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Damera SR, De Asis-Cruz J, Cook KM, Kapse K, Spoehr E, Murnick J, Basu S, Andescavage N, Limperopoulos C. Regional homogeneity as a marker of sensory cortex dysmaturity in preterm infants. iScience 2024; 27:109662. [PMID: 38665205 PMCID: PMC11043889 DOI: 10.1016/j.isci.2024.109662] [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: 09/07/2023] [Revised: 01/23/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Atypical perinatal sensory experience in preterm infants is thought to increase their risk of neurodevelopmental disabilities by altering the development of the sensory cortices. Here, we used resting-state fMRI data from preterm and term-born infants scanned between 32 and 48 weeks post-menstrual age to assess the effect of early ex-utero exposure on sensory cortex development. Specifically, we utilized a measure of local correlated-ness called regional homogeneity (ReHo). First, we demonstrated that the brain-wide distribution of ReHo mirrors the known gradient of cortical maturation. Next, we showed that preterm birth differentially reduces ReHo across the primary sensory cortices. Finally, exploratory analyses showed that the reduction of ReHo in the primary auditory cortex of preterm infants is related to increased risk of autism at 18 months. In sum, we show that local connectivity within sensory cortices has different developmental trajectories, is differentially affected by preterm birth, and may be associated with later neurodevelopment.
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Affiliation(s)
- Srikanth R. Damera
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kevin M. Cook
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kushal Kapse
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Emma Spoehr
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Jon Murnick
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Sudeepta Basu
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
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2
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Moran CA, Costa VSLP, Marx LO, Fernandes Costa M. Visual stimulation in the neonatal intensive care unit: A systematic literature review. J Child Health Care 2024:13674935241227344. [PMID: 38213009 DOI: 10.1177/13674935241227344] [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] [Indexed: 01/13/2024]
Abstract
We aimed to systematically categorize evidence on the types of early visual stimulation applied to preterm infants (PTIs) admitted to neonatal intensive care units (NICUs), aiming to improve visual function parameters. This study was conducted according to PRISMA and registered in PROSPERO with CRD42022333753. Last search was conducted on March 15, 2023, in four different databases. Articles written in English, Portuguese, Spanish, or Italian, and available in full text were included. Two independent authors performed study selection, data extraction, and bias risk assessment. If there was any disagreement, a third author was contacted. A total of eight studies were included. From these, 62.5% presented a low risk of bias. 100% used a multisensory intervention, which included visual stimulation. In 50%, visual intervention consisted of black and white stimulation cards placed inside the incubator for three minutes. The outcomes showed positive benefits in visual function parameters and other reported clinical benefits in breastfeeding and neuromuscular development. This review demonstrated there is still scarce literature on the effects of early visual stimulation on purely visual functional outcomes, although the existing findings are promising. Parental involvement has been generating unquestionable benefits for the binomial mother-infant and gaining greater acceptance by health professionals.
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Affiliation(s)
| | | | - Letícia Oliveira Marx
- Department of Health Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
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3
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Maciel RP, Marchi BS, Silveira HDSD, Rodovanski GP, Al-Rob A, Souza R, Costa MF, Moran CA, Sobieranski AC. Computational methodology to support functional vision assessment in premature infants: A viability study. NeuroRehabilitation 2024; 54:227-235. [PMID: 38306062 DOI: 10.3233/nre-230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Premature newborns have a higher risk of abnormal visual development and visual impairment. OBJECTIVE To develop a computational methodology to help assess functional vision in premature infants by tracking iris distances. METHODS This experimental study was carried out with children up to two years old. A pattern of image capture with the visual stimulus was proposed to evaluate visual functions of vertical and horizontal visual tracking, visual field, vestibulo-ocular reflex, and fixation. The participants' visual responses were filmed to compose a dataset and develop a detection algorithm using the OpenCV library allied with FaceMesh for the detection and selection of the face, detection of specific facial points and tracking of the iris positions is done. A feasibility study was also conducted from the videos processed by the software. RESULTS Forty-one children of different ages and diagnoses participated in the experimental study, forming a robust dataset. The software resulted in the tracking of iris positions during visual function evaluation stimuli. Furthermore, in the feasibility study, 8 children participated, divided into Pre-term and Term groups. There was no statistical difference in any visual variable analyzed in the comparison between groups. CONCLUSION The computational methodology developed was able to track the distances traveled by the iris, and thus can be used to help assess visual function in children.
