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Jain S, Barnes-Davis ME, Fu TT, Sahay RD, Ehrlich SR, Liu C, Kline-Fath B, Habli M, Parikh NA. Hypertensive Disorders of Pregnancy and Risk of Early Brain Abnormalities on MRI at Term among Infants Born at ≤32 Weeks' Gestational Age. J Pediatr 2024:114133. [PMID: 38838850 DOI: 10.1016/j.jpeds.2024.114133] [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: 02/20/2024] [Revised: 04/23/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To evaluate the proximal effects of hypertensive disorders of pregnancy (HDP) on a validated measure of brain abnormalities in infants born at ≤32 weeks' gestational age (GA) using magnetic resonance imaging (MRI) at term-equivalent age. STUDY DESIGN In a multisite prospective cohort study, 395 infants born at ≤32 weeks' GA, underwent 3T MRI scan between 39 through 44 weeks' postmenstrual age. A single neuroradiologist, blinded to clinical history, evaluated the standardized Kidokoro global brain abnormality score as the primary outcome. We classified infants as HDP-exposed by maternal diagnosis of chronic hypertension, gestational hypertension, preeclampsia, or eclampsia. Linear regression analysis identified the independent effects of HDP on infant brain abnormalities, adjusting for histologic chorioamnionitis, maternal smoking, antenatal steroids, magnesium sulfate, and infant sex. Mediation analyses quantified the indirect effect of HDP mediated via impaired intrauterine growth and prematurity and remaining direct effects on brain abnormalities. RESULTS 170/395 infants (43%) were HDP-exposed. Adjusted multivariable analyses revealed HDP-exposed infants had 27% (95% CI 5-53%) higher brain abnormality scores than those without HDP exposure (p=0.02), primarily driven by increased white matter injury/abnormality scores (p=0.01). Mediation analyses showed HDP-induced impaired intrauterine growth significantly (p=0.02) contributed to brain abnormality scores (22% of the total effect). CONCLUSIONS Maternal hypertension independently increased the risk for early brain injury and/or maturational delays in infants born at ≤32 weeks' GA with an indirect effect of 22% resulting from impaired intrauterine growth. Enhanced prevention/treatment of maternal hypertension may mitigate the risk of infant brain abnormalities and potential neurodevelopmental impairments.
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Affiliation(s)
- Shipra Jain
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Maria E Barnes-Davis
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; University of Cincinnati College of Medicine, Cincinnati, Ohio, United States; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Ting Ting Fu
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Shelley R Ehrlich
- University of Cincinnati College of Medicine, Cincinnati, Ohio, United States; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Beth Kline-Fath
- University of Cincinnati College of Medicine, Cincinnati, Ohio, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Mounira Habli
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; Trihealth Good Samaritan Hospital, Cincinnati, Ohio, United States
| | - Nehal A Parikh
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States; University of Cincinnati College of Medicine, Cincinnati, Ohio, United States; Neurodevelopmental Disorders Prevention Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
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Schmidbauer VU, Yildirim MS, Dovjak GO, Goeral K, Buchmayer J, Weber M, Kienast P, Diogo MC, Prayer F, Stuempflen M, Kittinger J, Malik J, Nowak NM, Klebermass-Schrehof K, Fuiko R, Berger A, Prayer D, Kasprian G, Giordano V. Quantitative Magnetic Resonance Imaging for Neurodevelopmental Outcome Prediction in Neonates Born Extremely Premature-An Exploratory Study. Clin Neuroradiol 2024; 34:421-429. [PMID: 38289377 PMCID: PMC11129968 DOI: 10.1007/s00062-023-01378-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/26/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE Neonates born at < 28 weeks of gestation are at risk for neurodevelopmental delay. The aim of this study was to identify quantitative MR-based metrics for the prediction of neurodevelopmental outcomes in extremely preterm neonates. METHODS T1-/T2-relaxation times (T1R/T2R), ADC, and fractional anisotropy (FA) of the left/right posterior limb of the internal capsule (PLIC) and the brainstem were determined at term-equivalent ages in a sample of extremely preterm infants (n = 33). Scores for cognitive, language, and motor outcomes were collected at one year corrected-age. Pearson's correlation analyses detected relationships between quantitative measures and outcome data. Stepwise regression procedures identified imaging metrics to estimate neurodevelopmental outcomes. RESULTS Cognitive outcomes correlated significantly with T2R (r = 0.412; p = 0.017) and ADC (r = -0.401; p = 0.021) (medulla oblongata). Furthermore, there were significant correlations between motor outcomes and T1R (pontine tegmentum (r = 0.346; p = 0.049), midbrain (r = 0.415; p = 0.016), right PLIC (r = 0.513; p = 0.002), and left PLIC (r = 0.504; p = 0.003)); T2R (right PLIC (r = 0.405; p = 0.019)); ADC (medulla oblongata (r = -0.408; p = 0.018) and pontine tegmentum (r = -0.414; p = 0.017)); and FA (pontine tegmentum (r = -0.352; p = 0.045)). T2R/ADC (medulla oblongata) (cognitive outcomes (R2 = 0.296; p = 0.037)) and T1R (right PLIC)/ADC (medulla oblongata) (motor outcomes (R2 = 0.405; p = 0.009)) revealed predictive potential for neurodevelopmental outcomes. CONCLUSION There are relationships between relaxometry‑/DTI-based metrics determined by neuroimaging near term and neurodevelopmental outcomes collected at one year of age. Both modalities bear prognostic potential for the prediction of cognitive and motor outcomes. Thus, quantitative MRI at term-equivalent ages represents a promising approach with which to estimate neurologic development in extremely preterm infants.
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Affiliation(s)
- Victor U Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Mehmet S Yildirim
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor O Dovjak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Goeral
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Patric Kienast
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mariana C Diogo
- Department of Neuroradiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marlene Stuempflen
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Kittinger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Malik
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nikolaus M Nowak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Renate Fuiko
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Angelika Berger
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Vito Giordano
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Li H, Wang J, Li Z, Cecil KM, Altaye M, Dillman JR, Parikh NA, He L. Supervised contrastive learning enhances graph convolutional networks for predicting neurodevelopmental deficits in very preterm infants using brain structural connectome. Neuroimage 2024; 291:120579. [PMID: 38537766 PMCID: PMC11059107 DOI: 10.1016/j.neuroimage.2024.120579] [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: 11/28/2023] [Revised: 02/15/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Very preterm (VPT) infants (born at less than 32 weeks gestational age) are at high risk for various adverse neurodevelopmental deficits. Unfortunately, most of these deficits cannot be accurately diagnosed until the age of 2-5 years old. Given the benefits of early interventions, accurate diagnosis and prediction soon after birth are urgently needed for VPT infants. Previous studies have applied deep learning models to learn the brain structural connectome (SC) to predict neurodevelopmental deficits in the preterm population. However, none of these models are specifically designed for graph-structured data, and thus may potentially miss certain topological information conveyed in the brain SC. In this study, we aim to develop deep learning models to learn the SC acquired at term-equivalent age for early prediction of neurodevelopmental deficits at 2 years corrected age in VPT infants. We directly treated the brain SC as a graph, and applied graph convolutional network (GCN) models to capture complex topological information of the SC. In addition, we applied the supervised contrastive learning (SCL) technique to mitigate the effects of the data scarcity problem, and enable robust training of GCN models. We hypothesize that SCL will enhance GCN models for early prediction of neurodevelopmental deficits in VPT infants using the SC. We used a regional prospective cohort of ∼280 VPT infants who underwent MRI examinations at term-equivalent age from the Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS). These VPT infants completed neurodevelopmental assessment at 2 years corrected age to evaluate cognition, language, and motor skills. Using the SCL technique, the GCN model achieved mean areas under the receiver operating characteristic curve (AUCs) in the range of 0.72∼0.75 for predicting three neurodevelopmental deficits, outperforming several competing models. Our results support our hypothesis that the SCL technique is able to enhance the GCN model in our prediction tasks.
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Affiliation(s)
- Hailong Li
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Artificial Intelligence Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Junqi Wang
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zhiyuan Li
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Kim M Cecil
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Artificial Intelligence Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lili He
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Artificial Intelligence Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA; Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Mahabee-Gittens EM, Priyanka Illapani VS, Merhar SL, Kline-Fath B, Harun N, He L, Parikh NA. Prenatal Opioid Exposure and Risk for Adverse Brain and Motor Outcomes in Infants Born Premature. J Pediatr 2024; 267:113908. [PMID: 38220065 DOI: 10.1016/j.jpeds.2024.113908] [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: 10/05/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To compare brain magnetic resonance imaging (MRI) biomarkers and neurodevelopmental test scores in infants born preterm with and without prenatal opioid exposure (POE). STUDY DESIGN We examined 395 preterm infants (≤32 weeks gestational age) who had term-equivalent brain MRIs, composite scores from the Bayley Scales of Infant and Toddler Development-III at 2 years corrected age, and POE data. MRI parameters included total/regional brain volumes and severe punctate white matter lesions (PWMLs). We conducted bivariable analysis and multivariable logistic regression analyses. RESULTS The mean ± SD gestational age was 29.3 ± 2.5 weeks; 35 (8.9%) had POE and 20 (5.1%) had severe PWML. Compared with unexposed infants, those with POE exhibited higher rates of severe PWML (17.1% vs 3.9%, respectively; P = .002); findings remained significant with an OR of 4.16 (95% CI, 1.26-13.68) after adjusting for confounders. On mediation analysis, the significant relationship between POE and severe PWML was not indirectly mediated through preterm birth/gestational age (OR, 0.93; 95% CI, 0.78-1.10), thus suggesting the association was largely driven by a direct adverse effect of POE on white matter. In multivariable analyses, POE was associated with a significantly lower score by -6.2 (95% CI, -11.8 to -0.6) points on the Bayley Scales of Infant and Toddler Development-III Motor subscale compared with unexposed infants. CONCLUSIONS POE was associated with severe PWML; this outcome may be a direct effect of POE rather than being mediated by premature birth. POE was also associated with worse motor development. Continued follow-up to understand the long-term effects of POE is warranted.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH.
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephanie L Merhar
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lili He
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nehal A Parikh
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Halbmeijer NM, Onland W, Dudink J, Cools F, Debeer A, van Kaam AH, Benders MJNL, van der Aa NE. Effect of Systemic Hydrocortisone on Brain Abnormalities and Regional Brain Volumes in Ventilator-dependent Infants Born Preterm: Substudy of the SToP-BPD Study. J Pediatr 2024; 265:113807. [PMID: 37923196 DOI: 10.1016/j.jpeds.2023.113807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/04/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate whether a high cumulative dose of systemic hydrocortisone affects brain development compared with placebo when initiated between 7 and 14 days after birth in ventilated infants born preterm. STUDY DESIGN A double-blind, placebo-controlled, randomized trial was conducted in 16 neonatal intensive care units among infants born at <30 weeks of gestation or with a birth weight of <1250 g who were ventilator-dependent in the second week after birth. Three centers performed MRI at term-equivalent age. Brain injury was assessed on MRI using the Kidokoro scoring system and compared between the 2 treatment groups. Both total and regional brain volumes were calculated using an automatic segmentation method and compared using multivariable regression analysis adjusted for baseline variables. RESULTS From the 3 centers, 78 infants participated in the study and 59 had acceptable MRI scans (hydrocortisone group, n = 31; placebo group, n = 28). Analyses of the median global brain abnormality score of the Kidokoro score showed no difference between the hydrocortisone and placebo groups (median, 7; IQR, 5-9 vs median, 8, IQR, 4-10, respectively; P = .92). In 39 infants, brain tissue volumes were measured, showing no differences in the adjusted mean total brain tissue volumes, at 352 ± 32 mL in the hydrocortisone group and 364 ± 51 mL in the placebo group (P = .80). CONCLUSIONS Systemic hydrocortisone started in the second week after birth in ventilator-dependent infants born very preterm was not found to be associated with significant differences in brain development compared with placebo treatment. TRIAL REGISTRATION The SToP-BPD study was registered with the Netherlands Trial Register (NTR2768; registered on 17 February 2011; https://www.trialregister.nl/trial/2640) and the European Union Clinical Trials Register (EudraCT, 2010-023777-19; registered on 2 November 2010; https://www.clinicaltrialsregister.eu/ctr-search/trial/2010-023777-19/NL).
