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Parmentier CEJ, El Bakkali L, Verhagen EA, Steggerda SJ, Alderliesten T, Lequin MH, van de Pol LA, Benders MJNL, van Bel F, Koopman-Esseboom C, de Haan TR, de Vries LS, Groenendaal F. Brain MRI Injury Patterns across Gestational Age among Preterm Infants with Perinatal Asphyxia. Neonatology 2024:1-11. [PMID: 38838655 DOI: 10.1159/000538986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/06/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Brain injury patterns of preterm infants with perinatal asphyxia (PA) are underreported. We aimed to explore brain magnetic resonance imaging (MRI) findings and associated neurodevelopmental outcomes in these newborns. METHODS Retrospective multicenter study included infants with gestational age (GA) 24.0-36.0 weeks and PA, defined as ≥2 of the following: (1) umbilical cord pH ≤7.0, (2) 5-min Apgar score ≤5, and (3) fetal distress or systemic effects of PA. Findings were compared between GA <28.0 (group 1), 28.0-31.9 (group 2), and 32.0-36.0 weeks (group 3). Early MRI (<36 weeks postmenstrual age or <10 postnatal days) was categorized according to predominant injury pattern, and MRI around term-equivalent age (TEA, 36.0-44.0 weeks and ≥10 postnatal days) using the Kidokoro score. Adverse outcomes included death, cerebral palsy, epilepsy, severe hearing/visual impairment, or neurodevelopment <-1 SD at 18-24 months corrected age. RESULTS One hundred nineteen infants with early MRI (n = 94) and/or MRI around TEA (n = 66) were included. Early MRI showed predominantly hemorrhagic injury in groups 1 (56%) and 2 (45%), and white matter (WM)/watershed injury in group 3 (43%). Around TEA, WM scores were highest in groups 2 and 3. Deep gray matter (DGM) (aOR 15.0, 95% CI: 3.8-58.9) and hemorrhagic injury on early MRI (aOR 2.5, 95% CI: 1.3-4.6) and Kidokoro WM (aOR 1.3, 95% CI: 1.0-1.6) and DGM sub-scores (aOR 4.8, 95% CI: 1.1-21.7) around TEA were associated with adverse neurodevelopmental outcomes. CONCLUSION The brain injury patterns following PA in preterm infants differ across GA. Particularly DGM abnormalities are associated with adverse neurodevelopmental outcomes.
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Affiliation(s)
- Corline E J Parmentier
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loubna El Bakkali
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elise A Verhagen
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Radiology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laura A van de Pol
- Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Christensen R, de Vries LS, Cizmeci MN. Neuroimaging to guide neuroprognostication in the neonatal intensive care unit. Curr Opin Pediatr 2024; 36:190-197. [PMID: 37800448 DOI: 10.1097/mop.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
PURPOSE OF REVIEW Neurological problems are common in infants admitted to the neonatal intensive care unit (NICU). Various neuroimaging modalities are available for neonatal brain imaging and are selected based on presenting problem, timing and patient stability. RECENT FINDINGS Neuroimaging findings, taken together with clinical factors and serial neurological examination can be used to predict future neurodevelopmental outcomes. In this narrative review, we discuss neonatal neuroimaging modalities, and how these can be optimally utilized to assess infants in the NICU. We will review common patterns of brain injury and neurodevelopmental outcomes in hypoxic-ischemic encephalopathy, perinatal arterial ischemic stroke and preterm brain injury. SUMMARY Timely and accurate neuroprognostication can identify infants at risk for neurodevelopmental impairment and allow for early intervention and targeted therapies to improve outcomes.
