatic fetal and neonatal brain MRI segmentation. Neuroimage 2018; 170:231-248. [DOI: 10.1016/j.neuroimage.2017.06.074] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/06/2017] [Accepted: 06/26/2017] [Indexed: 01/18/2023] Open
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Makropoulos A, Robinson EC, Schuh A, Wright R, Fitzgibbon S, Bozek J, Counsell SJ, Steinweg J, Vecchiato K, Passerat-Palmbach J, Lenz G, Mortari F, Tenev T, Duff EP, Bastiani M, Cordero-Grande L, Hughes E, Tusor N, Tournier JD, Hutter J, Price AN, Teixeira RPAG, Murgasova M, Victor S, Kelly C, Rutherford MA, Smith SM, Edwards AD, Hajnal JV, Jenkinson M, Rueckert D. The developing human connectome project: A minimal processing pipeline for neonatal cortical surface reconstruction. Neuroimage 2018. [PMID: 29409960 DOI: 10.1101/125526] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Developing Human Connectome Project (dHCP) seeks to create the first 4-dimensional connectome of early life. Understanding this connectome in detail may provide insights into normal as well as abnormal patterns of brain development. Following established best practices adopted by the WU-MINN Human Connectome Project (HCP), and pioneered by FreeSurfer, the project utilises cortical surface-based processing pipelines. In this paper, we propose a fully automated processing pipeline for the structural Magnetic Resonance Imaging (MRI) of the developing neonatal brain. This proposed pipeline consists of a refined framework for cortical and sub-cortical volume segmentation, cortical surface extraction, and cortical surface inflation, which has been specifically designed to address considerable differences between adult and neonatal brains, as imaged using MRI. Using the proposed pipeline our results demonstrate that images collected from 465 subjects ranging from 28 to 45 weeks post-menstrual age (PMA) can be processed fully automatically; generating cortical surface models that are topologically correct, and correspond well with manual evaluations of tissue boundaries in 85% of cases. Results improve on state-of-the-art neonatal tissue segmentation models and significant errors were found in only 2% of cases, where these corresponded to subjects with high motion. Downstream, these surfaces will enhance comparisons of functional and diffusion MRI datasets, supporting the modelling of emerging patterns of brain connectivity.
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Affiliation(s)
- Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Emma C Robinson
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Robert Wright
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Johannes Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Passerat-Palmbach
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Gregor Lenz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Filippo Mortari
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Tencho Tenev
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nora Tusor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Murgasova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
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George JM, Pannek K, Rose SE, Ware RS, Colditz PB, Boyd RN. Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:134-146. [PMID: 29193032 DOI: 10.1111/dmcn.13611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/18/2023]
Abstract
AIM To examine the diagnostic ability of early magnetic resonance imaging (MRI; <36wks postmenstrual age) to detect later adverse motor outcomes or cerebral palsy (CP) in infants born preterm. METHOD Studies of infants born preterm with MRI earlier than 36 weeks postmenstrual age and quantitative motor data or a diagnosis of CP at or beyond 1 year corrected age were identified. Study details were extracted and meta-analyses performed where possible. Quality of included studies was evaluated with the QUADAS-2 (a revised tool for the quality assessment of diagnostic accuracy studies). RESULTS Thirty-one articles met the inclusion criteria, five of which reported diagnostic accuracy and five reported data sufficient for calculation of diagnostic accuracy. Early structural MRI global scores detected a later diagnosis of CP with a pooled sensitivity of 100% (95% confidence interval [CI] 86-100) and a specificity of 93% (95% CI 59-100). Global structural MRI scores determined adverse motor outcomes with a pooled sensitivity of 89% (95% CI 44-100) and a specificity of 98% (95% CI 90-100). White matter scores determined adverse motor outcomes with a pooled sensitivity of 33% (95% CI 20-48) and a specificity of 83% (95% CI 78-88). INTERPRETATION Early structural MRI has reasonable sensitivity and specificity to determine adverse motor outcomes and CP in infants born preterm. Greater reporting of diagnostic accuracy in studies examining relationships with motor outcomes and CP is required to facilitate clinical utility of early MRI. WHAT THIS PAPER ADDS Early magnetic resonance imaging (MRI) has reasonable sensitivity and specificity to determine later adverse motor outcomes and cerebral palsy (CP). Detection of infants who progressed to CP was stronger than motor outcomes. Global MRI scores determined adverse motor outcomes more accurately than white matter scores. Few studies report diagnostic accuracy of early MRI findings. Diagnostic accuracy is required to draw clinically meaningful conclusions from early MRI studies.
