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Govaert P, Arena R, Dudink J, Steggerda S, Agut T, Marissens G, Hoebeek F. Developmental anatomy of the thalamus, perinatal lesions, and neurological development. Dev Med Child Neurol 2024. [PMID: 38875159 DOI: 10.1111/dmcn.15992] [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: 11/21/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
The thalamic nuclei develop before a viable preterm age. GABAergic neuronal migration is especially active in the third trimester. Thalamic axons meet cortical axons during subplate activation and create the definitive cortical plate in the second and third trimesters. Default higher-order cortical driver connections to the thalamus are then replaced by the maturing sensory networks, in a process that is driven by first-order thalamic neurons. Surface electroencephalographic activity, generated first in the subplate and later in the cortical plate, gradually show oscillations based on the interaction of the cortex with thalamus, which is controlled by the thalamic reticular nucleus. In viable newborn infants, in addition to sensorimotor networks, the thalamus already contributes to visual, auditory, and pain processing, and to arousal and sleep. Isolated thalamic lesions may present as clinical seizures. In addition to asphyxia and stroke, infection and network injury are also common. Cranial ultrasound can be used to classify neonatal thalamic injuries based on functional parcelling of the mature thalamus. We provide ample illustration and a detailed description of the impact of neonatal focal thalamic injury on neurological development, and discuss the potential for neuroprotection based on thalamocortical plasticity.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Roberta Arena
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | - Jeroen Dudink
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Thais Agut
- Department of Neonatology, UZBrussel, Brussels, Belgium
| | | | - Freek Hoebeek
- Department for Developmental Origins of Disease/Brain Centre, Division Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Kim YJ, Lee JH, Lee JK, Yoon SA, Woo SI. Higher prevalence of rotavirus infection among out-born newborns transferred to a regional neonatal intensive care unit in Korea. BMC Pediatr 2022; 22:686. [PMID: 36447202 PMCID: PMC9706948 DOI: 10.1186/s12887-022-03753-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Rotavirus is one of important pathogens which require infection control in nurseries and neonatal intensive care unit (NICU). METHOD We retrospectively reviewed 1,135 out-born newborns who were transferred to a regional tertiary NICU of Chungbuk National University Hospital between January 2012 and December 2016. We assessed the clinical characteristics of newborns based on the results of rotavirus surveillance tests. The prevalence of rotavirus was evaluated according to the year, month, and season. RESULTS Among the 1,135 infants, 213 (18.8%) had positive results in the rotavirus surveillance test. The rotavirus positive group had a significantly higher gestational age, birth weight, and Apgar score. They also had a significantly higher rate of postpartum care centers when compared to the rotavirus negative group (45.5% vs. 12.6%, P < 0.001). Notably, the prevalence of rotavirus was significantly increased from 3.2 to 33.8% when infants were hospitalized 48 h after birth (P < 0.001). During the study period, there were no significant differences in the annual, monthly, or seasonal prevalence of rotavirus infection. CONCLUSION AND DISCUSSION: These findings suggest that more active screening for rotavirus infection is necessary, especially for out-born newborns admitted to NICUs 48 h after birth or hospitalized after using postpartum care centers in Korea.
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Affiliation(s)
- Yoo-Jin Kim
- grid.254229.a0000 0000 9611 0917Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, 28644 Cheongju, Korea
| | - Ji Hyuk Lee
- grid.254229.a0000 0000 9611 0917Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, 28644 Cheongju, Korea
| | - Joon Kee Lee
- grid.254229.a0000 0000 9611 0917Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, 28644 Cheongju, Korea
| | - Shin Ae Yoon
- grid.254229.a0000 0000 9611 0917Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, 28644 Cheongju, Korea
| | - Sung-Il Woo
- grid.254229.a0000 0000 9611 0917Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, 28644 Cheongju, Korea
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Kim JS. Increasing our understanding of rotavirus-induced central nervous system manifestations. Clin Exp Pediatr 2022; 65:536-537. [PMID: 35538712 PMCID: PMC9650360 DOI: 10.3345/cep.2022.00395] [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: 03/06/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jon Soo Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
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Hellysaz A, Hagbom M. Understanding the Central Nervous System Symptoms of Rotavirus: A Qualitative Review. Viruses 2021; 13:v13040658. [PMID: 33920421 PMCID: PMC8069368 DOI: 10.3390/v13040658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/08/2023] Open
Abstract
This qualitative review on rotavirus infection and its complications in the central nervous system (CNS) aims to understand the gut–brain mechanisms that give rise to CNS driven symptoms such as vomiting, fever, feelings of sickness, convulsions, encephalitis, and encephalopathy. There is substantial evidence to indicate the involvement of the gut–brain axis in symptoms such as vomiting and diarrhea. The underlying mechanisms are, however, not rotavirus specific, they represent evolutionarily conserved survival mechanisms for protection against pathogen entry and invasion. The reviewed studies show that rotavirus can exert effects on the CNS trough nervous gut–brain communication, via the release of mediators, such as the rotavirus enterotoxin NSP4, which stimulates neighboring enterochromaffin cells in the intestine to release serotonin and activate both enteric neurons and vagal afferents to the brain. Another route to CNS effects is presented through systemic spread via lymphatic pathways, and there are indications that rotavirus RNA can, in some cases where the blood brain barrier is weakened, enter the brain and have direct CNS effects. CNS effects can also be induced indirectly as a consequence of systemic elevation of toxins, cytokines, and/or other messenger molecules. Nevertheless, there is still no definitive or consistent evidence for the underlying mechanisms of rotavirus-induced CNS complications and more in-depth studies are required in the future.