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Affiliation(s)
- Rhandi Christensen
- Division of Neurology, The Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Linda S de Vries
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mehmet N Cizmeci
- Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Toronto, Canada
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Binet L, Debillon T, Beck J, Vilotitch A, Guellec I, Ego A, Chevallier M. Effect of gestational age on cerebral lesions in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326131. [PMID: 38418209 DOI: 10.1136/archdischild-2023-326131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy. DESIGN Secondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy. SETTING French neonatal intensive care units. PATIENTS Neonates with moderate or severe neonatal encephalopathy (NE) born at ≥34 weeks' GA (wGA) between September 2015 and March 2017. MAIN OUTCOME MEASURES The results of MRI performed within the first 12 days were classified in seven injured brain regions: basal ganglia and thalami, white matter (WM), cortex, posterior limb internal capsule, corpus callosum, brainstem and cerebellum. A given infant could have several brain structures affected. Risk of brain lesion according to GA was estimated by crude and adjusted ORs (aOR). RESULTS MRI was available for 626 (78.8%) of the 794 included infants with NE. WM lesions predominated in preterm compared with term infants. Compared with 39-40 wGA neonates, those born at 34-35 wGA and 37-38 wGA had greater risk of WM lesions after adjusting for perinatal factors (aOR 4.0, 95% CI (1.5 to 10.7) and ORa 2.0, 95% CI (1.1 to 3.5), respectively). CONCLUSION WM is the main brain structure affected in late-preterm and early-term infants with NE, with fewer WM lesions as GA increases. This finding could help clinicians to estimate prognosis and improve the understanding of the pathophysiology of NE. TRIAL REGISTRATION NUMBER NCT02676063, ClinicalTrials.gov.
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Affiliation(s)
- Lauren Binet
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
| | - Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
| | - Antoine Vilotitch
- Univversité Grenoble Alpes, Data Engineering Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Guellec
- 7 Neonatal Intensive Care Medicine Department, University Hospital Nice Cote d'Azur, Nice, France
| | - Anne Ego
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004, Paris, France
| | - Marie Chevallier
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
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Shevell MI. The First Cut Is Not Necessarily the Deepest: Major Surgery as a Marker of Brain Injury in Extreme Prematurity. Neurology 2023; 101:925-926. [PMID: 37788933 DOI: 10.1212/wnl.0000000000207988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Michael I Shevell
- From the Pediatrics & Neurology/Neurosurgery, McGill University, Montreal; and Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Centre, Quebec, Canada.
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Laccetta G, Di Chiara M, De Nardo MC, Tagliabracci M, Travaglia E, De Santis B, Spiriti C, Dito L, Regoli D, Caravale B, Cellitti R, Parisi P, Terrin G. Quantitative ultrasonographic examination of cerebral white matter by pixel brightness intensity as marker of middle-term neurodevelopment: a prospective observational study. Sci Rep 2023; 13:16816. [PMID: 37798394 PMCID: PMC10556025 DOI: 10.1038/s41598-023-44083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Abstract
Non-cystic white matter (WM) injury has become prevalent among preterm newborns and is associated with long-term neurodevelopmental impairment. Magnetic resonance is the gold-standard for diagnosis; however, cranial ultrasound (CUS) is more easily available but limited by subjective interpretation of images. To overcome this problem, we enrolled in a prospective observational study, patients with gestational age at birth < 32 weeks with normal CUS scans or grade 1 WM injury. Patients underwent CUS examinations at 0-7 days of life (T0), 14-35 days of life (T1), 370/7-416/7 weeks' postmenstrual age (T2), and 420/7-520/7 weeks' postmenstrual age (T3). The echogenicity of parieto-occipital periventricular WM relative to that of homolateral choroid plexus (RECP) was calculated on parasagittal scans by means of pixel brightness intensity and its relationship with Bayley-III assessment at 12 months' corrected age was evaluated. We demonstrated that: (1) Left RECP values at T1 negatively correlated with cognitive composite scores; (2) Right RECP values at T2 and T3 negatively correlated with language composite scores; (3) Left RECP values at T1 and T2 negatively correlated with motor composite scores. Thus, this technique may be used as screening method to early identify patients at risk of neurodevelopmental issues and promptly initiate preventive and therapeutic interventions.
