1
|
Zareen Z, Allen J, Kelly LA, McDonald D, Sweetman D, Molloy EJ. An observational study of sleep in childhood post-neonatal encephalopathy. Acta Paediatr 2021; 110:2352-2356. [PMID: 33942377 DOI: 10.1111/apa.15902] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/04/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
AIM Neonatal encephalopathy (NE) is associated with altered cognitive, motor, sensory abilities and behavioural outcomes. This case-control study aimed to assess whether Quality of Life (QoL) and sleep disorders are affected in older children following NE compared to age-matched controls. METHODS Children at school-age post-NE were recruited and compared to age-matched controls. Sleep and QoL were assessed with the Pediatric Quality of Life Inventory and the Child Sleep Habit Questionnaire. RESULTS One hundred children were recruited with an age range of 4-6 years, including children post-NE (n=45) and age-matched controls (n = 55). Significantly higher pathological sleep scores were evident in 58% of children post-NE compared to controls (43.8 vs 40.2; p = 0.001). Children post-NE had increased bedtime resistance (p = 0.028) and sleep anxiety (p = 0.01) compared to controls. Children in the post-NE group had lower total QoL scores versus controls (mean score 82.5 vs 95.8; p < 0.01). Children with mild NE also had lower total QoL scores than controls (90.0 vs 95.8, p = 0.003). There was a strong correlation between low QoL with high total sleep scores (Rho 0.339, p = 0.014). CONCLUSION There were high rates of sleep issues in school-aged children with mild and moderate-severe NE. Consideration and management of sleep problems may improve QoL in childhood post-NE.
Collapse
Affiliation(s)
- Zunera Zareen
- Discipline of Paediatrics Trinity CollegeThe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI) & Trinity Research in Childhood Centre (TRiCC) Trinity College Dublin Dublin Ireland
- Paediatrics Children’s Health Ireland (CHI) at Tallaght Dublin Ireland
- Paediatrics National Maternity Hospital Dublin Ireland
| | - John Allen
- Discipline of Paediatrics Trinity CollegeThe University of Dublin Dublin Ireland
- Paediatrics Children’s Health Ireland (CHI) at Tallaght Dublin Ireland
| | - Lynne A. Kelly
- Discipline of Paediatrics Trinity CollegeThe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI) & Trinity Research in Childhood Centre (TRiCC) Trinity College Dublin Dublin Ireland
- Coombe Women and Infants University Hospital Dublin Ireland
| | - Denise McDonald
- Discipline of Paediatrics Trinity CollegeThe University of Dublin Dublin Ireland
- Paediatrics Children’s Health Ireland (CHI) at Tallaght Dublin Ireland
| | | | - Eleanor J. Molloy
- Discipline of Paediatrics Trinity CollegeThe University of Dublin Dublin Ireland
- Trinity Translational Medicine Institute (TTMI) & Trinity Research in Childhood Centre (TRiCC) Trinity College Dublin Dublin Ireland
- Paediatrics Children’s Health Ireland (CHI) at Tallaght Dublin Ireland
- Paediatrics National Maternity Hospital Dublin Ireland
- Coombe Women and Infants University Hospital Dublin Ireland
| |
Collapse
|
2
|
Isweisi E, Moore CM, Hurley T, Sola-Visner M, McCallion N, Ainle FN, Zareen Z, Sweetman DU, Curley AE, Molloy EJ. Haematological issues in neonates with neonatal encephalopathy treated with hypothermia. Semin Fetal Neonatal Med 2021; 26:101270. [PMID: 34330681 DOI: 10.1016/j.siny.2021.101270] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neonatal encephalopathy (NE) is associated with abnormality of neurological function and involves multiorgan dysfunction. There are long-term complications such as cerebral palsy and developmental delay. Cardiac, renal, neurological and other organ dysfunctions are well described. Haematological dysfunction is relatively common and includes anaemia, thrombocytopenia, monocyte and neutrophil activation, hypofibrinogenemia and coagulopathy. There is a lack of consensus definitions of hematological parameters and optimal levels for intervention due to the lack of interventional studies in term neonates and the lack of knowledge of the optimal values during therapeutic hypothermia. However, derangements in hematological values are also associated with neurodevelopmental outcomes. This article outlines the different hematological complications associated with NE and therapeutic hypothermia and suggests a framework for management.