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Affiliation(s)
- Nienke M Halbmeijer
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Wes Onland
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Filip Cools
- Department of Neonatology, University Hospital Brussel, Brussel, Belgium
| | - Anne Debeer
- Department of Neonatology, University Hospital Leuven, Leuven, Belgium
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
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Tamm L, McNally KA, Altaye M, Parikh NA. Mathematics abilities associated with adaptive functioning in preschool children born preterm. Child Neuropsychol 2024; 30:315-328. [PMID: 36939102 PMCID: PMC10509309 DOI: 10.1080/09297049.2023.2191942] [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: 09/14/2022] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
It is well known that infants born very preterm (VPT) often demonstrate deficits in mathematical abilities in early childhood which are associated with poorer academic outcomes. Mathematic skills are also critical for other areas of functioning. However, it is not known whether mathematics skills are associated with adaptive functioning in children born preterm. Infants born at ≤31 weeks gestation and full term were recruited at birth and followed over time. At the 36-month corrected age assessment, children were administered the Early Number Concepts subtest of the Differential Abilities Scale, Second Edition, and caregivers completed the Adaptive Behavior Assessment System, Third Edition. After controlling for age, sex, cognitive abilities, and caregiver education, performance on the mathematics measure was uniquely and positively associated with adaptive behavior for preschool children in the VPT group only. Exploratory analyses revealed this association to be specifically related to the Practical and Social composites. Knowledge of concepts of number and quantity were associated with better adaptive functioning, particularly for behaviors related to functioning at home and in the community and play/social functioning, for children born VPT. Although replication is warranted, it would appear that mathematical skills may be an important early intervention target for children born VPT.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Mekibib Altaye
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nehal A. Parikh
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-3039
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Agyeman K, McCarty T, Multani H, Mattingly K, Koziar K, Chu J, Liu C, Kokkoni E, Christopoulos V. Task-based functional neuroimaging in infants: a systematic review. Front Neurosci 2023; 17:1233990. [PMID: 37655006 PMCID: PMC10466897 DOI: 10.3389/fnins.2023.1233990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Infancy is characterized by rapid neurological transformations leading to consolidation of lifelong function capabilities. Studying the infant brain is crucial for understanding how these mechanisms develop during this sensitive period. We review the neuroimaging modalities used with infants in stimulus-induced activity paradigms specifically, for the unique opportunity the latter provide for assessment of brain function. Methods Conducted a systematic review of literature published between 1977-2021, via a comprehensive search of four major databases. Standardized appraisal tools and inclusion/exclusion criteria were set according to the PRISMA guidelines. Results Two-hundred and thirteen papers met the criteria of the review process. The results show clear evidence of overall cumulative growth in the number of infant functional neuroimaging studies, with electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) to be the most utilized and fastest growing modalities with behaving infants. However, there is a high level of exclusion rates associated with technical limitations, leading to limited motor control studies (about 6 % ) in this population. Conclusion Although the use of functional neuroimaging modalities with infants increases, there are impediments to effective adoption of existing technologies with this population. Developing new imaging modalities and experimental designs to monitor brain activity in awake and behaving infants is vital.
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Affiliation(s)
- Kofi Agyeman
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Tristan McCarty
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Harpreet Multani
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Kamryn Mattingly
- Neuroscience Graduate Program, University of California, Riverside, Riverside, CA, United States
| | - Katherine Koziar
- Orbach Science Library, University of California, Riverside, Riverside, CA, United States
| | - Jason Chu
- Division of Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Charles Liu
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Elena Kokkoni
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Vassilios Christopoulos
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
- Neuroscience Graduate Program, University of California, Riverside, Riverside, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
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8
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Li H, Li Z, Du K, Zhu Y, Parikh NA, He L. A Semi-Supervised Graph Convolutional Network for Early Prediction of Motor Abnormalities in Very Preterm Infants. Diagnostics (Basel) 2023; 13:1508. [PMID: 37189608 PMCID: PMC10137879 DOI: 10.3390/diagnostics13081508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Approximately 32-42% of very preterm infants develop minor motor abnormalities. Earlier diagnosis soon after birth is urgently needed because the first two years of life represent a critical window of opportunity for early neuroplasticity in infants. In this study, we developed a semi-supervised graph convolutional network (GCN) model that is able to simultaneously learn the neuroimaging features of subjects and consider the pairwise similarity between them. The semi-supervised GCN model also allows us to combine labeled data with additional unlabeled data to facilitate model training. We conducted our experiments on a multisite regional cohort of 224 preterm infants (119 labeled subjects and 105 unlabeled subjects) who were born at 32 weeks or earlier from the Cincinnati Infant Neurodevelopment Early Prediction Study. A weighted loss function was applied to mitigate the impact of an imbalanced positive:negative (~1:2) subject ratio in our cohort. With only labeled data, our GCN model achieved an accuracy of 66.4% and an AUC of 0.67 in the early prediction of motor abnormalities, outperforming prior supervised learning models. By taking advantage of additional unlabeled data, the GCN model had significantly better accuracy (68.0%, p = 0.016) and a higher AUC (0.69, p = 0.029). This pilot work suggests that the semi-supervised GCN model can be utilized to aid early prediction of neurodevelopmental deficits in preterm infants.
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Affiliation(s)
- Hailong Li
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Artificial Intelligence Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Zhiyuan Li
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Computer Science, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Kevin Du
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Yu Zhu
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nehal A. Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Lili He
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Artificial Intelligence Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Computer Science, University of Cincinnati, Cincinnati, OH 45221, USA
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9
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Mahabee-Gittens EM, Kline-Fath BM, Harun N, Folger AT, He L, Parikh NA. Prenatal tobacco smoke exposure and risk of brain abnormalities on magnetic resonance imaging at term in infants born very preterm. Am J Obstet Gynecol MFM 2023; 5:100856. [PMID: 36592820 PMCID: PMC9974884 DOI: 10.1016/j.ajogmf.2022.100856] [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: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prenatal tobacco smoke exposure and preterm birth are associated with abnormal brain and neurodevelopmental outcomes in infants. Studies that can disentangle indirect mediating effects from direct effects of prenatal tobacco smoke exposure on sensitive early brain magnetic resonance imaging biomarkers in very preterm infants are needed. OBJECTIVE This study aimed to determine whether prenatal tobacco smoke exposure in preterm infants posed any direct effects on magnetic resonance imaging-determined global brain abnormality score and secondary measures of brain abnormalities after removing any indirect mediating effects of preterm birth on neurostructural outcomes. STUDY DESIGN We examined brain magnetic resonance imaging findings collected at 39 to 44 weeks postmenstrual age from a prospective cohort of 395 infants born very preterm (gestational age of ≤32 weeks). The primary outcome was global brain abnormality score, and the secondary outcomes were global efficiency of structural connectome, diffuse white matter abnormality volume, total brain tissue volume, total gray and white matter volumes, and cerebellar volume. Maternal reports of smoking during pregnancy were obtained. We performed multivariable linear regression analyses to examine the association between prenatal tobacco smoke exposure and our magnetic resonance imaging outcomes, controlling for prospectively collected confounders. Moreover, we performed a mediation analysis to estimate the direct effects of prenatal tobacco smoke exposure on brain abnormalities and any indirect effects through preterm birth. RESULTS Overall, 12.6% of infants had prenatal tobacco smoke exposure. Infants with prenatal tobacco smoke exposure had a higher median global brain abnormality score than nonexposed infants (7 [interquartile range, 0-41] vs 5 [interquartile range, 0-34]; P≤.001); the findings remained significant (P<.001) after controlling for antenatal confounders. Global efficiency (P<.001), diffuse white matter volume (P=.037), and total brain tissue volume (P=.047) were significantly different between TSE groups in multivariable analyses. On mediation analysis, preterm birth mediated between 0% and 29% of the indirect effect of prenatal tobacco smoke exposure on several measures of brain abnormality outcomes. Thus, prenatal tobacco smoke exposure had a direct adverse effect between 71% and 100% on brain injury or abnormal development. CONCLUSION Our study has identified multiple adverse effects of prenatal tobacco smoke exposure on sensitive and objective measures of neonatal brain injury and abnormal development; most cases seemed to be a direct effect of prenatal tobacco smoke exposure on fetal brain development. The results underscored the significant adverse neurostructural effects of prenatal tobacco smoke exposure to tobacco smoke pollutants.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Mahabee-Gittens).
| | - Beth M Kline-Fath
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH (Drs Mahabee-Gittens, Kline-Fath, Folger, He, and Parikh)
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati OH (Dr Harun and Folger)
| | - Alonzo T Folger
- Departments of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Drs Kline-Fath and He)
| | - Lili He
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH (Drs Mahabee-Gittens, Kline-Fath, Folger, He, and Parikh)
| | - Nehal A Parikh
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Mahabee-Gittens); Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States (Drs He and Parikh)
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10
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Schmidbauer VU, Yildirim MS, Dovjak GO, Weber M, Diogo MC, Milos RI, Giordano V, Prayer F, Stuempflen M, Goeral K, Buchmayer J, Klebermass-Schrehof K, Berger A, Prayer D, Kasprian G. Synthetic MR Imaging-Based WM Signal Suppression Identifies Neonatal Brainstem Pathways in Vivo. AJNR Am J Neuroradiol 2022; 43:1817-1823. [PMID: 36396336 DOI: 10.3174/ajnr.a7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Multidynamic multiecho sequence-based imaging enables investigators to reconstruct multiple MR imaging contrasts on the basis of a single scan. This study investigated the feasibility of synthetic MRI-based WM signal suppression (syWMSS), a synthetic inversion recovery approach in which a short TI suppresses myelin-related signals, for the identification of early myelinating brainstem pathways. MATERIALS AND METHODS Thirty-one cases of neonatal MR imaging, which included multidynamic multiecho data and conventionally acquired T1- and T2-weighted sequences, were analyzed. The multidynamic multiecho postprocessing software SyMRI was used to generate syWMSS data (TR/TE/TI = 3000/5/410 ms). Two raters discriminated early myelinating brainstem pathways (decussation of the superior cerebellar peduncle, medial lemniscus, central tegmental tract, and medial longitudinal fascicle [the latter 3 assessed at the level of the pons]) on syWMSS data and reference standard contrasts. RESULTS On the basis of syWMSS data, the decussation of the superior cerebellar peduncle (31/31); left/right medial lemniscus (31/31; 30/31); left/right central tegmental tract (19/31; 20/31); and left/right medial longitudinal fascicle (30/31) were reliably identified by both raters. On the basis of T1-weighted contrasts, the decussation of the superior cerebellar peduncle (14/31); left/right medial lemniscus (22/31; 16/31); left/right central tegmental tract (1/31); and left/right medial longitudinal fascicle (9/31; 8/31) were reliably identified by both raters. On the basis of T2-weighted contrasts, the decussation of the superior cerebellar peduncle (28/31); left/right medial lemniscus (16/31; 12/31); left/right central tegmental tract (23/31; 18/31); and left/right medial longitudinal fascicle (15/31; 14/31) were reliably identified by both raters. CONCLUSIONS syWMSS data provide a feasible imaging technique with which to study early myelinating brainstem pathways. MR imaging approaches that use myelin signal suppression contribute to a more sensitive assessment of myelination patterns at early stages of cerebral development.
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Affiliation(s)
- V U Schmidbauer
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M S Yildirim
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - G O Dovjak
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M Weber
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M C Diogo
- Department of Neuroradiology (M.C.D.), Hospital Garcia de Orta, Almada, Portugal
| | - R-I Milos
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - V Giordano
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - F Prayer
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M Stuempflen
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - K Goeral
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - J Buchmayer
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - K Klebermass-Schrehof
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - A Berger
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - G Kasprian
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
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11
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Kline JE, Dudley J, Illapani VSP, Li H, Kline-Fath B, Tkach J, He L, Yuan W, Parikh NA. Diffuse excessive high signal intensity in the preterm brain on advanced MRI represents widespread neuropathology. Neuroimage 2022; 264:119727. [PMID: 36332850 PMCID: PMC9908008 DOI: 10.1016/j.neuroimage.2022.119727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Preterm brains commonly exhibit elevated signal intensity in the white matter on T2-weighted MRI at term-equivalent age. This signal, known as diffuse excessive high signal intensity (DEHSI) or diffuse white matter abnormality (DWMA) when quantitatively assessed, is associated with abnormal microstructure on diffusion tensor imaging. However, postmortem data are largely lacking and difficult to obtain, and the pathological significance of DEHSI remains in question. In a cohort of 202 infants born preterm at ≤32 weeks gestational age, we leveraged two newer diffusion MRI models - Constrained Spherical Deconvolution (CSD) and neurite orientation dispersion and density index (NODDI) - to better characterize the macro and microstructural properties of DWMA and inform the ongoing debate around the clinical significance of DWMA. With increasing DWMA volume, fiber density broadly decreased throughout the white matter and fiber cross-section decreased in the major sensorimotor tracts. Neurite orientation dispersion decreased in the centrum semiovale, corona radiata, and temporal lobe. These findings provide insight into DWMA's biological underpinnings and demonstrate that it is a serious pathology.
