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Lapidaire W, Clayden JD, Fewtrell MS, Clark CA. Increased white matter fibre dispersion and lower IQ scores in adults born preterm. Hum Brain Mapp 2024; 45:e26545. [PMID: 38070181 PMCID: PMC10789207 DOI: 10.1002/hbm.26545] [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: 08/22/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Preterm birth has been associated with altered microstructural properties of the white matter and lower cognitive ability in childhood and adulthood. Due to methodological limitations of the diffusion tensor model, it is not clear whether alterations in myelination or variation in fibre orientation are driving these differences. Novel models applied to multi-shell diffusion imaging have been used to disentangle these effects, but to date this has not been used to study the preterm brain in adulthood. This study investigated whether novel advanced diffusion MRI metrics such as microscopic anisotropy and orientation dispersion are altered in adults born preterm, and whether this was associated with cognitive performance. Seventy-two preterm born participants (<37 weeks gestational age) were recruited from a 1982-1984 cohort (33 males, mean age 33.5 ± 1.0 years). Seventy-two term born (>37 weeks gestational age) controls (34 males, mean age 30.9 ± 4.0 years) were recruited from the general population. Tensor FA was calculated with FSL, while microscopic FA and orientation dispersion entropy (ODE) were estimated using the Spherical Mean Technique (SMT). Estimated Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) were obtained from the WASI-II (abbreviated) IQ test. Voxel-wise comparisons using FSL's tract-based spatial statistics were performed to test between-group differences in diffusion MRI metrics as well as within-group associations of diffusion MRI metrics and IQ outcomes. The preterm group had significantly lower FSIQ, VCI and PRI scores. Preterm subjects demonstrated widespread decreases in ODE reflecting increased fibre dispersion, but no differences in microscopic FA. Tensor FA was increased in a small area in the anterior corona radiata. Lower FA values in the preterm population were associated with lower FSIQ and PRI scores. An increase in fibre dispersion in white matter and lower IQ scores after preterm birth exist in adulthood. Advanced diffusion MRI metrics such as the orientation dispersion entropy can be used to monitor white matter alterations across the lifespan in preterm born individuals. Although not significantly different between preterm and term groups, tensor FA values in the preterm group were associated with cognitive outcome.
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Affiliation(s)
- Winok Lapidaire
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Jonathan D. Clayden
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Mary S. Fewtrell
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Christopher A. Clark
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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2
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Wang R, Li T, Diao S, Chen C. Inhibition of the proteoglycan receptor PTPσ promotes functional recovery on a rodent model of preterm hypoxic-ischemic brain injury. Exp Neurol 2023; 370:114564. [PMID: 37806512 DOI: 10.1016/j.expneurol.2023.114564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Preterm white matter injury (WMI) is the most common brain injury in preterm infants and is associated with long-term adverse neurodevelopmental outcomes. Protein tyrosine phosphatase sigma (PTPσ) was discovered as chondroitin sulfate proteoglycan (CSPG) receptor that played roles in inhibiting myelin regeneration in spinal injury, experimental autoimmune encephalomyelitis, and stroke models. However, the role of PTPσ in perinatal WMI is not well understood. AIMS This study examines the effect of PTPσ inhibition on neurodevelopmental outcomes, myelination, and neuroinflammation in a mouse model of preterm WMI. MATERIALS AND METHODS Modified Rice-Vannucci model was performed on postnatal day 3 (P3) C57BL/6 mice. Intracellular Sigma Peptide (ISP) or vehicle was administrated subcutaneously one hour after injury for an additional 14 consecutive days. A battery of behavioral tests was performed to evaluate the short- and long-term effects of ISP on neurobehavioral deficit. Real time qPCR, western blot, immunofluorescence, and transmission electron microscopy were performed to assess white matter development. qPCR and flow cytometry were performed to evaluate neuroinflammation and microglia/macrophage phenotype. RESULTS The expression of PTPσ was increased after preterm WMI. ISP improved short-term neurological outcomes and ameliorated long-term motor and cognitive function of mice after preterm WMI. ISP promoted oligodendrocyte differentiation, maturation, myelination, and improved microstructure of myelin after preterm WMI. Furthermore, ISP administration fostered a beneficial inflammatory response in the acute phase after preterm WMI, inhibited the infiltration of peripheral macrophages, and promoted anti-inflammatory phenotype of microglia/macrophages. CONCLUSION PTPσ inhibition can ameliorate neurofunctional deficit, promote white matter development, modulate neuroinflammation and microglia/macrophage phenotype after preterm WMI. Thus, ISP administration may be a potential therapeutic strategy to improve neurodevelopmental outcomes of perinatal WMI.
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Affiliation(s)
- Ran Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; Key Laboratory of Neonatal Diseases, National Health Commission, China; Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tiantian Li
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; Key Laboratory of Neonatal Diseases, National Health Commission, China
| | - Sihao Diao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; Key Laboratory of Neonatal Diseases, National Health Commission, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China; Key Laboratory of Neonatal Diseases, National Health Commission, China.
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Brown RN, Burnett AC, Thompson DK, Spittle AJ, Ellis R, Cheong JLY, Doyle LW, Pascoe L, Anderson PJ. Motor performance and attention outcomes in children born very preterm. Dev Med Child Neurol 2023; 65:1501-1510. [PMID: 37060580 DOI: 10.1111/dmcn.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/17/2023]
Abstract
AIM To examine the relationship between motor performance and attention in children born very preterm and at term, and investigate the presence of individual profiles of motor and attention performance. METHOD Attention and motor performance at 7 and 13 years were assessed in 197 children born very preterm (52.5% male) and 69 children born at term (47.8% male) between 2001 and 2003. Linear regression models were fitted including an interaction term for birth group. Subgroups of children with similar attention and motor performance profiles were identified using latent profile analysis. RESULTS Balance was positively associated with all attention outcomes at both ages (p < 0.006). There were specific birth group interactions for aiming and catching and manual dexterity with attention at 13 years, with positive associations observed only for children born very preterm (p < 0.001). At 7 years, three profiles were observed: average attention and motor functioning; average motor functioning and low attention functioning; and low attention and motor functioning. At 13 years, two profiles of average attention and motor functioning emerged, as well as one profile of below-average attention and motor functioning. Children born very preterm were overrepresented in the lower functioning profiles (born very preterm 56%; born at term 29%). INTERPRETATION Motor functioning at age 7 years may be a useful marker of later attention skills, particularly for children born very preterm who are at greater risk of poorer long-term cognitive outcomes. WHAT THIS PAPER ADDS Balance was positively associated with attention in children born very preterm and at term. Relationships between motor performance and attention at age 13 years differed between children born very preterm and at term. Heterogeneous motor functioning and attention outcomes were noted for children born very preterm and at term. Children born very preterm were more likely to have lower attention and motor functioning profiles than children born at term. There was greater movement in motor functioning and attention profiles between the ages of 7 and 13 years in children born very preterm.
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Affiliation(s)
- Rebecca N Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Alice C Burnett
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Premature Infant Follow-up Program, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Ellis
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Leona Pascoe
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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DiPiero M, Rodrigues PG, Gromala A, Dean DC. Applications of advanced diffusion MRI in early brain development: a comprehensive review. Brain Struct Funct 2023; 228:367-392. [PMID: 36585970 PMCID: PMC9974794 DOI: 10.1007/s00429-022-02605-8] [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: 09/02/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
Brain development follows a protracted developmental timeline with foundational processes of neurodevelopment occurring from the third trimester of gestation into the first decade of life. Defining structural maturational patterns of early brain development is a critical step in detecting divergent developmental trajectories associated with neurodevelopmental and psychiatric disorders that arise later in life. While considerable advancements have already been made in diffusion magnetic resonance imaging (dMRI) for pediatric research over the past three decades, the field of neurodevelopment is still in its infancy with remarkable scientific and clinical potential. This comprehensive review evaluates the application, findings, and limitations of advanced dMRI methods beyond diffusion tensor imaging, including diffusion kurtosis imaging (DKI), constrained spherical deconvolution (CSD), neurite orientation dispersion and density imaging (NODDI) and composite hindered and restricted model of diffusion (CHARMED) to quantify the rapid and dynamic changes supporting the underlying microstructural architectural foundations of the brain in early life.
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Affiliation(s)
- Marissa DiPiero
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | | | - Alyssa Gromala
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
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Kim SY, Kim EK, Song H, Cheon JE, Kim BN, Kim HS, Shin SH. Association of Brain Microstructure and Functional Connectivity With Cognitive Outcomes and Postnatal Growth Among Early School-Aged Children Born With Extremely Low Birth Weight. JAMA Netw Open 2023; 6:e230198. [PMID: 36862414 PMCID: PMC9982697 DOI: 10.1001/jamanetworkopen.2023.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
IMPORTANCE Postnatal growth may be associated with longitudinal brain development in children born preterm. OBJECTIVE To compare brain microstructure and functional connectivity strength with cognitive outcomes in association with postnatal growth among early school-aged children born preterm with extremely low birth weight. DESIGN, SETTING, AND PARTICIPANTS This single-center cohort study prospectively enrolled 38 children 6 to 8 years of age born preterm with extremely low birth weight: 21 with postnatal growth failure (PGF) and 17 without PGF. Children were enrolled, past records were retrospectively reviewed, and imaging data and cognitive assessments occurred from April 29, 2013, through February 14, 2017. Image processing and statistical analyses were conducted through November 2021. EXPOSURE Postnatal growth failure in the early neonatal period. MAIN OUTCOMES AND MEASURES Diffusion tensor images and resting-state functional magnetic resonance images were analyzed. Cognitive skills were tested using the Wechsler Intelligence Scale; executive function was assessed based on a composite score calculated from the synthetic composite of the Children's Color Trails Test, STROOP Color and Word Test, and Wisconsin Card Sorting Test; attention function was evaluated using the Advanced Test of Attention (ATA); and the Hollingshead Four Factor Index of Social Status-Child was estimated. RESULTS Twenty-one children born preterm with PGF (14 girls [66.7%]), 17 children born preterm without PGF (6 girls [35.3%]), and 44 children born full term (24 girls [54.5%]) were recruited. Attention function was less favorable in children with PGF than those without PGF (mean [SD] ATA score: children with PGF, 63.5 [9.4]; children without PGF, 55.7 [8.0]; P = .008). Significantly lower mean (SD) fractional anisotropy in the forceps major of the corpus callosum (0.498 [0.067] vs 0.558 [0.044] vs 0.570 [0.038]) and higher mean (SD) mean diffusivity in the left superior longitudinal fasciculus-parietal bundle (8.312 [0.318] vs 7.902 [0.455] vs 8.083 [0.393]; originally calculated as millimeter squared per second and rescaled 10 000 times as mean diffusivity × 10 000) were seen among children with PGF compared with children without PGF and controls, respectively. Decreased resting-state functional connectivity strength was observed in the children with PGF. The mean diffusivity of the forceps major of the corpus callosum significantly correlated with the attention measures (r = 0.225; P = .047). Functional connectivity strength between the left superior lateral occipital cortex and both superior parietal lobules correlated with cognitive outcomes of intelligence (right superior parietal lobule, r = 0.262; P = .02; and left superior parietal lobule, r = 0.286; P = .01) and executive function (right superior parietal lobule, r = 0.367; P = .002; and left superior parietal lobule, r = 0.324; P = .007). The ATA score was positively correlated with functional connectivity strength between the precuneus and anterior division of the cingulate gyrus (r = 0.225; P = .048); however, it was negatively correlated with functional connectivity strength between the posterior cingulate gyrus and both superior parietal lobules (the right superior parietal lobule [r = -0.269; P = .02] and the left superior parietal lobule [r = -0.338; P = .002]). CONCLUSIONS AND RELEVANCE This cohort study suggests that the forceps major of the corpus callosum and the superior parietal lobule were vulnerable regions in preterm infants. Preterm birth and suboptimal postnatal growth could have negative associations with brain maturation, including altered microstructure and functional connectivity. Postnatal growth may be associated with differences in long-term neurodevelopment among children born preterm.
