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Vitaliti G, Falsaperla R. Chorioamnionitis, Inflammation and Neonatal Apnea: Effects on Preterm Neonatal Brainstem and on Peripheral Airways: Chorioamnionitis and Neonatal Respiratory Functions. CHILDREN-BASEL 2021; 8:children8100917. [PMID: 34682182 PMCID: PMC8534519 DOI: 10.3390/children8100917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
Background: The present manuscript aims to be a narrative review evaluating the association between inflammation in chorioamnionitis and damage on respiratory centers, peripheral airways, and lungs, explaining the pathways responsible for apnea in preterm babies born by delivery after chorioamnionitis. Methods: A combination of keywords and MESH words was used, including: "inflammation", "chorioamnionitis", "brainstem", "cytokines storm", "preterm birth", "neonatal apnea", and "apnea physiopathology". All identified papers were screened for title and abstracts by the two authors to verify whether they met the proper criteria to write the topic. Results: Chorioamnionitis is usually associated with Fetal Inflammatory Response Syndrome (FIRS), resulting in injury of brain and lungs. Literature data have shown that infections causing chorioamnionitis are mostly associated with inflammation and consequent hypoxia-mediated brain injury. Moreover, inflammation and infection induce apneic episodes in neonates, as well as in animal samples. Chorioamnionitis-induced inflammation favors the systemic secretion of pro-inflammatory cytokines that are involved in abnormal development of the respiratory centers in the brainstem and in alterations of peripheral airways and lungs. Conclusions: Preterm birth shows a suboptimal development of the brainstem and abnormalities and altered development of peripheral airways and lungs. These alterations are responsible for reduced respiratory control and apnea. To date, mostly animal studies have been published. Therefore, more clinical studies on the role of chorioamninitis-induced inflammation on prematurity and neonatal apnea are necessary.
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Affiliation(s)
- Giovanna Vitaliti
- Unit of Pediatrics, Department of Medical Sciences, Section of Pediatrics, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-34-0471-0614
| | - Raffaele Falsaperla
- Pediatrics and Pediatric Emergency Operative Unit, Azienda Ospedaliero Universitaria Policlinico G.Rodolico-San Marco, San Marco Hospital, University of Catania, 95124 Catania, Italy;
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Policlinico G.Rodolico-San Marco, San Marco Hospital, San Marco Hospital, University of Catania, 95124 Catania, Italy
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Mohammed ST, El-Farrash RA, Taha HM, Moustafa OA. Auditory Brainstem Evoked Response Patterns in the Neonatal Intensive Care Unit. Am J Perinatol 2021; 38:e231-e238. [PMID: 32276280 DOI: 10.1055/s-0040-1709467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Delayed maturation of auditory brainstem pathway in neonates admitted to the neonatal intensive care unit (NICU) may lead to misdiagnosis of children with normal peripheral hearing and inappropriate use of amplification devices. The aim of this study is to determine the pattern of auditory brain stem response in neonates admitted to the NICU for proper hearing assessment in this high-risk population. STUDY DESIGN This prospective study was conducted on 1,469 infants who were admitted to the NICU, of which 1,423 had one or more risk factors for permanent congenital hearing loss and were screened with automated auditory brain stem response (AABR). A total of 60 infants were referred for diagnostic ABR analysis after failure on AABR screening. The control group comprised 60 well-baby nursery neonates with no risk factors for PCHL. RESULTS Mean values of absolute latencies of waves III and V; interpeak latencies I-III, III-V, and I-V; amplitude of waves I, and V; and I/V amplitude ratio at 90 dBnHL measured for the right and left ears at 1 and 3 months of age show significant difference in NICU neonates compared with controls (p < 0.05). All the diagnostic ABR measurements significantly improved at the age of 3 months (p < 0.001) except wave I absolute latency of both groups (p > 0.05). Significant correlations were found between ABR readings at the age of 1 and 3 months and the gestational age of the NICU neonates (p < 0.05). CONCLUSION Diagnostic ABR findings in NICU neonates suggested delayed maturation of the auditory brainstem pathway with a great impact of gestational age on this maturation. Auditory maturational changes were observed at 3 months of age of patient and control groups.