Collapse
Affiliation(s)
- Eman Isweisi
- Paediatrics, Trinity College, The University of Dublin, Ireland; Trinity Translational Medicine Institute (TTMI), Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC), Ireland.
| | - Carmel Maria Moore
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Dublin, Ireland
| | - Tim Hurley
- Paediatrics, Trinity College, The University of Dublin, Ireland; Trinity Translational Medicine Institute (TTMI), Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC), Ireland.
| | - Martha Sola-Visner
- Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Naomi McCallion
- Department of Paediatrics, Rotunda Hospital & Department of Paediatrics, Royal College of Surgeons in Ireland, Ireland.
| | - Fionnuala Ni Ainle
- Departments of Haematology, Mater Misericordiae University Hospitals, Dublin & University College Dublin School of Medicine, Dublin, Ireland.
| | - Zunera Zareen
- Paediatrics, Trinity College, The University of Dublin, Ireland; Trinity Translational Medicine Institute (TTMI), Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC), Ireland; Departments of Haematology, Mater Misericordiae University Hospitals, Dublin & University College Dublin School of Medicine, Dublin, Ireland; Paediatrics, St Michaels House, Dublin, Ireland.
| | - Deirdre U Sweetman
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Dublin, Ireland.
| | - Anna E Curley
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Dublin, Ireland.
| | - Eleanor J Molloy
- Paediatrics, Trinity College, The University of Dublin, Ireland; Trinity Translational Medicine Institute (TTMI), Trinity College Dublin & Trinity Research in Childhood Centre (TRiCC), Ireland; Neonatology, Children's Health Ireland (CHI) at Crumlin & Tallaght, Dublin, Ireland; Neonatology, Coombe Women and Infants University Hospital Dublin, Ireland.
| | | |
Collapse
|
3
|
Abstract
BACKGROUND Cerebral palsy (CP) is a heterogeneous group of non-progressive disorders of posture or movement, caused by a lesion of the developing brain. Osteoporosis is common in children with cerebral palsy, particularly in children with reduced gross motor function, and leads to an increased risk of fractures. Gross motor function in children with CP can be categorised using a tool called the Gross Motor Function Classification System (GMFCS). Bisphosphonate increases bone mineral density (BMD) and reduces fracture rates. Bisphosphonate is used widely in the treatment of adult osteoporosis. However, the use of bisphosphonate in children with CP remains controversial, due to a paucity of evidence and a lack of recent trials examining the efficacy and safety of bisphosphonate use in this population. OBJECTIVES To examine the efficacy and safety of bisphosphonate therapy in the treatment of low BMD or secondary osteoporosis (or both) in children with cerebral palsy (GMFCS Levels III to V) who are under 18 years of age. SEARCH METHODS In September 2020, we searched CENTRAL, MEDLINE, Embase, six other databases, and two trial registers for relevant studies. We also searched the reference lists of relevant systematic reviews, trials, and case studies identified by the search, and contacted the authors of relevant studies in an attempt to identify unpublished literature. SELECTION CRITERIA All relevant randomised controlled trials (RCTs), and quasi-RCTs, comparing at least one bisphosphonate (given at any dose, orally or intravenously) with placebo or no drug, for the treatment of low BMD or osteoporosis in children up to 18 years old, with cerebral palsy (GMFCS Levels III to V). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We were unable to conduct any meta-analyses due to insufficient data, and therefore provide a narrative assessment of the results. MAIN RESULTS We found two relevant RCTs (34 participants). Both studies included participants with non-ambulatory CP or CP and osteoporosis. Participants in both studies were similar in severity of CP, age distribution, and sex distribution. The two trials used different bisphosphonate medications and different intervention durations, but further comparison of the interventions was not possible due to a lack of published data from one trial. One trial received funding and support from research, academic, and hospital foundations, with pharmaceutical companies providing components of the calcium and vitamin supplement; the other trial did not report sources of funding. We judged one study at an overall high risk of bias; the other as overall unclear risk of bias. PRIMARY OUTCOME Compared to placebo or no treatment, both studies provided very low certainty evidence of improved BMD at least four months post-intervention in children treated with bisphosphonate. Only one study (12 participants) provided sufficient detail to assess a measure of the effect, and reported an improvement at six months post-intervention in lumbar spine z-score (mean difference (MD) 18%, 95% confidence interval (CI) 6.57 to 29.43; very low certainty evidence). SECONDARY OUTCOMES Very low certainty evidence from one study found that bisphosphonate reduced serum N-telopeptides (NTX) more than placebo; the other study reported that both bisphosphonate plus alfacalcidol and alfacalcidol alone reduced NTX, but did not compare groups. One study reported inconclusive results between groups for serum bone-specific alkaline phosphatase (BAP). The other study reported that both bisphosphonate plus alfacalcidol and alfacalcidol alone reduced BAP, but did not compare groups. Neither study reported data for the effect of bisphosphonate treatment on changes in volumetric BMD in the distal radius or tibia, changes in fracture frequency, bone pain, or quality of life. One study reported that two participants had febrile events noted during their first dosing schedule, but no further adverse events were reported in either relevant study. AUTHORS' CONCLUSIONS Based on the available evidence, there is very low certainty evidence that bisphosphonate treatment may improve bone health in children with cerebral palsy. We could only include one study with 14 participants in the assessment of the effect size; therefore, the precision of the effect estimate is low. We could only evaluate one planned primary outcome, as there was insufficient detail reported in the relevant studies. Further research from RCTs on the effect and safety of bisphosphonate to improve bone health in children with cerebral palsy is required. These studies should clarify the optimal standard treatment regarding weight-bearing exercises, vitamin D and calcium supplementation, and should include fracture frequency as a primary outcome.
Collapse
Affiliation(s)
- Tim Hurley
- Department of Paediatrics, Trinity College Dublin, Dublin, Ireland
| | - Zunera Zareen
- Department of Paediatrics, Trinity College Dublin, Dublin, Ireland
- Department of Paediatrics, The National Children's Hospital, Dublin, Ireland
| | - Philip Stewart
- Department of Paediatrics, The National Children's Hospital, Dublin, Ireland
| | - Ciara McDonnell
- Department of Paediatric Endocrinology & Diabetes, The National Children's Hospital, Tallaght, Dublin, Ireland
| | - Denise McDonald
- Department of Paediatrics, The National Children's Hospital, Dublin, Ireland
| | - Eleanor Molloy
- Department of Paediatrics, Trinity College Dublin, Dublin, Ireland
- Department of Paediatrics, The National Children's Hospital, Dublin, Ireland
| |
Collapse
|
4
|
Kelly LA, O'Dea MI, Zareen Z, Melo AM, McKenna E, Strickland T, McEneaney V, Donoghue V, Boylan G, Sweetman D, Butler J, Vavasseur C, Miletin J, El-Khuffash AF, O'Neill LAJ, O'Leary JJ, Molloy EJ. Altered inflammasome activation in neonatal encephalopathy persists in childhood. Clin Exp Immunol 2021; 205:89-97. [PMID: 33768526 PMCID: PMC8209598 DOI: 10.1111/cei.13598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/03/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
