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Zhang C, Cheng M, Zhu Z, Wang K, Moon BF, Shen S, Zhang B, Wang Z, Lu L, Shang H, Qin C, Yang J, Lu Y, Zhang X, Zhao X. Associations between diffusion kurtosis imaging metrics and neurodevelopmental outcomes in neonates with low-grade germinal matrix and intraventricular hemorrhage. Sci Rep 2024; 14:16455. [PMID: 39014184 PMCID: PMC11252380 DOI: 10.1038/s41598-024-67517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
Diffusion Kurtosis Imaging (DKI)-derived metrics are recognized as indicators of maturation in neonates with low-grade germinal matrix and intraventricular hemorrhage (GMH-IVH). However, it is not yet known if these factors are associated with neurodevelopmental outcomes. The objective of this study was to acquire DKI-derived metrics in neonates with low-grade GMH-IVH, and to demonstrate their association with later neurodevelopmental outcomes. In this prospective study, neonates with low-grade GMH-IVH and control neonates were recruited, and DKI were performed between January 2020 and March 2021. These neonates underwent the Bayley Scales of Infant Development test at 18 months of age. Mean kurtosis (MK), radial kurtosis (RK) and gray matter values were measured. Spearman correlation analyses were conducted for the measured values and neurodevelopmental outcome scores. Forty controls (18 males, average gestational age (GA) 30 weeks ± 1.3, corrected GA at MRI scan 38 weeks ± 1) and thirty neonates with low-grade GMH-IVH (13 males, average GA 30 weeks ± 1.5, corrected GA at MRI scan 38 weeks ± 1). Neonates with low-grade GMH-IVH exhibited lower MK and RK values in the PLIC and the thalamus (P < 0.05). The MK value in the thalamus was associated with Mental Development Index (MDI) (r = 0.810, 95% CI 0.695-0.13; P < 0.001) and Psychomotor Development Index (PDI) (r = 0.852, 95% CI 0.722-0.912; P < 0.001) scores. RK value in the caudate nucleus significantly and positively correlated with MDI (r = 0.496, 95% CI 0.657-0.933; P < 0.001) and PDI (r = 0.545, 95% CI 0.712-0.942; P < 0.001) scores. The area under the curve (AUC) were used to assess diagnostic performance of MK and RK in thalamus (AUC = 0.866, 0.787) and caudate nucleus (AUC = 0.833, 0.671) for predicting neurodevelopmental outcomes. As quantitative neuroimaging markers, MK in thalamus and RK in caudate nucleus may help predict neurodevelopmental outcomes in neonates with low-grade GMH-IVH.
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Affiliation(s)
- Chunxiang Zhang
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou University, Zhengzhou, China
| | - Meiying Cheng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Kaiyu Wang
- GE Healthcare, MR Research China, Beijing, China
| | | | | | - Bohao Zhang
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou University, Zhengzhou, China
| | - Zihe Wang
- Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Honglei Shang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chi Qin
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinze Yang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Lu
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Henan International Joint Laboratory of Neuroimaging, Zhengzhou University, Zhengzhou, China.
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Yen CW, Chiang MC, Chu SM, Wang HC, Wu LC, Yen PC, Yu MC. Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center. BMC Pediatr 2024; 24:233. [PMID: 38566029 PMCID: PMC10985966 DOI: 10.1186/s12887-024-04568-7] [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: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Acute kidney injury (AKI) is commonly seen in neonatal intensive care units (NICUs) and is potentially associated with adverse prognoses in later stages of life. Our study evaluated the impact of sustained AKI (SAKI) on both neurodevelopmental impairment (NDI) and early growth restriction (EGR) in neonates. METHODS This case-control study retrospectively analyzed the medical records of neonates diagnosed with SAKI in the NICU of a tertiary medical center during the period from January 2007 to December 2020. Cases without subsequent follow-up and those resulting in death were excluded. We analyzed demographic, biochemical, and clinical outcome data. RESULTS Of the 93 neonates with SAKI, 51 cases (54.8%) were included in this study, while 42 cases (45.2%) were excluded due to a lack of follow-up or death. An age-matched control group comprised 103 neonates, who had never experienced AKI or SAKI, were selected at random. In total, 59 (38.3%) cases were identified as NDI and 43 (27.9%) as EGR. Multivariate analysis revealed that patients with SAKI had significantly higher risks of developing NDI (odds ratio, [OR] = 4.013, p = 0.001) and EGR (OR = 4.894, p < 0.001). The AKI interval had an area under the receiver operating characteristic curve of 0.754 for NDI at 9.5 days and 0.772 for EGR at 12.5 days. CONCLUSIONS SAKI is an independent risk factor for both NDI and EGR in neonates. Consequently, regular monitoring, neurological development assessments, and appropriate nutritional advice are crucial to these infants who have experienced renal injury.
