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Kim F, Bateman DA, Goldshtrom N, Sheen JJ, Garey D. Intracranial ultrasound abnormalities and mortality in preterm infants with and without fetal growth restriction stratified by fetal Doppler study results. J Perinatol 2023; 43:560-567. [PMID: 36717608 DOI: 10.1038/s41372-023-01621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate whether fetal growth restriction (FGR) with or without abnormal Dopplers is associated with intracranial abnormalities and death in premature infants. STUDY DESIGN Premature infants with and without FGR born between 2016 and 2019 were included. Primary outcome was death, severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). Groups were compared using standard bivariate testing and multivariable regression. RESULTS Among 168 FGR and 560 non-FGR infants, FGR infants with abnormal Dopplers had an increased incidence of death, severe IVH or PVL compared to non-FGR infants (13% (16/123) vs. 7% (41/560); p = 0.03) while FGR infants with normal Dopplers had a nonsignificant decrease. In a logistic regression model, FGR with abnormal Dopplers was associated with more than three times higher odds of death, severe IVH or PVL (OR 3.2, 95% CI 1.54,6.49; p < 0.001). CONCLUSIONS Growth-restricted infants with abnormal Dopplers had an increased risk of death, intracranial abnormalities, and prematurity-related morbidities.
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Affiliation(s)
- Faith Kim
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
| | - David A Bateman
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Nimrod Goldshtrom
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jean-Ju Sheen
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Donna Garey
- Division of Neonatology, Department of Pediatrics, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
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2
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Tian M, Xu F, Xia Q, Tang Y, Zhang Z, Lin X, Meng H, Feng L, Liu S. Morphological development of the human fetal striatum during the second trimester. Cereb Cortex 2022; 32:5072-5082. [PMID: 35078212 DOI: 10.1093/cercor/bhab532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 12/27/2022] Open
Abstract
The morphological development of the fetal striatum during the second trimester has remained poorly described. We manually segmented the striatum using 7.0-T MR images of the fetal specimens ranging from 14 to 22 gestational weeks. The global development of the striatum was evaluated by volume measurement. The absolute volume (Vabs) of the caudate nucleus (CN) increased linearly with gestational age, while the relative volume (Vrel) showed a quadratic growth. Both Vabs and Vrel of putamen increased linearly. Through shape analysis, the changes of local structure in developing striatum were specifically demonstrated. Except for the CN tail, the lateral and medial parts of the CN grew faster than the middle regions, with a clear rostral-caudal growth gradient as well as a distinct "outside-in" growth gradient. For putamen, the dorsal and ventral regions grew obviously faster than the other regions, with a dorsal-ventral bidirectional developmental pattern. The right CN was larger than the left, whereas there was no significant hemispheric asymmetry in the putamen. By establishing the developmental trajectories, spatial heterochrony, and hemispheric dimorphism of human fetal striatum, these data bring new insight into the fetal striatum development and provide detailed anatomical references for future striatal studies.
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Affiliation(s)
- Mimi Tian
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
| | - Feifei Xu
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
| | - Qing Xia
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
| | - Yuchun Tang
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
| | - Zhonghe Zhang
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Department of Medical Imaging, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
| | - Xiangtao Lin
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Department of Medical Imaging, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
| | - Haiwei Meng
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
| | - Lei Feng
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
| | - Shuwei Liu
- Department of Anatomy and Neurobiology, Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Mental Disorders, Shandong Key Laboratory of Digital Human and Clinical Anatomy, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong 250012, China
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3
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He L, Wang J, Lu ZL, Kline-Fath BM, Parikh NA. Optimization of magnetization-prepared rapid gradient echo (MP-RAGE) sequence for neonatal brain MRI. Pediatr Radiol 2018; 48:1139-1151. [PMID: 29721599 PMCID: PMC6148771 DOI: 10.1007/s00247-018-4140-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/01/2018] [Accepted: 04/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sequence optimization in neonates might improve detection sensitivity of abnormalities for a variety of conditions. However this has been historically challenging because tissue properties such as the longitudinal relaxation time and proton density differ significantly between neonates and adults. OBJECTIVE To optimize the magnetization-prepared rapid gradient echo (MP-RAGE) sequence to enhance both signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) efficiencies. MATERIALS AND METHODS We optimized neonatal MP-RAGE sequence through (1) reducing receive bandwidth to decrease noise, (2) shortening acquisition train length (acquisition number per repetition time or total number of read-out radiofrequency rephrasing pulses) using slice partial Fourier acquisition and (3) simulating the solution of Bloch's equation under optimal receive bandwidth and acquisition train length. Using the optimized sequence parameters, we scanned 12 healthy full-term infants within 2 weeks of birth and four preterm infants at 40 weeks' corrected age. RESULTS Compared with a previously published neonatal protocol, we were able to reduce the total scan time by reduce the total scan time by 60% and increase the average SNR efficiency by 160% (P<0.001) and the average CNR efficiency by 26% (P=0.029). CONCLUSION Our in vivo neonatal brain imaging experiments confirmed that both SNR and CNR efficiencies significantly increased with our proposed protocol. Our proposed optimization methodology could be readily extended to other populations (e.g., older children, adults), as well as different organ systems, field strengths and MR sequences.
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Affiliation(s)
- Lili He
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7009, Cincinnati, OH, 45229, USA.
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Jinghua Wang
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Zhong-Lin Lu
- Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7009, Cincinnati, OH, 45229, USA
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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4
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Bruno CJ, Bengani S, Gomes WA, Brewer M, Vega M, Xie X, Kim M, Fuloria M. MRI Differences Associated with Intrauterine Growth Restriction in Preterm Infants. Neonatology 2017; 111:317-323. [PMID: 28076856 DOI: 10.1159/000453576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at risk for neurodevelopmental impairment. Intrauterine growth restriction (IUGR) further increases this risk. Brain imaging studies are often utilized at or near term-equivalent age to determine later prognosis. OBJECTIVE To evaluate the association between intrauterine growth and regional brain volume on MRI scans performed in preterm infants at or near term-equivalent age. METHODS This is a retrospective case-control study of 24 infants born at gestational age ≤30 weeks and cared for in a large, inner-city, academic neonatal intensive-care unit from 2012 to 2013. Each IUGR infant was matched with 1-2 appropriate for gestational age (AGA) infants who served as controls. Predischarge MRI scans routinely obtained at ≥36 weeks' adjusted age were analyzed for regional brain volumetric differences. We examined the association between IUGR and thalamic, basal ganglion, and cerebellar brain volumes in these preterm infants. RESULTS Compared to AGA infants, IUGR infants had a smaller thalamus (7.88 vs. 5.87 mL, p = 0.001) and basal ganglion (8.87 vs. 6.92 mL, p = 0.002) volumes. There was no difference in cerebellar volumes between the two study groups. Linear regression analyses revealed similar trends in the associations between IUGR and brain volumes after adjusting for sex, gestational age at birth, and postconceptual age and weight at MRI. CONCLUSIONS Thalamus and basal ganglion volumes are reduced in growth-restricted preterm infants. These differences may preferentially impact neurodevelopmental outcomes. Further research is needed to explore these relationships.
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Affiliation(s)
- Christie J Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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5
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Brown LD, Hay WW. Impact of placental insufficiency on fetal skeletal muscle growth. Mol Cell Endocrinol 2016; 435:69-77. [PMID: 26994511 PMCID: PMC5014698 DOI: 10.1016/j.mce.2016.03.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/03/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
Intrauterine growth restriction (IUGR) caused by placental insufficiency is one of the most common and complex problems in perinatology, with no known cure. In pregnancies affected by placental insufficiency, a poorly functioning placenta restricts nutrient supply to the fetus and prevents normal fetal growth. Among other significant deficits in organ development, the IUGR fetus characteristically has less lean body and skeletal muscle mass than their appropriately-grown counterparts. Reduced skeletal muscle growth is not fully compensated after birth, as individuals who were born small for gestational age (SGA) from IUGR have persistent reductions in muscle mass and strength into adulthood. The consequences of restricted muscle growth and accelerated postnatal "catch-up" growth in the form of adiposity may contribute to the increased later life risk for visceral adiposity, peripheral insulin resistance, diabetes, and cardiovascular disease in individuals who were formerly IUGR. This review will discuss how an insufficient placenta results in impaired fetal skeletal muscle growth and how lifelong reductions in muscle mass might contribute to increased metabolic disease risk in this vulnerable population.
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Affiliation(s)
- Laura D Brown
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus F441, Perinatal Research Center, 13243 East 23rd Avenue, Aurora, CO 80045, United States.
| | - William W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus F441, Perinatal Research Center, 13243 East 23rd Avenue, Aurora, CO 80045, United States.
