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Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, Pryde P, Wolf HT, Crowther CA. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2024; 5:CD004661. [PMID: 38726883 PMCID: PMC11082932 DOI: 10.1002/14651858.cd004661.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND Magnesium sulphate is a common therapy in perinatal care. Its benefits when given to women at risk of preterm birth for fetal neuroprotection (prevention of cerebral palsy for children) were shown in a 2009 Cochrane review. Internationally, use of magnesium sulphate for preterm cerebral palsy prevention is now recommended practice. As new randomised controlled trials (RCTs) and longer-term follow-up of prior RCTs have since been conducted, this review updates the previously published version. OBJECTIVES To assess the effectiveness and safety of magnesium sulphate as a fetal neuroprotective agent when given to women considered to be at risk of preterm birth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 17 March 2023, as well as reference lists of retrieved studies. SELECTION CRITERIA We included RCTs and cluster-RCTs of women at risk of preterm birth that assessed prenatal magnesium sulphate for fetal neuroprotection compared with placebo or no treatment. All methods of administration (intravenous, intramuscular, and oral) were eligible. We did not include studies where magnesium sulphate was used with the primary aim of preterm labour tocolysis, or the prevention and/or treatment of eclampsia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed RCTs for inclusion, extracted data, and assessed risk of bias and trustworthiness. Dichotomous data were presented as summary risk ratios (RR) with 95% confidence intervals (CI), and continuous data were presented as mean differences with 95% CI. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included six RCTs (5917 women and their 6759 fetuses alive at randomisation). All RCTs were conducted in high-income countries. The RCTs compared magnesium sulphate with placebo in women at risk of preterm birth at less than 34 weeks' gestation; however, treatment regimens and inclusion/exclusion criteria varied. Though the RCTs were at an overall low risk of bias, the certainty of evidence ranged from high to very low, due to concerns regarding study limitations, imprecision, and inconsistency. Primary outcomes for infants/children: Up to two years' corrected age, magnesium sulphate compared with placebo reduced cerebral palsy (RR 0.71, 95% CI 0.57 to 0.89; 6 RCTs, 6107 children; number needed to treat for additional beneficial outcome (NNTB) 60, 95% CI 41 to 158) and death or cerebral palsy (RR 0.87, 95% CI 0.77 to 0.98; 6 RCTs, 6481 children; NNTB 56, 95% CI 32 to 363) (both high-certainty evidence). Magnesium sulphate probably resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.96, 95% CI 0.82 to 1.13; 6 RCTs, 6759 children); major neurodevelopmental disability (RR 1.09, 95% CI 0.83 to 1.44; 1 RCT, 987 children); or death or major neurodevelopmental disability (RR 0.95, 95% CI 0.85 to 1.07; 3 RCTs, 4279 children) (all moderate-certainty evidence). At early school age, magnesium sulphate may have resulted in little to no difference in death (fetal, neonatal, or later) (RR 0.82, 95% CI 0.66 to 1.02; 2 RCTs, 1758 children); cerebral palsy (RR 0.99, 95% CI 0.69 to 1.41; 2 RCTs, 1038 children); death or cerebral palsy (RR 0.90, 95% CI 0.67 to 1.20; 1 RCT, 503 children); and death or major neurodevelopmental disability (RR 0.81, 95% CI 0.59 to 1.12; 1 RCT, 503 children) (all low-certainty evidence). Magnesium sulphate may also have resulted in little to no difference in major neurodevelopmental disability, but the evidence is very uncertain (average RR 0.92, 95% CI 0.53 to 1.62; 2 RCTs, 940 children; very low-certainty evidence). Secondary outcomes for infants/children: Magnesium sulphate probably reduced severe intraventricular haemorrhage (grade 3 or 4) (RR 0.76, 95% CI 0.60 to 0.98; 5 RCTs, 5885 infants; NNTB 92, 95% CI 55 to 1102; moderate-certainty evidence) and may have resulted in little to no difference in chronic lung disease/bronchopulmonary dysplasia (average RR 0.92, 95% CI 0.77 to 1.10; 5 RCTs, 6689 infants; low-certainty evidence). Primary outcomes for women: Magnesium sulphate may have resulted in little or no difference in severe maternal outcomes potentially related to treatment (death, cardiac arrest, respiratory arrest) (RR 0.32, 95% CI 0.01 to 7.92; 4 RCTs, 5300 women; low-certainty evidence). However, magnesium sulphate probably increased maternal adverse effects severe enough to stop treatment (average RR 3.21, 95% CI 1.88 to 5.48; 3 RCTs, 4736 women; moderate-certainty evidence). Secondary outcomes for women: Magnesium sulphate probably resulted in little to no difference in caesarean section (RR 0.96, 95% CI 0.91 to 1.02; 5 RCTs, 5861 women) and postpartum haemorrhage (RR 0.94, 95% CI 0.80 to 1.09; 2 RCTs, 2495 women) (both moderate-certainty evidence). Breastfeeding at hospital discharge and women's views of treatment were not reported. AUTHORS' CONCLUSIONS The currently available evidence indicates that magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus, compared with placebo, reduces cerebral palsy, and death or cerebral palsy, in children up to two years' corrected age, and probably reduces severe intraventricular haemorrhage for infants. Magnesium sulphate may result in little to no difference in outcomes in children at school age. While magnesium sulphate may result in little to no difference in severe maternal outcomes (death, cardiac arrest, respiratory arrest), it probably increases maternal adverse effects severe enough to stop treatment. Further research is needed on the longer-term benefits and harms for children, into adolescence and adulthood. Additional studies to determine variation in effects by characteristics of women treated and magnesium sulphate regimens used, along with the generalisability of findings to low- and middle-income countries, should be considered.