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Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Galinsky R, Lear CA, Dean JM, Wassink G, Dhillon SK, Fraser M, Davidson JO, Bennet L, Gunn AJ. Complex interactions between hypoxia-ischemia and inflammation in preterm brain injury. Dev Med Child Neurol 2018; 60:126-133. [PMID: 29194585 DOI: 10.1111/dmcn.13629] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Children surviving preterm birth have a high risk of disability, particularly cognitive and learning problems. There is extensive clinical and experimental evidence that disability is now primarily related to dysmaturation of white and gray matter, defined by failure of oligodendrocyte maturation and neuronal dendritic arborization, rather than cell death alone. The etiology of this dysmaturation is multifactorial, with contributions from hypoxia-ischemia, infection/inflammation and barotrauma. Intriguingly, these factors can interact to both increase and decrease damage. In this review we summarize preclinical and clinical evidence that all of these factors trigger secondary or chronic inflammation and gliosis. Thus, we hypothesize that these shared pathological features play a key role in a final common pathway that leads to the impaired neural maturation and connectivity and cognitive/motor impairments that are commonly observed in infants born preterm. This raises the possibility that secondary or chronic inflammation may be a viable therapeutic target for delayed interventions to improve neurodevelopmental outcomes after preterm birth. WHAT THIS PAPER ADDS Hypoxia-ischemia, infection/inflammation, and barotrauma/volutrauma all contribute to preterm brain injury. Multiple different triggers of preterm brain injury are associated with central nervous system dysmaturation. Secondary brain inflammation may be a viable target to improve neurodevelopment after preterm birth.
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Affiliation(s)
- Robert Galinsky
- The Department of Physiology, University of Auckland, Auckland, New Zealand.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Christopher A Lear
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Justin M Dean
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Guido Wassink
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | | | - Mhoyra Fraser
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- The Department of Physiology, University of Auckland, Auckland, New Zealand
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40
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Bennet L, Dhillon S, Lear CA, van den Heuij L, King V, Dean JM, Wassink G, Davidson JO, Gunn AJ. Chronic inflammation and impaired development of the preterm brain. J Reprod Immunol 2018; 125:45-55. [DOI: 10.1016/j.jri.2017.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 12/17/2022]
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41
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Bouyssi-Kobar M, Murnick J, Brossard-Racine M, Chang T, Mahdi E, Jacobs M, Limperopoulos C. Altered Cerebral Perfusion in Infants Born Preterm Compared with Infants Born Full Term. J Pediatr 2018; 193:54-61.e2. [PMID: 29212618 PMCID: PMC5794508 DOI: 10.1016/j.jpeds.2017.09.083] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare regional cerebral cortical blood flow (CBF) in infants born very preterm at term-equivalent age (TEA) and healthy newborns born full term and to examine the impact of clinical risk factors on CBF in the cohort born preterm. STUDY DESIGN This prospective, cross-sectional study included infants born very preterm (gestational age at birth <32 weeks; birth weight <1500 g) and healthy infants born full term. Using noninvasive 3T arterial spin labeling magnetic resonance imaging, we quantified regional CBF in the cerebral cortex: sensorimotor/auditory/visual cortex, superior medial/dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)/posterior cingulate cortex, insula, and lateral posterior parietal cortex, as well as in the brainstem, and deep gray matter. Analyses were performed controlling for sex, gestational age, and age at magnetic resonance imaging. RESULTS We studied 202 infants: 98 born preterm and 104 born full term at TEA. Infants born preterm demonstrated greater global CBF (β = 9.03; P < .0001) and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, ACC and auditory cortex were decreased significantly in infants born preterm compared with their peers born at full term (P < .0001; P = .026; P = .036, respectively). In addition, the presence of parenchymal brain injury correlated with lower global and regional CBF (insula, ACC, sensorimotor, auditory, and visual cortices) whereas the need for cardiac vasopressor support correlated with lower regional CBF in the insula and visual cortex. CONCLUSIONS Altered regional cortical CBF in infants born very preterm at TEA may reflect early brain dysmaturation despite the absence of cerebral cortical injury. Furthermore, specific cerebral cortical areas may be vulnerable to early hemodynamic instability and parenchymal brain injury.