Neonatal encephalopathy (NE) is characterized by altered neurological function in term infants and inflammation plays an important pathophysiological role. Inflammatory cytokines interleukin (IL)‐1β, IL‐1ra and IL‐18 are activated by the nucleotide‐binding and oligomerization domain (NOD)‐, leucine‐rich repeat domain (LRR)‐ and NOD‐like receptor protein 3 (NLRP3) inflammasome; furthermore, we aimed to examine the role of the inflammasome multiprotein complex involved in proinflammatory responses from the newborn period to childhood in NE. Cytokine concentrations were measured by multiplex enzyme‐linked immunosorbent assay (ELISA) in neonates and children with NE in the absence or presence of lipopolysaccharide (LPS) endotoxin. We then investigated expression of the NLRP3 inflammasome genes, NLRP3, IL‐1β and ASC by polymerase chain reaction (PCR). Serum samples from 40 NE patients at days 1 and 3 of the first week of life and in 37 patients at age 4–7 years were analysed. An increase in serum IL‐1ra and IL‐18 in neonates with NE on days 1 and 3 was observed compared to neonatal controls. IL‐1ra in NE was decreased to normal levels at school age, whereas serum IL‐18 in NE was even higher at school age compared to school age controls and NE in the first week of life. Percentage of LPS response was higher in newborns compared to school‐age NE. NLRP3 and IL‐1β gene expression were up‐regulated in the presence of LPS in NE neonates and NLRP3 gene expression remained up‐regulated at school age in NE patients compared to controls. Increased inflammasome activation in the first day of life in NE persists in childhood, and may increase the window for therapeutic intervention.
Collapse
Affiliation(s)
- L A Kelly
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - M I O'Dea
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - Z Zareen
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.,Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland
| | - A M Melo
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - E McKenna
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - T Strickland
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - V McEneaney
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - V Donoghue
- Radiology, National Maternity Hospital, Dublin, Ireland
| | - G Boylan
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.,Infant Research Centre, Cork University Hospital, Cork, Ireland
| | - D Sweetman
- National Maternity Hospital, Dublin, Ireland
| | - J Butler
- Meso-Scale Diagnostics, Manchester, UK
| | - C Vavasseur
- National Maternity Hospital, Dublin, Ireland
| | - J Miletin
- Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - L A J O'Neill
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - J J O'Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - E J Molloy
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.,Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.,Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland.,CHI at Crumlin, Dublin, Ireland
| |
Collapse
|
5
|
Taher NAB, Kelly LA, Al-Harbi AI, O'Dea MI, Zareen Z, Ryan E, Molloy EJ, Doherty DG. Altered distributions and functions of natural killer T cells and γδ T cells in neonates with neonatal encephalopathy, in school-age children at follow-up, and in children with cerebral palsy. J Neuroimmunol 2021; 356:577597. [PMID: 33964735 DOI: 10.1016/j.jneuroim.2021.577597] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
We enumerated conventional and innate lymphocyte populations in neonates with neonatal encephalopathy (NE), school-age children post-NE, children with cerebral palsy and age-matched controls. Using flow cytometry, we demonstrate alterations in circulating T, B and natural killer cell numbers. Invariant natural killer T cell and Vδ2+ γδ T cell numbers and frequencies were strikingly higher in neonates with NE, children post-NE and children with cerebral palsy compared to age-matched controls, whereas mucosal-associated invariant T cells and Vδ1 T cells were depleted from children with cerebral palsy. Upon stimulation ex vivo, T cells, natural killer cells and Vδ2 T cells from neonates with NE more readily produced inflammatory cytokines than their counterparts from healthy neonates, suggesting that they were previously primed or activated. Thus, innate and conventional lymphocytes are numerically and functionally altered in neonates with NE and these changes may persist into school-age.
