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Chirigos AJ, Ostrander B, Burton VJ, Mirecki M, Maitre NL. Prechtl's General Movements Assessment at writhing age guides MRI use in clinical implementation network. Pediatr Res 2024; 95:1188-1190. [PMID: 37919380 DOI: 10.1038/s41390-023-02856-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Allison J Chirigos
- Department of Pediatrics, University of Utah Hospital and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Betsy Ostrander
- Department of Pediatrics, University of Utah Hospital and Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Vera Joanna Burton
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
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2
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Rees P, Callan C, Chadda K, Vaal M, Diviney J, Sabti S, Harnden F, Gardiner J, Battersby C, Gale C, Sutcliffe A. School-age outcomes of children after perinatal brain injury: a systematic review and meta-analysis. BMJ Paediatr Open 2023; 7:e001810. [PMID: 37270200 PMCID: PMC10255042 DOI: 10.1136/bmjpo-2022-001810] [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] [Received: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Over 3000 children suffer a perinatal brain injury in England every year according to national surveillance. The childhood outcomes of infants with perinatal brain injury are however unknown. METHODS A systematic review and meta-analyses were undertaken of studies published between 2000 and September 2021 exploring school-aged neurodevelopmental outcomes of children after perinatal brain injury compared with those without perinatal brain injury. The primary outcome was neurodevelopmental impairment, which included cognitive, motor, speech and language, behavioural, hearing or visual impairment after 5 years of age. RESULTS This review included 42 studies. Preterm infants with intraventricular haemorrhage (IVH) grades 3-4 were found to have a threefold greater risk of moderate-to-severe neurodevelopmental impairment at school age OR 3.69 (95% CI 1.7 to 7.98) compared with preterm infants without IVH. Infants with perinatal stroke had an increased incidence of hemiplegia 61% (95% CI 39.2% to 82.9%) and an increased risk of cognitive impairment (difference in full scale IQ -24.2 (95% CI -30.73 to -17.67) . Perinatal stroke was also associated with poorer academic performance; and lower mean receptive -20.88 (95% CI -36.66 to -5.11) and expressive language scores -20.25 (95% CI -34.36 to -6.13) on the Clinical Evaluation of Language Fundamentals (CELF) assessment. Studies reported an increased risk of persisting neurodevelopmental impairment at school age after neonatal meningitis. Cognitive impairment and special educational needs were highlighted after moderate-to-severe hypoxic-ischaemic encephalopathy. However, there were limited comparative studies providing school-aged outcome data across neurodevelopmental domains and few provided adjusted data. Findings were further limited by the heterogeneity of studies. CONCLUSIONS Longitudinal population studies exploring childhood outcomes after perinatal brain injury are urgently needed to better enable clinicians to prepare affected families, and to facilitate targeted developmental support to help affected children reach their full potential.
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Affiliation(s)
- Philippa Rees
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Caitriona Callan
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karan Chadda
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Meriel Vaal
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - James Diviney
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Fergus Harnden
- Neonatal Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julian Gardiner
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Alastair Sutcliffe
- Population Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
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3
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Dell'Aversana V, Tofani M, Valente D. Emotional Regulation Interventions on Developmental Course for Preterm Children: A Systematic Review of Randomized Control Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030603. [PMID: 36980161 PMCID: PMC10047217 DOI: 10.3390/children10030603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to PRISMA guidelines. The literature screening was carried out on PUBMED, SCOPUS and WEB OF SCIENCE in August 2022. An author identified eligible studies based on predefined inclusion criteria and extracted the data. RCT quality was assessed using the JADAD and PEDro scales. We selected five RCTs for qualitative synthesis, having the common objective of evaluating the changes in emotional regulation after a rehabilitation intervention. Evidence of benefits was found after parent training intervention (PCIT; p < 0.05). Moreover, there was an improvement in day-to-day executive life and fewer behavioral problems after mindfulness intervention. Clinical, but not statistical, efficacy was found for the group-based physiotherapy intervention. In conclusion, parent training and mindfulness interventions can be helpful rehabilitation techniques, but the relatively small sample limited statistical power, so the discovery needs to be interpreted cautiously. Further research on these aspects is recommended.
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Affiliation(s)
- Vincenza Dell'Aversana
- MSc in Rehabilitaiton Sciences for Healthcare Professions, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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4
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Xuan C, Cui H, Jin Z, Yue Y, Cao S, Cui S, Xu D. Glutamine ameliorates hyperoxia-induced hippocampal damage by attenuating inflammation and apoptosis via the MKP-1/MAPK signaling pathway in neonatal rats. Front Pharmacol 2023; 14:1096309. [PMID: 36817145 PMCID: PMC9932780 DOI: 10.3389/fphar.2023.1096309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Glutamine (Gln) is an immunomodulatory protein that mediates oxidative stress, inflammation, and apoptosis, but has not been reported in the treatment of hyperoxia (Hyp)-induced brain injury. The aim of this study was to determine whether Gln could improve hyp-induced brain injury in neonatal rats to and later learning and memory dysfunction, and to explore its possible mechanisms. We prepared a model of neonatal rat brain injury caused by normobaric hyperoxia while administered with Gln for 7 days for evaluation. Learning memory function was assessed with the Morris water maze test. Histological analysis, protein expression analysis, oxidative stress and inflammation level analysis were performed using hippocampal tissue. Gln treatment significantly reduced brain tissue water content, oxidative stress levels, microglia activation and inflammatory factor expression, and attenuated tissue damage and apoptosis in the hippocampal region. Gln ameliorates hyp-induced learning, memory impairment in neonatal rats in water maze test. It also increased MKP-1 protein expression and decreased p-p38, p-ERK and p-JNK. Therefore, it is hypothesized that Gln may exert neuroprotective effects by increasing MKP-1 expression to negatively regulate MAPK signaling, with potential cognitive improvement in hyp-induced brain injury.
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Affiliation(s)
- Chouhui Xuan
- Department of Pediatrics, Yanbian University Hospital, Yanji, Jilin, China
| | - Haixia Cui
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, Jilin, China
| | - Zhengyong Jin
- Department of Pediatrics, Yanbian University Hospital, Yanji, Jilin, China
| | - Yuyang Yue
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
| | - Shuxia Cao
- Department of Center of Morphological Experiment, Yanbian University, Yanji, Jilin, China
| | - Songbiao Cui
- Department of Neurology, Yanbian University Hospital, Yanji, Jilin, China,*Correspondence: Songbiao Cui, ; Dongyuan Xu,
| | - Dongyuan Xu
- Key Laboratory of Cellular Function and Pharmacology of Jilin Province, Yanbian University, Yanji, China,*Correspondence: Songbiao Cui, ; Dongyuan Xu,
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5
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Lowe J, Fuller JF, Dempsey AG, Do B, Bann CM, Das A, Gustafson KE, Vohr BR, Hintz SR, Watterberg KL. Cortisol awakening response and developmental outcomes at 6-7 years in children born extremely preterm. Pediatr Res 2023; 93:689-695. [PMID: 35715492 PMCID: PMC9758271 DOI: 10.1038/s41390-022-02113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/17/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extremely preterm (EPT) birth has been related to dysregulation of stress responses and behavioral/learning problems at school age. Early adverse experiences can blunt HPA axis reactivity. We hypothesized that an attenuated cortisol awakening response would be associated with developmental and behavioral problems at school age in EPT children. METHODS This secondary analysis of a sub-cohort of the SUPPORT study included children born between 24 and 27 weeks, evaluated at 6-7 years with a neurodevelopmental battery and cortisol measures. Differences were tested between EPT and a term-born group. Relationships of cortisol awakening response to test scores were analyzed. RESULTS Cortisol was measured in 110 EPT and 29 term-born 6-7 year olds. Unadjusted WISC-IV and NEPSY-II scores were significantly worse among EPT children only. Conners Parent Rating Scale behavior scores were significantly worse among EPT children. After adjusting for covariates, blunted cortisol awakening responses were found to be associated with poorer scores on memory tests and greater problems with inattention for the EPT group (p < 0.05) only. CONCLUSIONS Among children born EPT, we identified an association of blunted cortisol awakening response with memory and inattention problems. This may have implications related to stress reactivity and its relationship to learning problems in children born EPT. CLINICALTRIALS GOV ID Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324. IMPACT In children born EPT, stress reactivity may have a relationship to learning problems. Cortisol awakening response should be a component for follow-up in EPT born children. Components of executive function, such as memory and attention, are related to stress reactivity.
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Affiliation(s)
- Jean Lowe
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Janell F Fuller
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Allison G Dempsey
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Barbara Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA
| | | | - Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Kristi L Watterberg
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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6
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Ho SS, Zhou Y, Rajderkar D. Intracranial Imaging of Preterm Infants with Suspected Hypoxic Ischemic Encephalopathy: Comparing MRI and Ultrasound. Curr Pediatr Rev 2023; 19:179-186. [PMID: 35440311 DOI: 10.2174/1573396318666220417233146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/25/2022] [Accepted: 02/15/2022] [Indexed: 02/08/2023]
Abstract
AIMS We correlate ultrasound, MRI, and clinical findings in neonates with suspected hypoxic ischemic injury. BACKGROUND Recent advances in neuroimaging have led to improved detection of subtle insults associated with neurodevelopmental outcomes, beyond more historically described lesions such as large hemorrhages and hydrocephalus. OBJECTIVE In this study, we compare cranial ultrasound to MRI for the evaluation of suspected HIE in preterm infants. METHODS 147 premature infant patients with paired ultrasound and MRI exams were retrospectively analyzed to compare imaging finding accuracy and clinical value. RESULT We confirm that ultrasound is highly sensitive and specific for hydrocephalus, ventricular prominence, and gross structural abnormalities. Ultrasound is not a substitute for MRI in cases of small hemorrhages or white matter injury, however, certain US findings were associated with Apgar score and MRI sequelae of HIE. CONCLUSION Choosing between ultrasound and MRI for preterm neonates at risk for intracranial abnormalities based on their strengths can reduce cost and maximize clinical utility. MRI provides a highly sensitive identification of subtle brain injury, yet ultrasound is correlated with the peripartum clinical picture as measured by Apgar score.