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6
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Polat A, Barlow S, Ber R, Achiron R, Katorza E. Volumetric MRI study of the intrauterine growth restriction fetal brain. Eur Radiol 2016; 27:2110-2118. [PMID: 27491875 DOI: 10.1007/s00330-016-4502-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intrauterine growth restriction (IUGR) is a pathologic fetal condition known to affect the fetal brain regionally and associated with future neurodevelopmental abnormalities. This study employed MRI to assess in utero regional brain volume changes in IUGR fetuses compared to controls. METHODS Retrospectively, using MRI images of fetuses at 30-34 weeks gestational age, a total of 8 brain regions-supratentorial brain and cavity, cerebral hemispheres, temporal lobes and cerebellum-were measured for volume in 13 fetuses with IUGR due to placental insufficiency and in 21 controls. Volumes and their ratios were assessed for difference using regression models. Reliability was assessed by intraclass correlation coefficients (ICC) between two observers. RESULTS In both groups, all structures increase in absolute volume during that gestation period, and the rate of cerebellar growth is higher compared to that of supratentorial structures. All structures' absolute volumes were significantly smaller for the IUGR group. Cerebellar to supratentorial ratios were found to be significantly smaller (P < 0.05) for IUGR compared to controls. No other significant ratio differences were found. ICC showed excellent agreement. CONCLUSIONS The cerebellar to supratentorial volume ratio is affected in IUGR fetuses. Additional research is needed to assess this as a radiologic marker in relation to long-term outcome. KEY POINTS • IUGR is a pathologic fetal condition affecting the brain • IUGR is associated with long-term neurodevelopmental abnormalities; fetal characterization is needed • This study aimed to evaluate regional brain volume differences in IUGR • Cerebellar to supratentorial volume ratios were smaller in IUGR fetuses • This finding may play a role in long-term development of IUGR fetuses.
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Affiliation(s)
- A Polat
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - S Barlow
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Ber
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Katorza
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel Hashomer, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Kazanci E, Gucuyener K, Ergenekon E, Aktas S. Functional brain maturation of prematurely born, growth discordant monochorionic twins assessed by aEEG. Brain Dev 2016; 38:100-2. [PMID: 26170018 DOI: 10.1016/j.braindev.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/01/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
The amplitude-integrated electroencephalogram (aEEG) is a simple and convenient tool for brain function monitoring. It is being more widely used in monitoring high risk neonates in neonatal intensive care units. Normal values and patterns for aEEG activity in preterm infants are still being developing. Here we report the functional brain maturation of preterm twin siblings with aEEG who were severely affected by fetal growth discordance. The aEEG records of growth retarded twin was compared with her appropriate for gestational age sibling in order to see if there is also a developmental discordance in the functional brain maturation of these twins.
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Affiliation(s)
- Ebru Kazanci
- Division of Newborn Medicine, Gazi University Hospital, Ankara, Turkey.
| | - Kivilcim Gucuyener
- Division of Pediatric Neurology, Gazi University Hospital, Ankara, Turkey
| | - Ebru Ergenekon
- Division of Newborn Medicine, Gazi University Hospital, Ankara, Turkey
| | - Selma Aktas
- Division of Newborn Medicine, Gazi University Hospital, Ankara, Turkey
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8
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Placental and fetal growth restriction, size at birth and neonatal growth alter cognitive function and behaviour in sheep in an age- and sex-specific manner. Physiol Behav 2015; 152:1-10. [DOI: 10.1016/j.physbeh.2015.08.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 12/22/2022]
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9
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Polen KND, Sandhu PK, Honein MA, Green KK, Berkowitz JM, Pace J, Rasmussen SA. Knowledge and attitudes of adults towards smoking in pregnancy: results from the HealthStyles© 2008 survey. Matern Child Health J 2015; 19:144-54. [PMID: 24825031 DOI: 10.1007/s10995-014-1505-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Smoking during pregnancy is causally associated with many adverse health outcomes. Quitting smoking, even late in pregnancy, improves some outcomes. Among adults in general and reproductive-aged women, we sought to understand knowledge and attitudes towards prenatal smoking and its effects on pregnancy outcomes. Using data from the 2008 HealthStyles© survey, we assessed knowledge and attitudes about prenatal smoking and smoking cessation. We classified respondents as having high knowledge if they gave ≥ 5 correct responses to six knowledge questions regarding the health effects of prenatal smoking. We calculated frequencies of correct responses to assess knowledge about prenatal smoking and estimated relative risk to examine knowledge by demographic and lifestyle factors. Only 15 % of all respondents and 23 % of reproductive-aged women had high knowledge of the adverse effects of prenatal smoking on pregnancy outcomes. Preterm birth and low birth weight were most often recognized as adverse outcomes associated with prenatal smoking. Nearly 70 % of reproductive-aged women smokers reported they would quit smoking if they became pregnant without any specific reasons from their doctor. Few respondents recognized the benefits of quitting smoking after the first trimester of pregnancy. Our results suggest that many women lack knowledge regarding the increased risks for adverse outcomes associated with prenatal smoking. Healthcare providers should follow the recommendations provided by the American Congress of Obstetricians and Gynecologists, which include educating women about the health risks of prenatal smoking and the benefits of quitting. Healthcare providers should emphasize quitting smoking even after the first trimester of pregnancy.
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Affiliation(s)
- Kara N D Polen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-86, Atlanta, GA, 30333, USA,
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10
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Yalin Imamoglu E, Gursoy T, Sancak S, Ovali F. Does being born small-for-gestational-age affect cerebellar size in neonates? J Matern Fetal Neonatal Med 2015; 29:892-6. [DOI: 10.3109/14767058.2015.1022863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Roldan-Valadez E, Suarez-May MA, Favila R, Aguilar-Castañeda E, Rios C. Selected Gray Matter Volumes and Gender but Not Basal Ganglia nor Cerebellum Gyri Discriminate Left Versus Right Cerebral Hemispheres: Multivariate Analyses in human Brains at 3T. Anat Rec (Hoboken) 2015; 298:1336-46. [PMID: 25902919 DOI: 10.1002/ar.23165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/22/2015] [Accepted: 03/11/2015] [Indexed: 02/05/2023]
Abstract
Interest in the lateralization of the human brain is evident through a multidisciplinary number of scientific studies. Understanding volumetric brain asymmetries allows the distinction between normal development stages and behavior, as well as brain diseases. We aimed to evaluate volumetric asymmetries in order to select the best gyri able to classify right- versus left cerebral hemispheres. A cross-sectional study performed in 47 right-handed young-adults healthy volunteers. SPM-based software performed brain segmentation, automatic labeling and volumetric analyses for 54 regions involving the cerebral lobes, basal ganglia and cerebellum from each cerebral hemisphere. Multivariate discriminant analysis (DA) allowed the assembling of a predictive model. DA revealed one discriminant function that significantly differentiated left vs. right cerebral hemispheres: Wilks' λ = 0.008, χ(2) (9) = 238.837, P < 0.001. The model explained 99.20% of the variation in the grouping variable and depicted an overall predictive accuracy of 98.8%. With the influence of gender; the selected gyri able to discriminate between hemispheres were middle orbital frontal gyrus (g.), angular g., supramarginal g., middle cingulum g., inferior orbital frontal g., calcarine g., inferior parietal lobule and the pars triangularis inferior frontal g. Specific brain gyri are able to accurately classify left vs. right cerebral hemispheres by using a multivariate approach; the selected regions correspond to key brain areas involved in attention, internal thought, vision and language; our findings favored the concept that lateralization has been evolutionary favored by mental processes increasing cognitive efficiency and brain capacity.
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Affiliation(s)
- Ernesto Roldan-Valadez
- MRI Unit, Division of Medial Imaging, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Marcela A Suarez-May
- MRI Unit, Division of Medial Imaging, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Rafael Favila
- GE Healthcare, Division of Healthcare, Mexico City, Mexico
| | - Erika Aguilar-Castañeda
- Cognitive and Behavioral Unit, Department of Neuropsychology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Camilo Rios
- Neurochemistry Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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12
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Sigaard RK, Kjær M, Pakkenberg B. Development of the Cell Population in the Brain White Matter of Young Children. Cereb Cortex 2014; 26:89-95. [PMID: 25122465 DOI: 10.1093/cercor/bhu178] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
While brain gray matter is primarily associated with sensorimotor processing and cognition, white matter modulates the distribution of action potentials, coordinates communication between different brain regions, and acts as a relay for input/output signals. Previous studies have described morphological changes in gray and white matter during childhood and adolescence, which are consistent with cellular genesis and maturation, but corresponding events in infants are poorly documented. In the present study, we estimated the total number of cells (neurons, oligodendrocytes, astrocytes, and microglia) in the cerebral white matter of 9 infants aged 0-33 months, using design-based stereological methods to obtain quantitative data about brain development. There were linear increases with age in the numbers of oligodendrocytes (7-28 billion) and astrocytes (1.5-6.7 billion) during the first 3 years of life, thus attaining two-thirds of the corresponding numbers in adults. The numbers of neurons (0.7 billion) and microglia (0.2 billion) in the white matter did not increase during the first 3 years of life, but showed large biological variation.
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Affiliation(s)
- Rasmus Krarup Sigaard
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospitals, Denmark
| | - Majken Kjær
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospitals, Denmark
| | - Bente Pakkenberg
- Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospitals, Denmark
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13
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Jaekel J, Wolke D. Preterm birth and dyscalculia. J Pediatr 2014; 164:1327-32. [PMID: 24630355 DOI: 10.1016/j.jpeds.2014.01.069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/03/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate whether the risk for dyscalculia in preterm children increases the lower the gestational age (GA) and whether small-for-gestational age birth is associated with dyscalculia. STUDY DESIGN A total of 922 children ranging from 23 to 41 weeks' GA were studied as part of a prospective geographically defined longitudinal investigation of neonatal at-risk children in South Germany. At 8 years of age, children's cognitive and mathematic abilities were measured with the Kaufman Assessment Battery for Children and with a standardized mathematics test. Dyscalculia diagnoses were evaluated with discrepancy-based residuals of a linear regression predicting children's math scores by IQ and with fixed cut-off scores. We investigated each GA group's ORs for general cognitive impairment, general mathematic impairment, and dyscalculia by using binary logistic regressions. RESULTS The risk for general cognitive and mathematic impairment increased with lower GA. In contrast, preterm children were not at increased risk of dyscalculia after statistically adjusting for child sex, family socioeconomic status, and small-for-gestational age birth. CONCLUSION The risk of general cognitive and mathematic impairments increases with lower GA but preterm children are not at increased risk of dyscalculia.