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Affiliation(s)
- Emily S Shepherd
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lex W Doyle
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Stéphane Marret
- INSERM Unit 1245, Team 4, Rouen School of Medicine, Normandy University, Rouen, France
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
| | - Dwight J Rouse
- Women & Infants Hospital of Rhode Island, The Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peter Pryde
- Department of Anesthesiology, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Hanne T Wolf
- Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
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Fuma K, Kotani T, Ushida T, Imai K, Iitani Y, Nakamura N, Miki R, Katsuki S, Kinoshita F, Sato Y, Hayakawa M, Kajiyama H. Antenatal corticosteroids-to-delivery interval associates cord blood S100B levels. J Obstet Gynaecol Res 2023; 49:1129-1136. [PMID: 36759328 DOI: 10.1111/jog.15582] [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: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
AIM Antenatal corticosteroids (ACS) are recommended for women at risk of preterm birth before 34 weeks' gestation. However, adverse effects of ACS on the fetal brain have also been reported. The time interval from ACS administration to delivery (ACS-to-delivery interval) might alter the effect of ACS on the fetal brain. This study aimed to evaluate the effect of ACS-to-delivery interval on cord blood S100 calcium-binding protein B (S100B) levels as a biomarker of brain damage. METHODS Women who delivered between 2012 and 2020 at a tertiary medical center were divided into three groups according to ACS use and ACS-to-delivery interval, retrospectively: non-ACS, ACS ≤7 days, and ACS >7 days. Patients who did not complete the ACS regimen were excluded. The primary outcome was cord blood S100B levels. RESULTS Cord blood S100B levels were significantly lower in the ACS ≤7 days group than in the non-ACS and ACS >7 days groups. In the multiple regression analysis, birth ≤7 days after ACS showed a significant negative association with S100B level (p < 0.001). CONCLUSIONS Reduced S100B levels were observed in infants born ≤7 days after ACS but not in infants born >7 days after ACS. These findings suggest the importance of ACS timing to optimize its effects on the fetal brain, although further studies are required to identify these mechanisms.
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Affiliation(s)
- Kazuya Fuma
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Obstetrics and Gynecology, Anjo Kosei Hospital, Japan
| | - Rika Miki
- Laboratory of Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Nagoya University Graduate School of Medicine, Japan
| | - Satoru Katsuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumie Kinoshita
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Dizon MLV, deRegnier RAO, Weiner SJ, Varner MW, Rouse DJ, Costantine MM, Wapner RJ, Thorp JM, Blackwell SC, Ayala NK, Saad AF, Caritis SN. Differential Gene Expression in Cord Blood of Infants Diagnosed with Cerebral Palsy: A Pilot Analysis of the Beneficial Effects of Antenatal Magnesium Cohort. Dev Neurosci 2022; 44:412-425. [PMID: 35705018 PMCID: PMC9474611 DOI: 10.1159/000525483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
The Beneficial Effects of Antenatal Magnesium clinical trial was conducted between 1997 and 2007, and demonstrated a significant reduction in cerebral palsy (CP) in preterm infants who were exposed to peripartum magnesium sulfate (MgSO4). However, the mechanism by which MgSO4 confers neuroprotection remains incompletely understood. Cord blood samples from this study were interrogated during an era when next-generation sequencing was not widely accessible and few gene expression differences or biomarkers were identified between treatment groups. Our goal was to use bulk RNA deep sequencing to identify differentially expressed genes comparing the following four groups: newborns who ultimately developed CP treated with MgSO4 or placebo, and controls (newborns who ultimately did not develop CP) treated with MgSO4 or placebo. Those who died after birth were excluded. We found that MgSO4 upregulated expression of SCN5A only in the control group, with no change in gene expression in cord blood of newborns who ultimately developed CP. Regardless of MgSO4 exposure, expression of NPBWR1 and FTO was upregulated in cord blood of newborns who ultimately developed CP compared with controls. These data support that MgSO4 may not exert its neuroprotective effect through changes in gene expression. Moreover, NPBWR1 and FTO may be useful as biomarkers and may suggest new mechanistic pathways to pursue in understanding the pathogenesis of CP. The small number of cases ultimately available for this secondary analysis, with male predominance and mild CP phenotype, is a limitation of the study. In addition, differentially expressed genes were not validated by qRT-PCR.
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Affiliation(s)
- Maria L V Dizon
- The Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | | | - Steven J Weiner
- The George Washington University Biostatistics Center, Washington, District of Columbia, USA
| | - Michael W Varner
- The Departments of Obstetrics and Gynecology of the University of Utah, Salt Lake City, Utah, USA
| | - Dwight J Rouse
- The Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maged M Costantine
- The Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Ronald J Wapner
- The Department of Obstetrics and Gynecology, Thomas Jefferson University and Drexel University, Philadelphia, Pennsylvania, USA
- The Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - John M Thorp
- The Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sean C Blackwell
- University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Nina K Ayala
- The Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, USA
| | - Antonio F Saad
- The Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Steve N Caritis
- The Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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张 伊. Recent research on the influence of intrauterine growth restriction on the structure and function of the nervous system. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1184-1189. [PMID: 34753552 PMCID: PMC8580033 DOI: 10.7499/j.issn.1008-8830.2108044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
Intrauterine growth restriction (IUGR) is caused by many factors, and most newborns with IUGR are small for gestational age (SGA). SGA infants have a relatively high risk of death and disease in the perinatal period, and the nervous system already has structural changes in the uterus, including the reduction of brain volume and gray matter volume, accompanied by abnormal imaging and pathological changes. IUGR fetuses undergo intrauterine blood flow redistribution to protect brain blood supply, and there are still controversies over the clinical effect of brain protection mechanism. SGA infants have a relatively high risk of abnormal cognitive, motor, language, and behavioral functions in the neonatal period and childhood, and preterm infants tend to have a higher degree of neurological impairment than full-term infants. Early intervention may help to improve the function of the nervous system.