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Affiliation(s)
- Ricardo Pires Maciel
- Special Interdisciplinary Coordination of Information and Communication Technologies, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Bruna Samantha Marchi
- Rehabilitation Sciences Postgraduate Program, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | | | - Giovana Pascoali Rodovanski
- Neurosciences and Behavior Postgraduate Program, Department of Experimental Psychology, Institute of Psychology, São Paulo University, São Paulo, Brazil
| | - Aicha Al-Rob
- Department of Computing, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Rodrigo Souza
- Department of Computing, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Marcelo Fernandes Costa
- Neurosciences and Behavior Postgraduate Program, Department of Experimental Psychology, Institute of Psychology, São Paulo University, São Paulo, Brazil
| | - Cristiane Aparecida Moran
- Rehabilitation Sciences Postgraduate Program, Federal University of Santa Catarina, Araranguá, SC, Brazil
- Department of Health Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil
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Gay JD, Dangcil E, Nacipucha J, Botrous JE, Suresh N, Tucker A, Carayannopoulos NL, Khan MR, Meng R, Yao JD, Wackym PA, Mowery TM. An Animal Model of Neonatal Intensive Care Unit Exposure to Light and Sound in the Preterm Infant. Integr Comp Biol 2023; 63:585-596. [PMID: 37164937 PMCID: PMC10503467 DOI: 10.1093/icb/icad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
According to the World Health Organization, ∼15 million children are born prematurely each year. Many of these infants end up spending days to weeks in a neonatal intensive care unit (NICU). Infants who are born prematurely are often exposed to noise and light levels that affect their auditory and visual development. Children often have long-term impairments in cognition, visuospatial processing, hearing, and language. We have developed a rodent model of NICU exposure to light and sound using the Mongolian gerbil (Meriones unguiculatus), which has a low-frequency human-like audiogram and is altricial. To simulate preterm infancy, the eyes and ears were opened prematurely, and animals were exposed to the NICU-like sensory environment throughout the gerbil's cortical critical period of auditory development. After the animals matured into adults, auditory perceptual testing was carried out followed by auditory brainstem response recordings and then histology to assess the white matter morphology of various brain regions. Compared to normal hearing control animals, NICU sensory-exposed animals had significant impairments in learning at later stages of training, increased auditory thresholds reflecting hearing loss, and smaller cerebellar white matter volumes. These have all been reported in longitudinal studies of preterm infants. These preliminary results suggest that this animal model could provide researchers with an ethical way to explore the effects of the sensory environment in the NICU on the preterm infant's brain development.
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Affiliation(s)
- Jennifer D Gay
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - Evelynne Dangcil
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Jacqueline Nacipucha
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Jonathon E Botrous
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Nikhil Suresh
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Aaron Tucker
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Nicolas L Carayannopoulos
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Muhammad R Khan
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Raphael Meng
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Justin D Yao
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - P Ashley Wackym
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - Todd M Mowery
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
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Lai M, D'Acunto G, Guzzetta A, Finnigan S, Ngenda N, Ware RS, Boyd RN, Colditz PB. Infant massage and brain maturation measured using EEG: A randomised controlled trial. Early Hum Dev 2022; 172:105632. [PMID: 35905636 DOI: 10.1016/j.earlhumdev.2022.105632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Very preterm (VPT) infants develop adverse neurological sequelae from early exposure of the immature brain to the extrauterine environment. AIMS To determine the effects of infant massage on brain maturation in low-risk VPT infants. STUDY DESIGN A randomised controlled trial of VPT infants, who received standard care or daily massage therapy, administered by the mother, from 34 weeks' to 40 weeks' corrected age (CA). SUBJECTS VPT infants (born at 28 weeks to 32 + 6 weeks' gestational age, G.A.) and a healthy at term cohort for comparison. OUTCOME MEASURES At term equivalent age (39 weeks' to 42 weeks' CA), EEG was recorded to calculate global relative power (GRP), using power spectral analysis. RESULTS Sixty infants were recruited, and EEGs of 25 massage and 20 standard care infants were analysable. There was no difference between groups in primary outcome (beta GRP). There was a significantly higher central alpha relative power measured in the intervention group infants, compared to standard care (SC) group (mean difference = 1.42, 95 % confidence interval (CI): 0.12 to 2.73; p = 0.03). A massage dose effect was shown by a positive correlation between, massage dose and beta, alpha and theta GRP (r = 0.42, 95%CI = 0.12 to 0.64, r = 0.45; 95%CI = 0.16 to 0.66, r = 0.39; 95%CI = 0.10 to 0.62 respectively) and a negative correlation between massage dose and delta GRP (r = -0.41, 95%CI = -0.64 to -0.12), suggesting that a higher dose of massage is associated with more favourable brain maturation. CONCLUSIONS Central alpha regional relative power was greater in massaged infants compared to SC group infants, suggesting relatively greater brain maturation in this area. A measurable massage dose effect in favour of greater brain maturation, shows promise for verification in a larger clinical trial.