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Affiliation(s)
| | - Rania Ali El-Farrash
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kasapoğlu I, Çetinkaya Demir B, Atalay MA, Orhan A, Özkan H, Çakır SC, Tütüncü Toker R, Kasapoğlu F, Özerkan K. Does antenatal magnesium sulphate improve hearing function in premature newborns? J Turk Ger Gynecol Assoc 2020; 21:187-192. [PMID: 31927812 PMCID: PMC7495126 DOI: 10.4274/jtgga.galenos.2019.2019.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/02/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate whether antenatal magnesium sulphate (MgSO4) exposure has a neuroprotective effect against hearing impairment in premature newborns. Material and Methods Retrospective cohort study was performed with prematurely (<37 weeks) delivered newborns at a tertiary university hospital. Newborns of 92 women who received MgSO4 infusions (study group) for various indications were compared to newborns of 147 women who did not receive MgSO4 infusions (control group). All eligible premature newborn underwent hearing screening by auditory brainstem response (ABR) testing before being discharged from the hospital. Results The fail rate for ABR hearing screening was 3.3% (n=3) in the study group and 10.9% (n=16) in the control group (p=0.034). The rate of concurrent use of betamethasone was higher in the study group (72.8%; n=67) compared to control group (29.2%; n=43) (p<0.001). Other neonatal parameters, such as the number of neonates who were small for gestational age and the rate of microcephaly were similar between the groups (p=0.54, p=0.48, respectively). After adjusting for co-variates including the use of betamethasone and gestational age at delivery, no statistically significant association between antenatal administration of MgSO4 and ABR fail rates were found (p=0.07). Conclusion These results do not suggest a significant benefit in terms of hearing impairment in premature newborns when antenatal MgSO4 infusion was given.
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Affiliation(s)
- Işıl Kasapoğlu
- Department of Obstetrics and Gynecology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Bilge Çetinkaya Demir
- Department of Obstetrics and Gynecology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Mehmet Aral Atalay
- Department of Obstetrics and Gynecology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Adnan Orhan
- Department of Obstetrics and Gynecology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Hilal Özkan
- Department of Pediatrics, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Salih Cağrı Çakır
- Department of Pediatrics, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Rabia Tütüncü Toker
- Department of Pediatrics, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Fikret Kasapoğlu
- Department of Otorhinolaryngology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Kemal Özerkan
- Department of Obstetrics and Gynecology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
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Stojanovska V, Miller SL, Hooper SB, Polglase GR. The Consequences of Preterm Birth and Chorioamnionitis on Brainstem Respiratory Centers: Implications for Neurochemical Development and Altered Functions by Inflammation and Prostaglandins. Front Cell Neurosci 2018; 12:26. [PMID: 29449803 PMCID: PMC5799271 DOI: 10.3389/fncel.2018.00026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022] Open
Abstract
Preterm birth is a major cause for neonatal morbidity and mortality, and is frequently associated with adverse neurological outcomes. The transition from intrauterine to extrauterine life at birth is particularly challenging for preterm infants. The main physiological driver for extrauterine transition is the establishment of spontaneous breathing. However, preterm infants have difficulty clearing lung liquid, have insufficient surfactant levels, and underdeveloped lungs. Further, preterm infants have an underdeveloped brainstem, resulting in reduced respiratory drive. These factors facilitate the increased requirement for respiratory support. A principal cause of preterm birth is intrauterine infection/inflammation (chorioamnionitis), and infants with chorioamnionitis have an increased risk and severity of neurological damage, but also demonstrate impaired autoresuscitation capacity and prevalent apnoeic episodes. The brainstem contains vital respiratory centers which provide the neural drive for breathing, but the impact of preterm birth and/or chorioamnionitis on this brain region is not well understood. The aim of this review is to provide an overview of the role and function of the brainstem respiratory centers, and to highlight the proposed mechanisms of how preterm birth and chorioamnionitis may affect central respiratory functions.