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Bouvier D, Giguère Y, Pereira B, Bernard N, Marc I, Sapin V, Forest JC. Cord blood S100B: reference ranges and interest for early identification of newborns with brain injury. Clin Chem Lab Med 2021; 58:285-293. [PMID: 31622243 DOI: 10.1515/cclm-2019-0737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/30/2019] [Indexed: 12/26/2022]
Abstract
Background Neurological complications are common in the premature and full-term neonates admitted to the intensive care unit, but the diagnosis of these complications is often difficult to make. S100B protein, measured in cord blood, may represent a valuable tool to better identify patients at risk of brain injury. Methods As a first step, we established S100B cord blood serum reference intervals from 183 preterm and 200 full-term neonates. We then measured cord blood serum S100B to identify neurological complications in 272 neonates hospitalized at the neonatal intensive care unit (NICU). Diagnosis of brain injury relied on imaging examination. Results The 95th percentiles of S100B concentration in cord blood were established as 1.21 μg/L for the 383 neonates, 0.96 μg/L for full-term neonates and 1.36 μg/L for premature neonates. Among the 272 neonates hospitalized at the NICU, 11 presented neurological complications. Using 1.27 μg/L as the optimal sensitivity/specificity threshold, S100B differentiate neonates with and without neurological complications with a sensitivity of 45.5% (95% confidence intervals [CI]: 16.7-76.6) and a specificity of 88.9% (95% CI: 84.4-92.4) (p = 0.006). In combination with arterial pH (<7.25), sensitivity increased to 90.9% (95% CI: 58.7-99.8), while specificity was 51.2% (95% CI: 44.8-57.7). The sensitivity is significantly (p = 0.03) increased in comparison to S100B alone. The specificity is significantly higher with S100B only than with pH + S100B (p < 0.001). Conclusions Cord blood S100B protein, in combination with arterial cord blood pH, has the potential to help clinicians to detect at birth neurological complications in neonates hospitalized in an NCIU.
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Affiliation(s)
- Damien Bouvier
- Service de Biochimie Médicale, Centre de Biologie, CHU Gabriel Montpied, 58 Rue Montalembert, 63000 Clermont-Ferrand, France.,Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France
| | - Yves Giguère
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Bernard
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Canada
| | - Isabelle Marc
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, Faculty of Medicine, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France
| | - Jean-Claude Forest
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, Canada
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Go H, Ohto H, Nollet KE, Sato K, Miyazaki K, Maeda H, Ichikawa H, Chishiki M, Kashiwabara N, Kume Y, Ogasawara K, Sato M, Hosoya M. Biomarker Potential of the Soluble Receptor for Advanced Glycation End Products to Predict Bronchopulmonary Dysplasia in Premature Newborns. Front Pediatr 2021; 9:649526. [PMID: 33996692 PMCID: PMC8116889 DOI: 10.3389/fped.2021.649526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a common cause of pulmonary disease in preterm infants. The soluble receptor for advanced glycation end products (sRAGE) is implicated in the development of various pulmonary diseases. The objectives of the current study were to investigate perinatal factors associated with serum sRAGE levels at birth and to establish whether serum sRAGE could be a biomarker for BPD. This retrospective single-center study was conducted at Fukushima Medical University Hospital's Department of Pediatrics Neonatal Intensive Care Unit from April 2014 to September 2020. Mechanically ventilated or oxygenated neonates born at <32 weeks gestational age and healthy control neonates were included in this study. Serum sRAGE levels in cord blood were measured using an enzyme-linked immunosorbent assay. Eighty-four preterm infants born at <32 weeks and 40 healthy infants were identified. The 84 born at <32 weeks were categorized as BPD (n = 34) or non-BPD (n = 50) neonates. The median gestational age (GA) and birthweight (BW) were significantly lower in BPD vs. non-BPD neonates (24.4 vs. 27.6 weeks, P < 0.001, 634 vs. 952 g, P < 0.001, respectively). Serum sRAGE at birth in all 124 preterm and term infants significantly correlated with BW (r = 0.417, P < 0.0001) and GA (r = 0.415, P < 0.0001). Among those born at <32 weeks, median serum sRAGE levels at birth were significantly lower in infants with BPD than without (1,726 vs. 2,797 pg/mL, P = 0.0005). Receiver operating characteristic analysis for sRAGE levels at birth in infants with and without BPD revealed that the area under the curve was 0.724 (95% confidence interval 0.714-0.834, P = 0.001). However, serum RAGE levels were not associated with severity of BPD. Serum sRAGE levels at birth were significantly correlated with BW and GA. Furthermore, serum sRAGE levels at birth could serve as a biomarker for predicting BPD, but not its severity.
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Affiliation(s)
- Hayato Go
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kyohei Miyazaki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hajime Maeda
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirotaka Ichikawa
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mina Chishiki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nozomi Kashiwabara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yohei Kume
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kei Ogasawara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Maki Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
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Metallinou D, Karampas G, Nyktari G, Iacovidou N, Lykeridou K, Rizos D. S100B as a biomarker of brain injury in premature neonates. A prospective case - control longitudinal study. Clin Chim Acta 2020; 510:781-786. [PMID: 32941837 DOI: 10.1016/j.cca.2020.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Neonatal brain injury (NBI) is a serious adverse outcome in premature neonates. We sought to determine the levels and prognostic value of serum S100B during the first three days of life in premature neonates (<34 weeks) that later developed NBI in the form of either intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). METHODS This is a prospective case - control longitudinal study. Each case (n = 29) was matched according to birthweight and gestational age to one neonate with normal head ultrasound scans. RESULTS Neonates with NBI, had significantly higher S100B concentration during the first three days of life. In both groups S100B was significantly higher on the first day when compared to the next two days of life showing a downwards trend. Serum S100B on the first day was the best predictor for adverse neonatal outcome such as death or II-IV IVH grade. A cut-off value of 10.51 ng/ml serum S100B performed a sensitivity of 100% and a specificity of 93.9% to predict adverse neonatal outcome. CONCLUSION Further research on the predictive value of serum S100B regarding NBI in premature neonates is of great interest and may provide the first clinically useful biomarker for early detection of neonates at high risk.