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Affiliation(s)
- Simon S Ho
- Department of Radiology, College of Medicine, University of Florida, Gainesville FL, USA
| | - Yujia Zhou
- College of Medicine, Medical Student, University of Florida, Gainesville FL, USA
| | - Dhanashree Rajderkar
- Department of Radiology, College of Medicine, University of Florida, Gainesville FL, USA
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Watterberg KL, Carlo WA, Brion LP, Cotten CM, Higgins RD. Overview of the neonatal research network: History, contributions, challenges, and future. Semin Perinatol 2022; 46:151634. [PMID: 35786518 PMCID: PMC10996928 DOI: 10.1016/j.semperi.2022.151634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) has been a leader in neonatal research since 1986. In this chapter we review its history and achievements in (1) continuing observation of populations, treatments, short and longer-term outcomes, and trends over time; (2) "negative studies" (trials with non-significant primary outcomes) and trials stopped for futility or adverse events, which have influenced practice and subsequent trial design; and, (3) landmark trials that have changed neonatal care. Its consistent framework has enabled the NRN to be a pioneer in conducting longer-term, school-age follow-up. Leveraging its established infrastructure, the NRN has also partnered with other NIH institutes, governmental agencies, and industry to more effectively advance neonatal care. As current examples of its evolution with changing times, the Network has instituted a process to open specific network trials to external institutions and is adding a parent and participant component to future endeavors.
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Affiliation(s)
- Kristi L Watterberg
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luc P Brion
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Raleigh, NC, USA
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8
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Syltern J, Ursin L, Solberg B, Støen R. Postponed Withholding: Balanced Decision-Making at the Margins of Viability. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:15-26. [PMID: 33998962 DOI: 10.1080/15265161.2021.1925777] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support into an ethical dilemma. Shared decision-making with parents has gained ground. However, the need to start immediate life support and the ensuing difficulty of withdrawing treatment stands in tension with the possibility of a fair decision-making process. Both the parental "instinct of saving" and "withdrawal resistance" involved can preclude shared decision-making. To help health care personnel and empower parents, we propose a novel approach labeled "postponed withholding." In the absence of a prenatal advance directive, life support is started at birth, followed by planned redirection to palliative care after one week, unless parents, after a thorough counseling process, actively ask for continued life support. Despite the emotional challenges, this approach can facilitate ethically balanced decision-making processes in the gray zone.
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Affiliation(s)
- Janicke Syltern
- Norwegian University of Science and Technology
- St Olavs Hospital University Hospital in Trondheim
| | - Lars Ursin
- The Norwegian University of Science and Technology
| | | | - Ragnhild Støen
- Norwegian University of Science and Technology
- St Olavs Hospital University Hospital in Trondheim
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9
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Kilbride HW, Vohr BR, McGowan EM, Peralta-Carcelen M, Stringer K, Das A, Archer SW, Hintz SR. Early neurodevelopmental follow-up in the NICHD neonatal research network: Advancing neonatal care and outcomes, opportunities for the future. Semin Perinatol 2022; 46:151642. [PMID: 35842320 PMCID: PMC11068160 DOI: 10.1016/j.semperi.2022.151642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
At the inception of the Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN), provision of care for extremely preterm (EPT) infants was considered experimental. The NRN Follow-up Study Group, initiated in 1993, developed infrastructure with certification processes and standards, allowing the NRN to assess 2-year outcomes for EPT and to provide important metrics for randomized clinical trials. This chapter will review the NRN Follow-up Study Group's contributions to understanding factors related to improved neurodevelopmental, behavioral, and social-emotional outcomes of EPT infants. We will also discuss follow up challenges, including reassessing which outcomes are most meaningful for parents and investigators. Finally, we will explore how outcome studies have informed clinical decisions and ethical considerations, given limitations of prediction of complex later childhood outcomes from early neurodevelopmental findings.
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Affiliation(s)
- Howard W Kilbride
- Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City, 2401 Gillham Road, 3rd Floor Annex, Kansas City, MO.
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | - Elisabeth M McGowan
- Department of Pediatrics, Women and Infants Hospital of Rhode Island and Brown University, Providence, RI
| | | | - Kimberlly Stringer
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Stephanie Wilson Archer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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10
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DeMauro SB, Merhar SL, Peralta-Carcelen M, Vohr BR, Duncan AF, Hintz SR. The critical importance of follow-up to school age: Contributions of the NICHD Neonatal Research Network. Semin Perinatol 2022; 46:151643. [PMID: 35850744 PMCID: PMC10983779 DOI: 10.1016/j.semperi.2022.151643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Follow-up studies are essential for understanding outcomes and informing the care of infants with high risk for medical and developmental consequences because of extreme prematurity or perinatal illness. Studies that extend to school age often identify sequelae that go unrecognized in neonatal or short-term follow-up studies. Many critical neurocognitive, behavioral, functional, and health outcomes are best assessed beginning at school age. The Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN) has performed comprehensive school age evaluations of several key trial cohorts. This manuscript summarizes the important contributions of school age follow-up studies in the NRN, both historically and in ongoing research. We describe in detail the clinical questions that have been answered by the completed studies and new questions about the outcomes of high-risk infants that must be addressed by ongoing and future studies.
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Affiliation(s)
- Sara B DeMauro
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, Pennsylvania 19146, United States.
| | - Stephanie L Merhar
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Betty R Vohr
- Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island, United States
| | - Andrea F Duncan
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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11
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Neurodevelopmental consequences of preterm punctate white matter lesions: a systematic review. Pediatr Res 2022; 93:1480-1490. [PMID: 36085366 DOI: 10.1038/s41390-022-02232-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate punctate white matter lesion (PWML) influence in preterm infants on the long-term neurodevelopmental outcome (NDO). METHODS PubMed and EMBASE were searched from January 1, 2000, to May 31, 2021. Studies were included in which PWML in preterm infants on MRI around term-equivalent age (TEA) and NDO at ≥12 months were reported. Study and patient characteristics and NDO on motor, cognitive, and behavioral domains were extracted. The quality of studies was assessed using the Cochrane-approved Quality in Prognosis Studies tool. RESULTS This analysis included nine studies with a total of 1655 patients. Mean incidence of isolated PWML was 22.1%. All studies showed a relationship between PWML and motor delay. Two studies found a significant correlation between cognitive and behavioral outcomes and PWML. Number and PWML location are related to severity and impairment types. LIMITATIONS PWML were not always separately described from generalized WMI, only studies with imaging around TEA were included, and studies were heterogenic in design and quality. CONCLUSIONS PWML is common in preterm infants and predictive of adverse NDO, in particular on motor outcomes and less on cognitive and behavioral outcomes. The type and severity of impairments are related to the number and location of PMWL. IMPACT PWML is common in preterm infants and seems predictive of adverse NDO. DWI and SWI MRI sequences are informative because the different patterns suggest a difference in the underlying pathology. The type and severity of impairments are related to the number and location of PMWL. Our review can inform clinicians and parents about the NDO of preterm infants with a diagnosis of PWML. Prospective neuroimaging case-control cohort studies are recommended.
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12
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Joseph RM, Hooper SR, Heeren T, Santos HP, Frazier JA, Venuti L, Foley A, Rollins CK, Kuban KCK, Fry RC, O’Shea TM. Maternal Social Risk, Gestational Age at Delivery, and Cognitive Outcomes among Adolescents Born Extremely Preterm. Paediatr Perinat Epidemiol 2022; 36:654-664. [PMID: 36530363 PMCID: PMC9754639 DOI: 10.1111/ppe.12893] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/22/2022] [Indexed: 01/09/2023]
Abstract
Background Children born extremely preterm (EP) are at increased risk of cognitive deficits that persist into adulthood. Few large cohort studies have examined differential impairment of cognitive function in EP-born adolescents in relation to early life risk factors, including maternal social disadvantage, gestational age at delivery, and neonatal morbidities prevalent among EP neonates. Objectives To assess cognitive abilities in relation to early life risk factors in an EP-born cohort at 15 years of age. Methods 681 of 1198 surviving participants (57%) enrolled from 2002 to 2004 in the Extremely Low Gestational Age Newborn Study returned at age 15 years for an assessment of cognitive abilities with the Wechsler Abbreviated Scale of Intelligence-II and the NIH Toolbox Cognition Battery (NTCB) verbal cognition and fluid processing composites, the latter of which measured executive functions and processing speed. Three cognitive outcomes, WASI-II IQ, NTCB verbal cognition, and NTCB fluid processing, were analyzed for associations with maternal social disadvantage and gestational age. Mediation of maternal social disadvantage by gestational age and mediation of gestational age by neonatal morbidities were also examined. Results Test scores were lower for NTCB fluid processing relative to IQ and NTCB verbal abilities. Social disadvantage and gestational age were associated with all three cognitive outcomes. Mediation analyses indicated partial mediation of gestational age associations with all three outcomes by neonatal morbidities but did not support mediation by gestational age of social risk associations with cognitive outcomes. Conclusions Greater maternal social disadvantage and lower gestational age are associated with less favorable cognitive outcomes among EP-born adolescents at 15 years of age. Neonatal morbidities partially mediate associations between lower gestational age and cognitive outcomes. These findings highlight the need for improved medical and remedial interventions to mitigate risk of poor cognitive outcomes among EP-born adolescents.