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Affiliation(s)
- Sae Yun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Huijin Song
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Brown RN, Pascoe L, Treyvaud K, McMahon G, Nguyen TNN, Ellis R, Stedall P, Haebich K, Collins SE, Cheong J, Doyle LW, Thompson DK, Burnett A, Anderson PJ. Early parenting behaviour is associated with complex attention outcomes in middle to late childhood in children born very preterm. Child Neuropsychol 2023; 29:165-182. [PMID: 35549808 DOI: 10.1080/09297049.2022.2075334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Attention deficits are common in children born very preterm (VP), especially for children with higher social risk. The aim of this study was to examine the association between parenting behavior and attention in children born VP, and whether this association is influenced by familial social risk. Two hundred and twenty-four children born <30 weeks' gestation and/or with a birth weight <1250 g were recruited at birth. At 2 years, social risk was calculated and parenting behaviors were observed during a parent-child interaction task, with children's attention skills assessed at 7 and 13 years using standardized assessments. Higher levels of sensitive parenting at 2 years were positively associated with divided attention at age 7 years, and higher levels of intrusive parenting were negatively associated with divided attention at 13 years. Children born VP with higher social risk were more positively influenced by sensitive parenting behavior for sustained attention at 7 years, selective attention at 13 years, and divided attention at 7 and 13 years than children born VP with lower social risk. Additionally, children born VP with higher social risk were more negatively influenced by intrusive parenting for sustained attention outcomes at 7 years than those with lower social risk. In summary, the evidence for a contribution of early parenting to attention outcomes in children born VP was stronger for more complex attention (divided attention) compared with basic attention domains. Our findings also suggest that early parenting behavior has a particular influence on children born VP from socially disadvantaged environments for attention outcomes.
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Affiliation(s)
- Rebecca N Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Leona Pascoe
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Psychology and Counselling, La Trobe University, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Neonatal Services, Royal Women's Hospital, Victoria, Australia
| | - Grace McMahon
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Thi-Nhu-Ngoc Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Rachel Ellis
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Paulina Stedall
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Kristina Haebich
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Simonne E Collins
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
| | - Jeanie Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Neonatal Services, Royal Women's Hospital, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Neonatal Services, Royal Women's Hospital, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alice Burnett
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Victoria, Australia
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Chen Q, Zhang K, Wang M, Gao R, Wang Q, Xiao M, Chen C. A translational mouse model for investigation of the mechanism of preterm diffuse white matter injury. Transl Pediatr 2022; 11:1074-1084. [PMID: 35957997 PMCID: PMC9360811 DOI: 10.21037/tp-22-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing incidence of preterm birth has led to a global problem of adverse neurodevelopmental outcomes in preterm neonates as a result of brain injury. There is still a lack of models mimicking diffuse white matter injury (WMI) in preterm neonates that can be applied to transgenic mice. METHODS The right common carotid artery of the neonatal mouse was ligated on postnatal day 3 (P3) C57BL/6 mice and followed by 80, 90, or 100 min of hypoxia using a mixture of 10%±0.2% oxygen-nitrogen. The most suitable model was chosen by characterizing the effects of this hypoxic-ischemic insult on development of myelin, glial cell conditions, and neurological outcomes by hematoxylin-eosin (HE) staining performed at postnatal day 17 (P17), western blot measuring myelin basic protein (MBP) at postnatal day 10 (P10) and P17, immunofluorescence staining of MBP-neurofilament protein heavy chain (NFH), oligodendrocyte transcription factor-2 (Olig2)-adenomatous polyposis coli clone (CC1), glial fibrillary acidic protein (GFAP) and ionic calcium linker protein (Iba-1) at P17, electron microscopy observing myelin microstructure at postnatal day 52 (P52) and behavioral testing at postnatal day 45-50 (P45-P50). RESULTS The 90-min group showed neuroanatomical changes in the ipsilateral side of the brain, the 80-min group showed minor changes, and the 100-min group showed severe injury. Mice in the 90-min group subsequently showed marked activation of astrocytes, augmentation of microglia, a notable decrease in expression of MBP with a normal level of NFH, long-term cognitive dysfunction, and impairment of the myelin ultrastructure in adulthood. CONCLUSIONS In conclusion, a mouse model of preterm diffuse WMI rather than cystic periventricular leukomalacia was successfully achieved by ligating one of the common carotid arteries on P3 followed by 90 min of hypoxia in a mixture of 10%±0.2% oxygen-nitrogen. The attempt provides an adequate translational animal model for elucidating the underlying mechanism.
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Affiliation(s)
- Qiufan Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Ke Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Minjie Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Ruiwei Gao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Qian Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Mili Xiao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
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Vo Van P, Alison M, Morel B, Beck J, Bednarek N, Hertz-Pannier L, Loron G. Advanced Brain Imaging in Preterm Infants: A Narrative Review of Microstructural and Connectomic Disruption. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030356. [PMID: 35327728 PMCID: PMC8947160 DOI: 10.3390/children9030356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Preterm birth disrupts the in utero environment, preventing the brain from fully developing, thereby causing later cognitive and behavioral disorders. Such cerebral alteration occurs beneath an anatomical scale, and is therefore undetectable by conventional imagery. Prematurity impairs the microstructure and thus the histological process responsible for the maturation, including the myelination. Cerebral MRI diffusion tensor imaging sequences, based on water’s motion into the brain, allows a representation of this maturation process. Similarly, the brain’s connections become disorganized. The connectome gathers structural and anatomical white matter fibers, as well as functional networks referring to remote brain regions connected one over another. Structural and functional connectivity is illustrated by tractography and functional MRI, respectively. Their organizations consist of core nodes connected by edges. This basic distribution is already established in the fetal brain. It evolves greatly over time but is compromised by prematurity. Finally, cerebral plasticity is nurtured by a lifetime experience at microstructural and macrostructural scales. A preterm birth causes a negative and early disruption, though it can be partly mitigated by positive stimuli based on developmental neonatal care.
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Affiliation(s)
- Philippe Vo Van
- Department of Neonatology, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59 Boulevard Pinel, 69500 Bron, France
- Correspondence:
| | - Marianne Alison
- Service d’Imagerie Pédiatrique, Hôpital Robert Debré, APHP, 75019 Paris, France;
- U1141 Neurodiderot, Équipe 5 inDev, Inserm, CEA, Université de Paris, 75019 Paris, France;
| | - Baptiste Morel
- Pediatric Radiology Department, Clocheville Hospital, CHRU of Tours, 37000 Tours, France;
- UMR 1253, iB-Rain, Université de Tours, Inserm, 37000 Tours, France
| | - Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (N.B.); (G.L.)
- CReSTIC EA 3804, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (N.B.); (G.L.)
- CReSTIC EA 3804, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Lucie Hertz-Pannier
- U1141 Neurodiderot, Équipe 5 inDev, Inserm, CEA, Université de Paris, 75019 Paris, France;
- NeuroSpin, CEA-Saclay, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (N.B.); (G.L.)
- CReSTIC EA 3804, Université de Reims Champagne Ardenne, 51100 Reims, France
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9
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Rosenbaum J, Ceyte H, Hamon I, Deforge H, Hascoët AMJ, Caudron S, Hascoët JM. Influence of body mobility on attention networks in school-aged prematurely born children: A controlled trial. Front Pediatr 2022; 10:928541. [PMID: 36160773 PMCID: PMC9492848 DOI: 10.3389/fped.2022.928541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
School-aged prematurely born children (PC) have a higher risk of academic difficulties, which may be partly explained by attention difficulties. It has been suggested that children's attentional performance might be influenced by their body posture and spontaneous body motion. The aim of this study (ClinicalTrials.gov - NCT03125447) was to test the influence of three body mobility conditions on the three functions of attention (alertness, orienting, and executive control) among school-aged PC vs. term-born children (TC). Notably, 21 PC and 21 TC performed the Attention Network Test for Children in three body mobility conditions, namely, sitting and standing imposed fixed postures and a free-to-move condition. The children's median reaction times were compared between trials (1) with and without alerting cues, (2) with valid and invalid orienting cues, and (3) with and without distracting information, to calculate the performance of alertness, orienting, and executive control, respectively. Results showed that with distracting information, PC exhibited significantly slower responses in the standing-still posture than in the sitting-still posture (1,077 ± 240 vs. 1,175 ± 273 ms, p < 0.05), but not TC. No difference was observed with the free-to-move condition. PC and TC did not significantly differ in alertness or orienting, regardless of body mobility condition. These data suggest that PC must use executive resources to stand still and maintain position, which impairs their performance during executive tasks. We speculate that these results may be related to less developed postural control and motor inhibition in PC.
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Affiliation(s)
- Joëlle Rosenbaum
- Développement, Adaptation et Handicap Laboratory (DevAH), Université de Lorraine, Nancy, France
| | - Hadrien Ceyte
- Développement, Adaptation et Handicap Laboratory (DevAH), Université de Lorraine, Nancy, France.,Aix-Marseille University, CNRS, ISM, Marseille, France
| | - Isabelle Hamon
- Développement, Adaptation et Handicap Laboratory (DevAH), Université de Lorraine, Nancy, France.,CHRU, Maternité Régionale, Nancy, France
| | - Hélène Deforge
- Développement, Adaptation et Handicap Laboratory (DevAH), Université de Lorraine, Nancy, France.,CHRU, Maternité Régionale, Nancy, France
| | - Alexandre M J Hascoët
- Développement, Adaptation et Handicap Laboratory (DevAH), Université de Lorraine, Nancy, France.,CHRU, Maternité Régionale, Nancy, France
| | - Sébastien Caudron
- CNRS, LPNC, Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Jean-Michel Hascoët
- Développement, Adaptation et Handicap Laboratory (DevAH), Université de Lorraine, Nancy, France.,CHRU, Maternité Régionale, Nancy, France
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10
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Gamage TKJB, Fraser M. The Role of Extracellular Vesicles in the Developing Brain: Current Perspective and Promising Source of Biomarkers and Therapy for Perinatal Brain Injury. Front Neurosci 2021; 15:744840. [PMID: 34630028 PMCID: PMC8498217 DOI: 10.3389/fnins.2021.744840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
This comprehensive review focuses on our current understanding of the proposed physiological and pathological functions of extracellular vesicles (EVs) in the developing brain. Furthermore, since EVs have attracted great interest as potential novel cell-free therapeutics, we discuss advances in the knowledge of stem cell- and astrocyte-derived EVs in relation to their potential for protection and repair following perinatal brain injury. This review identified 13 peer-reviewed studies evaluating the efficacy of EVs in animal models of perinatal brain injury; 12/13 utilized mesenchymal stem cell-derived EVs (MSC-EVs) and 1/13 utilized astrocyte-derived EVs. Animal model, method of EV isolation and size, route, timing, and dose administered varied between studies. Notwithstanding, EV treatment either improved and/or preserved perinatal brain structures both macroscopically and microscopically. Additionally, EV treatment modulated inflammatory responses and improved brain function. Collectively this suggests EVs can ameliorate, or repair damage associated with perinatal brain injury. These findings warrant further investigation to identify the optimal cell numbers, source, and dosage regimens of EVs, including long-term effects on functional outcomes.
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Affiliation(s)
- Teena K J B Gamage
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Mhoyra Fraser
- Department of Physiology, The University of Auckland, Auckland, New Zealand
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11
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Bugada MC, Kline JE, Parikh NA. Microstructural Measures of the Inferior Longitudinal Fasciculus Predict Later Cognitive and Language Development in Infants Born With Extremely Low Birth Weight. J Child Neurol 2021; 36:981-989. [PMID: 34187223 PMCID: PMC8458222 DOI: 10.1177/08830738211019862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Extremely preterm children are at high risk for adverse neurodevelopmental outcomes. Identifying predictors of discrete developmental outcomes early in life would allow for targeted neuroprotective therapies when neuroplasticity is at its peak. Our goal was to examine whether diffusion magnetic resonance imaging (MRI) metrics of the inferior longitudinal and uncinate fasciculi early in life could predict later cognitive and language outcomes. STUDY DESIGN In this pilot study, 43 extremely low-birth-weight preterm infants were scanned using diffusion MRI at term-equivalent age. White matter tracts were assessed via diffusion tensor imaging metrics of fractional anisotropy and mean diffusivity. The Language and Cognitive subscale scores of the Bayley Scales of Infant & Toddler Development-III at 18-22 months corrected age were our outcomes of interest. Multiple linear regression models were created to assess diffusion metrics of the inferior longitudinal and uncinate fasciculi as predictors of Bayley scores. We controlled for brain injury score on structural MRI, maternal education, birth weight, and age at MRI scan. RESULTS Of the 43 infants, 36 infants had high-quality diffusion tensor imaging and returned for developmental testing. The fractional anisotropy of the inferior longitudinal fasciculus was associated with Bayley-III scores in univariate analyses and was an independent predictor of Bayley-III cognitive and language development over and above known predictors in multivariable analyses. CONCLUSIONS Incorporating new biomarkers such as the fractional anisotropy of the inferior longitudinal fasciculus with structural MRI findings could enhance accuracy of neurodevelopment predictive models. Additional research is needed to validate our findings in a larger cohort.