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Affiliation(s)
- Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University and Hudson Institute of Medical Research, Melbourne, VIC, Australia
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Leung JC, Cifra CL, Agthe AG, Sun CCJ, Viscardi RM. Antenatal factors modulate hearing screen failure risk in preterm infants. Arch Dis Child Fetal Neonatal Ed 2016. [PMID: 26195624 DOI: 10.1136/archdischild-2014-307843] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to characterise the effects of antenatal inflammatory factors and maternal therapies on neonatal hearing screen outcomes in very low birthweight infants. METHODS We conducted a retrospective study of a cohort of infants <33 weeks' gestational age and <1501 g birth weight prospectively enrolled between 1999 and 2003 for whom placental pathology, cord blood interleukin (IL) 6, IL-1ß, tumour necrosis factor-α and neonatal hearing screen results were available. RESULTS Of 289 infants with documented hearing screen results, 244 (84%) passed and 45 (16%) failed the hearing screen (unilateral, N=25 (56%); bilateral, N=20 (44%)). In the final logistic model, the fetal inflammatory response syndrome defined as the presence of fetal vasculitis and/or cord serum IL-6>18.2 pg/mL was the factor with greatest risk for hearing screen failure (OR 3.62, 95% CI 1.38 to 9.5). A patent ductus arteriosus treated with indomethacin significantly increased the risk (OR 3.3, 95% CI 1.3 to 8.26), while combined maternal steroid and magnesium sulfate exposure (0.37, 95% CI 0.11 to 0.81) reduced the risk for hearing screen failure. CONCLUSIONS Intrauterine infection with a fetal inflammatory response is a risk factor for neonatal hearing loss while maternal therapies significantly reduced the risk of neonatal hearing loss in very low birthweight infants.
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Affiliation(s)
- Jocelyn C Leung
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christina L Cifra
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alexander G Agthe
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chen-Chih J Sun
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Choudhury V, Amin SB, Agarwal A, Srivastava LM, Soni A, Saluja S. Latent iron deficiency at birth influences auditory neural maturation in late preterm and term infants. Am J Clin Nutr 2015; 102:1030-4. [PMID: 26310540 DOI: 10.3945/ajcn.115.113084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In utero latent iron deficiency has been associated with abnormal neurodevelopmental outcomes during childhood. Its concomitant effect on auditory neural maturation has not been well studied in late preterm and term infants. OBJECTIVE The objective was to determine whether in utero iron status is associated with auditory neural maturation in late preterm and term infants. DESIGN This prospective cohort study was performed at Sir Ganga Ram Hospital, New Delhi, India. Infants with a gestational age ≥34 wk were eligible unless they met the exclusion criteria: craniofacial anomalies, chromosomal disorders, hemolytic disease, multiple gestation, third-trimester maternal infection, chorioamnionitis, toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex virus infections (TORCH), Apgar score <5 at 5 min, sepsis, cord blood not collected, or auditory evaluation unable to be performed. Sixty consecutive infants with risk factors for iron deficiency, such as small for gestational age and maternal diabetes, and 30 without risk factors for iron deficiency were enrolled. Absolute wave latencies and interpeak latencies, evaluated by auditory brainstem response within 48 h after birth, were measured and compared between infants with latent iron deficiency (serum ferritin ≤75 ng/mL) and infants with normal iron status (serum ferritin >75 ng/mL) at birth. RESULTS Twenty-three infants had latent iron deficiency. Infants with latent iron deficiency had significantly prolonged wave V latencies (7.10 ± 0.68 compared with 6.60 ± 0.66), III-V interpeak latencies (2.37 ± 0.64 compared with 2.07 ± 0.33), and I-V interpeak latencies (5.10 ± 0.57 compared with 4.72 ± 0.56) compared with infants with normal iron status (P < 0.05). This difference remained significant on regression analyses after control for confounders. No difference was noted between latencies I and III and interpeak latencies I-III. CONCLUSION Latent iron deficiency is associated with abnormal auditory neural maturation in infants at ≥34 wk gestational age. This trial was registered at clinicaltrials.gov as NCT02503397.
