1
|
Veldhuis MS, Dix LML, Breur JMPJ, de Vries WB, Koopman C, Eijsermans MJC, Swanenburg de Veye HFN, Molenschot MC, Lemmers PMA, van Bel F, Vijlbrief DC. Role of patent ductus arteriosus in preterms in long-term outcome. Early Hum Dev 2024; 190:105953. [PMID: 38330542 DOI: 10.1016/j.earlhumdev.2024.105953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to determine long-term neurodevelopmental outcome and cerebral oxygenation in extremely preterm infants, comparing those with a hemodynamic significant patent ductus arteriosus (hsPDA) to those without. STUDY DESIGN We included infants born before 28 weeks of gestation from 2008 to 2010 with routine echocardiography. Prior to echocardiography, regional cerebral oxygen saturation was measured. At 5 years of age, we evaluated neurodevelopmental outcomes using the Movement Assessment Battery for Children 2nd Dutch edition for motor skills and the Wechsler Preschool and Primary Scale of Intelligence 3rd Dutch edition for cognition. RESULTS A total of 66 infants (gestational age 26.6 ± 0.9 weeks, birth weight 912 ± 176 g) were included, 34 infants with a hsPDA (including treatment). The group infants with hsPDA showed lower pre-closure cerebral saturation levels (58.2 % ±7.8 % versus 62.8 % ±7.0 %; p = 0.01). At 5 years, impaired motor outcome occurred more often in infants with hsPDA (17 (53 %) vs. 7 (23 %); p = 0.01). In multivariate analysis existence of hsPDA remained unfavourably related to the motor subdomain "aiming and catching". There were no potential effects of hsPDA on cognitive performance at 5 years of age. CONCLUSION Treatment-receiving infants with hsPDA appear to exhibit motor deficits, specifically in "aiming and catching", by the age 5. Persistent ductal patency could be a contributing factor.
Collapse
Affiliation(s)
- Moniek S Veldhuis
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura M L Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes M P J Breur
- Department of Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem B de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Corine Koopman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maria J C Eijsermans
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Mirella C Molenschot
- Department of Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel C Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
2
|
Delayed Surgical Closure of the Patent Ductus Arteriosus: Does the Brain Pay the Price? J Pediatr 2023; 254:25-32. [PMID: 36241053 DOI: 10.1016/j.jpeds.2022.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the relation between duration of hemodynamically significant patent ductus arteriosus (PDA), cerebral oxygenation, magnetic resonance imaging-determined brain growth, and 2-year neurodevelopmental outcome in a cohort of infants born preterm whose duct was closed surgically. STUDY DESIGN Infants born preterm at <30 weeks of gestational age who underwent surgical ductal closure between 2008 and 2018 (n = 106) were included in this observational study. Near infrared spectroscopy-monitored cerebral oxygen saturation during and up to 24 hours after ductal closure and a Bayley III developmental test at the corrected age of 2 years is the institutional standard of care for this patient group. Infants also had magnetic resonance imaging at term-equivalent age. RESULTS In total, 90 infants fulfilled the inclusion criteria (median [range]: 25.9 weeks [24.0-28.9]; 856 g [540-1350]. Days of a PDA ranged from 1 to 41. Multivariable linear regression analysis showed that duration of a PDA negatively influenced cerebellar growth and motor and cognitive outcome at 2 years of corrected age. CONCLUSIONS Prolonged duration of a PDA in this surgical cohort is associated with reduced cerebellar growth and suboptimal neurodevelopmental outcome.
Collapse
|
3
|
Ana K, Iris ŽI, Nina P, Marina R, Tomislav Ć, Snježana S, Andrea B, Milan R, Ivica K. Linking integrity of visual pathways trajectories to visual behavior deficit in very preterm infants. Infant Behav Dev 2022; 67:101697. [DOI: 10.1016/j.infbeh.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
|
4
|
Zhumalina AK, Tusupkaliev BT, Zharlykasinova MB, Zhekeyeva BA, Darzhanova KB. The levels of pro- and anti-inflammatory cytokines in premature infants with perinatal infections. Mol Cell Biochem 2022; 477:621-625. [PMID: 34860348 DOI: 10.1007/s11010-021-04314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
Intrauterine infections are an urgent problem of modern neonatology. One of the causes of intrauterine infective foetal lesions is physiological immunosuppression. The purpose of this study is to investigate the cytokine status in newborns infected with perinatal infections, depending on their body weight. The study examined 145 newborns. Taking into account their body weight, they were divided into 2 groups: main and secondary. The study was conducted in the immunological laboratory of the Medical Centre of Marat Ospanov West Kazakhstan Medical University in the city of Aktobe, with the determination of the level of IgM and IgG to the herpes simplex virus (HSV) types 1, 2, cytomegalovirus (CMV), and chlamydia using the MULTISKANASCENT analyser with the "Chemo" T system. The main results of this study are the predominance of the anti-inflammatory component in both normal weight and underweight infants, which is evidence of the Th-cell-mediated immune response prevalence. The applied value of this study lies in the possibility of applying its results in practice to obtain effective methods to counteract the occurrence and development of intrauterine infections.