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Affiliation(s)
- Melissa Lai
- Grantley Stable Neonatal Unit, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; University of Queensland Centre for Clinical Research, Herston, Brisbane, Queensland, Australia.
| | - Giulia D'Acunto
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Simon Finnigan
- University of Queensland Centre for Clinical Research, Herston, Brisbane, Queensland, Australia
| | - Naoni Ngenda
- Grantley Stable Neonatal Unit, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Paul B Colditz
- Grantley Stable Neonatal Unit, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; University of Queensland Centre for Clinical Research, Herston, Brisbane, Queensland, Australia
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6
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Ana K, Iris ŽI, Nina P, Marina R, Tomislav Ć, Snježana S, Andrea B, Milan R, Ivica K. Linking integrity of visual pathways trajectories to visual behavior deficit in very preterm infants. Infant Behav Dev 2022; 67:101697. [DOI: 10.1016/j.infbeh.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
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Buonsenso D, Costa S, Giordano L, Priolo F, Colonna AT, Morini S, Sbarbati M, Pata D, Acampora A, Conti G, Crudo F, Cantiani A, Martina BM, Amorelli GM, Orazi L, Petrianni M, Ricci D, Lanzone A, Sanguinetti M, Cattani P, Sali M, Romeo D, Zampino G, Vento G, Valentini P. Short- and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 in utero or during the perinatal period: preliminary findings. Eur J Pediatr 2022; 181:1507-1520. [PMID: 35013811 PMCID: PMC8747884 DOI: 10.1007/s00431-021-04319-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022]
Abstract
UNLABELLED The long-term outcomes of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life are still unknown. We performed a single-center, prospective, observational study of newborns born from mothers with microbiologically confirmed SARS-CoV-2 infection in pregnancy or at time of delivery. Infants were offered a multidisciplinary follow-up consisting of nasopharyngeal Polymerase Chain Reaction test at birth and at 48-72 h of life, auxological growth and neurological development, serologic testing, and audiological and ophthalmological assessments. One-hundred ninety-eight mothers and 199 newborns were enrolled. Of the 199 newborns, 171 underwent nasopharyngeal swab, four (2.3%) and two (1.15%) children tested positive at birth and 48-72 h of life, respectively. None had SARS-CoV-2 related symptoms. Auxologic and neurologic development were normal in all children during follow-up. Nine out of 59 infants had SARS-CoV-2 IgG at 3 months of life, which was associated with a positive nasopharyngeal swab at birth (P = 0.04). Twenty seven out of 143 (18.8%) newborns had pathologic transitory evoked otoacoustic emissions at birth, although 14/27 repeated after 1 month were normal. Audiological evaluation was completed with Auditory Brainstem Response between the third and sixth month of life in 34 children, showing in all normal hearing threshold. The ophthalmological evaluation found retinal vascular anomalies in 3/20 (15%) children, immature visual acuity in 5/20 (25%) children, and reduced distance attention in 6/20 cases (30%). CONCLUSIONS Our study showed that the neonatal and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life are mostly positive, with the exception of ophthalmologic findings which, in a preliminary cohort, were abnormal in about 15% of cases. Further prospective, longitudinal studies are needed to better understand the clinical outcomes of children exposed to SARS-CoV-2 in utero and in the early postnatal life. WHAT IS KNOWN • In utero mother-to-child transmission of SARS-CoV-2 has been documented by several independent studies. • Neonatal COVID-19 is a systemic disease that can be severe, although rarely. WHAT IS NEW • Newborns exposed in utero to SARS-CoV-2 have mostly a normal auxological, audiological, and neurological development during the first months of life. • Fundus fluorescein angiography revealed that up to 5% of newborns exposed in utero to SARS-CoV2 can show retinal and choroidal abnormalities, including peripheral hypofluorescence of the choroid and increased vascular tortuosity.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy. .,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy. .,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Simonetta Costa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Lucia Giordano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francessca Priolo
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Arianna Turriziani Colonna
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Sofia Morini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Martina Sbarbati
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Davide Pata
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Anna Acampora
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Guido Conti
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A Gemelli,” IRCCS, Rome, Italy
| | - Fabrizio Crudo
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A Gemelli,” IRCCS, Rome, Italy
| | - Alessandro Cantiani
