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Basu SK, Kapse KJ, Murnick J, Pradhan S, Spoehr E, Zhang A, Andescavage N, Nino G, du Plessis AJ, Limperopoulos C. Impact of bronchopulmonary dysplasia on brain GABA concentrations in preterm infants: Prospective cohort study. Early Hum Dev 2023; 186:105860. [PMID: 37757548 PMCID: PMC10843009 DOI: 10.1016/j.earlhumdev.2023.105860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is associated with cognitive-behavioral deficits in very preterm (VPT) infants, often in the absence of structural brain injury. Advanced GABA-editing techniques like Mescher-Garwood point resolved spectroscopy (MEGA-PRESS) can quantify in-vivo gamma-aminobutyric acid (GABA+, with macromolecules) and glutamate (Glx, with glutamine) concentrations to investigate for neurophysiologic perturbations in the developing brain of VPT infants. OBJECTIVE To investigate the relationship between the severity of BPD and basal-ganglia GABA+ and Glx concentrations in VPT infants. METHODS MRI studies were performed on a 3 T scanner in a cohort of VPT infants [born ≤32 weeks gestational age (GA)] without major structural brain injury and healthy-term infants (>37 weeks GA) at term-equivalent age. MEGA-PRESS (TE68ms, TR2000ms, 256averages) sequence was acquired from the right basal-ganglia voxel (∼3cm3) and metabolite concentrations were quantified in institutional units (i.u.). We stratified VPT infants into no/mild (grade 0/1) and moderate-severe (grade 2/3) BPD. RESULTS Reliable MEGA-PRESS data was available from 63 subjects: 29 healthy-term and 34 VPT infants without major structural brain injury. VPT infants with moderate-severe BPD (n = 20) had the lowest right basal-ganglia GABA+ (median 1.88 vs. 2.28 vs. 2.12 i.u., p = 0.025) and GABA+/choline (0.73 vs. 0.99 vs. 0.88, p = 0.004) in comparison to infants with no/mild BPD and healthy-term infants. The GABA+/Glx ratio was lower (0.34 vs. 0.44, p = 0.034) in VPT infants with moderate-severe BPD than in infants with no/mild BPD. CONCLUSIONS Reduced GABA+ and GABA+/Glx in VPT infants with moderate-severe BPD indicate neurophysiologic perturbations which could serve as early biomarkers of future cognitive deficits.
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Affiliation(s)
- Sudeepta K Basu
- Neonatology, Children's National Hospital, Washington, D.C., USA; Developing Brain Institute, Children's National Hospital, Washington, D.C., USA; The George Washington University School of Medicine, Washington, D.C., USA
| | - Kushal J Kapse
- Developing Brain Institute, Children's National Hospital, Washington, D.C., USA
| | - Jonathan Murnick
- The George Washington University School of Medicine, Washington, D.C., USA; Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, D.C., USA
| | - Subechhya Pradhan
- Developing Brain Institute, Children's National Hospital, Washington, D.C., USA; The George Washington University School of Medicine, Washington, D.C., USA
| | - Emma Spoehr
- Developing Brain Institute, Children's National Hospital, Washington, D.C., USA
| | - Anqing Zhang
- The George Washington University School of Medicine, Washington, D.C., USA; Division of Biostatistics and Epidemiology, Children's National Hospital, Washington, D.C., USA
| | - Nickie Andescavage
- Neonatology, Children's National Hospital, Washington, D.C., USA; Developing Brain Institute, Children's National Hospital, Washington, D.C., USA; The George Washington University School of Medicine, Washington, D.C., USA; Division of Neurology, Children's National Hospital, Washington, D.C., USA
| | - Gustavo Nino
- The George Washington University School of Medicine, Washington, D.C., USA; Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, D.C., USA
| | - Adre J du Plessis
- The George Washington University School of Medicine, Washington, D.C., USA; Division of Neurology, Children's National Hospital, Washington, D.C., USA; Perinatal Pediatrics institute, Children's National Hospital, Washington, D.C., USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, D.C., USA; The George Washington University School of Medicine, Washington, D.C., USA; Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, D.C., USA; Division of Neurology, Children's National Hospital, Washington, D.C., USA.
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2
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Gay JD, Dangcil E, Nacipucha J, Botrous JE, Suresh N, Tucker A, Carayannopoulos NL, Khan MR, Meng R, Yao JD, Wackym PA, Mowery TM. An Animal Model of Neonatal Intensive Care Unit Exposure to Light and Sound in the Preterm Infant. Integr Comp Biol 2023; 63:585-596. [PMID: 37164937 PMCID: PMC10503467 DOI: 10.1093/icb/icad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
According to the World Health Organization, ∼15 million children are born prematurely each year. Many of these infants end up spending days to weeks in a neonatal intensive care unit (NICU). Infants who are born prematurely are often exposed to noise and light levels that affect their auditory and visual development. Children often have long-term impairments in cognition, visuospatial processing, hearing, and language. We have developed a rodent model of NICU exposure to light and sound using the Mongolian gerbil (Meriones unguiculatus), which has a low-frequency human-like audiogram and is altricial. To simulate preterm infancy, the eyes and ears were opened prematurely, and animals were exposed to the NICU-like sensory environment throughout the gerbil's cortical critical period of auditory development. After the animals matured into adults, auditory perceptual testing was carried out followed by auditory brainstem response recordings and then histology to assess the white matter morphology of various brain regions. Compared to normal hearing control animals, NICU sensory-exposed animals had significant impairments in learning at later stages of training, increased auditory thresholds reflecting hearing loss, and smaller cerebellar white matter volumes. These have all been reported in longitudinal studies of preterm infants. These preliminary results suggest that this animal model could provide researchers with an ethical way to explore the effects of the sensory environment in the NICU on the preterm infant's brain development.
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Affiliation(s)
- Jennifer D Gay
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - Evelynne Dangcil
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Jacqueline Nacipucha
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Jonathon E Botrous
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Nikhil Suresh
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Aaron Tucker
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Nicolas L Carayannopoulos
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Muhammad R Khan
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Raphael Meng
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Justin D Yao
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - P Ashley Wackym
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - Todd M Mowery
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
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3
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Neubauer A, Menegaux A, Wendt J, Li HB, Schmitz-Koep B, Ruzok T, Thalhammer M, Schinz D, Bartmann P, Wolke D, Priller J, Zimmer C, Rueckert D, Hedderich DM, Sorg C. Aberrant claustrum structure in preterm-born neonates: an MRI study. Neuroimage Clin 2023; 37:103286. [PMID: 36516730 PMCID: PMC9755238 DOI: 10.1016/j.nicl.2022.103286] [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: 09/09/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
The human claustrum is a gray matter structure in the white matter between insula and striatum. Previous analysis found altered claustrum microstructure in very preterm-born adults associated with lower cognitive performance. As the claustrum development is related to hypoxia-ischemia sensitive transient cell populations being at-risk in premature birth, we hypothesized that claustrum structure is already altered in preterm-born neonates. We studied anatomical and diffusion-weighted MRIs of 83 preterm- and 83 term-born neonates at term-equivalent age. Additionally, claustrum development was analyzed both in a spectrum of 377 term-born neonates and longitudinally in 53 preterm-born subjects. Data was provided by the developing Human Connectome Project. Claustrum development showed increasing volume, increasing fractional anisotropy (FA), and decreasing mean diffusivity (MD) around term both across term- and preterm-born neonates. Relative to term-born ones, preterm-born neonates had (i) increased absolute and relative claustrum volumes, both indicating increased cellular and/or extracellular matter and being in contrast to other subcortical gray matter regions of decreased volumes such as thalamus; (ii) lower claustrum FA and higher claustrum MD, pointing at increased extracellular matrix and impaired axonal integrity; and (iii) aberrant covariance between claustrum FA and MD, respectively, and that of distributed gray matter regions, hinting at relatively altered claustrum microstructure. Results together demonstrate specifically aberrant claustrum structure in preterm-born neonates, suggesting altered claustrum development in prematurity, potentially relevant for later cognitive performance.
