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Arena R, Gallini F, De Rose DU, Conte F, Giraldi L, Pianini T, Perri A, Catenazzi P, Orfeo L, Vento G, Govaert P. Brain Growth Evaluation Assessed with Transfontanellar (B-GREAT) Ultrasound. Old and New Bedside Markers to Estimate Cerebral Growth in Preterm Infants: a Pilot Study. Am J Perinatol 2024; 41:488-497. [PMID: 34814194 DOI: 10.1055/a-1704-1716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain Growth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT). STUDY DESIGN In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, and 7 of life, and then weekly until discharge, and at term) in preterm infants born with gestational age (GA) less than 32 weeks. We evaluated corpus callosum length, corpus callosum-fastigium length, anterior horn width, frontal white matter height, total brain surface, deep grey matter height, hemisphere height, transverse cerebellar diameter in the axial view, and transverse cerebellar diameter coronal view. Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied. RESULTS A total of 528 cranial ultrasounds were performed in 80 neonates (median birth GA: 28+5 weeks and interquartile range: 27+3-30+5). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed. CONCLUSION B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates. KEY POINTS · Overall neonatal brain growth is not routinely monitored using ultrasound.. · Old and new markers were used to build a standardized and non-invasive tool to monitor brain growth.. · All B-GREAT measurements had a good intra-observer and inter-observer agreement..
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Affiliation(s)
- Roberta Arena
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Francesca Conte
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Luca Giraldi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa Pianini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Piero Catenazzi
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paul Govaert
- Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Pascal A, de Bruyn N, Naulaers G, Ortibus E, Hanssen B, Oostra A, de Coen K, Sonnaert M, Cloet E, Casaer A, D'Haese J, Laroche S, Jonckheere A, Plaskie K, van Mol C, Bruneel E, van Hoestenberghe MR, Samijn B, Govaert P, Van den Broeck C. The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study. J Pediatr 2023; 262:113600. [PMID: 37402440 DOI: 10.1016/j.jpeds.2023.113600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE To survey the incidence of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) by gestational age and to report the impact on mortality and neurodevelopmental outcome in very preterm/very low birthweight infants. STUDY DESIGN This was a population-based cohort study of 1927 very preterm/very low birthweight infants born in 2014-2016 and admitted to Flemish neonatal intensive care units. Infants underwent standard follow-up assessment until 2 years corrected age with the Bayley Scales of Infant and Toddler Development and neurological assessments. RESULTS No brain lesion was present in 31% of infants born at <26 weeks of gestation and 75.8% in infants born at 29-32 weeks of gestation. The prevalence of low-grade IVH/PVL (grades I and II) was 16.8% and 12.7%, respectively. Low-grade IVH/PVL was not related significantly to an increased likelihood of mortality, motor delay, or cognitive delay, except for PVL grade II, which was associated with a 4-fold increase in developing cerebral palsy (OR, 4.1; 95% CI, 1.2-14.6). High-grade lesions (III-IV) were present in 22.0% of the infants born at <26 weeks of gestational and 3.1% at 29-32 weeks of gestation, and the odds of death were ≥14.0 (IVH: OR, 14.0; 95% CI, 9.0-21.9; PVL: OR, 14.1; 95% CI, 6.6-29.9). PVL grades III-IV showed an increased odds of 17.2 for motor delay and 12.3 for cerebral palsy, but were not found to be associated significantly with cognitive delay (OR, 2.9; 95% CI, 0.5-17.5; P = .24). CONCLUSIONS Both the prevalence and severity of IVH/PVL decreased significantly with advancing gestational age. More than 75% of all infants with low grades of IVH/PVL showed normal motor and cognitive outcome at 2 years corrected age. High-grade PVL/IVH has become less common and is associated with adverse outcomes.
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Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nele de Bruyn
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium; Center for Developmental Disabilities, University Hospital Gasthuisberg, Leuven, Belgium
| | - Britta Hanssen
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ann Oostra
- Center for Developmental Disorders, University Hospital Ghent, Ghent, Belgium
| | - Kris de Coen
- Department of Neonatology, University Hospital Ghent, Ghent, Belgium
| | - Michel Sonnaert
- Department of Neonatology, University Hospital Brussels, Brussels, Belgium
| | - Eva Cloet
- Department of Pediatric Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Alexandra Casaer
- Center for Developmental Disorders, University Hospital Ghent, Ghent, Belgium; Department of Neonatology, AZ Sint-Jan, Brugge, Brugge, Belgium
| | - James D'Haese
- Department of Neonatology, AZ Sint-Jan, Brugge, Brugge, Belgium
| | - Sabine Laroche
- Department of Neonatology, University Hospital Antwerp, Antwerp, Belgium; Center for Developmental Disorders, University Hospital Antwerp, Antwerp, Belgium
| | - An Jonckheere
- Center for Developmental Disorders, University Hospital Antwerp, Antwerp, Belgium
| | - Katleen Plaskie
- Department of Neonatology, GasthuisZusters Antwerpen, Antwerp, Belgium
| | - Christine van Mol
- Department of Neonatology, GasthuisZusters Antwerpen, Antwerp, Belgium
| | - Els Bruneel
- Department of Neonatology, Algemeen Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Bieke Samijn
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Paul Govaert
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Lequin M, Groenendaal F, Dudink J, Govaert P. Susceptibility weighted imaging can be a sensitive sequence to detect brain damage in neonates with kernicterus: a case report. BMC Neurol 2023; 23:104. [PMID: 36906546 PMCID: PMC10007770 DOI: 10.1186/s12883-023-03125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/15/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Kernicterus in the acute phase is difficult to diagnose. It depends on a high signal on T1 at the globus pallidum and subthalamic nucleus level. Unfortunately, these areas also show a relatively high signal on T1 in neonates as an expression of early myelination. Therefore, a less myelin-dependent sequence, like SWI, may be more sensitive to detecting damage in the globus pallidum area. CASE PRESENTATION A term baby developed jaundice on day three following an uncomplicated pregnancy and delivery. Total bilirubin peaked at 542 μmol/L on day four. Phototherapy was started, and an exchange transfusion was performed. ABR showed absent responses on day 10. MRI on day eight demonstrated abnormal high signal globus pallidus on T1w, isointense on T2w, without diffusion restriction, and high signal on SWI at globus pallidal and subthalamus level and phase image at globus pallidal level. These findings were consistent with the challenging diagnosis of kernicterus. On follow-up, the infant presented with sensorineural hearing loss and had a work-up for cochlear implant surgery. At 3 months of age, the follow-up MR shows normalization of the T1 and SWI signals and a high signal on T2. CONCLUSIONS SWI seems more sensitive to injury than the T1w and lacks the disadvantage of the T1w sequence, where early myelin confers a high signal.
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Affiliation(s)
- Maarten Lequin
- UMC Utrecht: Universitair Medisch Centrum, Utrecht, Netherlands.
| | | | - Jeroen Dudink
- UMC Utrecht: Universitair Medisch Centrum, Utrecht, Netherlands
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Beunders VAA, Roelants JA, Suurland J, Dudink J, Govaert P, Swarte RMC, Kouwenberg-Raets MMA, Reiss IKM, Joosten KFM, Vermeulen MJ. Early Ultrasonic Monitoring of Brain Growth and Later Neurodevelopmental Outcome in Very Preterm Infants. AJNR Am J Neuroradiol 2022; 43:639-644. [PMID: 35332022 PMCID: PMC8993199 DOI: 10.3174/ajnr.a7456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In infants born very preterm, monitoring of early brain growth could contribute to prediction of later neurodevelopment. Therefore, our aim was to investigate associations between 2 early cranial ultrasound markers (corpus callosum-fastigium and corpus callosum length) and neurodevelopmental outcome and the added value of both markers in the prediction of neurodevelopmental outcome based on neonatal risk factors and head circumference in very preterm infants. MATERIALS AND METHODS This prospective observational study included 225 infants born at <30 weeks' gestational age, of whom 153 were without any brain injury on cranial ultrasound. Corpus callosum-fastigium and corpus callosum length and head circumference were measured at birth, 29 weeks' gestational age, transfer from the neonatal intensive care unit to a level II hospital, and 2 months' corrected age. We analyzed associations of brain markers and their growth with cognitive, motor, language, and behavioral outcome at 2 years' corrected age. RESULTS In infants without brain injury, greater corpus callosum-fastigium length at 2 months was associated with better cognitive outcome. Corpus callosum length at 2 months was positively associated with cognitive, motor, and language outcome. Faster growth of the corpus callosum length between birth and 2 months was associated with better cognitive and motor function. Prediction of neurodevelopmental outcome based on neonatal risk factors with or without head circumference was significantly improved by adding corpus callosum length. CONCLUSIONS Both corpus callosum-fastigium and corpus callosum length on cranial ultrasound are associated with neurodevelopmental outcome of very preterm infants without brain injury at 2 years, but only corpus callosum length shows the added clinical utility in predicting neurodevelopmental outcome.
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Affiliation(s)
- V A A Beunders
- From the Department of Pediatrics (V.A.A.B., J.A.R., P.G., R.M.C.S., I.K.M.R., M.J.V.)
| | - J A Roelants
- From the Department of Pediatrics (V.A.A.B., J.A.R., P.G., R.M.C.S., I.K.M.R., M.J.V.)
| | - J Suurland
- Division of Neonatology, Department of Child and Adolescent Psychiatry/Psychology (J.S.)
| | - J Dudink
- Department of Neonatology (J.D.), Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center (J.D.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - P Govaert
- From the Department of Pediatrics (V.A.A.B., J.A.R., P.G., R.M.C.S., I.K.M.R., M.J.V.)
| | - R M C Swarte
- From the Department of Pediatrics (V.A.A.B., J.A.R., P.G., R.M.C.S., I.K.M.R., M.J.V.)
| | - M M A Kouwenberg-Raets
- Department of Pediatrics (M.M.A.K-.R.), Division of Neonatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - I K M Reiss
- From the Department of Pediatrics (V.A.A.B., J.A.R., P.G., R.M.C.S., I.K.M.R., M.J.V.)
| | - K F M Joosten
- Department of Pediatrics (K.F.M.J.), Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M J Vermeulen
- From the Department of Pediatrics (V.A.A.B., J.A.R., P.G., R.M.C.S., I.K.M.R., M.J.V.)