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A Gemelli,” IRCCS, Rome, Italy
| | - Bianca Maria Martina
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A Gemelli,” IRCCS, Rome, Italy
| | - Giulia Maria Amorelli
- Department of Ophthalmology, Gemelli Foundation IRCSS, Catholic University of the Sacred Heart, Rome, Italy ,National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus- Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Orazi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus- Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Petrianni
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus- Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Daniela Ricci
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus- Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy ,Dipartimento di Scienze di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Paola Cattani
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy ,Dipartimento di Scienze di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Michela Sali
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy ,Dipartimento di Scienze di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Domenico Romeo
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giuseppe Zampino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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Pascoali Rodovanski G, Bêz Reus BA, Cechinel Damiani AV, Franco Mattos K, Moreira RS, Neves Dos Santos A. Home-based early stimulation program targeting visual and motor functions for preterm infants with delayed tracking: Feasibility of a Randomized Clinical Trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104037. [PMID: 34293634 DOI: 10.1016/j.ridd.2021.104037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
AIMS To verify the feasibility of a home-based early stimulation program targeting visual and motor functions in preterm infants with delayed visual tracking. METHOD We applied a randomized controlled trial. We included thirty low-risk preterm infants, from both genders, with delayed visual tracking, gestational between 28-37 weeks, and age at entrance between 1-2 months of corrected age, and absence of visual impairments. Infants were divided into two groups as follows: a) standard care group (SC) that received general orientation about sensory and motor development (16 infants); b) experimental group, that received a four-week home-based early stimulation program targeting visual and motor functions (ESPVM) applied by the caregivers (14 infants). The feasibility outcomes were retention and loss rates, adherence, adverse events, and stress signals. We obtained preliminary data by comparing visual tracking, motor development, and sensory behavior between groups at the end of the intervention. RESULTS Retention rate was high, 90 % of the caregivers provided ESPVM at least 22 days, and 70 % provided SC at least 17 days. No adverse events were reported. At the end of intervention, the ESPVM group presented higher frequencies of complete visual tracking for cards 7 (ESPVM = 57.3 %, SC = 6.3 %, p = 0.006) and 8 (ESPVM = 64.3 %, SC = 12.2 %, p = 0.013), and lower scores for total sensory profile (ESPVM: median = 58, range = 46-69; SC: median = 71, range = 54-90; p = 0.016). The groups were similar for motor development. CONCLUSIONS The protocol was feasible, and the results encourage a larger randomized controlled trial.
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Affiliation(s)
| | | | | | - Karina Franco Mattos
- Department of Health Science, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Rafaela Silva Moreira
- Department of Health Science, Federal University of Santa Catarina, Araranguá, SC, Brazil
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9
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Lepore D, Ji MH, Quinn GE, Amorelli GM, Orazi L, Ricci D, Mercuri E. Functional and Morphologic Findings at Four Years After Intravitreal Bevacizumab or Laser for Type 1 ROP. Ophthalmic Surg Lasers Imaging Retina 2021; 51:180-186. [PMID: 32211908 DOI: 10.3928/23258160-20200228-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare morphologic and functional status at age 4 years for patients treated in one eye with laser photocoagulation and the other eye with intravitreal bevacizumab (IVB) injection for Type 1 retinopathy of prematurity (ROP). PATIENTS AND METHODS In this single-center, randomized, controlled trial, best-corrected visual acuity (BCVA) in logMAR was obtained along with spherical equivalent refraction (SER), fluorescein angiography (FA), optical coherent tomography (OCT), and OCT angiography (OCTA). RESULTS Eighteen babies (36 eyes) were selected for this study. BCVA and SER were similar in the two groups, but six patients had anisometropia of 4 diopters or more. IVB-treated eyes tended to have thinner foveal thickness than laser-treated eyes (mean difference: -5.33 pixels; 95% confidence interval, -9.62 to -1.05). CONCLUSION Although the differences found here are minimal between the IVB-treated and laser-treated groups, further long-term evaluation of not only FA, but also OCT and OCTA, are needed in larger studies. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:180-186.].