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Affiliation(s)
- Julia Jaekel
- Department of Developmental Psychology, Ruhr-University Bochum, Bochum, Germany; Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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14
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Yerushalmy-Feler A, Marom R, Peylan T, Korn A, Haham A, Mandel D, Yarkoni I, Bassan H. Electroencephalographic characteristics in preterm infants born with intrauterine growth restriction. J Pediatr 2014; 164:756-761.e1. [PMID: 24485822 DOI: 10.1016/j.jpeds.2013.12.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/29/2013] [Accepted: 12/13/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the impact of fetal growth on postnatal amplitude-integrated electroencephalography (aEEG) and power spectrum electroencephalography (EEG) data in preterm infants born with intrauterine growth restriction (IUGR). STUDY DESIGN We defined IUGR as birth weight <10th percentile, and control as birth weight appropriate for gestational age (GA). We performed single-channel (C3-C4) EEG during the first 48 hours of life and measured the upper and lower margins of the aEEG trace width. EEG readings were analyzed by spectral analysis, and the relative power of the frequency bands was calculated. The Lacey Assessment of the Preterm Infant was administered before discharge. RESULTS We enrolled 14 infants with IUGR (mean GA, 34.3 ± 1.8 weeks; mean birth weight 1486 ± 304 g) and 16 appropriate for GA controls (mean GA, 33.7 ± 2 weeks; mean birth weight, 1978 ± 488 g). There were no significant between-group differences in perinatal complications. The mean aEEG trace width was 20.8 ± 1.4 μv in the infants with IUGR versus 17.3 ± 1.6 μv in controls (P < .001). The infants with IUGR also had significantly greater delta frequency activity and decreased theta, alpha, and beta frequency activities compared with controls. Delta frequency activity decreased with increasing GA (r = -0.8; P = .001 for infants with IUGR and r = -0.9; P < .001 for controls). The Lacey Assessment of the Preterm Infant developmental score was significantly lower in the infants with IUGR (P < .02) and was correlated with aEEG trace width (r = -0.6; P = .002) and with delta activity (r = -0.5; P = .02). CONCLUSION Preterm infants with IUGR have delayed EEG maturation associated with delayed neuromotor development. The predictive value of these alterations regarding developmental deficits associated with IUGR remains undetermined, however.
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Affiliation(s)
- Anat Yerushalmy-Feler
- Department of Neonatology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Child Neurology and Development Unit, Department of Pediatric Neurosurgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronella Marom
- Department of Neonatology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Peylan
- Child Neurology and Development Unit, Department of Pediatric Neurosurgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Akiva Korn
- Division of Neurophysiology, Department of Pediatric Neurosurgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Haham
- Department of Neonatology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Inbal Yarkoni
- Department of Neonatology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Bassan
- Child Neurology and Development Unit, Department of Pediatric Neurosurgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Chronic allopurinol treatment during the last trimester of pregnancy in sows: effects on low and normal birth weight offspring. PLoS One 2014; 9:e86396. [PMID: 24466072 PMCID: PMC3899238 DOI: 10.1371/journal.pone.0086396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022] Open
Abstract
Low-birth-weight (LBW) children are born with several risk factors for disease, morbidity and neonatal mortality, even if carried to term. Placental insufficiency leading to hypoxemia and reduced nutritional supply is the main cause for LBW. Brain damage and poor neurological outcome can be the consequence. LBW after being carried to term gives better chances for survival, but these children are still at risk for poor health and the development of cognitive impairments. Preventive therapies are not yet available. We studied the risk/efficacy of chronic prenatal treatment with the anti-oxidative drug allopurinol, as putative preventive treatment in piglets. LBW piglets served as a natural model for LBW. A cognitive holeboard test was applied to study the learning and memory abilities of these allopurinol treated piglets after weaning. Preliminary analysis of the plasma concentrations in sows and their piglets suggested that a daily dose of 15 mg.kg(-1) resulted in effective plasma concentration of allopurinol in piglets. No adverse effects of chronic allopurinol treatment were found on farrowing, birth weight, open field behavior, learning abilities, relative brain, hippocampus and spleen weights. LBW piglets showed increased anxiety levels in an open field test, but cognitive performance was not affected by allopurinol treatment. LBW animals treated with allopurinol showed the largest postnatal compensatory body weight gain. In contrast to a previous study, no differences in learning abilities were found between LBW and normal-birth-weight piglets. This discrepancy might be attributable to experimental differences. Our results indicate that chronic prenatal allopurinol treatment during the third trimester of pregnancy is safe, as no adverse side effects were observed. Compensatory weight gain of treated piglets is a positive indication for the chronic prenatal use of allopurinol in these animals. Further studies are needed to assess the possible preventive effects of allopurinol on brain functions in LBW piglets.
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Prickaerts J, Gieling ET, Bruder AK, Staay FJ, Vanmierlo T. Long‐term effects of prenatal allopurinol treatment on brain plasticity markers in low and normal birth weight piglets. Int J Dev Neurosci 2013; 33:29-32. [DOI: 10.1016/j.ijdevneu.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jos Prickaerts
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNS)Faculty of Health, Medicine and Life ScienceMaastricht UniversityUniversiteitssingel 506229ERMaastrichtThe Netherlands
| | - Elise T. Gieling
- Emotion & Cognition GroupDepartment of Farm Animal Health, Faculty of Veterinary MedicineUniversity UtrechtP.O. Box 80151UtrechtThe Netherlands
- Rudolf Magnus Institute of NeuroscienceUtrecht UniversityUniversiteitsweg 1003584CGUtrechtThe Netherlands
| | - Ann K. Bruder
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNS)Faculty of Health, Medicine and Life ScienceMaastricht UniversityUniversiteitssingel 506229ERMaastrichtThe Netherlands
| | - Franz J. Staay
- Emotion & Cognition GroupDepartment of Farm Animal Health, Faculty of Veterinary MedicineUniversity UtrechtP.O. Box 80151UtrechtThe Netherlands
- Rudolf Magnus Institute of NeuroscienceUtrecht UniversityUniversiteitsweg 1003584CGUtrechtThe Netherlands
| | - Tim Vanmierlo
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNS)Faculty of Health, Medicine and Life ScienceMaastricht UniversityUniversiteitssingel 506229ERMaastrichtThe Netherlands
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Abstract
Two translational studies--one in humans and one in sheep--suggest that (i) premature birth is associated with delayed maturation of grey matter in the cerebral cortex and (ii) medical care that prohibits impairment of growth in premature neonates may enhance cortical development and reduce neurological disabilities associated with preterm birth.
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Affiliation(s)
- Zoltán Molnár
- Department of Physiology, Anatomy and Genetics, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK.
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18
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Vinall J, Grunau RE, Brant R, Chau V, Poskitt KJ, Synnes AR, Miller SP. Slower postnatal growth is associated with delayed cerebral cortical maturation in preterm newborns. Sci Transl Med 2013; 5:168ra8. [PMID: 23325801 DOI: 10.1126/scitranslmed.3004666] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Slower postnatal growth is an important predictor of adverse neurodevelopmental outcomes in infants born preterm. However, the relationship between postnatal growth and cortical development remains largely unknown. Therefore, we examined the association between neonatal growth and diffusion tensor imaging measures of microstructural cortical development in infants born very preterm. Participants were 95 neonates born between 24 and 32 weeks gestational age studied twice with diffusion tensor imaging: scan 1 at a median of 32.1 weeks (interquartile range, 30.4 to 33.6) and scan 2 at a median of 40.3 weeks (interquartile range, 38.7 to 42.7). Fractional anisotropy and eigenvalues were recorded from 15 anatomically defined cortical regions. Weight, head circumference, and length were recorded at birth and at the time of each scan. Growth between scans was examined in relation to diffusion tensor imaging measures at scans 1 and 2, accounting for gestational age, birth weight, sex, postmenstrual age, known brain injury (white matter injury, intraventricular hemorrhage, and cerebellar hemorrhage), and neonatal illness (patent ductus arteriosus, days intubated, infection, and necrotizing enterocolitis). Impaired weight, length, and head growth were associated with delayed microstructural development of the cortical gray matter (fractional anisotropy: P < 0.001), but not white matter (fractional anisotropy: P = 0.529), after accounting for prenatal growth, neonatal illness, and brain injury. Avoiding growth impairment during neonatal care may allow cortical development to proceed optimally and, ultimately, may provide an opportunity to reduce neurological disabilities related to preterm birth.