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Affiliation(s)
- Chen-Wei Yen
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pediatric General Medicine, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Department of Neonatology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Department of Neonatology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Chin Wang
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chun Wu
- Department of Neonatal Intensive Care Unit, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Cheng Yen
- Department of Pharmacy Administration, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Ching Yu
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, 5 Fusing Street, Gueishan, Taoyuan, 333, Taiwan.
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Zhang C, Zhu Z, Wang K, Moon BF, Zhang B, Shen Y, Wang Z, Zhao X, Zhang X. Assessment of brain structure and volume reveals neurodevelopmental abnormalities in preterm infants with low-grade intraventricular hemorrhage. Sci Rep 2024; 14:5709. [PMID: 38459090 PMCID: PMC10923809 DOI: 10.1038/s41598-024-56148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
There is increasing evidence of abnormal neurodevelopmental outcomes in preterm infants with low-grade intraventricular hemorrhage (IVH). The purpose of the study was to explore whether brain microstructure and volume are associated with neuro-behavioral outcomes at 40 weeks corrected gestational age in preterm infants with low-grade IVH. MR imaging at term-equivalent age (TEA) was performed in 25 preterm infants with mild IVH (Papile grading I/II) and 40 control subjects without IVH. These subjects all had neonatal behavioral neurological assessment (NBNA) at 40 weeks' corrected age. Microstructure and volume evaluation of the brain were performed by using diffusion kurtosis imaging (DKI) and Synthetic MRI. Correlations among microstructure parameters, volume, and developmental outcomes were explored by using Spearman's correlation. In preterm infants with low-grade IVH, the volume of brain parenchymal fraction (BPF) was reduced. In addition, mean kurtosis (MK), fractional anisotropy (FA), radial kurtosis (RK), axial kurtosis (AK) in several major brain regions were reduced, while mean diffusivity (MD) was increased (P < 0.05). BPF, RK in the cerebellum, MK in the genu of the corpus callosum, and MK in the thalamus of preterm infants with low-grade IVH were associated with lower NBNA scores (r = 0.831, 0.836, 0.728, 0.772, P < 0.05). DKI and Synthetic MRI can quantitatively evaluate the microstructure alterations and brain volumes in preterm infants with low-grade IVH, which provides clinicians with a more comprehensive and accurate neurobehavioral assessment of preterm infants with low-grade IVH.
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Affiliation(s)
- Chunxiang Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | | | - Kaiyu Wang
- GE Healthcare, MR Research China, Beijing, China
| | - Brianna F Moon
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bohao Zhang
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Yanyong Shen
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zihe Wang
- Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, China.
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, China.
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Rees P, Callan C, Chadda KR, Diviney J, Harnden F, Gardiner J, Battersby C, Gale C, Sutcliffe A. Childhood outcomes after low-grade intraventricular haemorrhage: A systematic review and meta-analysis. Dev Med Child Neurol 2024; 66:282-289. [PMID: 37488717 DOI: 10.1111/dmcn.15713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 07/26/2023]
Abstract
AIM To undertake a systematic review and meta-analysis exploring school-age neurodevelopmental outcomes of children after low-grade intraventricular haemorrhage (IVH). METHOD The published and grey literature was extensively searched to identify observational comparative studies exploring neurodevelopmental outcomes after IVH grades 1 and 2. Our primary outcome was neurodevelopmental impairment after 5 years of age, which included cognitive, motor, speech and language, behavioural, hearing, or visual impairments. RESULTS This review included 12 studies and over 2036 infants born preterm with low grade IVH. Studies used 30 different neurodevelopmental tools to determine outcomes. There was conflicting evidence of the composite risk of neurodevelopmental impairment after low-grade IVH. There was evidence of an association between low-grade IVH and lower IQ at school age (-4.23, 95% confidence interval [CI] -7.53, -0.92, I2 = 0%) but impact on school performance was unclear. Studies reported an increased crude risk of cerebral palsy after low-grade IVH (odds ratio [OR] 2.92, 95% CI 1.95, 4.37, I2 = 41%). No increased risk of speech and language impairment or behavioural impairment was found. Few studies addressed hearing and visual impairment. INTERPRETATION This systematic review presents evidence that low-grade IVH is associated with specific neurodevelopmental impairments at school age, lending support to the theory that low-grade IVH is not a benign condition. WHAT THIS PAPER ADDS The functional impact of low-grade intraventricular haemorrhage (IVH) at school age is unknown. Low-grade IVH is associated with a lower IQ at school age. The risk of cerebral palsy is increased after low-grade IVH. Low-grade IVH is not associated with speech and language impairment.
