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Kumar M, Ali A, Khan MA, Sohail S, Saleem SM, Khan M, Naz F, Khan WA, Salat MS, Hussain K, Ambreen G. Relationship of caffeine regimen with osteopenia of prematurity in preterm neonates: a cohort retrospective study. BMC Pediatr 2022; 22:437. [PMID: 35864501 PMCID: PMC9306044 DOI: 10.1186/s12887-022-03493-x] [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: 03/31/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life. METHODS This retrospective cohort study was conducted including neonates of < 32 weeks gestational age (GA) and birth weight < 1500 g, admitted to NICU from April-2017 to December-2018 and received caffeine therapy till 28 days of life for AOP. Based on serum-ALP levels, formed the high and low-ALP groups. Neonatal characteristics, caffeine regimen, risk factors for OOP, including duration of parenteral nutrition (PN), exposure to medicines associated with MBD, and intake of essential vitamins and minerals, were compared in both groups. Predictors of OOP were analyzed through logistic regression. RESULTS From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p < 0.001). The high-ALP group received significantly (p < 0.001) higher daily and cumulative caffeine doses and were associated with a higher likelihood of developing OOP in this study cohort [cumulative dose (mg) (AOR = 1.082 95% CI 1.011 to 1.157) and daily dose (mg/kg/day) (AOR = 2.892 95% CI 1.392 to 6.007)]. Smaller GA was found directly related to OOP. Among the other medical risk factors, phosphorus intake was significantly low in the high-ALP group. No, significant relationship between duration of PN and use of steroids and diuretics, and intake of vitamins and minerals were identified. CONCLUSION The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.
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Affiliation(s)
- Manoj Kumar
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Amin Ali
- Department of Neonatology & Paediatrics, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Azeem Khan
- Department of Neonatology & Paediatrics, Medicare Hospital, Karachi, Pakistan
| | - Sadia Sohail
- Department of Paediatrics, Fatimiyah Hospital Paediatrics, Karachi, Pakistan
| | - Syed Muzafar Saleem
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Midhat Khan
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Fizzah Naz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Wasif Ahmed Khan
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan
| | - Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital, Karachi, Pakistan.
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Watson RS, Beers SR, Asaro LA, Burns C, Koh MJ, Perry MA, Angus DC, Wypij D, Curley MA. Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes. JAMA 2022; 327:836-845. [PMID: 35230393 PMCID: PMC8889465 DOI: 10.1001/jama.2022.1480] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Approximately 23 700 US children undergo invasive mechanical ventilation for acute respiratory failure annually, with unknown long-term effects on neurocognitive function. OBJECTIVE To evaluate neurocognitive outcomes of children who survive pediatric intensive care unit (PICU) hospitalization for acute respiratory failure compared with their biological siblings. DESIGN, SETTING, AND PARTICIPANTS Prospective sibling-matched cohort study conducted at 31 US PICUs and associated neuropsychology testing centers. Patients were 8 years or younger with a Pediatric Cerebral Performance Category score of 1 (normal) before PICU admission and less than or equal to 3 (no worse than moderate neurocognitive dysfunction) at PICU discharge, excluding patients with a history of neurocognitive deficits or who were readmitted and underwent mechanical ventilation. Biological siblings were aged 4 to 16 years at testing, with Pediatric Cerebral Performance Category score of 1 and no history of mechanical ventilation or general anesthesia. A total of 121 sibling pairs were enrolled from September 2, 2014, to December 13, 2017, and underwent neurocognitive testing starting March 14, 2015. The date of the final follow-up was November 6, 2018. EXPOSURES Critical illness and PICU treatment for acute respiratory failure. MAIN OUTCOMES AND MEASURES The primary outcome was IQ, estimated by the age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale. Secondary outcomes included measures of attention, processing speed, learning and memory, visuospatial skills, motor skills, language, and executive function. Evaluations occurred 3 to 8 years after hospital discharge. RESULTS Patients (n = 121; 55 [45%] female patients) underwent PICU care at a median (IQR) age of 1.0 (0.2-3.2) years, received a median (IQR) of 5.5 (3.1-7.7) days of invasive mechanical ventilation, and were tested at a median (IQR) age of 6.6 (5.4-9.1) years. Matched siblings (n = 121; 72 [60%] female siblings) were tested at a median (IQR) age of 8.4 (7.0-10.2) years. Patients had a lower mean estimated IQ than matched siblings (101.5 vs 104.3; mean difference, -2.8 [95% CI, -5.4 to -0.2]). Among secondary outcomes, patients had significantly lower scores than matched siblings on nonverbal memory (mean difference, -0.9 [95% CI, -1.6 to -0.3]), visuospatial skills (mean difference, -0.9 [95% CI, -1.8 to -0.1]), and fine motor control (mean difference, -3.1 [95% CI, -4.9 to -1.4]) and significantly higher scores on processing speed (mean difference, 4.4 [95% CI, 0.2-8.5]). There were no significant differences in the remaining secondary outcomes, including attention, verbal memory, expressive language, and executive function. CONCLUSIONS AND RELEVANCE Among children, survival of PICU hospitalization for respiratory failure and discharge without severe cognitive dysfunction was associated with significantly lower subsequent IQ scores compared with matched siblings. However, the magnitude of the difference was small and of uncertain clinical importance.