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10
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Deramore Denver B, Froude E, Rosenbaum P, Imms C. Measure of Early Vision Use: development of a new assessment tool for children with cerebral palsy. Disabil Rehabil 2021; 44:4055-4065. [PMID: 33689557 DOI: 10.1080/09638288.2021.1890241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the development of an assessment tool to describe "how vision is used" for children with cerebral palsy. METHOD Measurement development consisted of three steps: (i) an online survey to explore the relevance and comprehensiveness of visual behaviours identified in a previous conceptualisation study; (ii) construction of items and a rating scale for the new measure; and (iii) cognitive interviews to explore comprehensibility and refine the measure in preparation for field testing. Survey respondents were 130 parents of children with cerebral palsy, eight adults with cerebral palsy, and 108 clinicians (n = 246). Nine parents participated in the interviews. RESULTS The new tool, the Measure of Early Vision Use, is a 14-item descriptive measure of typical performance of visual behaviours observable in everyday activities, as rated by parent/caregiver observation. Each item is rated on a 4-point ordinal scale. CONCLUSIONS This new measure is conceptually grounded within the Activity level domain of the International Classification of Functioning, Disability and Health as a measure of a single visual ability construct. The target population is children with cerebral palsy, and using parent report the Measure of Early Vision Use describes both strengths and limitations in using vision. This study addressed the selection of items and response options for the new scale, and provides evidence to support content relevance, comprehensiveness and comprehensibility from key stakeholders. Further research will explore psychometric properties and clinical utility.Implications for rehabilitationThe ability to use vision in daily activities is relevant to the development and learning of all children, so the availability of a method for describing visual abilities has potential for diverse research and clinical purposes.The Measure of Early Vision Use is a parent-report tool that provides a criterion-referenced method for quantifying and describing how children use vision in typical daily activities to support intervention planning.Clinicians and parents wishing to measure vision use in children with cerebral palsy can be confident about the rigorous methods used to develop this tool, including consultation with key stakeholders.
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Affiliation(s)
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Christine Imms
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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11
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Burstein O, Zevin Z, Geva R. Preterm Birth and the Development of Visual Attention During the First 2 Years of Life: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e213687. [PMID: 33783515 PMCID: PMC8010593 DOI: 10.1001/jamanetworkopen.2021.3687] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Preterm birth is associated with an increased risk for long-lasting attention deficits. Early-life markers of attention abnormalities have not been established to date but could provide insights into the pathogenesis of attention abnormalities and could help identify susceptible individuals. Objective To examine whether preterm birth is associated with visual attention impairments in early life, and if so, in which attention functions and at which developmental period during the first 2 years of life. Data Sources PubMed and PsycINFO were searched on November 17, 2019, to identify studies involving visual attention outcomes in infants born preterm vs full term. Study Selection Peer-reviewed studies from the past 50 years met the eligibility criteria if they directly assessed visual attention outcomes until the age of 2 years in generally healthy infants born preterm or full term. The selection process was conducted by 2 independent reviewers. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Random-effects models were used to determine standardized mean differences. The risk of bias was assessed both within and between studies. Main Outcomes and Measures Five nascent indices of visual attention were analyzed, including very basic functions-namely, the abilities to follow and fixate on visual targets-and more complex functions, such as visual processing (ie, habituation), recognition memory (ie, novelty preference), and the ability to effortfully focus attention for learning. Results A total of 53 studies were included, with 69 effect sizes and assessing a total of 3998 infants (2047 born preterm and 1951 born full term; of the 3376 for whom sex was reported, 1693 [50.1%] were girls). Preterm birth was associated with impairments in various attention indices, including visual-following in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31), latency to fixate (Cohen d, -0.18; 95% CI, -0.33 to -0.02), novelty preference (Cohen d, -0.20; 95% CI, -0.32 to -0.08), and focused attention (Cohen d, -0.28; 95% CI, -0.45 to -0.11). In the neonatal period, preterm birth was associated with superior visual-following (Cohen d, 0.22; 95% CI, 0.03 to 0.40), possibly owing to the additional extrauterine exposure to sensory stimulation. However, this early association waned rapidly in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31). Conclusions and Relevance The findings suggest that preterm birth is associated with impingements to visual attention development in early life, as manifested in basic and then complex forms of attention. Advancements in neonatal care may underlie improvements found in the current era and accentuate several early protective factors.