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Affiliation(s)
- Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Stephen R. Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Tim Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Hudson P. Santos
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lauren Venuti
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ann Foley
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Caitlin K. Rollins
- Department of Neurology, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Karl C. K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas M. O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
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Abstract
Neurodevelopmental impairment rates remain high among extremely preterm and very low birth weight infants. This review describes the rates of brain injury and neuro-developmental impairment at 2,3 years, early school age, adolescence, and young adulthood for survivors with intraventricular hemorrhage (IVH). Former preterm infants with a history of high-grade IVH are at the greatest risk of adverse neurodevelopmental outcomes. There is variability, however, in definitions of brain injury, methods for assessing brain injury, and definitions of adverse outcomes among multicenter networks. Despite differences in methods described in publications, perinatal grade III-IV intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and white matter injury are consistently associated with increased rates of adverse motor and cognitive outcomes in the first 2,3 years of life, at early school age, in adolescence and early adulthood. Effects of socioeconomic status on outcomes, however, increase with the increasing age of the child. In summary, although preterm survivors of IVH are at an increased risk of adverse outcomes across a lifetime, there is evidence that social and environmental factors contribute to recovery over time.
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Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung. Monatsschr Kinderheilkd 2022; 170:688-703. [PMID: 35909417 PMCID: PMC9309449 DOI: 10.1007/s00112-022-01542-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
Das sich entwickelnde Gehirn ist in der Perinatalperiode besonders empfindlich für eine Vielzahl von Insulten, wie z. B. Extremfrühgeburtlichkeit und perinatale Asphyxie. Ihre Komplikationen können zu lebenslangen neurokognitiven, sensorischen und psychosozialen Einschränkungen führen; deren Vorhersage bleibt eine Herausforderung. Eine Schlüsselfunktion kommt der möglichst exakten Identifikation von Hirnläsionen und funktionellen Störungen zu. Die Prädiktion stützt sich auf frühe diagnostische Verfahren und die klinische Erfassung der Meilensteine der Entwicklung. Zur klinischen Diagnostik und zum Neuromonitoring in der Neonatal- und frühen Säuglingsperiode stehen bildgebende Verfahren zur Verfügung. Hierzu zählen zerebrale Sonographie, MRT am errechneten Termin, amplitudenintegriertes (a)EEG und/oder klassisches EEG, Nah-Infrarot-Spektroskopie, General Movements Assessment und die frühe klinische Nachuntersuchung z. B. mithilfe der Hammersmith Neonatal/Infant Neurological Examination. Innovative Biomarker und -muster (Omics) sowie (epi)genetische Prädispositionen sind Gegenstand wissenschaftlicher Untersuchungen. Neben der Erfassung klinischer Risiken kommt psychosozialen Faktoren im Umfeld des Kindes eine entscheidende Rolle zu. Eine möglichst akkurate Prognose ist mit hohem Aufwand verbunden, jedoch zur gezielten Beratung der Familien und der Einleitung von frühen Interventionen, insbesondere vor dem Hintergrund der hohen Plastizität des sich entwickelnden Gehirns, von großer Bedeutung. Diese Übersichtsarbeit fokussiert die Charakterisierung der oben genannten Verfahren und ihrer Kombinationsmöglichkeiten. Zudem wird ein Ausblick gegeben, wie innovative Techniken in Zukunft die Prädiktion der Entwicklung und Nachsorge dieser Kinder vereinfachen können.
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15
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Amplitude-integrated EEG recorded at 32 weeks postconceptional age. Correlation with MRI at term. J Perinatol 2022; 42:880-884. [PMID: 35031690 DOI: 10.1038/s41372-021-01295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aims to establish the role of late aEEG (scored by Burdjalov) in predicting brain maturation as well as abnormalities evaluated at term equivalent age (TEA) by brain MRI. METHODS 91 infants born before 30 wks gestation underwent an aEEG monitoring at 32 wks postconceptional age (PCA). aEEG, was correlated with TEA MRI, scored by Kidokoro. RESULTS A significant correlation between the aEEG score and the MRI scores was found. The same results were obtained for the aEEG continuity score; cyclicity and bandwidth scores were associated with grey matter and cerebellar MRI items. Moreover, a correlation between aEEG and cEEG recorded both at 32 and 40 wks PCA, was found. CONCLUSIONS aEEG monitoring can be predictive of MRI findings at TEA, suggesting that it could be implemented as a useful tool to support ultrasound to help identify neonates who will benefit from early intervention services.
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16
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Padbury JF, Do BT, Bann CM, Marsit C, Hintz SR, Vohr BR, Lowe J, Newman JE, Granger DA, Payne A, Watterberg K. DNA methylation in former extremely low birth weight newborns: association with cardiovascular and endocrine function. Pediatr Res 2022; 91:1469-1477. [PMID: 33953357 PMCID: PMC8568736 DOI: 10.1038/s41390-021-01531-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is increased risk of cardiovascular, metabolic, and hypertensive disorders in later life in the preterm population. We studied school-age children who had been born extremely premature who had undergone endocrine, cardiovascular, and anthropometric evaluations. METHODS School age measurements of salivary cortisol, adrenal androgens, blood pressure, and anthropometric markers were correlated with DNA methylation of 11-betahydroxysteroid dehydrogenase type 2 (11BHSD2), leptin, and the LINE1 repetitive DNA element. RESULTS We observed a modest correlation between log AUC for salivary cortisol and methylation of leptin in preterm infants and a negative correlation between methylation of region 1 of the glucocorticoid receptor (GR in term-born infants. There was an association between LINE1 methylation and cortisol response to awakening and a negative correlation between LINE1 and systolic blood pressure at 6-7 years. Methylation of the GR promoter region showed a positive association with systolic blood pressure at 6-7 years of age. CONCLUSIONS These results show that extremely preterm birth, followed by complex patterns of endocrine, cardiovascular, and metabolic exposures during early postnatal life, is associated with lasting changes in DNA methylation patterns in genes involved in hypothalamic pituitary adrenal axis function, adrenal hormonal regulation, and cardiometabolic risk. IMPACT Preterm infants have significant environmental and physiological exposures during early life that may have lasting impact on later function. Alterations in hypothalamic pituitary adrenal axis (HPA) function have been associated with these exposures. We examined the associated changes in DNA methylation of important genes involved in HPA function, metabolism, and global DNA methylation. The changes we saw in DNA methylation may help to explain associated cardiovascular, metabolic, and growth disturbance in these children in later life.
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Affiliation(s)
- James F. Padbury
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Barbara T. Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Carla M. Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Carmen Marsit
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Betty R. Vohr
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Jean Lowe
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Jamie E. Newman
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA, Johns Hopkins University School of Medicine, Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Nursing, Baltimore, MD
| | - Allison Payne
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH
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17
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Helderman J, O’Shea TM, Dansereau L, Check J, Hofheimer JA, Smith LM, McGowan E, Neal CR, Carter BS, Pastyrnak SL, Betz B, Junewick J, Borders HL, DellaGrotta SA, Lester BM. Association of Abnormal Findings on Neonatal Cranial Ultrasound With Neurobehavior at Neonatal Intensive Care Unit Discharge in Infants Born Before 30 Weeks' Gestation. JAMA Netw Open 2022; 5:e226561. [PMID: 35394511 PMCID: PMC8994127 DOI: 10.1001/jamanetworkopen.2022.6561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Cranial ultrasound (CUS) findings are routinely used to identify preterm infants at risk for impaired neurodevelopment, and neurobehavioral examinations provide information about early brain function. The associations of abnormal findings on early and late CUS with neurobehavior at neonatal intensive care unit (NICU) discharge have not been reported. OBJECTIVE To examine the associations between early and late CUS findings and infant neurobehavior at NICU discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included infants enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study between April 2014 and June 2016. Infants born before 30 weeks' gestational age were included. Exclusion criteria were maternal age younger than 18 years, maternal cognitive impairment, maternal inability to read or speak English or Spanish, maternal death, and major congenital anomalies. Overall, 704 infants were enrolled. The study was conducted at 9 university-affiliated NICUs in Providence, Rhode Island; Grand Rapids, Michigan; Kansas City, Missouri; Honolulu, Hawaii; Winston-Salem, North Carolina; and Torrance and Long Beach, California. Data were analyzed from September 2019 to September 2021. EXPOSURES Early CUS was performed at 3 to 14 days after birth and late CUS at 36 weeks' postmenstrual age or NICU discharge. Abnormal findings were identified by consensus of standardized radiologists' readings. MAIN OUTCOMES AND MEASURES Neurobehavioral examination was performed using the NICU Network Neurobehavioral Scale (NNNS). RESULTS Among the 704 infants enrolled, 675 had both CUS and NNNS data (135 [20.0%] Black; 368 [54.5%] minority race or ethnicity; 339 [50.2%] White; 376 [55.7%] male; mean [SD] postmenstrual age, 27.0 [1.9] weeks). After covariate adjustment, lower attention (adjusted mean difference, -0.346; 95% CI, -0.609 to -0.083), hypotonicity (mean difference, 0.358; 95% CI, 0.055 to 0.662), and poorer quality of movement (mean difference, -0.344; 95% CI, -0.572 to -0.116) were observed in infants with white matter damage (WMD). Lower attention (mean difference, -0.233; 95% CI, -0.423 to -0.044) and hypotonicity (mean difference, 0.240; 95% CI, 0.014 to 0.465) were observed in infants with early CUS lesions. CONCLUSIONS AND RELEVANCE In this cohort study of preterm infants, certain early CUS lesions were associated with hypotonicity and lower attention around term-equivalent age. WMD was associated with poor attention, hypotonicity, and poor quality of movement. Infants with these CUS lesions might benefit from targeted interventions to improve neurobehavioral outcomes during their NICU hospitalization.