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Moltoni G, D'Arco F, Pasquini L, Carducci C, Bhatia A, Longo D, Kaliakatsos M, Lancella L, Romano A, Di Napoli A, Bozzao A, Rossi-Espagnet MC. Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child. Pediatr Radiol 2020; 50:1757-1767. [PMID: 32651625 DOI: 10.1007/s00247-020-04746-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Non-congenital viral infections of the central nervous system in children can represent a severe clinical condition that needs a prompt diagnosis and management. However, the aetiological diagnosis can be challenging because symptoms are often nonspecific and cerebrospinal fluid analysis is not always diagnostic. In this context, neuroimaging represents a helpful tool, even though radiologic patterns sometimes overlap. The purpose of this pictorial essay is to suggest a schematic representation of different radiologic patterns of non-congenital viral encephalomyelitis based on the predominant viral tropism and vulnerability of specific regions: cortical grey matter, deep grey matter, white matter, brainstem, cerebellum and spine.
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Affiliation(s)
- Giulia Moltoni
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Felice D'Arco
- Neuroradiology Unit, Great Ormond Street Hospital, London, UK
| | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Chiara Carducci
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Aashim Bhatia
- Neuroradiology Unit, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Daniela Longo
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Marios Kaliakatsos
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Laura Lancella
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy.
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
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Yadav A, Kumar J. Febrile encephalopathy and diarrhoea in infancy: do not forget this culprit. BMJ Case Rep 2019; 12:12/7/e231195. [PMID: 31296630 DOI: 10.1136/bcr-2019-231195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arushi Yadav
- Radiodiagnosis and Imaging, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Jogender Kumar
- Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The first weeks of life are a time of heightened risk for seizures due to age-dependent physiologic features of the developing brain that lead to increased neuronal excitation and decreased inhibition. Usually, seizures in neonates are a symptom of an acute brain injury; seizures are only rarely due to neonatal-onset epilepsy syndromes. Neonatal seizures are harmful to the developing brain; early and accurate diagnosis is critical. For suspected seizures, EEG monitoring should be initiated as soon as is feasible, in order to evaluate for events of concern, screen for subclinical seizures, and assess the EEG background. Amplitude-integrated EEG can provide excellent complementary data, particularly with regard to evolution of background patterns, but has limited sensitivity to detect individual neonatal seizures. An urgent and systematic approach to precise etiologic diagnosis is key for optimal management and estimates of prognosis. Evaluation of the seizure etiology must occur in parallel with initiation of appropriate treatment. It is critical that neonatologists and neurologists develop hospital-specific, consensus-based practice pathways for neonatal seizure evaluation and treatment. Such practice pathways can streamline medical decision making, facilitate rapid medication administration, and potentially decrease seizure burden and optimize outcomes. Herein, the pathophysiology, epidemiology, treatment, and long-term management considerations for neonatal seizures are presented.
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Affiliation(s)
- Renée A Shellhaas
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, United States.
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Ku JK, Heo YJ, Lee KS, Lee BL. Clinical Findings and Neurologic Outcome in Neonatal Encephalopathy With White Matter Injury Accompanied by Rotavirus. J Child Neurol 2018; 33:297-305. [PMID: 29433417 DOI: 10.1177/0883073817753290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to elucidate the clinical characteristics and neurodevelopmental outcomes in neonatal encephalopathy with characteristic white matter injury as compared with other injury patterns on magnetic resonance diffusion-weighted imaging. We conducted a retrospective study comparing clinical and laboratory findings, and neurologic outcomes between 17 newborns with diffuse lesions in the periventricular white matter and white matter tract (group I) and 22 newborns with other patterns (group II). Stool samples indicated that 16 neonates (94.1%) in group I were rotavirus-positive, whereas none in group II had rotavirus infection. Significantly lower calcium levels were found in group I than in group II ( P < .001). Moreover, a more favorable neurodevelopmental outcome was observed in group I than in group II. This study suggests that characteristic white matter injury in neonatal encephalopathy may be related to decreased calcium levels induced by rotavirus, and may have a better neurodevelopmental prognosis than other causes.
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Affiliation(s)
- Jae Kyun Ku
- 1 Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Young Jin Heo
- 2 Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Keun Soo Lee
- 3 Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Bo Lyun Lee
- 1 Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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