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Costerus SA, Kortenbout AJ, Vos HJ, Govaert P, Tibboel D, Wijnen RMH, de Jong N, Bosch JG, de Graaff JC. Feasibility of Doppler Ultrasound for Cortical Cerebral Blood Flow Velocity Monitoring During Major Non-cardiac Surgery of Newborns. Front Pediatr 2021; 9:656806. [PMID: 33829005 PMCID: PMC8019737 DOI: 10.3389/fped.2021.656806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aim: Newborns needing major surgical intervention are at risk of brain injury and impaired neurodevelopment later in life. Disturbance of cerebral perfusion might be an underlying factor. This study investigates the feasibility of serial transfontanellar ultrasound measurements of the pial arteries during neonatal surgery, and whether perioperative changes in cerebral perfusion can be observed and related to changes in the perioperative management. Methods: In this prospective, observational feasibility study, neonates with congenital diaphragmatic hernia and esophageal atresia scheduled for surgical treatment within the first 28 days of life were eligible for inclusion. We performed transfontanellar directional power Doppler and pulsed wave Doppler ultrasound during major high-risk non-cardiac neonatal surgery. Pial arteries were of interest for the measurements. Extracted Doppler ultrasound parameters were: peak systolic velocity, end diastolic velocity, the resistivity index and pulsatility index. Results: In 10 out of 14 patients it was possible to perform perioperative measurements; the others failed for logistic and technical reasons. In 6 out of 10 patients, it was feasible to perform serial intraoperative transfontanellar ultrasound measurements with directional power Doppler and pulsed wave Doppler of the same pial artery during neonatal surgery. Median peak systolic velocity was ranging between 5.7 and 7.0 cm s-1 and end diastolic velocity between 1.9 and 3.2 cm s-1. In patients with a vasoactive-inotropic score below 12 the trend of peak systolic velocity and end diastolic velocity corresponded with the mean arterial blood pressure trend. Conclusion: Perioperative transfontanellar ultrasound Doppler measurements of the pial arteries are feasible and provide new longitudinal data about perioperative cortical cerebral blood flow velocity. Trial Registration: https://www.trialregister.nl/trial/6972, identifier: NL6972.
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Affiliation(s)
- Sophie A Costerus
- Department of Paediatric Surgery, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Anna J Kortenbout
- Department of Biomedical Engineering, Thorax Centre, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Hendrik J Vos
- Department of Biomedical Engineering, Thorax Centre, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Paul Govaert
- Department of Neonatology, Ziekenhuis Netwerk Antwerp, Middelheim Antwerp, Belgium
| | - Dick Tibboel
- Department of Paediatric Surgery, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Nico de Jong
- Department of Biomedical Engineering, Thorax Centre, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Johan G Bosch
- Department of Biomedical Engineering, Thorax Centre, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Jurgen C de Graaff
- Department of Anaesthesiology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
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Geraldo AF, Messina SS, Tortora D, Parodi A, Malova M, Morana G, Gandolfo C, D'Amico A, Herkert E, Govaert P, Ramenghi LA, Rossi A, Severino M. Neonatal Developmental Venous Anomalies: Clinicoradiologic Characterization and Follow-Up. AJNR Am J Neuroradiol 2020; 41:2370-2376. [PMID: 33093132 DOI: 10.3174/ajnr.a6829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although developmental venous anomalies have been frequently studied in adults and occasionally in children, data regarding these entities are scarce in neonates. We aimed to characterize clinical and neuroimaging features of neonatal developmental venous anomalies and to evaluate any association between MR imaging abnormalities in their drainage territory and corresponding angioarchitectural features. MATERIALS AND METHODS We reviewed parenchymal abnormalities and angioarchitectural features of 41 neonates with developmental venous anomalies (20 males; mean corrected age, 39.9 weeks) selected through a radiology report text search from 2135 neonates who underwent brain MR imaging between 2008 and 2019. Fetal and longitudinal MR images were also reviewed. Neurologic outcomes were collected. Statistics were performed using χ2, Fisher exact, Mann-Whitney U, or t tests corrected for multiple comparisons. RESULTS Developmental venous anomalies were detected in 1.9% of neonatal scans. These were complicated by parenchymal/ventricular abnormalities in 15/41 cases (36.6%), improving at last follow-up in 8/10 (80%), with normal neurologic outcome in 9/14 (64.2%). Multiple collectors (P = .008) and larger collector caliber (P < .001) were significantly more frequent in complicated developmental venous anomalies. At a patient level, multiplicity (P = .002) was significantly associated with the presence of ≥1 complicated developmental venous anomaly. Retrospective fetal detection was possible in 3/11 subjects (27.2%). CONCLUSIONS One-third of neonatal developmental venous anomalies may be complicated by parenchymal abnormalities, especially with multiple and larger collectors. Neuroimaging and neurologic outcomes were favorable in most cases, suggesting a benign, self-limited nature of these vascular anomalies. A congenital origin could be confirmed in one-quarter of cases with available fetal MR imaging.
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Affiliation(s)
- A F Geraldo
- From the Neuroradiology Unit (A.F.G.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.,Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - S S Messina
- Radiology Unit (S.S.M.), Casa di Cura Regina Pacis, Palermo, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - A Parodi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - M Malova
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - G Morana
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A D'Amico
- Dipartimento di Scienze Biomediche Avanzate (A.D.), Universita' Federico II, Napoli, Italy
| | - E Herkert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - P Govaert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - L A Ramenghi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
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Pascal A, Naulaers G, Ortibus E, Oostra A, De Coen K, Michel S, Cloet E, Casaer A, D'haese J, Laroche S, Jonckheere A, Plaskie K, Van Mol C, Delanghe G, Bruneel E, Van Hoestenberghe MR, Samijn B, Govaert P, Van den Broeck C. Neurodevelopmental outcomes of very preterm and very-low-birthweight infants in a population-based clinical cohort with a definite perinatal treatment policy. Eur J Paediatr Neurol 2020; 28:133-141. [PMID: 32788055 DOI: 10.1016/j.ejpn.2020.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With constant changes in neonatal care practices, recent information is valuable for healthcare providers and for parental counselling. The aim of the study was to describe the neurodevelopmental outcome in a cohort of very preterm (VPT)/very-low-birthweight (VLBW) infants at 2 years corrected age (CA). MATERIAL AND METHODS This is a population-based cohort study of all infants born with a GA <31 weeks and/or BW < 1500 g between 2014 and 2016 admitted to the Flemish (Belgium) neonatal intensive care units. Infants had routine clinical follow-up around 2 years CA. The diagnosis of cerebral palsy (CP), visual and hearing impairments were recorded. Motor, cognitive and language outcomes were assessed using the Bayley-III. Neurodevelopmental impairment (NDI) was classified as mild (<1 standard deviation [SD]) or moderate-severe (<2SD) based on the defined categories of motor, cognitive, hearing, and vision impairments. RESULTS Of the 1941 admissions, 92% survived to discharge and follow-up data were available for 1089 infants (61.1%). Overall, 19.3%, 18.9% and 41.8% of infants had a motor, cognitive and language delay, respectively. CP was diagnosed in 4.3% of the infants. Mild and moderate-to-severe NDI was observed in 25.2% and 10.9% of the infants, respectively. The number of infants with a normal outcome increased from nearly 40% in the category of GA<26 weeks to 70% for infants in the category of 30─31 weeks GA. CONCLUSION At 2 years CA, 64% were free from NDI and 90% were free from moderate-to-severe NDI. However, a lower GA and BW are associated with higher rates of adverse neurodevelopmental outcomes at 2 years CA.
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Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium. http://
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Els Ortibus
- Centre for Developmental Disorders, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Ann Oostra
- Centre for Developmental Disorders, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Kris De Coen
- Department of Neonatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Sonnaert Michel
- Department of Neonatology, University Hospital Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Eva Cloet
- Department of Pediatric Neurology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Belgium.
| | - Alexandra Casaer
- Department of Neonatology, AZ Sint-Jan, Brugge, Ruddershove 10, 8000, Brugge, Belgium; Centre for Developmental Disorders, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - James D'haese
- Department of Neonatology, AZ Sint-Jan, Brugge, Ruddershove 10, 8000, Brugge, Belgium.
| | - Sabrina Laroche
- Department of Neonatology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium; Centre for Developmental Disorders, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
| | - An Jonckheere
- Centre for Developmental Disorders, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
| | - Katleen Plaskie
- Department of Neonatology, GasthuisZusters Antwerpen, Oosterveldlaan 24, Antwerp, Belgium.
| | - Christine Van Mol
- Department of Neonatology, GasthuisZusters Antwerpen, Oosterveldlaan 24, Antwerp, Belgium.
| | - Gwenda Delanghe
- Department of Neonatology, Algemeen Ziekenhuis Middelheim, Lindendreef 1, 2020, Antwerp, Belgium.
| | - Els Bruneel
- Department of Neonatology, Algemeen Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | | | - Bieke Samijn
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Paul Govaert
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Christine Van den Broeck
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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8
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Affiliation(s)
| | - Charles C Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Medical Sciences Division, Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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9
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Abstract
Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.
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Affiliation(s)
- Alessandro Parodi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy
| | - Paul Govaert
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
- Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium
| | - Sandra Horsch
- Department of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Luca A Ramenghi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy.
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10
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Camfferman FA, de Goederen R, Govaert P, Dudink J, van Bel F, Pellicer A, Cools F. Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review. Pediatr Res 2020; 87:50-58. [PMID: 32218536 PMCID: PMC7098887 DOI: 10.1038/s41390-020-0777-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Very and extremely preterm infants frequently have brain injury-related long-term neurodevelopmental problems. Altered perfusion, for example, seen in the context of a hemodynamically significant patent ductus arteriosus (PDA), has been linked to injury of the immature brain. However, a direct relation with outcome has not been reviewed systematically. METHODS A systematic review was conducted to provide an overview of the value of different cerebral arterial blood flow parameters assessed by Doppler ultrasound, in relation to brain injury, to predict long-term neurodevelopmental outcome in preterm infants. RESULTS In total, 23 studies were included. Because of heterogeneity of studies, a meta-analysis of results was not possible. All included studies on resistance index (RI) showed significantly higher values in subjects with a hemodynamically significant PDA. However, absolute differences in RI values were small. Studies using Doppler parameters to predict brain injury and long-term neurodevelopmental outcome were inconsistent. DISCUSSION There is no clear evidence to support the routine determination of RI or other Doppler parameters in the cerebral arteries to predict brain injury and long-term neurodevelopmental outcome in the preterm infant. However, there is evidence that elevated RI can point to the presence of a hemodynamically significant PDA.