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Affiliation(s)
- Julia E Kline
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jon Dudley
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Venkata Sita Priyanka Illapani
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hailong Li
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Beth Kline-Fath
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jean Tkach
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lili He
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Weihong Yuan
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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12
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Jain VG, Kline JE, He L, Kline-Fath BM, Altaye M, Muglia LJ, DeFranco EA, Ambalavanan N, Parikh NA. Acute histologic chorioamnionitis independently and directly increases the risk for brain abnormalities seen on magnetic resonance imaging in very preterm infants. Am J Obstet Gynecol 2022; 227:623.e1-623.e13. [PMID: 35644247 PMCID: PMC10008527 DOI: 10.1016/j.ajog.2022.05.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The independent risk for neurodevelopmental impairments attributed to chorioamnionitis in premature infants remains controversial. Delayed brain maturation or injury identified on magnetic resonance imaging at term-equivalent age can be used as a surrogate measure of neurodevelopmental impairments that is less confounded by postdelivery neonatal intensive care unit environmental factors to investigate this relationship more clearly. OBJECTIVE This study aimed to determine whether preterm infants born with moderate to severe acute histologic chorioamnionitis would have a higher magnetic resonance imaging-determined global brain abnormality score, independent of early premature birth, when compared with preterm infants with no or mild chorioamnionitis. STUDY DESIGN This was a prospective, multicenter cohort study involving infants born very prematurely ≤32 weeks' gestational age with acute moderate to severe histologic chorioamnionitis, graded using standard histologic criteria. Brain abnormalities were diagnosed and scored using a well-characterized, standardized scoring system captured using a high-resolution 3 Tesla magnetic resonance imaging research magnet. In secondary analyses, total brain volume and 4 magnetic resonance imaging metrics of cortical maturation (cortical surface area, sulcal depth, gyral index, and inner cortical curvature) were calculated using an automated algorithm and correlated with chorioamnionitis. The association of funisitis (any grade) with brain abnormalities was also explored. We investigated if premature birth mediated the relationship between histologic chorioamnionitis and brain abnormality score using mediation analysis. RESULTS Of 353 very preterm infants, 297 infants had mild or no chorioamnionitis (controls), and 56 were diagnosed with moderate to severe acute histologic chorioamnionitis. The primary outcome brain abnormality score was significantly higher in histologic chorioamnionitis-exposed infants than in the controls (median, 4 vs 7; P<.001). Infants with acute histologic chorioamnionitis had significantly lower brain tissue volume (P=.03) and sulcal depth (P=.04), whereas other morphometric indices did not differ statistically. In the multiple regression analysis, we observed persistent significant relationships between moderate to severe acute histologic chorioamnionitis and brain abnormality scores (β=2.84; 1.51-4.16; P<.001), total brain volume (P=.03), and sulcal depth (P=.02). Funisitis was also significantly associated with brain abnormality score after adjustment for clinical confounders (P=.005). Mediation analyses demonstrated that 50% of brain abnormalities was an indirect consequence of premature birth, and the remaining 50% was a direct effect of moderate to severe acute histologic chorioamnionitis when compared with preterm infants with no or mild chorioamnionitis exposure. Examining gestational age as a mediator, funisitis did not exert a significant direct effect on brain abnormalities after the significant indirect effects of preterm birth were accounted for. CONCLUSION Acute histologic chorioamnionitis increases the risk for brain injury and delayed maturation, both directly and indirectly, by inducing premature birth.
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Affiliation(s)
- Viral G Jain
- Division of Neonatology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL; Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Louis J Muglia
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Burroughs Wellcome Fund, Research Triangle Park, NC; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Emily A DeFranco
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Namasivayam Ambalavanan
- Division of Neonatology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Prevention of Neurodevelopmental Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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13
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Romberg J, Wilke M, Allgaier C, Nägele T, Engel C, Poets CF, Franz A. MRI-based brain volumes of preterm infants at term: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:520-526. [PMID: 35078779 PMCID: PMC9411894 DOI: 10.1136/archdischild-2021-322846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND MRI allows a detailed assessment of brain structures in preterm infants, outperforming cranial ultrasound. Neonatal MR-based brain volumes of preterm infants could serve as objective, quantitative and reproducible surrogate parameters of early brain development. To date, there are no reference values for preterm infants' brain volumes at term-equivalent age. OBJECTIVE Systematic review of the literature to determine reference ranges for MRI-based brain volumes of very preterm infants at term-equivalent age. METHODS PubMed Database was searched on 6 April 2020 for studies reporting MR-based brain volumes on representative unselected populations of very preterm and/or very low birthweight infants examined at term equivalent age (defined as 37-42 weeks mean postmenstrual age at MRI). Analyses were limited to volumetric parameters reported in >3 studies. Weighted mean volumes and SD were both calculated and simulated for each parameter. RESULTS An initial 367 publications were identified. Following application of exclusion criteria, 13 studies from eight countries were included for analysis, yielding four parameters. Weighted mean total brain volume was 379 mL (SD 72 mL; based on n=756). Cerebellar volume was 21 mL (6 mL; n=791), cortical grey matter volume 140 mL (47 mL; n=572) and weighted mean volume of unmyelinated white matter was 195 mL (38 mL; n=499). CONCLUSION This meta-analysis reports pooled data on several brain and cerebellar volumes which can serve as reference for future studies assessing MR-based volumetric parameters as a surrogate outcome for neurodevelopment and for the interpretation of individual or cohort MRI-based volumetric findings.
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Affiliation(s)
- Julia Romberg
- Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Marko Wilke
- Pediatric Neurology & Developmental Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Allgaier
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Nägele
- Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Corinna Engel
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Axel Franz
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
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14
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Illapani VSP, Edmondson DA, Cecil KM, Altaye M, Kumar M, Harpster K, Parikh NA. Magnetic resonance spectroscopy brain metabolites at term and 3-year neurodevelopmental outcomes in very preterm infants. Pediatr Res 2022; 92:299-306. [PMID: 33654289 PMCID: PMC8410891 DOI: 10.1038/s41390-021-01434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Noninvasive advanced neuroimaging and neurochemical assessment can identify subtle abnormalities and predict neurodevelopmental impairments. Our objective was to quantify white matter metabolite levels and evaluate their relationship with neurodevelopmental outcomes at age 3 years. METHODS Our study evaluated a longitudinal prospective cohort of very premature infants (<32 weeks gestational age) with single-voxel proton magnetic resonance spectroscopy from the centrum semiovale performed at term-equivalent age and standardized cognitive, verbal, and motor assessments at 3 years corrected age. We separately examined metabolite ratios in the left and right centrum semiovale. We also conducted an exploratory interaction analysis for high/low socioeconomic status (SES) to evaluate the relationship between metabolites and neurodevelopmental outcomes, after adjusting for confounders. RESULTS We found significant relationships between choline/creatine levels in the left and right centrum semiovale and motor development scores. Exploratory interaction analyses revealed that, for infants with low SES, there was a negative association between choline/creatine in the left centrum semiovale and motor assessment scores at age 3 years. CONCLUSIONS Brain metabolites from the centrum semiovale at term-equivalent age were associated with motor outcomes for very preterm infants at 3 years corrected age. This effect may be most pronounced for infants with low SES. IMPACT Motor development at 3 years corrected age for very preterm infants is inversely associated with choline neurochemistry within the centrum semiovale on magnetic resonance spectroscopy at term-equivalent age, especially in infants with low socioeconomic status. No prior studies have studied metabolites in the centrum semiovale to predict neurodevelopmental outcomes at 3 years corrected age based on high/low socioeconomic status. For very preterm infants with lower socioeconomic status, higher choline-to-creatine ratio in central white matter is associated with worse neurodevelopmental outcomes.
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Affiliation(s)
| | - David A. Edmondson
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kim M. Cecil
- Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Manoj Kumar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, INDIA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nehal A. Parikh
- Division of Neonatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Corresponding author’s contact information: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, (513) 636-7584 (Business), (513) 803-0969 (Fax),
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15
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van 't Westende C, Steggerda SJ, Jansen L, van den Berg-Huysmans AA, van de Pol LA, Wiggers-de Bruine FT, Stam CJ, Peeters-Scholte CMPCD. Combining advanced MRI and EEG techniques better explains long-term motor outcome after very preterm birth. Pediatr Res 2022; 91:1874-1881. [PMID: 34031571 DOI: 10.1038/s41390-021-01571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm born children are at high risk for adverse motor neurodevelopment. The aim of this study was to establish the relationship between motor outcome and advanced magnetic resonance imaging (MRI) and electroencephalography (EEG) measures. METHODS In a prospective cohort study of 64 very preterm born children, the motor outcome was assessed at 9.83 (SD 0.70) years. Volumetric MRI, diffusion tensor imaging (DTI), and EEG were acquired at 10.85 (SD 0.49) years. We investigated associations between motor outcome and brain volumes (white matter, deep gray matter, cerebellum, and ventricles), white matter integrity (fractional anisotropy and mean, axial and radial diffusivity), and brain activity (upper alpha (A2) functional connectivity and relative A2 power). The independence of associations with motor outcome was investigated with a final model. For each technique, the measure with the strongest association was selected to avoid multicollinearity. RESULTS Ventricular volume, radial diffusivity, mean diffusivity, relative A2 power, and A2 functional connectivity were significantly correlated to motor outcome. The final model showed that ventricular volume and relative A2 power were independently associated with motor outcome (B = -9.42 × 10-5, p = 0.027 and B = 28.9, p = 0.007, respectively). CONCLUSIONS This study suggests that a lasting interplay exists between brain structure and function that might underlie motor outcome at school age. IMPACT This is the first study that investigates the relationships between motor outcome and brain volumes, DTI, and brain function in preterm born children at school age. Ventricular volume and relative upper alpha power on EEG have an independent relation with motor outcome in preterm born children at school age. This suggests that there is a lasting interplay between structure and function that underlies adverse motor outcome.
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Affiliation(s)
- Charlotte van 't Westende
- Department of Child Neurology, Amsterdam University Medical Centers, AMC Site, Amsterdam, The Netherlands. .,Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette Jansen
- Department of Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Laura A van de Pol
- Department of Child Neurology, Amsterdam University Medical Centers, AMC Site, Amsterdam, The Netherlands
| | | | - Cornelis J Stam
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, VUmc Site, Amsterdam, The Netherlands
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Chandwani R, Harpster K, Kline JE, Mehta V, Wang H, Merhar SL, Schwartz TL, Parikh NA. Brain microstructural antecedents of visual difficulties in infants born very preterm. Neuroimage Clin 2022; 34:102987. [PMID: 35290855 PMCID: PMC8918861 DOI: 10.1016/j.nicl.2022.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/12/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Infants born very preterm (VPT) are at risk of later visual problems. Although neonatal screening can identify ophthalmologic abnormalities, subtle perinatal brain injury and/or delayed brain maturation may be significant contributors to complex visual-behavioral problems. Our aim was to assess the micro and macrostructural antecedents of early visual-behavioral difficulties in VPT infants by using diffusion MRI (dMRI) at term-equivalent age. We prospectively recruited a cohort of 262 VPT infants (≤32 weeks gestational age [GA]) from five neonatal intensive care units. We obtained structural and diffusion MRI at term-equivalent age and administered the Preverbal Visual Assessment (PreViAs) questionnaire to parents at 3-4 months corrected age. We used constrained spherical deconvolution to reconstruct nine white matter tracts of the visual pathways with high reliability and performed fixel-based analysis to derive fiber density (FD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC). In multiple logistic regression analyses, we related these tract metrics to visual-behavioral function. Of 262 infants, 191 had both high-quality dMRI and completed PreViAs, constituting the final cohort: mean (SD) GA was 29.3 (2.4) weeks, 90 (47.1%) were males, and postmenstrual age (PMA) at MRI was 42.8 (1.3) weeks. FD and FC of several tracts were altered in infants with (N = 59) versus those without retinopathy of prematurity (N = 132). FDC of the left posterior thalamic radiations (PTR), left inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), and left inferior fronto-occipital fasciculus (IFOF) were significantly associated with visual attention scores, prior to adjusting for confounders. After adjustment for PMA at MRI, GA, severe retinopathy of prematurity, and total brain volume, FDC of the left PTR, left ILF, and left IFOF remained significantly associated with visual attention. Early visual-behavioral difficulties in VPT infants are preceded by micro and macrostructural abnormalities in several major visual pathways at term-equivalent age.
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Affiliation(s)
- Rahul Chandwani
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Karen Harpster
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Julia E Kline
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ved Mehta
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hui Wang
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; MR Clinical Science, Philips, Cincinnati, OH, United States
| | - Stephanie L Merhar
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Terry L Schwartz
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Schmidbauer VU, Yildirim MS, Dovjak GO, Goeral K, Buchmayer J, Weber M, Diogo MC, Giordano V, Mayr-Geisl G, Prayer F, Stuempflen M, Lindenlaub F, List V, Glatter S, Rauscher A, Stuhr F, Lindner C, Klebermass-Schrehof K, Berger A, Prayer D, Kasprian G. Different from the Beginning: WM Maturity of Female and Male Extremely Preterm Neonates-A Quantitative MRI Study. AJNR Am J Neuroradiol 2022; 43:611-619. [PMID: 35332014 PMCID: PMC8993206 DOI: 10.3174/ajnr.a7472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Former preterm born males are at higher risk for neurodevelopmental disabilities compared with female infants born at the same gestational age. This retrospective study investigated sex-related differences in the maturity of early myelinating brain regions in infants born <28 weeks' gestational age using diffusion tensor- and relaxometry-based MR imaging. MATERIALS AND METHODS Quantitative MR imaging sequence acquisitions were analyzed in a sample of 35 extremely preterm neonates imaged at term-equivalent ages. Quantitative MR imaging metrics (fractional anisotropy; ADC [10-3mm2/s]; and T1-/T2-relaxation times [ms]) of the medulla oblongata, pontine tegmentum, midbrain, and the right/left posterior limbs of the internal capsule were determined on diffusion tensor- and multidynamic, multiecho sequence-based imaging data. ANCOVA and a paired t test were used to compare female and male infants and to detect hemispheric developmental asymmetries. RESULTS Seventeen female (mean gestational age at birth: 26 + 0 [SD, 1 + 4] weeks+days) and 18 male (mean gestational age at birth: 26 + 1 [SD, 1 + 3] weeks+days) infants were enrolled in this study. Significant differences were observed in the T2-relaxation time (P = .014) of the pontine tegmentum, T1-relaxation time (P = .011)/T2-relaxation time (P = .024) of the midbrain, and T1-relaxation time (P = .032) of the left posterior limb of the internal capsule. In both sexes, fractional anisotropy (P [♀] < .001/P [♂] < .001) and ADC (P [♀] = .017/P [♂] = .028) differed significantly between the right and left posterior limbs of the internal capsule. CONCLUSIONS The combined use of various quantitative MR imaging metrics detects sex-related and interhemispheric differences of WM maturity. The brainstem and the left posterior limb of the internal capsule of male preterm neonates are more immature compared with those of female infants at term-equivalent ages. Sex differences in WM maturation need further attention for the personalization of neonatal brain imaging.