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Affiliation(s)
| | - Sanjiv B Amin
- Department of Pediatrics, Division of Neonatology, University of Rochester, Rochester, NY
| | - Asha Agarwal
- Department of Otorhinology and Cochlear Implant Unit, and
| | - L M Srivastava
- Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India; and
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Greminger AR, Mayer-Pröschel M. Identifying the threshold of iron deficiency in the central nervous system of the rat by the auditory brainstem response. ASN Neuro 2015; 7:7/1/1759091415569911. [PMID: 25732706 PMCID: PMC4366421 DOI: 10.1177/1759091415569911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The deleterious effects of anemia on auditory nerve (AN) development have been well investigated; however, we have previously reported that significant functional consequences in the auditory brainstem response (ABR) can also occur as a consequence of marginal iron deficiency (ID). As the ABR has widespread clinical use, we evaluated the ability of this electrophysiological method to characterize the threshold of tissue ID in rats by examining the relationship between markers of tissue ID and severity of ABR latency defects. To generate various levels of ID, female Long-Evans rats were exposed to diets containing sufficient, borderline, or deficient iron (Fe) concentrations throughout gestation and offspring lifetime. We measured hematological indices of whole body iron stores in dams and offspring to assess the degree of ID. Progression of AN ID in the offspring was measured as ferritin protein levels at different times during postnatal development to complement ABR functional measurements. The severity of ABR deficits correlated with the level of Fe restriction in each diet. The sufficient Fe diet did not induce AN ID and consequently did not show an impaired ABR latency response. The borderline Fe diet, which depleted AN Fe stores but did not cause systemic anemia resulted in significantly increased ABR latency isolated to Peak I.The low Fe diet, which induced anemia and growth retardation, significantly increased ABR latencies of Peaks I to IV. Our findings indicate that changes in the ABR could be related to various degrees of ID experienced throughout development.
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Affiliation(s)
- Allison R. Greminger
- Department of Environmental Medicine, University of Rochester, Rochester, NY, USA
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Amin SB, Vogler-Elias D, Orlando M, Wang H. Auditory neural myelination is associated with early childhood language development in premature infants. Early Hum Dev 2014; 90:673-8. [PMID: 25194836 PMCID: PMC4301398 DOI: 10.1016/j.earlhumdev.2014.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Auditory neural myelination (ANM) as evaluated by auditory brainstem evoked response (ABR) during the neonatal period has been used as a surrogate outcome for long-term neurodevelopment. The validity of ANM as a surrogate outcome for long-term neurodevelopment has not been well studied. AIM Evaluate the association of ABR I-V interpeak latency (IPL), an index of ANM, at 35 week postmenstrual age (PMA) with language outcome at 3 years of age. DESIGN Prospective study. SUBJECTS 24-33 week gestational age (GA) infants were eligible if they did not meet exclusion criteria: craniofacial malformation, chromosomal disorders, deafness, auditory dys-synchrony, TORCH infection, or non-English speaking parents. Infants with malignancy, head injury, encephalopathy, meningitis, blindness, or who died or relocated were also excluded. OUTCOME MEASURES ABRs were performed at 35 week PMA using 80 dB nHL and I-V IPL (ms) measured. Auditory Comprehension (AC) and Expressive Communication (EC) were evaluated by a speech-language pathologist at 3 years of age using Preschool Language Scale. RESULTS Eighty infants were studied. The mean GA and birth weight of infants were 29.2 weeks and 1336 g, respectively. There was association of worse ear I-V IPL and better ear I-V IPL with AC (Coefficient-5.4, 95% CI: -9.8 to -0.9 and Coefficient-5.5, 95% CI: -10 to-0.9, respectively) and EC (Coefficient-5.6, 95% CI: -9.5 to-1.8 and Coefficient-6.7, 95% CI: -10.6 to-2.7, respectively) after controlling for confounders. CONCLUSION The neonatal I-V IPL is a predictor of language development at 3 years of age in preterms.