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Affiliation(s)
- Dimitra Metallinou
- Department of Midwifery, University of West Attica, Ag. Spyridonos Str., Egaleo, PC 12243 Athens, Greece; Neonatal Department, "Alexandra" General Hospital, 80 Vasillisis Sofias Avenue, Ilisia, PC 11528 Athens, Greece; Neonatal Intensive Care Unit, "Gaia" Maternity Hospital, 9 Distomou Str., Marousi, PC 15125 Athens, Greece.
| | - Grigorios Karampas
- 2(nd) Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Aretaieio" University Hospital, 76 Vasilissis Sofias Avenue, Ilisia, PC 11528, Athens, Greece
| | - Georgia Nyktari
- Neonatal Intensive Care Unit, "Gaia" Maternity Hospital, 9 Distomou Str., Marousi, PC 15125 Athens, Greece
| | - Nikoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, "Aretaieio" University Hospital, 76 Vasilissis Sofias Avenue, Ilisia, PC 11528, Athens, Greece
| | - Katerina Lykeridou
- Department of Midwifery, University of West Attica, Ag. Spyridonos Str., Egaleo, PC 12243 Athens, Greece
| | - Demetrios Rizos
- Hormone Laboratory, Medical School, National and Kapodistrian University of Athens, ''Aretaieio'' University Hospital, 76 Vasilissis Sofias Avenue, Ilisia, PC 11528, Athens, Greece
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Abstract
Cerebral palsy (CP), defined as a group of nonprogressive disorders of movement and posture, is the most common cause of severe neurodisability in children. The prevalence of CP is the same across the globe, affecting approximately 17 million people worldwide. Cerebral Palsy is an umbrella term used to describe the disease due to its inherent heterogeneity. For instance, CP has multiple (1) causes; (2) clinical types; (3) patterns of neuropathology on brain imaging and (4) it's associated with several developmental pathologies such as intellectual disability, autism, epilepsy, and visual impairment. Understanding its physiopathology is crucial to developing protective strategies. Despite its importance, there is still insufficient progress in the areas of CP prediction, early diagnosis, treatment, and prevention. Herein we describe the current risk factors and biomarkers used for the diagnosis and prediction of CP. With the advancement in biomarker discovery, we predict that our understanding of the etiopathophysiology of CP will also increase, lending to more opportunities for developing novel treatments and prognosis.
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Affiliation(s)
- Zeynep Alpay Savasan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, Royal Oak, MI, United States; Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States.
| | - Sun Kwon Kim
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, Royal Oak, MI, United States; Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States
| | - Kyung Joon Oh
- Beaumont Research Institute, Beaumont Health, Royal Oak, MI, United States; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Stewart F Graham
- Oakland University-William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI, United States; Beaumont Research Institute, Beaumont Health, Royal Oak, MI, United States
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Bersani I, Pluchinotta F, Dotta A, Savarese I, Campi F, Auriti C, Chuklantseva N, Piersigilli F, Gazzolo F, Varrica A, Satriano A, Gazzolo D. Early predictors of perinatal brain damage: the role of neurobiomarkers. Clin Chem Lab Med 2020; 58:471-486. [PMID: 31851609 DOI: 10.1515/cclm-2019-0725] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/31/2019] [Indexed: 09/17/2023]
Abstract
The early detection of perinatal brain damage in preterm and term newborns (i.e. intraventricular hemorrhage, periventricular leukomalacia and perinatal asphyxia) still constitute an unsolved issue. To date, despite technological improvement in standard perinatal monitoring procedures, decreasing the incidence of perinatal mortality, the perinatal morbidity pattern has a flat trend. Against this background, the measurement of brain constituents could be particularly useful in the early detection of cases at risk for short-/long-term brain injury. On this scenario, the main European and US international health-care institutions promoted perinatal clinical and experimental neuroprotection research projects aimed at validating and including a panel of biomarkers in the clinical guidelines. Although this is a promising attempt, there are several limitations that do not allow biomarkers to be included in standard monitoring procedures. The main limitations are: (i) the heterogeneity of neurological complications in the perinatal period, (ii) the small cohort sizes, (iii) the lack of multicenter investigations, (iv) the different techniques for neurobiomarkers assessment, (iv) the lack of consensus for the validation of assays in biological fluids such as urine and saliva, and (v), the lack of reference curves according to measurement technique and biological fluid. In the present review we offer an up-to-date overview of the most promising developments in the use of biomarkers in the perinatal period such as calcium binding proteins (S100B protein), vasoactive agents (adrenomedullin), brain biomarkers (activin A, neuron specific enolase, glial fibrillary acidic protein, ubiquitin carboxyl-terminal hydrolase-L1) and oxidative stress markers.