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Affiliation(s)
- Marine Bouyssi-Kobar
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC; Institute for Biomedical Sciences, George Washington University, Washington, DC
| | - Jonathan Murnick
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
| | - Marie Brossard-Racine
- Department of Pediatrics Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Québec, Canada
| | - Taeun Chang
- Department of Neurology, Children's National Health System, Washington, DC
| | - Eman Mahdi
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
| | - Marni Jacobs
- Department of Epidemiology and Biostatistics, Children's Research Institute, Children's National Health System, Washington, DC
| | - Catherine Limperopoulos
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
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42
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Makropoulos A, Robinson EC, Schuh A, Wright R, Fitzgibbon S, Bozek J, Counsell SJ, Steinweg J, Vecchiato K, Passerat-Palmbach J, Lenz G, Mortari F, Tenev T, Duff EP, Bastiani M, Cordero-Grande L, Hughes E, Tusor N, Tournier JD, Hutter J, Price AN, Teixeira RPAG, Murgasova M, Victor S, Kelly C, Rutherford MA, Smith SM, Edwards AD, Hajnal JV, Jenkinson M, Rueckert D. The developing human connectome project: A minimal processing pipeline for neonatal cortical surface reconstruction. Neuroimage 2018; 173:88-112. [PMID: 29409960 DOI: 10.1016/j.neuroimage.2018.01.054] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 12/11/2022] Open
Abstract
The Developing Human Connectome Project (dHCP) seeks to create the first 4-dimensional connectome of early life. Understanding this connectome in detail may provide insights into normal as well as abnormal patterns of brain development. Following established best practices adopted by the WU-MINN Human Connectome Project (HCP), and pioneered by FreeSurfer, the project utilises cortical surface-based processing pipelines. In this paper, we propose a fully automated processing pipeline for the structural Magnetic Resonance Imaging (MRI) of the developing neonatal brain. This proposed pipeline consists of a refined framework for cortical and sub-cortical volume segmentation, cortical surface extraction, and cortical surface inflation, which has been specifically designed to address considerable differences between adult and neonatal brains, as imaged using MRI. Using the proposed pipeline our results demonstrate that images collected from 465 subjects ranging from 28 to 45 weeks post-menstrual age (PMA) can be processed fully automatically; generating cortical surface models that are topologically correct, and correspond well with manual evaluations of tissue boundaries in 85% of cases. Results improve on state-of-the-art neonatal tissue segmentation models and significant errors were found in only 2% of cases, where these corresponded to subjects with high motion. Downstream, these surfaces will enhance comparisons of functional and diffusion MRI datasets, supporting the modelling of emerging patterns of brain connectivity.