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Affiliation(s)
- R. Scott Watson
- Department of Pediatrics, University of Washington, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa A. Asaro
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Cheryl Burns
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Min Jung Koh
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mallory A. Perry
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Derek C. Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Senior Editor, JAMA
| | - David Wypij
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martha A.Q. Curley
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
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Therapeutic potential of stem cells for preterm infant brain damage: Can we move from the heterogeneity of preclinical and clinical studies to established therapeutics? Biochem Pharmacol 2021; 186:114461. [PMID: 33571501 DOI: 10.1016/j.bcp.2021.114461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
Acquired perinatal brain injuries are a set of conditions that remains a key challenge for neonatologists and that have significant social, emotional and financial implications for our communities. In our perspective article, we will introduce perinatal brain injury focusing specifically on the events leading to brain damage in preterm born infants and outcomes for these infants. Then we will summarize and discuss the preclinical and clinical studies testing the efficacy of stem cells as neuroprotectants in the last ten years in perinatal brain injury. There are no therapies to treat brain damage in preterm born infants and a primary finding from this review is that there is a scarcity of stem cell trials focused on overcoming brain injuries in these infants. Overall, across all forms of perinatal brain injury there is a remarkable heterogeneity in previous and on-going preclinical and clinical studies in terms of the stem cell type, animal models/patient selection, route and time of administration. Despite the quality of many of the studies this variation makes it difficult to reach a valid consensus for future developments. However, it is clear that stem cells (and stem cell derived exosomes) can reduce perinatal brain injury and our field needs to work collectively to refine an effective protocol for each type of injury. The use of standardized stem cell products and testing these products across multiple models of injury will provide a stronger framework for clinical trials development.
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Placental origins of neonatal diseases: toward a precision medicine approach. Pediatr Res 2021; 89:377-383. [PMID: 33288874 DOI: 10.1038/s41390-020-01293-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/30/2023]
Abstract
The placenta is the single most reliable source for precise information on intrauterine environment, as well as maternal and fetal health. It mediates the physiology of two distinct yet highly interconnected individuals. The pathology that develops in the placenta, and the adaptations the placenta undergoes to mitigate this pathology, may influence the later life health of the mother and baby. Pathological placental examination provides a unique opportunity to explore and understand the intrauterine environment, as well as providing a record of events that may be associated with adverse pregnancy outcomes. A number of placental lesions have been described in association with various neonatal morbidities. The purpose of this review is to summarize the evidence for the association of placental pathologic lesions with neurodevelopmental outcomes infants with specific neonatal morbidities, including (1) neonatal encephalopathy, (2) bronchopulmonary dysplasia, (3) congenital heart diseases, and (4) autism spectrum disorders. For each of these disease processes, we will also propose specific research priorities in future studies. We conclude with a hospital-specific protocol for triaging which placentas should receive histological evaluation as a fundamental first step for the field of neuroplacentology to guide precision-based therapeutic approaches in the affected newborns. IMPACT: The purpose of this review is to summarize the evidence for placental origins of neonatal diseases. We propose specific research priorities in the field of neuroplacentology in future studies. We also present a targeted hospital-based approach for triaging which placentas should receive histological evaluation.