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Affiliation(s)
- Sanjiv B. Amin
- Department of Pediatrics, Division of Neonatology, The University of Rochester School of Medicine and Dentistry and Nazarath College
| | - Dawn Vogler-Elias
- Department of Otolaryngology and Department of Audiology, The University of Rochester School of Medicine and Dentistry and Nazarath College
| | - Mark Orlando
- Department of Otolaryngology and Department of Audiology, The University of Rochester School of Medicine and Dentistry and Nazarath College
| | - Hongyue Wang
- Department of Biostatistics, The University of Rochester School of Medicine and Dentistry and Nazarath College
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Church MW, Adams BR, Anumba JI, Jackson DA, Kruger ML, Jen KLC. Repeated antenatal corticosteroid treatments adversely affect neural transmission time and auditory thresholds in laboratory rats. Neurotoxicol Teratol 2011; 34:196-205. [PMID: 21963399 DOI: 10.1016/j.ntt.2011.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 12/12/2022]
Abstract
Antenatal corticosteroid (AC) treatment is given to pregnant women at risk for preterm birth to reduce infant morbidity and mortality by enhancing lung and brain maturation. However, there is no accepted regimen on how frequently AC treatments should be given and some studies found that repeated AC treatments can cause growth retardation and brain damage. Our goal was to assess the dose-dependent effects of repeated AC treatment and estimate the critical number of AC courses to cause harmful effects on the auditory brainstem response (ABR), a sensitive measure of brain development, neural transmission and hearing loss. We hypothesized that repeated AC treatment would have harmful effects on the offspring's ABRs and growth only if more than 3 AC treatment courses were given. To test this hypothesis, pregnant Wistar rats were given either a high regimen of AC (HAC), a moderate regimen (MAC), a low regimen (LAC), or saline (SAL). An untreated control (CON) group was also used. Simulating the clinical condition, the HAC dams received 0.2mg/kg Betamethasone (IM) twice daily for 6 days during gestation days (GD) 17-22. The MAC dams received 3 days of AC treatment followed by 3 days of saline treatment on GD 17-19 and GD 20-22, respectively. The LAC dams received 1 day of AC treatment followed by 5 days of saline treatment on GD 17 and GD 18-22, respectively. The SAL dams received 6 days of saline treatment from GD 17 to 22 (twice daily, isovolumetric to the HAC injections, IM). The offspring were ABR-tested on postnatal day 24. Results indicated that the ABR's P4 latencies (neural transmission time) were significantly prolonged (worse) in the HAC pups and that ABR's thresholds were significantly elevated (worse) in the HAC and MAC pups when compared to the CON pups. The HAC and MAC pups were also growth retarded and had higher postnatal mortality than the CON pups. The SAL and LAC pups showed little or no adverse effects. In conclusion, repeated AC treatment had harmful effects on the rat offspring's ABRs, postnatal growth and survival. The prolonged ABR latencies reflect slowed neural transmission times along the auditory nerve and brainstem auditory pathway. The elevated ABR thresholds reflect hearing deficits. We concluded that repeated AC treatment can have harmful neurological, sensory and developmental effects on the rat offspring. These effects should be considered when weighing the benefits and risks of repeated AC treatment and when monitoring and managing the prenatally exposed child for possible adverse effects.
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Affiliation(s)
- M W Church
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Church MW, Wapner RJ, Mele LM, Johnson F, Dudley DJ, Spong CY, Peaceman AM, Moawad AH, O’Sullivan MJ, Miodovnik M. Repeated courses of antenatal corticosteroids: are there effects on the infant's auditory brainstem responses? Neurotoxicol Teratol 2010; 32:605-10. [PMID: 20553856 PMCID: PMC2955992 DOI: 10.1016/j.ntt.2010.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 05/04/2010] [Accepted: 05/20/2010] [Indexed: 11/17/2022]
Abstract
Our objective was to assess the effects of repeated antenatal corticosteroid treatments on the neonatal auditory brainstem response (ABR), a sensitive measure of neonatal brain maturity and auditory function. To achieve this, we performed and blindly evaluated neonatal ABRs on a subset of infants delivering within a multicenter randomized placebo-controlled clinical trial comparing single versus repeated courses of antenatal corticosteroid treatments for women at 23-31 weeks gestation who remained at increased risk for preterm birth. The women were randomly assigned to either the single or the repeated antenatal corticosteroid treatment group. Women in the repeated antenatal corticosteroid group received weekly antenatal corticosteroid treatments until 34 weeks gestation or until they reached a study-determined limited number of courses, whereas women in the single antenatal corticosteroid group received an initial course of corticosteroid followed by weekly placebo injections. We performed ABR testing on their infants prior to discharge. The latencies of waves I, III and V and the peak-to-trough amplitudes of waves I and V were compared between those in the single (n=27) and repeated antenatal corticosteroid treatment (n=24) groups. The majority of repeated antenatal corticosteroid infants (20 of 24) were exposed to ≥ 4 antenatal corticosteroid treatments. Even though gestational age was similar between our subset of single and repeated antenatal corticosteroid treatment groups, infant birth weight and length and head circumference were significantly smaller in the repeated antenatal corticosteroid group (p <0.05). Despite these differences in birth sizes, there were no significant group differences in the ABR wave latencies or amplitudes. We concluded that our repeated antenatal corticosteroid treatments, in comparison to a single treatment, did not significantly benefit or harm the neonatal ABR despite significant effects on birth size.