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Affiliation(s)
- Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics/Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Lynne Dansereau
- Brown Center for Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Julie A. Hofheimer
- Department of Pediatrics/Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Lynne M. Smith
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA, Torrance, California
| | - Elisabeth McGowan
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Charles R. Neal
- Department of Pediatrics, University of Hawaii John A Burns School of Medicine, Honolulu
| | - Brian S. Carter
- Department of Pediatrics–Neonatology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Steven L. Pastyrnak
- Department of Pediatrics, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | - Bradford Betz
- Department of Pediatric Radiology, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | - Joseph Junewick
- Department of Diagnostic Radiology, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | | | - Sheri A. DellaGrotta
- Brown Center for Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Barry M. Lester
- Brown Center for Children at Risk, Women and Infants Hospital of Rhode Island, Providence
- Department of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island
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18
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Vohr BR, McGowan EC, Brumbaugh JE, Hintz SR. Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth. J Pediatr 2022; 241:12-21. [PMID: 34673090 DOI: 10.1016/j.jpeds.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI.
| | - Elisabeth C McGowan
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI
| | - Jane E Brumbaugh
- Children's Center of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
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19
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Savchenko O, Pavlinova E. Long-term neurological outcomes in premature children with excitotoxic brain damage. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:37-41. [DOI: 10.17116/jnevro202212209237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Abstract
White matter injury (WMI) represents a frequent form of parenchymal brain injury in preterm neonates. Several dimensions of WMI are recognized, with distinct neuropathologic features involving a combination of destructive and maturational anomalies. Hypoxia-ischemia is the main mechanism leading to WMI and adverse white matter development, which result from injury to the oligodendrocyte precursor cells. Inflammation might act as a potentiator for WMI. A combination of hypoxia-ischemia and inflammation is frequent in several neonatal comorbidities such as postnatal infections, NEC and bronchopulmonary dysplasia, all known contributors to WMI. White matter injury is an important predictor of adverse neurodevelopmental outcomes. When WMI is detected on neonatal brain imaging, a detailed characterization of the injury (pattern of injury, severity and location) may enhance the ability to predict outcomes. This clinically-oriented review will provide an overview of the pathophysiology and imaging diagnosis of the multiple dimensions of WMI, will explore the association between postnatal complications and WMI, and will provide guidance on the signification of white matter anomalies for motor and cognitive development.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada; Department of Pediatrics (Neonatology), Université Laval and Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Steven P Miller
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada.
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21
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Law JB, Wood TR, Gogcu S, Comstock BA, Dighe M, Perez K, Puia-Dumitrescu M, Mayock DE, Heagerty PJ, Juul SE. Intracranial Hemorrhage and 2-Year Neurodevelopmental Outcomes in Infants Born Extremely Preterm. J Pediatr 2021; 238:124-134.e10. [PMID: 34217769 PMCID: PMC8551011 DOI: 10.1016/j.jpeds.2021.06.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the incidence, timing, progression, and risk factors for intracranial hemorrhage (ICH) in infants 240/7 to 276/7 weeks of gestational age and to characterize the association between ICH and death or neurodevelopmental impairment (NDI) at 2 years of corrected age. STUDY DESIGN Infants enrolled in the Preterm Erythropoietin Neuroprotection Trial had serial cranial ultrasound scans performed on day 1, day 7-9, and 36 weeks of postmenstrual age to evaluate ICH. Potential risk factors for development of ICH were examined. Outcomes included death or severe NDI as well as Bayley Scales of Infant and Toddler Development, 3rd Edition, at 2 years of corrected age. RESULTS ICH was identified in 38% (n = 339) of 883 enrolled infants. Multiple gestation and cesarean delivery reduced the risk of any ICH on day 1. Risk factors for development of bilateral Grade 2, Grade 3, or Grade 4 ICH at day 7-9 included any ICH at day 1; 2 or more doses of prenatal steroids decreased risk. Bilateral Grade 2, Grade 3, or Grade 4 ICH at 36 weeks were associated with previous ICH at day 7-9. Bilateral Grade 2, any Grade 3, and any Grade 4 ICH at 7-9 days or 36 weeks of postmenstrual age were associated with increased risk of death or severe NDI and lower Bayley Scales of Infant and Toddler Development, 3rd Edition, scores. CONCLUSIONS Risk factors for ICH varied by timing of bleed. Bilateral and increasing grade of ICH were associated with death or NDI in infants born extremely preterm.
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Affiliation(s)
- Janessa B Law
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Thomas R. Wood
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake
Forest School of Medicine, NC
| | | | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle,
WA
| | - Krystle Perez
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Dennis E. Mayock
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | | | - Sandra E. Juul
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
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22
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Predictive value of brain MRI at term-equivalent age in extremely preterm children on neurodevelopmental outcome at school-age. Brain Imaging Behav 2021; 16:878-887. [PMID: 34661873 DOI: 10.1007/s11682-021-00559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
This study's objective was to correlate the abnormalities in brain MRIs performed at corrected-term age for minor or moderate neurocognitive disorders in children school-age born extremely premature (EPT) and without serious sequelae such as autism, cerebral palsy, mental impairment. Data were issued from a cross-sectional multicenter study (GP-Qol study, number NCT01675726). Clinical examination and psychometric assessments were performed when the children were between 7 and 10 years old during a day-long evaluation. Term-equivalent age brain MRIs on EPT were analyzed with a standardized scoring system. There were 114 children included in the study. The mean age at the time of evaluation, was 8.47 years old (± 0.70). 59% of children with at least one cognitive impairment and 53% who had a dysexecutive disorder. Only ten EPT (8.7%) presented moderate to severe white and grey matter abnormalities. These moderate to severe grey matter abnormalities were associated with at least two abnormal executive functions [OR 3.08 (95% CI 1.04-8.79), p = 0.04] and language delay [OR 3.25 (95% CI 1.03-9.80), p = 0.04]. These results remained significant in the multivariate analysis. Moderate to severe ventricular dilatation abnormalities (15%, n = 17) were associated with ideomotor dyspraxia [OR 7.49 (95% CI 1.48-35.95), p = 0.02] and remained significant in multivariate analysis [OR 11.2 (95% CI 1.45-131.4), p = 0.02]. Biparietal corrected diameters were moderate abnormal in 20% of cases (n = 23) and were associated to visuo spatial integration delay [OR 4.13 (95% CI 1.23-13.63), p = 0.02]. Cerebral MRI at term-equivalent age with scoring system analysis can provide information on long-term neuropsychological outcomes at school-age in EPTs children having no severe disability.
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23
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Vohr BR, McGowan EC, Bann C, Das A, Higgins R, Hintz S. Association of High Screen-Time Use With School-age Cognitive, Executive Function, and Behavior Outcomes in Extremely Preterm Children. JAMA Pediatr 2021; 175:1025-1034. [PMID: 34251406 PMCID: PMC8276120 DOI: 10.1001/jamapediatrics.2021.2041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Both preterm birth and increased screen time are known to be associated with an increase in risk of developmental and behavioral sequelae. The association between high screen time or a television or computer in the bedroom in early school age and adverse cognitive, executive function, language, and behavior outcomes of extremely preterm children (EPT) is not well understood. Objective To assess the association of high screen time with cognition, language, executive function, and behavior of EPT children aged 6 to 7 years; a second objective was to examine the association between high screen time and rates of structured physical activity and weight. Design, Setting, and Participants This cohort study was a secondary analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial Neuroimaging and Neurodevelopmental Outcomes school-aged cohort and includes 414 EPT children born between February 1, 2005, and February 28, 2009, and evaluated in between 2012 and 2016 at ages 6 years 4 months to 7 years 2 months. The study was conducted from July 7, 2012, and August 15, 2016, and data were analyzed between December 10, 2018, and April 1, 2021. Exposures Cohorts included children exposed to low (≤2 hours per day) vs high (>2 hours per day) amounts of screen time and by the presence (no vs yes) of a television/computer in the bedroom. Main Outcomes and Measures In addition to growth parameters, assessments included the Wechsler Intelligence Scale for Children-IV, the Behavior Rating Inventory of Executive Function, the Developmental Neuropsychological Assessment, the Conners 3rd Edition-Parent Short-Form, and the Social Communication Questionnaire. Results Of the 414 children included in the analysis, 227 (55%) were boys; mean (SD) birth weight was 870.6 (191) g. A total of 238 children (57%) had high screen time and 266 (64%) had a television/computer in their bedroom. In multivariable linear regressions adjusted for center, male sex, gestational age, and social determinants of health, high screen time was independently associated with the following mean (SE) test score changes: lower full-scale IQ (-3.92 [1.64]; P = .02); an increase in association with deficits in executive functions, including metacognition (8.18 [3.01]; P = .007), global executive function (7.49 [2.99]; P = .01), inhibition (-0.79 [0.38]; P = .03), and Conners 3rd Edition-Parent Short-Form inattention (3.32 [1.67]; P = .047). A television/computer in the bedroom was associated with an increase in inhibition (-0.80 [0.39]; P = .04) and hyperactivity/impulsivity (3.50 [1.75]; P = .046) problems. Conclusions and Relevance The findings of this study suggest that high screen time contributes to adverse cognitive, executive function, and behavior outcomes at ages 6 to 7 years in children born at less than 28 weeks. These findings support the need for clinicians to have heightened awareness of the risks for EPT children and discuss both the benefits and risks of screen time with families.