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Affiliation(s)
- V U Schmidbauer
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - M S Yildirim
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - G O Dovjak
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - K Goeral
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - J Buchmayer
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - M Weber
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - M C Diogo
- Department of Neuroradiology (M.C.D.), Hospital Garcia de Orta, Almada, Portugal
| | - V Giordano
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - G Mayr-Geisl
- Department of Neurosurgery (G.M.-G.), Medical University of Vienna, Vienna, Austria
| | - F Prayer
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - M Stuempflen
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - F Lindenlaub
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - V List
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - S Glatter
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - A Rauscher
- Department of Pediatrics (A.R.), University of British Columbia, Vancouver, British Columbia, Canada
| | - F Stuhr
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - C Lindner
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - K Klebermass-Schrehof
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - A Berger
- Comprehensive Center for Pediatrics (K.G., J.B., V.G., V.L., S.G., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics
| | - D Prayer
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
| | - G Kasprian
- From the Department of Biomedical Imaging and Image-guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., F.P., M.S., F.L., F.S., C.L., D.P., G.K.)
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Multivariable Predictive Models of Death or Neurodevelopmental Impairment Among Extremely Low Birth Weight Infants Using Heart Rate Characteristics. J Pediatr 2022; 242:137-144.e4. [PMID: 34798080 DOI: 10.1016/j.jpeds.2021.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We hypothesized that a cumulative heart rate characteristics (HRC) index in real-time throughout the neonatal intensive care unit (NICU) hospitalization, alone or combined with birth demographics and clinical characteristics, can predict a composite outcome of death or neurodevelopmental impairment (NDI). STUDY DESIGN We performed a retrospective analysis using data from extremely low birth weight infants who were monitored for HRC during neonatal intensive care. Surviving infants were assessed for NDI at 18-22 months of age. Multivariable predictive modeling of subsequent death or NDI using logistic regression, cross-validation with repeats, and step-wise feature elimination was performed each postnatal day through day 60. RESULTS Among the 598 study participants, infants with the composite outcome of death or moderate-to-severe NDI had higher mean HRC scores during their stay in the NICU (3.1 ± 1.8 vs 1.3 ± 0.8; P < .001). Predictive models for subsequent death or NDI were consistently higher when the cumulative mean HRC score was included as a predictor variable. A parsimonious model including birth weight, sex, ventilatory status, and cumulative mean HRC score had a cross-validated receiver-operator characteristic curve as high as 0.84 on days 4, 5, 6, and 8 and as low as 0.78 on days 50-52 and 56-58 to predict subsequent death or NDI. CONCLUSIONS In extremely low birth weight infants, higher mean HRC scores throughout their stay in the NICU were associated with a higher risk of the composite outcome of death or NDI. TRIAL REGISTRATION ClinicalTrials.gov: NCT00307333.
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Na JY, Lee WH, Lim YH, Cho SH, Cho SH, Park HK. Early screening tool for developmental delay in infancy: Quantified assessment of movement asymmetry using IR-UWB radar. Front Pediatr 2022; 10:731534. [PMID: 36313883 PMCID: PMC9614076 DOI: 10.3389/fped.2022.731534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/26/2022] [Indexed: 12/01/2022] Open
Abstract
In the untact COVID-19 era, the feasibility of a noncontact, impulse-radio ultrawideband (IR-UWB) radar sensor has important medical implications. Premature birth is a major risk factor for brain injury and developmental delay; therefore, early intervention is crucial for potentially achieving better developmental outcomes. Early detection and screening tests in infancy are limited to the quantification of differences between normal and spastic movements. This study investigated the quantified asymmetry in the general movements of an infant with hydrocephalus and proposes IR-UWB radar as a novel, early screening tool for developmental delay. To support this state-of-the-art technology, data from actigraphy and video camcorder recordings were adopted simultaneously to compare relevant time series as the infant grew. The data from the three different methods were highly concordant; specifically, the ρz values comparing radar and actigraphy, which served as the reference for measuring movements, showed excellent agreement, with values of 0.66 on the left and 0.56 on the right. The total amount of movement measured by radar over time increased overall; movements were almost dominant on the left at first (75.2% of total movements), but following shunt surgery, the frequency of movement on both sides was similar (54.8% of total movements). As the hydrocephalus improved, the lateralization of movement on radar began to coincide with the clinical features. These results support the important complementary role of this radar system in predicting motor disorders very early in life.
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Affiliation(s)
- Jae Yoon Na
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Won Hyuk Lee
- Department of Electronics and Computer Engineering, Hanyang University, Seoul, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seok Hyun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, Hanyang University, Seoul, South Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
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20
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Kline JE, Yuan W, Harpster K, Altaye M, Parikh NA. Association between brain structural network efficiency at term-equivalent age and early development of cerebral palsy in very preterm infants. Neuroimage 2021; 245:118688. [PMID: 34758381 PMCID: PMC9264481 DOI: 10.1016/j.neuroimage.2021.118688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Very preterm infants (born at less than 32 weeks gestational age) are at high risk for serious motor impairments, including cerebral palsy (CP). The brain network changes that antecede the early development of CP in infants are not well characterized, and a better understanding may suggest new strategies for risk-stratification at term, which could lead to earlier access to therapies. Graph theoretical methods applied to diffusion MRI-derived brain connectomes may help quantify the organization and information transfer capacity of the preterm brain with greater nuance than overt structural or regional microstructural changes. Our aim was to shed light on the pathophysiology of early CP development, before the occurrence of early intervention therapies and other environmental confounders, to help identify the best early biomarkers of CP risk in VPT infants. In a cohort of 395 very preterm infants, we extracted cortical morphometrics and brain volumes from structural MRI and also applied graph theoretical methods to diffusion MRI connectomes, both acquired at term-equivalent age. Metrics from graph network analysis, especially global efficiency, strength values of the major sensorimotor tracts, and local efficiency of the motor nodes and novel non-motor regions were strongly inversely related to early CP diagnosis. These measures remained significantly associated with CP after correction for common risk factors of motor development, suggesting that metrics of brain network efficiency at term may be sensitive biomarkers for early CP detection. We demonstrate for the first time that in VPT infants, early CP diagnosis is anteceded by decreased brain network segregation in numerous nodes, including motor regions commonly-associated with CP and also novel regions that may partially explain the high rate of cognitive impairments concomitant with CP diagnosis. These advanced MRI biomarkers may help identify the highest risk infants by term-equivalent age, facilitating earlier interventions that are informed by early pathophysiological changes.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, United States
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Division of Occupational Therapy and Physical Therapy, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Karen Harpster
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, United States; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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21
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Bugada MC, Kline JE, Parikh NA. Microstructural Measures of the Inferior Longitudinal Fasciculus Predict Later Cognitive and Language Development in Infants Born With Extremely Low Birth Weight. J Child Neurol 2021; 36:981-989. [PMID: 34187223 PMCID: PMC8458222 DOI: 10.1177/08830738211019862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Extremely preterm children are at high risk for adverse neurodevelopmental outcomes. Identifying predictors of discrete developmental outcomes early in life would allow for targeted neuroprotective therapies when neuroplasticity is at its peak. Our goal was to examine whether diffusion magnetic resonance imaging (MRI) metrics of the inferior longitudinal and uncinate fasciculi early in life could predict later cognitive and language outcomes. STUDY DESIGN In this pilot study, 43 extremely low-birth-weight preterm infants were scanned using diffusion MRI at term-equivalent age. White matter tracts were assessed via diffusion tensor imaging metrics of fractional anisotropy and mean diffusivity. The Language and Cognitive subscale scores of the Bayley Scales of Infant & Toddler Development-III at 18-22 months corrected age were our outcomes of interest. Multiple linear regression models were created to assess diffusion metrics of the inferior longitudinal and uncinate fasciculi as predictors of Bayley scores. We controlled for brain injury score on structural MRI, maternal education, birth weight, and age at MRI scan. RESULTS Of the 43 infants, 36 infants had high-quality diffusion tensor imaging and returned for developmental testing. The fractional anisotropy of the inferior longitudinal fasciculus was associated with Bayley-III scores in univariate analyses and was an independent predictor of Bayley-III cognitive and language development over and above known predictors in multivariable analyses. CONCLUSIONS Incorporating new biomarkers such as the fractional anisotropy of the inferior longitudinal fasciculus with structural MRI findings could enhance accuracy of neurodevelopment predictive models. Additional research is needed to validate our findings in a larger cohort.
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Affiliation(s)
- Matthew C. Bugada
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julia E. Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nehal A. Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
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22
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Zhang C, Zhao X, Cheng M, Wang K, Zhang X. The Effect of Intraventricular Hemorrhage on Brain Development in Premature Infants: A Synthetic MRI Study. Front Neurol 2021; 12:721312. [PMID: 34566865 PMCID: PMC8458889 DOI: 10.3389/fneur.2021.721312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: Synthetic MRI can obtain multiple parameters in one scan, including T1 and T2 relaxation time, proton density (PD), brain volume, etc. This study aimed to investigate the parameter values T1 and T2 relaxation time, PD, and volume characteristics of intraventricular hemorrhage (IVH) newborn brain, and the ability of synthetic MRI parameters T1 and T2 relaxation time and PD to diagnose IVH. Materials and methods: The study included 50 premature babies scanned with conventional and synthetic MRI. Premature infants were allocated to the case group (n = 15) and NON IVH (n = 35). The T1, T2, PD values, and brain volume were obtained by synthetic MRI. Then we assessed the impact of IVH on these parameters. Results: In the posterior limbs of the internal capsule (PLIC), genu of the corpus callosum (GCC), central white matter (CWM), frontal white matter (FWM), and cerebellum (each p < 0.05), the T1 and T2 relaxation times of the IVH group were significantly prolonged. There were significant differences also in PD. The brain volume in many parts were also significantly reduced, which was best illustrated in gray matter (GM), cerebrospinal fluid and intracranial volume, and brain parenchymal fraction (BPF) (each p < 0.001, t = −5.232 to 4.596). The differential diagnosis ability of these quantitative values was found to be excellent in PLIC, CWM, and cerebellum (AUC 0.700–0.837, p < 0.05). Conclusion: The quantitative parameters of synthetic MRI show well the brain tissue characteristic values and brain volume changes of IVH premature infants. T1 and T2 relaxation times and PD contribute to the diagnosis and evaluation of IVH.
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Affiliation(s)
- Chunxiang Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Meiying Cheng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- GE Healthcare, MR Research China, Beijing, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience, Zhengzhou University, Zhengzhou, China
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23
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Neurodevelopmental outcome of preterm very low birth weight infants admitted to an Italian tertiary center over an 11-year period. Sci Rep 2021; 11:16316. [PMID: 34381139 PMCID: PMC8357917 DOI: 10.1038/s41598-021-95864-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
Preterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome. Identifying early factors associated with outcome is essential in order to refer patients for early intervention. Few studies have investigated neurodevelopmental outcome in Italian VLBWi. The aim of our longitudinal study is to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year cohort of 502 Italian preterm VLBWi and to identify associations with outcome. At 24 months, Griffiths’ Mental Developmental Scales were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). 75.3% showed a normal outcome, 13.9% minor sequelae and 10.8% major sequelae (3.8% cerebral palsy). Male gender, bronchopulmonary dysplasia, abnormal neonatal neurological assessment and severe brain ultrasound abnormalities were independently associated with poor outcome on multivariate ordered logistic regression. Rates of major sequelae are in line with international studies, as is the prevalence of developmental delay over cerebral palsy. Analysis of perinatal complications and the combination of close cUS monitoring and neurological assessment are still essential for early identification of infants with adverse outcome.