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Affiliation(s)
- Fleur A Camfferman
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Robbin de Goederen
- Dutch Craniofacial Centre Rotterdam, Department of Plastic and Reconstructive Surgery, Erasmus Medical Center University, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
- Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium
| | - Jeroen Dudink
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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11
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Abstract
Transient anatomical entities play a role in the maturation of brain regions and early functional fetal networks. At the postmenstrual age of 7 weeks, major subdivisions of the brain are visible. At the end of the embryonic period, the cortical plate covers the neopallium. The choroid plexus develops in concert with it, and the dorsal thalamus covers about half the diencephalic third ventricle surface. In addition to the fourth ventricle neuroepithelium the rhombic lips are an active neuroepithelial production site. Early reciprocal connections between the thalamus and cortex are present. The corticospinal tract has reached the pyramidal decussation, and the arteries forming the mature circle of Willis are seen. Moreover, the superior sagittal sinus has formed, and at the rostral neuropore the massa commissuralis is growing. At the viable preterm age of around 24 weeks PMA, white matter tracts are in full development. Asymmetric progenitor division permits production of neurons, subventricular zone precursors, and glial cells. Myelin is present in the ventral spinal quadrant, cuneate fascicle, and spinal motor fibers. The neopallial mantle has been separated into transient layers (stratified transitional fields) between the neuroepithelium and the cortical plate. The subplate plays an important role in organizing the structuring of the cortical plate. Commissural tracts have shaped the corpus callosum, early primary gyri are present, and opercularization has started caudally, forming the lateral fissure. Thalamic and striatal nuclei have formed, although GABAergic neurons continue to migrate into the thalamus from the corpus gangliothalamicum. Near-term PMA cerebral sublobulation is active. Between 24 and 32 weeks, primary sulci develop. Myelin is present in the superior cerebellar peduncle, rubrospinal tract, and inferior olive. Germinal matrix disappears from the telencephalon, except for the GABAergic frontal cortical subventricular neuroepithelium.
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Affiliation(s)
- Paul Govaert
- Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Neonatology, ZNA Middelheim, Antwerp, Belgium; Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium.
| | - Fabio Triulzi
- Department of Pediatric Neuroradiology, Università Degli Studi di Milano, Milan, Italy
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center, Utrecht, The Netherlands
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12
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De Bisschop B, Camfferman F, Hengel‐Jacobs M, Delanghe G, Vanderhasselt T, Govaert P. Abnormal primary gyration in relation to deep brain injury in preterm infants. Acta Paediatr 2020; 109:204-205. [PMID: 31483907 DOI: 10.1111/apa.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara De Bisschop
- Department of Neonatology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Fleur Camfferman
- Department of Neonatology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Marjoleine Hengel‐Jacobs
- Department of Neonatology Erasmus Medisch Centrum‐Sophia Kinderziekenhuis Rotterdam The Netherlands
| | | | - Tim Vanderhasselt
- Department of Radiology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussels Belgium
| | - Paul Govaert
- Department of Neonatology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Neonatology Erasmus Medisch Centrum‐Sophia Kinderziekenhuis Rotterdam The Netherlands
- Department of Neonatology ZNA Middelheim Antwerpen Belgium
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13
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Cizmeci MN, Khalili N, Claessens NHP, Groenendaal F, Liem KD, Heep A, Benavente-Fernández I, van Straaten HLM, van Wezel-Meijler G, Steggerda SJ, Dudink J, Išgum I, Whitelaw A, Benders MJNL, de Vries LS, Woerdeman P, ter Horst H, Dijkman K, Ley D, Fellman V, de Haan T, Brouwer A, van ‘t Verlaat E, Govaert P, Smit B, Agut Quijano T, Barcik U, Mathur A, Graca A. Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled ELVIS Trial. J Pediatr 2019; 208:191-197.e2. [PMID: 30878207 DOI: 10.1016/j.jpeds.2018.12.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI. STUDY DESIGN In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis. RESULTS The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P < .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03). CONCLUSIONS More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation. TRIAL REGISTRATION ISRCTN43171322.
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Affiliation(s)
- Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nadieh Khalili
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kian D Liem
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel Heep
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, United Kingdom
| | | | | | - Gerda van Wezel-Meijler
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, The Netherlands; Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew Whitelaw
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, United Kingdom
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
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14
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Dereymaeker A, Matic V, Vervisch J, Cherian PJ, Ansari AH, De Wel O, Govaert P, De Vos M, Van Huffel S, Naulaers G, Jansen K. Automated EEG background analysis to identify neonates with hypoxic-ischemic encephalopathy treated with hypothermia at risk for adverse outcome: A pilot study. Pediatr Neonatol 2019; 60:50-58. [PMID: 29705390 PMCID: PMC6372079 DOI: 10.1016/j.pedneo.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/12/2017] [Accepted: 03/29/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To improve the objective assessment of continuous video-EEG (cEEG) monitoring of neonatal brain function, the aim was to relate automated derived amplitude and duration parameters of the suppressed periods in the EEG background (dynamic Interburst Interval= dIBIs) after neonatal hypoxic-ischemic encephalopathy (HIE) to favourable or adverse neurodevelopmental outcome. METHODS Nineteen neonates (gestational age 36-41 weeks) with HIE underwent therapeutic hypothermia and had cEEG-monitoring. EEGs were retrospectively analyzed with a previously developed algorithm to detect the dynamic Interburst Intervals. Median duration and amplitude of the dIBIs were calculated at 1 h-intervals. Sensitivity and specificity of automated EEG background grading for favorable and adverse outcomes were assessed at 6 h-intervals. RESULTS Dynamic IBI values reached the best prognostic value between 18 and 24 h (AUC of 0.93). EEGs with dIBI amplitude ≥15 μV and duration <10 s had a specificity of 100% at 6-12 h for favorable outcome but decreased subsequently to 67% at 25-42 h. Suppressed EEGs with dIBI amplitude <15 μV and duration >10 s were specific for adverse outcome (89-100%) at 18-24 h (n = 10). Extremely low voltage and invariant EEG patterns were indicative of adverse outcome at all time points. CONCLUSIONS Automated analysis of the suppressed periods in EEG of neonates with HIE undergoing TH provides objective and early prognostic information. This objective tool can be used in a multimodal strategy for outcome assessment. Implementation of this method can facilitate clinical practice, improve risk stratification and aid therapeutic decision-making. A multicenter trial with a quantifiable outcome measure is warranted to confirm the predictive value of this method in a more heterogeneous dataset.
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Affiliation(s)
- Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Vladimir Matic
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium; Faculty of Technical Science, Singidunum University, Belgrade, Serbia
| | - Jan Vervisch
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium
| | - Perumpillichira J Cherian
- Section of Clinical Neurophysiology, Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Division of Neurology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Amir H Ansari
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium; Imec KU Leuven Medical IT Department, Leuven, Belgium
| | - Ofelie De Wel
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium; Imec KU Leuven Medical IT Department, Leuven, Belgium
| | - Paul Govaert
- Section of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Section of Neonatology, ZNA Middelheim, Antwerp, Belgium
| | - Maarten De Vos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Sabine Van Huffel
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium; Imec KU Leuven Medical IT Department, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium
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15
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de Vries LS, Groenendaal F, Liem KD, Heep A, Brouwer AJ, van 't Verlaat E, Benavente-Fernández I, van Straaten HL, van Wezel-Meijler G, Smit BJ, Govaert P, Woerdeman PA, Whitelaw A. Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104:F70-F75. [PMID: 29440132 DOI: 10.1136/archdischild-2017-314206] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare a low versus a higher threshold for intervention in preterm infants with posthaemorrhagic ventricular dilatation. DESIGN Multicentre randomised controlled trial (ISRCTN43171322). SETTING 14 neonatal intensive care units in six countries. PATIENTS 126 preterm infants ≤34 weeks gestation with ventricular dilatation after grade III-IV haemorrhage were randomised to low threshold (LT) (ventricular index (VI) >p97 and anterior horn width (AHW) >6 mm) or higher threshold (HT) (VI>p97+4 mm and AHW >10 mm). INTERVENTION Cerebrospinal fluid tapping by lumbar punctures (LPs) (max 3), followed by taps from a ventricular reservoir, to reduce VI, and eventually a ventriculoperitoneal (VP) shunt if stabilisation of the VI below the p97+4 mm did not occur. COMPOSITE MAIN OUTCOME MEASURE VP shunt or death. RESULTS 19 of 64 (30%) LT infants and 23 of 62 (37%) HT infants were shunted or died (P=0.45). A VP shunt was inserted in 12/64 (19%) in the LT and 14/62 (23%) infants in the HT group. 7/12 (58%) LT infants and 1/14 (7%) HT infants required shunt revision (P<0.01). 62 of 64 (97%) LT infants and 36 of 62 (58%) HT infants had LPs (P<0.001). Reservoirs were inserted in 40 of 64 (62%) LT infants and 27 of 62 (43%) HT infants (P<0.05). CONCLUSIONS There was no significant difference in the primary composite outcome of VP shunt placement or death in infants with posthaemorrhagic ventricular dilatation who were treated at a lower versus a higher threshold for intervention. Infants treated at the lower threshold received more invasive procedures. Assessment of neurodevelopmental outcomes will provide further important information in assessing the risks and benefits of the two treatment approaches.
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Affiliation(s)
- Linda S de Vries
- Department of Neonatology and Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology and Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kian D Liem
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel Heep
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, UK
| | - Annemieke J Brouwer
- Department of Neonatology and Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Ellen van 't Verlaat
- University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Gerda van Wezel-Meijler
- Isala Women and Children's Hospital, Zwolle, The Netherlands.,Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert J Smit
- Directorate Quality & Patientcare, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter A Woerdeman
- Division of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew Whitelaw
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, UK
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16
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De Wispelaere LA, Ouwehand S, Olsthoorn M, Govaert P, Smit LS, de Jonge RC, Lequin MH, Reiss IK, Dudink J. Electroencephalography and brain magnetic resonance imaging in asphyxia comparing cooled and non-cooled infants. Eur J Paediatr Neurol 2019; 23:181-190. [PMID: 30279083 DOI: 10.1016/j.ejpn.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/29/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim was to establish any differences in the predictive value of EEG and MRI for outcome in infants treated and not-treated with therapeutic hypothermia (HT) for perinatal asphyxia. We hypothesize that they are equally predictive and that combining both has the highest predictive value. STUDY DESIGN We retrospectively compared data of infants with hypoxic-ischemic encephalopathy (HIE) who received HT (n = 45) between September 2009 and December 2013 with those of infants with HIE born between January 2004 and August 2009, before HT was available (NT, n = 37). All received conventional and/or amplitude-integrated EEG during the first days and early MRI (day 4-5). Associations of EEG, MRI and severe neurodevelopmental outcome (death or Bayley's -2SD below mean), were tested with a multivariable logistic regression analysis, corrected for HT. RESULTS Forty-eight hours' EEG background pattern had a PPV of 92% and a NPV of 81% in HT, versus 100% and 58% in NT. MRI had a PPV of 71% and a NPV of 93% in HT, versus 82% and 75% in NT. The adjusted OR for adverse outcome was 0.013 (95% CI 0.002-0.154, p < 0.001) for EEG background normalization within 48 h and 32.19 (95% CI 4.84-214.25, p < 0.001) for abnormal MRI. CONCLUSION The predictive value of EEG and MRI is equal in cooled and non-cooled infants with HIE. Our data show a higher predictive value (death and severe outcome) for EEG compared to MRI. In HIE, persistent abnormal EEG background pattern until 48 h, combined with abnormal early MRI is strongly predictive for poor neurodevelopment.