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Affiliation(s)
- Philippa Rees
- Population Policy and Practice, Great Ormond Street UCL Institute of Child Health, London, UK
| | - Caitriona Callan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karan R Chadda
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Diviney
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | - Fergus Harnden
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julian Gardiner
- Population Policy and Practice, Great Ormond Street UCL 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, Great Ormond Street UCL Institute of Child Health, London, UK
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Kvanta H, Bolk J, Broström L, Fernández de Gamarra-Oca L, Padilla N, Ådén U. Extreme prematurity and perinatal risk factors related to extremely preterm birth are associated with complex patterns of regional brain volume alterations at 10 years of age: a voxel-based morphometry study. Front Neurol 2023; 14:1148781. [PMID: 37273719 PMCID: PMC10235462 DOI: 10.3389/fneur.2023.1148781] [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: 01/20/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Structural brain volumetric differences have been investigated previously in very preterm children. However, children born extremely preterm, at the border of viability, have been studied to a lesser degree. Our group previously analyzed children born extremely preterm at term using voxel-based morphometry. In this study, we aimed to examine regional gray and white matter differences for children born extremely preterm derived from the same cohort during childhood. We also aimed to explore the effect of perinatal risk factors on brain volumes in the same group. Methods At 10 years of age, 51 children born extremely preterm (before 27 weeks and 0 days) and 38 term-born controls with high-quality 3.0 Tesla magnetic resonance images were included. Statistical analyses using voxel-based morphometry were conducted on images that were normalized using age-specific templates, modulated, and smoothed. Analyses were also performed in stratified groups of children born extremely preterm in the absence or presence of perinatal risk factors that have previously been shown to be associated with volumetric differences at term. Results We found volumetric decreases in gray and white matter in the temporal lobes, gray matter decreases in the precuneus gyri, and white matter decreases in the anterior cingulum for children born extremely preterm (all p < 0.001, and pfwe < 0.05). Gray and white matter increases were predominantly observed in the right posterior cingulum and occipital lobe (all p < 0.001, and pfwe < 0.05). Of the examined perinatal risk factors, intraventricular hemorrhage grades I-II compared with no intraventricular hemorrhage and patent ductus arteriosus ligation compared with no treated patent ductus arteriosus or patent ductus arteriosus treated with ibuprofen led to volumetric differences at 10 years of age (all p < 0.001, and pfwe < 0.05). Conclusions Children born extremely preterm exhibit volumetric alterations in a pattern overlapping that previously found at term, where many regions with differences are the main hubs of higher order networks. Some, but not all, risk factors known to be associated with structural alterations at term were associated with alterations at 10 years of age.
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Affiliation(s)
- Hedvig Kvanta
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jenny Bolk
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lina Broström
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | | | - Nelly Padilla
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Fernández de Gamarra-Oca L, Kvanta H, Broström L, Nosko D, Eklöf E, Ojeda N, Zubiaurre-Elorza L, Padilla N, Ådén U. Hippocampal volumes and cognitive performance in children born extremely preterm with and without low-grade intraventricular haemorrhage. Brain Struct Funct 2023:10.1007/s00429-023-02643-w. [PMID: 37081204 DOI: 10.1007/s00429-023-02643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
Children born extremely preterm, especially those with intraventricular haemorrhage (IVH), are at increased risk of adverse cognitive outcomes during childhood. The present study aimed to explore the effects of IVH (grades I-II) on hippocampal volumes, and their correlates with cognitive performance. The sample consisted of 94 participants, including 54 children born extremely preterm (19 with IVH, grades I-II), and 40 children born at term. All participants underwent a magnetic resonance imaging study at the age of 10 (Mage = 10.20 years; SDage = 0.78), and 74 of them (45 extremely preterm and 29 full-term) carried out a cognitive assessment at 12 years old. Children born extremely preterm had lower scores in cognitive performance compared to their full-term peers. Significant positive partial correlations were observed between global bilateral hippocampus, left CA-field, and left subiculum volumes with processing speed in the full-term group, while no significant correlations were found in the extremely preterm group. Moderation analyses in the extremely preterm sample revealed that low-grade IVH moderated the relationship between right hippocampal volume and full-IQ (F(4,40) = 5.42, p = 0.001, R2 = 0.35). Having greater right hippocampal volume had a protective effect on full-IQ in those children born extremely preterm with low-grade IVH.