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Kobus S, Diezel M, Dewan MV, Huening B, Dathe AK, Felderhoff-Mueser U, Bruns N. Music Therapy Is Effective during Sleep in Preterm Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168245. [PMID: 34443994 PMCID: PMC8391215 DOI: 10.3390/ijerph18168245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Recent research found evidence supporting music therapy for preterm infants to stabilize vital signs and possibly promote neurodevelopment. Even though preterm infants spend a considerable amount of time sleeping, the effectiveness of music therapy during sleep has not been studied. The aim of this study was to investigate the effect of music therapy on preterm infants' vital signs with respect to the state of wakefulness. The first 20 consecutive infants born with <32 weeks' gestational age (GA) from the intervention group of an ongoing randomized controlled trial received live music therapy twice a week until hospital discharge. The heart rate, respiratory rate, oxygen saturation, and state of wakefulness were recorded before and after therapy. We observed significantly lower heart and respiratory rates and higher oxygen saturation after live music therapy sessions in general (mean differences -4.9 beats per min; -7.0 breaths per min and +1.5%, respectively). When music therapy was applied during sleep, respiratory rates significantly lowered by 8.8 breaths per min and oxygen saturation increased by 1.6%, whereas in the awake state the vital parameters did not significantly change (heart rate -5.2 beats per min; respiratory rate +0.6 breaths per min and oxygen saturation +1.0%). Music therapy stabilized the respiratory rates and oxygen saturations in sleeping preterm infants.
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Aisa MC, Barbati A, Cappuccini B, Clerici G, Gerli S, Borisova A, De Rosa F, Kaptilnyy VA, Ishenko AI, Renzo GCD. 3-D Echo Brain Volumes to Predict Neurodevelopmental Outcome in Infants: A Prospective Observational Follow-up Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2220-2232. [PMID: 33994230 DOI: 10.1016/j.ultrasmedbio.2021.03.029] [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: 10/16/2020] [Revised: 02/10/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
Prematurity and intra-uterine growth restriction (IUGR) are risk factors for long-term poor neurodevelopmental outcomes and are associated with reductions in regional brain volumes. In this study, the aim was to determine the possible role of 3-D ultrasonography (3-DUS) volumes of whole brain, thalamus, frontal cortex and cerebellum, measured at postnatal days 30-40, as early predictors of long-term risk for neurobehavioral disorders. To this purpose, a heterogeneous population of full-term, preterm, IUGR and preterm IUGR (pre-IUGR) born individuals (n = 334), characterized by gestational age and birth weight in the ranges 24-41 wk and 860-4000 g, respectively, was followed from postnatal days 30-40 to the second year of life. At enrollment, brain volumes were measured using 3-DUS, whereas neurodevelopment was assessed at 2 y using the Griffiths III test. Cerebral volumes were strictly and significantly lower in infants characterized by a negative outcome and had excellent diagnostic accuracy. The 3-DUS volume of whole brain, thalamus, frontal cortex or cerebellum may be an early predictor of neonates at major risk for neurobehavioral disorders in later life.
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Affiliation(s)
- Maria Cristina Aisa
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy.
| | - Antonella Barbati
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Graziano Clerici
- Centro Europeo per la Medicina e la Ricerca (CEMER), Perugia, Italy; Department of Obstetrics and Gynecology, No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Anna Borisova
- Department of Obstetrics and Gynecology with the Course of Perinatology, People's Friendship University of Russia (RUDN University), Moscow, Russia
| | | | - Vitaly Alexandrovich Kaptilnyy
- Department of Obstetrics and Gynecology, No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anatoly Ivanovich Ishenko
- Department of Obstetrics and Gynecology, No. 1 of the Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Gian Carlo Di Renzo
- Section of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; GeBiSa, Research Foundation, Perugia, Italy; Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy; Second Department of Obstetrics and Gynecology, I. M. Sechenov First State Medical University, Moscow, Russia
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26
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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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An assessment of prevalence and expenditure associated with discharge brain MRI in preterm infants. PLoS One 2021; 16:e0247857. [PMID: 33667251 PMCID: PMC7935297 DOI: 10.1371/journal.pone.0247857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/15/2021] [Indexed: 11/28/2022] Open
Abstract
To assess national expenditure associated with preterm-infant brain MRI and potential impact of reduction per Choosing Wisely campaign 2015 recommendation to “avoid routine screening term-equivalent or discharge brain MRIs in preterm-infants”. Cross-sectional U.S. trend data from the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) database (2006, 2009, 2012, 2016) was used to estimate overall national expenditure associated with brain MRI among infants with gestational age (GA) ≤36 weeks, and also when classified as ‘not indicated’ (NI-MRI) i.e., equivalent to routine use without clinical indications and regarded as low-value service (LVS). Associated cost was determined by querying CMS-database for physician-fee-schedules to find the highest global procedure-cost per cycle, then adjusting for inflation. Sensitivity-analyses were conducted to account for additional clinical charges associated with NI-MRI. 3,768 (0.26%) of 1,472,236 preterm-infants had brain MRI across all cycles (inflation-adjusted total $3,690,088). Overall proportion of brain MRIs increased across 2006–2012 from 0.25%-0.33% but decreased in 2016 to 0.16% (P<0.001). Inflation-adjusted overall expenditure by cycle was: 2006, $1,299,130 (95% CI: $987,505, $1,610,755); 2009, $1,194,208 (95% CI: $873,487, $1,516,154); 2012, $931,836 (95% CI: $666,114, $1,197,156); and 2016, $264,648 (95% CI: $172,061, $357,280). Prevalence for NI-MRI in 2006, 2009, 2012 and 2016 was 86% (n = 809), 88% (n = 940), 89% (n = 1028) and 50% (n = 299), respectively; and 70% were in infants 35–36 weeks GA. NI-MRI prevalence was not different over time by payer-type (Medicaid, private), sex or race/ethnicity (white, black, Hispanic); larger hospital size was significantly associated across 2006–2012 but this declined for all sizes in 2016, with most decline in larger hospitals (P for interaction <0.05). NI-MRI expenditure sensitivity-analysis with addition of cycle median total-admission-charge to inflation-adjusted CMS-fee was $1,190,919/$518,343, for 2012/2016 cycles respectively. National MRI prevalence in preterm infants (both overall and LVS) and associated expenditure decreased substantially post recommendation; however, annual savings are modest and unlikely to be >$1.2 million.
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Schmidbauer V, Dovjak G, Geisl G, Weber M, Diogo MC, Yildirim MS, Goeral K, Klebermass-Schrehof K, Berger A, Prayer D, Kasprian G. Impact of Prematurity on the Tissue Properties of the Neonatal Brain Stem: A Quantitative MR Approach. AJNR Am J Neuroradiol 2021; 42:581-589. [PMID: 33478940 DOI: 10.3174/ajnr.a6945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Preterm birth interferes with regular brain development. The aim of this study was to investigate the impact of prematurity on the physical tissue properties of the neonatal brain stem using a quantitative MR imaging approach. MATERIALS AND METHODS A total of 55 neonates (extremely preterm [n = 30]: <28 + 0 weeks gestational age; preterm [n = 10]: 28 + 0-36 + 6 weeks gestational age; term [n = 15]: ≥37 + 0 weeks gestational age) were included in this retrospective study. In most cases, imaging was performed at approximately term-equivalent age using a standard MR protocol. MR data postprocessing software SyMRI was used to perform multidynamic multiecho sequence (acquisition time: 5 minutes, 24 seconds)-based MR postprocessing to determine T1 relaxation time, T2 relaxation time, and proton density. Mixed-model ANCOVA (covariate: gestational age at MR imaging) and the post hoc Bonferroni test were used to compare the groups. RESULTS There were significant differences between premature and term infants for T1 relaxation time (midbrain: P < .001; pons: P < .001; basis pontis: P = .005; tegmentum pontis: P < .001; medulla oblongata: P < .001), T2 relaxation time (midbrain: P < .001; tegmentum pontis: P < .001), and proton density (tegmentum pontis: P = .004). The post hoc Bonferroni test revealed that T1 relaxation time/T2 relaxation time in the midbrain differed significantly between extremely preterm and preterm (T1 relaxation time: P < .001/T2 relaxation time: P = .02), extremely preterm and term (T1 relaxation time/T2 relaxation time: P < .001), and preterm and term infants (T1 relaxation time: P < .001/T2 relaxation time: P = .006). CONCLUSIONS Quantitative MR parameters allow preterm and term neonates to be differentiated. T1 and T2 relaxation time metrics of the midbrain allow differentiation between the different stages of prematurity. SyMRI allows for a quantitative assessment of incomplete brain maturation by providing tissue-specific properties while not exceeding a clinically acceptable imaging time.
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Affiliation(s)
- V Schmidbauer
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - G Dovjak
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - G Geisl
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - M Weber
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - M C Diogo
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - M S Yildirim
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - K Goeral
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics (K.G., K.K.-S., A.B.), Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - K Klebermass-Schrehof
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics (K.G., K.K.-S., A.B.), Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - A Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics (K.G., K.K.-S., A.B.), Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
| | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy (V.S., G.D., G.G., M.W., M.C.D., M.S.Y., D.P., G.K.)
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Adverse effects of perinatal illness severity on neurodevelopment are partially mediated by early brain abnormalities in infants born very preterm. J Perinatol 2021; 41:519-527. [PMID: 33028936 PMCID: PMC7954885 DOI: 10.1038/s41372-020-00854-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND We sought to determine the mediating effects of magnetic resonance imaging (MRI) biomarkers at term gestation on the relationship between perinatal illness severity and neurodevelopment. METHODS The Clinical Risk Index for Babies-second edition (CRIB-II) was correlated with indices of brain maturation or injury and neurodevelopment at 2-year follow-up in infants born less than 32 weeks gestation. Using a counterfactual mediation analysis, associations between CRIB-II, MRI biomarkers, and neurodevelopment were confirmed, followed by an assessment of the mediating effects of MRI biomarkers on the relationship between CRIB-II and neurodevelopment. RESULTS CRIB-II correlated significantly with neurodevelopment and MRI biomarkers of brain injury or cortical maturation. Two MRI biomarkers, cortical surface area and global injury score, were associated with neurodevelopmental scores at follow-up and included in mediation analyses. CONCLUSION Biomarkers of cortical maturation or brain injury at term-equivalent age mediated a substantial portion of the risks conveyed by perinatal illness severity on neurodevelopmental outcomes at 2 years corrected age.
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Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
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31
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Vanderhasselt T, Zolfaghari R, Naeyaert M, Dudink J, Buls N, Allemeersch GJ, Raeymaekers H, Cools F, de Mey J. Synthetic MRI demonstrates prolonged regional relaxation times in the brain of preterm born neonates with severe postnatal morbidity. NEUROIMAGE-CLINICAL 2020; 29:102544. [PMID: 33385883 PMCID: PMC7786121 DOI: 10.1016/j.nicl.2020.102544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/13/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To identify preterm infants at risk for neurodevelopment impairment that might benefit from early neurorehabilitation, early prognostic biomarkers of future outcomes are needed. OBJECTIVE To determine whether synthetic MRI is sensitive to age-related changes in regional tissue relaxation times in the brain of preterm born neonates when scanned at term equivalent age (TEA, 37-42 weeks), and to investigate whether severe postnatal morbidity results in prolonged regional tissue relaxation times. MATERIALS AND METHODS This retrospective study included 70 very preterm born infants scanned with conventional and synthetic MRI between January 2017 and June 2019 at TEA. Infants with severe postnatal morbidity were allocated to a high-risk group (n = 22). All other neonates were allocated to a low-risk group (n = 48). Linear regression analysis was performed to determine the relationship between relaxation times and postmenstrual age (PMA) at scan. Analysis of covariance was used to evaluate the impact of severe postnatal morbidity in the high-risk group on T1 and T2 relaxation times. Receiver operating characteristic (ROC) curves were plotted and analysed with area under the ROC curve (AUC) to evaluate the accuracy of classifying high-risk patients based on regional relaxation times. RESULTS A linear age-related decrease of T1 and T2 relaxation times correlating with PMA at scan (between 37 and 42 weeks) was found in the deep gray matter, the cerebellum, the cortex, and the posterior limb of the internal capsule (PLIC) (p < .005 each), but not in the global, frontal, parietal, or central white matter. Analysis of covariance for both risk groups, adjusted for PMA, revealed significantly prolonged regional tissue relaxation times in neonates with severe postnatal morbidity, which was best illustrated in the central white matter of the centrum semiovale (T1 Δ = 11.5%, T2 Δ = 13.4%, p < .001) and in the PLIC (T1 Δ = 9.2%, T2 Δ = 6.9%, p < .001). The relaxation times in the PLIC and the central white matter predicted high-risk status with excellent accuracy (AUC range 0.82-0.86). CONCLUSION Synthetic MRI-based relaxometry in the brain of preterm born neonates is sensitive to age-related maturational changes close to TEA. Severe postnatal morbidity correlated with a significant delay in tissue relaxation. Synthetic MRI may provide early prognostic biomarkers for neurodevelopment impairment.