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Affiliation(s)
- Leen Att De Wispelaere
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands; Department of Neonatology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Sabine Ouwehand
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Marielle Olsthoorn
- Department of Radiology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Liesbeth S Smit
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Rogier Cj de Jonge
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands; Department of Neonatology, VU University Medical Center, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
| | - Maarten H Lequin
- Department of Radiology, Wilhelmina Children's Hospital, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Irwin K Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands; Department of Pediatrics, Division of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
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17
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Cizmeci MN, Thewissen L, Zecic A, Woerdeman PA, Boer BD, Baert E, Govaert P, Dudink J, Groenendaal F, Lequin M, de Vries LS. Bedside Ultrasound-Guided Percutaneous Needle Aspiration of Intra- and Extra-Axial Intracranial Hemorrhage in Neonates. Neuropediatrics 2018; 49:238-245. [PMID: 29689584 DOI: 10.1055/s-0038-1641568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Intracranial hemorrhage is an important cause of brain injury in the neonatal population and bedside percutaneous needle aspiration has emerged as an alternative due to the major risks that can be caused by standard neurosurgical decompression. We aimed to assess the effectiveness of this minimally invasive bedside technique and conducted a retrospective analysis of all newborn infants with a large extra-axial hemorrhage associated with a parenchymal hemorrhage causing a midline shift, managed at three academic centers over a 15-year period. Collected data included clinical history, laboratory results, review of all imaging studies performed, and neurodevelopmental follow-up. Eight infants (3 preterm and 5 full-term) presented on day 1 to 2 with seizures (n = 6) and apneas (n = 5), signs of increased intracranial pressure (n = 4), and coning (n = 1). Risk factors were present in six. Cranial ultrasound and computed tomography showed a midline shift in all; two infants showed status epilepticus on amplitude-integrated electroencephalography with complete resolution after the procedure. Between 7 and 34 mL could be aspirated associated with a decrease in the midline shift as seen by ultrasonography performed during the puncture. No complications were seen related to the procedure and none of the infants required further acute neurosurgical intervention. On follow-up, three had mild sequelae, including motor coordination problems (n = 1) and hemianopia (n = 2); none developed cerebral palsy or postneonatal epilepsy. Neonates, presenting with severe symptoms, can be managed successfully using ultrasound-guided needle aspiration and this minimally invasive bedside method should be kept in mind before performing neurosurgical decompression.
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Affiliation(s)
- Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Alexandra Zecic
- Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Peter A Woerdeman
- Division of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - Bart de Boer
- Division of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - Edward Baert
- Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Paul Govaert
- Section of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Section of Neonatology, Middelheim Ziekenhuis-ZNA, Antwerp, Belgium
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten Lequin
- Department Pediatric Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Ansari AH, Cherian PJ, Caicedo Dorado A, Jansen K, Dereymaeker A, De Wispelaere L, Dielman C, Vervisch J, Govaert P, De Vos M, Naulaers G, Huffel SV. Weighted Performance Metrics for Automatic Neonatal Seizure Detection Using Multiscored EEG Data. IEEE J Biomed Health Inform 2018; 22:1114-1123. [DOI: 10.1109/jbhi.2017.2750769] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Cornelissen MJ, de Goederen R, Doerga P, Cuperus I, van Veelen ML, Lequin M, Govaert P, Mathijssen IMJ, Dudink J, Tasker RC. Pilot study of intracranial venous physiology in craniosynostosis. J Neurosurg Pediatr 2018; 21:626-631. [PMID: 29624144 DOI: 10.3171/2018.1.peds17480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In addition to craniocerebral disproportion, other factors, such as Chiari malformation type I, obstructive sleep apnea, and venous outflow obstruction, are considered to have a role in the occurrence of intracranial hypertension in craniosynostosis. This pilot study examined cerebral venous flow velocity to better characterize the complex intracranial venous physiology of craniosynostosis. METHODS The authors performed a prospective cohort study of craniosynostosis patients (n = 34) referred to a single national (tertiary) craniofacial unit. Controls (n = 28) consisted of children who were referred to the unit's outpatient clinic and did not have craniosynostosis. Transfontanelle ultrasound scans with venous Doppler flow velocity assessment were performed at the first outpatient clinic visit and after each surgery, if applicable. Mean venous blood flow velocities of the internal cerebral vein (ICVv) and the superior sagittal sinus (SSSv) were recorded and blood flow waveform was scored. RESULTS Preoperatively, SSSv was decreased in craniosynostosis patients compared with controls (7.57 vs 11.31 cm/sec, p = 0.009). ICVv did not differ significantly between patients and controls. Postoperatively, SSSv increased significantly (7.99 vs 10.66 cm/sec, p = 0.023). Blood flow waveform analyses did not differ significantly between patients and controls. CONCLUSIONS Premature closure of cranial sutures was associated with decreased SSSv but not ICVv; indicating an effect on the superficial rather than deep venous drainage. Further Doppler ultrasound studies are needed to test the hypothesis that at an early stage of craniosynostosis pathology SSSv, but not pulsatility, is abnormal, and that abnormality in both SSSv and the superficial venous waveform reflect a more advanced stage of evolution in suture closure.
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Affiliation(s)
| | | | - Priya Doerga
- Departments of1Plastic and Reconstructive Surgery and Hand Surgery and
| | - Iris Cuperus
- Departments of1Plastic and Reconstructive Surgery and Hand Surgery and
| | - Marie-Lise van Veelen
- 2Neurosurgery, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam
| | | | - Paul Govaert
- 4Neonatology Division, Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium; and
| | | | - Jeroen Dudink
- 5Neonatology Division, Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Robert C Tasker
- 6Departments of Neurology and Anesthesia (Pediatrics), Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
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Pascal A, Govaert P, Oostra A, Naulaers G, Ortibus E, Van den Broeck C. Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review. Dev Med Child Neurol 2018; 60:342-355. [PMID: 29350401 DOI: 10.1111/dmcn.13675] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this systematic review was to provide an up-to-date global overview of the separate prevalences of motor and cognitive delays and cerebral palsy (CP) in very preterm (VPT) and very-low-birthweight (VLBW) infants. METHOD A comprehensive search was conducted across four databases. Cohort studies reporting the prevalence of CP and motor or cognitive outcome from 18 months corrected age until 6 years of VPT or VLBW infants born after 2006 were included. Pooled prevalences were calculated with random-effects models. RESULTS Thirty studies were retained, which included a total of 10 293 infants. The pooled prevalence of cognitive and motor delays, evaluated with developmental tests, was estimated at 16.9% (95% confidence interval [CI] 10.4-26.3) and 20.6% (95% CI 13.9-29.4%) respectively. Mild delays were more frequent than moderate-to-severe delays. Pooled prevalence of CP was estimated to be 6.8% (95% CI 5.5-8.4). Decreasing gestational age and birthweight resulted in higher prevalences. Lower pooled prevalences were found with the Third Edition of the Bayley Scales of Infant Development than with the Second Edition. INTERPRETATION Even though neonatal intensive care has improved over recent decades, there is still a wide range of neurodevelopmental disabilities resulting from VPT and VLBW births. However, pooled prevalences of CP have diminished over the years. WHAT THIS PAPER ADDS The Bayley Scales of Infant and Toddler Development, Third Edition reported lower pooled prevalences of motor and cognitive delays than the Second Edition. The pooled prevalence of cerebral palsy in infants born extremely preterm was reduced compared with previous meta-analyses.
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Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul Govaert
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Ann Oostra
- Center for Developmental Disorders, University Hospital Ghent, Ghent, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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21
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Delanghe G, Squier W, Sonnaert M, Dudink J, Lequin M, Govaert P. Neonatal subcortical bruising. Clin Case Rep 2018; 6:407-415. [PMID: 29445487 PMCID: PMC5799613 DOI: 10.1002/ccr3.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 12/04/2022] Open
Abstract
A specific type of acute brain injury can occur during birth, presenting on ultrasound examination with focal, unilateral, or asymmetrical change in the core of the superior frontal gyri. Ultrasound inspection of the superior gyri near the convexity of the frontal lobe is warranted following mechanically difficult delivery.
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Affiliation(s)
- Gwenda Delanghe
- Department of NeonatologyMiddelheim Hospital AntwerpAntwerpBelgium
| | - Waney Squier
- Formerly Consultant Neuropathologist at Oxford John Radcliffe University HospitalOxfordUK
| | - Michel Sonnaert
- Department of NeonatologyUniversity Hospital BrusselsBrusselsBelgium
| | - Jeroen Dudink
- Department of NeonatologyWilhelmina Children's Hospital UtrechtUtrechtThe Netherlands
| | - Maarten Lequin
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Paul Govaert
- Department of NeonatologyMiddelheim Hospital AntwerpAntwerpBelgium
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22
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Tortora D, Severino M, Malova M, Parodi A, Morana G, Sedlacik J, Govaert P, Volpe JJ, Rossi A, Ramenghi LA. Differences in subependymal vein anatomy may predispose preterm infants to GMH-IVH. Arch Dis Child Fetal Neonatal Ed 2018; 103:F59-F65. [PMID: 28588126 DOI: 10.1136/archdischild-2017-312710] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE The anatomy of the deep venous system plays an important role in the pathogenesis of brain lesions in the preterm brain as shown by different histological studies. The aims of this study were to compare the subependymal vein anatomy of preterm neonates with germinal matrix haemorrhage-intraventricular haemorrhage (GMH-IVH), as evaluated by susceptibility-weighted imaging (SWI) venography, with a group of age-matched controls with normal brain MRI, and to explore the relationship between the anatomical features of subependymal veins and clinical risk factors for GMH-IVH. METHODS SWI venographies of 48 neonates with GMH-IVH and 130 neonates with normal brain MRI were retrospectively evaluated. Subependymal vein anatomy was classified into six different patterns: type 1 represented the classic pattern and types 2-6 were considered anatomic variants. A quantitative analysis of the venous curvature index was performed. Variables were analysed by using Mann-Whitney U and χ2 tests, and a multiple logistic regression analysis was performed to evaluate the association between anatomical features, clinical factors and GMH-IVH. RESULTS A significant difference was noticed among the six anatomical patterns according to the presence of GMH-IVH (χ2=14.242, p=0.014). Anatomic variants were observed with higher frequency in neonates with GMH-IVH than in controls (62.2% and 49.6%, respectively). Neonates with GMH-IVH presented a narrower curvature of the terminal portion of subependymal veins (p<0.05). These anatomical features were significantly associated with GMH-IVH (p<0.05). CONCLUSION Preterm neonates with GMH-IVH show higher variability of subependymal veins anatomy confirming a potential role as predisposing factor for GMH-IVH.