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Affiliation(s)
- Iliana Bersani
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Pluchinotta
- Laboratory Research Department of Pediatric Cardiovascular Surgery, SanDonato Milanese Univerity Hospital, San Donato Milanese, Milan, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Natalia Chuklantseva
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fiammetta Piersigilli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Varrica
- Laboratory Research Department of Pediatric Cardiovascular Surgery, SanDonato Milanese Univerity Hospital, San Donato Milanese, Milan, Italy
| | - Angela Satriano
- Laboratory Research Department of Pediatric Cardiovascular Surgery, SanDonato Milanese Univerity Hospital, San Donato Milanese, Milan, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
- Neonatal Intesive Care Unit, AO S.S. Antonio, Biagio, C. Arrigo Hospital, Spalto Marengo 46, 15100 Alessandria, Italy
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Smirnova AV, Borzova NY, Sotnikova NY, Malyshkina AI, Bojko EL. [Method for predicting perinatal hypoxic lesions of the central nervous system in newborns.]. Klin Lab Diagn 2019; 64:89-93. [PMID: 30917249 DOI: 10.18821/0869-2084-2019-64-2-89-93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 01/27/2023]
Abstract
Perinatal lesions of the Central nervous system (CNS) in newborns occupy a leading place in the structure of perinatal morbidity and subsequent disability of children. To identify the features of the content of sRAGE in pregnant women with threatening preterm labor (UPR) in the period of 22-27 weeks, who subsequently gave birth to children with perinatal CNS lesion. Serum of venous blood of pregnant women with UPR at the term of 22-27 weeks was determined by ELISA once the content of sRAGE. If the value of sRAGE in pregnant women is 659.5 PG/ml or less, perinatal hypoxic lesions of the Central nervous system in newborns are predicted with an accuracy of 75.8% (sensitivity of 82.6%, specificity of 66.7%).
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Affiliation(s)
- A V Smirnova
- Federal State Budgetary Institution "Research Institute of Maternity and Childhood named by V.N. Gorodkov" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia.,Federal State Budgetary Educational Institution of Higher Education "Ivanovo State Medical Academy" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia
| | - N Yu Borzova
- Federal State Budgetary Educational Institution of Higher Education "Ivanovo State Medical Academy" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia
| | - N Yu Sotnikova
- Federal State Budgetary Institution "Research Institute of Maternity and Childhood named by V.N. Gorodkov" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia.,Federal State Budgetary Educational Institution of Higher Education "Ivanovo State Medical Academy" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia
| | - A I Malyshkina
- Federal State Budgetary Institution "Research Institute of Maternity and Childhood named by V.N. Gorodkov" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia.,Federal State Budgetary Educational Institution of Higher Education "Ivanovo State Medical Academy" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia
| | - E L Bojko
- Federal State Budgetary Educational Institution of Higher Education "Ivanovo State Medical Academy" of the Ministry of Healthcare of the Russian Federation, Ivanovo, Russia
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Yakıştıran B, Katlan DC, Yüce T, Koç A. Neural and cardiac injury markers in fetal growth restriction and their relation to perinatal outcomes. Turk J Obstet Gynecol 2019; 16:50-54. [PMID: 31019840 PMCID: PMC6463424 DOI: 10.4274/tjod.galenos.2019.84665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/07/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the levels of umbilical cord blood Neuron-Specific Enolase (NSE) and troponin T and venous blood gas samples between healthy newborns and growth-retarded fetuses with impaired Doppler velocity or low APGAR scores. Materials and Methods: This study was a prospective cohort study. The study group comprised 26 patients with intrauterine growth restriction and pathologic Doppler symptoms, and the control group included 24 healthy fetuses. Umbilical cord blood and blood gas samples were taken from all patients. The blood samples were centrifuged and sent to a laboratory to study NSE and troponin T Perinatal outcomes were evaluated from the medical records of the newborns. Results: Both groups were similar in terms of demographic characteristics. Fetuses with fetal growth restriction (FGR) were born earlier and had lower APGAR scores than the study group. Chronic hypoxemic fetuses in the study group had lower cord pH and HCO3 levels. Further, troponin T levels were higher in the study group than in the control group. There were no major differences in Doppler velocity measurements. Conclusion: It has been understood that cardiac and neuronal injury detection on fetuses with FGR, troponin T, and NSE are indicators that can be used. In the literature there are studies with heterogeneous paradigms using different indicators to find neuronal injury. As a result of this study, it is clear that to assess neonatal prognosis, wider-scoped and comparative studies will provide more information about the subject.
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Affiliation(s)
- Betül Yakıştıran
- University of Health Sciences, Ankara Zekai Tahir Burak Woman's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Doruk Cevdi Katlan
- İstanbul Süleymaniye Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Tuncay Yüce
- University of Health Sciences, Ankara Zekai Tahir Burak Woman's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Acar Koç
- Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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12
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Crowgey EL, Marsh AG, Robinson KG, Yeager SK, Akins RE. Epigenetic machine learning: utilizing DNA methylation patterns to predict spastic cerebral palsy. BMC Bioinformatics 2018; 19:225. [PMID: 29925314 PMCID: PMC6011336 DOI: 10.1186/s12859-018-2224-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Spastic cerebral palsy (CP) is a leading cause of physical disability. Most people with spastic CP are born with it, but early diagnosis is challenging, and no current biomarker platform readily identifies affected individuals. The aim of this study was to evaluate epigenetic profiles as biomarkers for spastic CP. A novel analysis pipeline was employed to assess DNA methylation patterns between peripheral blood cells of adolescent subjects (14.9 ± 0.3 years old) with spastic CP and controls at single CpG site resolution. RESULTS Significantly hypo- and hyper-methylated CpG sites associated with spastic CP were identified. Nonmetric multidimensional scaling fully discriminated the CP group from the controls. Machine learning based classification modeling indicated a high potential for a diagnostic model, and 252 sets of 40 or fewer CpG sites achieved near-perfect accuracy within our adolescent cohorts. A pilot test on significantly younger subjects (4.0 ± 1.5 years old) identified subjects with 73% accuracy. CONCLUSIONS Adolescent patients with spastic CP can be distinguished from a non-CP cohort based on DNA methylation patterns in peripheral blood cells. A clinical diagnostic test utilizing a panel of CpG sites may be possible using a simulated classification model. A pilot validation test on patients that were more than 10 years younger than the main adolescent cohorts indicated that distinguishing methylation patterns are present earlier in life. This study is the first to report an epigenetic assay capable of distinguishing a CP cohort.