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Affiliation(s)
- Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Emma C Robinson
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Robert Wright
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Johannes Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Passerat-Palmbach
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Gregor Lenz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Filippo Mortari
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Tencho Tenev
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nora Tusor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Murgasova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
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43
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Edwards AD, Redshaw ME, Kennea N, Rivero-Arias O, Gonzales-Cinca N, Nongena P, Ederies M, Falconer S, Chew A, Omar O, Hardy P, Harvey ME, Eddama O, Hayward N, Wurie J, Azzopardi D, Rutherford MA, Counsell S. Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation. Arch Dis Child Fetal Neonatal Ed 2018; 103:F15-F21. [PMID: 28988160 PMCID: PMC5750369 DOI: 10.1136/archdischild-2017-313102] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND We tested the hypothesis that routine MRI would improve the care and well-being of preterm infants and their families. DESIGN Parallel-group randomised trial (1.1 allocation; intention-to-treat) with nested diagnostic and cost evaluations (EudraCT 2009-011602-42). SETTING Participants from 14 London hospitals, imaged at a single centre. PATIENTS 511 infants born before 33 weeks gestation underwent both MRI and ultrasound around term. 255 were randomly allocated (siblings together) to receive only MRI results and 255 only ultrasound from a paediatrician unaware of unallocated results; one withdrew before allocation. MAIN OUTCOME MEASURES Maternal anxiety, measured by the State-Trait Anxiety inventory (STAI) assessed in 206/214 mothers receiving MRI and 217/220 receiving ultrasound. Secondary outcomes included: prediction of neurodevelopment, health-related costs and quality of life. RESULTS After MRI, STAI fell from 36.81 (95% CI 35.18 to 38.44) to 32.77 (95% CI 31.54 to 34.01), 31.87 (95% CI 30.63 to 33.12) and 31.82 (95% CI 30.65 to 33.00) at 14 days, 12 and 20 months, respectively. STAI fell less after ultrasound: from 37.59 (95% CI 36.00 to 39.18) to 33.97 (95% CI 32.78 to 35.17), 33.43 (95% CI 32.22 to 34.63) and 33.63 (95% CI 32.49 to 34.77), p=0.02. There were no differences in health-related quality of life. MRI predicted moderate or severe functional motor impairment at 20 months slightly better than ultrasound (area under the receiver operator characteristic curve (CI) 0.74; 0.66 to 0.83 vs 0.64; 0.56 to 0.72, p=0.01) but cost £315 (CI £295-£336) more per infant. CONCLUSIONS MRI increased costs and provided only modest benefits. TRIAL REGISTRATION ClinicalTrials.gov NCT01049594 https://clinicaltrials.gov/ct2/show/NCT01049594. EudraCT: EudraCT: 2009-011602-42 (https://www.clinicaltrialsregister.eu/).
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Affiliation(s)
- A David Edwards
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Maggie E Redshaw
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | | | | - Nuria Gonzales-Cinca
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Phumza Nongena
- Division of Clinical Sciences, Imperial College London, London, UK
| | - Moegamad Ederies
- Division of Clinical Sciences, Imperial College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Omar Omar
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Merryl Elizabeth Harvey
- Faculty of Health, School of Midwifery, Nursing and Social Work, Birmingham City University, Birmingham, UK
| | - Oya Eddama
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Naomi Hayward
- Division of Clinical Sciences, Imperial College London, London, UK
| | - Julia Wurie
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Denis Azzopardi
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
| | - Serena Counsell
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King’s College London and Evelina London Children’s Hospital, London, UK
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44
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Galinsky R, Davidson JO, Dean JM, Green CR, Bennet L, Gunn AJ. Glia and hemichannels: key mediators of perinatal encephalopathy. Neural Regen Res 2018; 13:181-189. [PMID: 29557357 PMCID: PMC5879879 DOI: 10.4103/1673-5374.226378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Perinatal encephalopathy remains a major cause of disability, such as cerebral palsy. Therapeutic hypothermia is now well established to partially reduce risk of disability in late preterm/term infants. However, new and complementary therapeutic targets are needed to further improve outcomes. There is increasing evidence that glia play a key role in neural damage after hypoxia-ischemia and infection/inflammation. In this review, we discuss the role of astrocytic gap junction (connexin) hemichannels in the spread of neural injury after hypoxia-ischemia and/or infection/inflammation. Potential mechanisms of hemichannel mediated injury likely involve impaired intracellular calcium handling, loss of blood-brain barrier integrity and release of adenosine triphosphate (ATP) resulting in over-activation of purinergic receptors. We propose the hypothesis that inflammation-induced opening of connexin hemichannels is a key regulating event that initiates a vicious cycle of excessive ATP release, which in turn propagates activation of purinergic receptors on microglia and astrocytes. This suggests that developing new neuroprotective strategies for preterm infants will benefit from a detailed understanding of glial and connexin hemichannel responses.