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Affiliation(s)
- Gianluigi Laccetta
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Maria Di Chiara
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Tagliabracci
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Travaglia
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Benedetta De Santis
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Spiriti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Lucia Dito
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Regoli
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Raffaella Cellitti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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McLean G, Ditchfield M, Paul E, Malhotra A, Lombardo P. Evaluation of a Cranial Ultrasound Screening Protocol for Very Preterm Infants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1081-1091. [PMID: 36321412 DOI: 10.1002/jum.16121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Cranial ultrasound (cUS) screening is recommended for preterm neonates born before 32 weeks' gestational age (GA). The primary aim of this study was to determine if both a day 3 and day 8 cUS screening examination is necessary for all neonates. METHODS A retrospective observational study was performed at a tertiary-level Australian hospital. Frequencies of cranial ultrasound abnormality (CUA) were compared between routine screening performed at postnatal days 3, 8, and 42. Univariate and multivariate analyses of risk factors for intraventricular hemorrhage (IVH) was performed using logistic regression. RESULTS cUS examinations on 712 neonates born before 32 weeks' GA were included. Neonates were divided into 2 groups: 99 neonates in the 23-25 weeks 6 days GA (group A) and 613 neonates in the 26-31 weeks 6 days GA (group B). All CUA occurred more frequently in group A neonates and in the subset of group B neonates who had defined risk factors. Low-risk group B neonates had lower incidence of CUAs demonstrated on day 8 cUS than high-risk group B neonates, with no significant differences between day 3 and day 8. Logistic regression analysis identified a number of risk factors (vaginal delivery, small for GA, Apgar score <7 at 5 minutes, intubation, patent ductus arteriosus and infection) that were associated with increased frequency of IVH on day 8. In neonates born between 30 and 31 weeks 6 days GA, 35% had a CUA identified. CONCLUSIONS Low-risk preterm neonates born between 26 and 31 weeks 6 days GA, without complications, could be screened with a single early cUS examination around day 8 without missing substantial abnormality.
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Affiliation(s)
- Glenda McLean
- Diagnostic Imaging Department, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
| | - Michael Ditchfield
- Diagnostic Imaging Department, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Imaging, Monash University, Clayton, VIC, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, VIC, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
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Kobus S, Diezel M, Dewan MV, Huening B, Dathe AK, Felderhoff-Mueser U, Bruns N. Impact of Physical Contact on Preterm Infants' Vital Sign Response to Live Music Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159524. [PMID: 35954880 PMCID: PMC9368366 DOI: 10.3390/ijerph19159524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Evidence that music therapy stabilises vital parameters in preterm infants is growing, but the optimal setting for therapy is still under investigation. Our study aimed to quantify the effect of physical contact during live music therapy in preterm infants born < 32 weeks’ gestational age (GA) on post-therapy vital sign values. Live music therapy was delivered twice-weekly until discharge from hospital to 40 stable infants < 32 weeks’ GA. Baseline and post-therapy heart rate, respiratory rate, oxygen saturation and physical contact during each session were recorded. 159 sessions were performed with, and 444 sessions without, physical contact. Descriptive and multivariable regression analyses based on directed acyclic graphs were performed. The mean GA was 28.6 ± 2.6 weeks, and 26 (65%) infants were male. Mean absolute values for heart and respiratory rates lowered during music therapy regardless of physical contact. The mean post-therapy SaO2 was higher compared to baseline values regardless of physical contact (mean differences −8.6 beats/min; −13.3 breaths/min and +2.0%). There were no clinically relevant changes in vital sign responses between therapy sessions, with or without physical contact, or adjusted post-therapy values for any of the studied vital signs. Physical contact caused better baseline and post-therapy vital sign values but did not enhance the vital sign response to music therapy. Thus, the effect of music therapy on preterm infants’ vital signs is independent of physical contact and parents’ presence during music therapy in the neonatal intensive care unit.
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Affiliation(s)
- Susann Kobus
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence:
| | - Marlis Diezel
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Britta Huening
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences Jena, 07745 Jena, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
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