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Affiliation(s)
- Matthew C. Bugada
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julia E. Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nehal A. Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
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12
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Ginnell L, Boardman JP, Reynolds RM, Fletcher‐Watson S. Attention profiles following preterm birth: A review of methods and findings from infancy to adulthood. INFANT AND CHILD DEVELOPMENT 2021. [DOI: 10.1002/icd.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lorna Ginnell
- Centre for Clinical Brain Sciences The University of Edinburgh Edinburgh UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute The University of Edinburgh Edinburgh UK
| | - Rebecca M. Reynolds
- Centre for Cardiovascular Science, The Queen's Medical Research Institute The University of Edinburgh Edinburgh UK
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13
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Kennedy E, Poppe T, Tottman A, Harding J. Neurodevelopmental impairment is associated with altered white matter development in a cohort of school-aged children born very preterm. NEUROIMAGE-CLINICAL 2021; 31:102730. [PMID: 34174689 PMCID: PMC8246637 DOI: 10.1016/j.nicl.2021.102730] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 01/02/2023]
Abstract
Over 30% of children born VPT have neurodevelopmental impairment. VPT children with neurodevelopmental impairment have smaller total brain volume. VPT children with neurodevelopmental impairment have lower FA and higher RD. Neurodevelopmental impairment in a VPT cohort may reflect altered microstructure.
Individuals born very preterm (<32 weeks gestation) have altered brain growth and white matter maturation relative to their full-term peers, and approximately 30% will experience neurodevelopmental impairment. We investigated the relationship between neurodevelopmental impairment and MRI measures of white matter microstructure and brain volume. Children born before 30 weeks’ gestation or who had very low birthweight (< 1500 g) underwent neurodevelopmental assessment and MRI at age 7 years as part of the PIANO study, a New Zealand-based cohort study. Fractional anisotropy (FA) and diffusivity measures were derived from diffusion tensor imaging to index white matter microstructure. Volumes were derived from T1-weighted imaging. Neurodevelopmental impairment was defined as a score < 85 on the Wechsler Intelligence Scale for Children, <5th centile on the Movement Assessment Battery for Children or a diagnosis of cerebral palsy by a paediatrician. Relationships between MRI and neurodevelopmental impairment were assessed with general linear models adjusted for sex, gestational age at birth, birthweight z-score, age at assessment, New Zealand Deprivation index score and multiplicity. Children with neurodevelopmental impairment (n = 38) had smaller total brain, cortical grey matter and cerebral white matter volumes compared to children without neurodevelopmental impairment (n = 62) (p < 0.05, false discovery rate corrected), but the regional volume differences did not remain significant after adjustment for total brain volume. Lower FA and higher radial diffusivity were observed in the superior longitudinal fasciculi, uncinate fasciculi and right hemisphere corticospinal tract in children with neurodevelopmental impairment. This may reflect differences in cellular properties such as myelination or axonal packing. Neurodevelopmental impairment may reflect smaller overall brain volume and altered microstructure in white matter tracts that are important for language, cognitive and motor functioning.
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Affiliation(s)
- Eleanor Kennedy
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Tanya Poppe
- Liggins Institute, University of Auckland, Auckland, New Zealand; Centre for the Developing Brain, Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Anna Tottman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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14
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Kelly CE, Thompson DK, Cooper M, Pham J, Nguyen TD, Yang JY, Ball G, Adamson C, Murray AL, Chen J, Inder TE, Cheong JL, Doyle LW, Anderson PJ. White matter tracts related to memory and emotion in very preterm children. Pediatr Res 2021; 89:1452-1460. [PMID: 32920605 PMCID: PMC7954988 DOI: 10.1038/s41390-020-01134-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Very preterm (VP) children are at risk of memory and emotional impairments; however, the neural correlates remain incompletely defined. This study investigated the effect of VP birth on white matter tracts traditionally related to episodic memory and emotion. METHODS The cingulum, fornix, uncinate fasciculus, medial forebrain bundle and anterior thalamic radiation were reconstructed using tractography in 144 VP children and 33 full-term controls at age 7 years. RESULTS Compared with controls, VP children had higher axial, radial, and mean diffusivities and neurite orientation dispersion, and lower volume and neurite density in the fornix, along with higher neurite orientation dispersion in the medial forebrain bundle. Support vector classification models based on tract measures significantly classified VP children and controls. Higher fractional anisotropy and lower diffusivities in the cingulum, uncinate fasciculus, medial forebrain bundle and anterior thalamic radiation were associated with better episodic memory, independent of key perinatal risk factors. Support vector regression models using tract measures did not predict episodic memory and emotional outcomes. CONCLUSIONS Altered tract structure is related to adverse episodic memory outcomes in VP children, but further research is required to determine the ability of tract structure to predict outcomes of individual children. IMPACT We studied white matter fibre tracts thought to be involved in episodic memory and emotion in VP and full-term children using diffusion magnetic resonance imaging and machine learning. VP children have altered fornix and medial forebrain bundle structure compared with full-term children. Altered tract structure can be detected using machine learning, which accurately classified VP and full-term children using tract data. Altered cingulum, uncinate fasciculus, medial forebrain bundle and anterior thalamic radiation structure was associated with poorer episodic memory skills using linear regression. The ability of tract structure to predict episodic memory and emotional outcomes of individual children based on support vector regression was limited.
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Affiliation(s)
- Claire E. Kelly
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia,Corresponding author: Claire Kelly, Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria, Australia, 3052.
| | - Deanne K. Thompson
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Malcolm Cooper
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jenny Pham
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Thanh D. Nguyen
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Joseph Y.M. Yang
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Australia,Neuroscience Advanced Clinical Imaging Suite (NACIS), Department of Neurosurgery, The Royal Children’s Hospital, Melbourne, Australia,Neuroscience Research, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Gareth Ball
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Chris Adamson
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Andrea L. Murray
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Jeanie L.Y. Cheong
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Newborn Research, The Royal Women’s Hospital, Melbourne, Australia,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Lex W. Doyle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Australia,Newborn Research, The Royal Women’s Hospital, Melbourne, Australia,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Peter J. Anderson
- Victorian Infant Brain Studies (VIBeS), Murdoch Children’s Research Institute, Melbourne, Australia,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia
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15
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Dean B, Ginnell L, Boardman JP, Fletcher-Watson S. Social cognition following preterm birth: A systematic review. Neurosci Biobehav Rev 2021; 124:151-167. [PMID: 33524414 DOI: 10.1016/j.neubiorev.2021.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 01/15/2023]
Abstract
Social cognitive abilities are affected by preterm birth, but pathways to, and risk factors for this outcome are not well mapped. We examined direct assessment tasks including objective coding of parent-child play to chart social development in infancy and pre-school years. A systematic search and data-extraction procedure yielded seventy-nine studies (4930 preterm and 2109 term children, aged birth - five years), for inclusion. We detected a pattern of reduced social attention in the first 12 months of life with evidence of reduced performance in social cognitive tasks later in the preschool years. However, we did not identify a consistent, distinctive preterm social phenotype in early life. Instead, the interactive behaviour of preterm infants reflects factors from outside the social cognitive domain, such as attention, language, and socioeconomic status. By combining data across samples and measures we revealed the role of domain-general skills, which may in future prove fruitful intervention targets.
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Affiliation(s)
- Bethan Dean
- MRC Centre for Reproductive Health, University of Edinburgh, UK
| | - Lorna Ginnell
- MRC Centre for Reproductive Health, University of Edinburgh, UK
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16
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Jaeger DA, Gawehn N, Schneider DT, Suchan B. Phasic and tonic alertness in preterm 5-year-old healthy children. Child Neuropsychol 2021; 27:1073-1087. [PMID: 33899687 DOI: 10.1080/09297049.2021.1919297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Preterm delivery may interrupt the intrauterine brain development and implies a risk factor for the developing brain. In the long term, most frequently particular forms of attention deficits are described which refer to the basic aspects of attention i.e., arousal or tonic alertness. As this reflects top-down processes, the current study focuses on bottom-up processed phasic alertness in preschool aged preterm children. Additionally, we made a division of response times into decision and movement time to quantify more exactly the contribution of cognitive and motor performance to reaction times. We investigated basic aspects of attention functioning and contrasted phasic and tonic alertness in 31 low-risk healthy preterm (28-36 weeks of gestation) and 22 term children of five to 6 years of age by using a self-designed computerized test. Preterm children exhibited delayed decision and reaction time in the tonic non-cued alertness condition but not in the phasic cued alertness condition compared to term children. Current results suggest that preterm birth, even when clinically relevant symptoms are absent, may have long-term consequences on basic aspects of attention functioning. Results further suggest that preterm children may profit from auditory cues to overcome these deviations, which yield evidence for a clear distinction between impaired top-down and intact bottom-up controlled processes. These findings might provide a promising groundwork for the development of therapeutical interventions and prevention strategies, whose use and impact to support preterm children should be addressed in further investigations.
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Affiliation(s)
- Dominique A Jaeger
- Outpatients´ Department for Developmental Neuropsychology, Department of Social Paediatrics and Neuropediatrics, Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Nina Gawehn
- University of Health Sciences, Bochum, Germany
| | | | - Boris Suchan
- Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University Bochum, Bochum, Germany
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17
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Advances in functional and diffusion neuroimaging research into the long-term consequences of very preterm birth. J Perinatol 2021; 41:689-706. [PMID: 33099576 DOI: 10.1038/s41372-020-00865-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022]
Abstract
Very preterm birth (<32 weeks of gestation) has been associated with lifelong difficulties in a variety of neurocognitive functions. Magnetic resonance imaging (MRI) combined with advanced analytical approaches have been employed in order to increase our understanding of the neurodevelopmental problems that many very preterm born individuals face as they grow up. In this review, we will focus on two novel imaging techniques that have explored relationships between specific brain mechanisms and behavioural outcomes. These are functional MRI, which maps regional, time-varying changes in brain metabolism and diffusion-weighted MRI, which measures the displacement of water molecules in tissue and provides quantitative information about tissue microstructure. Identifying the neurobiological underpinning of the long-term sequelae associated with very preterm birth could inform the development and implementation of preventative interventions (before any cognitive problem emerges) and could facilitate the identification of behavioural targets for improving the life course outcomes of very preterm individuals.
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18
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Cainelli E, Vedovelli L, Wigley ILCM, Bisiacchi PS, Suppiej A. Neonatal spectral EEG is prognostic of cognitive abilities at school age in premature infants without overt brain damage. Eur J Pediatr 2021; 180:909-918. [PMID: 32989487 PMCID: PMC7886838 DOI: 10.1007/s00431-020-03818-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
Prematurity is a prototype of biological risk that could affect the late neurocognitive outcome; however, the condition itself remains a non-specific marker. This longitudinal 6-year study aimed to evaluate the prognostic role of neonatal spectral EEG in premature infants without neurological complications. The study cohort was 26 children born 23-34 gestational ages; all neonates underwent multichannel EEG recordings at 35 weeks post-conception. EEG data were transformed into the frequency domain and divided into delta (0.5-4 Hz), theta (5-7 Hz), alpha (8-13 Hz), and beta (14-20 Hz) frequency bands. At 6 years, a neuropsychological and behavioral evaluation was performed. Correlations between spectral bands and neuropsychological assessments were performed with a conservative and robust Bayesian correlation model using weakly informative priors. The correlation of neuropsychological tasks to spectral frequency bands highlighted a significant association with visual and auditory attention tests. The performance on the same tests appears to be mainly impaired.Conclusions: We found that spectral EEG frequencies are independent predictors of performance in attention tasks. We hypothesized that spectral EEG might reflect early circuitries' imbalance in the reticular ascending system and cumulative effect on ongoing development, pointing to the importance of early prognostic instruments. What is Known: • Prematurity is a non-specific marker of late neurocognitive risk. • Precise prognostic instruments are lacking, mostly in patients with low-grade conditions. What is New: • Longitudinal long-term studies are scarce but crucial for the inferential attributive process. • Spectral EEG frequencies are independent predictors of performance in attention tasks.