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Affiliation(s)
| | | | - Mariya Malova
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Jan Sedlacik
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Paul Govaert
- Section of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,ZNA Koningin Paola Kinderziekenhuis, Antwerp, Belgium
| | - Joseph J Volpe
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
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23
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Appel I, Lequin M, Mol C, Govaert P, Swarte R. Factor II gene (prothrombin G20210A) mutation and neonatal cerebrovenous thrombosis. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Tajdar M, Orlando C, Casini A, Herpol M, De Bisschop B, Govaert P, Neerman-Arbez M, Jochmans K. Heterozygous FGA p.Asp473Ter (fibrinogen Nieuwegein) presenting as antepartum cerebral thrombosis. Thromb Res 2017; 163:185-189. [PMID: 29122299 DOI: 10.1016/j.thromres.2017.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/04/2017] [Accepted: 10/26/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The propositus - a two-week-old boy - was transferred to our university hospital for investigation of increased head circumference and full fontanel. On ultrasound, thrombosis of the right internal cerebral vein and intraventricular haemorrhage was diagnosed, confirmed by MRI. Family history revealed a bleeding history in the mother. A haemostatic work-up in both mother and child was performed in order to rule out congenital coagulopathy. AIM We document a clinical case of congenital dysfibrinogenemia, caused by heterozygosity for the mutation FGA p.Asp473Ter, previously reported as fibrinogen Nieuwegein in homozygosity in an asymptomatic patient. METHODS Fibrinogen activity in plasma was determined by functional Clauss assay, and immunological fibrinogen concentration by nephelometry. In vitro fibrin clot investigations and genetic analysis of the fibrinogen gene were performed. Complete haemostatic work-up was done by conventional methods. RESULTS AND DISCUSSION After full laboratory work-up, dysfibrinogenemia was diagnosed, based on fibrinogen activity:antigen ratio, thrombin time, and reptilase time. Molecular analysis showed a frameshift mutation in exon 5 of FGA: c.1415_1416 insC, leading to a termination codon immediately after the insertion (CCT GAT>CCC TGA) and resulting in a truncated αC-domain. This mutation has been reported earlier as fibrinogen Nieuwegein. Further in vitro investigations revealed an abnormally tight clot structure, prolonged clot lysis time and affected polymerization, suggesting a thrombotic phenotype. Cerebral imaging revealed thrombosis, most likely developed in the antenatal period, leading to extensive intraventricular haemorrhage and posthaemorrhagic ventricular dilatation. CONCLUSION We highlight the combined thrombotic and haemorrhagic phenotype linked to heterozygous fibrinogen Nieuwegein, in contrast to the previously reported asymptomatic homozygous case.
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Affiliation(s)
- Mercedeh Tajdar
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Haematology, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Christelle Orlando
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Haematology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alessandro Casini
- University Hospitals of Geneva, Division of Angiology-Haemostasis, Rue Michel Servet 1, 1211 Geneva 4, Switzerland
| | - Margaux Herpol
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Haematology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Barbara De Bisschop
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Neonatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Paul Govaert
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Neonatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Marguerite Neerman-Arbez
- University of Geneva, Department of Genetic Medicine and Development, Rue Michel Servet 1, 1211 Geneva 4, Switzerland
| | - Kristin Jochmans
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Haematology, Laarbeeklaan 101, 1090 Brussels, Belgium
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25
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de Goederen R, Raets MMA, Ecury-Goossen GM, de Jonge RCJ, Ramenghi LA, Koning IV, Govaert P, Dudink J. Effect of Preterm Birth on Echogenicity in Basal Ganglia. Ultrasound Med Biol 2017; 43:2192-2199. [PMID: 28750943 DOI: 10.1016/j.ultrasmedbio.2017.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
In this study, the influence of prematurity on echogenicity of deep gray matter at 30-wk corrected age was assessed using ultrasound measurements. In an observational cohort study, ultrasound scans of 224 extremely preterm infants were prospectively collected. Gray values were assessed in putamen and globus pallidus. Intra- and inter-observer reliability was analyzed and showed excellent agreement. The globus pallidus to putamen ratio was significantly related to gestational age at birth, adjusted regression coefficient in points per wk: 1.28 (95% confidence interval [CI]: 0.38-2.19) for left and 2.12 (95% CI: 1.23-3.02) for right-side images. At 30-wk corrected age this was still the case, adjusted regression coefficient: 0.45 (95% CI: -0.57 to 1.47) for left and 1.29 (95% CI: 0.10-2.48) for right. The putamen is more hyperechoic with lower gestational age. Measuring ultrasound gray values in deep gray matter seems highly reproducible. Prematurity shows a negative correlation with echogenicity of the putamen, this persists at 30-wk corrected age, suggesting altered maturation.
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Affiliation(s)
- Robbin de Goederen
- Department of Pediatrics, Division of Neonatology Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marlou M A Raets
- Department of Pediatrics, Division of Neonatology Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ginette M Ecury-Goossen
- Department of Pediatrics, Division of Neonatology Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rogier C J de Jonge
- Department of Pediatrics, Division of Neonatology Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Luca A Ramenghi
- Department of Neonatology, Istituto Giannina Gaslini, Genoa, Italy
| | - Irene V Koning
- Department of Obstetrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Neonatology, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Neonatology, UMCU Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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Ardemani G, Govaert P, Oussoren E, Dorresteijn E, Wildschut E, Lequin M, Dudink J. Crystal clear cerebral ultrasound images mimicking acute asphyxia in an infant with primary hyperoxaluria. Eur J Paediatr Neurol 2017; 21:792-794. [PMID: 28651815 DOI: 10.1016/j.ejpn.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
Genetic deficiencies in enzymes involved in glyoxylate metabolism lead to primary hyperoxaluria (PH) type I, typically characterized by deposition of oxalate crystals in kidneys. A 2-month-old infant was admitted, and was diagnosed with renal failure. Abdominal ultrasound images revealed enlarged and hyperechoic kidneys. Additionally, on cerebral ultrasound (CUS) hyperechoic changes of thalami and basal ganglia were noted, reminiscent of perinatal hypoxic-ischemic brain damage. However, MRI of the brain did not show any abnormal signal intensities compatible with asphyxia. The hyperechoic appearance of deep grey matter, in particular putamen, was therefore not due to asphyxiated brain damage but seemed related to the deposition of oxalate salts. Moreover, macular crystals were detected at ophthalmoscopy. Our case report shows the potential of US imaging to detect deposition of crystals not only in kidneys but also in brain mimicking, perinatal asphyxia.
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Affiliation(s)
- Giulia Ardemani
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Paul Govaert
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium.
| | - Esmee Oussoren
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Eiske Dorresteijn
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Enno Wildschut
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Maarten Lequin
- Department of Radiology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Jeroen Dudink
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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Dereymaeker A, Ansari AH, Jansen K, Cherian PJ, Vervisch J, Govaert P, De Wispelaere L, Dielman C, Matic V, Dorado AC, De Vos M, Van Huffel S, Naulaers G. Interrater agreement in visual scoring of neonatal seizures based on majority voting on a web-based system: The Neoguard EEG database. Clin Neurophysiol 2017; 128:1737-1745. [DOI: 10.1016/j.clinph.2017.06.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 01/15/2023]
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Ansari A, Cherian P, Dereymaeker A, Matic V, Jansen K, De Wispelaere L, Dielman C, Vervisch J, Swarte R, Govaert P, Naulaers G, De Vos M, Van Huffel S. Corrigendum to “Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor” [Clin Neurophysiol 127 (2016) 3014–3024]. Clin Neurophysiol 2016; 127:3498. [DOI: 10.1016/j.clinph.2016.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ansari A, Cherian P, Dereymaeker A, Matic V, Jansen K, De Wispelaere L, Dielman C, Vervisch J, Swarte R, Govaert P, Naulaers G, De Vos M, Van Huffel S. Improved multi-stage neonatal seizure detection using a heuristic classifier and a data-driven post-processor. Clin Neurophysiol 2016; 127:3014-3024. [DOI: 10.1016/j.clinph.2016.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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30
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Roelants JA, Koning IV, Raets MMA, Willemsen SP, Lequin MH, Steegers-Theunissen RPM, Reiss IKM, Vermeulen MJ, Govaert P, Dudink J. A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth. AJNR Am J Neuroradiol 2016; 37:1516-22. [PMID: 26988817 DOI: 10.3174/ajnr.a4731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preterm neonates are at risk for neurodevelopmental impairment, but reliable, bedside-available markers to monitor preterm brain growth during hospital stay are still lacking. The aim of this study was to assess the feasibility of corpus callosum-fastigium length as a new cranial sonography marker for monitoring of preterm brain growth. MATERIALS AND METHODS In this longitudinal prospective cohort study, cranial ultrasound was planned on the day of birth, days 1, 2, 3, and 7 of life; and then weekly until discharge in preterm infants born before 29 weeks of gestational age. Reproducibility and associations between clinical variables and corpus callosum-fastigium growth trajectories were studied. RESULTS A series of 1-8 cranial ultrasounds was performed in 140 infants (median gestational age at birth, 27(+2) weeks (interquartile range, 26(+1) to 28(+1); 57.9% male infants). Corpus callosum-fastigium measurements showed good-to-excellent agreement for inter- and intraobserver reproducibility (intraclass correlation coefficient >0.89). Growth charts for preterm infants between 24 and 32 weeks of gestation were developed. Male sex and birth weight SD score were positively associated with corpus callosum-fastigium growth rate. CONCLUSIONS Corpus callosum-fastigium length measurement is a new reproducible marker applicable for bedside monitoring of preterm brain growth during neonatal intensive care stay.