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Affiliation(s)
- Betty R Vohr
- Division of Neonatal Medicine, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence
| | - Elisabeth C McGowan
- Division of Neonatal Medicine, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence
| | - Carla Bann
- Division of Statistical and Data Sciences, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland
| | - Rosemary Higgins
- National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, Maryland.,George Mason University, Fairfax, Virginia
| | - Susan Hintz
- Division of Perinatal Neonatal Medicine, Stanford University, Palo Alto, California
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24
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Inder TE, de Vries LS, Ferriero DM, Grant PE, Ment LR, Miller SP, Volpe JJ. Neuroimaging of the Preterm Brain: Review and Recommendations. J Pediatr 2021; 237:276-287.e4. [PMID: 34146549 DOI: 10.1016/j.jpeds.2021.06.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Donna M Ferriero
- Department of Neurology, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Francisco, San Francisco, CA; Weill Institute of Neurosciences, University of California San Francisco, San Francisco, CA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Laura R Ment
- Department of Pediatrics, Yale School of Medicine, New Haven, CT; Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Steven P Miller
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Joseph J Volpe
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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25
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Campbell H, Check J, Kuban KCK, Leviton A, Joseph RM, Frazier JA, Douglass LM, Roell K, Allred EN, Fordham LA, Hooper SR, Jara H, Paneth N, Mokrova I, Ru H, Santos HP, Fry RC, O’Shea TM. Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age. J Pediatr 2021; 237:197-205.e4. [PMID: 34090894 PMCID: PMC8478718 DOI: 10.1016/j.jpeds.2021.05.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the association between neonatal cranial ultrasound (CUS) abnormalities among infants born extremely preterm and neurodevelopmental outcomes at 10 years of age. STUDY DESIGN In a multicenter birth cohort of infants born at <28 weeks of gestation, 889 of 1198 survivors were evaluated for neurologic, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal CUS findings were classified as intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD. RESULTS WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes. CONCLUSIONS Among children born extremely preterm, CUS abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.
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Affiliation(s)
- Heather Campbell
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Jennifer Check
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA
| | - Laurie M. Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA
| | - Kyle Roell
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Lynn Ansley Fordham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Stephen R. Hooper
- Department of Allied Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hernan Jara
- Department of Radiology, Boston University Medical Center, Boston, MA
| | - Nigel Paneth
- Michigan State University College of Human Medicine, East Lansing, MI
| | | | - Hongyu Ru
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hudson P. Santos
- Biobehavioral Laboratory, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Romeo DM, Cowan FM, Haataja L, Ricci D, Pede E, Gallini F, Cota F, Brogna C, Vento G, Romeo MG, Mercuri E. Hammersmith Infant Neurological Examination for infants born preterm: predicting outcomes other than cerebral palsy. Dev Med Child Neurol 2021; 63:939-946. [PMID: 33336801 DOI: 10.1111/dmcn.14768] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
AIM We explored the ability of the Hammersmith Infant Neurological Examination (HINE) to identify typical and delayed cognitive performance in a large population of infants born preterm, both with and without cerebral palsy (CP). METHOD We conducted a retrospective study of infants born preterm who had repeated HINEs between 3 and 12 months corrected age. At 2 years, cognition was assessed using the Mental Development Index (MDI; from the Bayley Scales of Infant Development, Second Edition) and the presence and severity of CP was determined. All children were classified as cognitively typical/mildly delayed or significantly delayed (MDI <70) and CP. The predictive validity of HINE scores for significantly delayed cognitive performance, in children with and without CP, was calculated using specific cut-off scores according to age at assessment. RESULTS Of 1229 eligible infants (gestational age 25-36wks, mean [SD] 34.9 [2.3]; 646 males, 583 females), 1108 did not develop CP, 891 had an MDI that was typical/mildly delayed, and 217 had an MDI less than 70. Of the 121 infants who developed CP, the MDI was typical in 28, mildly delayed in 27, and less than 70 in 66. HINE scores showed a good sensitivity and specificity, especially after 3 months, for detecting significantly delayed cognitive performance in infants without CP. In those who developed CP, the score was associated with their cognitive level. INTERPRETATION The HINE provides information about the risk of delayed cognitive performance in infants born preterm with and without CP. What this paper adds The Hammersmith Infant Neurological Examination (HINE) can be used in the first year to identify infants born preterm at risk for delayed cognitive performance. Age-dependent HINE cut-off scores are proposed for detecting increased risk of delayed cognitive performance.
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Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | | | - Leena Haataja
- Division of Pediatric Neurology, Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki, Finland
| | - Daniela Ricci
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus, Rome, Italy
| | - Elisa Pede
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario G Romeo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Catania, Catania, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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Guillot M, Sebastianski M, Lemyre B. Comparative performance of head ultrasound and MRI in detecting preterm brain injury and predicting outcomes: A systematic review. Acta Paediatr 2021; 110:1425-1432. [PMID: 33206399 DOI: 10.1111/apa.15670] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
AIM To systematically review the literature to compare the performance of head ultrasound (HUS) and magnetic resonance imaging (MRI) in their ability to detect brain injury and their predictive value for neurodevelopmental outcomes. METHODS This was a systematic review based on literature search in three electronic databases (MEDLINE, EMBASE, Cochrane Library) and additional sources for studies on routine brain injury screening in preterm neonates published during 2000-May 2020. Studies were included if they reported on the comparative performance of HUS and MRI in detecting preterm brain injury and/or their predictive value for neurodevelopmental outcomes. Findings from the included studies underwent narrative synthesis. RESULTS Forty-six studies were included. In comparison with HUS, MRI detected more anomalies and provided more details on the severity and the extent of preterm brain injury, particularly for white matter injury and cerebellar haemorrhage. Neonatal neuroimaging predicted outcomes with high negative predictive value but relatively low positive predictive value. The prognostic value of neonatal neuroimaging varied according to several factors including modality and timing of imaging, and tools used for grading brain injury. CONCLUSION Compared with HUS, MRI offers a better characterisation of preterm brain injury and may enhance the ability to predict neurodevelopmental outcomes.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics (Neurology) University of Toronto and the Hospital for Sick Children Toronto Ontario Canada
- Department of Pediatrics (Neonatology) Université Laval and Centre Hospitalier Universitaire de Québec Québec City Québec Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient‐Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform University of Alberta Edmonton Alberta Canada
| | - Brigitte Lemyre
- Department of Pediatrics (Neonatology) University of Ottawa and the Children’s Hospital of Eastern Ontario Ottawa Ontario Canada
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28
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Lönnberg P, Pihko E, Lauronen L, Nurminen J, Andersson S, Metsäranta M, Lano A, Nevalainen P. Secondary somatosensory cortex evoked responses and 6-year neurodevelopmental outcome in extremely preterm children. Clin Neurophysiol 2021; 132:1572-1583. [PMID: 34023633 DOI: 10.1016/j.clinph.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We assessed in extremely preterm born (EPB) children whether secondary somatosensory cortex (SII) responses recorded with magnetoencephalography (MEG) at term-equivalent age (TEA) correlate with neurodevelopmental outcome at age 6 years. Secondly, we assessed whether SII responses differ between 6-year-old EPB and term-born (TB) children. METHODS 39 EPB children underwent MEG with tactile stimulation at TEA. At age 6 years, 32 EPB and 26 TB children underwent MEG including a sensorimotor task requiring attention and motor inhibition. SII responses to tactile stimulation were modeled with equivalent current dipoles. Neurological outcome, motor competence, and general cognitive ability were prospectively evaluated at age 6 years. RESULTS Unilaterally absent SII response at TEA was associated with abnormal motor competence in 6-year-old EPB children (p = 0.03). At age 6 years, SII responses were bilaterally detectable in most EPB (88%) and TB (92%) children (group comparison, p = 0.69). Motor inhibition was associated with decreased SII peak latencies in TB children, but EPB children lacked this effect (p = 0.02). CONCLUSIONS Unilateral absence of an SII response at TEA predicted poorer motor outcome in EPB children. SIGNIFICANCE Neurophysiological methods may provide new means for outcome prognostication in EPB children.
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Affiliation(s)
- Piia Lönnberg
- Child Neurology, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Elina Pihko
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Lauronen
- Clinical Neurophysiology, New Children's Hospital, HUS Medical Imaging Center, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Nurminen
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sture Andersson
- Pediatrics, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjo Metsäranta
- Pediatrics, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aulikki Lano
- Child Neurology, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Nevalainen
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Clinical Neurophysiology, New Children's Hospital, HUS Medical Imaging Center, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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29
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Greisen G, Dempsey E, Mimouni F. The clinical usefulness of cerebral oximetry. J Perinatol 2021; 41:655-657. [PMID: 33574583 DOI: 10.1038/s41372-021-00939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark & University of Copenhagen, Copenhagen, Denmark.
| | | | - Francis Mimouni
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Sackler School of Medicine, Tel Aviv, Israel
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Banihani R, Seesahai J, Asztalos E, Terrien Church P. Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary. CHILDREN (BASEL, SWITZERLAND) 2021; 8:227. [PMID: 33809745 PMCID: PMC8002329 DOI: 10.3390/children8030227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
Advances in neuroimaging of the preterm infant have enhanced the ability to detect brain injury. This added information has been a blessing and a curse. Neuroimaging, particularly with magnetic resonance imaging, has provided greater insight into the patterns of injury and specific vulnerabilities. It has also provided a better understanding of the microscopic and functional impacts of subtle and significant injuries. While the ability to detect injury is important and irresistible, the evidence for how these injuries link to specific long-term outcomes is less clear. In addition, the impact on parents can be profound. This narrative summary will review the history and current state of brain imaging, focusing on magnetic resonance imaging in the preterm population and the current state of the evidence for how these patterns relate to long-term outcomes.
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Affiliation(s)
- Rudaina Banihani
- Newborn & Developmental Paediatrics, Sunnybrook Health Science Centre, 2075 Bayview Ave, The University of Toronto, Toronto, ON M4N 3M5, Canada; (J.S.); (E.A.); (P.T.C.)