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Yang L, Yu X, Zhang Y, Liu N, Xue X, Fu J. Encephalopathy in Preterm Infants: Advances in Neuroprotection With Caffeine. Front Pediatr 2021; 9:724161. [PMID: 34660486 PMCID: PMC8517339 DOI: 10.3389/fped.2021.724161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022] Open
Abstract
With the improvement in neonatal rescue technology, the survival rate of critically ill preterm infants has substantially increased; however, the incidence of brain injury and sequelae in surviving preterm infants has concomitantly increased. Although the etiology and pathogenesis of preterm brain injury, and its prevention and treatment have been investigated in recent years, powerful and effective neuroprotective strategies are lacking. Caffeine is an emerging neuroprotective drug, and its benefits have been widely recognized; however, its effects depend on the dose of caffeine administered, the neurodevelopmental stage at the time of administration, and the duration of exposure. The main mechanisms of caffeine involve adenosine receptor antagonism, phosphodiesterase inhibition, calcium ion activation, and γ-aminobutyric acid receptor antagonism. Studies have shown that there are both direct and indirect beneficial effects of caffeine on the immature brain. Accordingly, this article briefly reviews the pharmacological characteristics of caffeine, its mechanism of action in the context of encephalopathy in premature infants, and its use in the neuroprotection of encephalopathy in this patient population.
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Affiliation(s)
- Liu Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Pediatrics, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xuefei Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yajun Zhang
- Department of Anesthesiology, Dalian Municipal Maternal and Child Health Care Hospital, Dalian, China
| | - Na Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xindong Xue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianhua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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6
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Faruk T, King C, Muhit M, Islam MK, Jahan I, Baset KU, Badawi N, Khandaker G. Screening tools for early identification of children with developmental delay in low- and middle-income countries: a systematic review. BMJ Open 2020; 10:e038182. [PMID: 33234622 PMCID: PMC7684835 DOI: 10.1136/bmjopen-2020-038182] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To systematically review, identify and report the screening tools used for early identification of developmental delay in low- and middle-income countries. DESIGN Systematic review. DATA SOURCES Four bibliographic databases: Medline (1946 to 13 July 2020), Embase (1974 to 13 July 2020), Scopus (1823 to 11 July 2020) and PsycINFO (1987 to July week 1 2020). ELIGIBILITY CRITERIA Peer-reviewed original articles published in English addressing validated culturally sensitive developmental screening tools among children aged <5 years were included in this review. DATA EXTRACTION AND SYNTHESIS One author (CK, medical librarian) developed the search strategy. Three authors conducted the database search (phase I: CK; phase II: IJ and MKI). Three authors (TF, IJ and MKI) independently screened the title and abstracts. TF, MKI and GK independently performed the full-text review of the screened articles. During each step of the study selection process, disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the systematic review. Data extraction and analysis were performed using MS Excel. Meta-analysis was not possible due to heterogeneity of the study findings. RESULTS We identified 3349 articles, of which 18 studies from 10 countries, reporting 16 screening tools, were selected for qualitative synthesis. Six cultural contexts were explored. Twelve general, two motor and two speech-language tools were identified. Seven of them found to be parent-completed ones. Five screening tools (American Speech-Language and Hearing Association, Guide for Monitoring Child Development, Infant Neurological International Battery, New Delhi-Development Screening Questionnaire and Woodside Screening Technique) reported relatively higher sensitivity (82.5%-100%) and specificity (83%-98.93%). CONCLUSIONS Limited number of culturally sensitive developmental screening tools were validated for children aged <5 years in low- and middle-income countries. Revising existing screening tools in different ethnic and cultural settings and subsequent validation with normative value should be a research priority.