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Affiliation(s)
- Elisa Cainelli
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy
- Child Neurology and Clinical Neurophysiology, Padua University Hospital, via Giustiniani 3, 35133 Padova, Italy
| | - Luca Vedovelli
- Lab LeSexp, Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, via Loredan 18, 35131 Padova, Italy
| | | | - Patrizia Silvia Bisiacchi
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy
- Padova Neuroscience Centre, PNC, Padova, Italy
| | - Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Padua University Hospital, via Giustiniani 3, 35133 Padova, Italy
- Department of Medical Sciences, Pediatric Section, University of Ferrara, via Aldo Moro 8, 44124 Cona, Fe Italy
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19
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Yang F, Li Y, Sheng X, Liu Y. Paeoniflorin treatment regulates TLR4/NF-κB signaling, reduces cerebral oxidative stress and improves white matter integrity in neonatal hypoxic brain injury. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2021; 25:97-109. [PMID: 33602880 PMCID: PMC7893490 DOI: 10.4196/kjpp.2021.25.2.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 02/04/2023]
Abstract
Neonatal hypoxia/ischemia (H/I), injures white matter, results in neuronal loss, disturbs myelin formation, and neural network development. Neuroinflammation and oxidative stress have been reported in neonatal hypoxic brain injuries. We investigated whether Paeoniflorin treatment reduced H/I-induced inflammation and oxidative stress and improved white matter integrity in a neonatal rodent model. Seven-day old Sprague–Dawley pups were exposed to H/I. Paeoniflorin (6.25, 12.5, or 25 mg/kg body weight) was administered every day via oral gavage from postpartum day 3 (P3) to P14, and an hour before induction of H/I. Pups were sacrificed 24 h (P8) and 72 h (P10) following H/I. Paeoniflorin reduced the apoptosis of neurons and attenuated cerebral infarct volume. Elevated expression of cleaved caspase-3 and Bad were regulated. Paeoniflorin decreased oxidative stress by lowering levels of malondialdehyde and reactive oxygen species generation and while, and it enhanced glutathione content. Microglial activation and the TLR4/NF-κB signaling were significantly down-regulated. The degree of inflammatory mediators (interleukin 1β and tumor necrosis factor-α) were reduced. Paeoniflorin markedly prevented white matter injury via improving expression of myelin binding protein and increasing O1-positive olidgodendrocyte and O4-positive oligodendrocyte counts. The present investigation demonstrates the potent protective efficiency of paeoniflorin supplementation against H/I-induced brain injury by effectually preventing neuronal loss, microglial activation, and white matter injury via reducing oxidative stress and inflammatory pathways.
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Affiliation(s)
- Fan Yang
- Department of Clinical Nutrition, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Ya Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China.,Yunnan Institute of Laboratory Diagnosis, Kunming 650032, Yunnan, China.,Yunnan Key Laboratory of Laboratory Medicine, Kunming 650032, Yunnan, China
| | - Xun Sheng
- School of Stomatology, Kunming Medical University, Kunming 650032, Yunnan, China
| | - Yu Liu
- Department of Pharmacy, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
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20
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Lammertink F, Vinkers CH, Tataranno ML, Benders MJNL. Premature Birth and Developmental Programming: Mechanisms of Resilience and Vulnerability. Front Psychiatry 2021; 11:531571. [PMID: 33488409 PMCID: PMC7820177 DOI: 10.3389/fpsyt.2020.531571] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
The third trimester of pregnancy represents a sensitive phase for infant brain plasticity when a series of fast-developing cellular events (synaptogenesis, neuronal migration, and myelination) regulates the development of neural circuits. Throughout this dynamic period of growth and development, the human brain is susceptible to stress. Preterm infants are born with an immature brain and are, while admitted to the neonatal intensive care unit, precociously exposed to stressful procedures. Postnatal stress may contribute to altered programming of the brain, including key systems such as the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. These neurobiological systems are promising markers for the etiology of several affective and social psychopathologies. As preterm birth interferes with early development of stress-regulatory systems, early interventions might strengthen resilience factors and might help reduce the detrimental effects of chronic stress exposure. Here we will review the impact of stress following premature birth on the programming of neurobiological systems and discuss possible stress-related neural circuits and pathways involved in resilience and vulnerability. Finally, we discuss opportunities for early intervention and future studies.
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Affiliation(s)
- Femke Lammertink
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Christiaan H. Vinkers
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Maria L. Tataranno
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Wheelock MD, Lean RE, Bora S, Melzer TR, Eggebrecht AT, Smyser CD, Woodward LJ. Functional Connectivity Network Disruption Underlies Domain-Specific Impairments in Attention for Children Born Very Preterm. Cereb Cortex 2021; 31:1383-1394. [PMID: 33067997 PMCID: PMC8179512 DOI: 10.1093/cercor/bhaa303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 01/17/2023] Open
Abstract
Attention problems are common in school-age children born very preterm (VPT; < 32 weeks gestational age), but the contribution of aberrant functional brain connectivity to these problems is not known. As part of a prospective longitudinal study, brain functional connectivity (fc) was assessed alongside behavioral measures of selective, sustained, and executive attention in 58 VPT and 65 full-term (FT) born children at corrected-age 12 years. VPT children had poorer sustained, shifting, and divided attention than FT children. Within the VPT group, poorer attention scores were associated with between-network connectivity in ventral attention, visual, and subcortical networks, whereas between-network connectivity in the frontoparietal, cingulo-opercular, dorsal attention, salience and motor networks was associated with attention functioning in FT children. Network-level differences were also evident between VPT and FT children in specific attention domains. Findings contribute to our understanding of fc networks that potentially underlie typical attention development and suggest an alternative network architecture may help support attention in VPT children.
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Affiliation(s)
- M D Wheelock
- Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - R E Lean
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - S Bora
- Mothers, Babies, and Women’s Health Program, Mater Research Institute, University of Queensland, South Brisbane, Australia
| | - T R Melzer
- Department of Medicine, University of Otago, New Zealand Brain Research Institute, Christchurch 8011, New Zealand
| | - A T Eggebrecht
- Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - C D Smyser
- Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - L J Woodward
- School of Health Sciences and Child Wellbeing Research Institute, University of Canterbury, Christchurch 8041, New Zealand
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22
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Executive function training in very preterm children: a randomized controlled trial. Eur Child Adolesc Psychiatry 2021; 30:785-797. [PMID: 32458091 PMCID: PMC7250540 DOI: 10.1007/s00787-020-01561-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/15/2020] [Indexed: 11/20/2022]
Abstract
Objective of the current study was to assess whether game-formatted executive function (EF) training, is effective in improving attention, EF and academic performance in very preterm and/or extremely low birthweight children aged 8-12 years. A multi-center, double-blind, placebo- and waitlist controlled randomized trial (NTR5365) in two academic hospitals in The Netherlands was performed. Eighty-five very preterm children with parent-rated attention problems on the Child Behavior Checklist were randomized to one of three treatment conditions: EF training, placebo training or waitlist condition. EF or placebo training was completed at home (6 weeks, 25 sessions of 30-45 min each). At baseline, 2 weeks after training or being on the waitlist, and five months after first follow-up visit, children underwent assessments of primary outcomes (parent and teacher ratings of attention) and secondary outcomes (parent and teacher ratings of daily-life EF, computerized EF tasks and academic performance). Linear mixed model analyses were performed for all outcome measures. There were no significant differences in improvement over time on parent- and teacher ratings of attention, parent- and teacher ratings of daily-life EF, computerized EF tasks, and academic performance (arithmetic and reading) between the EF training, placebo training and waitlist condition. In conclusion, game-formatted EF training does not improve attention, EF or academic performance in very preterm children with parent-rated attention problems.
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Kallankari H, Saunavaara V, Parkkola R, Haataja L, Hallman M, Kaukola T. Diffusion tensor imaging in frontostriatal tracts is associated with executive functioning in very preterm children at 9 years of age. Pediatr Radiol 2021; 51:112-118. [PMID: 32870358 PMCID: PMC7796865 DOI: 10.1007/s00247-020-04802-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/27/2020] [Accepted: 08/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Very preterm birth can disturb brain maturation and subject these high-risk children to neurocognitive difficulties later. OBJECTIVE The aim of the study was to evaluate the impact of prematurity on microstructure of frontostriatal tracts in children with no severe neurologic impairment, and to study whether the diffusion tensor imaging metrics of frontostriatal tracts correlate to executive functioning. MATERIALS AND METHODS The prospective cohort study comprised 54 very preterm children (mean gestational age 28.8 weeks) and 20 age- and gender-matched term children. None of the children had severe neurologic impairment. The children underwent diffusion tensor imaging and neuropsychological assessments at a mean age of 9 years. We measured quantitative diffusion tensor imaging metrics of frontostriatal tracts using probabilistic tractography. We also administered five subtests from the Developmental Neuropsychological Assessment, Second Edition, to evaluate executive functioning. RESULTS Very preterm children had significantly higher fractional anisotropy and axial diffusivity values (P<0.05, corrected for multiple comparison) in dorsolateral prefrontal caudate and ventrolateral prefrontal caudate tracts as compared to term-born children. We found negative correlations between the diffusion tensor imaging metrics of frontostriatal tracts and inhibition functions (P<0.05, corrected for multiple comparison) in very preterm children. CONCLUSION Prematurity has a long-term effect on frontostriatal white matter microstructure that might contribute to difficulties in executive functioning.
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Affiliation(s)
- Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,Department of Child Neurology, Oulu University Hospital, P.O. Box 23, FIN-90029 OYS, Oulu, Finland.
| | - Virva Saunavaara
- PET Center, Turku University Hospital, Turku, Finland ,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Department of Child Neurology, Children and Adolescents, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Department of Neonatology, Oulu University Hospital, Oulu, Finland
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24
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Jeukens-Visser M, Koldewijn K, van Wassenaer-Leemhuis AG, Flierman M, Nollet F, Wolf MJ. Development and nationwide implementation of a postdischarge responsive parenting intervention program for very preterm born children: The TOP program. Infant Ment Health J 2020; 42:423-437. [PMID: 33336859 PMCID: PMC8247046 DOI: 10.1002/imhj.21902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A previous randomized controlled trial has suggested the effectiveness of a Dutch postdischarge responsive parenting program for very preterm (VPT) infants, indicating that nationwide implementation was justified. This paper describes the development and nationwide implementation of the intervention, known as the TOP program, which consisted of three phases. In the preparation phase (2006-2010), a theory of change and the structure of the TOP program were developed, and funding for phase two, based on a positive Business Case, was obtained. In the pilot implementation phase (2010-2014), intervention strategies were developed for a real-world setting, capacity and adoption were increased, systematic evaluations were incorporated, and sustained funding was obtained. In the full-implementation phase (2014-2019), all Dutch Healthcare Insurers reimbursed the TOP program, enabling VPT infants to participate in the program without charge. By 2018, the number of interventionists that provided the TOP program had increased from 37 to 91, and all level III hospitals and 65% of regional hospitals in the Netherlands referred VPT infants. Currently, the program reaches 70% of the Dutch target population and parental satisfaction with the TOP program is high. After a 12-year implementation period, the TOP program forms part of routine care in the Netherlands.