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31
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Setänen S, Fredriksson Kaul Y, Johansson M, Montgomery C, Naseh N, Holmström G, Strand‐Brodd K, Hellström‐Westas L. Using different definitions affected the reported prevalence of neurodevelopmental impairment in children born very preterm. Acta Paediatr 2021; 110:838-845. [PMID: 32640081 DOI: 10.1111/apa.15464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022]
Abstract
AIM We investigated the impact of varying definitions on the prevalence of neurodevelopmental impairment (NDI) in children born very preterm at 6.5 years of age. METHODS Cognitive development and neurosensory impairments were assessed in 91 children (40/51 girls/boys) born <32 gestational weeks, in 2004-2007 in Uppsala county, Sweden. The results were compared with data from a reference group of 67 children born full term. The prevalence of NDI in the present cohort was reported according to definitions used by seven contemporary studies of children born very or extremely preterm. RESULTS The prevalence of severe NDI varied from 2% to 23% depending on the definition used. The prevalence of cognitive impairment varied from 2% (-3 SD according to test norms) to 16% (-2 SD according to control group), the prevalence of cerebral palsy from 0% (severe) to 9% (any) and the prevalence of severe visual impairment from 0% (blindness) to 1% (visual acuity < 0.3). There were no children with severe hearing impairment. CONCLUSION A high variability in definitions affects the reporting of the prevalence of NDI in long-term follow-up studies of very or extremely preterm born children. There is a need for a better consensus to enable comparisons across studies.
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Affiliation(s)
- Sirkku Setänen
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | | | - Martin Johansson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Cecilia Montgomery
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Nima Naseh
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Gerd Holmström
- Department of Neuroscience, Ophtalmology Uppsala University Uppsala Sweden
| | - Katarina Strand‐Brodd
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Centre for Clinical Research Sörmland Uppsala University Uppsala Sweden
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Tacchino C, Impagliazzo M, Maggi E, Bertamino M, Blanchi I, Campone F, Durand P, Fato M, Giannoni P, Iandolo R, Izzo M, Morasso P, Moretti P, Ramenghi L, Shima K, Shimatani K, Tsuji T, Uccella S, Zanardi N, Casadio M. Spontaneous movements in the newborns: a tool of quantitative video analysis of preterm babies. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105838. [PMID: 33421664 DOI: 10.1016/j.cmpb.2020.105838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The number of preterm babies is steadily growing world-wide and these neonates are at risk of neuro-motor-cognitive deficits. The observation of spontaneous movements in the first three months of age is known to predict such risk. However, the analysis by specifically trained physiotherapists is not suited for the clinical routine, motivating the development of simple computerized video analysis systems, integrated with a well-structured Biobank to make available for preterm babies a growing service with diagnostic, prognostic and epidemiological purposes. METHODS MIMAS (Markerless Infant Movement Analysis System) is a simple, low-cost system of video analysis of spontaneous movements of newborns in their natural environment, based on a single standard RGB camera, without markers attached to the body. The original videos are transformed into binarized sequences highlighting the silhouette of the baby, in order to minimize the illumination effects and increase the robustness of the analysis; such sequences are then coded by a large set of parameters (39) related to the spatial and spectral changes of the silhouette. The parameter vectors of each baby were stored in the Biobank together with related clinical information. RESULTS The preliminary test of the system was carried out at the Gaslini Pediatric Hospital in Genoa, where 46 preterm (PT) and 21 full-term (FT) babies (as controls) were recorded at birth (T0) and 8-12 weeks thereafter (T1). A simple statistical analysis of the data showed that the coded parameters are sensitive to the degree of maturation of the newborns (comparing T0 with T1, for both PT and FT babies), and to the conditions at birth (PT vs. FT at T0), whereas this difference tends to vanish at T1. Moreover, the coding method seems also able to detect the few 'abnormal' preterm babies in the PT populations that were analyzed as specific case studies. CONCLUSIONS Preliminary results motivate the adoption of this tool in clinical practice allowing for a systematic accumulation of cases in the Biobank, thus for improving the accuracy of data analysis performed by MIMAS and ultimately allowing the adoption of data mining techniques.
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Affiliation(s)
- Chiara Tacchino
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | | | - Erika Maggi
- DIBRIS dept., University of Genoa, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Isa Blanchi
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Francesca Campone
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Paola Durand
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Marco Fato
- DIBRIS dept., University of Genoa, Genoa, Italy
| | | | - Riccardo Iandolo
- DIBRIS dept., University of Genoa, Genoa, Italy; RBCS dept., Italian Institute of Technology, Genoa, Italy
| | - Massimiliano Izzo
- DIBRIS dept., University of Genoa, Genoa, Italy; Oxford e-Research Centre, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Pietro Morasso
- DIBRIS dept., University of Genoa, Genoa, Italy; RBCS dept., Italian Institute of Technology, Genoa, Italy
| | - Paolo Moretti
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | - Luca Ramenghi
- Intensive Therapy and Neonatal Pathology, Gaslini Pediatric Hospital, Genoa, Italy
| | - Keisuke Shima
- Faculty of Engineering, Yokohama National University, Yokohama, Japan
| | - Koji Shimatani
- Dept. of Physical Therapy, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Toshio Tsuji
- Dept. of System Cybernetics, Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Sara Uccella
- Physical Medicine and Rehabilitation, Gaslini Pediatric Hospital, Genoa, Italy
| | | | - Maura Casadio
- DIBRIS dept., University of Genoa, Genoa, Italy; RBCS dept., Italian Institute of Technology, Genoa, Italy.
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General Movement Assessment Predicts Neuro-Developmental Outcome in Very Low Birth Weight Infants at Two Years - A Five-Year Observational Study. Indian J Pediatr 2021; 88:28-33. [PMID: 32488806 DOI: 10.1007/s12098-020-03365-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the value of general movements (GMs) in predicting the neurodevelopmental outcome using Bayley Scale of Infant Development III (BSID-III) at two years of age in very low birth weight (VLBW) infants. METHODS This is a five-year observational study (January 2012-June 2017). Two hundred twenty-seven VLBW infants were assessed in the neurodevelopmental clinic between Jan 2012 and June 2017. Of these 137 infants had GMs assessments at 3 mo post term (first visit to the clinic). RESULTS Absence of fidgety movements (FMs) at 3 mo post term had high specificity and negative predictive value for moderate to severe neurodevelopmental outcome in motor, cognition and language domains (composite score less than 70 in the Bayley III scales of Infant development scores). At 3 mo post term, absent FMs had high sensitivity, specificity and negative predictive value (NPV) for cerebral palsy (CP). CONCLUSIONS GMs assessment at 3 mo post term could be considered as an important screening tool for early identification of VLBW infants who are at risk of neurodevelopmental impairment/cerebral palsy.
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Bangma JT, Hartwell H, Santos HP, O'Shea TM, Fry RC. Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm. Pediatr Res 2021; 89:326-335. [PMID: 33184498 PMCID: PMC7658618 DOI: 10.1038/s41390-020-01236-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 01/30/2023]
Abstract
Individuals born extremely preterm are at significant risk for impaired neurodevelopment. After discharge from the neonatal intensive care, associations between the child's well-being and factors in the home and social environment become increasingly apparent. Mothers' prenatal health and socioeconomic status are associated with neurodevelopmental outcomes, and emotional and behavioral problems. Research on early life risk factors and on mechanisms underlying inter-individual differences in neurodevelopment later in life can inform the design of personalized approaches to prevention. Here, we review early life predictors of inter-individual differences in later life neurodevelopment among those born extremely preterm. Among biological mechanisms that mediate relationships between early life predictors and later neurodevelopmental outcomes, we highlight evidence for disrupted placental processes and regulated at least in part via epigenetic mechanisms, as well as perinatal inflammation. In relation to these mechanisms, we focus on four prenatal antecedents of impaired neurodevelopment, namely, (1) fetal growth restriction, (2) maternal obesity, (3) placental microorganisms, and (4) socioeconomic adversity. In the future, this knowledge may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm. IMPACT: This review highlights early life risk factors and mechanisms underlying inter-individual differences in neurodevelopment later in life. The review emphasizes research on early life risk factors (fetal growth restriction, maternal obesity, placental microorganisms, and socioeconomic adversity) and on mechanisms (disrupted placental processes and perinatal inflammation) underlying inter-individual differences in neurodevelopment later in life. The findings highlighted here may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm.
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Affiliation(s)
- Jacqueline T Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hadley Hartwell
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hudson P Santos
- Biobehavioral Laboratory, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Biobehavioral Laboratory, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Curriculum in Toxicology and Environmental Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Arulkumaran S, Tusor N, Chew A, Falconer S, Kennea N, Nongena P, Hajnal JV, Counsell SJ, Rutherford MA, Edwards AD. MRI Findings at Term-Corrected Age and Neurodevelopmental Outcomes in a Large Cohort of Very Preterm Infants. AJNR Am J Neuroradiol 2020; 41:1509-1516. [PMID: 32796100 DOI: 10.3174/ajnr.a6666] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/19/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Brain MR imaging at term-equivalent age is a useful tool to define brain injury in preterm infants. We report pragmatic clinical radiological assessment of images from a large unselected cohort of preterm infants imaged at term and document the spectrum and frequency of acquired brain lesions and their relation to outcomes at 20 months. MATERIALS AND METHODS Infants born at <33 weeks' gestation were recruited from South and North West London neonatal units and imaged in a single center at 3T at term-equivalent age. At 20 months' corrected age, they were invited for neurodevelopmental assessment. The frequency of acquired brain lesions and the sensitivity, specificity, and negative and positive predictive values for motor, cognitive, and language outcomes were calculated, and corpus callosal thinning and ventricular dilation were qualitatively assessed. RESULTS Five hundred four infants underwent 3T MR imaging at term-equivalent age; 477 attended for assessment. Seventy-six percent of infants had acquired lesions, which included periventricular leukomalacia, hemorrhagic parenchymal infarction, germinal matrix-intraventricular hemorrhage, punctate white matter lesions, cerebellar hemorrhage, and subependymal cysts. All infants with periventricular leukomalacia, and 60% of those with hemorrhagic parenchymal infarction had abnormal motor outcomes. Routine 3T MR imaging of the brain at term-equivalent age in an unselected preterm population that demonstrates no focal lesion is 45% sensitive and 61% specific for normal neurodevelopment at 20 months and 17% sensitive and 94% specific for a normal motor outcome. CONCLUSIONS Acquired brain lesions are common in preterm infants routinely imaged at term-equivalent age, but not all predict an adverse neurodevelopmental outcome.