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Affiliation(s)
- Jillian Vinall
- Neuroscience, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
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19
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Boersma M, de Bie HMA, Oostrom KJ, van Dijk BW, Hillebrand A, van Wijk BCM, Delemarre-van de Waal HA, Stam CJ. Resting-State Oscillatory Activity in Children Born Small for Gestational Age: An MEG Study. Front Hum Neurosci 2013; 7:600. [PMID: 24068993 PMCID: PMC3781344 DOI: 10.3389/fnhum.2013.00600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 09/04/2013] [Indexed: 02/03/2023] Open
Abstract
Growth restriction in utero during a period that is critical for normal growth of the brain, has previously been associated with deviations in cognitive abilities and brain anatomical and functional changes. We measured magnetoencephalography (MEG) in 4- to 7-year-old children to test if children born small for gestational age (SGA) show deviations in resting-state brain oscillatory activity. Children born SGA with postnatally spontaneous catch-up growth [SGA+; six boys, seven girls; mean age 6.3 year (SD = 0.9)] and children born appropriate for gestational age [AGA; seven boys, three girls; mean age 6.0 year (SD = 1.2)] participated in a resting-state MEG study. We calculated absolute and relative power spectra and used non-parametric statistics to test for group differences. SGA+ and AGA born children showed no significant differences in absolute and relative power except for reduced absolute gamma band power in SGA children. At the time of MEG investigation, SGA+ children showed significantly lower head circumference (HC) and a trend toward lower IQ, however there was no association of HC or IQ with absolute or relative power. Except for reduced absolute gamma band power, our findings suggest normal brain activity patterns at school age in a group of children born SGA in which spontaneous catch-up growth of bodily length after birth occurred. Although previous findings suggest that being born SGA alters brain oscillatory activity early in neonatal life, we show that these neonatal alterations do not persist at early school age when spontaneous postnatal catch-up growth occurs after birth.
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Affiliation(s)
- Maria Boersma
- Department of Clinical Neurophysiology, VU University Medical Center , Amsterdam , Netherlands ; Neuroscience Campus Amsterdam , Amsterdam , Netherlands
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20
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Jaekel J, Baumann N, Wolke D. Effects of gestational age at birth on cognitive performance: a function of cognitive workload demands. PLoS One 2013; 8:e65219. [PMID: 23717694 PMCID: PMC3663809 DOI: 10.1371/journal.pone.0065219] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/24/2013] [Indexed: 12/02/2022] Open
Abstract
Objective Cognitive deficits have been inconsistently described for late or moderately preterm children but are consistently found in very preterm children. This study investigates the association between cognitive workload demands of tasks and cognitive performance in relation to gestational age at birth. Methods Data were collected as part of a prospective geographically defined whole-population study of neonatal at-risk children in Southern Bavaria. At 8;5 years, n = 1326 children (gestation range: 23–41 weeks) were assessed with the K-ABC and a Mathematics Test. Results Cognitive scores of preterm children decreased as cognitive workload demands of tasks increased. The relationship between gestation and task workload was curvilinear and more pronounced the higher the cognitive workload: GA2 (quadratic term) on low cognitive workload: R2 = .02, p<0.001; moderate cognitive workload: R2 = .09, p<0.001; and high cognitive workload tasks: R2 = .14, p<0.001. Specifically, disproportionally lower scores were found for very (<32 weeks gestation) and moderately (32–33 weeks gestation) preterm children the higher the cognitive workload of the tasks. Early biological factors such as gestation and neonatal complications explained more of the variance in high (12.5%) compared with moderate (8.1%) and low cognitive workload tasks (1.7%). Conclusions The cognitive workload model may help to explain variations of findings on the relationship of gestational age with cognitive performance in the literature. The findings have implications for routine cognitive follow-up, educational intervention, and basic research into neuro-plasticity and brain reorganization after preterm birth.
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Affiliation(s)
- Julia Jaekel
- Department of Developmental Psychology, Ruhr-University Bochum, Bochum, Germany
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- * E-mail:
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21
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Jaekel J, Wolke D, Bartmann P. Poor attention rather than hyperactivity/impulsivity predicts academic achievement in very preterm and full-term adolescents. Psychol Med 2013; 43:183-196. [PMID: 22608065 DOI: 10.1017/s0033291712001031] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Very preterm (VP) children are at particular risk for attention deficit/hyperactivity disorder (ADHD) of the inattentive subtype. It is unknown whether the neurodevelopmental pathways to academic underachievement are the same as in the general population. This study investigated whether middle childhood attention or hyperactivity/impulsivity problems are better predictors of VP adolescents' academic achievement. METHOD In a geographically defined prospective whole-population sample of VP (<32 weeks gestation) and/or very low birth weight (<1500 g birth weight) (VLBW/VP; n = 281) and full-term control children (n = 286) in South Germany, ADHD subtypes were assessed at 6 years 3 months and 8 years 5 months using multiple data sources. Academic achievement was assessed at 13 years of age. RESULTS Compared with full-term controls, VLBW/VP children were at higher risk for ADHD inattentive subtype [6 years 3 months: odds ratio (OR) 2.8, p < 0.001; 8 years 5 months: OR 1.7, p = 0.020] but not for ADHD hyperactive-impulsive subtype (6 years 3 months: OR 1.4, p = 0.396; 8 years 5 months: OR 0.9, p = 0.820). Childhood attention measures predicted academic achievement in VLBW/VP and also full-term adolescents, whereas hyperactive/impulsive behaviour did not. CONCLUSIONS Attention is an important prerequisite for learning and predicts long-term academic underachievement. As ADHD inattentive subtype and cognitive impairments are frequent in VLBW/VP children, their study may help to identify the neurofunctional pathways from early brain development and dysfunction to attention problems and academic underachievement.
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Affiliation(s)
- J Jaekel
- Institute of Neonatology, University Hospital Bonn, Bonn, Germany
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22
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Hall J, Jaekel J, Wolke D. Gender distinctive impacts of prematurity and small for gestational age (SGA) on age-6 attention problems. Child Adolesc Ment Health 2012; 17:238-245. [PMID: 32847280 DOI: 10.1111/j.1475-3588.2012.00649.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Predictors of attention problems remain uncertain. Here we distinguish prematurity from small (birth weight) for gestational age (SGA). METHOD A total of 1437 children were studied between 0 and 6 years. Gender differences and indirect perinatal effects (via 20-month head circumference and cognition) were considered for age 6 attention problems. RESULTS Boys, preterms, and SGA children were all at increased risk for attention problems. Indirect perinatal effects differed between boys and girls. CONCLUSIONS The routes leading to attention problems seem to differ for SGA and preterm children. SGA appears to reduce brain volume while prematurity alters brain function. Although less frequent, female attention problems are more strongly predicted by prematurity and cognitive dysfunction.
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Affiliation(s)
- James Hall
- Department of Psychology, University of Warwick, UK.,Department of Education, University of Oxford, UK
| | - Julia Jaekel
- Department of Psychology, University of Warwick, UK.,Institute of Neonatology, University Hospital Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, UK.,Division of Mental Health and Wellbeing, University of Warwick Medical School, UK
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23
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Sotiriadis A, Dimitrakopoulos I, Eleftheriades M, Agorastos T, Makrydimas G. Thalamic volume measurement in normal fetuses using three-dimensional sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:207-213. [PMID: 22286969 DOI: 10.1002/jcu.21888] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 12/14/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE Brain thalami are important for a wide range of sensorimotor and neuropsychiatric functions. This study was carried out to calculate normative values for thalami volume during fetal life. METHODS Fetal thalami volumes were measured using 3D ultrasound in 122 normal, singleton fetuses at 20(+0) -34(+6) weeks' gestation. Virtual Organ Computer-aided AnaLysis (VOCAL) was used to obtain a sequence of six sections of each thalamus, starting from the transthalamic view of the brain at an axial plane. Thalamic contour was drawn manually. Volume contrast imaging was used to enhance image quality when needed. The volume of the thalamus distal to the transducer was also measured by a second operator in 30 randomly selected cases, blind to the measurements of the first, to calculate interobserver agreement. RESULTS Thalamic volume increased with gestational age, following a quadratic equation (R(2) = 0.83). There was no significant difference in volume between the right and left thalamus. The mean volume of each thalamus increased from 0.45 ml at 20(+0) weeks, to 1.39 ml at 28(+0) weeks, to 2.17 ml at 34(+0) weeks. The 95% limits of interobserver agreement for thalamic volume were -14.3% to +17.2%. CONCLUSIONS The increase in thalamic volume with gestation can be described adequately by a quadratic equation. The moderate interobserver repeatability is attributed to the similar echogenicity between the thalamus and its surrounding structures.
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Affiliation(s)
- Alexandros Sotiriadis
- Fourth Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateion Hospital, 49 Konstantinoupoleos Street, Thessaloniki, Greece
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24
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Kurjak A, Predojevic M, Stanojevic M, Kadic AS, Miskovic B, Badreldeen A, Talic A, Zaputovic S, Honemeyer U. Intrauterine growth restriction and cerebral palsy. Acta Inform Med 2012; 18:64-82. [PMID: 25473145 PMCID: PMC4232345 DOI: 10.5455/aim.2010.18.64-82] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/30/2010] [Indexed: 11/26/2022] Open
Abstract
Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.