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Affiliation(s)
- Martine Jeukens-Visser
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Koldewijn
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Emma Children's Hospital, Amsterdam UMC, Department of Neonatology, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Monique Flierman
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Jeanne Wolf
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, The Netherlands
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25
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Lee HJ, Kwon H, Kim JI, Lee JY, Lee JY, Bang S, Lee JM. The cingulum in very preterm infants relates to language and social-emotional impairment at 2 years of term-equivalent age. NEUROIMAGE-CLINICAL 2020; 29:102528. [PMID: 33338967 PMCID: PMC7750449 DOI: 10.1016/j.nicl.2020.102528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/15/2020] [Accepted: 12/04/2020] [Indexed: 01/25/2023]
Abstract
Maturation of specific WM tracts in preterm individuals differs from those of term controls. The elastic net logistic regression model was used to identify altered white matter tracts in the preterm brain. The alteration of the cingulum in the preterm at near-term correlate with neurodevelopmental scores at 18–22 months of age.
Background Relative to full-term infants, very preterm infants exhibit disrupted white matter (WM) maturation and problems related to development, including motor, cognitive, social-emotional, and receptive and expressive language processing. Objective The present study aimed to determine whether regional abnormalities in the WM microstructure of very preterm infants, as defined relative to those of full-term infants at a near-term age, are associated with neurodevelopmental outcomes at the age of 18–22 months. Methods We prospectively enrolled 89 very preterm infants (birth weight < 1500 g) and 43 normal full-term control infants born between 2016 and 2018. All infants underwent a structural brain magnetic resonance imaging scan at near-term age. The diffusion tensor imaging (DTI) metrics of the whole-brain WM tracts were extracted based on the neonatal probabilistic WM pathway. The elastic net logistic regression model was used to identify altered WM tracts in the preterm brain. We evaluated the associations between the altered WM microstructure at near-term age and motor, cognitive, social-emotional, and receptive and expressive language developments at 18–22 months of age, as measured using the Bayley Scales of Infant Development, Third Edition. Results We found that the elastic net logistic regression model could classify preterm and full-term neonates with an accuracy of 87.9% (corrected p < 0.008) using the DTI metrics in the pathway of interest with a 10% threshold level. The fractional anisotropy (FA) values of the body and splenium of the corpus callosum, middle cerebellar peduncle, left and right uncinate fasciculi, and right portion of the pathway between the premotor and primary motor cortices (premotor-PMC), as well as the mean axial diffusivity (AD) values of the left cingulum, were identified as contributive features for classification. Increased adjusted AD values in the left cingulum pathway were significantly correlated with language scores after false discovery rate (FDR) correction (r = 0.217, p = 0.043). The expressive language and social-emotional composite scores showed a significant positive correlation with the AD values in the left cingulum pathway (r = 0.226 [p = 0.036] and r = 0.31 [p = 0.003], respectively) after FDR correction. Conclusion Our approach suggests that the cingulum pathways of very preterm infants differ from those of full-term infants and significantly contribute to the prediction of the subsequent development of the language and social-emotional domains. This finding could improve our understanding of how specific neural substrates influence neurodevelopment at later ages, and individual risk prediction, thus helping to inform early intervention strategies that address developmental delay.
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Affiliation(s)
- Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea; Division of Neonatology and Developmental Medicine, Seoul Hanyang University Hospital, Seoul, South Korea
| | - Hyeokjin Kwon
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University, Seoul, South Korea; Division of Neonatology and Developmental Medicine, Seoul Hanyang University Hospital, Seoul, South Korea
| | - Joo Young Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, South Korea
| | - SungKyu Bang
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
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26
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Treyvaud K, Thompson DK, Kelly CE, Loh WY, Inder TE, Cheong JLY, Doyle LW, Anderson PJ. Early parenting is associated with the developing brains of children born very preterm. Clin Neuropsychol 2020; 35:885-903. [DOI: 10.1080/13854046.2020.1811895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Karli Treyvaud
- Department of Psychology and Counselling, La Trobe University, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
- Newborn Research, Royal Women’s Hospital, Victoria, Australia
| | - Deanne K. Thompson
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Claire E. Kelly
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
| | - Wai Yen Loh
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jeanie L. Y. Cheong
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
- Newborn Research, Royal Women’s Hospital, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Lex W. Doyle
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
- Newborn Research, Royal Women’s Hospital, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Peter J. Anderson
- Clinical Sciences, Murdoch Children’s Research Institute, Victoria, Australia
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
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27
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Schnider B, Disselhoff V, Held U, Latal B, Hagmann CF, Wehrle FM. Executive function deficits mediate the association between very preterm birth and behavioral problems at school-age. Early Hum Dev 2020; 146:105076. [PMID: 32470766 DOI: 10.1016/j.earlhumdev.2020.105076] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Children and adolescents born very preterm are at increased risk to develop executive function deficits and to suffer from social, emotional and attentional problems. This study investigated whether executive function deficits contribute to behavioral problems in children and adolescents born very preterm at school-age. STUDY DESIGN Thirty-eight children and adolescents born very preterm and 41 age-matched term-born peers were assessed at a mean age of 12.9 (±1.8) years with a comprehensive battery of executive function tests, including working memory, planning, cognitive flexibility, and verbal fluency. A composite score was calculated to reflect overall executive function abilities. To assess behavioral problems, parents completed the Strengths and Difficulties Questionnaire (SDQ). Mediation analysis was applied to quantify the effect of preterm birth on behavioral problems with executive function abilities as a mediating variable. RESULTS Executive function abilities were poorer in the very preterm compared to the term-born group (d = 0.62, p = .005) and the parents of very preterm children reported more behavioral problems on the SDQ Total Difficulties Score (d = 0.54, p = .01). The effect of birth status on behavioral problems was significantly mediated by executive function abilities while adjusting for age at assessment, sex, and socioeconomic status (F(2, 76) = 6.42, p = .002, R2 = 0.14). CONCLUSION Results from this study suggest that the increase in behavioral symptoms in very preterm children at school-age compared to term-born peers may partly be explained by their executive function deficits. These findings highlight the importance of continuously monitoring the development of children born very preterm to provide optimal care as they grow up.
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Affiliation(s)
- Barbara Schnider
- University Children's Hospital Zurich, Department of Neonatology and Pediatric Intensive Care, Zurich, Switzerland; University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
| | - Vera Disselhoff
- University Children's Hospital Zurich, Department of Neonatology and Pediatric Intensive Care, Zurich, Switzerland; University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
| | - Ulrike Held
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - Beatrice Latal
- University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Switzerland
| | - Cornelia F Hagmann
- University Children's Hospital Zurich, Department of Neonatology and Pediatric Intensive Care, Zurich, Switzerland; University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
| | - Flavia M Wehrle
- University Children's Hospital Zurich, Department of Neonatology and Pediatric Intensive Care, Zurich, Switzerland; University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Switzerland.
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28
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White matter injury and neurodevelopmental disabilities: A cross-disease (dis)connection. Prog Neurobiol 2020; 193:101845. [PMID: 32505757 DOI: 10.1016/j.pneurobio.2020.101845] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
White matter (WM) injury, once known primarily in preterm newborns, is emerging in its non-focal (diffused), non-necrotic form as a critical component of subtle brain injuries in many early-life diseases like prematurity, intrauterine growth restriction, congenital heart defects, and hypoxic-ischemic encephalopathy. While advances in medical techniques have reduced the number of severe outcomes, the incidence of tardive impairments in complex cognitive functions or psychopathology remains high, with lifelong detrimental effects. The importance of WM in coordinating neuronal assemblies firing and neural groups synchronizing within multiple frequency bands through myelination, even mild alterations in WM structure, may interfere with the cognitive performance that increasing social and learning demands would exploit tardively during children growth. This phenomenon may contribute to explaining longitudinally the high incidence of late-appearing impairments that affect children with a history of perinatal insults. Furthermore, WM abnormalities have been highlighted in several neuropsychiatric disorders, such as autism and schizophrenia. In this review, we gather and organize evidence on how diffused WM injuries contribute to neurodevelopmental disorders through different perinatal diseases and insults. An insight into a possible common, cross-disease, mechanism, neuroimaging and monitoring, biomarkers, and neuroprotective strategies will also be presented.
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29
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Tokariev M, Vuontela V, Lönnberg P, Lano A, Perkola J, Wolford E, Andersson S, Metsäranta M, Carlson S. Altered working memory-related brain responses and white matter microstructure in extremely preterm-born children at school age. Brain Cogn 2019; 136:103615. [PMID: 31563082 DOI: 10.1016/j.bandc.2019.103615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022]
Abstract
Preterm birth poses a risk for neurocognitive and behavioral development. Preterm children, who have not been diagnosed with neurological or cognitive deficits, enter normal schools and are expected to succeed as their term-born peers. Here we tested the hypotheses that despite an uneventful development after preterm birth, these children might exhibit subtle abnormalities in brain function and white-matter microstructure at school-age. We recruited 7.5-year-old children born extremely prematurely (<28 weeks' gestation), and age- and gender-matched term-born controls (≥37 weeks' gestation). We applied fMRI during working-memory (WM) tasks, and investigated white-matter microstructure with diffusion tensor imaging. Compared with controls, preterm-born children performed WM tasks less accurately, had reduced activation in several right prefrontal areas, and weaker deactivation of right temporal lobe areas. The weaker prefrontal activation correlated with poorer WM performance. Preterm-born children had higher fractional anisotropy (FA) and lower diffusivity than controls in several white-matter areas, and in the posterior cerebellum, the higher FA associated with poorer visuospatial test scores. In controls, higher FA and lower diffusivity correlated with faster WM performance. Together these findings demonstrate weaker WM-related brain activations and altered white matter microstructure in children born extremely preterm, who had normal global cognitive ability.
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Affiliation(s)
- Maksym Tokariev
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Virve Vuontela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Piia Lönnberg
- Department of Child Neurology, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aulikki Lano
- Department of Child Neurology, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Perkola
- Department of Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Wolford
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Sture Andersson
- Department of Pediatrics, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjo Metsäranta
- Department of Pediatrics, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Synnöve Carlson
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Advanced Magnetic Imaging Centre, Aalto University School of Science, Espoo, Finland.
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30
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Córcoles-Parada M, Giménez-Mateo R, Serrano-Del-Pueblo V, López L, Pérez-Hernández E, Mansilla F, Martínez A, Onsurbe I, San Roman P, Ubero-Martinez M, Clayden JD, Clark CA, Muñoz-López M. Born Too Early and Too Small: Higher Order Cognitive Function and Brain at Risk at Ages 8-16. Front Psychol 2019; 10:1942. [PMID: 31551853 PMCID: PMC6743534 DOI: 10.3389/fpsyg.2019.01942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022] Open
Abstract
Prematurity presents a risk for higher order cognitive functions. Some of these deficits manifest later in development, when these functions are expected to mature. However, the causes and consequences of prematurity are still unclear. We conducted a longitudinal study to first identify clinical predictors of ultrasound brain abnormalities in 196 children born very preterm (VP; gestational age ≤32 weeks) and with very low birth weight (VLBW; birth weight ≤1500 g). At ages 8-16, the subset of VP-VLBW children without neurological findings (124) were invited for a neuropsychological assessment and an MRI scan (41 accepted). Of these, 29 met a rigorous criterion for MRI quality and an age, and gender-matched control group (n = 14) was included in this study. The key findings in the VP-VLBW neonates were: (a) 37% of the VP-VLBW neonates had ultrasound brain abnormalities; (b) gestational age and birth weight collectively with hospital course (i.e., days in hospital, neonatal intensive care, mechanical ventilation and with oxygen therapy, surgeries, and retinopathy of prematurity) predicted ultrasound brain abnormalities. At ages 8-16, VP-VLBW children showed: a) lower intelligent quotient (IQ) and executive function; b) decreased gray and white matter (WM) integrity; (c) IQ correlated negatively with cortical thickness in higher order processing cortical areas. In conclusion, our data indicate that facets of executive function and IQ are the most affected in VP-VLBW children likely due to altered higher order cortical areas and underlying WM.