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Affiliation(s)
- Tim Vanderhasselt
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Roya Zolfaghari
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maarten Naeyaert
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gert-Jan Allemeersch
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Automated brain morphometric biomarkers from MRI at term predict motor development in very preterm infants. NEUROIMAGE-CLINICAL 2020; 28:102475. [PMID: 33395969 PMCID: PMC7649646 DOI: 10.1016/j.nicl.2020.102475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
Nearly 1/3 of very preterm (VPT) infants develop motor impairments later in life. Better early biomarkers are needed for risk-stratification and early intervention. We used MRI morphometrics at term to predict 2-year motor ability in VPT infants. Inner cortical curvature at term is a novel biomarker of early motor aptitude. In regression models, morphometrics explained nearly 50% of motor score variance.
Very preterm infants are at high risk for motor impairments. Early interventions can improve outcomes in this cohort, but they would be most effective if clinicians could accurately identify the highest-risk infants early. A number of biomarkers for motor development exist, but currently none are sufficiently accurate for early risk-stratification. We prospectively enrolled very preterm (gestational age ≤31 weeks) infants from four level-III NICUs. Structural brain MRI was performed at term-equivalent age. We used a established pipeline to automatically derive brain volumetrics and cortical morphometrics – cortical surface area, sulcal depth, gyrification index, and inner cortical curvature – from structural MRI. We related these objective measures to Bayley-III motor scores (overall, gross, and fine) at two-years corrected age. Lasso regression identified the three best predictive biomarkers for each motor scale from our initial feature set. In multivariable regression, we assessed the independent value of these brain biomarkers, over-and-above known predictors of motor development, to predict motor scores. 75 very preterm infants had high-quality T2-weighted MRI and completed Bayley-III motor testing. All three motor scores were positively associated with regional cortical surface area and subcortical volumes and negatively associated with cortical curvature throughout the majority of brain regions. In multivariable regression modeling, thalamic volume, curvature of the temporal lobe, and curvature of the insula were significant predictors of overall motor development on the Bayley-III, independent of known predictors. Objective brain morphometric biomarkers at term show promise in predicting motor development in very preterm infants.
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33
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Parikh NA, Harpster K, He L, Illapani VSP, Khalid FC, Klebanoff MA, O'Shea TM, Altaye M. Novel diffuse white matter abnormality biomarker at term-equivalent age enhances prediction of long-term motor development in very preterm children. Sci Rep 2020; 10:15920. [PMID: 32985533 PMCID: PMC7523012 DOI: 10.1038/s41598-020-72632-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/31/2020] [Indexed: 01/09/2023] Open
Abstract
Our objective was to evaluate the independent prognostic value of a novel MRI biomarker-objectively diagnosed diffuse white matter abnormality volume (DWMA; diffuse excessive high signal intensity)-for prediction of motor outcomes in very preterm infants. We prospectively enrolled a geographically-based cohort of very preterm infants without severe brain injury and born before 32 weeks gestational age. Structural brain MRI was obtained at term-equivalent age and DWMA volume was objectively quantified using a published validated algorithm. These results were compared with visually classified DWMA. We used multivariable linear regression to assess the value of DWMA volume, independent of known predictors, to predict motor development as assessed using the Bayley Scales of Infant & Toddler Development, Third Edition at 3 years of age. The mean (SD) gestational age of the cohort was 28.3 (2.4) weeks. In multivariable analyses, controlling for gestational age, sex, and abnormality on structural MRI, DWMA volume was an independent prognostic biomarker of Bayley Motor scores ([Formula: see text]= -12.59 [95% CI -18.70, -6.48] R2 = 0.41). Conversely, visually classified DWMA was not predictive of motor development. In conclusion, objectively quantified DWMA is an independent prognostic biomarker of long-term motor development in very preterm infants and warrants further study.
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Affiliation(s)
- Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Fatima Chughtai Khalid
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - T Michael O'Shea
- Departments of Pediatrics, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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He L, Li H, Wang J, Chen M, Gozdas E, Dillman JR, Parikh NA. A multi-task, multi-stage deep transfer learning model for early prediction of neurodevelopment in very preterm infants. Sci Rep 2020; 10:15072. [PMID: 32934282 PMCID: PMC7492237 DOI: 10.1038/s41598-020-71914-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022] Open
Abstract
Survivors following very premature birth (i.e., ≤ 32 weeks gestational age) remain at high risk for neurodevelopmental impairments. Recent advances in deep learning techniques have made it possible to aid the early diagnosis and prognosis of neurodevelopmental deficits. Deep learning models typically require training on large datasets, and unfortunately, large neuroimaging datasets with clinical outcome annotations are typically limited, especially in neonates. Transfer learning represents an important step to solve the fundamental problem of insufficient training data in deep learning. In this work, we developed a multi-task, multi-stage deep transfer learning framework using the fusion of brain connectome and clinical data for early joint prediction of multiple abnormal neurodevelopmental (cognitive, language and motor) outcomes at 2 years corrected age in very preterm infants. The proposed framework maximizes the value of both available annotated and non-annotated data in model training by performing both supervised and unsupervised learning. We first pre-trained a deep neural network prototype in a supervised fashion using 884 older children and adult subjects, and then re-trained this prototype using 291 neonatal subjects without supervision. Finally, we fine-tuned and validated the pre-trained model using 33 preterm infants. Our proposed model identified very preterm infants at high-risk for cognitive, language, and motor deficits at 2 years corrected age with an area under the receiver operating characteristic curve of 0.86, 0.66 and 0.84, respectively. Employing such a deep learning model, once externally validated, may facilitate risk stratification at term-equivalent age for early identification of long-term neurodevelopmental deficits and targeted early interventions to improve clinical outcomes in very preterm infants.
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Affiliation(s)
- Lili He
- The Perinatal Institute and Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA.
| | - Hailong Li
- The Perinatal Institute and Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
| | - Jinghua Wang
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ming Chen
- The Perinatal Institute and Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
- Department of Electronic Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH, USA
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
| | - Elveda Gozdas
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA
| | - Nehal A Parikh
- The Perinatal Institute and Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Kline JE, Illapani VSP, He L, Altaye M, Logan JW, Parikh NA. Early cortical maturation predicts neurodevelopment in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2020; 105:460-465. [PMID: 31704737 PMCID: PMC7205568 DOI: 10.1136/archdischild-2019-317466] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the ability of four objectively defined, cortical maturation features-surface area, gyrification index, sulcal depth and curvature-from structural MRI at term-equivalent age (TEA) to independently predict cognitive and language development at 2 years corrected age in very preterm (VPT) infants. DESIGN Population-based, prospective cohort study. Structural brain MRI was performed at term, between 40 and 44 weeks postmenstrual age and processed using the developing Human Connectome Project pipeline. SETTING Multicentre study comprising four regional level III neonatal intensive care units in the Columbus, Ohio region. PATIENTS 110 VPT infants (gestational age (GA) ≤ 31 weeks). MAIN OUTCOME MEASURES Cognitive and language scores at 2 years corrected age on the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS Of the 94 VPT infants with high-quality T2-weighted MRI scans, 75 infants (80%) returned for Bayley-III testing. Cortical surface area was positively correlated with cognitive and language scores in nearly every brain region. Curvature of the inner cortex was negatively correlated with Bayley scores in the frontal, parietal and temporal lobes. In multivariable regression models, adjusting for GA, sex, socioeconomic status, and injury score on MRI, regional measures of surface area and curvature independently explained more than one-third of the variance in cognitive and language scores at 2 years corrected age in our cohort. CONCLUSIONS We identified increased cortical curvature at TEA as a new prognostic biomarker of adverse neurodevelopment in very premature infants. When combined with cortical surface area, it enhanced prediction of cognitive and language development. Larger studies are needed to externally validate our findings.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA,Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - John Wells Logan
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, 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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Shah N, Farhat A, Tweed J, Wang Z, Lee J, McBeth R, Skinner M, Tian F, Thiagarajan R, Raman L. Neural Networks to Predict Radiographic Brain Injury in Pediatric Patients Treated with Extracorporeal Membrane Oxygenation. J Clin Med 2020; 9:jcm9092718. [PMID: 32842683 PMCID: PMC7565544 DOI: 10.3390/jcm9092718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023] Open
Abstract
Brain injury is a significant source of morbidity and mortality for pediatric patients treated with Extracorporeal Membrane Oxygenation (ECMO). Our objective was to utilize neural networks to predict radiographic evidence of brain injury in pediatric ECMO-supported patients and identify specific variables that can be explored for future research. Data from 174 ECMO-supported patients were collected up to 24 h prior to, and for the duration of, the ECMO course. Thirty-five variables were collected, including physiological data, markers of end-organ perfusion, acid-base homeostasis, vasoactive infusions, markers of coagulation, and ECMO-machine factors. The primary outcome was the presence of radiologic evidence of moderate to severe brain injury as established by brain CT or MRI. This information was analyzed by a neural network, and results were compared to a logistic regression model as well as clinician judgement. The neural network model was able to predict brain injury with an Area Under the Curve (AUC) of 0.76, 73% sensitivity, and 80% specificity. Logistic regression had 62% sensitivity and 61% specificity. Clinician judgment had 39% sensitivity and 69% specificity. Sequential feature group masking demonstrated a relatively greater contribution of physiological data and minor contribution of coagulation factors to the model's performance. These findings lay the foundation for further areas of research directions.
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Affiliation(s)
- Neel Shah
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Abdelaziz Farhat
- Department of Pediatrics, Pediatrix Medical Group, Orem, UT 84057, USA;
| | | | - Ziheng Wang
- Department of Mechanical Engineering, The University of Texas at Dallas, Dallas, TX 75080, USA;
| | - Jeon Lee
- Department of Bioinformatics, University of Texas Southwestern, Dallas, TX 75390, USA;
| | - Rafe McBeth
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, USA;
| | - Michael Skinner
- Department of Computer Science, The University of Texas at Dallas, Dallas, TX 75080, USA;
| | - Fenghua Tian
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Ravi Thiagarajan
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Lakshmi Raman
- Children’s Health Dallas, Dallas, TX 75201, USA;
- Department of Pediatrics, Division of Pediatric Critical Care, University of Texas Southwestern, Dallas, TX 75390, USA
- Correspondence:
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Janjic T, Pereverzyev S, Hammerl M, Neubauer V, Lerchner H, Wallner V, Steiger R, Kiechl-Kohlendorfer U, Zimmermann M, Buchheim A, Grams AE, Gizewski ER. Feed-forward neural networks using cerebral MR spectroscopy and DTI might predict neurodevelopmental outcome in preterm neonates. Eur Radiol 2020; 30:6441-6451. [PMID: 32683551 PMCID: PMC7599175 DOI: 10.1007/s00330-020-07053-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
Objectives We aimed to evaluate the ability of feed-forward neural networks (fNNs) to predict the neurodevelopmental outcome (NDO) of very preterm neonates (VPIs) at 12 months corrected age by using biomarkers of cerebral MR proton spectroscopy (1H-MRS) and diffusion tensor imaging (DTI) at term-equivalent age (TEA). Methods In this prospective study, 300 VPIs born before 32 gestational weeks received an MRI scan at TEA between September 2013 and December 2017. Due to missing or poor-quality spectroscopy data and missing neurodevelopmental tests, 173 VPIs were excluded. Data sets consisting of 103 and 115 VPIs were considered for prediction of motor and cognitive developmental delay, respectively. Five metabolite ratios and two DTI characteristics in six different areas of the brain were evaluated. A feature selection algorithm was developed for receiving a subset of characteristics prevalent for the VPIs with a developmental delay. Finally, the predictors were constructed employing multiple fNNs and fourfold cross-validation. Results By employing the constructed fNN predictors, we were able to predict cognitive delays of VPIs with 85.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.1% negative predictive value (NPV). For the prediction of motor delay, we achieved a sensitivity of 76.9%, a specificity of 98.9%, a PPV of 90.9% and an NPV of 96.7%. Conclusion FNNs might be able to predict motor and cognitive development of VPIs at 12 months corrected age when employing biomarkers of cerebral 1H-MRS and DTI quantified at TEA. Key Points • A feed-forward neuronal network is a promising tool for outcome prediction in premature infants. • Cerebral proton magnetic resonance spectroscopy and diffusion tensor imaging can be used for the construction of early prognostic biomarkers. • Premature infants that would most benefit from early intervention services can be spotted at the time of optimal neuroplasticity. Electronic supplementary material The online version of this article (10.1007/s00330-020-07053-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Janjic
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. .,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | - S Pereverzyev
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - M Hammerl
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - V Neubauer
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - H Lerchner
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - V Wallner
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - R Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - U Kiechl-Kohlendorfer
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Zimmermann
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - A E Grams
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - E R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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Tamm L, Patel M, Peugh J, Kline-Fath BM, Parikh NA. Early brain abnormalities in infants born very preterm predict under-reactive temperament. Early Hum Dev 2020; 144:104985. [PMID: 32163848 PMCID: PMC7577074 DOI: 10.1016/j.earlhumdev.2020.104985] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/27/2020] [Accepted: 02/13/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Early temperament may mediate the association between brain abnormalities following preterm birth and neurodevelopmental outcomes. AIMS This exploratory study investigated whether brain abnormalities in infants born very preterm predicted temperament. STUDY DESIGN Infants born prematurely underwent structural MRI at term. Mother self-reported depression symptoms at the scanning visit, and the Infant Behavior Questionnaire-Revised-Short (IBQ-R-S) about their infant at 3-months corrected age. SUBJECTS Infants (n = 214) born at ≤32 weeks gestation (M = 29.29, SD = 2.60). Average post-menstrual age at the MRI scan was 42.72 weeks (SD = 1.30). The majority of the infants were male (n = 115), and Caucasian (n = 145) or African American (n = 58). The average birthweight in grams was 1289.75 (SD = 448.5). OUTCOME MEASURES Infant Behavior Questionnaire-Revised-Short (IBQ-R-S) subscales. RESULTS Multivariate regression showed white matter abnormalities predicted lower ratings on High Intensity Pleasure and Vocal Reactivity, grey matter abnormalities predicted lower ratings on High Intensity Pleasure and Cuddliness, and cerebellar abnormalities predicted lower ratings on Fear and Sadness IBQ-R-S subscales adjusting for gestational age and sex. The pattern of results was essentially unchanged when maternal depression and socioeconomic status were included in the model. CONCLUSIONS Early MRI-diagnosed brain abnormalities in infants born very preterm were associated less vocalization and engagement during cuddling, decreased ability to take pleasure in stimulating activities, and lower emotionality in fear and sadness domains. Although replication is warranted, an under-reactive temperament in infants born preterm may have a neurobiological basis.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229-3039, United States of America; University of Cincinnati College of Medicine, United States of America.