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Affiliation(s)
- J A Roelants
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - I V Koning
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - M M A Raets
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - S P Willemsen
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.) Biostatistics (S.P.W.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M H Lequin
- Department of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - I K M Reiss
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - M J Vermeulen
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - P Govaert
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - J Dudink
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Department of Radiology (J.D.) Intensive Care Unit (J.D.), Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Abstract
A 12-year-old African girl presented with multiple, sharply bordered hyperpigmented patches predominantly on the dorsal, tip and lateral aspects of the tongue since 1 year (Figs 1 and 2). On clinical examination, we found an obese adolescent girl with a BMI: 26.5 kg/m(2) ( > P97) with acanthosis nigricans of the neck. No medications were taken. Vitamin B12, liver tests and kidney function were normal. There was a decreased serum iron, 25OH vitamin D and zinc. Hyperinsulinism and heterozygosity for HbS (32%) were detected. Menarche: 12 years. No other family members were known with this anomaly.
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Affiliation(s)
| | - Philippe Vandenberghe
- b Department of Paediatric Cardiology , Queen Paola Children's Hospital , Antwerp , Belgium
| | - Paul Govaert
- c Department of Neonatology , ZNA Middelheim , Antwerp , Belgium
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Abstract
A one day old Moroccan boy was admitted to our neonatal unit with a giant tuberous right abdominal haemangioma. The clinical examination revealed no other vascular tumours. There was no evidence of heart failure. Ultrasound and MRA documented a giant vascular structure suggestive of haemangioma. The tumor responded well to propranolol treatment.J Nepal Paediatr Soc 2015;35(2):189-191
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Ecury-Goossen GM, Raets MMA, Camfferman FA, Vos RHJ, van Rosmalen J, Reiss IKM, Govaert P, Dudink J. Resistive indices of cerebral arteries in very preterm infants: values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus. Pediatr Radiol 2016; 46:1291-300. [PMID: 27259991 PMCID: PMC4943974 DOI: 10.1007/s00247-016-3615-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/13/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about cerebral artery resistive index values in infants born extremely preterm. OBJECTIVE To report resistive index values in various cerebral arteries in a prospective cohort of preterm infants born at <29 weeks' gestation, and to compare resistive index in these arteries and assess the relationship between resistive index and hemodynamically significant patent ductus arteriosus. MATERIALS AND METHODS Using Doppler imaging, we obtained resistive index values of internal carotid arteries, basilar artery, anterior cerebral artery, and pial and striatal arteries in the first 3 days of age and weekly thereafter until discharge or death. We analyzed paired observations using the Wilcoxon signed-rank test, between-group comparisons with the Mann-Whitney test. RESULTS We performed 771 examinations in 235 infants. Resistive indices differed among arteries: vessels with larger diameters showed significantly higher resistive indices. Resistive index in infants without patent ductus arteriosus was lower than that in infants with hemodynamically significant patent ductus arteriosus (median in anterior cerebral artery: 0.75 and 0.82, respectively; P<0.001), though this was not statistically significant in all arteries. There was no difference in pre- and post-ligation resistive indices in infants who underwent patent ductus arteriosus ligation. CONCLUSION For accurate follow-up and comparison of cerebral artery resistive index, the same artery should be examined on each occasion.
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Affiliation(s)
- Ginette M Ecury-Goossen
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Marlou M A Raets
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Fleur A Camfferman
- Department of Pediatrics, Division of Neonatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Rik H J Vos
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | | | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
- Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
- Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Ecury-Goossen GM, van der Haer M, Smit LS, Feijen-Roon M, Lequin M, de Jonge RCJ, Govaert P, Dudink J. Neurodevelopmental outcome after neonatal perforator stroke. Dev Med Child Neurol 2016. [PMID: 26212612 DOI: 10.1111/dmcn.12857] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess outcome after neonatal perforator stroke in the largest cohort to date. METHOD Survivors from a cohort of children diagnosed with neonatal perforator stroke using cranial ultrasound or magnetic resonance imaging were eligible for inclusion. Recovery and Recurrence Questionnaire score, presence of cerebral palsy (CP), and crude outcome were assessed, specifically (1) the ability to walk independently, (2) participation in regular education, and (3) the presence of epilepsy. RESULTS Thirty-seven patients (20 males, 17 females) aged 3 to 14 years (mean age 8y) were included in the study: 14 with isolated single perforator stroke, four with multiple isolated perforator strokes, and 19 with additional brain injury. Out of 18 children with isolated perforator stroke(s), four had CP, one could not walk independently, and one developed epilepsy. The posterior limb of the internal capsule was involved in four out of 18 patients; three of these patients had CP. Of 19 children with additional brain injury, 11 had CP and three were not able to walk independently. Three out of nine children with concomitant cortical middle cerebral artery stroke developed epilepsy. INTERPRETATION Perforator stroke patterns can be of use in predicting long-term outcome and for guiding counselling and surveillance. Motor outcome was favourable in children with isolated perforator stroke(s), except when the posterior limb of the internal capsule was involved.
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Affiliation(s)
- Ginette M Ecury-Goossen
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marit van der Haer
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Liesbeth S Smit
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neurology, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique Feijen-Roon
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Maarten Lequin
- Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rogier C J de Jonge
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Kishita Y, Pajak A, Bolar NA, Marobbio CMT, Maffezzini C, Miniero DV, Monné M, Kohda M, Stranneheim H, Murayama K, Naess K, Lesko N, Bruhn H, Mourier A, Wibom R, Nennesmo I, Jespers A, Govaert P, Ohtake A, Van Laer L, Loeys BL, Freyer C, Palmieri F, Wredenberg A, Okazaki Y, Wedell A. Intra-mitochondrial Methylation Deficiency Due to Mutations in SLC25A26. Am J Hum Genet 2015; 97:761-8. [PMID: 26522469 PMCID: PMC4667130 DOI: 10.1016/j.ajhg.2015.09.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/29/2015] [Indexed: 01/24/2023] Open
Abstract
S-adenosylmethionine (SAM) is the predominant methyl group donor and has a large spectrum of target substrates. As such, it is essential for nearly all biological methylation reactions. SAM is synthesized by methionine adenosyltransferase from methionine and ATP in the cytoplasm and subsequently distributed throughout the different cellular compartments, including mitochondria, where methylation is mostly required for nucleic-acid modifications and respiratory-chain function. We report a syndrome in three families affected by reduced intra-mitochondrial methylation caused by recessive mutations in the gene encoding the only known mitochondrial SAM transporter, SLC25A26. Clinical findings ranged from neonatal mortality resulting from respiratory insufficiency and hydrops to childhood acute episodes of cardiopulmonary failure and slowly progressive muscle weakness. We show that SLC25A26 mutations cause various mitochondrial defects, including those affecting RNA stability, protein modification, mitochondrial translation, and the biosynthesis of CoQ10 and lipoic acid.
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Affiliation(s)
- Yoshihito Kishita
- Division of Functional Genomics & Systems Medicine, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka-shi, Saitama 350-1241, Japan
| | - Aleksandra Pajak
- Max Planck Institute Biology of Ageing - Karolinska Institutet Laboratory, Division of Metabolic Diseases, Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Nikhita Ajit Bolar
- Department of Medical Genetics, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp 2650, Belgium
| | - Carlo M T Marobbio
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Via Edoardo Orabona 4, 70125 Bari, Italy
| | - Camilla Maffezzini
- Max Planck Institute Biology of Ageing - Karolinska Institutet Laboratory, Division of Metabolic Diseases, Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Daniela V Miniero
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Via Edoardo Orabona 4, 70125 Bari, Italy
| | - Magnus Monné
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Via Edoardo Orabona 4, 70125 Bari, Italy; Department of Sciences, University of Basilicata, Via Ateneo Lucano 10, 85100 Potenza, Italy
| | - Masakazu Kohda
- Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka-shi, Saitama 350-1241, Japan
| | - Henrik Stranneheim
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden; Science for Life Laboratory and Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori, Chiba 266-0007, Japan
| | - Karin Naess
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Nicole Lesko
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Helene Bruhn
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Arnaud Mourier
- Max Planck Institute for Biology of Ageing, 50931 Cologne, Germany
| | - Rolf Wibom
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Inger Nennesmo
- Department of Pathology, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Ann Jespers
- Paola Children's Hospital, ZNA Middelheim, Antwerp 2650, Belgium
| | - Paul Govaert
- Paola Children's Hospital, ZNA Middelheim, Antwerp 2650, Belgium
| | - Akira Ohtake
- Department of Pediatrics, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Lut Van Laer
- Department of Medical Genetics, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp 2650, Belgium
| | - Bart L Loeys
- Department of Medical Genetics, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp 2650, Belgium; Department of Genetics, Radboud University Medical Center, Nijmegen, 6525 GA, the Netherlands
| | - Christoph Freyer
- Max Planck Institute Biology of Ageing - Karolinska Institutet Laboratory, Division of Metabolic Diseases, Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Ferdinando Palmieri
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Via Edoardo Orabona 4, 70125 Bari, Italy.
| | - Anna Wredenberg
- Max Planck Institute Biology of Ageing - Karolinska Institutet Laboratory, Division of Metabolic Diseases, Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Yasushi Okazaki
- Division of Functional Genomics & Systems Medicine, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka-shi, Saitama 350-1241, Japan; Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka-shi, Saitama 350-1241, Japan
| | - Anna Wedell
- Max Planck Institute Biology of Ageing - Karolinska Institutet Laboratory, Division of Metabolic Diseases, Department of Laboratory Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; Centre for Inherited Metabolic Diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden; Science for Life Laboratory and Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
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Affiliation(s)
- Martine Karine Francine Docx
- Department of Paediatrics Chronic Paediatric Diseases, Queen Paola Children's Hospital Antwerp, Antwerp, Belgium
| | - An Steylemans
- Department of Obstetrics, ZNA Middelheim Antwerp, Antwerp, Belgium
| | - Paul Govaert
- Department of Neonatology, ZNA Middelheim Antwerp, Antwerp, Belgium
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Matic V, Cherian PJ, Jansen K, Koolen N, Naulaers G, Swarte RM, Govaert P, Van Huffel S, De Vos M. Improving Reliability of Monitoring Background EEG Dynamics in Asphyxiated Infants. IEEE Trans Biomed Eng 2015; 63:973-983. [PMID: 26390441 DOI: 10.1109/tbme.2015.2477946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The goal of this study is to develop an automated algorithm to quantify background electroencephalography (EEG) dynamics in term neonates with hypoxic ischemic encephalopathy. The recorded EEG signal is adaptively segmented and the segments with low amplitudes are detected. Next, depending on the spatial distribution of the low-amplitude segments, the first part of the algorithm detects (dynamic) interburst intervals (dIBIs) and performs well on the relatively artifact-free EEG periods and well-defined burst-suppression EEG periods. However, on testing the algorithm on EEG recordings of more than 48 h per neonate, a significant number of misclassified and dubious detections were encountered. Therefore, as the next step, we applied machine learning classifiers to differentiate between definite dIBI detections and misclassified ones. The developed algorithm achieved a true positive detection rate of 98%, 97%, 88%, and 95% for four duration-related dIBI groups that we subsequently defined. We benchmarked our algorithm with an expert diagnostic interpretation of EEG periods (1 h long) and demonstrated its effectiveness in clinical practice. We show that the detection algorithm effectively discriminates challenging cases encountered within mild and moderate background abnormalities. The dIBI detection algorithm improves identification of neonates with good clinical outcome as compared to the classification based on the classical burst-suppression interburst interval.