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Affiliation(s)
- Marta Córcoles-Parada
- Human Neuroanatomy Laboratory, School of Medicine and Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain
| | - Rocio Giménez-Mateo
- Human Neuroanatomy Laboratory, School of Medicine and Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain
| | - Victor Serrano-Del-Pueblo
- Human Neuroanatomy Laboratory, School of Medicine and Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain
| | - Leidy López
- Human Neuroanatomy Laboratory, School of Medicine and Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain.,Department of Psychology, University of Area Andina, Bogotá, Colombia
| | | | - Francisco Mansilla
- Radiology Service, Sta. Cristina Clinic and University Hospital of Albacete, Albacete, Spain
| | - Andres Martínez
- Neonatology Service, University Hospital of Albacete, Albacete, Spain
| | - Ignacio Onsurbe
- Paediatric Neurology Service, University Hospital of Albacete, Albacete, Spain
| | - Paloma San Roman
- Child Psychiatry Service, University Hospital of Albacete, Albacete, Spain
| | - Mar Ubero-Martinez
- Human Neuroanatomy Laboratory, School of Medicine and Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain.,Department of Anatomy, Catholic University of Murcia, Murcia, Spain
| | - Jonathan D Clayden
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, London, United Kingdom
| | - Chris A Clark
- Developmental Imaging and Biophysics Section, Institute of Child Health, University College London, London, United Kingdom
| | - Mónica Muñoz-López
- Human Neuroanatomy Laboratory, School of Medicine and Regional Centre for Biomedical Research, University of Castilla-La Mancha, Albacete, Spain.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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31
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White matter microstructure correlates with mathematics but not word reading performance in 13-year-old children born very preterm and full-term. NEUROIMAGE-CLINICAL 2019; 24:101944. [PMID: 31426019 PMCID: PMC6706654 DOI: 10.1016/j.nicl.2019.101944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 01/24/2023]
Abstract
Individuals born very preterm (VPT; <32 weeks' gestational age) are at increased risk of impaired mathematics and word reading performance, as well as widespread white matter microstructural alterations compared with individuals born full term (FT; ≥37 weeks' gestational age). To date, the link between academic performance and white matter microstructure is not well understood. This study aimed to investigate the associations between mathematics and reading performance with white matter microstructure in 114 VPT and 36 FT 13-year-old children. Additionally, we aimed to investigate whether the association of mathematics and reading performance with white matter microstructure in VPT children varied as a function of impairment. To do this, we used diffusion tensor imaging and advanced diffusion modelling techniques (Neurite Orientation Dispersion and Density Imaging and the Spherical Mean Technique), combined with a whole-brain analysis approach (Tract-Based Spatial Statistics). Mathematics performance across VPT and FT groups was positively associated with white matter microstructural measurements of fractional anisotropy and neurite density, and negatively associated with radial and mean diffusivities in widespread, bilateral regions. Furthermore, VPT children with a mathematics impairment (>1 standard deviation below FT mean) had significantly reduced neurite density compared with VPT children without an impairment. Reading performance was not significantly associated with any of the white matter microstructure parameters. Additionally, the associations between white matter microstructure and mathematics and reading performance did not differ significantly between VPT and FT groups. Our findings suggest that alterations in white matter microstructure, and more specifically lower neurite density, are associated with poorer mathematics performance in 13-year-old VPT and FT children. More research is required to understand the association between reading performance and white matter microstructure in 13-year-old children. Diffusion tensor and neurite density metrics were associated with mathematics. Associations were present in very preterm and full-term children. Associations were widespread throughout the white matter microstructure. Decreased neurite density was evident in children with a mathematics impairment. Limited evidence of associations between white matter microstructure and reading.
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Reduction of the event-related potential P3 in preterm born 5-year-old healthy children. Clin Neurophysiol 2019; 130:675-682. [DOI: 10.1016/j.clinph.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/28/2019] [Accepted: 02/10/2019] [Indexed: 11/22/2022]
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Dubner SE, Dodson CK, Marchman VA, Ben-Shachar M, Feldman HM, Travis KE. White matter microstructure and cognitive outcomes in relation to neonatal inflammation in 6-year-old children born preterm. NEUROIMAGE-CLINICAL 2019; 23:101832. [PMID: 31075555 PMCID: PMC6603335 DOI: 10.1016/j.nicl.2019.101832] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive outcomes in preterm (PT) children have been associated with microstructural properties of white matter. PT children who experienced neonatal inflammatory conditions have poorer cognitive outcomes than those who did not. The goal of this study was to contrast white matter microstructure and cognitive outcomes after preterm birth in relation to the presence or absence of severe inflammatory conditions in the neonatal period. METHODS PT children (n = 35), born at gestational age 22-32 weeks, were classified as either PT+ (n = 12) based on a neonatal history of inflammatory conditions, including bronchopulmonary dysplasia, necrotizing enterocolitis or culture positive sepsis, or PT- (n = 23) based on the absence of the three inflammatory conditions. Full term (FT) children (n = 43) served as controls. Participants underwent diffusion MRI and cognitive testing (intelligence, reading, and executive function) at age 6 years. The corpus callosum was segmented into 7 regions using deterministic tractography and based on the cortical projection zones of the callosal fibers. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for each segment. General linear models with planned contrasts assessed group differences in FA, MD and cognitive outcomes. Pearson correlations assessed associations of white matter metrics and cognitive outcome measures. RESULTS FA was significantly lower and MD was significantly higher in PT+ compared to PT- or FT groups in multiple callosal segments, even after adjusting for gestational age. Executive function scores, but not intelligence or reading scores, were less favorable in PT+ than in PT- groups. Among the entire sample, occipital FA was significantly correlated with IQ (r = 0.25, p < 0.05), reading (r = 0.32, p < 0.01), and executive function (r = -0.28, p < 0.05) measures. Anterior frontal FA and superior parietal FA were significantly correlated with executive function (r = -0.25, r = 0.23, respectively, p < 0.05). CONCLUSIONS We observed differences in the white matter microstructure of the corpus callosum and in the cognitive skills of 6-year-old PT children based on their history of neonatal inflammation. Neonatal inflammation is one medical factor that may contribute to variation in long-term neurobiological and neuropsychological outcomes in PT samples.
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Affiliation(s)
- Sarah E Dubner
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cory K Dodson
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Michal Ben-Shachar
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel; Department of English Literature and Linguistics, Bar Ilan University, Ramat Gan, Israel
| | - Heidi M Feldman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine E Travis
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Thomi G, Surbek D, Haesler V, Joerger-Messerli M, Schoeberlein A. Exosomes derived from umbilical cord mesenchymal stem cells reduce microglia-mediated neuroinflammation in perinatal brain injury. Stem Cell Res Ther 2019; 10:105. [PMID: 30898154 PMCID: PMC6429800 DOI: 10.1186/s13287-019-1207-z] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background Preterm newborns are at high risk of developing neurodevelopmental deficits caused by neuroinflammation leading to perinatal brain injury. Human Wharton’s jelly mesenchymal stem cells (hWJ-MSC) derived from the umbilical cord have been suggested to reduce neuroinflammation, in part through the release of extracellular vesicle-like exosomes. Here, we studied whether exosomes derived from hWJ-MSC have anti-inflammatory effects on microglia-mediated neuroinflammation in perinatal brain injury. Methods Using ultracentrifugation, we isolated exosomes from hWJ-MSC culture supernatants. In an in vitro model of neuroinflammation, we stimulated immortalized BV-2 microglia and primary mixed glial cells with lipopolysaccharide (LPS) in the presence or absence of exosomes. In vivo, we introduced brain damage in 3-day-old rat pups and treated them intranasally with hWJ-MSC-derived exosomes. Results hWJ-MSC-derived exosomes dampened the LPS-induced expression of inflammation-related genes by BV-2 microglia and primary mixed glial cells. The secretion of pro-inflammatory cytokines by LPS-stimulated primary mixed glial was inhibited by exosomes as well. Exosomes interfered within the Toll-like receptor 4 signaling of BV-2 microglia, as they prevented the degradation of the NFκB inhibitor IκBα and the phosphorylation of molecules of the mitogen-activated protein kinase family in response to LPS stimulation. Finally, intranasally administered exosomes reached the brain and reduced microglia-mediated neuroinflammation in rats with perinatal brain injury. Conclusions Our data suggest that the administration of hWJ-MSC-derived exosomes represents a promising therapy to prevent and treat perinatal brain injury. Electronic supplementary material The online version of this article (10.1186/s13287-019-1207-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gierin Thomi
- Department of Obstetrics and Feto-maternal Medicine, University Women's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Feto-maternal Medicine, University Women's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Valérie Haesler
- Department of Obstetrics and Feto-maternal Medicine, University Women's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Marianne Joerger-Messerli
- Department of Obstetrics and Feto-maternal Medicine, University Women's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland. .,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.
| | - Andreina Schoeberlein
- Department of Obstetrics and Feto-maternal Medicine, University Women's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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Kooiker MJG, Swarte RMC, Smit LS, Reiss IKM. Perinatal risk factors for visuospatial attention and processing dysfunctions at 1 year of age in children born between 26 and 32 weeks. Early Hum Dev 2019; 130:71-79. [PMID: 30703620 DOI: 10.1016/j.earlhumdev.2019.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 12/03/2018] [Accepted: 01/19/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Children born preterm are at risk of visuospatial attention orienting and processing dysfunctions, which can be quantified early in life using visually-guided eye movement responses. AIMS To identify the prevalence and perinatal risk factors for visuospatial attention orienting and processing dysfunctions in children born preterm of 1 year of corrected age (CA). STUDY DESIGN 123 children born between 26 and 33 weeks of gestation underwent a nonverbal visuospatial test at 1y CA, using an eye tracking-based paradigm. For the detected high-salient (cartoon and contrast), intermediate-salient (form and motion) and low-salient (color) stimuli, we quantified the reaction time to fixation (RTF). RTFs were compared to normative references from an age-matched control group (N = 38). The prevalence of perinatal risk factors (gestational age and weight, indices of neurological damage, overal sickness, respiratory failure, and retinopathy) was compared between the groups with normal and delayed RTFs. RESULTS At 1y CA, the preterm group had 7-20% less detected stimuli than the control group, particularly for intermediate and low-salient stimuli. Compared to normative RTFs, modest delays were found for high-salient cartoon (in 19% of preterm children) and contrast (8%), intermediate-salient motion (23%) and form (21%), and low-salient color stimuli (8%). These children had a significantly higher prevalence of perinatal risk factors for respiratory failure and intraventricular hemorrhages. CONCLUSIONS Children born between 26 and 32 weeks have a modest risk (8-23%) of visuospatial attention and processing dysfunction. This warrants early monitoring and support of general visual development in preterm children at risk of respiratory distress and disrupted cerebral blood flow.
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Affiliation(s)
- M J G Kooiker
- Vestibular and Oculomotor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - R M C Swarte
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, the Netherlands
| | - L S Smit
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, the Netherlands; Department of Neurology, Division of Pediatric Neurology, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, the Netherlands
| | - I K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, the Netherlands
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Xu MY, Wang YF, Wei PJ, Gao YQ, Zhang WT. Hypoxic preconditioning improves long-term functional outcomes after neonatal hypoxia-ischemic injury by restoring white matter integrity and brain development. CNS Neurosci Ther 2019; 25:734-747. [PMID: 30689302 PMCID: PMC6515700 DOI: 10.1111/cns.13102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022] Open
Abstract
Aims Neonatal hypoxia–ischemia (H/I) results in gray and white matter injury, characterized by neuronal loss, failure of neural network formation, retarded myelin formation, and abnormal accumulation of oligodendrocyte progenitor cells (OPCs). These changes lead to severe neurological deficits and mortality. Sublethal hypoxic preconditioning (HPC) can protect the developing brain against H/I. However, limited evidence is available concerning its effect on white matter injury. Methods In this study, P6 neonatal Sprague‐Dawley rats were subjected to normoxic (21% O2) or HPC (7.8% O2) for 3 hours followed 24 hours later by H/I brain injury. Neurological deficits were assessed by gait, righting reflex, foot fault, and Morris water maze tests. Compound action potential of the corpus callosum was recorded 35 days after surgery, and the correlation between axon myelination and neurological function was determined. Results Hypoxic preconditioning significantly attenuated H/I brain injury at 7 days and remarkably improved both sensorimotor and cognitive functional performances up to 35 days after H/I. HPC‐afforded improvement in long‐term neurological outcomes was attributable, at least in part, to restoration of the differentiation and maturation capacity in oligodendrocyte progenitor cells, amelioration of microglia/macrophage activation and neuroinflammation, and continuation of brain development after H/I. Conclusions Hypoxic preconditioning restores white matter repair, development, and functional integrity in developing brain after H/I brain injury.