| | - Meera Patel
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229-3039, United States of America.
| | - James Peugh
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229-3039, United States of America; University of Cincinnati College of Medicine, United States of America.
| | - Beth M. Kline-Fath
- University of Cincinnati College of Medicine, United States of America,Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229-3039, United States of America
| | - Nehal A. Parikh
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229-3039, United States of America,University of Cincinnati College of Medicine, United States of America,Correspondence to: N.A. Parikh, Perinatal Institute, Cincinnati Children’s Hospital Med. Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229-3039, United States of America.
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Differential Effect of Growth on Development between AGA and SGA Preterm Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093022. [PMID: 32349231 PMCID: PMC7246442 DOI: 10.3390/ijerph17093022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/22/2022]
Abstract
Predicting developmental outcomes with growth measurement would be beneficial for primary healthcare or in developing countries with low medical resources. This study aimed to identify physical growth measures that indicate neurodevelopment in very preterm infants. Preterm infants, born at <32 weeks’ gestation or weighing <1500 g, were included. We calculated the changes in z-score of weight, length, and head circumference (HC) at different time points: birth, postmenstrual age (PMA) 35 weeks, and 4 and 18 months corrected age (CA). We examined the relationship between growth and Bayley-III scores using linear regression. Among 122 infants, HC at 4 months CA and HC growth between PMA 35 weeks and 4 months CA showed a positive correlation with Bayley-III scores in appropriate-for-gestational-age infants (AGAs). Weight and length increases between birth and 18 months CA were also associated with AGAs’ development. In small-for-gestational-age infants (SGAs), only birthweight’s z-score was associated with improved neurodevelopmental outcomes. HC at 4 months CA was an important indicator of favorable neurodevelopmental outcomes, and head growth spurt between PMA 35 weeks and 4 months CA contributed to this benefit in preterm AGAs. The period and indices should be monitored differently for SGAs and AGAs.
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40
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Brunner P, Schneider J, Borradori-Tolsa C, Bickle-Graz M, Hagmann P, Macherel M, Huppi PS, Truttmann AC. Transient tone anomalies in very preterm infants: Association with term-equivalent brain magnetic resonance imaging and neurodevelopment at 18 months. Early Hum Dev 2020; 143:104998. [PMID: 32145503 DOI: 10.1016/j.earlhumdev.2020.104998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Very preterm (VPT) infants are at risk for neurodevelopmental impairments and early clinical findings such as transient tone anomalies (TTA) might represent potential predictive indicators. AIMS The aims of this study were to assess 1) the prevalence of TTA at 6 months corrected age in a population of VPT infants, 2) the association with term-equivalent age (TEA) brain MRI and 3) the neurodevelopmental outcome at 18 months corrected age. STUDY DESIGN AND SUBJECTS A prospective case-control cohort of 103 VPT infants (<29 weeks of gestation) was followed up at 6 months and classified into TTA+ or TTA-. TTA+ was defined by the presence of ≥2 criteria among anomalies of posture, anomalies of tone and hyperreflexia. OUTCOME MEASURES Conventional and diffusion-weighted MRIs at TEA were analyzed according to a semi-quantitative MRI scoring system and apparent diffusion coefficients (ADC) and fractional anisotropy (FA) were measured in frontal, occipital white matter and posterior limb of the internal capsule (PLIC). Neurodevelopment was assessed at 18 months using Bayley-II scales (Psychomotor Developmental Index: PDI; Mental Developmental Index: MDI). RESULTS TTA+ infants represented 29.1% of the total population. They had: 1) significantly higher ADC values in 3 regions of interest (p < 0.001), 2) significant lower FA in the PLIC (p < 0.001), and 3) significant lower PDI score (p < 0.05). No differences were observed regarding MDI scores. Interaction of TTA by cerebellum score was related to lower MDI scores. CONCLUSIONS In VPT infants, TTA at 6 months and/or structural brain abnormality at TEA are associated with poorer neurodevelopmental outcome at 18 months.
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Affiliation(s)
- Pauline Brunner
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Juliane Schneider
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland; Follow Up Unit, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Cristina Borradori-Tolsa
- Division of Development and Growth, Department of the Woman, Child and Adolescent, University Hospital Geneva, Switzerland
| | - Myriam Bickle-Graz
- Follow Up Unit, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Patric Hagmann
- Department of Radiology, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Manon Macherel
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland
| | - Petra S Huppi
- Division of Development and Growth, Department of the Woman, Child and Adolescent, University Hospital Geneva, Switzerland
| | - Anita C Truttmann
- Clinic of Neonatology, Department of Women Mother Child, University Center Hospital and University of Lausanne, Vaud, Switzerland.
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Abstract
Purpose The purpose of this study was to assess the diagnostic accuracy of T1-weighted and T2-weighted contrasts generated by the MR data postprocessing software SyMRI (Synthetic MR AB, Linköping, Sweden) for neonatal brain imaging. Methods In this study 36 cases of neonatal MRI were retrospectively collected, which included T1-weighted and T2-weighted sequences as well as multi-dynamic multi-echo (MDME) sequences. Of the 36 neonates 32 were included in this study and 4 neuroradiologists independently assessed neonatal brain examinations on the basis of conventional and SyMRI-generated T1-weighted and T2-weighted contrasts, in order to determine the presence or absence of lesions. The sensitivity and specificity of both methods were calculated and compared. Results Compared to conventionally acquired T1 and T2-weighted images, SyMRI-generated contrasts showed a lower sensitivity but a higher specificity (SyMRI sensitivity 0.88, confidence interval (CI): 0.72–0.95; specificity 1, CI: 0.89–1/conventional MRI: sensitivity: 0.94, CI: 0.80–0.98; specificity: 0.94, CI: 0.80–0.98). Conclusion The T1-weighted and T2-weighted images generated by SyMRI showed a diagnostic accuracy comparable to that of conventionally acquired contrasts. In addition to semiquantitative imaging data, SyMRI provides diagnostic images and leads to a more efficient use of available imaging time in neonatal brain MRI.
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Haslbeck FB, Jakab A, Held U, Bassler D, Bucher HU, Hagmann C. Creative music therapy to promote brain function and brain structure in preterm infants: A randomized controlled pilot study. Neuroimage Clin 2020; 25:102171. [PMID: 31972397 PMCID: PMC6974781 DOI: 10.1016/j.nicl.2020.102171] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/18/2019] [Accepted: 01/10/2020] [Indexed: 01/17/2023]
Abstract
Cognitive and neurobehavioral problems are among the most severe adverse outcomes in very preterm infants. Such neurodevelopmental impairments may be mitigated through nonpharmacological interventions such as creative music therapy (CMT), an interactive, resource- and needs-oriented approach that provides individual social contact and musical stimulation. The aim was to test the feasibility of a study investigating the role of CMT and to measure the short- and medium-term effects of CMT on structural and functional brain connectivity with MRI. In this randomized, controlled clinical pilot feasibility trial, 82 infants were randomized to either CMT or standard care. A specially trained music therapist provided CMT via infant-directed humming and singing in lullaby style. To test the short-term effects of CMT on brain structure and function, diffusion tensor imaging data and resting-state functional imaging data were acquired. Clinical feasibility was achieved despite moderate parental refusal mainly in the control group after randomization. 40 infants remained as final cohort for the MRI analysis. Structural brain connectivity appears to be moderately affected by CMT, structural connectomic analysis revealed increased integration in the posterior cingulate cortex only. Lagged resting-state MRI analysis showed lower thalamocortical processing delay, stronger functional networks, and higher functional integration in predominantly left prefrontal, supplementary motor, and inferior temporal brain regions in infants treated with CMT. This trial provides unique evidence that CMT has beneficial effects on functional brain activity and connectivity in networks underlying higher-order cognitive, socio-emotional, and motor functions in preterm infants. Our results indicate the potential of CMT to improve long-term neurodevelopmental outcomes in children born very preterm.
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Affiliation(s)
- Friederike Barbara Haslbeck
- Department of Neonatology, University Hospital Zurich and University Zurich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland.
| | - Andras Jakab
- MR Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Ulrike Held
- Department of Biostatistics Epidemiology, Biostatistics and Prevention Institute UZH, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich and University Zurich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Hans-Ulrich Bucher
- Department of Neonatology, University Hospital Zurich and University Zurich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, Children's University Hospital of Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zürich, Switzerland
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Kline JE, Illapani VSP, He L, Altaye M, Parikh NA. Retinopathy of Prematurity and Bronchopulmonary Dysplasia are Independent Antecedents of Cortical Maturational Abnormalities in Very Preterm Infants. Sci Rep 2019; 9:19679. [PMID: 31873183 PMCID: PMC6928014 DOI: 10.1038/s41598-019-56298-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023] Open
Abstract
Very preterm (VPT) infants are at high-risk for neurodevelopmental impairments, however there are few validated biomarkers at term-equivalent age that accurately measure abnormal brain development and predict future impairments. Our objectives were to quantify and contrast cortical features between full-term and VPT infants at term and to associate two key antecedent risk factors, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), with cortical maturational changes in VPT infants. We prospectively enrolled a population-based cohort of 110 VPT infants (gestational age ≤31 weeks) and 51 healthy full-term infants (gestational age 38-42 weeks). Structural brain MRI was performed at term. 94 VPT infants and 46 full-term infants with high-quality T2-weighted MRI were analyzed. As compared to full-term infants, VPT infants exhibited significant global cortical maturational abnormalities, including reduced surface area (-5.9%) and gyrification (-6.7%) and increased curvature (5.9%). In multivariable regression controlled for important covariates, BPD was significantly negatively correlated with lobar and global cortical surface area and ROP was significantly negatively correlated with lobar and global sulcal depth in VPT infants. Our cohort of VPT infants exhibited widespread cortical maturation abnormalities by term-equivalent age that were in part anteceded by two of the most potent neonatal diseases, BPD and ROP.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lili He
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Divison of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Picone S, Ariganello P, Mondì V, Di Palma F, Martini L, Marziali S, Fariello G, Paolillo P. A solution based on melatonin, tryptophan, and vitamin B6 (Melamil Tripto©) for sedation in newborns during brain MRI. Ital J Pediatr 2019; 45:122. [PMID: 31547831 PMCID: PMC6757392 DOI: 10.1186/s13052-019-0714-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Melatonin has been studied and used for several years as a sleep-wake cycle modulator in patients with sleep disorders. Experimental evidence has demonstrated the multiple neuroprotective benefits of this indoleamine secreted by the pineal gland. Melatonin is also used in neurological investigations, for its ability to induce sleep in children. In fact, it favors falling asleep during electroencephalogram, Magnetic Resonance Imaging (MRI), and during brainstem auditory evoked potentials. Previous studies are focused on infants and children. No investigation have been performed in neonates, before or during instrumental assessments. MATERIAL AND METHODS One hundred ten newborns (term and preterm) undergoing brain MRI were enrolled in the study. Thirty minutes before the planned time for the examination, we administered a single dose solution of melatonin- tryptophan-vitamin B6. Twenty minutes after the initial administration of 2 mg, a second dose of 1 mg was administered, if the baby was still awake. If after further 15 min the baby was still not sleeping, an additional dose of 1 mg was administered. RESULTS In 106 patients we obtained adequate sedation without adverse events, allowing us to perform an adequate quality MRI, with a median time of 25 min to reach sleeping. Only in three patients MRI could not be performed. In patients having a large weight, higher doses of melatonin were necessary to reach sleeping. Considering the pro kg dose of melatonin, the average dose that induced sleepiness in neonates was 0,64 ± 0.16 mg/Kg. CONCLUSION A solution based on Melatonin- tryptophan-vitamin B6 can be a helpful sedative to administer to neonates undergoing brain MRI, avoiding the use of anesthetics and achieving adequate assessments.