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Affiliation(s)
- Antonia Neubauer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany.
| | - Aurore Menegaux
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Jil Wendt
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Hongwei Bran Li
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Tobias Ruzok
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Melissa Thalhammer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - David Schinz
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Germany; Neuropsychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany; University of Edinburgh and UK DRI, Edinburgh, UK
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Daniel Rueckert
- School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; Department of Informatics, Technical University of Munich, Germany; Department of Computing, Imperial College London, UK
| | - Dennis M Hedderich
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany; School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany; Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Germany
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Vishnubhotla RV, Zhao Y, Wen Q, Dietrich J, Sokol GM, Sadhasivam S, Radhakrishnan R. Brain structural connectome in neonates with prenatal opioid exposure. Front Neurosci 2022; 16:952322. [PMID: 36188457 PMCID: PMC9523134 DOI: 10.3389/fnins.2022.952322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionInfants with prenatal opioid exposure (POE) are shown to be at risk for poor long-term neurobehavioral and cognitive outcomes. Early detection of brain developmental alterations on neuroimaging could help in understanding the effect of opioids on the developing brain. Recent studies have shown altered brain functional network connectivity through the application of graph theoretical modeling, in infants with POE. In this study, we assess global brain structural connectivity through diffusion tensor imaging (DTI) metrics and apply graph theoretical modeling to brain structural connectivity in infants with POE.MethodsIn this prospective observational study in infants with POE and control infants, brain MRI including DTI was performed before completion of 3 months corrected postmenstrual age. Tractography was performed on the whole brain using a deterministic fiber tracking algorithm. Pairwise connectivity and network measure were calculated based on fiber count and fractional anisotropy (FA) values. Graph theoretical metrics were also derived.ResultsThere were 11 POE and 18 unexposed infants included in the analysis. Pairwise connectivity based on fiber count showed alterations in 32 connections. Pairwise connectivity based on FA values showed alterations in 24 connections. Connections between the right superior frontal gyrus and right paracentral lobule and between the right superior occipital gyrus and right fusiform gyrus were significantly different after adjusting for multiple comparisons between POE infants and unexposed controls. Additionally, alterations in graph theoretical network metrics were identified with fiber count and FA value derived tracts.ConclusionComparisons show significant differences in fiber count in two structural connections. The long-term clinical outcomes related to these findings may be assessed in longitudinal follow-up studies.
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Affiliation(s)
- Ramana V. Vishnubhotla
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yi Zhao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Qiuting Wen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jonathan Dietrich
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Rupa Radhakrishnan,
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5
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Bobba PS, Weber CF, Mak A, Mozayan A, Malhotra A, Sheth KN, Taylor SN, Vossough A, Grant PE, Scheinost D, Constable RT, Ment LR, Payabvash S. Age-related topographic map of magnetic resonance diffusion metrics in neonatal brains. Hum Brain Mapp 2022; 43:4326-4334. [PMID: 35599634 PMCID: PMC9435001 DOI: 10.1002/hbm.25956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 01/15/2023] Open
Abstract
Accelerated maturation of brain parenchyma close to term-equivalent age leads to rapid changes in diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) metrics of neonatal brains, which can complicate the evaluation and interpretation of these scans. In this study, we characterized the topography of age-related evolution of diffusion metrics in neonatal brains. We included 565 neonates who had MRI between 0 and 3 months of age, with no structural or signal abnormality-including 162 who had DTI scans. We analyzed the age-related changes of apparent diffusion coefficient (ADC) values throughout brain and DTI metrics (fractional anisotropy [FA] and mean diffusivity [MD]) along white matter (WM) tracts. Rate of change in ADC, FA, and MD values across 5 mm cubic voxels was calculated. There was significant reduction of ADC and MD values and increase of FA with increasing gestational age (GA) throughout neonates' brain, with the highest temporal rates in subcortical WM, corticospinal tract, cerebellar WM, and vermis. GA at birth had significant effect on ADC values in convexity cortex and corpus callosum as well as FA/MD values in corpus callosum, after correcting for GA at scan. We developed online interactive atlases depicting age-specific normative values of ADC (ages 34-46 weeks), and FA/MD (35-41 weeks). Our results show a rapid decrease in diffusivity metrics of cerebral/cerebellar WM and vermis in the first few weeks of neonatal age, likely attributable to myelination. In addition, prematurity and low GA at birth may result in lasting delay in corpus callosum myelination and cerebral cortex cellularity.
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Affiliation(s)
- Pratheek S. Bobba
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Clara F. Weber
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA,Social Neuroscience Lab, Department of Psychiatry and PsychotherapyLübeck UniversityLübeckGermany
| | - Adrian Mak
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA,CLAIM ‐ Charité Lab for Artificial Intelligence in MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Ali Mozayan
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Ajay Malhotra
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Kevin N. Sheth
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA
| | - Sarah N. Taylor
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Arastoo Vossough
- Department of RadiologyChildren's Hospital of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Patricia Ellen Grant
- Division of Newborn Medicine, Department of MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA,Department of Radiology, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Dustin Scheinost
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Robert Todd Constable
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
| | - Laura R. Ment
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA,Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenConnecticutUSA
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Diffusion Tensor Imaging Changes Do Not Affect Long-Term Neurodevelopment following Early Erythropoietin among Extremely Preterm Infants in the Preterm Erythropoietin Neuroprotection Trial. Brain Sci 2021; 11:brainsci11101360. [PMID: 34679424 PMCID: PMC8533828 DOI: 10.3390/brainsci11101360] [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: 09/21/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to evaluate diffusion tensor imaging (DTI) in infants born extremely preterm, to determine the effect of erythropoietin (Epo) on DTI, and to correlate DTI with neurodevelopmental outcomes at 2 years of age for infants in the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Infants who underwent MRI with DTI at 36 weeks postmenstrual age were included. Neurodevelopmental outcomes were evaluated by Bayley Scales of Infant and Toddler Development (BSID-III). Generalized linear models were used to assess the association between DTI parameters and treatment group, and then with neurodevelopmental outcomes. A total of 101 placebo- and 93 Epo-treated infants underwent MRI. DTI white matter mean diffusivity (MD) was lower in placebo- compared to Epo-treated infants in the cingulate and occipital regions, and occipital white matter fractional isotropy (FA) was lower in infants born at 24-25 weeks vs. 26-27 weeks. These values were not associated with lower BSID-III scores. Certain decreases in clustering coefficients tended to have lower BSID-III scores. Consistent with the PENUT Trial findings, there was no effect on long-term neurodevelopment in Epo-treated infants even in the presence of microstructural changes identified by DTI.
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7
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van Eijk L, Seidel M, Pannek K, George JM, Fiori S, Guzzetta A, Coulthard A, Bursle J, Ware RS, Bradford D, Rose S, Colditz PB, Boyd RN, Fripp J. Automating Quantitative Measures of an Established Conventional MRI Scoring System for Preterm-Born Infants Scanned between 29 and 47 Weeks' Postmenstrual Age. AJNR Am J Neuroradiol 2021; 42:1870-1877. [PMID: 34413061 DOI: 10.3174/ajnr.a7230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging scoring is a valuable tool for risk stratification and prognostication of outcomes, but manual scoring is time-consuming, operator-dependent, and requires high-level expertise. This study aimed to automate the regional measurements of an established brain MR imaging scoring system for preterm neonates scanned between 29 and 47 weeks' postmenstrual age. MATERIALS AND METHODS This study used T2WI from the longitudinal Prediction of PREterm Motor Outcomes cohort study and the developing Human Connectome Project. Measures of biparietal width, interhemispheric distance, callosal thickness, transcerebellar diameter, lateral ventricular diameter, and deep gray matter area were extracted manually (Prediction of PREterm Motor Outcomes study only) and automatically. Scans with poor quality, failure of automated analysis, or severe pathology were excluded. Agreement, reliability, and associations between manual and automated measures were assessed and compared against statistics for manual measures. Associations between measures with postmenstrual age, gestational age at birth, and birth weight were examined (Pearson correlation) in both cohorts. RESULTS A total of 652 MRIs (86%) were suitable for analysis. Automated measures showed good-to-excellent agreement and good reliability with manual measures, except for interhemispheric distance at early MR imaging (scanned between 29 and 35 weeks, postmenstrual age; in line with poor manual reliability) and callosal thickness measures. All measures were positively associated with postmenstrual age (r = 0.11-0.94; R2 = 0.01-0.89). Negative and positive associations were found with gestational age at birth (r = -0.26-0.71; R2 = 0.05-0.52) and birth weight (r = -0.25-0.75; R2 = 0.06-0.56). Automated measures were successfully extracted for 80%-99% of suitable scans. CONCLUSIONS Measures of brain injury and impaired brain growth can be automatically extracted from neonatal MR imaging, which could assist with clinical reporting.