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Affiliation(s)
- L Fernández de Gamarra-Oca
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda de Las Universidades 24, 48007, Bilbao, Bizkaia, Spain.
| | - H Kvanta
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - L Broström
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - D Nosko
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - E Eklöf
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - N Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda de Las Universidades 24, 48007, Bilbao, Bizkaia, Spain
| | - L Zubiaurre-Elorza
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda de Las Universidades 24, 48007, Bilbao, Bizkaia, Spain
| | - N Padilla
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - U Ådén
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Legge N, Lutz T, Wocadlo C, Rieger I. Long-term neurodevelopmental outcome in preterm infants with intraventricular haemorrhage. J Paediatr Child Health 2022; 58:1797-1802. [PMID: 35837759 PMCID: PMC9796685 DOI: 10.1111/jpc.16108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intraventricular haemorrhage (IVH) is one of the key risks for long-term neurodevelopmental issues. There remains controversy over the impact low-grade IVH has on the long-term outcome of premature infants. This study describes the long-term neurodevelopmental impact of Grade I and II IVH in former preterm infants in the early school years. METHODS This is a retrospective cohort analysis from one tertiary neonatal intensive care unit (NICU) in Australia including all infants born at <30 weeks' gestation and admitted to the NICU between 2006 and 2013 with complete ultrasound reports and follow-up results. Results of standardised tests for neurodevelopmental outcomes at 5 and 8 years were compared between infants who suffered mild IVH and infants who had normal head ultrasounds. RESULTS During the study period, 491 infants <30 weeks gestation were admitted; 275 patients had full follow-up data available. We found no significant difference in examined outcomes at 5- and 8-year follow-up. CONCLUSION Mild IVH does not affect cognitive, motor and academic outcomes at school age.
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Affiliation(s)
- Nele Legge
- Neonatal Intensive Care unitLiverpool HospitalSydneyNew South WalesAustralia,School of MedicineUniversity of SydneySydneyNew South WalesAustralia
| | - Tracey Lutz
- School of MedicineUniversity of SydneySydneyNew South WalesAustralia,Newborn CareRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Crista Wocadlo
- Newborn CareRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Ingrid Rieger
- School of MedicineUniversity of SydneySydneyNew South WalesAustralia,Newborn CareRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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Zhang C, Zhao X, Cheng M, Wang K, Zhang X. The Effect of Intraventricular Hemorrhage on Brain Development in Premature Infants: A Synthetic MRI Study. Front Neurol 2021; 12:721312. [PMID: 34566865 PMCID: PMC8458889 DOI: 10.3389/fneur.2021.721312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: Synthetic MRI can obtain multiple parameters in one scan, including T1 and T2 relaxation time, proton density (PD), brain volume, etc. This study aimed to investigate the parameter values T1 and T2 relaxation time, PD, and volume characteristics of intraventricular hemorrhage (IVH) newborn brain, and the ability of synthetic MRI parameters T1 and T2 relaxation time and PD to diagnose IVH. Materials and methods: The study included 50 premature babies scanned with conventional and synthetic MRI. Premature infants were allocated to the case group (n = 15) and NON IVH (n = 35). The T1, T2, PD values, and brain volume were obtained by synthetic MRI. Then we assessed the impact of IVH on these parameters. Results: In the posterior limbs of the internal capsule (PLIC), genu of the corpus callosum (GCC), central white matter (CWM), frontal white matter (FWM), and cerebellum (each p < 0.05), the T1 and T2 relaxation times of the IVH group were significantly prolonged. There were significant differences also in PD. The brain volume in many parts were also significantly reduced, which was best illustrated in gray matter (GM), cerebrospinal fluid and intracranial volume, and brain parenchymal fraction (BPF) (each p < 0.001, t = −5.232 to 4.596). The differential diagnosis ability of these quantitative values was found to be excellent in PLIC, CWM, and cerebellum (AUC 0.700–0.837, p < 0.05). Conclusion: The quantitative parameters of synthetic MRI show well the brain tissue characteristic values and brain volume changes of IVH premature infants. T1 and T2 relaxation times and PD contribute to the diagnosis and evaluation of IVH.