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Affiliation(s)
- S Picone
- Neonatology and Neonatal Intensive Care Department, Policlinico Casilino General Hospital, Via Casilina 1069, 00169, Rome, Italy.
| | - P Ariganello
- Neonatology and Neonatal Intensive Care Department, Policlinico Casilino General Hospital, Via Casilina 1069, 00169, Rome, Italy
| | - V Mondì
- Neonatology and Neonatal Intensive Care Department, Policlinico Casilino General Hospital, Via Casilina 1069, 00169, Rome, Italy
| | - F Di Palma
- Medical School, La Sapienza University, Piazzale Aldo Moro 5, Rome, Italy
| | - L Martini
- Neonatology and Neonatal Intensive Care Department, Policlinico Casilino General Hospital, Via Casilina 1069, 00169, Rome, Italy
| | - S Marziali
- Department of Neuroradiology, Policlinico Casilino General Hospital, Via Casilina, 1069, Rome, Italy
| | - G Fariello
- Department of Neuroradiology, Policlinico Casilino General Hospital, Via Casilina, 1069, Rome, Italy
| | - P Paolillo
- Neonatology and Neonatal Intensive Care Department, Policlinico Casilino General Hospital, Via Casilina 1069, 00169, Rome, Italy
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45
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Parikh NA, Hershey A, Altaye M. Early Detection of Cerebral Palsy Using Sensorimotor Tract Biomarkers in Very Preterm Infants. Pediatr Neurol 2019; 98:53-60. [PMID: 31201071 PMCID: PMC6717543 DOI: 10.1016/j.pediatrneurol.2019.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/25/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Our objectives were to evaluate the brain's sensorimotor network microstructure using diffusion magnetic resonance imaging (MRI) at term-corrected age and test the ability of sensorimotor microstructural parameters to accurately predict cerebral palsy in extremely-low-birth-weight infants. METHODS We enrolled a prospective pilot cohort of extremely-low-birth-weight preterm infants (birth weight ≤ 1000 g) before neonatal intensive care unit discharge and studied them with structural and diffusion MRI at term-corrected age. Six sensorimotor tracts were segmented, and microstructural parameters from these tracts were evaluated for their ability to predict later development of cerebral palsy, diagnosed at 18 to 22 months corrected age. RESULTS We found significant differences in multiple diffusion MRI parameters from five of the six sensorimotor tracts in infants who developed cerebral palsy (n = 5) versus those who did not (n = 36). When compared with structural MRI or individual diffusion MRI biomarkers, the combination of two individual biomarkers-fractional anisotropy of superior thalamic radiations (sensory component) and radial diffusivity of the corticospinal tract-exhibited the highest sensitivity (80%), specificity (97%), and positive likelihood ratio (28.0) for prediction of cerebral palsy. This combination of diffusion MRI biomarkers accurately classified 95% of the study infants. CONCLUSIONS Development of cerebral palsy in very preterm infants is preceded by early brain injury or immaturity to one or more sensorimotor tracts. A larger study is warranted to evaluate if a combination of sensorimotor microstructural biomarkers could accurately facilitate early diagnosis of cerebral palsy.
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Affiliation(s)
- Nehal A. Parikh
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA,The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Corresponding author’s contact information: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229,
| | - Alexa Hershey
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA,Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Schmidbauer V, Geisl G, Diogo M, Weber M, Goeral K, Klebermass-Schrehof K, Berger A, Prayer D, Kasprian G. SyMRI detects delayed myelination in preterm neonates. Eur Radiol 2019; 29:7063-7072. [PMID: 31286188 PMCID: PMC6828642 DOI: 10.1007/s00330-019-06325-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/28/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The software "SyMRI" generates different MR contrasts and characterizes tissue properties based on a single acquisition of a multi-dynamic multi-echo (MDME)-FLAIR sequence. The aim of this study was to assess the applicability of "SyMRI" in the assessment of myelination in preterm and term-born neonates. Furthermore, "SyMRI" was compared with conventional MRI. METHODS A total of 30 preterm and term-born neonates were examined at term-equivalent age using a standardized MRI protocol. MDME sequence (acquisition time, 5 min, 24 s)-based post-processing was performed using "SyMRI". Myelination was assessed by scoring seven brain regions on quantitative T1-/T2-maps, generated by "SyMRI" and on standard T1-/T2-weighted images, acquired separately. Analysis of covariance (ANCOVA) (covariate, gestational age (GA) at MRI (GAMRI)) was used for group comparison. RESULTS In 25/30 patients (83.3%) (18 preterm and seven term-born neonates), "SyMRI" acquisitions were successfully performed. "SyMRI"-based myelination scores were significantly lower in preterm compared with term-born neonates (ANCOVA: T1: F(1, 22) = 7.420, p = 0.012; T2: F(1, 22) = 5.658, p = 0.026). "SyMRI"-based myelination scores positively correlated with GAMRI (T1: r = 0.662, n = 25, p ≤ 0.001; T2: r = 0.676, n = 25, p ≤ 0.001). The myelination scores based on standard MRI did not correlate with the GAMRI. No significant differences between preterm and term-born neonates were detectable. CONCLUSIONS "SyMRI" is a highly promising MR technique for neonatal brain imaging. "SyMRI" is superior to conventional MR sequences in the visual detection of delayed myelination in preterm neonates. KEY POINTS • By providing multiple MR contrasts, "SyMRI" is a time-saving method in neonatal brain imaging. • Differences concerning the myelination in term-born and preterm infants are visually detectable on T1-/T2-weighted maps generated by "SyMRI". • "SyMRI" allows a faster and more sensitive assessment of myelination compared with standard MR sequences.
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Affiliation(s)
- Victor Schmidbauer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gudrun Geisl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mariana Diogo
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Goeral
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Piris Borregas S, Torres Valdivieso MJ, Martín‐Arriscado C, Cruz Bértolo J, Sierra García P, Pallás Alonso CR. Model that predicted death or disabilities in premature infants was valid at seven years of age. Acta Paediatr 2019; 108:1245-1249. [PMID: 30536707 DOI: 10.1111/apa.14679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
AIM Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. METHODS A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. RESULTS A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56-6.50, and so was BPD (OR 1.52, 95% CI: 1.03-2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51-7.86). The model behaved differently in the two subcohorts. CONCLUSION The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.
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48
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Li H, Parikh NA, Wang J, Merhar S, Chen M, Parikh M, Holland S, He L. Objective and Automated Detection of Diffuse White Matter Abnormality in Preterm Infants Using Deep Convolutional Neural Networks. Front Neurosci 2019; 13:610. [PMID: 31275101 PMCID: PMC6591530 DOI: 10.3389/fnins.2019.00610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022] Open
Abstract
Diffuse white matter abnormality (DWMA), or diffuse excessive high signal intensity is observed in 50-80% of very preterm infants at term-equivalent age. It is subjectively defined as higher than normal signal intensity in periventricular and subcortical white matter in comparison to normal unmyelinated white matter on T2-weighted MRI images. Despite the well-documented presence of DWMA, it remains debatable whether DWMA represents pathological tissue injury or a transient developmental phenomenon. Manual tracing of DWMA exhibits poor reliability and reproducibility and unduly increases image processing time. Thus, objective and ideally automatic assessment is critical to accurately elucidate the biologic nature of DWMA. We propose a deep learning approach to automatically identify DWMA regions on T2-weighted MRI images. Specifically, we formulated DWMA detection as an image voxel classification task; that is, the voxels on T2-weighted images are treated as samples and exclusively assigned as DWMA or normal white matter voxel classes. To utilize the spatial information of individual voxels, small image patches centered on the given voxels are retrieved. A deep convolutional neural networks (CNN) model was developed to differentiate DWMA and normal voxels. We tested our deep CNN in multiple validation experiments. First, we examined DWMA detection accuracy of our CNN model using computer simulations. This was followed by in vivo assessments in a cohort of very preterm infants (N = 95) using cross-validation and holdout validation. Finally, we tested our approach on an independent preterm cohort (N = 28) to externally validate our model. Our deep CNN model achieved Dice similarity index values ranging from 0.85 to 0.99 for DWMA detection in the aforementioned validation experiments. Our proposed deep CNN model exhibited significantly better performance than other popular machine learning models. We present an objective and automated approach for accurately identifying DWMA that may facilitate the clinical diagnosis of DWMA in very preterm infants.
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Affiliation(s)
- Hailong Li
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Nehal A. Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Jinghua Wang
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Stephanie Merhar
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Ming Chen
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Electronic Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Milan Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Scott Holland
- Medpace Inc., Cincinnati, OH, United States
- Department of Physics, University of Cincinnati, Cincinnati, OH, United States
| | - Lili He
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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49
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Alpay Savasan Z, Yilmaz A, Ugur Z, Aydas B, Bahado-Singh RO, Graham SF. Metabolomic Profiling of Cerebral Palsy Brain Tissue Reveals Novel Central Biomarkers and Biochemical Pathways Associated with the Disease: A Pilot Study. Metabolites 2019; 9:metabo9020027. [PMID: 30717353 PMCID: PMC6409919 DOI: 10.3390/metabo9020027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/17/2022] Open
Abstract
Cerebral palsy (CP) is one of the most common causes of motor disability in childhood, with complex and heterogeneous etiopathophysiology and clinical presentation. Understanding the metabolic processes associated with the disease may aid in the discovery of preventive measures and therapy. Tissue samples (caudate nucleus) were obtained from post-mortem CP cases (n = 9) and age- and gender-matched control subjects (n = 11). We employed a targeted metabolomics approach using both 1H NMR and direct injection liquid chromatography-tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 55 metabolites using 1H NMR and 186 using DI/LC-MS/MS. Among the 222 detected metabolites, 27 showed significant concentration changes between CP cases and controls. Glycerophospholipids and urea were the most commonly selected metabolites used to develop predictive models capable of discriminating between CP and controls. Metabolomics enrichment analysis identified folate, propanoate, and androgen/estrogen metabolism as the top three significantly perturbed pathways. We report for the first time the metabolomic profiling of post-mortem brain tissue from patients who died from cerebral palsy. These findings could help to further investigate the complex etiopathophysiology of CP while identifying predictive, central biomarkers of CP.
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Affiliation(s)
- Zeynep Alpay Savasan
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Ali Yilmaz
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Zafer Ugur
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Buket Aydas
- Departments of Mathematics and Computer Sciences, Albion College, 611 E. Porter St., Albion, MI 49224, USA.
| | - Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Beaumont Health System, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Stewart F Graham
- Oakland University-William Beaumont School of Medicine, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA.
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50
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Dewan MV, Herrmann R, Schweiger B, Sirin S, Müller H, Storbeck T, Dransfeld F, Felderhoff-Müser U, Hüning B. Are Simple Magnetic Resonance Imaging Biomarkers Predictive of Neurodevelopmental Outcome at Two Years in Very Preterm Infants? Neonatology 2019; 116:331-340. [PMID: 31454812 DOI: 10.1159/000501799] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at increased risk of neurodevelopmental impairment due to the vulnerability of the immature brain. Early risk stratification is necessary for predicting outcome in the period of highest neuroplasticity. Several biomarkers in magnetic resonance imaging (MRI) at term equivalent age (TEA) have therefore been suggested. OBJECTIVE To assess the predictive value of simple brain metrics and the total abnormality score (TAS) - a modified score for brain injury and growth - in relation to neurodevelopmental outcome of very preterm infants in MRI at TEA. METHODS Single-centre cohort study including preterm infants with gestational age (GA) ≤32 weeks and birth weight ≤1,500 g. Biparietal width (BPW), interhemispheric distance, transcerebellar diameter (TCD) and TAS were assessed. To detect subtle haemorrhages, additional susceptibility-weighted imaging (SWI) was used in addition to conventional MRI to evaluate its clinical relevance. Neurodevelopment was tested by the Mental and Psychomotor Developmental Index (MDI/PDI) of the Bayley Scales of Infant Development II at a corrected age of 24 months. RESULTS One hundred twenty-nine children with median GA of 28.1 weeks and median birth weight of 980 g were included. BPW significantly correlated with PDI (p= 0.01, R2 = 0.06) and TCD with MDI (p < 0.01, R2 = 0.05) and PDI (p < 0.01, R2 = 0.06) but explained variances were low. TAS was not predictive of neurodevelopmental outcome. By using SWI, additional 4 cases of low grade haemorrhages were identified compared to conventional sequences. In one case this additional information was clinically relevant (MDI/PDI below average). CONCLUSION Simple brain metrics and TAS did not reliably predict neurodevelopmental outcome in a cohort with low prevalence of high grade brain injury. The additional value of SWI is yet to be determined in larger cohorts. The combination of imaging and functional biomarkers may be advisable for the prediction of neurodevelopmental outcome.
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Affiliation(s)
- Monia Vanessa Dewan
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany,
| | - Ralf Herrmann
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Selma Sirin
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hanna Müller
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Paediatrics, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Storbeck
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frauke Dransfeld
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Britta Hüning
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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