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Affiliation(s)
- Robert Galinsky
- Department of Physiology, University of Auckland, Auckland, New Zealand; The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia
| | - Joanne O Davidson
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Justin M Dean
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Colin R Green
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand
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45
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Keunen K, Counsell SJ, Benders MJ. The emergence of functional architecture during early brain development. Neuroimage 2017; 160:2-14. [DOI: 10.1016/j.neuroimage.2017.01.047] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/22/2016] [Accepted: 01/18/2017] [Indexed: 01/12/2023] Open
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46
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Girardi G. Complement activation, a threat to pregnancy. Semin Immunopathol 2017; 40:103-111. [PMID: 28900713 DOI: 10.1007/s00281-017-0645-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022]
Abstract
Pregnancy poses a challenge for the immune systems of placental mammals. As fetal tissues are semi-allogeneic and alloantibodies that commonly develop in the mother, the fetus and the placenta might be subject to complement-mediated immune attack with the potential risk of adverse pregnancy outcomes. Here, I describe how the use of animal models was pivotal in demonstrating that complement inhibition at the fetomaternal interface is essential for a successful pregnancy. Studies in animals also helped the identification of uncontrolled complement activation as a crucial effector in the pathogenesis of recurrent miscarriages, intrauterine growth restriction, preeclampsia, and preterm birth. Clinical studies employing complement biomarkers in plasma and urine showed an association between dysregulation of the complement system and adverse pregnancy outcomes. A better understanding of the role of the complement system in pregnancy complications will allow a rational approach to manipulate its activation as a potential therapeutic strategy with the goal of protecting pregnancies and improving long-term outcomes for mother and child.
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Affiliation(s)
- Guillermina Girardi
- Pregnancy Laboratory, Department of Women and Children's Health, The Rayne Institute, St Thomas' Hospital, King's College London, London, SE1 7EH, UK.
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47
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Claessens NHP, Kelly CJ, Counsell SJ, Benders MJNL. Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease. Dev Med Child Neurol 2017; 59:894-902. [PMID: 28542743 DOI: 10.1111/dmcn.13461] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
This review integrates data on brain dysmaturation and acquired brain injury using fetal and neonatal magnetic resonance imaging (MRI), including the contribution of cardiovascular physiology to differences in brain development, and the relationship between brain abnormalities and subsequent neurological impairments in infants with congenital heart disease (CHD). The antenatal and neonatal period are critical for optimal brain development; the developing brain is particularly vulnerable to haemodynamic disturbances during this time. Altered cerebral perfusion and decreased cerebral oxygen delivery in the antenatal period can affect functional and structural brain development, while postnatal haemodynamic fluctuations may cause additional injury. In critical CHD, brain dysmaturation and acquired brain injury result from a combination of underlying cardiovascular pathology and surgery performed in the neonatal period. MRI findings in infants with CHD can be used to evaluate potential clinical risk factors for brain abnormalities, and aid prediction of functional outcomes at an early stage. In addition, information on timing of brain dysmaturation and acquired brain injury in CHD has the potential to be used when developing strategies to optimize neurodevelopment.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christopher J Kelly
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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48
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Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
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Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
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Prediction of cognitive and motor outcome of preterm infants based on automatic quantitative descriptors from neonatal MR brain images. Sci Rep 2017; 7:2163. [PMID: 28526882 PMCID: PMC5438406 DOI: 10.1038/s41598-017-02307-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022] Open
Abstract
This study investigates the predictive ability of automatic quantitative brain MRI descriptors for the identification of infants with low cognitive and/or motor outcome at 2-3 years chronological age. MR brain images of 173 patients were acquired at 30 weeks postmenstrual age (PMA) (n = 86) and 40 weeks PMA (n = 153) between 2008 and 2013. Eight tissue volumes and measures of cortical morphology were automatically computed. A support vector machine classifier was employed to identify infants who exhibit low cognitive and/or motor outcome (<85) at 2-3 years chronological age as assessed by the Bayley scales. Based on the images acquired at 30 weeks PMA, the automatic identification resulted in an area under the receiver operation characteristic curve (AUC) of 0.78 for low cognitive outcome, and an AUC of 0.80 for low motor outcome. Identification based on the change of the descriptors between 30 and 40 weeks PMA (n = 66) resulted in an AUC of 0.80 for low cognitive outcome and an AUC of 0.85 for low motor outcome. This study provides evidence of the feasibility of identification of preterm infants at risk of cognitive and motor impairments based on descriptors automatically computed from images acquired at 30 and 40 weeks PMA.