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Affiliation(s)
- L van Eijk
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,Faculty of Medicine (L.V.E., M.S.), The University of Queensland, Brisbane, Australia
| | - M Seidel
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,Faculty of Medicine (L.V.E., M.S.), The University of Queensland, Brisbane, Australia
| | - K Pannek
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - J M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - S Fiori
- Department of Developmental Neuroscience (S.F., A.G.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy
| | - A Guzzetta
- Department of Developmental Neuroscience (S.F., A.G.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine (A.G.), University of Pisa, Pisa, Italy
| | - A Coulthard
- Department of Medical Imaging (A.C., J.B.), Royal Brisbane and Women's Hospital, Brisbane, Australia.,Discipline of Medical Imaging (A.C.), The University of Queensland, Brisbane, Australia
| | - J Bursle
- Department of Medical Imaging (A.C., J.B.), Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R S Ware
- Menzies Health Institute Queensland (R.S.W.), Griffith University, Brisbane, Australia
| | - D Bradford
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - S Rose
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - P B Colditz
- Perinatal Research Centre (P.B.C.), University of Queenland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Brisbane and Women's Hospital (P.B.C.), Brisbane, Australia
| | - R N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - J Fripp
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
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8
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Chandwani R, Kline JE, Harpster K, Tkach J, Parikh NA. Early micro- and macrostructure of sensorimotor tracts and development of cerebral palsy in high risk infants. Hum Brain Mapp 2021; 42:4708-4721. [PMID: 34322949 PMCID: PMC8410533 DOI: 10.1002/hbm.25579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Infants born very preterm (VPT) are at high risk of motor impairments such as cerebral palsy (CP), and diagnosis can take 2 years. Identifying in vivo determinants of CP could facilitate presymptomatic detection and targeted intervention. Our objectives were to derive micro‐ and macrostructural measures of sensorimotor white matter tract integrity from diffusion MRI at term‐equivalent age, and determine their association with early diagnosis of CP. We enrolled 263 VPT infants (≤32 weeks gestational age) as part of a large prospective cohort study. Diffusion and structural MRI were acquired at term. Following consensus guidelines, we defined early diagnosis of CP based on abnormal structural MRI at term and abnormal neuromotor exam at 3–4 months corrected age. Using Constrained Spherical Deconvolution, we derived a white matter fiber orientation distribution (fOD) for subjects, performed probabilistic whole‐brain tractography, and segmented nine sensorimotor tracts of interest. We used the recently developed fixel‐based (FB) analysis to compute fiber density (FD), fiber‐bundle cross‐section (FC), and combined fiber density and cross‐section (FDC) for each tract. Of 223 VPT infants with high‐quality diffusion MRI data, 14 (6.3%) received an early diagnosis of CP. The cohort's mean (SD) gestational age was 29.4 (2.4) weeks and postmenstrual age at MRI scan was 42.8 (1.3) weeks. FD, FC, and FDC for each sensorimotor tract were significantly associated with early CP diagnosis, with and without adjustment for confounders. Measures of sensorimotor tract integrity enhance our understanding of white matter changes that antecede and potentially contribute to the development of CP in VPT infants.
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Affiliation(s)
- Rahul Chandwani
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Jean Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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9
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Uus A, Grigorescu I, Pietsch M, Batalle D, Christiaens D, Hughes E, Hutter J, Cordero Grande L, Price AN, Tournier JD, Rutherford MA, Counsell SJ, Hajnal JV, Edwards AD, Deprez M. Multi-Channel 4D Parametrized Atlas of Macro- and Microstructural Neonatal Brain Development. Front Neurosci 2021; 15:661704. [PMID: 34220423 PMCID: PMC8248811 DOI: 10.3389/fnins.2021.661704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
Structural (also known as anatomical) and diffusion MRI provide complimentary anatomical and microstructural characterization of early brain maturation. However, the existing models of the developing brain in time include only either structural or diffusion MRI channels. Furthermore, there is a lack of tools for combined analysis of structural and diffusion MRI in the same reference space. In this work, we propose a methodology to generate a multi-channel (MC) continuous spatio-temporal parametrized atlas of the brain development that combines multiple MRI-derived parameters in the same anatomical space during 37-44 weeks of postmenstrual age range. We co-align structural and diffusion MRI of 170 normal term subjects from the developing Human Connectomme Project using MC registration driven by both T2-weighted and orientation distribution functions channels and fit the Gompertz model to the signals and spatial transformations in time. The resulting atlas consists of 14 spatio-temporal microstructural indices and two parcellation maps delineating white matter tracts and neonatal transient structures. In order to demonstrate applicability of the atlas for quantitative region-specific studies, a comparison analysis of 140 term and 40 preterm subjects scanned at the term-equivalent age is performed using different MRI-derived microstructural indices in the atlas reference space for multiple white matter regions, including the transient compartments. The atlas and software will be available after publication of the article.
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Affiliation(s)
- Alena Uus
- Department of Biomedical Engineering, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Irina Grigorescu
- Department of Biomedical Engineering, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daan Christiaens
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Emer Hughes
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Lucilio Cordero Grande
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
- Biomedical Image Technologies, ETSI Telecomunicacion, Universidad Politécnica de Madrid, CIBER-BBN, Madrid, Spain
| | - Anthony N. Price
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Mary A. Rutherford
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Serena J. Counsell
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Joseph V. Hajnal
- Department of Biomedical Engineering, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - A. David Edwards
- Centre for the Developing Brain, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Maria Deprez
- Department of Biomedical Engineering, School Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas Hospital, London, United Kingdom
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10
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Ahn SJ, Lee JY, Lee JY, Lee YJ, Lee JM, Lee BR, Kim J, Lee HJ. Brain White Matter Maturation and Early Developmental Outcomes in Preterm Infants With Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 33523200 PMCID: PMC7862727 DOI: 10.1167/iovs.62.2.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose To investigate brain white matter pathways using magnetic resonance diffusion tensor imaging (DTI) and correlate the findings with developmental outcomes at 18 months of corrected age in preterm infants with and without retinopathy of prematurity (ROP). Methods In this prospective cohort study, probabilistic maps of the 26 white matter pathways associated with motor, cognitive, visual, and limbic/language functions were generated in 84 preterm infants using DTI obtained at term-equivalent age. The mean fractional anisotropy (FA) and mean diffusivity (MD) values were compared between those with and without ROP. Developmental outcomes were assessed using the third edition of Bayley Scales of Infant and Toddler Development (BSID-III) at 18 months of corrected age. Multiple regression analyses were performed to confirm the association among developmental outcomes, white matter pathways, and ROP or severe ROP after adjusting for potential confounders. Results The white matter pathways were insignificantly associated with ROP or severe ROP. There were no significant differences in the FA and MD values of the pathways between ROP infants treated with and without bevacizumab therapy. Furthermore, there were no significant differences in BSID-III scores between infants with and without ROP or severe ROP. The BSID-III scores at 18 months of age showed a significant association with FA or MD values in several pathways. Conclusions ROP or severe ROP was insignificantly associated with maturation delay of the white matter pathways. Developmental outcomes were similar between preterm infants with and without ROP or severe ROP or between ROP infants with and without intravitreal bevacizumab therapy.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joo Young Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.,Division of Neonatology and Developmental Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Byung Ro Lee
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jinsup Kim
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.,Division of Neonatology and Developmental Medicine, Hanyang University Hospital, Seoul, Republic of Korea
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11
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Matei A, Montalva L, Goodbaum A, Lauriti G, Zani A. Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2020; 105:432-439. [PMID: 31801792 DOI: 10.1136/archdischild-2019-317830] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023]
Abstract
AIM To determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC. METHODS Systematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC. RESULTS Of 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%-64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001). CONCLUSIONS This study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC. TRIAL REGISTRATION NUMBER CRD42019120522.
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Affiliation(s)
- Andreea Matei
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louise Montalva
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexa Goodbaum
- Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, Spirito Santo Hospital, Pescara, Italy.,G. d'Annunzio University, Chieti-Pescara, Italy
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Vassar R, Schadl K, Cahill-Rowley K, Yeom K, Stevenson D, Rose J. Neonatal Brain Microstructure and Machine-Learning-Based Prediction of Early Language Development in Children Born Very Preterm. Pediatr Neurol 2020; 108:86-92. [PMID: 32279900 DOI: 10.1016/j.pediatrneurol.2020.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Very-low-birth-weight preterm infants have a higher rate of language impairments compared with children born full term. Early identification of preterm infants at risk for language delay is essential to guide early intervention at the time of optimal neuroplasticity. This study examined near-term structural brain magnetic resonance imaging (MRI) and white matter microstructure assessed on diffusion tensor imaging (DTI) in relation to early language development in children born very preterm. METHODS A total of 102 very-low-birth-weight neonates (birthweight≤1500g, gestational age ≤32-weeks) were recruited to participate from 2010 to 2011. Near-term structural MRI was evaluated for white matter and cerebellar abnormalities. DTI fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were assessed. Language development was assessed with Bayley Scales of Infant-Toddler Development-III at 18 to 22 months adjusted age. Multivariate models with leave-one-out cross-validation and exhaustive feature selection identified three brain regions most predictive of language function. Distinct logistic regression models predicted high-risk infants, defined by language scores >1 S.D. below average. RESULTS Of 102 children, 92 returned for neurodevelopmental testing. Composite language score mean ± S.D. was 89.0 ± 16.0; 31 of 92 children scored <85, including 15 of 92 scoring <70, suggesting moderate-to-severe delay. Children with cerebellar asymmetry had lower receptive language subscores (P = 0.016). Infants at high risk for language impairments were predicted based on regional white matter microstructure on DTI with high accuracy (sensitivity, specificity) for composite (89%, 86%), expressive (100%, 90%), and receptive language (100%, 90%). CONCLUSIONS Multivariate models of near-term structural MRI and white matter microstructure on DTI may assist in identification of preterm infants at risk for language impairment, guiding early intervention.