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Affiliation(s)
- Asim Kurjak
- Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia ; Feto Maternal Medicine Unit, Women'S Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maja Predojevic
- Department Of Physiology, Medical School, University Of Zagreb, Zagreb, Croatia
| | - Milan Stanojevic
- Division Of Neonatology, Department Of Obstetrics And Gynecology, Clinical Hospital "Sv. Duh", Zagreb, Croatia
| | - Aida Salihagic- Kadic
- Department Of Physiology, Medical School, University Of Zagreb, Zagreb, Croatia ; Croatian Institute For Brain Research, Medical School, University Of Zagreb, Zagreb, Croatia
| | - Berivoj Miskovic
- Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia
| | - Ahmed Badreldeen
- Feto Maternal Medicine Unit, Women'S Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amira Talic
- University Of Medical Sciences And Technology, Khartoum, Sudan
| | - Sanja Zaputovic
- Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia
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25
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De Bie HMA, Oostrom KJ, Boersma M, Veltman DJ, Barkhof F, Delemarre-van de Waal HA, van den Heuvel MP. Global and regional differences in brain anatomy of young children born small for gestational age. PLoS One 2011; 6:e24116. [PMID: 21931650 PMCID: PMC3172224 DOI: 10.1371/journal.pone.0024116] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/01/2011] [Indexed: 12/12/2022] Open
Abstract
In children who are born small for gestational age (SGA), an adverse intrauterine environment has led to underdevelopment of both the body and the brain. The delay in body growth is (partially) restored during the first two years in a majority of these children. In addition to a negative influence on these physical parameters, decreased levels of intelligence and cognitive impairments have been described in children born SGA. In this study, we used magnetic resonance imaging to examine brain anatomy in 4- to 7-year-old SGA children with and without complete bodily catch-up growth and compared them to healthy children born appropriate for gestational age. Our findings demonstrate that these children strongly differ on brain organisation when compared with healthy controls relating to both global and regional anatomical differences. Children born SGA displayed reduced cerebral and cerebellar grey and white matter volumes, smaller volumes of subcortical structures and reduced cortical surface area. Regional differences in prefrontal cortical thickness suggest a different development of the cerebral cortex. SGA children with bodily catch-up growth constitute an intermediate between those children without catch-up growth and healthy controls. Therefore, bodily catch-up growth in children born SGA does not implicate full catch-up growth of the brain.
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Affiliation(s)
- Henrica M A De Bie
- Department of Pediatrics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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26
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Lodygensky GA, Vasung L, Sizonenko SV, Hüppi PS. Neuroimaging of cortical development and brain connectivity in human newborns and animal models. J Anat 2011; 217:418-28. [PMID: 20979587 DOI: 10.1111/j.1469-7580.2010.01280.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Significant human brain growth occurs during the third trimester, with a doubling of whole brain volume and a fourfold increase of cortical gray matter volume. This is also the time period during which cortical folding and gyrification take place. Conditions such as intrauterine growth restriction, prematurity and cerebral white matter injury have been shown to affect brain growth including specific structures such as the hippocampus, with subsequent potentially permanent functional consequences. The use of 3D magnetic resonance imaging (MRI) and dedicated postprocessing tools to measure brain tissue volumes (cerebral cortical gray matter, white matter), surface and sulcation index can elucidate phenotypes associated with early behavior development. The use of diffusion tensor imaging can further help in assessing microstructural changes within the cerebral white matter and the establishment of brain connectivity. Finally, the use of functional MRI and resting-state functional MRI connectivity allows exploration of the impact of adverse conditions on functional brain connectivity in vivo. Results from studies using these methods have for the first time illustrated the structural impact of antenatal conditions and neonatal intensive care on the functional brain deficits observed after premature birth. In order to study the pathophysiology of these adverse conditions, MRI has also been used in conjunction with histology in animal models of injury in the immature brain. Understanding the histological substrate of brain injury seen on MRI provides new insights into the immature brain, mechanisms of injury and their imaging phenotype.
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Kazemi K, Moghaddam HA, Grebe R, Gondry-Jouet C, Wallois F. Design and construction of a brain phantom to simulate neonatal MR images. Comput Med Imaging Graph 2010; 35:237-50. [PMID: 21146956 DOI: 10.1016/j.compmedimag.2010.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 08/25/2010] [Accepted: 11/11/2010] [Indexed: 11/17/2022]
Abstract
This paper presents the design and construction of a 3D digital neonatal neurocranial phantom and its application for the simulation of brain magnetic resonance (MR) images. Commonly used digital brain phantoms (e.g. BrainWeb) are based on the adult brain. With the growing interest in computer-aided methods for neonatal MR image processing, there is a growing demand a digital phantom and brain MR image simulator especially for the neonatal brains. This is due to the pronounced differences between adult and neonatal brains not only in terms of size but also, more importantly, in terms of geometrical proportions and the need to subdivide white matter into two different tissue types in neonates. Therefore the neonatal brain phantom created in the here presented work consists of 9 different tissue types: skin, fat, muscle, skull, dura mater, gray matter, myelinated white matter, nonmyelinated white matter and cerebrospinal fluid. Each voxel has a vector consisting of 9 components, one for each of these nine tissue types. This digital phantom can be used to map simulated magnetic resonance signal intensities resulting in simulated MR images of the newborns head. These images with controlled degradation of the image data present a representative, reproducible data set ideal for development and evaluation of neonatal MRI analysis methods, e.g. segmentation and registration algorithms.
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Affiliation(s)
- Kamran Kazemi
- Department of Electrical and Electronics Engineering, Shiraz University of Technology, Shiraz, Iran
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Bertoni M, Sclavi N. Isovoxel-Based Morphology of Hippocampi and Amygdalae: A Comparison of Manual and Automated Volume Measurements. Neuroradiol J 2010; 23:711-7. [DOI: 10.1177/197140091002300612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 11/05/2010] [Indexed: 11/15/2022] Open
Affiliation(s)
- M.A. Bertoni
- East Kent Hospitals University NHS Foundation Trust and University of Kent; Ashford, United Kingdom
| | - N.E. Sclavi
- East Kent Hospitals University NHS Foundation Trust and University of Kent; Ashford, United Kingdom
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Bassan H, Kidron D, Bassan M, Rotstein M, Kariv N, Giladi E, Davidson A, Gozes I, Harel S. The effects of vascular intrauterine growth retardation on cortical astrocytes. J Matern Fetal Neonatal Med 2010. [DOI: 10.3109/14767050903197068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Modeling brain tissue volumes over the lifespan: quantitative analysis of postmortem weights and in vivo MR images. Magn Reson Imaging 2010; 28:716-20. [PMID: 20233647 DOI: 10.1016/j.mri.2010.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 01/05/2010] [Indexed: 11/22/2022]
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Halliday HL. Neonatal management and long-term sequelae. Best Pract Res Clin Obstet Gynaecol 2009; 23:871-80. [PMID: 19632899 DOI: 10.1016/j.bpobgyn.2009.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 03/26/2009] [Indexed: 01/21/2023]
Abstract
Intrauterine or fetal growth restriction is best defined by using customised birth weight percentiles based upon the growth potential for an individual infant. Growth restriction in utero may be classified as asymmetric or symmetric depending upon the duration of the process. Asymmetric growth restriction is caused by placental insufficiency, maternal hypertensive conditions, long-standing maternal diabetes, smoking, living at altitude or multiple gestation. Symmetric growth restriction may be due to congenital infections, chromosomal or other abnormalities, fetal alcohol syndrome, low socioeconomic status or be constitutional. The underlying cause of growth restriction often predicts the potential adverse effects on the foetus and newborn and later effects in childhood and adulthood. With placental insufficiency, there may be chronic or acute on chronic fetal hypoxia with birth asphyxia and hypothermia, neonatal hypoglycaemia, polycythaemia and coagulopathy. Management is directed at prevention or early treatment of these conditions. In contrast, symmetrically growth-restricted infants should be examined carefully to look for congenital infections and malformations that may need specific interventions. Infants with constitutional short stature generally do not need any specific management. Feeding of growth-restricted infants is important to overcome deficiencies incurred in utero. Most infants show catch-up growth although about 10% do not. Those with excessive catch-up growth may be at greatest risk of developing insulin resistance in adulthood leading to diabetes, obesity and heart disease. The so-called fetal origins of disease may actually have a postnatal onset related more to excessive weight gain in infancy. There is still controversy over the indications for growth hormone treatment in growth-restricted infants who remain of short stature in early childhood. Intrauterine growth restriction is also associated with a five- to seven-fold increased risk of cerebral palsy probably due to chronic placental insufficiency.
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Affiliation(s)
- Henry L Halliday
- Perinatal Medicine, Royal Maternity Hospital, and Department of Child Health, Queen's University Belfast, Belfast, Northern Ireland.
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Fattal-Valevski A, Toledano-Alhadef H, Leitner Y, Geva R, Eshel R, Harel S. Growth patterns in children with intrauterine growth retardation and their correlation to neurocognitive development. J Child Neurol 2009; 24:846-51. [PMID: 19617460 DOI: 10.1177/0883073808331082] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relationship between somatic growth and neurocognitive outcome was studied in a cohort of 136 children with intrauterine growth retardation. The children were followed up from birth to 9 to 10 years of age by annual measurements of growth parameters, neurodevelopmental evaluations, and IQ. The rate of catch-up for height between 1 and 2 years of age was significantly higher than the catch-up for weight (P < .001). The cognitive outcome at 9 to 10 years correlated with head circumference at all ages. The neurodevelopmental outcome at 9 to 10 years correlated with weight at all ages. Correlation with head circumference was more significant with IQ, while with weight it was stronger with the neurodevelopmental score. Height at 1 year was a significant predictor for IQ and neurodevelopmental outcome at 9 to 10 years. These findings are of distinct importance for prediction of subsequent neurodevelopmental outcome in children with intrauterine growth retardation.