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Affiliation(s)
- Erin L Crowgey
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Adam G Marsh
- Genome Profiling LLC, 4701 Ogletown Stanton Rd #4300, Newark, DE, 19713, USA.,Center for Bioinformatics and Computational Biology and The School of Marine Science and Policy, University of Delaware, Newark, DE, 19713, USA
| | - Karyn G Robinson
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Stephanie K Yeager
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Robert E Akins
- Nemours Biomedical Research, Nemours - Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
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Mazarico E, Llurba E, Cabero L, Sánchez O, Valls A, Martín-Ancel A, Cardenas D, Gómez Roig MD. Associations between neural injury markers of intrauterine growth-restricted infants and neurodevelopment at 2 years of age. J Matern Fetal Neonatal Med 2018; 32:3197-3203. [PMID: 29606022 DOI: 10.1080/14767058.2018.1460347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: The aim of this study was to evaluate the relationships between brain injury biomarkers in intrauterine growth-restricted (IUGR) infants (S100B and neuron-specific enolase (NSE)) and neurodevelopment at 2 years of age. Methods: This prospective case-control study was a cooperative effort among Spanish Maternal and Child Health Network (Retic SAMID) hospitals. At inclusion, biometry for estimated fetal weight and feto-placental Doppler variables were measured for each infant. Maternal venous blood and fetal umbilical arterial blood samples were collected at the time of delivery and neural injury markers S100B and NSE concentrations were measured. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). Results: Fifty six pregnancies were included. Thirty-one infants were classified as IUGR and 25 as non-IUGR. Neurodevelopmental evaluation at 2 years of age indicated that there were no between-group differences for any of the tests. For all patients in both groups, we found statistically significant inverse relationships between the concentrations of NSE in the cord blood and the results of the cognitive test (r = -271, p = .042), fine motor subtest (r = -280, p = .036), and social-emotional test (r = -349, p = .015). We also found statistically significant differences between the concentrations of S100B in the cord blood and the results of the cognitive test (r = -306, p = .022) and expressive communication subtest (r = -304, p = .023). For the IUGR group, we found a significant inverse relationship between the concentrations of S100B in the maternal serum and the results of adaptive behavior test (p < .05). In the non-IUGR group, we found statistically significant inverse relationships between the concentration of NSE in the cord blood and the results of the fine motor subtest (r = -446, p = .025) and social-emotional test (r = -489, p = .021). The difference between the concentration of S100B in the cord blood and the language composite score was also statistically significant (p = .038). Conclusions: At 2 years of age, the concentrations of NSE and S100B were higher in the non-IUGR and IUGR groups with the worst scores for some areas of neurodevelopmental evaluation. The value of these biomarkers for prognostic neurodevelopmental use requires further investigation for both non-IUGR and IUGR infants.
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Affiliation(s)
- E Mazarico
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu , Barcelona , Spain.,b Institut de Recerca Sant Joan de Déu , Esplugues de Llobregat , Spain
| | - E Llurba
- c Department of Obstetrics, Maternal-Foetal Medicine Unit , Vall d'Hebrón University Hospital, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - L Cabero
- c Department of Obstetrics, Maternal-Foetal Medicine Unit , Vall d'Hebrón University Hospital, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - O Sánchez
- c Department of Obstetrics, Maternal-Foetal Medicine Unit , Vall d'Hebrón University Hospital, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - A Valls
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu , Barcelona , Spain
| | - A Martín-Ancel
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu , Barcelona , Spain.,b Institut de Recerca Sant Joan de Déu , Esplugues de Llobregat , Spain
| | - D Cardenas
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu , Barcelona , Spain
| | - M D Gómez Roig
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu , Barcelona , Spain.,b Institut de Recerca Sant Joan de Déu , Esplugues de Llobregat , Spain
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14
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Neural injury markers in intrauterine growth restriction and their relation to perinatal outcomes. Pediatr Res 2017; 82:452-457. [PMID: 28426650 DOI: 10.1038/pr.2017.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/31/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUNDThe aims of this study were to (i) compare the concentrations of two neural injury markers, S100B protein and neuron-specific enolase (NSE), in intrauterine growth-restricted (IUGR) fetuses and in fetuses with appropriate growth-for-gestational-age (AGA), and (ii) investigate potential relationships between concentrations of these markers, Doppler abnormalities, and adverse perinatal or neonatal outcomes.METHODSThis was a case-controlled, cooperative, prospective study among Spanish Maternal and Child Health Network (Retic SAMID) hospitals. At inclusion, biometry for estimated fetal weight and feto-placental Doppler were measured. At the time of delivery, maternal venous blood and fetal umbilical arterial blood samples were collected. S100B and NSE concentrations were determined from these samples.RESULTSIn total, 254 pregnancies were included. Among these, 147 were classified as IUGR and 107 as AGA. There were no differences between the groups in S100B concentrations. However, levels of NSE in maternal and umbilical cord serum differed significantly between these groups (2.31 in AGA vs. 2.51 in IUGR in (P<0.05); and 2.89 in AGA vs. 3.25 in IUGR (P<0.05), respectively). No differences were observed in these neurological markers when stratified by perinatal or neonatal complications.CONCLUSIONAlthough some variations exist in these neurological markers, they did not correlate with perinatal or neonatal complications.