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Plaisier A, Raets MMA, Ecury-Goossen GM, Govaert P, Feijen-Roon M, Reiss IKM, Smit LS, Lequin MH, Dudink J. Serial cranial ultrasonography or early MRI for detecting preterm brain injury? Arch Dis Child Fetal Neonatal Ed 2015; 100:F293-300. [PMID: 25637006 DOI: 10.1136/archdischild-2014-306129] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 01/10/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate detection ability and feasibility of serial cranial ultrasonography (CUS) and early MRI in preterm brain injury. DESIGN Prospective cohort study. SETTING Level III neonatal intensive care unit. PATIENTS 307 infants, born below 29 weeks of gestation. METHODS Serial CUS and MRI were performed according to standard clinical protocol. In case of instability, MRI was postponed or cancelled. Brain images were assessed by independent experts and compared between modalities. MAIN OUTCOME MEASURES Presence of preterm brain injury on either CUS or MRI and discrepant imaging findings on CUS and MRI. RESULTS Serial CUS was performed in all infants; early MRI was often postponed (n=59) or cancelled (n=126). Injury was found in 146 infants (47.6%). Clinical characteristics differed significantly between groups that were subdivided according to timing of MRI. 61 discrepant imaging findings were found. MRI was superior in identifying cerebellar haemorrhage; CUS in detection of acute intraventricular haemorrhage, perforator stroke and cerebral sinovenous thrombosis. CONCLUSIONS Advanced serial CUS seems highly effective in diagnosing preterm brain injury, but may miss cerebellar abnormalities. Although MRI does identify these lesions, feasibility is limited. Improved safety, better availability and tailored procedures are essential for MRI to increase its value in clinical care.
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Affiliation(s)
- Annemarie Plaisier
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marlou M A Raets
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Ginette M Ecury-Goossen
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Paul Govaert
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Monique Feijen-Roon
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Liesbeth S Smit
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Division of Pediatric Neurology, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten H Lequin
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Matic V, Cherian PJ, Koolen N, Ansari AH, Naulaers G, Govaert P, Van Huffel S, De Vos M, Vanhatalo S. Objective differentiation of neonatal EEG background grades using detrended fluctuation analysis. Front Hum Neurosci 2015; 9:189. [PMID: 25954174 PMCID: PMC4407610 DOI: 10.3389/fnhum.2015.00189] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/20/2015] [Indexed: 12/22/2022] Open
Abstract
A quantitative and objective assessment of background electroencephalograph (EEG) in sick neonates remains an everyday clinical challenge. We studied whether long range temporal correlations quantified by detrended fluctuation analysis (DFA) could be used in the neonatal EEG to distinguish different grades of abnormality in the background EEG activity. Long-term EEG records of 34 neonates were collected after perinatal asphyxia, and their background was scored in 1 h epochs (8 h in each neonate) as mild, moderate or severe. We applied DFA on 15 min long, non-overlapping EEG epochs (n = 1088) filtered from 3 to 8 Hz. Our formal feasibility study suggested that DFA exponent can be reliably assessed in only part of the EEG epochs, and in only relatively short time scales (10-60 s), while it becomes ambiguous if longer time scales are considered. This prompted further exploration whether paradigm used for quantifying multifractal DFA (MF-DFA) could be applied in a more efficient way, and whether metrics from MF-DFA paradigm could yield useful benchmark with existing clinical EEG gradings. Comparison of MF-DFA metrics showed a significant difference between three visually assessed background EEG grades. MF-DFA parameters were also significantly correlated to interburst intervals quantified with our previously developed automated detector. Finally, we piloted a monitoring application of MF-DFA metrics and showed their evolution during patient recovery from asphyxia. Our exploratory study showed that neonatal EEG can be quantified using multifractal metrics, which might offer a suitable parameter to quantify the grade of EEG background, or to monitor changes in brain state that take place during long-term brain monitoring.
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Affiliation(s)
- Vladimir Matic
- Department of Electrical Engineering (ESAT), STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven Leuven, Belgium ; iMinds Medical IT Department Leuven, Belgium
| | - Perumpillichira Joseph Cherian
- Section of Clinical Neurophysiology, Department of Neurology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Ninah Koolen
- Department of Electrical Engineering (ESAT), STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven Leuven, Belgium ; iMinds Medical IT Department Leuven, Belgium
| | - Amir H Ansari
- Department of Electrical Engineering (ESAT), STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven Leuven, Belgium ; iMinds Medical IT Department Leuven, Belgium
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospital Gasthuisberg Leuven, Belgium
| | - Paul Govaert
- Section of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven Leuven, Belgium ; iMinds Medical IT Department Leuven, Belgium
| | - Maarten De Vos
- Department of Engineering, Institute of Biomedical Engineering, University of Oxford Oxford, UK
| | - Sampsa Vanhatalo
- Department of Children's Clinical Neurophysiology, HUS Medical Imaging Center and Children's Hospital, Helsinki University Central Hospital and University of Helsinki Helsinki, Finland
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Abstract
The brain veins of infants are in a complex phase of remodelling in the perinatal period. Magnetic resonance venography and susceptibility-weighted imaging, together with high-resolution Doppler ultrasound, have provided new tools to aid study of venous developmental anatomy and disease. This review aims to provide a comprehensive background of vein development and perinatal venous lesions in preterm and term-born infants, and to encourage further research in both the fetus and the newborn infant, with the aim of preventing or mitigating parenchymal injury related to diseases involving veins.
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Affiliation(s)
- Marlou Raets
- Department of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Abstract
Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal intensive care units, these possibilities are not optimally used. We present a comprehensive approach for neonatal CUS, focusing on optimal settings, different probes, multiple acoustic windows and Doppler techniques. This approach is suited for both routine clinical practice and research purposes. In a live demonstration, we show how this technique is performed in the neonatal intensive care unit. Using optimal settings and probes allows for better imaging quality and improves the diagnostic value of CUS in experienced hands. Traditionally, images are obtained through the anterior fontanel. Use of supplemental acoustic windows (lambdoid, mastoid, and lateral fontanels) improves detection of brain injury. Adding Doppler studies allows screening of patency of large intracranial arteries and veins. Flow velocities and indices can be obtained. Doppler CUS offers the possibility of detecting cerebral sinovenous thrombosis at an early stage, creating a window for therapeutic intervention prior to thrombosis-induced tissue damage. Equipment, data storage and safety aspects are also addressed.
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Affiliation(s)
| | | | - Lara M Leijser
- Department of Pediatrics, Division of Neonatology, UZ Brussel; Department of Pediatrics, Division of Neonatology, Leiden University Medical Center
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital; Department of Pediatrics, Division of Neonatology, Isala Hospital
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital; Department of Radiology, Erasmus MC-Sophia Children's Hospital;
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42
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Camfferman FA, Ecury-Goossen GM, La Roche JE, de Jong N, van 't Leven W, Vos HJ, Verweij MD, Nasserinejad K, Cools F, Govaert P, Dudink J. Calibrating Doppler imaging of preterm intracerebral circulation using a microvessel flow phantom. Front Hum Neurosci 2015; 8:1068. [PMID: 25628560 PMCID: PMC4292584 DOI: 10.3389/fnhum.2014.01068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/22/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction: Preterm infants are born during critical stages of brain development, in which the adaptive capacity of the fetus to extra-uterine environment is limited. Inadequate brain perfusion has been directly linked to preterm brain damage. Advanced high-frequency ultrasound probes and processing algorithms allow visualization of microvessels and depiction of regional variation. To assess whether visualization and flow velocity estimates of preterm cerebral perfusion using Doppler techniques are accurate, we conducted an in vitro experiment using a microvessel flow phantom. Materials and Methods: An in-house developed flow phantom containing two microvessels (inner diameter 200 and 700 μm) with attached syringe pumps, filled with blood-mimicking fluid, was used to generate non-pulsatile perfusion of variable flow. Measurements were performed using an Esaote MyLab70 scanner. Results: Microvessel mimicking catheters with velocities as low as 1 cm/s were adequately visualized with a linear ultrasound probe. With a convex probe, velocities <2 cm/s could not be depicted. Within settings, velocity and diameter measurements were highly reproducible [intra-class correlation 0.997 (95% CI 0.996–0.998) and 0.914 (0.864–0.946)]. Overall, mean velocity was overestimated up to threefold, especially in high velocity ranges. Significant differences were seen in velocity measurements when using steer angle correction and in vessel diameter estimation (p < 0.05). Conclusion: Visualization of microvessel-size catheters mimicking small brain vessels is feasible. Reproducible velocity and diameter results can be obtained, although important overestimation of the values is observed. Before velocity estimates of microcirculation can find its use in clinical practice, calibration of the ultrasound machine for any specific Doppler purpose is essential. The ultimate goal is to develop a sonographic tool that can be used for objective study of regional perfusion in routine practice.
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Affiliation(s)
- Fleur A Camfferman
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | | | - Jhuresy E La Roche
- Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands
| | - Nico de Jong
- Department of Biomedical Engineering, Erasmus Medical Centre , Rotterdam , Netherlands ; Department of Imaging Physics, Delft University of Technology , Delft , Netherlands
| | - Willem van 't Leven
- Department of Biomedical Engineering, Erasmus Medical Centre , Rotterdam , Netherlands
| | - Hendrik J Vos
- Department of Biomedical Engineering, Erasmus Medical Centre , Rotterdam , Netherlands ; Department of Imaging Physics, Delft University of Technology , Delft , Netherlands
| | - Martin D Verweij
- Department of Imaging Physics, Delft University of Technology , Delft , Netherlands
| | - Kazem Nasserinejad
- Department of Biostatistics, Erasmus Medical Centre , Rotterdam , Netherlands
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Paul Govaert
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium ; Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Erasmus Medical Centre , Rotterdam , Netherlands ; Department of Radiology, Erasmus Medical Centre , Rotterdam , Netherlands
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Bousema S, Govaert P, Dudink J, Steegers EAP, Reiss IKM, de Jonge RCJ. [Kernicterus is preventable but still occurs]. Ned Tijdschr Geneeskd 2015; 159:A8518. [PMID: 25944067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Kernicterus is a severe neurological condition, caused by bilirubin-induced damage in the basal ganglia. The neurological outcome is often poor. In the past decades there seems to have been an increase in the number of reported cases of kernicterus. In order to raise awareness of this condition, we present two patients with kernicterus caused by different pathophysiological mechanisms. In both cases we make suggestions for the improvement of the medical care process. The first patient is a 7-day-old girl with kernicterus due to haemolysis caused by G6PD deficiency. Patient B is a 3-day-old boy with hyperbilirubinaemia based on 0/B blood group incompatibility. Kernicterus resulted in significant disabilities in these children. A proper diagnostic approach and precise treatment of hyperbilirubinaemia are essential to prevent major neurological damage. Awareness of this condition, education of health care professionals and changes in in- and outpatient care are needed to achieve this goal.