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Affiliation(s)
- Tasnuva Faruk
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
| | - Catherine King
- The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammad Muhit
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Md Kafiul Islam
- Department of Electrical and Electronic Engineering, Independent University Bangladesh, Dhaka, Bangladesh
| | - Israt Jahan
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kamran Ul Baset
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
- Road Safety and Driving School, BRAC, Dhaka, Bangladesh
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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7
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Pregnolato S, Chakkarapani E, Isles AR, Luyt K. Glutamate Transport and Preterm Brain Injury. Front Physiol 2019; 10:417. [PMID: 31068830 PMCID: PMC6491644 DOI: 10.3389/fphys.2019.00417] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Preterm birth complications are the leading cause of child death worldwide and a top global health priority. Among the survivors, the risk of life-long disabilities is high, including cerebral palsy and impairment of movement, cognition, and behavior. Understanding the molecular mechanisms of preterm brain injuries is at the core of future healthcare improvements. Glutamate excitotoxicity is a key mechanism in preterm brain injury, whereby the accumulation of extracellular glutamate damages the delicate immature oligodendrocytes and neurons, leading to the typical patterns of injury seen in the periventricular white matter. Glutamate excitotoxicity is thought to be induced by an interaction between environmental triggers of injury in the perinatal period, particularly cerebral hypoxia-ischemia and infection/inflammation, and developmental and genetic vulnerabilities. To avoid extracellular build-up of glutamate, the brain relies on rapid uptake by sodium-dependent glutamate transporters. Astrocytic excitatory amino acid transporter 2 (EAAT2) is responsible for up to 95% of glutamate clearance, and several lines of evidence suggest that it is essential for brain functioning. While in the adult EAAT2 is predominantly expressed by astrocytes, EAAT2 is transiently upregulated in the immature oligodendrocytes and selected neuronal populations during mid-late gestation, at the peak time for preterm brain injury. This developmental upregulation may interact with perinatal hypoxia-ischemia and infection/inflammation and contribute to the selective vulnerability of the immature oligodendrocytes and neurons in the preterm brain. Disruption of EAAT2 may involve not only altered expression but also impaired function with reversal of transport direction. Importantly, elevated EAAT2 levels have been found in the reactive astrocytes and macrophages of human infant post-mortem brains with severe white matter injury (cystic periventricular leukomalacia), potentially suggesting an adaptive mechanism against excitotoxicity. Interestingly, EAAT2 is suppressed in animal models of acute hypoxic-ischemic brain injury at term, pointing to an important and complex role in newborn brain injuries. Enhancement of EAAT2 expression and transport function is gathering attention as a potential therapeutic approach for a variety of adult disorders and awaits exploration in the context of the preterm brain injuries.
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Affiliation(s)
- Silvia Pregnolato
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elavazhagan Chakkarapani
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anthony R Isles
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Karen Luyt
- Department of Neonatal Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Wang Q, Lv H, Lu L, Ren P, Li L. Neonatal hypoxic-ischemic encephalopathy: emerging therapeutic strategies based on pathophysiologic phases of the injury. J Matern Fetal Neonatal Med 2018; 32:3685-3692. [PMID: 29681183 DOI: 10.1080/14767058.2018.1468881] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neonatal hypoxic ischemic encephalopathy (HIE) is an important cause of neonatal death and disability. At present, there is no unified standard and specialized treatment method for neonatal HIE. In clinical practice, we have found that a gap remains between preclinical medical research and clinical application in the treatment of neonatal HIE. To promote an organic combination of preclinical research and clinical application, we propose the different phases as intervention targets, based on the pathophysiologic changes in phases I, II, and III of neonatal HIE; moreover, we suggest transformative medicine as a principle that may improve the therapeutic effect by blocking the progression of the disease to an irreversible stage. For instance, in phase I, mild hypothermia, free radical scavenger (erythropoietin, hydrogen-rich saline), excitatory amino acid receptor blocker, and neuroprotective agents should be administered to neonates with moderate/severe HIE; in phase II, following phase I treatment, anti-inflammatory agents, neuroprotective or nerve regeneration agents, and stem cell transplantation should be administered to patients; in phase III, anti-inflammatory agents, neuroprotective or nerve regeneration agents, and stem cell transplantation should be administered to patients. As soon as the patient's condition has stabilized, acupuncture, massage, and rehabilitation training should be performed. Following further study of stem cells, stem cell transplantation is expected to become the most promising therapeutic candidate for treatment of severe neonatal HIE with its sequelae.