Collapse
Affiliation(s)
- Akmaral K Zhumalina
- Department of Childhood Diseases No. 1 with Neonatology, West Kazakhstan Marat Ospanov Medical University, 68 Maresyev Str., 030000, Aktobe, Republic of Kazakhstan.
| | - Balash T Tusupkaliev
- Department of Childhood Diseases No. 1 with Neonatology, West Kazakhstan Marat Ospanov Medical University, 68 Maresyev Str., 030000, Aktobe, Republic of Kazakhstan
| | - Mairamkul B Zharlykasinova
- Department of Childhood Diseases No. 1 with Neonatology, West Kazakhstan Marat Ospanov Medical University, 68 Maresyev Str., 030000, Aktobe, Republic of Kazakhstan
| | - Botagoz A Zhekeyeva
- Department of Childhood Diseases No. 1 with Neonatology, West Kazakhstan Marat Ospanov Medical University, 68 Maresyev Str., 030000, Aktobe, Republic of Kazakhstan
| | - Klara B Darzhanova
- Department of Normal and Topographic Anatomy with Operative Surgery, West Kazakhstan Marat Ospanov Medical University, 68 Maresyev Str., 030000, Aktobe, Republic of Kazakhstan
| |
Collapse
|
5
|
Benavente-Fernández I, Ruiz-González E, Lubian-Gutiérrez M, Lubián-Fernández SP, Cabrales Fontela Y, Roca-Cornejo C, Olmo-Duran P, Lubián-López SP. Ultrasonographic Estimation of Total Brain Volume: 3D Reliability and 2D Estimation. Enabling Routine Estimation During NICU Admission in the Preterm Infant. Front Pediatr 2021; 9:708396. [PMID: 34368031 PMCID: PMC8339409 DOI: 10.3389/fped.2021.708396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study is to explore if manually segmented total brain volume (TBV) from 3D ultrasonography (US) is comparable to TBV estimated by magnetic resonance imaging (MRI). We then wanted to test 2D based TBV estimation obtained through three linear axes which would enable monitoring brain growth in the preterm infant during admission. Methods: We included very low birth weight preterm infants admitted to our neonatal intensive care unit (NICU) with normal neuroimaging findings. We measured biparietal diameter, anteroposterior axis, vertical axis from US and MRI and TBV from both MRI and 3D US. We calculated intra- and interobserver agreement within and between techniques using the intraclass correlation coefficient and Bland-Altman methodology. We then developed a multilevel prediction model of TBV based on linear measurements from both US and MRI, compared them and explored how they changed with increasing age. The multilevel prediction model for TBV from linear measures was tested for internal and external validity and we developed a reference table for ease of prediction of TBV. Results: We used measurements obtained from 426 US and 93 MRI scans from 118 patients. We found good intra- and interobserver agreement for all the measurements. US measurements were reliable when compared to MRI, including TBV which achieved excellent agreement with that of MRI [ICC of 0.98 (95% CI 0.96-0.99)]. TBV estimated through 2D measurements of biparietal diameter, anteroposterior axis, and vertical axis was comparable among both techniques. We estimated the population 95% confidence interval for the mean values of biparietal diameter, anteroposterior axis, vertical axis, and total brain volume by post-menstrual age. A TBV prediction table based on the three axes is proposed to enable easy implementation of TBV estimation in routine 2D US during admission in the NICU. Conclusions: US measurements of biparietal diameter, vertical axis, and anteroposterior axis are reliable. TBV segmented through 3D US is comparable to MRI estimated TBV. 2D US accurate estimation of TBV is possible through biparietal diameter, vertical, and anteroposterior axes.
Collapse
Affiliation(s)
- Isabel Benavente-Fernández
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, Cádiz, Spain.,Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain
| | - Estefanía Ruiz-González
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Simón Pedro Lubián-Fernández
- Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain
| | - Yunior Cabrales Fontela
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, Cádiz, Spain
| | - Cristina Roca-Cornejo
- Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain
| | - Pedro Olmo-Duran
- Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain
| | - Simón Pedro Lubián-López
- Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, Cádiz, Spain.,Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, Cádiz, Spain
| |
Collapse
|
6
|
Morken TS, Dammann O, Skranes J, Austeng D. Retinopathy of prematurity, visual and neurodevelopmental outcome, and imaging of the central nervous system. Semin Perinatol 2019; 43:381-389. [PMID: 31174874 DOI: 10.1053/j.semperi.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent findings indicate that retinopathy of prematurity (ROP), presently classified by clinical examinations of retinal vascular tissue, is associated with structural alterations of the central nervous system. Such alterations may be the correlate of the association between ROP and impaired long-term neurocognitive and visual development. The advent of imaging techniques such as structural and diffusion tensor magnetic resonance imaging of the brain, and optical coherence tomography of the retina, will allow the complete visual system to be characterized in greater detail. It has been suggested that ROP may be not only a vascular, but a neurovascular disease, being part of a spectrum that includes pathological development in both the retinal and cerebral neurovascular interphase. We review the present knowledge in the field and point to future directions for research to tackle these questions.