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Affiliation(s)
- Aviva Fattal-Valevski
- Institute for Child Development and Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Pitcher JB, Robertson AL, Cockington RA, Moore VM. Prenatal growth and early postnatal influences on adult motor cortical excitability. Pediatrics 2009; 124:e128-36. [PMID: 19564259 DOI: 10.1542/peds.2008-1638] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Suboptimal prenatal growth may adversely influence motor neurophysiologic development and predispose the individual to greater risk of neurodegenerative disorders in later life. We investigated the influences of prenatal growth and the postnatal environment on motor cortical function in young adults. METHODS Transcranial magnetic stimulation was used to construct corticospinal stimulus-response curves for 35 young adults (mean age: 28 +/- 0.5 years; 19 males) born >or=37 weeks' gestation. Birth weight centile was calculated relative to maternal size, parity, ethnicity, gender, and gestation. Handgrip strength and dexterity were measured separately. Regression analyses assessed the influence of prenatal (birth weight centile and gestation) and postnatal (socioeconomic indices and maternal education) factors on corticospinal parameters, strength, and dexterity scores. RESULTS Lower birth weight was associated with increased interhemispheric asymmetry in motor threshold and increased cortical stimulus-response curve slope. A shorter gestation predicted a larger area under this curve in the right hand. High motor threshold was predicted by greater environmental adversity in early postnatal life, but not by prenatal factors. Higher birth weight centile and lower motor threshold were associated with greater educational achievement. CONCLUSIONS Poor in utero growth and mild prematurity are associated with altered corticospinal excitability in adulthood. An early postnatal environment with less early postnatal socioeconomic disadvantage and having a mother with a completed high school education partly ameliorates this. While altered cortical development has some functional consequences already evident in early adulthood, it may have a later, additional adverse impact on aging-related changes in motor function.
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Affiliation(s)
- Julia B Pitcher
- School of Paediatrics and Reproductive Health, Research Centre for the Early Origins of Health and Disease, University of Adelaide, Adelaide, Australia.
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Pickett KE, Rathouz PJ, Dukic V, Kasza K, Niessner M, Wright RJ, Wakschlag LS. The complex enterprise of modelling prenatal exposure to cigarettes: what is 'enough'? Paediatr Perinat Epidemiol 2009; 23:160-70. [PMID: 19159402 PMCID: PMC10087299 DOI: 10.1111/j.1365-3016.2008.01010.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
While there is a burgeoning body of research linking smoking during pregnancy to problem behaviour in offspring, a major criticism of this work has been the crude measurement of exposure in these studies (e.g. retrospective, self-reported only) that could lead to biased estimates. To address this issue, we used a pregnancy cohort with repeated prospective measures of exposure as well as biological assays to generate estimates of exposure patterns using a range of modelling techniques. In this paper we report on the analytical approaches we have developed, including patterns of exposure over time and best-estimate approaches that combine self-report and cotinine measures, and compare their predictive value in relation to different dimensions of fetal growth as a first step towards examining the utility of greater precision of exposure measurement. Surprisingly, in this sample the more complex assessments of exposure, including biological measures, generally did not perform better than simple indicators of exposure based on repeated self-report measures, with one exception: a combined self-report cotinine 'best estimate' of third trimester exposure was uniquely associated with lower brain : body ratio. Further study is needed using more sophisticated cotinine assays and testing prediction of a range of outcomes to ascertain whether these findings represent true differences or are specific to the sample, methods and outcomes used. Such research will inform the development of guidelines for adequate exposure characterisation in developmental studies.
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Affiliation(s)
- Kate E Pickett
- Department of Health Sciences, University of York, Heslington, York, UK.
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Schober ME, McKnight RA, Yu X, Callaway CW, Ke X, Lane RH. Intrauterine growth restriction due to uteroplacental insufficiency decreased white matter and altered NMDAR subunit composition in juvenile rat hippocampi. Am J Physiol Regul Integr Comp Physiol 2009; 296:R681-92. [DOI: 10.1152/ajpregu.90396.2008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Uteroplacental insufficiency (UPI), the major cause of intrauterine growth restriction (IUGR) in developed nations, predisposes to learning impairment. The underlying mechanism is unknown. Neuronal N-methyl-d-aspartate receptors (NMDARs) are critical for synaptogenesis and learning throughout life. We hypothesized that UPI-induced IUGR alters rat hippocampal NMDAR NR2A/NR2B subunit ratio and/or NR1 mRNA isoform expression and synaptic density at day 21 (P21). To test this hypothesis, IUGR was induced by bilateral uterine artery ligation of the late-gestation Sprague-Dawley dam. At P21, hippocampal NMDAR subunit mRNA and protein were measured, as were levels of synaptophysin. Neuronal, synaptic, and glial density in CA1, CA3, and dentate gyrus (DG) was assessed by immunofluorescence. IUGR increased NR1 mRNA isoform NR1-3a and 1-3b expression in both sexes. In P21 males, IUGR increased protein levels of NR1 C2′ and decreased NR1 C2, NR2A, and the NR2A-to-NR2B ratio, whereas in females, IUGR increased NR2B protein. In males, IUGR was associated with decreased myelin basic protein-to-neuronal nuclei ratio in CA1, CA3, and DG. We conclude that IUGR has sex-specific effects and that neither neuronal loss nor decreased synaptic density appears to account for the changes in NMDAR subunits. Rather, it is possible that synaptic NMDAR subunit composition is altered. Our results suggest that apparent recovery in the IUGR hippocampus may be associated with synaptic hyperexcitability. We speculate that the NMDAR plays an important role in IUGR-associated cognitive impairment.
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Animal models of perinatal hypoxic-ischemic brain damage. Pediatr Neurol 2009; 40:156-67. [PMID: 19218028 DOI: 10.1016/j.pediatrneurol.2008.10.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 10/02/2008] [Accepted: 10/06/2008] [Indexed: 12/22/2022]
Abstract
Animal models are often presumably the first step in determining mechanisms underlying disease, and the approach and effectiveness of therapeutic interventions. Perinatal brain damage, however, evolves over months of gestation, during the rapid maturation of the fetal and newborn brain. Despite marked advances in our understanding of these processes and technologic advances providing an improved window on the timing and duration of injury, neonatal brain injury remains a "moving target" regarding our ability to "mimic" its processes in an animal model. Moreover, interfering with normal processes of development as part of a therapeutic intervention may do "more harm than good." Hence, controversy continues over which animal model can reflect human disease states. Numerous models have provided information regarding the pathophysiology of brain damage in term and preterm infants. Our challenges consist of identifying infants at greatest risk for permanent injury, identifying the timing of injury, and adapting therapies that provide more benefit than harm. A combination of appropriately suitable animal models to conduct these studies will bring us closer to understanding human perinatal damage and the means to treat it.
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Jacobsson B, Ahlin K, Francis A, Hagberg G, Hagberg H, Gardosi J. Cerebral palsy and restricted growth status at birth: population-based case-control study. BJOG 2008; 115:1250-5. [PMID: 18715410 DOI: 10.1111/j.1471-0528.2008.01827.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the association between growth status at birth and subsequent development of cerebral palsy in preterm and term infants. DESIGN Population-based case-controlled study. SETTING Cerebral palsy register in Western Sweden. Subjects Cohort of 334 singletons born between 1983 and 1990, with cerebral palsy diagnosed from age 4, and 668 singletons matched for gestation, gender and delivery unit. METHOD Growth status at birth was determined using small for gestational age (SGA) categories, with customised birthweight percentiles (SGAcust) based on the Swedish population. MAIN OUTCOME MEASURES Proportion of babies that were SGAcust, comparing cases and controls in three gestational age categories: early preterm (24-33 weeks), late preterm (34-36 weeks) and term (37+ weeks). RESULTS Of the 334 children with cerebral palsy, 87 (26.6%) were born early preterm, 27 (8.1%) late preterm and 218 (66%) at term. Children who had been born at term were more likely to have been SGA <1st customised percentile (SGAcust1) than their matched controls (OR 6.6, 95% CI 2.3-18.6). In contrast, children with cerebral palsy born preterm were not more likely to have been SGAcust1 (OR 0.9, 95% CI 0.4-1.9), and this applied to early preterm as well as late preterm births. For less severely small babies (SGA between 1st and 5th customised percentiles), the association with cerebral palsy remained significant for term births (OR 5.2, 95% CI 2.7-10.1) but was again not significant for preterm births. CONCLUSIONS Term singletons with severely SGA birthweights had a five- to seven-fold risk of developing cerebral palsy compared with gestational age-matched infants with birthweights within normal limits. For children born preterm, SGA was not more likely to be present in cases than in controls. These findings support the concept of cerebral palsy as a multifactorial condition and highlight the importance of antenatal surveillance of fetal growth.
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Affiliation(s)
- B Jacobsson
- Perinatal Center, Department of Obstetrics and Gynaecology, Institute for the Health of Women and Children, Sahlgrenska University Hospital, Sweden
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Affiliation(s)
- Petra S Hüppi
- Department of Pediatrics, University of Geneva, Switzerland.
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Anbeek P, Vincken KL, Groenendaal F, Koeman A, van Osch MJP, van der Grond J. Probabilistic brain tissue segmentation in neonatal magnetic resonance imaging. Pediatr Res 2008; 63:158-63. [PMID: 18091357 DOI: 10.1203/pdr.0b013e31815ed071] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A fully automated method has been developed for segmentation of four different structures in the neonatal brain: white matter (WM), central gray matter (CEGM), cortical gray matter (COGM), and cerebrospinal fluid (CSF). The segmentation algorithm is based on information from T2-weighted (T2-w) and inversion recovery (IR) scans. The method uses a K nearest neighbor (KNN) classification technique with features derived from spatial information and voxel intensities. Probabilistic segmentations of each tissue type were generated. By applying thresholds on these probability maps, binary segmentations were obtained. These final segmentations were evaluated by comparison with a gold standard. The sensitivity, specificity, and Dice similarity index (SI) were calculated for quantitative validation of the results. High sensitivity and specificity with respect to the gold standard were reached: sensitivity >0.82 and specificity >0.9 for all tissue types. Tissue volumes were calculated from the binary and probabilistic segmentations. The probabilistic segmentation volumes of all tissue types accurately estimated the gold standard volumes. The KNN approach offers valuable ways for neonatal brain segmentation. The probabilistic outcomes provide a useful tool for accurate volume measurements. The described method is based on routine diagnostic magnetic resonance imaging (MRI) and is suitable for large population studies.