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Affiliation(s)
- Qiuli Wang
- a Department of Neonatology , Handan Maternal and Child Health Care Hospital , Handan , PR China
| | - Hongyan Lv
- a Department of Neonatology , Handan Maternal and Child Health Care Hospital , Handan , PR China.,b Department of Neonatal Pathology , Handan Maternal and Child Health Care Hospital , Handan , PR China
| | - Lixin Lu
- c Department of Pediatrics , Handan 7th Hospital , Handan , PR China
| | - Pengshun Ren
- a Department of Neonatology , Handan Maternal and Child Health Care Hospital , Handan , PR China
| | - Lianxiang Li
- b Department of Neonatal Pathology , Handan Maternal and Child Health Care Hospital , Handan , PR China.,d Department of Neural Development and Neural Pathology , Hebei University of Engineering School of Medicine , Handan , PR China
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9
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Ali E, Rockman-Greenberg C, Moffatt M, Narvey M, Reed M, Jiang D. Caffeine is a risk factor for osteopenia of prematurity in preterm infants: a cohort study. BMC Pediatr 2018; 18:9. [PMID: 29357829 PMCID: PMC5776771 DOI: 10.1186/s12887-017-0978-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Caffeine, the most commonly used medication in Neonatal Intensive Care Units, has calciuric and osteoclastogenic effects. Methods To examine the association between the cumulative dose and duration of therapy of caffeine and osteopenia of prematurity, a retrospective cohort study was conducted including premature infants less than 31 weeks and birth weight less than 1500 g. Osteopenia of prematurity was evaluated using chest X-rays on a biweekly basis over 12 weeks of hospitalization. Results The cohort included 109 infants. 51% had osteopenia of prematurity and 8% had spontaneous rib fractures. Using the generalized linear mixed model, caffeine dose and duration of caffeine therapy showed a strong association with osteopenia of prematurity. Steroids and vitamin D were also significantly correlated with osteopenia of prematurity while diuretic use did not show a statistically significant effect. Conclusion The cumulative dose and duration of therapy of caffeine, as well as steroid are associated with osteopenia of prematurity in this cohort. Future studies are needed to confirm these findings and determine the lowest dose of caffeine needed to treat effectively apnea of prematurity.
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Affiliation(s)
- Ebtihal Ali
- Community Health Sciences Department, Faculty of Health Sciences, University of Manitoba, MS361K, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada. .,Child Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada.