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Affiliation(s)
- Rachel Vassar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Division of Pediatric Neurology, Department of Neurology, University of California San Francisco, San Francisco, California.
| | - Kornél Schadl
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Semmelweis University School of Medicine, Budapest, Hungary
| | - Katelyn Cahill-Rowley
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Motion Analysis Laboratory, Lucile Packard Children's Hospital, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California
| | - Kristen Yeom
- Division of Pediatric Neuroradiology, Department of Radiology, Stanford University, Stanford, California
| | - David Stevenson
- Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Division of Pediatric Neonatology, Department of Pediatrics, Stanford University, Stanford, California
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Neonatal Neuroimaging Research Laboratory, Stanford University School of Medicine, Stanford, California; Motion Analysis Laboratory, Lucile Packard Children's Hospital, Stanford, California
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13
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Ahn SJ, Park HK, Lee BR, Lee HJ. Diffusion Tensor Imaging Analysis of White Matter Microstructural Integrity in Infants With Retinopathy of Prematurity. ACTA ACUST UNITED AC 2019; 60:3024-3033. [DOI: 10.1167/iovs.18-25849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
- Division of Neonatology and Developmental Medicine, Hanyang University Hospital, Seoul, Korea
| | - Byung Ro Lee
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
- Division of Neonatology and Developmental Medicine, Hanyang University Hospital, Seoul, Korea
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14
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Park BS, Yoo YM, Noh OK, Park MS, Lee JH. Adverse Events and Risk Factors Associated with Chloral Hydrate Sedation for Brain Magnetic Resonance Imaging in the Neonatal Intensive Care Unit. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.2.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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15
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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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16
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Deng Q, Li Q, Wang H, Sun H, Xu X. Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial. Trials 2018; 19:701. [PMID: 30577818 PMCID: PMC6303962 DOI: 10.1186/s13063-018-3060-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China's health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants. METHODS/DESIGN A randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320-346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants' physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers' mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant's admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants' discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05. DISCUSSION The effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IOR-1701274 . Registered on 20 September 2017. Retrospectively registered.
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Affiliation(s)
- Qingqi Deng
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiufang Li
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Wang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilian Sun
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinfen Xu
- Haining Maternal and Child Health Hospital, Branch of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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17
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Saadani-Makki F, Hagmann C, Balédent O, Makki MI. Early assessment of lateralization and sex influences on the microstructure of the white matter corticospinal tract in healthy term neonates. J Neurosci Res 2018; 97:480-491. [PMID: 30548647 DOI: 10.1002/jnr.24359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 11/12/2022]
Abstract
We assessed the sex and the lateralization differences in the corticospinal tract (CST) during the early postnatal period. Twenty-five healthy term neonates (13 girls, aged 39.2 ± 1.2 weeks, and 12 boys aged 38.6 ± 3.0 weeks) underwent Diffusion Tensor Imaging (DTI). Fiber tracking was performed to extract bilaterally the CST pathways and to quantify the parallel (E1 ) and perpendicular (E23 ) diffusions, the apparent diffusion coefficient (ADC), and fractional anisotropy (FA). The measurements were performed on the entire CST fibers and on four segments: base of the pons (CST-Po), cerebral peduncles (CST-CP), posterior limb of the internal capsule (CST-PLIC), and corona-radiata (CST-CR). Significantly higher E1 , lower E23, and higher FA in the right compared to the left were noted in the CST-PLIC of the girls. Significantly lower E23 and lower ADC with higher FA in the right compared to left were observed in the CST-CP of the boys. Moreover, the CST-PLIC of the boys had significantly higher E1 in the right compared to the left. There was a significant increase in left CST E1 of boys when compared with girls. Girls had a significantly lower E1 , lower E23 and, lower ADC in the left CST-CP compared with boys. In addition, girls had a significantly lower E23 and higher FA in the right CST-PLIC compared with boys. Sex differences and lateralization in structure-based segments of the CST were found in healthy term infants during early postnatal period. These findings are vital to understanding motor development of healthy term born neonates to better interpret newborn infants with abnormal neurodevelopment.
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Affiliation(s)
- Fadoua Saadani-Makki
- Unite de Traitement de l'Image, CHU Amiens-Picardie, Amiens, France.,CHIMERE EA 7516, Université de Picardie Jules Vernes, Amiens, France
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Olivier Balédent
- Unite de Traitement de l'Image, CHU Amiens-Picardie, Amiens, France.,CHIMERE EA 7516, Université de Picardie Jules Vernes, Amiens, France
| | - Malek I Makki
- MRI Research, CHU Amiens-Picardie, Amiens, France.,MRI Research, University Children's Hospital Zurich, Zurich, Switzerland
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18
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Morsing E, Malova M, Kahn A, Lätt J, Björkman-Burtscher IM, Maršál K, Ley D. Brain Volumes and Developmental Outcome in Childhood Following Fetal Growth Restriction Leading to Very Preterm Birth. Front Physiol 2018; 9:1583. [PMID: 30505278 PMCID: PMC6250887 DOI: 10.3389/fphys.2018.01583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Children born very preterm (PT) after fetal growth restriction (FGR) exhibit cognitive impairment at early school age. The relationship between neurodevelopmental impairment and attained regional brain volumes is unknown. Methods: We studied 23 preterm children with FGR (PT-FGR), 24 matched preterm children AGA (PT-AGA), and 27 matched term AGA children (T-AGA) by measuring brain volumes with magnetic resonance imaging at early school age. Cognitive and motor functions were assessed by the Wechsler Intelligence Scales for Children and the ABC-Movement score. Results: The mean (SD) full-scale IQ was 80 (17) in the PT-FGR group and 103 (12) in the PT-AGA group (p < 0.001). The PT-FGR group had lower mean total, gray matter, white matter, thalamic, cerebellar white matter, and hippocampal volumes as compared to the T-AGA group (p = 0.01, 0.04, 0.003, 0.002, 0.001, and 0.009, respectively). Brain volumes did not differ significantly between the PT groups. Reduction of hippocampal volume correlated with degree of growth restriction at birth (r = 0.46, p = 0.05). Neither the full-scale IQ nor the ABC movement score <5th percentile were related to brain volumes. Conclusion: Brain volumes as determined by MRI at early school age were primarily associated with degree of prematurity at birth and less with FGR. Regional brain volumes did not discriminate cognitive and motor function beyond that predicted by gestational age at birth.
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Affiliation(s)
- Eva Morsing
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mariya Malova
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Anna Kahn
- Department of Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Department of Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Karel Maršál
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - David Ley
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
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Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury. J Perinatol 2018; 38:1431-1443. [PMID: 30166622 PMCID: PMC6215507 DOI: 10.1038/s41372-018-0209-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes. The goal of this review is to describe the distinct and often overlapping types of brain injury in the preterm neonate, with a focus on neonatal hydrocephalus, and to connect injury on imaging to neurodevelopmental outcome risk. Head ultrasound and magnetic resonance imaging findings are described separately. The current state of the literature is imprecise and we end the review with recommendations for future radiologic and neurodevelopmental research.
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20
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Teli R, Hay M, Hershey A, Kumar M, Yin H, Parikh NA. Postnatal Microstructural Developmental Trajectory of Corpus Callosum Subregions and Relationship to Clinical Factors in Very Preterm Infants. Sci Rep 2018; 8:7550. [PMID: 29765059 PMCID: PMC5954149 DOI: 10.1038/s41598-018-25245-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/13/2018] [Indexed: 11/30/2022] Open
Abstract
Our objectives were to define the microstructural developmental trajectory of six corpus callosum subregions and identify perinatal clinical factors that influence early development of these subregions in very preterm infants. We performed a longitudinal cohort study of very preterm infants (32 weeks gestational age or younger) (N = 36) who underwent structural MRI and diffusion tensor imaging serially at four time points - before 32, 32, 38, and 52 weeks postmenstrual age. We divided the corpus callosum into six subregions, performed probabilistic tractography, and used linear mixed effects models to evaluate the influence of antecedent clinical factors on its microstructural growth trajectory. The genu and splenium demonstrated the most rapid developmental maturation, exhibited by a steep increase in fractional anisotropy. We identified several factors that favored greater corpus callosum microstructural development, including advancing postmenstrual age, higher birth weight, and college level or higher maternal education. Bronchopulmonary dysplasia, low 5-minute Apgar scores, caffeine therapy/apnea of prematurity and male sex were associated with reduced corpus callosum microstructural integrity/development over the first six months after very preterm birth. We identified a unique postnatal microstructural growth trajectory and associated clinical factor profile for each of the six corpus callosum subregions that is consistent with the heterogeneous functional role of these white matter subregions.