Collapse
Affiliation(s)
- Nawal A B Taher
- Discipline of Immunology, School of Medicine, Trinity College Dublin, Ireland; Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Lynne A Kelly
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Alhanouf I Al-Harbi
- Discipline of Immunology, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Mary I O'Dea
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland; Paediatrics, Children's Health Ireland at Tallaght & Crumlin, Dublin, Ireland; Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland; National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Zunera Zareen
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland
| | - Emer Ryan
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland; Paediatrics, Children's Health Ireland at Tallaght & Crumlin, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; Trinity Research in Childhood Centre, Trinity College Dublin, Ireland; Paediatrics, Children's Health Ireland at Tallaght & Crumlin, Dublin, Ireland; Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland; National Children's Research Centre, Crumlin, Dublin, Ireland
| | - Derek G Doherty
- Discipline of Immunology, School of Medicine, Trinity College Dublin, Ireland; Trinity Translational Medicine Institute, Trinity College Dublin, Ireland.
| |
Collapse
|
6
|
Zareen Z, Strickland T, Fallah L, McEneaney V, Kelly L, McDonald D, Molloy EJ. Cytokine dysregulation in children with cerebral palsy. Dev Med Child Neurol 2021; 63:407-412. [PMID: 33185287 DOI: 10.1111/dmcn.14724] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
AIM To examine pro- and anti-inflammatory cytokines in children with cerebral palsy (CP) at baseline and in response to endotoxin (lipopolysaccharide), and correlate outcomes compared with age-matched comparisons, to evaluate their ability to mount an immune response. METHOD Serum cytokines were assessed in 12 children (eight males, four females; mean age 10y 1mo [SD 1y 8mo], 6-16y) with CP against 12 age-matched comparisons (eight males, four females; mean age 9y 1mo [SD 1y 1mo]). Pro- and anti-inflammatory cytokines (interleukin-1β, interleukin-2, interleukin-6, interleukin-8, interleukin-10, interleukin-18, tumour necrosis factor [TNF]-α, TNF-β, interferon-γ, granulocyte-macrophage colony-stimulating factor [GM-CSF], vascular endothelial growth factor [VEGF], erythropoietin, and interleukin-1 receptor antagonist) were measured at baseline and in response to in vitro simulation with lipopolysaccharide by multiplex enzyme-linked immunosorbent assay. RESULTS Significantly higher erythropoietin was found at baseline in children with CP compared with the comparison group. There was a strong response to lipopolysaccharide for interleukin-8, VEGF, TNF-α, and GM-CSF in both children with CP and the comparison group; however, there was significant lipopolysaccharide hyporesponsiveness in children with CP compared with the comparison group for interleukin-1α, interleukin-1β, interleukin-2, and interleukin-6. INTERPRETATION Altered cytokine responses in children with CP compared with the comparison group demonstrate an altered inflammatory state that may contribute to ongoing sequelae and could be a target for therapy. WHAT THIS PAPER ADDS Altered inflammatory responses persist in children with cerebral palsy (CP). Erythropoietin is elevated in children with CP compared with the comparison group. Children with CP have reduced interleukin-1α, interleukin-1β, interleukin-2, and interleukin-6 inflammatory responses to lipopolysaccharide.