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Affiliation(s)
- Petronella Anbeek
- Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
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Williams LA, DeVito TJ, Winter JD, Orr TN, Thompson RT, Gelman N. Optimization of 3D MP-RAGE for neonatal brain imaging at 3.0 T. Magn Reson Imaging 2007; 25:1162-70. [PMID: 17391887 DOI: 10.1016/j.mri.2007.01.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 01/28/2007] [Accepted: 01/29/2007] [Indexed: 11/29/2022]
Abstract
Three-dimensional (3D) magnetic resonance imaging (MRI) has shown great potential for studying the impact of prematurity and pathology on brain development. We have investigated the potential of optimized T1-weighted 3D magnetization-prepared rapid gradient-echo imaging (MP-RAGE) for obtaining contrast between white matter (WM) and gray matter (GM) in neonates at 3 T. Using numerical simulations, we predicted that the inversion time (TI) for obtaining strongest contrast at 3 T is approximately 2 s for neonates, whereas for adults, this value is approximately 1.3 s. The optimal neonatal TI value was found to be insensitive to reasonable variations of the assumed T1 relaxation times. The maximum theoretical contrast for neonates was found to be approximately one third of that for adults. Using the optimized TI values, MP-RAGE images were obtained from seven neonates and seven adults at 3 T, and the contrast-to-noise ratio (CNR) was measured for WM versus five GM regions. Compared to adults, neonates exhibited lower CNR between cortical GM and WM and showed a different pattern of regional variation in CNR. These results emphasize the importance of sequence optimization specifically for neonates and demonstrate the challenge in obtaining strong contrast in neonatal brain with T1-weighted 3D imaging.
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Affiliation(s)
- Lori-Anne Williams
- Imaging Division, Lawson Health Research Institute, London, ON, Canada N6A 4V2
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Mewes AUJ, Zöllei L, Hüppi PS, Als H, McAnulty GB, Inder TE, Wells WM, Warfield SK. Displacement of brain regions in preterm infants with non-synostotic dolichocephaly investigated by MRI. Neuroimage 2007; 36:1074-85. [PMID: 17513129 PMCID: PMC3358776 DOI: 10.1016/j.neuroimage.2007.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 02/26/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022] Open
Abstract
Regional investigations of newborn MRI are important to understand the appearance and consequences of early brain injury. Previously, regionalization in neonates has been achieved with a Talairach parcellation, using internal landmarks of the brain. Non-synostotic dolichocephaly defines a bi-temporal narrowing of the preterm infant's head caused by pressure on the immature skull. The impact of dolichocephaly on brain shape and regional brain shift, which may compromise the validity of the parcellation scheme, has not yet been investigated. Twenty-four preterm and 20 fullterm infants were scanned at term equivalent. Skull shapes were investigated by cephalometric measurements and population registration. Brain tissue volumes were calculated to rule out brain injury underlying skull shape differences. The position of Talairach landmarks was evaluated. Cortical structures were segmented to determine a positional shift between both groups. The preterm group displayed dolichocephalic head shapes and had similar brain volumes compared to the mesocephalic fullterm group. In preterm infants, Talairach landmarks were consistently positioned relative to each other and to the skull base, but were displaced with regard to the calvarium. The frontal and superior region was enlarged; central and temporal gyri and sulci were shifted comparing preterm and fullterm infants. We found that, in healthy preterm infants, dolichocephaly led to a shift of cortical structures, but did not influence deep brain structures. We concluded that the validity of a Talairach parcellation scheme is compromised and may lead to a miscalculation of regional brain volumes and inconsistent parcel contents when comparing infant populations with divergent head shapes.
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Affiliation(s)
- Andrea U J Mewes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Lindqvist S, Vik T, Indredavik MS, Brubakk AM. Visual acuity, contrast sensitivity, peripheral vision and refraction in low birthweight teenagers. ACTA ACUST UNITED AC 2007; 85:157-64. [PMID: 17305728 DOI: 10.1111/j.1600-0420.2006.00808.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess visual acuity (VA), contrast sensitivity, visual fields, refractive errors and use of correction in adolescents with very low birthweight (VLBW; birthweight < 1500 g) and adolescents born at term but small for gestational age (SGA; birthweight < 10th percentile) in a population-based study. METHODS Ophthalmological examination including VA, Vistech contrast sensitivity and Humphrey two-zone, 120-point perimetry was performed in 51 VLBW, 59 SGA and 77 control adolescents. RESULTS The VLBW adolescents had reduced VA, reduced contrast sensitivity, and were more often anisometropic compared with control adolescents. They had started wearing glasses earlier, but were not more likely to use correction as teenagers. However, they were more often undercorrected (for refractive status) than control adolescents. Hypermetropia was more common in the SGA group than in the control group, but otherwise the SGA group did not differ from the control group. CONCLUSIONS Being born SGA may be a risk factor for hypermetropia in adolescence. Prematurely born adolescents present lower VA and contrast sensitivity and are more prone to anisometropia than adolescents born at term. It may be noteworthy that a higher proportion of VLBW than control adolescents were undercorrected, despite the well known vulnerability of visual function associated with preterm birth.
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Affiliation(s)
- Susanne Lindqvist
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
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Mewes AUJ, Hüppi PS, Als H, Rybicki FJ, Inder TE, McAnulty GB, Mulkern RV, Robertson RL, Rivkin MJ, Warfield SK. Regional brain development in serial magnetic resonance imaging of low-risk preterm infants. Pediatrics 2006; 118:23-33. [PMID: 16818545 DOI: 10.1542/peds.2005-2675] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE MRI studies have shown that preterm infants with brain injury have altered brain tissue volumes. Investigation of preterm infants without brain injury offers the opportunity to define the influence of early birth on brain development and provide normative data to assess effects of adverse conditions on the preterm brain. In this study, we investigated serial MRI of low-risk preterm infants with the aim to identify regions of altered brain development. METHODS Twenty-three preterm infants appropriate for gestational age without magnetic resonance-visible brain injury underwent MRI twice at 32 and at 42 weeks' postmenstrual age. Fifteen term infants were scanned 2 weeks after birth. Brain tissue classification and parcellation were conducted to allow comparison of regional brain tissue volumes. Longitudinal brain growth was assessed from preterm infants' serial scans. RESULTS At 42 weeks' postmenstrual age, gray matter volumes were not different between preterm and term infants. Myelinated white matter was decreased, as were unmyelinated white matter volumes in the region including the central gyri. The gray matter proportion of the brain parenchyma constituted 30% and 37% at 32 and 42 weeks' postmenstrual age, respectively. CONCLUSIONS This MRI study of preterm infants appropriate for gestational age and without brain injury establishes the influence of early birth on brain development. No decreased cortical gray matter volumes were found, which is in contrast to findings in preterm infants with brain injury. Moderately decreased white matter volumes suggest an adverse influence of early birth on white matter development. We identified a sharp increase in cortical gray matter volume in preterm infants' serial data, which may correspond to a critical period for cortical development.
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Affiliation(s)
- Andrea U J Mewes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115, USA.
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Williams LA, Gelman N, Picot PA, Lee DS, Ewing JR, Han VK, Thompson RT. Neonatal Brain: Regional Variability of in Vivo MR Imaging Relaxation Rates at 3.0 T—Initial Experience. Radiology 2005; 235:595-603. [PMID: 15858099 DOI: 10.1148/radiol.2352031769] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively investigate regional in vivo magnetic resonance (MR) imaging transverse and longitudinal relaxation rates at 3.0 T in neonatal brain, the relationship between these rates, and their potential use for gray matter (GM) versus white matter (WM) tissue discrimination. MATERIALS AND METHODS Informed parental consent for performance of imaging procedures was obtained in each infant. Informed consent for retrospective image analysis was not required; ethics approval was obtained from institutional review board. At 3.0 T, R1 and R2 were measured in brain regions (frontal WM, posterior WM, periventricular WM, frontal GM, posterior GM, basal ganglia, and thalamus) in 13 infants with suspected neurologic abnormality (two term, 11 preterm). Maps of R1 and R2 were acquired with T1 by multiple readout pulses and segmented spin-echo echo-planar imaging sequences, respectively. Accuracy of R1 and R2 map acquisition methods was tested in phantoms by comparing them with inversion-recovery and spin-echo sequences, respectively. Statistical analysis included linear regression analysis to determine relationship between R1 and R2 and Wilcoxon signed rank test to investigate the potential for discrimination between GM and WM. RESULTS In phantoms, R1 values measured with T1 by multiple readout pulses sequence were 3%-8% lower than those measured with inversion recovery sequence, and R2 values measured with segmented echo-planar sequence were 1%-8% lower than those measured with spin-echo sequence. A strong correlation of 0.944 (P < .001) between R1 and R2 in neonatal brain was observed. For R2, relative differences between GM and WM were larger than were those for R1 (z = -2.366, P < .05). For frontal GM and frontal WM, (R2(GM) - R2(WM))/R2(WM) yielded 0.8 +/- 0.2 (mean +/- standard deviation) and (R1(GM) - R1(WM))/R1(WM) yielded 0.3 +/- 0.09. CONCLUSION Results at 3.0 T indicate that R1 decreases with increasing field strength, while R2 values are similar to those reported at lower field strengths. For neonates, R2 image contrast may be more advantageous than R1 image contrast for differentiation between GM and WM.