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Affiliation(s)
- Radhika Teli
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Margaret Hay
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Alexa Hershey
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Manoj Kumar
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Han Yin
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America. .,Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio, United States of America.
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21
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Oishi K, Chang L, Huang H. Baby brain atlases. Neuroimage 2018; 185:865-880. [PMID: 29625234 DOI: 10.1016/j.neuroimage.2018.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/27/2018] [Accepted: 04/02/2018] [Indexed: 01/23/2023] Open
Abstract
The baby brain is constantly changing due to its active neurodevelopment, and research into the baby brain is one of the frontiers in neuroscience. To help guide neuroscientists and clinicians in their investigation of this frontier, maps of the baby brain, which contain a priori knowledge about neurodevelopment and anatomy, are essential. "Brain atlas" in this review refers to a 3D-brain image with a set of reference labels, such as a parcellation map, as the anatomical reference that guides the mapping of the brain. Recent advancements in scanners, sequences, and motion control methodologies enable the creation of various types of high-resolution baby brain atlases. What is becoming clear is that one atlas is not sufficient to characterize the existing knowledge about the anatomical variations, disease-related anatomical alterations, and the variations in time-dependent changes. In this review, the types and roles of the human baby brain MRI atlases that are currently available are described and discussed, and future directions in the field of developmental neuroscience and its clinical applications are proposed. The potential use of disease-based atlases to characterize clinically relevant information, such as clinical labels, in addition to conventional anatomical labels, is also discussed.
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Affiliation(s)
- Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Linda Chang
- Departments of Diagnostic Radiology and Nuclear Medicine, and Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Hao Huang
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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22
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Rosyidah S, Mahmudiono T. Hubungan Riwayat BBLR Dengan Pekembangan Anak Prasekolah (Usia 4-5 Tahun) Di TK Dharma Wanita III Karangbesuki Malang. AMERTA NUTRITION 2018. [DOI: 10.20473/amnt.v2i1.2018.66-73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Around 5-10% children aged 0-5 years in Indonesia experienced developmental delays. Children with a low birth weight history have a greater risk of developing developmental disorders, especially they who not get more stimulation.Objectives: The purpose of this study is to analyze the relationship between the histories of low birth weight with the development of preschoolers (4-5 years) in kindergarten Dharma Wanita III Karang Besuki Malang.Methods: This study used cross-sectional design. Population on this study was all of students of TK Dharma Wanita III Karangbesuki Malang who was 4-5 years old, willing to join development screening test with their parent’s permission, and have KIA book or KMS. Exclution criteria was student whose parents can’t joint this research. Number of sample were 32 taken with simple random sampling technique and analyzed using fisher exact. History of BBLR Data collected from KIA book or KMS, Children Development data collected from Denver Development screening test.Results: The results showed that 18.8% of respondents have a history of Low Birth Weight. The development of preschoolers (aged 4-5 years) in TK Dharma Wanita III Malang which were in the normal category 65.6%, and who are in the category of suspect were 34.4%. There was significant correlation between the history of LBW with the development of preschool age children (Age 4-5 Years) (p-value = 0.011).Conclusion: There was significant correlation between histories of LBW with development of preschoolers (Age 4-5 Years) in TK Dharma Wanita III Karangbesuki Malang. Children who have a history of LBW suggested to be given special attention and early detection of child development on a regular basis to recognized some possible developmental disorders immediately and can immediately get the management.ABSTRAKLatar Belakang : Masih ditemukan sebanyak 5-10% anak usia 0-5 tahun yang mengalami keterlambatan perkembangan di Indonesia. Anak dengan riwayat berat lahir rendah memiliki risiko lebih besar mengalami gangguan perkembangan, terutama jika tidak diimbangi dengan pemberian stimulasi yang adekuat.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan antara riwayat berat badan lahir rendah dengan perkembangan anak usia prasekolah (4-5 tahun) di TK Dharma Wanita III Karang Besuki Kota Malang.Metode: Penelitian ini bersifat obervasional dengan rancang bangun cross-sectional. Populasi penelitian ini adalah seluruh siwa TK Dharma Wanita III Karangbesuki Malang yang berusia 4-5 tahun dengan kriteria inklusi siswa/siswi bersedia mengikuti skrining perkembangan atas persetujuan orang tua siswa, dan masih memiliki buku KIA atau KMS. Kriteria eksklusi dalam populasi penelitian ini adalah siswa yang orang tuanya tidak dapat ditemui pada saat penelitian. Jumlah sampel 32 yang diambil dengan teknik simple random sampling dan dianalisa menggunakan fisher exact .Data riwayat BBLR didapatkan melalui buku KIA atau KMS siswa, dan perkembangan anak di nilai melalui metode DDST (Denver Development screening test).Hasil: Sebanyak 18.8% responden memiliki riwayat BBLR. Perkembangan anak prasekolah (usia 4-5 tahun) di TK Dharma Wanita III Malang yang berada dalam kategori normal sebesar 65,6%, dan yang berada dalam kategori suspect sebesar 34,4%. Terdapat hubungan antara riwayat BBLR dengan perkembangan anak usia prasekolah (Usia 4-5 Tahun) (p = 0.011).Kesimpulan: Terdapat hubungan antara riwayat BBLR dengan perkembangan anak usia prasekolah (Usia 4-5 Tahun) di TK Dharma Wanita III Karangbesuki Malang. Siswa yang memiliki riwayat BBLR disarankan untuk diberikan perhatian khusus dan dilakukan deteksi dini perkembangan anak secara rutin agar gangguan perkembangan yang mungkin terjadi dapat segera dikenali dan segera mendapatkan tata laksana.
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Neonatal erythropoietin mitigates impaired gait, social interaction and diffusion tensor imaging abnormalities in a rat model of prenatal brain injury. Exp Neurol 2017; 302:1-13. [PMID: 29288070 DOI: 10.1016/j.expneurol.2017.12.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/13/2017] [Accepted: 12/22/2017] [Indexed: 12/20/2022]
Abstract
Children who are born preterm are at risk for encephalopathy of prematurity, a leading cause of cerebral palsy, cognitive delay and behavioral disorders. Current interventions are limited and none have been shown to reverse cognitive and behavioral impairments, a primary determinant of poor quality of life for these children. Moreover, the mechanisms of perinatal brain injury that result in functional deficits and imaging abnormalities in the mature brain are poorly defined, limiting the potential to target interventions to those who may benefit most. To determine whether impairments are reversible after a prenatal insult, we investigated a spectrum of functional deficits and diffusion tensor imaging (DTI) abnormalities in young adult animals. We hypothesized that prenatal transient systemic hypoxia-ischemia (TSHI) would induce multiple functional deficits concomitant with reduced microstructural white and gray matter integrity, and tested whether these abnormalities could be ameliorated using postnatal erythropoietin (EPO), an emerging neurorestorative intervention. On embryonic day 18 uterine arteries were transiently occluded for 60min via laparotomy. Shams underwent anesthesia and laparotomy for 60min. Pups were born and TSHI pups were randomized to receive EPO or vehicle via intraperitoneal injection on postnatal days 1 to 5. Gait, social interaction, olfaction and open field testing was performed from postnatal day 25-35 before brains underwent ex vivo DTI to measure fractional anisotropy, axial diffusivity and radial diffusivity. Prenatal TSHI injury causes hyperactivity, impaired gait and poor social interaction in young adult rats that mimic the spectrum of deficits observed in children born preterm. Collectively, these data show for the first time in a model of encephalopathy of prematurity that postnatal EPO treatment mitigates impairments in social interaction, in addition to gait deficits. EPO also normalizes TSHI-induced microstructural abnormalities in fractional anisotropy and radial diffusivity in multiple regions, consistent with improved structural integrity and recovery of myelination. Taken together, these results show behavioral and memory deficits from perinatal brain injury are reversible. Furthermore, resolution of DTI abnormalities may predict responsiveness to emerging interventions, and serve as a biomarker of CNS injury and recovery.
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24
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Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. Neuroimage Clin 2017; 16:355-368. [PMID: 28861337 PMCID: PMC5568883 DOI: 10.1016/j.nicl.2017.08.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 01/30/2023]
Abstract
Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.