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Affiliation(s)
- S Arulkumaran
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - N Tusor
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - A Chew
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - S Falconer
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - N Kennea
- Neonatal Unit (N.K.), St. George's Hospital, London, UK
| | - P Nongena
- Division of Clinical Sciences (P.N.), Imperial College London, London, UK
| | - J V Hajnal
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - S J Counsell
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - M A Rutherford
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
| | - A D Edwards
- From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK
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刘 莲, 张 鹏, 夏 红, 王 斌, 马 雪, 程 国, 史 源. [Application of magnetic resonance imaging-compatible incubator in cranial magnetic resonance imaging for neonates: a multicenter prospective randomized clinical trial]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1251-1255. [PMID: 33327993 PMCID: PMC7735921 DOI: 10.7499/j.issn.1008-8830.2007081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the safety and efficacy of magnetic resonance imaging (MRI)-compatible incubator in cranial MRI examination for neonates. METHODS A total of 120 neonates who were hospitalized in three hospitals and needed to undergo MRI examination were randomly divided into a control group and an experimental group, with 60 neonates in each group. The neonates in the experimental group were transferred with MRI-compatible incubator and underwent cranial MRI examination inside the MRI-compatible incubator, and those in the control group were transferred using a conventional neonatal transfer incubator and then underwent MRI examination outside the incubator. The two groups were compared in terms of the primary efficacy index (total examination time), secondary efficacy indices (times of examination, MRI completion rate on the first day of use), and safety indices (incidence rate of adverse events and vital signs). RESULTS There were no significant differences in total examination time, times of examination, and MRI completion rate on the first day of use between the two groups (P > 0.05). There were also no significant differences between the two groups in the incidence rate of adverse events and vital signs such as respiratory rate, heart rate, blood pressure, and blood oxygen saturation rate at different time points before and after examination (P > 0.05). CONCLUSIONS The use of MRI-compatible incubator does not significantly shorten the examination time of cranial MRI, but it does provide a relatively stable environment for examination with acceptable safety. There is a need for further studies with a larger population.
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Affiliation(s)
- 莲 刘
- 重庆医科大学附属儿童医院新生儿科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室, 重庆 400014Department of Neonatology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 鹏 张
- 复旦大学附属儿科医院新生儿科, 上海 201102
| | - 红萍 夏
- 上海交通大学医学院附属新华医院新生儿科, 上海 202150
| | - 斌 王
- 南方医科大学珠江医院儿科中心, 广东 广州 510282
| | - 雪玲 马
- 重庆医科大学附属儿童医院新生儿科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室, 重庆 400014Department of Neonatology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 国强 程
- 复旦大学附属儿科医院新生儿科, 上海 201102
| | - 源 史
- 重庆医科大学附属儿童医院新生儿科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室, 重庆 400014Department of Neonatology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Outcomes Following Post-Hemorrhagic Ventricular Dilatation among Infants of Extremely Low Gestational Age. J Pediatr 2020; 226:36-44.e3. [PMID: 32739261 PMCID: PMC7855243 DOI: 10.1016/j.jpeds.2020.07.080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation. STUDY DESIGN Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score <70, blindness, or deafness. Multivariable logistic regression examined the association of death or impairment, adjusting for neonatal course, center, maternal education, and parenchymal hemorrhage. RESULTS Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week. CONCLUSIONS PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.
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Abstract
Neuroimaging of the preterm infant is a common assessment performed in the NICU. Timely and focused studies can be used for diagnostic, therapeutic, and prognostic information. However, significant variability exists among neonatal units as to which modalities are used and when imaging studies are obtained. Appropriate timing and selection of neuroimaging studies can help identify neonates with brain injury who may require therapeutic intervention or who may be at risk for neurodevelopmental impairment. This clinical report reviews the different modalities of imaging broadly available to the clinician. Evidence-based indications for each modality, optimal timing of examinations, and prognostic value are discussed.
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Affiliation(s)
- Ivan L Hand
- Department of Pediatrics, New York City Health + Hospitals/Kings County, State University of New York Downstate Medical Center, Brooklyn, New York;
| | - Renée A Shellhaas
- Pediatric Neurology Division, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Sarah S Milla
- Departments of Radiology and Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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Hand Function at 18-22 Months Is Associated with School-Age Manual Dexterity and Motor Performance in Children Born Extremely Preterm. J Pediatr 2020; 225:51-57.e3. [PMID: 32474029 PMCID: PMC7652574 DOI: 10.1016/j.jpeds.2020.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine associations between hand function at age 18-22 months (early) and scores on the Movement Assessment Battery for Children, 2nd edition (MABC) at 6-7 years of age (school age) in extremely preterm children. STUDY DESIGN Prospective multicenter cohort of 313 extremely preterm children with early hand function assessment and school-age MABC testing. Early hand function was compared with "definite deficits" (MABC <5th percentile) and MABC standard scores. Early hand function was categorized as "no deficit" vs "any deficit." Mixed-effects regression models were used to evaluate the association of early hand function with MABC deficits, controlling for multiple demographic, neonatal, and childhood factors. RESULTS Children with early hand function deficits were more likely to have definite school-age deficits in all MABC subtests (Manual Dexterity, Aiming and Catching, and Balance) and to have received physical or occupational therapy (45% vs 26%; P < .001). Children with early hand function deficits had lower Manual Dexterity (P = .006), Balance (P = .035), and Total Test (P = .039) scores. Controlling for confounders, children with early hand function deficits had higher odds of definite school-age deficits in Manual Dexterity (aOR, 2.78; 95% CI, 1.36-5.68; P = .005) and lower Manual Dexterity (P = .031) and Balance (P = .027) scores. When excluding children with cerebral palsy and those with an IQ <70, hand function deficits remained significantly associated with manual dexterity. CONCLUSION Hand function deficits at age 18-22 months are associated with manual dexterity deficits and motor difficulties at school age, independent of perinatal-neonatal factors and the use of occupational or physical therapy. This has significant implications for school success, intervention, and rehabilitative therapy development.
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Kuiper MJ, Meiners LC, Chandler ES, Brandsma R, Bos AF, Horst HT, Sival DA, Brouwer O, Elema A, Heineman K, Hitzert M, vd Hoeven J, Lunsing R. Dyskinesia Impairment Scale scores in Dutch pre-school children after neonatal therapeutic hypothermia. Eur J Paediatr Neurol 2020; 28:70-76. [PMID: 32950367 DOI: 10.1016/j.ejpn.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neonatal therapeutic hypothermia (TH) can ameliorate or prevent the development of dyskinetic cerebral palsy (CP) after hypoxic-ischemic encephalopathy (HIE). The Dyskinesia Impairment Scale (DIS) was recently launched to quantify dyskinetic (dystonic and choreatic) motor features in patients with CP. In TH treated children, who are at risk of developing dyskinetic CP, we aimed to determine DIS-scores at pre-school age. METHOD In 21 Dutch pre-school children (3-6 years of age) who had received TH according to the Dutch-Flemish treatment protocol, we determined DIS-scores. We associated DIS-scores with 1. age-matched control values (Kuiper et al., 2018) [1], and 2. previously reported DIS-score range in dyskinetic CP (Monbaliu E et al., 2015). RESULTS The motor phenotype was determined as: normal (n = 18/21), mildly impaired (reduced coordination (n = 2/21)) and abnormal (dyskinetic CP; n = 1/21). In absence of CP (n = 20/21), DIS-scores were lower (more favorable) than in dyskinetic CP, without any overlapping group scores (mean difference: 71 points; p < .05). However, the obtained DIS-scores were still higher than previously reported in healthy age-matched controls (mean difference: 14 points; p < .05). There was an association between DIS-scores and retrospective neonatal MRI (basal ganglia and thalamus injury on diffusion weighted imaging (DWI)) and (a)EEG parameters (p < .05). CONCLUSION In the vast majority (95%) of Dutch TH-HIE treated pre-school children, the phenotypic motor outcome was favorable. However, DIS-scores were moderately increased compared with healthy age-matched controls. Future studies may elucidate the significance of moderately increased DIS-scores should to further extent.
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Affiliation(s)
- M J Kuiper
- Department of Neurology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - L C Meiners
- Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - E S Chandler
- Department of Neurology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - R Brandsma
- Department of Neurology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - A F Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hj Ter Horst
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - D A Sival
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.