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Affiliation(s)
- Or Burstein
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Zipi Zevin
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Ronny Geva
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
- Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
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12
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De Asis-Cruz J, Kapse K, Basu SK, Said M, Scheinost D, Murnick J, Chang T, du Plessis A, Limperopoulos C. Functional brain connectivity in ex utero premature infants compared to in utero fetuses. Neuroimage 2020; 219:117043. [PMID: 32534962 PMCID: PMC7493786 DOI: 10.1016/j.neuroimage.2020.117043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022] Open
Abstract
Brain structural changes in premature infants appear before term age. Functional differences between premature infants and healthy fetuses during this period have yet to be explored. Here, we examined brain connectivity using resting state functional MRI in 25 very premature infants (VPT; gestational age at birth <32 weeks) and 25 healthy fetuses with structurally normal brain MRIs. Resting state data were evaluated using seed-based correlation analysis and network-based statistics using 23 regions of interest (ROIs) per hemisphere. Functional connectivity strength, the Pearson correlation between blood oxygenation level dependent signals over time across all ROIs, was compared between groups. In both cohorts, connectivity between homotopic ROIs showed a decreasing medial to lateral gradient. The cingulate cortex, medial temporal lobe and the basal ganglia shared the strongest connections. In premature infants, connections involving superior temporal, hippocampal, and occipital areas, among others, were stronger compared to fetuses. Premature infants showed stronger connectivity in sensory input and stress-related areas suggesting that extra-uterine environment exposure alters the development of select neural networks in the absence of structural brain injury.
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Affiliation(s)
| | - Kushal Kapse
- Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA
| | | | - Mariam Said
- Neonatology, Children's National, Washington, DC, USA
| | - Dustin Scheinost
- Radiology and Biomedical Imaging, Statistics and Data Science, and Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Murnick
- Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA
| | - Taeun Chang
- Neurology, Children's National, Washington, DC, USA
| | - Adre du Plessis
- Fetal Medicine Institute, Children's National, Washington, DC, USA
| | - Catherine Limperopoulos
- Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA; Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.
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13
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Fontana C, De Carli A, Ricci D, Dessimone F, Passera S, Pesenti N, Bonzini M, Bassi L, Squarcina L, Cinnante C, Mosca F, Fumagalli M. Effects of Early Intervention on Visual Function in Preterm Infants: A Randomized Controlled Trial. Front Pediatr 2020; 8:291. [PMID: 32582595 PMCID: PMC7287146 DOI: 10.3389/fped.2020.00291] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: To determine the effectiveness of an early intervention program in enhancing visual function in very preterm infants. Methods: We conducted a RCT. We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA), without severe morbidities, and their families. Infants were randomized to either receive Standard Care (SC) or Early Intervention (EI). SC, according to NICU protocols, included Kangaroo Mother Care and minimal handling. EI included, in addition to routine care, parental training according to the PremieStart program, and multisensory stimulation (infant massage and visual interaction) performed by parents. Visual function was assessed at term equivalent age (TEA) using a prevalidated battery evaluating ocular spontaneous motility, ability to fix and follow a target, reaction to color, stripes discrimination and visual attention at distance. Results: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to protocol. Fifty-seven infants (EI = 27, SC = 30) were assessed at TEA. The two groups were comparable for parental and infant characteristics. In total, 59% of infants in the EI group achieved the highest score in all the nine assessed items compared to 17% in the SC group (p = 0.001): all infants in both groups showed complete maturation in four items, but EI infants showed more mature findings in the other five items (ocular motility both spontaneous and with target, tracking arc, stripes discrimination and attention at distance). Conclusions: Our results suggest that EI has a positive effect on visual function maturation in preterm infants at TEA. Trial Registration: clinicalTrial.gov (NCT02983513).