Collapse
Affiliation(s)
- Tora Sund Morken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norway and Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Olaf Dammann
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Jon Skranes
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway; Department of Child Neurology and Rehabilitation and Regional Competence Center for children with prenatal alcohol/drug exposure, Sørlandet Hospital, Arendal, Norway
| | - Dordi Austeng
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norway and Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
7
|
Wirth M, Naud A, Schmitt E, Clerc-Urmès I, Hascoët JM. Visual Maturation at Term Equivalent Age in Very Premature Infants According to Factors Influencing Its Development. Front Physiol 2018; 9:1649. [PMID: 30515105 PMCID: PMC6255895 DOI: 10.3389/fphys.2018.01649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction: Visual impairment is a concern in premature infants as perinatal factors may alter maturation during visual development. This observational study aimed at evaluating visual maturation at term equivalent age and factors associated with impaired visual maturation. Methods: Infants born before 32 weeks’ gestation were evaluated with routine brain MRI, visual acuity, refraction, fundus, and clinical eye examination. Environmental factors were collected from infant’s files. Results: Fifty-four infants (29.5 ± 1.7 weeks’ gestation, birth weight 1194 ± 288 g) were studied at term equivalent age. Visual acuity was higher in premature infants at term equivalent age than in a reference publication with the same method in term newborns at birth (1.54 ± 0.67 vs. 0.99 ± 0.40 cycles/degree, p = 0.008). In multivariate analysis, abnormal brain MRI was the only factor associated with visual acuity (r2= 0.203; p = 0.026). Incomplete retinal vascularization was observed in 29/53 of infants at term equivalent age and associated with MRI abnormalities of the posterior fossa (p = 0.027) and larger refractive sphere difference between both eyes (1.2 ± 0.8 vs. 0.6 ± 0.4 diopters; p = 0.0005). Retinopathy of prematurity was associated with indices of smaller cerebral volume (p = 0.035). Conclusion: Higher visual acuity in premature infants at term equivalent age than in term newborns at birth may be related to longer visual experience from birth. Lower visual acuity was correlated with abnormal MRI in preterm infants at term equivalent age.
Collapse
Affiliation(s)
- Maëlle Wirth
- Department of Neonatology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,EA 3450 DevAH, University of Lorraine, Nancy, France
| | - Aurélie Naud
- Department of Neonatology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Emmanuelle Schmitt
- Department of Neuroradiology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Isabelle Clerc-Urmès
- PARC Clinical Research Support Facility, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Jean-Michel Hascoët
- Department of Neonatology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,EA 3450 DevAH, University of Lorraine, Nancy, France
| |
Collapse
|
8
|
Morsing E, Malova M, Kahn A, Lätt J, Björkman-Burtscher IM, Maršál K, Ley D. Brain Volumes and Developmental Outcome in Childhood Following Fetal Growth Restriction Leading to Very Preterm Birth. Front Physiol 2018; 9:1583. [PMID: 30505278 PMCID: PMC6250887 DOI: 10.3389/fphys.2018.01583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Children born very preterm (PT) after fetal growth restriction (FGR) exhibit cognitive impairment at early school age. The relationship between neurodevelopmental impairment and attained regional brain volumes is unknown. Methods: We studied 23 preterm children with FGR (PT-FGR), 24 matched preterm children AGA (PT-AGA), and 27 matched term AGA children (T-AGA) by measuring brain volumes with magnetic resonance imaging at early school age. Cognitive and motor functions were assessed by the Wechsler Intelligence Scales for Children and the ABC-Movement score. Results: The mean (SD) full-scale IQ was 80 (17) in the PT-FGR group and 103 (12) in the PT-AGA group (p < 0.001). The PT-FGR group had lower mean total, gray matter, white matter, thalamic, cerebellar white matter, and hippocampal volumes as compared to the T-AGA group (p = 0.01, 0.04, 0.003, 0.002, 0.001, and 0.009, respectively). Brain volumes did not differ significantly between the PT groups. Reduction of hippocampal volume correlated with degree of growth restriction at birth (r = 0.46, p = 0.05). Neither the full-scale IQ nor the ABC movement score <5th percentile were related to brain volumes. Conclusion: Brain volumes as determined by MRI at early school age were primarily associated with degree of prematurity at birth and less with FGR. Regional brain volumes did not discriminate cognitive and motor function beyond that predicted by gestational age at birth.
Collapse
Affiliation(s)
- Eva Morsing
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mariya Malova
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Anna Kahn
- Department of Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Department of Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Karel Maršál
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - David Ley
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|