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Tolia VN, Clark RH, Ellsbury DL, Ho T, Zupancic JAF, Ahmad K. Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units. J Perinatol 2020; 40:1389-1393. [PMID: 32327710 DOI: 10.1038/s41372-020-0667-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify patterns of neuroimaging (NI), including cranial ultrasounds (CUS) and magnetic resonance imaging (MRI), among a large cohort of United States NICU infants. STUDY DESIGN The retrospective cohort study of the Pediatrix Clinical Data Warehouse for infants discharged between 2008 and 2017. RESULTS From the 863,863 infants during the study period, 204,197 (24%) had at least one NI study. CUS was the most common study (n = 189,190, 22%) followed by MRI (n = 37,107, 4%). From 2008 to 2017, the percentage of infants who underwent any NI decreased from 28 to 21% (p < 0.001) driven primarily by a reduction in CUS. MRI use for infants ≤33 weeks increased through 2015 and then decreased. CONCLUSIONS Overall reductions in NI have been driven by decreased use of CUS in infants born at 31-33 weeks' gestational age. MRI use among preterm infants has been more dynamic with an initial rise and recent decrease.
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Affiliation(s)
- Veeral N Tolia
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA. .,Pediatrix Medical Group, Dallas, TX, USA. .,The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA.
| | - Reese H Clark
- The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA
| | - Dan L Ellsbury
- The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kaashif Ahmad
- The Center for Research Education, Quality, and Safety, Mednax, Inc, Sunrise, FL, USA.,Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA.,Pediatrix Medical Group, San Antonio, TX, USA
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Pillay K, Dereymaeker A, Jansen K, Naulaers G, De Vos M. Applying a data-driven approach to quantify EEG maturational deviations in preterms with normal and abnormal neurodevelopmental outcomes. Sci Rep 2020; 10:7288. [PMID: 32350387 PMCID: PMC7190650 DOI: 10.1038/s41598-020-64211-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/11/2020] [Indexed: 12/02/2022] Open
Abstract
Premature babies are subjected to environmental stresses that can affect brain maturation and cause abnormal neurodevelopmental outcome later in life. Better understanding this link is crucial to developing a clinical tool for early outcome estimation. We defined maturational trajectories between the Electroencephalography (EEG)-derived ‘brain-age’ and postmenstrual age (the age since the last menstrual cycle of the mother) from longitudinal recordings during the baby’s stay in the Neonatal Intensive Care Unit. Data consisted of 224 recordings (65 patients) separated for normal and abnormal outcome at 9–24 months follow-up. Trajectory deviations were compared between outcome groups using the root mean squared error (RMSE) and maximum trajectory deviation (δmax). 113 features were extracted (per sleep state) to train a data-driven model that estimates brain-age, with the most prominent features identified as potential maturational and outcome-sensitive biomarkers. RMSE and δmax showed significant differences between outcome groups (cluster-based permutation test, p < 0.05). RMSE had a median (IQR) of 0.75 (0.60–1.35) weeks for normal outcome and 1.35 (1.15–1.55) for abnormal outcome, while δmax had a median of 0.90 (0.70–1.70) and 1.90 (1.20–2.90) weeks, respectively. Abnormal outcome trajectories were associated with clinically defined dysmature and disorganised EEG patterns, cementing the link between early maturational trajectories and neurodevelopmental outcome.
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Affiliation(s)
- Kirubin Pillay
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom. .,Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
| | - Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.,Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium
| | - Maarten De Vos
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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Gotardo JW, Volkmer NDFV, Stangler GP, Dornelles AD, Bohrer BBDA, Carvalho CG. Impact of peri-intraventricular haemorrhage and periventricular leukomalacia in the neurodevelopment of preterms: A systematic review and meta-analysis. PLoS One 2019; 14:e0223427. [PMID: 31600248 PMCID: PMC6786801 DOI: 10.1371/journal.pone.0223427] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Whether all degrees of periventricular leukomalacia (PVL) and peri-intraventricular haemorrhage (PIVH) have a negative impact on neurodevelopment. OBJECTIVE To determine the impact of PVL and PIVH in the incidence of cerebral palsy, sensorineural impairment and development scores in preterm neonates. Registered in PROSPERO (CRD42017073113). DATA SOURCES PubMed, Embase, SciELO, LILACS, and Cochrane databases. STUDY SELECTION Prospective cohort studies evaluating neurodevelopment in children born preterm which performed brain imaging in the neonatal period. DATA EXTRACTION Two independent researchers extracted data using a predesigned data extraction sheet. STATISTICAL METHODS A random-effects model was used, with Mantel-Haenszel approach and a Sidik-Jonkman method for the estimation of variances, combined with Hartung-Knapp-Sidik-Jonkman correction. Heterogeneity was assessed through the I2 statistic and sensitivity analysis were performed when possible. No funnel plots were generated but publication bias was discussed as a possible limitation. RESULTS Our analysis concluded premature children with any degree of PIVH are at increased risk for cerebral palsy (CP) when compared to children with no PIVH (3.4, 95% CI 1.60-7.22; 9 studies), a finding that persisted on subgroup analysis for studies with mean birth weight of less than 1000 grams. Similarly, PVL was associated with CP, both in its cystic (19.12, 95% CI 4.57-79.90; 2 studies) and non-cystic form (9.27, 95% CI 5.93-14.50; 2 studies). We also found children with cystic PVL may be at risk for visual and hearing impairment compared to normal children, but evidence is weak. LIMITATIONS Major limitations were the lack of data for PVL in general, especially for the outcome of neurodevelopment, the high heterogeneity among methods used to assess neurodevelopment and the small number of studies, which led to meta-analysis with high heterogeneity and wide confidence intervals. CONCLUSIONS There was no evidence supporting the hypothesis that PIVH causes impairment in neuropsychomotor development in our meta-analysis, but review of newer studies show an increased risk for lower intelligence scores in children with severe lesions, both PIVH and PVL. There is evidence to support the hypothesis that children with any degree of PIVH, especially those born below 1000 grams and those with severe haemorrhage, are at increased risk of developing CP, as well as children with PVL, both cystic and non-cystic.
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Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm. Pediatr Res 2019; 86:339-347. [PMID: 30631138 PMCID: PMC6561840 DOI: 10.1038/s41390-018-0243-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low birth weight in term-born individuals correlates with adverse cardiometabolic outcomes; excess glucocorticoid exposure has been linked to these relationships. We hypothesized that cortisol and adrenal androgens would correlate inversely with birthweight and directly with markers of cardiometabolic risk in school-aged children born extremely preterm; further, preterm-born would have increased cortisol and adrenal androgens compared to term-born children. METHODS Saliva samples were obtained at age 6 from 219 preterm-born children followed since birth and 40 term-born children and analyzed for dehydroepiandrosterone (DHEA) and cortisol. Cortisol was also measured at home (awakening, 30' later, evening). RESULTS For preterm-born children, cortisol and DHEA correlated inversely with weight and length Z-scores at 36 weeks PMA and positively with systolic BP. DHEA was higher in preterm-born than term-born children (boys p < 0.01; girls p = 0.04). Cortisol was similar between preterm-born and term-born at study visit; however, preterm-born children showed a blunted morning cortisol. In term-born children, DHEA correlated with BMI (p = 0.04), subscapular, and abdominal skinfold thicknesses (both p < 0.01). CONCLUSION Cortisol and DHEA correlated inversely with early postnatal growth and directly with systolic BP in extremely preterm-born children, suggesting perinatal programming. Blunted morning cortisol may reflect NICU stress, as seen after other adverse childhood experiences (ACEs).
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Duncan AF, Bann CM, Dempsey A, Peralta-Carcelen M, Hintz S. Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm. J Pediatr 2019; 204:148-156.e4. [PMID: 30292492 PMCID: PMC6394414 DOI: 10.1016/j.jpeds.2018.08.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/07/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes. STUDY DESIGN Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ2 test. We computed correlations between BITSEA and Bayley-III scores. RESULTS Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores <85 (P < .001). CONCLUSIONS Social-emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social-emotional competence and may be a useful predictor to guide early assessment and intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT00063063 and NCT00233324.
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Affiliation(s)
- Andrea F. Duncan
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center at Houston, TX
| | - Carla M. Bann
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Allison Dempsey
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center at Houston, TX
| | | | - Susan Hintz
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine Stanford University, Palo Alto, CA
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Abstract
OBJECTIVES The aim of this study was to investigate the effects of infant and toddler head growth on intelligence scores from early childhood to adulthood in very preterm (<32 weeks gestational age; VP) and/or very low birth weight (<1500 g; VLBW) and term born individuals. METHODS 203 VP/VLBW and 198 term comparisons were studied from birth to adulthood as part of the prospective geographically defined Bavarian Longitudinal Study (BLS). Head circumference was assessed at birth; 5, 20 months; and 4 years of age. Intelligence was assessed with standardized tests in childhood (6 and 8 years: K-ABC) and at 26 years (Wechsler Adult Intelligence Scale, WAIS). Structural equation modeling (SEM) was used to model the effect of head growth on IQ. RESULTS On average, VP/VLBW had lower head circumference at birth (27.61 cm vs. 35.11 cm, mean difference 7.49, 95% confidence interval [7.09-7.90]) and lower adult intelligence scores (88.98 vs. 102.54, mean difference 13.56 [10.59-16.53]) than term born comparison individuals. Head circumference at birth (e.g., total effect β=.48; p<.001 for adult IQ) and head growth in childhood predicted intelligence development from age 6 to 26 years in both VP/VLBW and term born individuals (70% of variance in adult IQ explained by full model). Effects of gestation and birth weight on intelligence were fully mediated by head circumference and growth. CONCLUSIONS This longitudinal investigation from birth to adulthood indicates head growth as a proxy of brain development and intelligence. Repeated early head circumference assessment adds valuable information when screening for long-term neurocognitive risk. (JINS, 2019, 25, 48#x2013;56).
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Shankaran S. Childhood neurodevelopmental outcome following extremely preterm birth. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:843-844. [PMID: 30361129 DOI: 10.1016/s2352-4642(18)30308-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Seetha Shankaran
- Wayne State University School of Medicine, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, MI 48201, USA.
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