Collapse
Affiliation(s)
- Zunera Zareen
- Discipline of Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, Ireland.,Paediatrics, National Maternity Hospital, Dublin, Ireland
| | - Tammy Strickland
- Discipline of Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Lida Fallah
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,School of Computer Science and Statistics (SCSS), Trinity College Dublin, Dublin, Ireland
| | - Victoria McEneaney
- Discipline of Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Lynne Kelly
- Discipline of Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Denise McDonald
- Discipline of Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Paediatrics, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Health Ireland at Tallaght, Tallaght University Hospital, Dublin, Ireland.,Paediatrics, National Maternity Hospital, Dublin, Ireland.,Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland.,Neonatology, Children's Health Ireland at Crumlin, Dublin, Ireland
| |
Collapse
|
7
|
Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
Collapse
Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
| |
Collapse
|
8
|
Zareen Z, Strickland T, Eneaney VM, Kelly LA, McDonald D, Sweetman D, Molloy EJ. Cytokine dysregulation persists in childhood post Neonatal Encephalopathy. BMC Neurol 2020; 20:115. [PMID: 32228505 PMCID: PMC7106837 DOI: 10.1186/s12883-020-01656-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 10/02/2019] [Accepted: 02/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background Cytokines are possible mediators of neuroinflammation and associated with adverse outcome in neonatal encephalopathy (NE). Our aim was to explore cytokine response in children with Neonatal Encephalopathy (NE) at school age compared to age-matched controls. Method Follow up at school age, children who had NE and age-matched controls were assessed for their cytokine responses and neurodevelopment outcome. Pro- and anti-inflammatory cytokines in the serum, [Interleukin (IL)-1α, IL-1β, IL-2, IL-6, IL-8, IL-18, Tumor necrosis factor (TNF)-α, TNF β, Interferon (IFN)-γ, granulocyte-macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF), erythropoietin (EPO), IL-10 & IL-1RA] were measured at baseline and in response to in vitro stimulation with lipopolysaccharide (LPS: endotoxin). Results GM-CSF, TNF-β, IL-2 IL-6 and IL-8 were significantly elevated at school age following NE (n = 40) compared to controls (n = 37). A rise in GM-CSF, IL-8, TNF-α, IL-1β, & IL-6 were seen in NE group following LPS stimulation. Relative LPS hypo-responsiveness was also noted in children with severe NE with IL-10, VEGF, EPO and TNF-β. Elevated TNF-β was associated with low gross motor scores on assessment at school age. Conclusion School-age children post-NE had significantly altered cytokine responses to endotoxin compared to controls. TNF-β was associated with adverse developmental outcomes. This suggests the inflammatory process may persist into childhood and a longer therapeutic window may be available for neuroprotection therapies.
Collapse
Affiliation(s)
- Zunera Zareen
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland (CHI) at Tallaght University Hospital, Dublin, 24, Ireland.,Paediatrics, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - Tammy Strickland
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Victoria Mc Eneaney
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Lynne A Kelly
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Denise McDonald
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland (CHI) at Tallaght University Hospital, Dublin, 24, Ireland
| | - Deirdre Sweetman
- Paediatrics, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland. .,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland. .,Paediatrics, Children's Hospital Ireland (CHI) at Tallaght University Hospital, Dublin, 24, Ireland. .,Paediatrics, National Maternity Hospital, Holles Street, Dublin, Ireland. .,Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland. .,Neonatology, CHI at Crumlin, Dublin, Ireland.
| |
Collapse
|
9
|
Sweetman D, Kelly LA, Zareen Z, Nolan B, Murphy J, Boylan G, Donoghue V, Molloy EJ. Coagulation Profiles Are Associated With Early Clinical Outcomes in Neonatal Encephalopathy. Front Pediatr 2019; 7:399. [PMID: 31632939 PMCID: PMC6779697 DOI: 10.3389/fped.2019.00399] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/08/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Neonatal encephalopathy (NE) is associated with coagulation abnormalities. We aimed to investigate the serial alterations in coagulation profiles in term infants with NE and correlate with their clinical outcomes. This was a prospective cohort study in a tertiary referral, university-affiliated maternity hospital. Neonates exposed to perinatal asphyxia were recruited (n = 82) and 39 received therapeutic hypothermia. Infants had serial coagulation tests including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen in the first week of life. The main outcome measures included MRI brain and EEG seizures. Our results show that mortality was predicted on day 1 by decreased Fibrinogen (AUC = 0.95, p = 0.009) and by PT on day 2 with a cutoff of 22 s. An abnormal MRI was predicted by Fibrinogen on day 3 with a cut-off value of 2 g/L. For prediction of grade II/III NE, PT on day 2 of life was strongest with a cut-off value of 14 s. Only elevated APTT levels on day 1 of life were predictive of seizures (AUC = 0.65, p = 0.04). Conclusion: Coagulation parameters are strong predictors of outcomes such as abnormal NE grade, seizures, and mortality.