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Affiliation(s)
- Michael W. Church
- Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Ronald J. Wapner
- Obstetrics & Gynecology, Drexel University College of Medicine, Philadelphia, PA 19103, USA
| | - Lisa M. Mele
- The George Washington University Biostatistics Center, Rockville, MD 20852, USA
| | - Francee Johnson
- Obstetrics & Gynecology, Ohio State University, Columbus, OH 43210, USA
| | - Donald J. Dudley
- Obstetrics & Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| | - Catherine Y. Spong
- National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - Alan M. Peaceman
- Obstetrics & Gynecology, Northwestern University, Chicago, IL 60611, USA
| | - Atef H. Moawad
- Obstetrics & Gynecology, University of Chicago, Chicago, IL 60637, USA
| | | | - Menachem Miodovnik
- Obstetrics & Gynecology, University of Cincinnati, Cincinnati, OH 45267, USA
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Amin SB, Wang H. Histologic chorioamnionitis and acute neurologic impairment in premature infants. J Matern Fetal Neonatal Med 2010; 23:1165-71. [PMID: 20350238 DOI: 10.3109/14767050903580383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if histologic chorioamnionitis is associated with acute neurologic impairment as evaluated by auditory brainstem response in premature infants. METHODS A prospective study was performed to compare auditory neural function at birth between premature infants with maternal histologic chorioamnionitis and infants without maternal histologic chorioamnionitis. Our inclusion criteria was 28-33 weeks gestational age (GA) infants who had maternal placental histopathology performed. Infants with toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex (TORCH) infections, chromosomal disorders, cranio-facial anomalies and/or unstable condition were excluded. Bilateral monaural auditory brainstem evoked responses were performed using 80 dB nHL click stimuli at a repetition rate of 29.9/s within 48 h after birth. RESULTS Of 101 infants who met study criteria, 29 infants were born with history of maternal histologic chorioamnionitis. There were no significant differences between infants with histologic chorioamnionitis and infants without histologic chorioamnionitis in perinatal factors except for GA, pregnancy induced hypertension, and exposure to antenatal magnesium sulphate. After controlling for confounders, histologic chorioamnionitis was not associated with prolonged absolute wave latencies I, III, and V and/or decreased frequency of mature auditory waveform compared to infants without histologic chorioamnionitis. CONCLUSION Histologic chorioamnionitis is not associated with neurologic impairment at birth in premature infants.
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Affiliation(s)
- Sanjiv B Amin
- Division of Neonatology, Department of Pediatrics, The University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Amin SB, Orlando M, Eddins A, MacDonald M, Monczynski C, Wang H. In utero iron status and auditory neural maturation in premature infants as evaluated by auditory brainstem response. J Pediatr 2010; 156:377-81. [PMID: 19939407 PMCID: PMC2827634 DOI: 10.1016/j.jpeds.2009.09.049] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 08/14/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether cord ferritin (CF) concentration, an index of in utero iron status, is associated with auditory neural maturation in premature infants. STUDY DESIGN A prospective cohort study was performed to compare auditory neural maturation in infants with latent iron deficiency (CF 11-75 ng/mL) and infants with normal iron status (CF > 75 ng/mL) at birth. Our inclusion criteria were infants of 27-33 weeks gestational age who were admitted to the neonatal intensive care unit between July 2007 and November 2008 within 12 hours after birth and had cord blood collected. Infants with TORCH infections (toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex), chromosomal disorders, craniofacial anomalies, culture-proven sepsis, and/or unstable conditions were excluded. CF level was measured using a chemiluminescence immunoassay method. Bilateral monaural auditory brainstem evoked response (ABR) was assessed using 80-dB nHL click stimuli at a repetition rate of 29.9/seconds within 48 hours after birth. RESULTS Of the 80 infants studied, 35 had latent iron deficiency. After controlling for confounders, the infants with latent iron deficiency had significantly prolonged absolute wave latencies I, III, and V and decreased frequency of mature ABR waveforms compared with the infants with normal iron status. CONCLUSION Premature infants with in utero latent iron deficiency have abnormal auditory neural maturation compared with infants with normal in utero iron status.