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Affiliation(s)
- Sara Bousema
- Radboudumc, afd. Intensive Care kinderen, Nijmegen
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Pieterman K, Plaisier A, Govaert P, Leemans A, Lequin MH, Dudink J. Data quality in diffusion tensor imaging studies of the preterm brain: a systematic review. Pediatr Radiol 2015; 45:1372-81. [PMID: 25820411 PMCID: PMC4526590 DOI: 10.1007/s00247-015-3307-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/15/2015] [Accepted: 02/05/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND To study early neurodevelopment in preterm infants, evaluation of brain maturation and injury is increasingly performed using diffusion tensor imaging, for which the reliability of underlying data is paramount. OBJECTIVE To review the literature to evaluate acquisition and processing methodology in diffusion tensor imaging studies of preterm infants. MATERIALS AND METHODS We searched the Embase, Medline, Web of Science and Cochrane databases for relevant papers published between 2003 and 2013. The following keywords were included in our search: prematurity, neuroimaging, brain, and diffusion tensor imaging. RESULTS We found 74 diffusion tensor imaging studies in preterm infants meeting our inclusion criteria. There was wide variation in acquisition and processing methodology, and we found incomplete reporting of these settings. Nineteen studies (26%) reported the use of neonatal hardware. Data quality assessment was not reported in 13 (18%) studies. Artefacts-correction and data-exclusion was not reported in 33 (45%) and 18 (24%) studies, respectively. Tensor estimation algorithms were reported in 56 (76%) studies but were often suboptimal. CONCLUSION Diffusion tensor imaging acquisition and processing settings are incompletely described in current literature, vary considerably, and frequently do not meet the highest standards.
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Affiliation(s)
- Kay Pieterman
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center - Sophia, dr. Molewaterplein 60, 3015, GJ, Rotterdam, The Netherlands,
| | - Annemarie Plaisier
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center – Sophia, dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands ,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul Govaert
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center – Sophia, dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands ,Department of Pediatrics, Koningin Paola Children’s Hospital, Antwerp, Belgium
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten H. Lequin
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center – Sophia, dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands ,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Matic V, Cherian PJ, Koolen N, Naulaers G, Swarte RM, Govaert P, Van Huffel S, De Vos M. Holistic approach for automated background EEG assessment in asphyxiated full-term infants. J Neural Eng 2014; 11:066007. [DOI: 10.1088/1741-2560/11/6/066007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van der Cammen-van Zijp MHM, Janssen AJWM, Raets MM, van Rosmalen J, Govaert P, Steiner K, Gischler SJ, Tibboel D, van Heijst AFJ, IJsselstijn H. Motor performance after neonatal extracorporeal membrane oxygenation: a longitudinal evaluation. Pediatrics 2014; 134:e427-35. [PMID: 25049349 DOI: 10.1542/peds.2013-3351] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess longitudinally children's motor performance 5 to 12 years after neonatal extracorporeal membrane oxygenation (ECMO) and to evaluate associations between clinical characteristics and motor performance. METHODS Two hundred fifty-four neonatal ECMO survivors in the Netherlands were tested with the Movement Assessment Battery for Children at 5, 8, and/or 12 years. Percentile scores were transformed to z scores for longitudinal evaluation (norm population mean = 0 and SD = 1). Primary diagnoses: meconium aspiration syndrome (n = 137), congenital diaphragmatic hernia (n = 49), persistent pulmonary hypertension of the newborn (n = 36), other diagnoses (n = 32). RESULTS Four hundred fifty-six tests were analyzed. At 5, 8, and 12 years motor performance was normal in 73.7, 74.8, and 40.5%, respectively (vs 85% expected based on reference values; P < .001 at all ages). In longitudinal analyses mean (95% confidence interval [CI]) z scores were -0.42 (-0.55 to -0.28), -0.25 (-0.40 to -0.10) and -1.00 (-1.26 to -0.75) at 5, 8, and 12 years, respectively. Mean score at 8 years was significantly higher than at 5 years (difference 0.16, 95% CI 0.02 to 0.30), and mean score at 12 years was significantly lower than at both other ages (differences -0.59 and -0.75; 95% CI -0.33 to -0.84 and -0.49 to -1.00, respectively). Children with congenital diaphragmatic hernia encountered problems at all ages. The presence of chronic lung disease was negatively related with outcome. CONCLUSIONS Motor problems in neonatal ECMO survivors persist throughout childhood and become more obvious with time.
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Affiliation(s)
| | | | - Marlou Ma Raets
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Paul Govaert
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Katerina Steiner
- Neonatology, Radboud University Medical Center, Nijmegen, Netherlands; and
| | | | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery
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Hulzebos CV, Dijk PH, van Imhoff DE, Bos AF, Lopriore E, Offringa M, Ruiter SAJ, van Braeckel KNJA, Krabbe PFM, Quik EH, van Toledo-Eppinga L, Nuytemans DHGM, van Wassenaer-Leemhuis AG, Benders MJN, Korbeeck-van Hof KKM, van Lingen RA, Groot Jebbink LJM, Liem D, Mansvelt P, Buijs J, Govaert P, van Vliet I, Mulder TLM, Wolfs C, Fetter WPF, Laarman C. The bilirubin albumin ratio in the management of hyperbilirubinemia in preterm infants to improve neurodevelopmental outcome: a randomized controlled trial--BARTrial. PLoS One 2014; 9:e99466. [PMID: 24927259 PMCID: PMC4057208 DOI: 10.1371/journal.pone.0099466] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/13/2014] [Indexed: 12/14/2022] Open
Abstract
Background and Objective High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome. Methods In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death. Results Composite motor (100±13 vs. 101±12) and cognitive (101±12 vs. 101±11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for the B/A ratio versus TSB groups were 15.4% versus 15.5% (P = 1.0) and 2.8% versus 1.4% (P = 0.62) for birth weights ≤1000 g and 1.8% versus 5.8% (P = 0.03) and 4.1% versus 2.0% (P = 0.26) for birth weights of >1000 g. Conclusions The additional use of B/A ratio in the management of hyperbilirubinemia in preterm infants did not improve their neurodevelopmental outcome. Trial Registration Controlled-Trials.com ISRCTN74465643
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Affiliation(s)
- Christian V. Hulzebos
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter H. Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Deirdre E. van Imhoff
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada
| | - Selma A. J. Ruiter
- Department of Orthopedagogy, University of Groningen, Groningen, The Netherlands
| | - Koen N. J. A. van Braeckel
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul F. M. Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise H. Quik
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Letty van Toledo-Eppinga
- Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Debbie H. G. M. Nuytemans
- Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | | | - Manon J. N. Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karen K. M. Korbeeck-van Hof
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard A. van Lingen
- Princess Amalia Department of Pediatrics, Department of Neonatology, Isala, Zwolle, The Netherlands
| | | | - Djien Liem
- Division of Neonatology, Department of Pediatrics, UMC St. Radboud Nijmegen, Nijmegen, The Netherlands
| | - Petri Mansvelt
- Division of Neonatology, Department of Pediatrics, UMC St. Radboud Nijmegen, Nijmegen, The Netherlands
| | - Jan Buijs
- Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands
| | - Paul Govaert
- Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ineke van Vliet
- Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Twan L. M. Mulder
- Department of Pediatrics, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Cecile Wolfs
- Department of Pediatrics, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Willem P. F. Fetter
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Celeste Laarman
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Horsch S, Govaert P, Cowan FM, Benders MJNL, Groenendaal F, Lequin MH, Saliou G, de Vries LS. Developmental venous anomaly in the newborn brain. Neuroradiology 2014; 56:579-88. [PMID: 24756165 DOI: 10.1007/s00234-014-1367-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
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Plaisier A, Pieterman K, Lequin MH, Govaert P, Heemskerk AM, Reiss IKM, Krestin GP, Leemans A, Dudink J. Choice of diffusion tensor estimation approach affects fiber tractography of the fornix in preterm brain. AJNR Am J Neuroradiol 2014; 35:1219-25. [PMID: 24407271 DOI: 10.3174/ajnr.a3830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neonatal DTI enables quantitative assessment of microstructural brain properties. Although its use is increasing, it is not widely known that vast differences in tractography results can occur, depending on the diffusion tensor estimation methodology used. Current clinical work appears to be insufficiently focused on data quality and processing of neonatal DTI. To raise awareness about this important processing step, we investigated tractography reconstructions of the fornix with the use of several estimation techniques. We hypothesized that the method of tensor estimation significantly affects DTI tractography results. MATERIALS AND METHODS Twenty-eight DTI scans of infants born <29 weeks of gestation, acquired at 30-week postmenstrual age and without intracranial injury observed, were prospectively collected. Four diffusion tensor estimation methods were applied: 1) linear least squares; 2) weighted linear least squares; 3) nonlinear least squares, and 4) robust estimation of tensors by outlier rejection. Quality of DTI data and tractography results were evaluated for each method. RESULTS With nonlinear least squares and robust estimation of tensors by outlier rejection, significantly lower mean fractional anisotropy values were obtained than with linear least squares and weighted linear least squares. Visualized quality of tract reconstruction was significantly higher by use of robust estimation of tensors by outlier rejection and correlated with quality of DTI data. CONCLUSIONS Quality assessment and choice of processing methodology have considerable impact on neonatal DTI analysis. Dedicated acquisition, quality assessment, and advanced processing of neonatal DTI data must be ensured before performing clinical analyses, such as associating microstructural brain properties with patient outcome.
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Affiliation(s)
- A Plaisier
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - K Pieterman
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - M H Lequin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - P Govaert
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartment of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - A M Heemskerk
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - I K M Reiss
- Neonatology (I.K.M.R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - G P Krestin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - A Leemans
- Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Dudink
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
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50
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Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial Cranial US for Detection of Cerebral Sinovenous Thrombosis in Preterm Infants. Radiology 2013. [DOI: 10.1148/radiology.13130401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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