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Botellero VL, Skranes J, Bjuland KJ, Håberg AK, Lydersen S, Brubakk AM, Indredavik MS, Martinussen M. A longitudinal study of associations between psychiatric symptoms and disorders and cerebral gray matter volumes in adolescents born very preterm. BMC Pediatr 2017; 17:45. [PMID: 28143492 PMCID: PMC5286868 DOI: 10.1186/s12887-017-0793-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022] Open
Abstract
Background Being born preterm with very low birthweight (VLBW ≤ 1500 g) poses a risk for cortical and subcortical gray matter (GM) abnormalities, as well as for having more psychiatric problems during childhood and adolescence than term-born individuals. The aim of this study was to investigate the relationship between cortical and subcortical GM volumes and the course of psychiatric disorders during adolescence in VLBW individuals. Methods We followed VLBW individuals and term-born controls (birth weight ≥10th percentile) from 15 (VLBW;controls n = 40;56) to 19 (n = 44;60) years of age. Of these, 30;37 individuals were examined longitudinally. Cortical and subcortical GM volumes were extracted from MRPRAGE images obtained with the same 1.5 T MRI scanner at both time points and analyzed at each time point with the longitudinal stream of the FreeSurfer software package 5.3.0. All participants underwent clinical interviews and were assessed for psychiatric symptoms and diagnosis (Schedule for Affective Disorders and Schizophrenia for School-age Children, Children’s Global Assessment Scale, Attention-Deficit/Hyperactivity Disorder Rating Scale-IV). VLBW adolescents were divided into two groups according to diagnostic status from 15 to 19 years of age: persisting/developing psychiatric diagnosis or healthy/becoming healthy. Results Reduction in subcortical GM volume at 15 and 19 years, not including the thalamus, was limited to VLBW adolescents with persisting/developing diagnosis during adolescence, whereas VLBW adolescents in the healthy/becoming healthy group had similar subcortical GM volumes to controls. Moreover, across the entire VLBW group, poorer psychosocial functioning was predicted by smaller subcortical GM volumes at both time points and with reduced GM volume in the thalamus and the parietal and occipital cortex at 15 years. Inattention problems were predicted by smaller GM volumes in the parietal and occipital cortex. Conclusions GM volume reductions in the parietal and occipital cortex as well as smaller thalamic and subcortical GM volumes were associated with the higher rates of psychiatric symptoms found across the entire VLBW group. Significantly smaller subcortical GM volumes in VLBW individuals compared with term-born peers might pose a risk for developing and maintaining psychiatric diagnoses during adolescence. Future research should explore the possible role of reduced cortical and subcortical GM volumes in the pathogenesis of psychiatric illness in VLBW adolescents. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0793-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Violeta L Botellero
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Medical Technology Research Center, P.O. Box 8905, NO-7491, Trondheim, Norway.
| | - Jon Skranes
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Medical Technology Research Center, P.O. Box 8905, NO-7491, Trondheim, Norway.,Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - Knut Jørgen Bjuland
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Medical Technology Research Center, P.O. Box 8905, NO-7491, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Medical Imaging, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann-Mari Brubakk
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Medical Technology Research Center, P.O. Box 8905, NO-7491, Trondheim, Norway.,Department of Pediatrics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit S Indredavik
- Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Martinussen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Medical Technology Research Center, P.O. Box 8905, NO-7491, Trondheim, Norway.,Department of Gynecology and Obstetrics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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