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Affiliation(s)
- Lori-Anne Williams
- Imaging Division, Lawson Health Research Institute, London, Ontario, Canada.
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Ley D, Marsal K, Dahlgren J, Hellstrom A. Abnormal retinal optic nerve morphology in young adults after intrauterine growth restriction. Pediatr Res 2004; 56:139-43. [PMID: 15128920 DOI: 10.1203/01.pdr.0000129660.32875.09] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrauterine growth restriction (IUGR) is a recognized risk factor for neurologic deficits later in life. Abnormal fetal blood flow in the presence of fetal growth retardation helps to distinguish true fetal growth impairment from small but normally grown infants. The present study aimed to investigate the influence of IUGR with abnormal fetal blood flow on retinal optic nerve morphology at 18 y of age. A prospective study was performed in 19 subjects with IUGR [abnormal fetal aortic blood flow velocity; median birth weight deviation of -31% (-22 to -42%; median (range)] and in 23 subjects with a normal birth weight for gestational age [normal fetal aortic blood flow velocity; median birth weight deviation of -2% (-10 to 22%)]. All subjects were previously examined concerning minor neurologic dysfunction (MND) at 7 y of age. The ocular fundus was examined by ophthalmoscopy, and the optic nerve morphology was evaluated by digital image analysis. Decrease in neuroretinal rim area at 18 y of age was associated with increasing negative birth weight deviation (r = 0.71, p < 0.0001). The subjects with severe MND at 7 y had a reduced neuroretinal rim area [median (range), 1.57 mm(2) (1.37-1.78 mm(2))] compared with those with less severe MND [1.94 mm(2) (1.33-2.71 mm(2))] and with those with normal neurologic function [2.18 mm(2) (1.75-2.70 mm(2)); p < 0.05 and p < 0.0001, respectively]. A decrease in neuroretinal rim area reflects either a reduction in axonal volume or a decrease in the number of axons in the optic nerve. It is yet unclear whether this finding represents neuronal changes within other cerebral regions in subjects with IUGR.
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Affiliation(s)
- David Ley
- Department of Pediatrics, Lunds University Hospital, 221 85 Lund, Sweden.
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Tolsa CB, Zimine S, Warfield SK, Freschi M, Sancho Rossignol A, Lazeyras F, Hanquinet S, Pfizenmaier M, Huppi PS. Early alteration of structural and functional brain development in premature infants born with intrauterine growth restriction. Pediatr Res 2004; 56:132-8. [PMID: 15128927 DOI: 10.1203/01.pdr.0000128983.54614.7e] [Citation(s) in RCA: 341] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Placental insufficiency with fetal intrauterine growth restriction (IUGR) is an important cause of perinatal mortality and morbidity and is subsequently associated with significant neurodevelopmental impairment in cognitive function, attention capacity, and school performance. The underlying biologic cause for this association is unclear. Twenty-eight preterm infants (gestational age 32.5 +/- 1.9 wk) were studied by early and term magnetic resonance imaging (MRI). An advanced quantitative volumetric three-dimensional MRI technique was used to measure brain tissue volumes in 14 premature infants with placental insufficiency, defined by abnormal antenatal Doppler measurements and mean birth weights <10(th) percentile (1246 +/- 299 g) (IUGR) and in 14 preterm infants matched for gestational age with normal mean birth weights 1843 +/- 246 g (control). Functional outcome was measured at term in all infants by a specialized assessment scale of preterm infant behavior. Premature infants with IUGR had a significant reduction in intracranial volume (mean +/- SD: 253.7 +/- 29.9 versus 300.5 +/- 43.5 mL, p < 0.01) and in cerebral cortical gray matter (mean +/- SD: 77.2 +/- 16.3 versus 106.8 +/- 24.6 mL, p < 0.01) when measured within the first 2 wk of life compared with control premature infants. These findings persisted at term with intracranial volume (mean +/- SD: 429.3 +/- 47.9 versus 475.9 +/- 53.4 mL, p < 0.05) and cerebral cortical gray matter (mean +/- SD: 149.3 +/- 29.2 versus 189 +/- 34.2 mL, p < 0.01). Behavioral assessment at term showed a significantly less mature score in the subsystem of attention-interaction availability in IUGR infants (p < 0.01). Cerebral cortical gray matter volume at term correlated with attention-interaction capacity measured at term (r = 0.45, p < 0.05). These results suggest that placental insufficiency with IUGR have specific structural and functional consequences on cerebral cortical brain development. These findings may provide insight into the structural-functional correlate for the developmental deficits associated with IUGR.
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Abstract
Two of every 1000 live-born children develop cerebral palsy (CP). The aetiology of CP is often unclear and because CP is a symptom complex rather than a disease, clinically defined at 4-5 years of age, it is not surprising that there are considerable problems associated with epidemiological studies of its aetiology. The only reason for the CP concept is that it emanates from an insult to a growing, developing brain and a dynamic clinical picture from static pathology. Evidence suggests that 70-80% of CP cases are due to prenatal factors and that birth asphyxia plays a relatively minor role (<10%). Some antenatal risk factors are repeatedly observed to be related to CP: low gestational age, male gender, multiple gestation, intrauterine viral infections and maternal thyroid abnormalities. Recently, intrauterine infection/inflammation with a maternal response (consisting of chorioamnionitis) and a fetal inflammatory response (consisting of funicitis or elevated interleukin-6 in fetal plasma) has been found to be related to white matter injury and CP. Some risk factors are associated with CP at all gestational ages whereas others mostly affect term or preterm infants, e.g. intrauterine growth restriction seems to be a risk factor in term infants. There also seems to be an association between autoimmune and coagulation disorders and CP.
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Affiliation(s)
- Bo Jacobsson
- Department of Obstetrics and Gynaecology, Institute for the Health of Women and Children, Perinatal Centre, Sahlgrenska University Hospital/East, SE-416 85 Göteborg, Sweden.
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Abstract
Controversy continues over which animal model to use as a reflection of human disease states. With respect to perinatal brain disorders, scientists must contend with a disease in evolution. In that regard, the perinatal brain is at risk during a time of extremely rapid development and maturation, involving processes that are required for normal growth. Interfering with these processes, as part of therapeutic intervention must be efficacious and safe. To date, numerous models have provided tremendous information regarding the pathophysiology of brain damage to term and preterm infants. Our challenges will continue to be in identifying those infants at greatest risk for permanent injury, and adapting therapies that provide more benefit than harm. Using animal models to conduct these studies will bring us closer to that goal.
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Affiliation(s)
- Jerome Y Yager
- Division of Pediatric Neurology, Department of Pediatrics and Child Health, University of Alberta, Edmonton, Alberta, Canada
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Fluctuations of Maternal Smoking During Pregnancy. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200301000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mallard C, Loeliger M, Copolov D, Rees S. Reduced number of neurons in the hippocampus and the cerebellum in the postnatal guinea-pig following intrauterine growth-restriction. Neuroscience 2001; 100:327-33. [PMID: 11008170 DOI: 10.1016/s0306-4522(00)00271-2] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Intrauterine growth restriction is a risk factor for neurological and behavioural deficits in children although the precise underlying biological correlate for this is unclear. The present study shows that animals with intrauterine growth restriction, induced by a period of reduced placental blood flow during the second half of pregnancy, demonstrate reduced numbers of neurons in the hippocampus and the cerebellum in conjunction with retarded dendritic and axonal growth within these structures. Intrauterine growth restriction was induced at 30 days gestational age by unilateral uterine artery ligation in pregnant guinea-pigs. At one week of age, the total number of CA1 pyramidal neurons in the hippocampus and the Purkinje neurons in the cerebellum were determined using the combined fractionator/optical disector technique. The Cavalieri Principle was used to determine the volume of specific regions within the hippocampus and cerebellum. The body weight of animals that were classified as intrauterine growth-restricted was reduced by 42% (n=8) compared with control animals (n=8, P<0.001), while there was a smaller effect on brain weight (16% reduction, P<0.01). Estimates of the total number of neurons showed a reduction in CA1 pyramidal neurons in growth-restricted animals (4.19+/-0.43x10(5)) compared with control (5.20+/-0.44x10(5), P<0.01), and the volume of the stratum oriens layer above the CA1 region, which contains the apical dendrites of the CA1 pyramidal neurons, was reduced by 21% (P<0.01) in growth-restricted animals. In the cerebellum there was a reduction in the number of Purkinje neurons in growth-restricted animals (3.97+/-0.50x10(5)) compared with control (5.13+/-0.52x10(5), P<0.01), and in the volume of the molecular layer (17%, P<0.05), the internal granular layer (22%, P<0.01) and in the volume of the cerebellar white matter (23%, P<0.01). These results show that a period of placental insufficiency during the second half of pregnancy can effect brain development in a way which could lead to neurological and behavioural deficits in the postnatal animal.
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Affiliation(s)
- C Mallard
- Department of Anatomy and Cell Biology, University of Melbourne, VIC 3052, Parkville, Australia.
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