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Affiliation(s)
- Ming-Yue Xu
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Yang-Fan Wang
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Peng-Ju Wei
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Yan-Qin Gao
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Wen-Ting Zhang
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Rogers CE, Lean RE, Wheelock MD, Smyser CD. Aberrant structural and functional connectivity and neurodevelopmental impairment in preterm children. J Neurodev Disord 2018; 10:38. [PMID: 30541449 PMCID: PMC6291944 DOI: 10.1186/s11689-018-9253-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 11/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Despite advances in antenatal and neonatal care, preterm birth remains a leading cause of neurological disabilities in children. Infants born prematurely, particularly those delivered at the earliest gestational ages, commonly demonstrate increased rates of impairment across multiple neurodevelopmental domains. Indeed, the current literature establishes that preterm birth is a leading risk factor for cerebral palsy, is associated with executive function deficits, increases risk for impaired receptive and expressive language skills, and is linked with higher rates of co-occurring attention deficit hyperactivity disorder, anxiety, and autism spectrum disorders. These same infants also demonstrate elevated rates of aberrant cerebral structural and functional connectivity, with persistent changes evident across advanced magnetic resonance imaging modalities as early as the neonatal period. Emerging findings from cross-sectional and longitudinal investigations increasingly suggest that aberrant connectivity within key functional networks and white matter tracts may underlie the neurodevelopmental impairments common in this population. Main body This review begins by highlighting the elevated rates of neurodevelopmental disorders across domains in this clinical population, describes the patterns of aberrant structural and functional connectivity common in prematurely-born infants and children, and then reviews the increasingly established body of literature delineating the relationship between these brain abnormalities and adverse neurodevelopmental outcomes. We also detail important, typically understudied, clinical, and social variables that may influence these relationships among preterm children, including heritability and psychosocial risks. Conclusion Future work in this domain should continue to leverage longitudinal evaluations of preterm infants which include both neuroimaging and detailed serial neurodevelopmental assessments to further characterize relationships between imaging measures and impairment, information necessary for advancing our understanding of modifiable risk factors underlying these disorders and best practices for improving neurodevelopmental trajectories in this high-risk clinical population.
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Affiliation(s)
- Cynthia E Rogers
- Departments of Psychiatry and Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO, 63110, USA.
| | - Rachel E Lean
- Departments of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO, 63110, USA
| | - Muriah D Wheelock
- Departments of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO, 63110, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA
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Developmental Disorders Among Very Preterm Children. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mürner-Lavanchy IM, Kelly CE, Reidy N, Doyle LW, Lee KJ, Inder T, Thompson DK, Morgan AT, Anderson PJ. White matter microstructure is associated with language in children born very preterm. Neuroimage Clin 2018; 20:808-822. [PMID: 30268990 PMCID: PMC6169247 DOI: 10.1016/j.nicl.2018.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/23/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022]
Abstract
Very preterm birth is associated with altered white matter microstructure and language difficulties, which may compromise communication, social function and academic achievement, but the relationship between these two factors is unclear. The aim of this study was to explore associations between white matter microstructure and language domains of semantics, grammar and phonological awareness at 7-years of age on a whole-brain level and within the arcuate fasciculus, an important language pathway, in very preterm and term-born children. Language was assessed in 145 very preterm-born (<30 weeks' gestation and/or <1250 g birth weight) and 33 term-born children aged 7 years. Fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), axon orientation dispersion and axon density were estimated from diffusion magnetic resonance images also obtained at 7 years. The correlation between diffusion values and language was assessed using Tract-Based Spatial Statistics (TBSS). The arcuate fasciculus was delineated using constrained spherical deconvolution tractography and diffusion parameters from this tract were related to language measures using linear regression. While there was evidence for widespread associations between white matter microstructure and language, there was little evidence of differences in these associations between very preterm and term-born groups. TBSS analyses revealed that higher FA and lower AD, RD, and MD in major fibre tracts, including those subserving language, were associated with better semantic, grammar and phonological awareness performance. Higher axon density in widespread fibre tracts was also associated with better semantic performance. The tractography analyses of the arcuate fasciculus showed some evidence for associations between white matter microstructure and language outcomes. White matter microstructural organisation in widespread fibre tracts, including language-relevant pathways, was associated with language performance in whole-brain and tract-based analyses. The associations were similar for very preterm and term-born groups, despite very preterm children performing more poorly across language domains.
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Affiliation(s)
- Ines M Mürner-Lavanchy
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia; Murdoch Children's Research Institute, Melbourne, Australia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland..
| | - Claire E Kelly
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Natalie Reidy
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Research Office, The Royal Women's Hospital, Melbourne, Australia
| | - Katherine J Lee
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Deanne K Thompson
- Murdoch Children's Research Institute, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Angela T Morgan
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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Abstract
Predicting neurodevelopmental outcomes in high-risk neonates remains challenging despite advances in neonatal care. Early and accurate characterization of infants at risk for neurodevelopmental delays is necessary to best identify those who may benefit from existing early interventions and novel therapies that become available. Although neuroimaging is a promising biomarker in the prediction of neurodevelopmental outcomes in high-risk infants, it requires additional resources and expertise. Despite many advances in neonatal neuroimaging, there remain limitations in relating early neuroimaging findings with long-term outcomes; further studies are necessary to determine the optimal protocols to best identify high-risk patients and improve neurodevelopmental outcome prediction.
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Hung PL, Hsu MH, Yu HR, Wu KLH, Wang FS. Thyroxin Protects White Matter from Hypoxic-Ischemic Insult in the Immature Sprague⁻Dawley Rat Brain by Regulating Periventricular White Matter and Cortex BDNF and CREB Pathways. Int J Mol Sci 2018; 19:ijms19092573. [PMID: 30158497 PMCID: PMC6164053 DOI: 10.3390/ijms19092573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Periventricular white-matter (WM) injury is a prominent feature of brain injury in preterm infants. Thyroxin (T4) treatment reduces the severity of hypoxic-ischemic (HI)-mediated WM injury in the immature brain. This study aimed to delineate molecular events underlying T4 protection following periventricular WM injury in HI rats. Methods: Right common-carotid-artery ligation, followed by hypoxia, was performed on seven-day-old rat pups. The HI pups were injected with saline, or 0.2 or 1 mg/kg of T4 at 48–96 h postoperatively. Cortex and periventricular WM were dissected for real-time (RT)-quantitative polymerase chain reactions (PCRs), immunoblotting, and for immunofluorescence analysis of neurotrophins, myelin, oligodendrocyte precursors, and neointimal. Results: T4 significantly mitigated hypomyelination and oligodendrocyte death in HI pups, whereas angiogenesis of periventricular WM, observed using antiendothelium cell antibody (RECA-1) immunofluorescence and vascular endothelium growth factor (VEGF) immunoblotting, was not affected. T4 also increased the brain-derived neurotrophic factors (BDNFs), but not the nerve growth factor (NGF) expression of injured periventricular WM. However, phosphorylated extracellular signal regulated kinase (p-ERK) and phosphorylated cyclic adenosine monophosphate response element-binding protein (p-CREB) concentrations, but not the BDNF downstream pathway kinases, p38, c-Jun amino-terminal kinase (c-JNK), or Akt, were reduced in periventricular WM with T4 treatment. Notably, T4 administration significantly increased BDNF and phosphorylated CREB in the overlying cortex of the HI-induced injured cortex. Conclusion: Our findings reveal that T4 reversed BNDF signaling to attenuate HI-induced WM injury by activating ERK and CREB pathways in the cortex, but not directly in periventricular WM. This study offers molecular insight into the neuroprotective actions of T4 in HI-mediated WM injury in the immature brain.
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Affiliation(s)
- Pi-Lien Hung
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 33303, Taiwan.
| | - Mei-Hsin Hsu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 33303, Taiwan.
| | - Hong-Ren Yu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 33303, Taiwan.
| | - Kay L H Wu
- Center for Translational Research in Biomedical Sciences, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung 33303, Taiwan.
| | - Feng-Sheng Wang
- Core facility for Phenomics & Diagnostics, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No123, Rd Ta-Pei, Niao-Song District, Kaohsiung 33303, Taiwan.
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Ou X, Glasier CM, Ramakrishnaiah RH, Kanfi A, Rowell AC, Pivik RT, Andres A, Cleves MA, Badger TM. Gestational Age at Birth and Brain White Matter Development in Term-Born Infants and Children. AJNR Am J Neuroradiol 2017; 38:2373-2379. [PMID: 29025726 DOI: 10.3174/ajnr.a5408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Studies on infants and children born preterm have shown that adequate gestational length is critical for brain white matter development. Less is known regarding how variations in gestational age at birth in term infants and children affect white matter development, which was evaluated in this study. MATERIALS AND METHODS Using DTI tract-based spatial statistics methods, we evaluated white matter microstructures in 2 groups of term-born (≥37 weeks of gestation) healthy subjects: 2-week-old infants (n = 44) and 8-year-old children (n = 63). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated by voxelwise and ROI methods and were correlated with gestational age at birth, with potential confounding factors such as postnatal age and sex controlled. RESULTS Fractional anisotropy values, which are markers for white matter microstructural integrity, positively correlated (P < .05, corrected) with gestational age at birth in most major white matter tracts/regions for the term infants. Mean diffusivity values, which are measures of water diffusivities in the brain, and axial and radial diffusivity values, which are markers for axonal growth and myelination, respectively, negatively correlated (P < .05, corrected) with gestational age at birth in all major white matter tracts/regions excluding the body and splenium of the corpus callosum for the term infants. No significant correlations with gestational age were observed for any tracts/regions for the term-born 8-year-old children. CONCLUSIONS Our results indicate that longer gestation during the normal term period is associated with significantly greater infant white matter development (as reflected by higher fractional anisotropy and lower mean diffusivity, axial diffusivity, and radial diffusivity values); however, similar associations were not observable in later childhood.
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Affiliation(s)
- X Ou
- From the Departments of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.)
- Pediatrics (X.O., C.M.G., R.T.P., A.A., M.A.C., T.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Children's Nutrition Center (X.O., R.T.P., A.A., T.M.B.), Little Rock, Arkansas
- Department of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.), Arkansas Children's Hospital, Little Rock, Arkansas
| | - C M Glasier
- From the Departments of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.)
- Pediatrics (X.O., C.M.G., R.T.P., A.A., M.A.C., T.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.), Arkansas Children's Hospital, Little Rock, Arkansas
| | - R H Ramakrishnaiah
- From the Departments of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.)
- Department of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.), Arkansas Children's Hospital, Little Rock, Arkansas
| | - A Kanfi
- From the Departments of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.)
- Department of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.), Arkansas Children's Hospital, Little Rock, Arkansas
| | - A C Rowell
- From the Departments of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.)
- Department of Radiology (X.O., C.M.G., R.H.R., A.K., A.C.R.), Arkansas Children's Hospital, Little Rock, Arkansas
| | - R T Pivik
- Pediatrics (X.O., C.M.G., R.T.P., A.A., M.A.C., T.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Children's Nutrition Center (X.O., R.T.P., A.A., T.M.B.), Little Rock, Arkansas
| | - A Andres
- Pediatrics (X.O., C.M.G., R.T.P., A.A., M.A.C., T.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Children's Nutrition Center (X.O., R.T.P., A.A., T.M.B.), Little Rock, Arkansas
| | - M A Cleves
- Pediatrics (X.O., C.M.G., R.T.P., A.A., M.A.C., T.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - T M Badger
- Pediatrics (X.O., C.M.G., R.T.P., A.A., M.A.C., T.M.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Children's Nutrition Center (X.O., R.T.P., A.A., T.M.B.), Little Rock, Arkansas
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Lee YA. White Matter Injury of Prematurity: Its Mechanisms and Clinical Features. J Pathol Transl Med 2017; 51:449-455. [PMID: 28797157 PMCID: PMC5611534 DOI: 10.4132/jptm.2017.07.25] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 11/17/2022] Open
Abstract
A developing central nervous system is vulnerable to various insults such as infection and ischemia. While increased understanding of the dynamic nature of brain development allows a deeper insight into the pathophysiology of perinatal brain injury, the precise nature of specific fetal and neonatal brain injuries and their short- and long-term clinical consequences need special attention and further elucidation. The current review will describe the pathophysiological aspects and clinical significance of white matter injury of prematurity, a main form of perinatal brain injury in premature newborns, with a particular emphasis on its potential antenatal components.