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Affiliation(s)
- Manuel Hinojosa-Rodríguez
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - Cristina Carrillo-Prado
- Unidad de Investigación en Neurodesarrollo, Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus Juriquilla, Mexico
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Andrei Irimia
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Carinna Torgerson
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
| | - Zachary Jacokes
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, 2025 Zonal Avenue, SHN, Los Angeles, California 90033, USA
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25
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Rajagopalan V, Scott JA, Liu M, Poskitt K, Chau V, Miller S, Studholme C. Complementary cortical gray and white matter developmental patterns in healthy, preterm neonates. Hum Brain Mapp 2017; 38:4322-4336. [PMID: 28608653 DOI: 10.1002/hbm.23618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 01/12/2023] Open
Abstract
Preterm birth is associated with brain injury and altered cognitive development. However, the consequences of extrauterine development are not clearly distinguished from perinatal brain injury. Therefore, we characterized cortical growth patterns from 30 to 46 postmenstrual weeks (PMW) in 27 preterm neonates (25-32 PMW at birth) without detectable brain injury on magnetic resonance imaging. We introduce surface-based morphometric descriptors that quantify radial (thickness) and tangential (area) change rates. Within a tensor-based morphometry framework, we use a temporally weighted formulation of regression to simultaneously model local age-related changes in cortical gray matter (GM) and underlying white matter (WM) mapped onto the cortical surface. The spatiotemporal pattern of GM and WM development corresponded to the expected gyrification time course of primary sulcal deepening and branching. In primary gyri, surface area and thickness rates were below average along sulcal pits and above average on gyral banks and crests in both GM and WM. Above average surface area rates in GM corresponded to emergence of secondary and tertiary folds. These findings map the development of neonatal cortical morphometry in the context of extrauterine brain development using a novel approach. Future studies may compare this developmental trajectory to preterm populations with brain injury. Hum Brain Mapp 38:4322-4336, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Vidya Rajagopalan
- Children's Hospital Los Angeles, and Rudi Schulte Research Institute, Santa Barbara, California
| | - Julia A Scott
- Department of Neurology, University of California Davis, Davis, California
| | - Mengyuan Liu
- Biomedical Image Computing Group, Departments of Pediatrics, Bioengineering, and Radiology, University of Washington, Seattle, Washington
| | - Kenneth Poskitt
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Vann Chau
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Steven Miller
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, M5G 1X8, Canada
| | - Colin Studholme
- Biomedical Image Computing Group, Departments of Pediatrics, Bioengineering, and Radiology, University of Washington, Seattle, Washington
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Kim DY, Park HK, Kim NS, Hwang SJ, Lee HJ. Neonatal diffusion tensor brain imaging predicts later motor outcome in preterm neonates with white matter abnormalities. Ital J Pediatr 2016; 42:104. [PMID: 27906083 PMCID: PMC5134238 DOI: 10.1186/s13052-016-0309-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND White matter (WM) abnormalities associated with prematurity are one of the most important causes of neurological disability that involves spastic motor deficits in preterm newborns. This study aimed to evaluate regional microstructural changes in diffusion tensor imaging (DTI) associated with WM abnormalities. METHODS We prospectively studied extremely low birth weight (ELBW; <1000 g) preterm infants who were admitted to the Neonatal Intensive Care Unit of Hanyang University Hospital between February 2011 and February 2014. WM abnormalities were assessed with conventional magnetic resonance (MR) imaging and DTI near term-equivalent age before discharge. Region-of-interests (ROIs) measurements were performed to examine the regional distribution of fractional anisotropy (FA) values. RESULTS Thirty-two out of 72 ELBW infants underwent conventional MR imaging and DTI at term-equivalent age. Ten of these infants developed WM abnormalities associated with prematurity. Five of ten of those with WM abnormalities developed cerebral palsy (CP). DTI in the WM abnormalities with CP showed a significant reduction of mean FA in the genu of the corpus callosum (p = 0.022), the ipsilateral posterior limb of the internal capsule (p = 0.019), and the ipsilateral centrum semiovale (p = 0.012) compared to normal WM and WM abnormalities without CP. In infants having WM abnormalities with CP, early FA values in neonatal DTI revealed abnormalities of the WM regions prior to the manifestation of hemiparesis. CONCLUSIONS DTI performed at term equivalent age shows different FA values in WM regions among infants with or without WM abnormalities associated with prematurity and/or CP. Low FA values of ROIs in DTI are related with later development of spastic CP in preterm infants with WM abnormalities.
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Affiliation(s)
- Do-Yeon Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Nam-Su Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Se-Jin Hwang
- Division of Neuroanatomy, Department of Anatomy and Histology, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea.
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Magnetization Transfer and Amide Proton Transfer MRI of Neonatal Brain Development. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3052723. [PMID: 27885356 PMCID: PMC5112326 DOI: 10.1155/2016/3052723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022]
Abstract
Purpose. This study aims to evaluate the process of brain development in neonates using combined amide proton transfer (APT) imaging and conventional magnetization transfer (MT) imaging. Materials and Methods. Case data were reviewed for all patients hospitalized in our institution's neonatal ward. Patients underwent APT and MT imaging (a single protocol) immediately following the routine MR examination. Single-slice APT/MT axial imaging was performed at the level of the basal ganglia. APT and MT ratio (MTR) measurements were performed in multiple brain regions of interest (ROIs). Data was statistically analyzed in order to assess for significant differences between the different regions of the brain or correlation with patient gestational age. Results. A total of 38 neonates were included in the study, with ages ranging from 27 to 41 weeks' corrected gestational age. There were statistically significant differences in both APT and MTR measurements between the frontal lobes, basal ganglia, and occipital lobes (APT: frontal lobe versus occipital lobe P = 0.031 and other groups P = 0.00; MTR: frontal lobe versus occipital lobe P = 0.034 and other groups P = 0.00). Furthermore, APT and MTR in above brain regions exhibited positive linear correlations with patient gestational age. Conclusions. APT/MT imaging can provide valuable information about the process of the neonatal brain development at the molecular level.
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Roelants JA, Koning IV, Raets MMA, Willemsen SP, Lequin MH, Steegers-Theunissen RPM, Reiss IKM, Vermeulen MJ, Govaert P, Dudink J. A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth. AJNR Am J Neuroradiol 2016; 37:1516-22. [PMID: 26988817 DOI: 10.3174/ajnr.a4731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preterm neonates are at risk for neurodevelopmental impairment, but reliable, bedside-available markers to monitor preterm brain growth during hospital stay are still lacking. The aim of this study was to assess the feasibility of corpus callosum-fastigium length as a new cranial sonography marker for monitoring of preterm brain growth. MATERIALS AND METHODS In this longitudinal prospective cohort study, cranial ultrasound was planned on the day of birth, days 1, 2, 3, and 7 of life; and then weekly until discharge in preterm infants born before 29 weeks of gestational age. Reproducibility and associations between clinical variables and corpus callosum-fastigium growth trajectories were studied. RESULTS A series of 1-8 cranial ultrasounds was performed in 140 infants (median gestational age at birth, 27(+2) weeks (interquartile range, 26(+1) to 28(+1); 57.9% male infants). Corpus callosum-fastigium measurements showed good-to-excellent agreement for inter- and intraobserver reproducibility (intraclass correlation coefficient >0.89). Growth charts for preterm infants between 24 and 32 weeks of gestation were developed. Male sex and birth weight SD score were positively associated with corpus callosum-fastigium growth rate. CONCLUSIONS Corpus callosum-fastigium length measurement is a new reproducible marker applicable for bedside monitoring of preterm brain growth during neonatal intensive care stay.
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Affiliation(s)
- J A Roelants
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - I V Koning
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
| | - M M A Raets
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - S P Willemsen
- Departments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.) Biostatistics (S.P.W.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M H Lequin
- Department of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - I K M Reiss
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - M J Vermeulen
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - P Govaert
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
| | - J Dudink
- From the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.) Department of Radiology (J.D.) Intensive Care Unit (J.D.), Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Navarra R, Sestieri C, Conte E, Salomone R, Mattei PA, Romani GL, Domizio S, Caulo M. Perinatal MRI diffusivity is related to early assessment of motor performance in preterm neonates. Neuroradiol J 2016; 29:137-45. [PMID: 26915895 DOI: 10.1177/1971400915628019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Preterm neonates represent a high-risk population for abnormal neuropsychological development. But presently, an accurate method for identifying those at risk is not available. This study evaluated the association between the microstructural organization measured with Diffusion Tensor Imaging (DTI) in term-corrected preterm neonates and subsequent motor performance. Fractional anisotropy (FA), axial diffusion (AD), mean diffusivity (MD) and radial diffusivity (RD) were determined in two regions of interest (ROIs) corresponding to the posterior limb of the internal capsule (PLIC) and cortico-spinal tract (CST). The Griffiths Mental Developmental Scales (GMDS) were longitudinally administered at 3, 6 and 15 months; and correlations between the metrics of diffusivity and the motor subscale of the GMDS were assessed using the Spearman correlation. A statistically significant negative correlation was observed between the AD of PLIC of the left hemisphere and the 3-month GMDS Locomotor Subscale. These results suggested that AD is a valid indicator of the stage of maturation of the motor pathway in preterm neonates, but not of later motor outcome.