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Affiliation(s)
- Sanjiv B. Amin
- Department of Pediatrics, Division of Neonatology, The University of Rochester School of Medicine and Dentistry
| | - Mark Orlando
- Department of Otolaryngology and Department of Audiology, The University of Rochester School of Medicine and Dentistry
| | - Ann Eddins
- Department of Otolaryngology and Department of Audiology, The University of Rochester School of Medicine and Dentistry
| | - Matthew MacDonald
- Department of Otolaryngology and Department of Audiology, The University of Rochester School of Medicine and Dentistry
| | - Christy Monczynski
- Department of Otolaryngology and Department of Audiology, The University of Rochester School of Medicine and Dentistry
| | - Hongye Wang
- Department of Biostatistics, The University of Rochester School of Medicine and Dentistry
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Differences in impaired brainstem conduction between neonatal chronic lung disease and perinatal asphyxia. Clin Neurophysiol 2010; 121:725-33. [PMID: 20097607 DOI: 10.1016/j.clinph.2009.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 11/06/2009] [Accepted: 12/08/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore any differences in impaired brainstem function between preterm infants with neonatal chronic lung disease (CLD) and term infants after perinatal asphyxia. METHODS Brainstem auditory evoked responses (BAERs) collected using maximum length sequence (MLS) technique were compared at term equivalent age between 43 CLD infants and 117 asphyxiated infants. RESULTS In both CLD and asphyxiated infants there was a significant increase in wave V latency and I-V interval in MLS BAER. CLD infants showed a significant increased III-V interval but a normal I-III interval at all click rates. However, asphyxiated infants showed a significant increase in both III-V and I-III intervals. I-III interval was shorter and III-V/I-III interval ratio was greater in CLD infants than in asphyxiated infants. The slope of I-III interval-rate function was steeper in asphyxiated infants than in CLD infants, while the slope of III-V/I-III interval ratio-rate function was the other way around. CONCLUSIONS CLD infants had a major increase in more central components of MLS BAER, without appreciable abnormality in more peripheral components. However, asphyxiated infants had a significant increase in both central and peripheral components. SIGNIFICANCE Neonatal CLD affects more central regions of the brainstem, whereas perinatal asphyxia affects both peripheral and central regions. This difference, which is likely related to the different nature of hypoxia in CLD and asphyxia, may have some significance for neuroprotective interventions for the two problems.
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Jiang ZD, Brosi DM, Chen C, Wilkinson AR. Impairment of perinatal hypoxia-ischemia to the preterm brainstem. J Neurol Sci 2009; 287:172-7. [PMID: 19735922 DOI: 10.1016/j.jns.2009.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 07/31/2009] [Indexed: 11/17/2022]
Abstract
Hypoxia-ischemia is a major perinatal problem that results in severe damage to the newborn brain. This study assessed functional integrity of the brainstem at term in preterm infants after perinatal hypoxia-ischemia to shed light on the influence of hypoxia-ischemia on the preterm brainstem. We recruited sixty-eight preterm infants after perinatal hypoxia-ischemia, ranging in gestation 28-35 weeks. Brainstem evoked response was studied at term age (37-42 weeks postconceptional age) with 91-910/s clicks using the maximum length sequence technique. Compared with healthy preterm infants, the preterm infants after perinatal hypoxia-ischemia showed a significant increase in I-V interval at very high rates 455 and 910/s of clicks (P<0.05, 0.05). III-V interval and III-V/I-III interval ratio also increased significantly at 455 and 910/s (P<0.05-0.01). The slope of III-V interval-rate function was significantly steeper than in the healthy preterm infants (P<0.05). Compared with normal term controls, the preterm infants after hypoxia-ischemia showed similar, but slightly more significant, abnormalities. The differences between the preterm infants after hypoxia-ischemia and the healthy preterm and term infants generally increased with increasing click rate. These results demonstrated that central components of brainstem auditory evoked response were abnormal at very high click rates in the preterm infants after perinatal hypoxia-ischemia. Click rate-dependent change in the more central part of the brainstem is also abnormal. Apparently, functional integrity of the brainstem, mainly in the more central part, is impaired. Hypoxic-ischemic damage to the preterm brainstem is unlikely to completely recover within a relatively short period after the insult, which is of clinical importance.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Shanghai Medical University, Shanghai, China.