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15
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Detection and assessment of brain injury in the growth-restricted fetus and neonate. Pediatr Res 2017; 82:184-193. [PMID: 28234891 DOI: 10.1038/pr.2017.37] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/14/2017] [Indexed: 11/08/2022]
Abstract
Fetal growth restriction (FGR) is a common complication of pregnancy and, in severe cases, is associated with elevated rates of perinatal mortality, neonatal morbidity, and poor neurodevelopmental outcomes. The leading cause of FGR is placental insufficiency, with the placenta failing to adequately meet the increasing oxygen and nutritional needs of the growing fetus with advancing gestation. The resultant chronic fetal hypoxia induces a decrease in fetal growth, and a redistribution of blood flow preferentially to the brain. However, this adaptation does not ensure normal brain development. Early detection of brain injury in FGR, allowing for the prediction of short- and long-term neurodevelopmental consequences, remains a significant challenge. Furthermore, in FGR infants the detection and diagnosis of neuropathology is complicated by preterm birth, the etiological heterogeneity of FGR, timing of onset of growth restriction, its severity, and coexisting complications. In this review, we examine existing and emerging diagnostic tools from human and preclinical studies for the detection and assessment of brain injury in FGR fetuses and neonates. Increased detection rates, and early detection of brain injury associated with FGR, will offer opportunities for developing and assessing interventions to improve long-term outcomes.
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16
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CAHILL AG, MATHUR AM, SMYSER CD, MCKINSTRY RC, ROEHL KA, LÓPEZ JD, INDER TE, MACONES GA. Neurologic Injury in Acidemic Term Infants. Am J Perinatol 2017; 34:668-675. [PMID: 27926973 PMCID: PMC6283275 DOI: 10.1055/s-0036-1597135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective To determine whether arterial umbilical cord gas (aUCG) pH, in anatomically normal-term infants, could select infants at risk for brain injury identified on magnetic resonance imaging (MRI). Study Design We performed a nested case-control within a prospective cohort of 8,580 women. Cases, with an aUCG pH < 7.10, were temporally, age, and sex matched to controls with an aUCG pH ≥ 7.20. Bi- and multivariable analyses compared the presence and severity of brain injury. Secondary analyses estimated whether elevated arterial base excess or lactate were associated with brain injury. Results Fifty-five cases were matched to 165 controls. There was no statistical difference in brain injury between the groups (adjusted odds ratio [aOR]: 1.8, 95% confidence interval [CI]: 0.7-4.4]). Base excess ≥ -8 mEq/L was not significantly associated with brain injury (p = 0.12). There was no increase in risk of injury based on elevation of arterial lactate ≥ 4 mmol ⁄L (p = 1.00). Cases were significantly more likely to have an abnormal score in several domains of the Dubowitz neurologic examination. Conclusion The aUCG acid-base parameters alone are not sufficient clinical markers to identify term infants that might benefit from MRI of the brain to identify injury.
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Affiliation(s)
- Alison G. CAHILL
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Amit M. MATHUR
- Department of Pediatrics, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8116, St. Louis, Missouri, 63110
| | - Christopher D. SMYSER
- Department of Neurology, Department of Pediatrics, Washington University in St. Louis, 4566 Scott Avenue, Campus Box 8111, St. Louis, Missouri, 63110
| | - Robert C. MCKINSTRY
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly A. ROEHL
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Julia D. LÓPEZ
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
| | - Terrie E. INDER
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, 02115
| | - George A. MACONES
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4566 Scott Avenue, Campus Box 8064, St. Louis, Missouri, 63110
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Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol 2016; 594:807-23. [PMID: 26607046 PMCID: PMC4753264 DOI: 10.1113/jp271402] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/19/2015] [Indexed: 12/18/2022] Open
Abstract
Fetal growth restriction (FGR) is a significant complication of pregnancy describing a fetus that does not grow to full potential due to pathological compromise. FGR affects 3-9% of pregnancies in high-income countries, and is a leading cause of perinatal mortality and morbidity. Placental insufficiency is the principal cause of FGR, resulting in chronic fetal hypoxia. This hypoxia induces a fetal adaptive response of cardiac output redistribution to favour vital organs, including the brain, and is in consequence called brain sparing. Despite this, it is now apparent that brain sparing does not ensure normal brain development in growth-restricted fetuses. In this review we have brought together available evidence from human and experimental animal studies to describe the complex changes in brain structure and function that occur as a consequence of FGR. In both humans and animals, neurodevelopmental outcomes are influenced by the timing of the onset of FGR, the severity of FGR, and gestational age at delivery. FGR is broadly associated with reduced total brain volume and altered cortical volume and structure, decreased total number of cells and myelination deficits. Brain connectivity is also impaired, evidenced by neuronal migration deficits, reduced dendritic processes, and less efficient networks with decreased long-range connections. Subsequent to these structural alterations, short- and long-term functional consequences have been described in school children who had FGR, most commonly including problems in motor skills, cognition, memory and neuropsychological dysfunctions.
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Affiliation(s)
- Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, and The Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Petra S Huppi
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Switzerland
| | - Carina Mallard
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Buschmann K, Tschada R, Metzger MS, Braach N, Kuss N, Hudalla H, Poeschl J, Frommhold D. RAGE controls leukocyte adhesion in preterm and term infants. BMC Immunol 2014; 15:53. [PMID: 25428166 PMCID: PMC4256735 DOI: 10.1186/s12865-014-0053-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/03/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Insufficient leukocyte recruitment may be one reason for the high incidence of life-threatening infections in preterm infants. Since the receptor of advanced glycation end products (RAGE) is a known leukocyte adhesion molecule and highly expressed during early development, we asked whether RAGE plays a role for leukocyte recruitment in preterm and term infants. METHODS Leukocyte adhesion was analyzed in dynamic flow chamber experiments using isolated leukocytes of cord blood from extremely premature (<30 weeks of gestation), moderately premature (30-35 weeks of gestation) and mature neonates (>35 weeks of gestation) and compared to the results of adults. For fluorescent microscopy leukocytes were labeled with rhodamine 6G. In the respective age groups we also measured the plasma concentration of soluble RAGE (sRAGE) by ELISA and Mac-1 and LFA-1 expression on neutrophils by flow cytometry. RESULTS The adhesive functions of fetal leukocytes significantly increase with gestational age. In all age groups, leukocyte adhesion was crucially dependent on RAGE. In particular, RAGE was equally effective to mediate leukocyte adhesion when compared to ICAM-1. The plasma levels of sRAGE were high in extremely premature infants and decreased with increasing gestational age. In contrast, expression of β2-Integrins Mac-1 and LFA-1 which are known ligands for RAGE and ICAM-1 did not change during fetal development. CONCLUSION We conclude that RAGE is a crucial leukocyte adhesion molecule in both preterm and term infants.