| | - Cheryl Rockman-Greenberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Child Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Michael Moffatt
- Community Health Sciences Department, Faculty of Health Sciences, University of Manitoba, MS361K, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.,Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Child Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Michael Narvey
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Child Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Martin Reed
- Department of Radiology, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Depeng Jiang
- Community Health Sciences Department, Faculty of Health Sciences, University of Manitoba, MS361K, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
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10
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Chew LJ, DeBoy CA. Pharmacological approaches to intervention in hypomyelinating and demyelinating white matter pathology. Neuropharmacology 2016; 110:605-625. [PMID: 26116759 PMCID: PMC4690794 DOI: 10.1016/j.neuropharm.2015.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 12/17/2022]
Abstract
White matter disease afflicts both developing and mature central nervous systems. Both cell intrinsic and extrinsic dysregulation result in profound changes in cell survival, axonal metabolism and functional performance. Experimental models of developmental white matter (WM) injury and demyelination have not only delineated mechanisms of signaling and inflammation, but have also paved the way for the discovery of pharmacological approaches to intervention. These reagents have been shown to enhance protection of the mature oligodendrocyte cell, accelerate progenitor cell recruitment and/or differentiation, or attenuate pathological stimuli arising from the inflammatory response to injury. Here we highlight reports of studies in the CNS in which compounds, namely peptides, hormones, and small molecule agonists/antagonists, have been used in experimental animal models of demyelination and neonatal brain injury that affect aspects of excitotoxicity, oligodendrocyte development and survival, and progenitor cell function, and which have been demonstrated to attenuate damage and improve WM protection in experimental models of injury. The molecular targets of these agents include growth factor and neurotransmitter receptors, morphogens and their signaling components, nuclear receptors, as well as the processes of iron transport and actin binding. By surveying the current evidence in non-immune targets of both the immature and mature WM, we aim to better understand pharmacological approaches modulating endogenous oligodendroglia that show potential for success in the contexts of developmental and adult WM pathology. This article is part of the Special Issue entitled 'Oligodendrocytes in Health and Disease'.
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Affiliation(s)
- Li-Jin Chew
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC, USA.
| | - Cynthia A DeBoy
- Biology Department, Trinity Washington University, Washington, DC, USA
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11
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Tronnes AA, Koschnitzky J, Daza R, Hitti J, Ramirez JM, Hevner R. Effects of Lipopolysaccharide and Progesterone Exposures on Embryonic Cerebral Cortex Development in Mice. Reprod Sci 2015; 23:771-8. [PMID: 26621965 DOI: 10.1177/1933719115618273] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our objective was to determine if progesterone pretreatment could ameliorate the detrimental effects of lipopolysaccharide (LPS)-induced inflammation on cortical neurogenesis. Timed pregnant mouse dams (n = 8) were given intraperitoneal injections of progesterone (42 mg/kg) or vehicle on embryonic day 17.5. Two hours later, mice were given intraperitoneal LPS (140 μg/kg) or vehicle. Mice were sacrificed 16 hours later on embryonic day 18. Two-color immunofluorescence was performed with primary antibodies T-box transcription factor 2 (Tbr2), ionized calcium binding adapter molecule 1 (Iba1), cleaved caspase 3 (CC3), and 5-bromo-2'-deoxyuridine (BrdU). Cells were counted, and statistical analysis was determined using analysis of variance and Tukey-Kramer method. The Tbr2 intermediate neural progenitor cell density decreased after LPS exposure (P = .0022). Pre-exposure to progesterone statistically increased Tbr2 intermediate neural progenitors compared to LPS treatment alone and was similar to controls (P = .0022). After LPS exposure, microglia displayed an activated phenotype, and cell density was increased (P < .001). Cell death rates were low among study groups but was increased in LPS exposure groups compared to progesterone alone (P = .0015). Lipopolysaccharide-induced systemic inflammation reduces prenatal neurogenesis in mice. Pre-exposure with progesterone is associated with increased neurogenesis. Progesterone may protect the preterm brain from defects of neurogenesis induced by inflammation.