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Abstract
AIM To characterize age-related changes in brainstem auditory evoked response (BAER) at different click rates from neonates to adults. METHODS BAER was studied at repetition rates 11-91/sec of clicks in 165 normal neonates and children of various ages and 29 young adults. RESULTS BAER wave latencies and inter-peak intervals increased linearly with increasing click rate at all ages. The younger was the age, the greater were BAER click rate-dependent changes. At 9 months and younger, the slopes of latency- and interval-rate functions were all significantly greater than in the adults (all p < 0.01). The slopes of wave I latency- and I-III interval-rate functions at 1-2 years and older were similar to those in adults. The slopes of wave III and V latency-rate functions and I-V and III-V interval-rate function at 3-4 years and older did not differ significantly from those in adults. CONCLUSION BAER is affected by stimulus rate more in younger children than in the older. Adult-like rate-dependent changes are reached at 1-2 years for wave I latency and I-III interval, and 3-4 years for wave III and V latencies and I-V and III-V intervals. Our BAER data at different click rates provide normal references for subjects of various ages.
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Affiliation(s)
- Ze Dong Jiang
- Department of Paediatrics, Children's Hospital, Fudan University, Shanghai, China.
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Jiang ZD, Brosi DM, Wilkinson AR. Depressed brainstem auditory electrophysiology in preterm infants after perinatal hypoxia–ischaemia. J Neurol Sci 2009; 281:28-33. [DOI: 10.1016/j.jns.2009.02.378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 02/26/2009] [Accepted: 02/26/2009] [Indexed: 11/16/2022]
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Abstract
UNLABELLED Few therapies in perinatal medicine have created as much controversy as corticosteroids. Despite five decades of extensive research and practice, major areas of uncertainty remain. In this article, we review the most current evidence on both antenatal and postnatal therapy. CONCLUSION Overall, it is clear that we must continue to investigate the most appropriate doses of the ideal preparation in the most appropriate target populations before we can let the steroid issues rest.
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Affiliation(s)
- S Eventov-Friedman
- Department of Neonatology, Kaplan Medical Center, Rehovot and Hebrew University, Jerusalem, Israel
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Abstract
OBJECTIVE We sought to evaluate neonatal hearing assessment by the otoacoustic emission (OAE) test in very low birth weight (VLBW) infants exposed to antenatal steroids. STUDY DESIGN This is a retrospective cohort study of infants <1500 g delivered between July 1998 and July 2004 who completed hearing screens on discharge. All screens were performed by the OAE. Only infants who failed or passed the exam were included in the analysis. Infants with a partial or an inadequate exam were excluded. Neonates exposed to antenatal steroids were then compared to unexposed infants for the results of their OAE. RESULT A total of 68,000 deliveries were performed during the study period. There were 703 VLBW infants who had hearing exams, of which 548 (78%) passed the screen, 95 (14%) failed and 59 (8%) were indeterminate. Gestational age, birth weight, score for neonatal acute physiology and severe intraventricular hemorrhage were associated with a failed screen (P<0.01). Antenatal steroid exposure was not associated with a failed screen (odds ratio: 0.83 (95% confidence interval 0.5-1.4), P=0.43). CONCLUSION In our population, antenatal steroids were not associated with a positive or negative effect on hearing assessment of VLBW infants.
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Church MW. Effects of multiple courses of antenatal betamethasone on the auditory brainstem responses of premature infants. Pediatrics 2007; 120:450; author reply 450-1. [PMID: 17671076 DOI: 10.1542/peds.2007-1125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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