Collapse
Affiliation(s)
- Deirdre Sweetman
- Neonatology, National Maternity Hospital, Dublin, Ireland.,Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Lynne A Kelly
- Paediatrics, Children's Health Ireland (CHI) at Tallaght and Trinity Translational Medicine Institute, Trinity College Dublin, St. James Hospital, Dublin, Ireland
| | - Zunera Zareen
- Paediatrics, Children's Health Ireland (CHI) at Tallaght and Trinity Translational Medicine Institute, Trinity College Dublin, St. James Hospital, Dublin, Ireland
| | - Beatrice Nolan
- Paediatrics, Children's Health Ireland (CHI) at Tallaght and Trinity Translational Medicine Institute, Trinity College Dublin, St. James Hospital, Dublin, Ireland.,Haematology, CHI at Crumlin, Dublin, Ireland
| | - John Murphy
- Neonatology, National Maternity Hospital, Dublin, Ireland.,Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Geraldine Boylan
- Neonatal Brain Research Group, Cork University Maternity Hospital, Cork, Ireland
| | - Veronica Donoghue
- Neonatology, National Maternity Hospital, Dublin, Ireland.,Radiology, National Maternity Hospital, Dublin, Ireland
| | - Eleanor J Molloy
- Neonatology, National Maternity Hospital, Dublin, Ireland.,Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland.,Paediatrics, Children's Health Ireland (CHI) at Tallaght and Trinity Translational Medicine Institute, Trinity College Dublin, St. James Hospital, Dublin, Ireland.,Neonatology, CHI at Crumlin, Dublin, Ireland.,Neonatology, Coombe Women's and Infant's University Hospital, Dublin, Ireland
| |
Collapse
|
10
|
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine the efficacy and safety of bisphosphonate therapy in the treatment of low BMD or secondary osteoporosis (or both) in children with cerebral palsy (GMFCS Levels III to V) who are under 18 years of age.
Collapse
Affiliation(s)
| | - Ciara McDonnell
- The National Children’s Hospital, TallaghtDepartment of Paediatric Endocrinology & DiabetesDublinIreland24
| | - Denise Mc Donald
- The National Children’s Hospital, TallaghtDepartment of PaediatricsDublinIreland24
| | | |
Collapse
|
11
|
Abstract
BACKGROUND A variety of suction catheters (type, size and design) are recommended for oropharyngeal suctioning of meconium during newborn resuscitation, but it is not known which performs best. In this study we compared different sizes of soft catheters, the Yankauer (YK) and the portable bulb syringe (BS), in suctioning a solution of varying viscosity. METHODS Simulated meconium (SM) was made using commercial canned pea soup in two strengths, full-strength thick-particulate (TP) and 50% strained soup diluted with water, that is, thin-non-particulate (TnP), with saline as a control. A 20 ml aliquot of solution was suctioned over 5 s with each device using an electrical suction pump set at two different pressures, 100 and 150 mm Hg (21 kpa). In addition, the negative pressure of five BSs was measured in order to compare generated pressures with the alternative devices. RESULTS The YK and BS suctioned almost 100% of saline, while the 6F and 8F catheters suctioned 50% and 75% saline, respectively. The YK suctioned 100% of TnP, saline and 30% of TP. At reduced suction pressures (100 and 50 mm Hg) the YK also suctioned all TnP. The 12F and 14F catheters suctioned a minimal amount of TP, whereas YK was the most efficient, suctioning 30% of TP. The mean negative pressure generated with five BSs was 78 and 71 mm Hg by a male and female operator, respectively. CONCLUSIONS The YK and BS outperform the catheters in suctioning SM. The YK is the best for TP, but all devices perform poorly in suctioning fluid of this consistency.
Collapse
Affiliation(s)
- Zunera Zareen
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland.
| | | | | | | | | |
Collapse
|
12
|
Zareen Z, Finn D, Killeen O. An alternative analgesic agent for intra-articular corticosteroid injections (IAI) in juvenile idiopathic arthritis (JIA) – a fentanyl lollipop. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194564 DOI: 10.1186/1546-0096-9-s1-p205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|