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Affiliation(s)
- Young Ah Lee
- Division of Pediatric Neurology, Department of Pediatrics, Beaumont Hospital, Oakland University School of Medicine, Royal Oak, MI, USA
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Abstract
OBJECTIVES This study examines the selective, sustained, and executive attention abilities of very preterm (VPT) born children in relation to concurrent structural magnetic resonance imaging (MRI) measures of regional gray matter development at age 12 years. METHODS A regional cohort of 110 VPT (≤32 weeks gestation) and 113 full term (FT) born children were assessed at corrected age 12 years on the Test of Everyday Attention-Children. They also had a structural MRI scan that was subsequently analyzed using voxel-based morphometry to quantify regional between-group differences in cerebral gray matter development, which were then related to attention measures using multivariate methods. RESULTS VPT children obtained similar selective (p=.85), but poorer sustained (p=.02) and executive attention (p=.01) scores than FT children. VPT children were also characterized by reduced gray matter in the bilateral parietal, temporal, prefrontal and posterior cingulate cortices, bilateral thalami, and left hippocampus; and increased gray matter in the occipital and anterior cingulate cortices (family-wise error-corrected p<.05). Poorer sustained auditory attention was associated with increased gray matter in the anterior cingulate cortex (p=.04). Poor executive shifting attention was associated with reduced gray matter in the right superior temporal cortex (p=.04) and bilateral thalami (p=.05). Poorer executive divided attention was associated with reduced gray matter in the occipital (p=.001), posterior cingulate (p=.02), and left temporal (p=.01) cortices; and increased gray matter in the anterior cingulate cortex (p=.001). CONCLUSIONS Disturbances in regional gray matter development appear to contribute, at least in part, to the poorer attentional performance of VPT children at school age. (JINS, 2017, 23, 539-550).
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Toselli B, Tortora D, Severino M, Arnulfo G, Canessa A, Morana G, Rossi A, Fato MM. Improvement in White Matter Tract Reconstruction with Constrained Spherical Deconvolution and Track Density Mapping in Low Angular Resolution Data: A Pediatric Study and Literature Review. Front Pediatr 2017; 5:182. [PMID: 28913326 PMCID: PMC5582070 DOI: 10.3389/fped.2017.00182] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/10/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Diffusion-weighted magnetic resonance imaging (DW-MRI) allows noninvasive investigation of brain structure in vivo. Diffusion tensor imaging (DTI) is a frequently used application of DW-MRI that assumes a single main diffusion direction per voxel, and is therefore not well suited for reconstructing crossing fiber tracts. Among the solutions developed to overcome this problem, constrained spherical deconvolution with probabilistic tractography (CSD-PT) has provided superior quality results in clinical settings on adult subjects; however, it requires particular acquisition parameters and long sequences, which may limit clinical usage in the pediatric age group. The aim of this work was to compare the results of DTI with those of track density imaging (TDI) maps and CSD-PT on data from neonates and children, acquired with low angular resolution and low b-value diffusion sequences commonly used in pediatric clinical MRI examinations. MATERIALS AND METHODS We analyzed DW-MRI studies of 50 children (eight neonates aged 3-28 days, 20 infants aged 1-8 months, and 22 children aged 2-17 years) acquired on a 1.5 T Philips scanner using 34 gradient directions and a b-value of 1,000 s/mm2. Other sequence parameters included 60 axial slices; acquisition matrix, 128 × 128; average scan time, 5:34 min; voxel size, 1.75 mm × 1.75 mm × 2 mm; one b = 0 image. For each subject, we computed principal eigenvector (EV) maps and directionally encoded color TDI maps (DEC-TDI maps) from whole-brain tractograms obtained with CSD-PT; the cerebellar-thalamic, corticopontocerebellar, and corticospinal tracts were reconstructed using both CSD-PT and DTI. Results were compared by two neuroradiologists using a 5-point qualitative score. RESULTS The DEC-TDI maps obtained presented higher anatomical detail than EV maps, as assessed by visual inspection. In all subjects, white matter (WM) tracts were successfully reconstructed using both tractography methodologies. The mean qualitative scores of all tracts obtained with CSD-PT were significantly higher than those obtained with DTI (p-value < 0.05 for all comparisons). CONCLUSION CSD-PT can be successfully applied to DW-MRI studies acquired at 1.5 T with acquisition parameters adapted for pediatric subjects, thus providing TDI maps with greater anatomical detail. This methodology yields satisfactory results for clinical purposes in the pediatric age group.
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Affiliation(s)
- Benedetta Toselli
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | | | - Gabriele Arnulfo
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Massimo Fato
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
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Ostrander B, Bardsley T, Korgenski EK, Greene T, Bonkowsky JL. Neonatal Magnesium Levels Between 24 and 48 Hours of Life and Outcomes for Epilepsy and Motor Impairment in Premature Infants. Pediatr Neurol 2016; 59:41-6. [PMID: 27025188 PMCID: PMC4912928 DOI: 10.1016/j.pediatrneurol.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/24/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Elevated rates of epilepsy and motor impairments including cerebral palsy are observed in children who were born prematurely. Maternal antenatal magnesium supplementation has been associated with decreased rates of cerebral palsy in infants born prematurely. Our objective was to determine whether the neonatal serum magnesium level between 24 and 48 hours after birth is associated with better long-term neurodevelopmental outcomes (epilepsy, motor impairment) in premature infants. METHODS We performed a retrospective cohort analysis in infants born less than 37-weeks gestation over a ten-year period. Prenatal, perinatal, and postnatal clinical and demographic information was collected. Crude and adjusted odds ratios were estimated under generalized linear models with generalized estimating equations to examine the association of the neonatal serum magnesium level between 24 and 48 hours after birth with the risk of epilepsy and/or motor impairment (spasticity; hypotonia; cerebral palsy). RESULTS The final cohort included 5461 infants born less than 37-weeks gestation from 2002 to 2011. The adjusted relative risk ratio for the combined outcomes of epilepsy and/or motor impairment, controlling for gestational age, current age, maternal magnesium supplementation, maternal steroid administration, five-minute Apgar score, neonatal infection, need for vasopressor use, and birth weight and with serum magnesium level as the main independent variable, was 0.85 (P = 0.24). Stratified analyses by gestational age less than 32 or greater than 32 weeks were not significantly associated with adverse neurodevelopmental outcome (risk ratio = 0.79 and 1.2, P = 0.12 and 0.49, respectively). A multivariate analysis for the risk of motor impairment alone had a risk ratio of 0.94 (P = 0.72). CONCLUSION This study demostrates that the neonatal magnesium level between 24 and 48 hours of life in premature infants is not significantly associated with the risk for developing epilepsy or motor impairment.
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Affiliation(s)
- Betsy Ostrander
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Tyler Bardsley
- Department of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Tom Greene
- Department of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah,Address correspondence to: Josh Bonkowsky, Division of Pediatric Neurology, Department of Pediatrics, University of Utah Health Sciences Center, 295 Chipeta Way/Williams Building, Salt Lake City, Utah 84108, , Phone: 801-581-6756, Fax: 801-581-4233
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47
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Kelly CE, Thompson DK, Chen J, Leemans A, Adamson CL, Inder TE, Cheong JLY, Doyle LW, Anderson PJ. Axon density and axon orientation dispersion in children born preterm. Hum Brain Mapp 2016; 37:3080-102. [PMID: 27133221 DOI: 10.1002/hbm.23227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/12/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Very preterm birth (VPT, <32 weeks' gestation) is associated with altered white matter fractional anisotropy (FA), the biological basis of which is uncertain but may relate to changes in axon density and/or dispersion, which can be measured using Neurite Orientation Dispersion and Density Imaging (NODDI). This study aimed to compare whole brain white matter FA, axon dispersion, and axon density between VPT children and controls (born ≥37 weeks' gestation), and to investigate associations with perinatal factors and neurodevelopmental outcomes. METHODS FA, neurite dispersion, and neurite density were estimated from multishell diffusion magnetic resonance images for 145 VPT and 33 control 7-year-olds. Diffusion values were compared between groups and correlated with perinatal factors (gestational age, birthweight, and neonatal brain abnormalities) and neurodevelopmental outcomes (IQ, motor, academic, and behavioral outcomes) using Tract-Based Spatial Statistics. RESULTS Compared with controls, VPT children had lower FA and higher axon dispersion within many major white matter fiber tracts. Neonatal brain abnormalities predicted lower FA and higher axon dispersion in many major tracts in VPT children. Lower FA, higher axon dispersion, and lower axon density in various tracts correlated with poorer neurodevelopmental outcomes in VPT children. CONCLUSIONS FA and NODDI measures distinguished VPT children from controls and were associated with neonatal brain abnormalities and neurodevelopmental outcomes. This study provides a more detailed and biologically meaningful interpretation of white matter microstructure changes associated with prematurity. Hum Brain Mapp 37:3080-3102, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Claire E Kelly
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jian Chen
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Jeanie L Y Cheong
- Murdoch Childrens Research Institute, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Very Early Brain Damage Leads to Remodeling of the Working Memory System in Adulthood: A Combined fMRI/Tractography Study. J Neurosci 2016; 35:15787-99. [PMID: 26631462 DOI: 10.1523/jneurosci.4769-14.2015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The human brain can adapt to overcome injury even years after an initial insult. One hypothesis states that early brain injury survivors, by taking advantage of critical periods of high plasticity during childhood, should recover more successfully than those who suffer injury later in life. This hypothesis has been challenged by recent studies showing worse cognitive outcome in individuals with early brain injury, compared with individuals with later brain injury, with working memory particularly affected. We invited individuals who suffered perinatal brain injury (PBI) for an fMRI/diffusion MRI tractography study of working memory and hypothesized that, 30 years after the initial injury, working memory deficits in the PBI group would remain, despite compensatory activation in areas outside the typical working memory network. Furthermore we hypothesized that the amount of functional reorganization would be related to the level of injury to the dorsal cingulum tract, which connects medial frontal and parietal working memory structures. We found that adults who suffered PBI did not significantly differ from controls in working memory performance. They exhibited less activation in classic frontoparietal working memory areas and a relative overactivation of bilateral perisylvian cortex compared with controls. Structurally, the dorsal cingulum volume and hindrance-modulated orientational anisotropy was significantly reduced in the PBI group. Furthermore there was uniquely in the PBI group a significant negative correlation between the volume of this tract and activation in the bilateral perisylvian cortex and a positive correlation between this activation and task performance. This provides the first evidence of compensatory plasticity of the working memory network following PBI.
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Gopagondanahalli KR, Li J, Fahey MC, Hunt RW, Jenkin G, Miller SL, Malhotra A. Preterm Hypoxic-Ischemic Encephalopathy. Front Pediatr 2016; 4:114. [PMID: 27812521 PMCID: PMC5071348 DOI: 10.3389/fped.2016.00114] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is a recognizable and defined clinical syndrome in term infants that results from a severe or prolonged hypoxic-ischemic episode before or during birth. However, in the preterm infant, defining hypoxic-ischemic injury (HII), its clinical course, monitoring, and outcomes remains complex. Few studies examine preterm HIE, and these are heterogeneous, with variable inclusion criteria and outcomes reported. We examine the available evidence that implies that the incidence of hypoxic-ischemic insult in preterm infants is probably higher than recognized and follows a more complex clinical course, with higher rates of adverse neurological outcomes, compared to term infants. This review aims to elucidate the causes and consequences of preterm hypoxia-ischemia, the subsequent clinical encephalopathy syndrome, diagnostic tools, and outcomes. Finally, we suggest a uniform definition for preterm HIE that may help in identifying infants most at risk of adverse outcomes and amenable to neuroprotective therapies.
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Affiliation(s)
| | - Jingang Li
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia
| | - Michael C Fahey
- Monash Children's Hospital, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Rod W Hunt
- The Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Atul Malhotra
- Monash Children's Hospital, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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