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Affiliation(s)
- Riccardo Navarra
- Department of Neuroscience and Imaging, G d'Annunzio University, Chieti, Italy Institute of Advanced Biomedical Technologies (ITAB), G d'Annunzio University, Chieti, Italy
| | - Carlo Sestieri
- Department of Neuroscience and Imaging, G d'Annunzio University, Chieti, Italy Institute of Advanced Biomedical Technologies (ITAB), G d'Annunzio University, Chieti, Italy
| | - Emanuela Conte
- Department of Neonatology, San Salvatore Hospital, L'Aquila, Italy
| | - Rita Salomone
- Department of Pediatrics and Neonatology, G d'Annunzio University, Chieti, Italy
| | - Peter A Mattei
- Department of Medicine and Aging Sciences, G d'Annunzio University, Chieti, Italy
| | - Gian L Romani
- Department of Neuroscience and Imaging, G d'Annunzio University, Chieti, Italy Institute of Advanced Biomedical Technologies (ITAB), G d'Annunzio University, Chieti, Italy
| | - Sergio Domizio
- Department of Pediatrics and Neonatology, G d'Annunzio University, Chieti, Italy
| | - Massimo Caulo
- Department of Neuroscience and Imaging, G d'Annunzio University, Chieti, Italy Institute of Advanced Biomedical Technologies (ITAB), G d'Annunzio University, Chieti, Italy
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Tran LT, Roos A, Fouche JP, Koen N, Woods RP, Zar HJ, Narr KL, Stein DJ, Donald KA. White Matter Microstructural Integrity and Neurobehavioral Outcome of HIV-Exposed Uninfected Neonates. Medicine (Baltimore) 2016; 95:e2577. [PMID: 26825902 PMCID: PMC5291572 DOI: 10.1097/md.0000000000002577] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The successful implementation of prevention programs for mother-to-child human immunodeficiency virus (HIV) transmission has dramatically reduced the prevalence of infants infected with HIV while increasing that of HIV-exposed uninfected (HEU) children. Neuropsychological assessments indicate that HEU children may exhibit differences in neurodevelopment compared to unexposed children (HUU). Pathological mechanisms leading to such neurodevelopmental delays are not clear. In this observational birth cohort study we explored the integrity of regional white matter microstructure in HEU infants, shortly after birth. Microstructural changes in white matter associated with prenatal HIV exposure were evaluated in HEU infants (n = 15) and matched controls (n = 22) using diffusion tensor imaging and tract-based spatial statistics. Additionally, diffusion values were extracted and compared for white matter tracts of interest, and associations with clinical outcomes from the Dubowitz neonatal neurobehavioral tool were investigated. Higher fractional anisotropy in the middle cerebellar peduncles of HEU compared to HUU neonates was found after correction for age and gender. Scores on the Dubowitz abnormal neurological signs subscale were positively correlated with FA (r = 0.58, P = 0.038) in the left uncinate fasciculus in HEU infants. This is the first study to present data suggesting that prenatal HIV exposure without infection is associated with altered white matter microstructural integrity in the neonatal period. Longitudinal studies of HEU infants as their brains mature are necessary to understand further the significance of prenatal HIV and antiretroviral treatment exposure on white matter integrity and neurodevelopmental outcomes.
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Affiliation(s)
- Linh T Tran
- From the Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town (LTT, KAD); SU/UCT MRC Unit on Anxiety & Stress Disorders, Stellenbosch University (AR); Department of Psychiatry and Mental Health, University of Cape Town (J-PF); Department of Psychiatry, Stellenbosch University (J-PF); Department of Psychiatry and Mental Health, MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa (NK, DJS); Department of Neurology, University of California, Los Angeles, CA (RPW, KLN); and Department of Paediatrics and Child Health and MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa (HJZ)
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Akazawa K, Chang L, Yamakawa R, Hayama S, Buchthal S, Alicata D, Andres T, Castillo D, Oishi K, Skranes J, Ernst T, Oishi K. Probabilistic maps of the white matter tracts with known associated functions on the neonatal brain atlas: Application to evaluate longitudinal developmental trajectories in term-born and preterm-born infants. Neuroimage 2015; 128:167-179. [PMID: 26712341 DOI: 10.1016/j.neuroimage.2015.12.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 01/23/2023] Open
Abstract
Diffusion tensor imaging (DTI) has been widely used to investigate the development of the neonatal and infant brain, and deviations related to various diseases or medical conditions like preterm birth. In this study, we created a probabilistic map of fiber pathways with known associated functions, on a published neonatal multimodal atlas. The pathways-of-interest include the superficial white matter (SWM) fibers just beneath the specific cytoarchitectonically defined cortical areas, which were difficult to evaluate with existing DTI analysis methods. The Jülich cytoarchitectonic atlas was applied to define cortical areas related to specific brain functions, and the Dynamic Programming (DP) method was applied to delineate the white matter pathways traversing through the SWM. Probabilistic maps were created for pathways related to motor, somatosensory, auditory, visual, and limbic functions, as well as major white matter tracts, such as the corpus callosum, the inferior fronto-occipital fasciculus, and the middle cerebellar peduncle, by delineating these structures in eleven healthy term-born neonates. In order to characterize maturation-related changes in diffusivity measures of these pathways, the probabilistic maps were then applied to DTIs of 49 healthy infants who were longitudinally scanned at three time-points, approximately five weeks apart. First, we investigated the normal developmental pattern based on 19 term-born infants. Next, we analyzed 30 preterm-born infants to identify developmental patterns related to preterm birth. Last, we investigated the difference in diffusion measures between these groups to evaluate the effects of preterm birth on the development of these functional pathways. Term-born and preterm-born infants both demonstrated a time-dependent decrease in diffusivity, indicating postnatal maturation in these pathways, with laterality seen in the corticospinal tract and the optic radiation. The comparison between term- and preterm-born infants indicated higher diffusivity in the preterm-born infants than in the term-born infants in three of these pathways: the body of the corpus callosum; the left inferior longitudinal fasciculus; and the pathway connecting the left primary/secondary visual cortices and the motion-sensitive area in the occipitotemporal visual cortex (V5/MT+). Probabilistic maps provided an opportunity to investigate developmental changes of each white matter pathway. Whether alterations in white matter pathways can predict functional outcomes will be further investigated in a follow-up study.
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Affiliation(s)
- Kentaro Akazawa
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda Chang
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Robyn Yamakawa
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Sara Hayama
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Steven Buchthal
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Daniel Alicata
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Tamara Andres
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Deborrah Castillo
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Kumiko Oishi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jon Skranes
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Ernst
- Department of Medicine, School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Neonatal brain microstructure correlates of neurodevelopment and gait in preterm children 18-22 mo of age: an MRI and DTI study. Pediatr Res 2015; 78:700-8. [PMID: 26322412 DOI: 10.1038/pr.2015.157] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/18/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Near-term brain structure was examined in preterm infants in relation to neurodevelopment. We hypothesized that near-term macrostructural brain abnormalities identified using conventional magnetic resonance imaging (MRI), and white matter (WM) microstructure detected using diffusion tensor imaging (DTI), would correlate with lower cognitive and motor development and slower, less-stable gait at 18-22 mo of age. METHODS One hundred and two very-low-birth-weight preterm infants (≤1,500 g birth weight; ≤32 wk gestational age) were recruited prior to routine near-term brain MRI at 36.6 ± 1.8 wk postmenstrual age. Cerebellar and WM macrostructure was assessed on conventional structural MRI. DTI was obtained in 66 out of 102 and WM microstructure was assessed using fractional anisotropy and mean diffusivity (MD) in six subcortical brain regions defined by DiffeoMap neonatal atlas. Neurodevelopment was assessed with Bayley-Scales-of-Infant-Toddler-Development, 3rd-Edition (BSID-III); gait was assessed using an instrumented mat. RESULTS Neonates with cerebellar abnormalities identified using MRI demonstrated lower mean BSID-III cognitive composite scores (89.0 ± 10.1 vs. 97.8 ± 12.4; P = 0.002) at 18-22 mo. Neonates with higher DTI-derived left posterior limb of internal capsule (PLIC) MD demonstrated lower cognitive and motor composite scores (r = -0.368; P = 0.004; r = -0.354; P = 0.006) at 18-22 mo; neonates with higher genu MD demonstrated slower gait velocity (r = -0.374; P = 0.007). Multivariate linear regression significantly predicted cognitive (adjusted r(2) = 0.247; P = 0.002) and motor score (adjusted r(2) = 0.131; P = 0.017). CONCLUSION Near-term cerebellar macrostructure and PLIC and genu microstructure were predictive of early neurodevelopment and gait.