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Affiliation(s)
- Chunxiang Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Meiying Cheng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- GE Healthcare, MR Research China, Beijing, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
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9
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Argyropoulou MI, Xydis VG, Drougia A, Giantsouli AS, Giapros V, Astrakas LG. Structural and functional brain connectivity in moderate-late preterm infants with low-grade intraventricular hemorrhage. Neuroradiology 2021; 64:197-204. [PMID: 34342681 DOI: 10.1007/s00234-021-02770-3] [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: 04/22/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Brain functional connectivity (FC) changes and microstructural abnormalities are reported in infants born moderate and late preterm (MLPT). We evaluated the effect of low-grade (grades I, II) intraventricular hemorrhage (IVH) in MLPT babies on brain structural connectivity (SC) and FC. METHODS Babies born MLPT between January 2014 and May 2017 underwent brain ultrasound (US) at 72 h and 7 days after birth, and MRI at around term equivalent. The MRI protocol comprised T1- and T2-weighted sequences, diffusion tensor imaging (DTI), and resting-state functional MRI (fMRI). SC and FC were assessed using graph analysis. RESULTS Of 350 MLPT neonates, 15 showed low-grade IVH on US at 72 h, for which brain MRI was available in 10. These 10 infants, with mean gestational age (GA) 34.0 ± 0.8 weeks, comprised the study group, and 10 MLPT infants of mean GA 33.9 ± 1.1 weeks, with no abnormalities on brain US and MRI, were control subjects. All study subjects presented modularity, small world topology, and rich club organization for both SC and FC. The patients with low-grade IVH had lower FC rich club coefficient and lower SC betweenness centrality in the left frontoparietal operculum, and lower SC rich club coefficient in the right superior orbitofrontal cortex than the control subjects. CONCLUSIONS Topological and functional properties of mature brain connectivity are present in MLPT infants. IVH in these infants was associated with structural and functional abnormalities in the left frontoparietal operculum and right orbitofrontal cortex, regions related to language and cognition.
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Affiliation(s)
- Maria I Argyropoulou
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece.
| | - Vasileios G Xydis
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
| | - Aikaterini Drougia
- Neonatal Intensive Care Unit, Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Anastasia S Giantsouli
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, P.O. Box 1186, 45110, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Loukas G Astrakas
- Department of Medical Physics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Huang WH, Li DM, Hsu CT, Lin YH, Hsu YC, Wang TM, Lin MC. Decreased Incidence of Intraventricular Hemorrhage in Extremely Low Birth Weight Infants Using Customized Circulatory Management to Evaluate the Hemodynamic Change of Patent Ductus Arteriosus. Front Pediatr 2021; 9:711871. [PMID: 34660481 PMCID: PMC8514993 DOI: 10.3389/fped.2021.711871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/06/2021] [Indexed: 11/15/2022] Open
Abstract
Background: In extremely low birth weight (ELBW) infants, the patent ductus arteriosus (PDA) with left-to-right shunt and an increase in systemic artery resistance may cause increasing preload and afterload of the left ventricle. The immature myocardium in ELBW infants has a limited ability to respond to the change, which leads to hemorrhagic complications. In this study, we detected the hemodynamic change of cardiac performance and applied a clinical strategy to prevent PDA-associated hemorrhagic complications in ELBW infants. Methods: We enrolled ELBW infants at a single medical center in Taiwan. The customized circulatory management was performed by echocardiography after birth until the PDA closed. Inotropic agents were administrated according to the requirements of hemodynamic parameters or clinical conditions. The primary outcomes were hemorrhagic complications including pulmonary hemorrhage and intraventricular hemorrhage (IVH) greater than grade II. The secondary outcomes were the rate of surgical ligation of PDA, mortality, necrotizing enterocolitis, and bronchopulmonary dysplasia. Results: A total of 20 ELBW infants were evaluated by customized circulatory management from 2019 to 2020. We reviewed 35 ELBW infants born between 2017 and 2018 in our hospital, who served as the non-management group. The management group had a significantly lower incidence rate of IVH greater than grade 2 (p = 0.02). Other outcomes showed no significant differences. Dobutamine was prescribed in 8 cases in the management group, and end-systolic wall stress (ESWS) was significantly decreased after Dobutamine administration (p = 0.017). Conclusion: The incidence rate of IVH greater than grade II in ELBW infants decreased after use of customized circulatory management in our study. The strategy of customized circulatory management might be an effective "early target therapy" for hemodynamically significant PDA in high-risk ELBW infants. Inotropic therapy with Dobutamine could be a useful medical choice for improving cardiac function to prevent hemorrhagic complications.
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Affiliation(s)
- Wan-Heng Huang
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Pediatric Neonatology, Da Chien General Hospital, Miaoli City, Taiwan
| | - De-Ming Li
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ting Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsuan Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Chi Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Teh-Ming Wang
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Food and Nutrition, Providence University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, National Chung Hsing University, Taichung, Taiwan
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Tortora D, Lo Russo FM, Severino M, Parodi A, Massirio P, Ramenghi LA, Rossi A. Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: an ASL study. Neuroradiology 2020; 62:1689-1699. [DOI: 10.1007/s00234-020-02514-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
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