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Affiliation(s)
- Kirsten Buschmann
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
| | - Raphaela Tschada
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
| | | | - Natascha Braach
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
| | - Navina Kuss
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
| | - Hannes Hudalla
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
| | - Johannes Poeschl
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
| | - David Frommhold
- Department of Neonatology, University Hospital, 69120, Heidelberg, Germany.
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Velipaşaoğlu M, Yurdakök M, Özyüncü Ö, Portakal O, Deren Ö. Neural injury markers to predict neonatal complications in intrauterine growth restriction. J OBSTET GYNAECOL 2014; 35:555-60. [DOI: 10.3109/01443615.2014.978848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guedes-Martins L, Matos L, Soares A, Silva E, Almeida H. AGEs, contributors to placental bed vascular changes leading to preeclampsia. Free Radic Res 2013; 47 Suppl 1:70-80. [PMID: 23796030 DOI: 10.3109/10715762.2013.815347] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Glycation of proteins or other biomolecules and their further long-term degradation result in the formation of advanced glycation end products, AGEs. AGEs and other ligands interact with their receptors, RAGEs, localized to a variety of tissues, but mainly in endothelium and vascular wall cells. This interaction triggers diverse signaling pathways that converge on the activation of NF-κB and the initiation of a local inflammatory reaction that, when prolonged, results in dysfunctional features. Preeclampsia is a serious vascular disorder centred at the placenta-uterine interface, the placental bed, but the condition extends to the mother's circulation. RAGEs have notorious expression in the placental bed tissues along pregnancy but, in addition, RAGEs and their ligands are expressed in the fetal membranes and are found in the amniotic fluid and the mother's serum. Disorders complicating pregnancies and having an important vascular involvement, as preeclampsia and diabetes mellitus, have additional enhanced AGE/RAGE expression variation. This indicates that for their assessment, the assay of RAGEs or their ligands may become useful diagnostic or prognostic procedures.
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Affiliation(s)
- L Guedes-Martins
- Departamento de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Costantine MM, Clark EAS, Lai Y, Rouse DJ, Spong CY, Mercer BM, Sorokin Y, Thorp JM, Ramin SM, Malone FD, Carpenter M, Miodovnik M, O'Sullivan MJ, Peaceman AM, Caritis SN. Association of polymorphisms in neuroprotection and oxidative stress genes and neurodevelopmental outcomes after preterm birth. Obstet Gynecol 2012; 120:542-50. [PMID: 22914463 PMCID: PMC3904537 DOI: 10.1097/aog.0b013e318265f232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To estimate the associations between polymorphisms in neuronal homeostasis, neuroprotection, and oxidative stress candidate genes and neurodevelopmental disability. METHODS This was a nested case-control analysis of a randomized trial of magnesium sulfate administered to women at imminent risk for early (before 32 weeks) preterm birth for the prevention of death or cerebral palsy in their offspring. We evaluated 21 single-nucleotide polymorphisms (SNPs) in 17 genes associated with neuronal homeostasis, neuroprotection, or oxidative stress in umbilical cord blood. Cases included infant deaths (n=43) and children with cerebral palsy (n=24), mental delay (Bayley Mental Developmental Index less than 70; n=109), or psychomotor delay (Bayley Psychomotor Developmental Index less than 70; n=91) diagnosed. Controls were race-matched and sex-matched children with normal neurodevelopment. Associations between each SNP and each outcome were assessed in logistic regression models assuming an additive genetic pattern, conditional on maternal race and infant sex, and adjusting for study drug assignment, gestational age at birth, and maternal education. RESULTS The odds of cerebral palsy were increased more than 2.5 times for each copy of the minor allele of vasoactive intestinal polypeptipe (VIP, rs17083008) (adjusted odds ratio 2.67, 95% confidence interval 1.09-6.55, P=.03) and 4.5 times for each copy of the minor allele of N-methyl-D-aspartate receptor subunit 3A (GRIN3A, rs3739722) (adjusted odds ratio 4.67, 95% CI 1.36-16.01, P=.01). The association between the advanced glycosylation end product-specific receptor (AGER, rs3134945) SNP and mental delay was modulated by study drug allocation (P=.02). CONCLUSION Vasoactive intestinal polypeptipe and GRIN3A SNPs may be associated with cerebral palsy at age 2 in children born preterm.
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MESH Headings
- Case-Control Studies
- Cerebral Palsy/genetics
- Child, Preschool
- Developmental Disabilities/genetics
- Female
- Genetic Markers
- Homeostasis/genetics
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/genetics
- Infant, Premature, Diseases/mortality
- Intellectual Disability/genetics
- Logistic Models
- Male
- Oxidative Stress/genetics
- Polymorphism, Single Nucleotide
- Psychological Tests
- Psychomotor Disorders/genetics
- Receptor for Advanced Glycation End Products
- Receptors, Immunologic/genetics
- Receptors, N-Methyl-D-Aspartate/genetics
- Vasoactive Intestinal Peptide/genetics
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Affiliation(s)
- Maged M Costantine
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA.
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