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Deshpande R, Chang L, Oishi K. Construction and application of human neonatal DTI atlases. Front Neuroanat 2015; 9:138. [PMID: 26578899 PMCID: PMC4620146 DOI: 10.3389/fnana.2015.00138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/12/2015] [Indexed: 01/18/2023] Open
Abstract
Atlas-based MRI analysis is one of many analytical methods and is used to investigate typical as well as abnormal neurodevelopment. It has been widely applied to the adult and pediatric populations. Successful applications of atlas-based analysis (ABA) in those cohorts have motivated the creation of a neonatal atlas and parcellation map (PM). The purpose of this review is to discuss the various neonatal diffusion tensor imaging (DTI) atlases that are available for use in ABA, examine how such atlases are constructed, review their applications, and discuss future directions in DTI. Neonatal DTI atlases are created from a template, which can be study-specific or standardized, and merged with the corresponding PM. Study-specific templates can retain higher image registration accuracy, but are usually not applicable across different studies. However, standardized templates can be used to make comparisons among various studies, but may not accurately reflect the anatomies of the study population. Methods such as volume-based template estimation are being developed to overcome these limitations. The applications for ABA, including atlas-based image quantification and atlas-based connectivity analysis, vary from quantifying neurodevelopmental progress to analyzing population differences in groups of neonates. ABA can also be applied to detect pathology related to prematurity at birth or exposure to toxic substances. Future directions for this method include research designed to increase the accuracy of the image parcellation. Methods such as multi-atlas label fusion and multi-modal analysis applied to neonatal DTI currently comprise an active field of research. Moreover, ABA can be used in high-throughput analysis to efficiently process medical images and to assess longitudinal brain changes. The overarching goal of neonatal ABA is application to the clinical setting, to assist with diagnoses, monitor disease progression and, ultimately, outcome prediction.
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Affiliation(s)
- Rajiv Deshpande
- Department of Radiology, Johns Hopkins University Baltimore, MD, USA ; Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA
| | - Linda Chang
- Department of Medicine, School of Medicine, University of Hawaii at Manoa Honolulu, HI, USA
| | - Kenichi Oishi
- Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA
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George JM, Boyd RN, Colditz PB, Rose SE, Pannek K, Fripp J, Lingwood BE, Lai MM, Kong AHT, Ware RS, Coulthard A, Finn CM, Bandaranayake SE. PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome. BMC Pediatr 2015; 15:123. [PMID: 26377791 PMCID: PMC4572671 DOI: 10.1186/s12887-015-0439-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12-24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age. METHODS/DESIGN This prospective cohort study will recruit 80 preterm infants born ≤ 30 week's gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women's Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay). DISCUSSION Earlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.
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Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Stephen E Rose
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Kerstin Pannek
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Jurgen Fripp
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Barbara E Lingwood
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Melissa M Lai
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Annice H T Kong
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia.
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Australia.
| | - Alan Coulthard
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Academic Discipline of Medical Imaging, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Christine M Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sasaka E Bandaranayake
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
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Kurtul BE, Kabatas EU, Zenciroglu A, Ozer PA, Ertugrul GT, Beken S, Okumus N. Serum neutrophil-to-lymphocyte ratio in retinopathy of prematurity. J AAPOS 2015; 19:327-31. [PMID: 26239207 DOI: 10.1016/j.jaapos.2015.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/17/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the relationship between serum neutrophil-to-lymphocyte ratio (NLR) and development of retinopathy of prematurity (ROP). METHODS Infants with a gestational age of ≤32 week were screened for ROP. Complete blood cell, high-sensitivity C-reactive protein, and interleukin 6 levels of subjects were measured within the first 24 hours of life. The NLR was calculated by dividing neutrophil count by lymphocyte count. The association between other risk factors and the development of ROP were analyzed using univariate analysis and multivariate logistic regression analysis. RESULTS A total of 100 infants were included: 80 with ROP and 20 without ROP. The NLR values differed significantly between the ROP group (median, 0.67; interquartile range, 0.38-1.09) and non-ROP group (median, 0.32; interquartile range, 0.22-0.79; P = 0.02). The lymphocyte count in the ROP group (4.01 ± 1.89) compared to that of the non-ROP group (5.69 ± 2.16) was significantly lower (P = 0.001). In multivariate analysis, lymphocyte count remained an independent predictor of ROP (OR = 0.599; 95% CI, 0.430-0.836; P = 0.003). CONCLUSIONS The NLR seems not to be an independent predictor of development of ROP. Lymphocyte count is inversely associated with ROP.
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Affiliation(s)
- Bengi Ece Kurtul
- Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Emrah Utku Kabatas
- Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aysegul Zenciroglu
- Department of Neonatology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Pinar Altiaylik Ozer
- Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Gokce Tasdemir Ertugrul
- Department of Ophthalmology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Serdar Beken
- Department of Neonatology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nurullah Okumus
- Department of Neonatology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Abstract
Advances in the care of neonatal hyperbilirubinemia have led to a decreased incidence of kernicterus. However, neonatal exposure to high levels of bilirubin continues to cause severe motor symptoms and cerebral palsy (CP). Exposure to moderate levels of unconjugated bilirubin may also cause damage to the developing central nervous system, specifically the basal ganglia and cerebellum. Brain lesions identified using magnetic resonance imaging following extreme hyperbilirubinemia have been linked to dyskinetic CP. Newer imaging techniques, such as diffusion tensor imaging or single-photon emission computed tomography, allow quantification of more subtle white matter injury following presumed exposure to unbound bilirubin, and may explain more subtle movement disorders. New categories of bilirubin-induced neurologic dysfunction, characterized by subtle bilirubin encephalopathy following moderate hyperbilirubinemia, have been implicated in long-term motor function. Further research is needed to identify subtle impairments resulting from moderate-severe neonatal hyperbilirubinemia, to understand the influence of perinatal risk factors on bilirubin toxicity, and to develop neuroprotective treatment strategies to prevent movement disorders due to bilirubin toxicity.
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Vassar RL, Barnea-Goraly N, Rose J. Identification of neonatal white matter on DTI: influence of more inclusive thresholds for atlas segmentation. PLoS One 2014; 9:e115426. [PMID: 25506943 PMCID: PMC4266649 DOI: 10.1371/journal.pone.0115426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/24/2014] [Indexed: 12/05/2022] Open
Abstract
Purpose Semi-automated diffusion tensor imaging (DTI) analysis of white matter (WM) microstructure offers a clinically feasible technique to assess neonatal brain development and provide early prognosis, but is limited by variable methods and insufficient evidence regarding optimal parameters. The purpose of this research was to investigate the influence of threshold values on semi-automated, atlas-based brain segmentation in very-low-birth-weight (VLBW) preterm infants at near-term age. Materials and Methods DTI scans were analyzed from 45 VLBW preterm neonates at near-term-age with no brain abnormalities evident on MRI. Brain regions were selected with a neonatal brain atlas and threshold values: trace <0.006 mm2/s, fractional anisotropy (FA)>0.15, FA>0.20, and FA>0.25. Relative regional volumes, FA, axial diffusivity (AD), and radial diffusivity (RD) were compared for twelve WM regions. Results Near-term brain regions demonstrated differential effects from segmentation with the three FA thresholds. Regional DTI values and volumes selected in the PLIC, CereP, and RLC varied the least with the application of different FA thresholds. Overall, application of higher FA thresholds significantly reduced brain region volume selected, increased variability, and resulted in higher FA and lower RD values. The lower threshold FA>0.15 selected 78±21% of original volumes segmented by the atlas, compared to 38±12% using threshold FA>0.25. Conclusion Results indicate substantial and differential effects of atlas-based DTI threshold parameters on regional volume and diffusion scalars. A lower, more inclusive FA threshold than typically applied for adults is suggested for consistent analysis of WM regions in neonates.
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Affiliation(s)
- Rachel L. Vassar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States of America
- Neonatal Neuroimaging Laboratory, Stanford University School of Medicine, Stanford, CA, United States of America
- * E-mail:
| | - Naama Barnea-Goraly
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States of America
- Neonatal Neuroimaging Laboratory, Stanford University School of Medicine, Stanford, CA, United States of America
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jessica Rose
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States of America
- Neonatal Neuroimaging Laboratory, Stanford University School of Medicine, Stanford, CA, United States of America
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