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Affiliation(s)
- Ashlie A Tronnes
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
| | - Jenna Koschnitzky
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ray Daza
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jane Hitti
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
| | - Jan Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Robert Hevner
- Department of Neurological Surgery, Center for Integrative Brain Research, University of Washington School of Medicine, Seattle, WA
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Gupte AS, Gupta D, Ravichandran S, Ma MM, Chouthai NS. Effect of early caffeine on neurodevelopmental outcome of very low-birth weight newborns. J Matern Fetal Neonatal Med 2015; 29:1233-7. [PMID: 26365887 DOI: 10.3109/14767058.2015.1041493] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the effect of early caffeine therapy started within the first 48 h of life on neurodevelopmental outcome in very low birth weight (VLBW) newborns. STUDY DESIGN VLBW newborns received either caffeine therapy within first 48 h of life (Early group), after 3rd day of life (Late group) or no caffeine during first month of life as per clinical team. A cohort of these newborns (n = 160) who survived were evaluated using Bayley Scale of Infant Development III (BSID III) developmental testing between 18 and 22 months of corrected age. RESULTS VLBW newborns in the "Early group" had significantly better composite, cognitive, language and motor BSID III scores as compared to those in "Late group" and no caffeine group. Composite BSID III scores were unchanged in the presence or absence of chorioamnionitis for "Early group", while the BSID III scores were significantly lower in the presence of acute chorioamnionitis in "Late group" and no caffeine group. CONCLUSIONS Early caffeine therapy was associated with better BSID III scores in a cohort of VLBW newborns. Newborns with acute chorioamnionitis benefited from early caffeine therapy.
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Affiliation(s)
- Avanti Sanjay Gupte
- a Carman and Ann Adams Departments of Pediatrics, Wayne State University , Detroit , MI , USA and
| | - Devyani Gupta
- a Carman and Ann Adams Departments of Pediatrics, Wayne State University , Detroit , MI , USA and
| | - Saranya Ravichandran
- a Carman and Ann Adams Departments of Pediatrics, Wayne State University , Detroit , MI , USA and
| | - Mia Michelle Ma
- a Carman and Ann Adams Departments of Pediatrics, Wayne State University , Detroit , MI , USA and
| | - Nitin Shashikant Chouthai
- a Carman and Ann Adams Departments of Pediatrics, Wayne State University , Detroit , MI , USA and.,b Division of Neonatal-Perinatal medicine, Carman and Ann Adams Departments of Pediatrics , Wayne State University , Detroit , MI , USA
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13
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Tataranno ML, Perrone S, Buonocore G. Plasma Biomarkers of Oxidative Stress in Neonatal Brain Injury. Clin Perinatol 2015; 42:529-39. [PMID: 26250915 DOI: 10.1016/j.clp.2015.04.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Perinatal encephalopathy is a leading cause of lifelong disability. Increasing evidence indicates that the pathogenesis of perinatal brain damage is much more complex than originally thought, with multiple pathways involved. An important role of oxidative stress (OS) in the pathogenesis of brain injury is recognized for preterm and term infants. This article examines potential reliable and specific OS biomarkers that can be used in premature and term infants for the early detection and follow-up of the most common neonatal brain injuries, such as hypoxic-ischemic encephalopathy, intraventricular hemorrhage, and periventricular leukomalacia. The next step will be to explore the correlation between brain-specific OS biomarkers and functional brain outcomes.
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Affiliation(s)
- Maria Luisa Tataranno
- Department of Molecular and Developmental Medicine, University of Siena, Via Banchi di Sotto, 55, 53100 Siena, Italy
| | - Serafina Perrone
- Department of Molecular and Developmental Medicine, University of Siena, Via Banchi di Sotto, 55, 53100 Siena, Italy.
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Via Banchi di Sotto, 55, 53100 Siena, Italy
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14
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Watchko JF, Maisels MJ. The enigma of low bilirubin kernicterus in premature infants: why does it still occur, and is it preventable? Semin Perinatol 2014; 38:397-406. [PMID: 25267279 DOI: 10.1053/j.semperi.2014.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Low bilirubin kernicterus in preterm neonates, though rare, remains an unpredictable and refractory form of brain injury. Hypoalbuminemia, co-morbid CNS insult(s), infection, and inflammation are contributing causes that, in many cases, appear to interact in potentiating bilirubin neurotoxicity. Despite compulsive attention to serum bilirubin levels, and clinical and laboratory indices of neurotoxicity risk, low bilirubin kernicterus continues to be seen in contemporary NICUs. While efforts to refine and improve current treatment guidelines are certainly needed, such revision(s) will also have to take into account the risks and benefits of any intervention, including phototherapy.
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Affiliation(s)
- Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - M Jeffrey Maisels
- Division of Newborn Medicine, Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI
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