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Affiliation(s)
- Camilla Fontana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Agnese De Carli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Daniela Ricci
- Pediatric Neurology, Department of Human and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy.,Department of Ophthalmology, National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired, IAPB, Rome, Italy
| | - Francesca Dessimone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Sofia Passera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Matteo Bonzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Occupational Health Unit, Milan, Italy
| | - Laura Bassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cinnante
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
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14
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Ortibus E, Fazzi E, Dale N. Cerebral Visual Impairment and Clinical Assessment: The European Perspective. Semin Pediatr Neurol 2019; 31:15-24. [PMID: 31548019 DOI: 10.1016/j.spen.2019.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper summarizes the multidisciplinary pediatric assessment methods of 3 European centers for identifying and assessing cerebral visual impairment in childhood. It describes a comprehensive neurodevelopmental assessment evaluation in which visual aspects play an important part. Developmental trajectories and the heterogeneity of the clinical picture are emphasized. Multidisciplinary ophthalmology and neurodisability/neurology teamwork together with the parent and teachers, to reach an integrated and individualized perspective for the individual child, are described. This comprehensive assessment is the starting point for habilitation programs and interventions, that can support and meet the child's needs and help them reach their optimal potential. Future developments in classification of the cerebral visual impairment conditions, building on the child's individual assessment profile, will further enhance the direction of clinical, educational, and research progress.
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Affiliation(s)
- Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatric Neurology, University Hospitals Leuven, Belgium.
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Child Neurology and Psychiatry Unit, ASST Civil Hospital -Brescia, Italy; Department of Pediatric Neurology, University Hospitals Leuven, Belgium
| | - Naomi Dale
- Department of Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, and Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Department of Pediatric Neurology, University Hospitals Leuven, Belgium
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15
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Lejeune F, Borradori Tolsa C, Gentaz E, Barisnikov K. Fragility of haptic memory in human full-term newborns. Infant Behav Dev 2018; 52:45-55. [PMID: 29860156 DOI: 10.1016/j.infbeh.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous studies have established that newborns can memorize tactile information about the specific features of an object with their hands and detect differences with another object. However, the robustness of haptic memory abilities has already been examined in preterm newborns and in full-term infants, but not yet in full-term newborns. This research is aimed to better understand the robustness of haptic memory abilities at birth by examining the effects of a change in the objects' temperature and haptic interference. METHODS Sixty-eight full-term newborns (mean postnatal age: 2.5 days) were included. The two experiments were conducted in three phases: habituation (repeated presentation of the same object, a prism or cylinder in the newborn's hand), discrimination (presentation of a novel object), and recognition (presentation of the familiar object). In Experiment 1, the change in the objects' temperature was controlled during the three phases. RESULTS AND CONCLUSION Results reveal that newborns can memorize specific features that differentiate prism and cylinder shapes by touch, and discriminate between them, but surprisingly they did not show evidence of recognizing them after interference. As no significant effect of the temperature condition was observed in habituation, discrimination and recognition abilities, these findings suggest that discrimination abilities in newborns may be determined by the detection of shape differences. Overall, it seems that the ontogenesis of haptic recognition memory is not linear. The developmental schedule is likely crucial for haptic development between 34 and 40 GW.
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Affiliation(s)
- Fleur Lejeune
- Child Clinical Neuropsychology Unit, FPSE, University of Geneva, Switzerland; Sensorimotor, Affective and Social Development Unit, FPSE, University of Geneva, Switzerland.
| | - Cristina Borradori Tolsa
- Division of Development and Growth, Child and Adolescent Department, Geneva University Hospital, Switzerland
| | - Edouard Gentaz
- Sensorimotor, Affective and Social Development Unit, FPSE, University of Geneva, Switzerland
| | - Koviljka Barisnikov
- Child Clinical Neuropsychology Unit, FPSE, University of Geneva, Switzerland
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16
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Perszyk DR, Ferguson B, Waxman SR. Maturation constrains the effect of exposure in linking language and thought: evidence from healthy preterm infants. Dev Sci 2018; 21:10.1111/desc.12522. [PMID: 28032433 PMCID: PMC5519447 DOI: 10.1111/desc.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/20/2016] [Indexed: 01/27/2023]
Abstract
The power of human language rests upon its intricate links to human cognition. By 3 months of age, listening to language supports infants' ability to form object categories, a building block of cognition. Moreover, infants display a systematic shift between 3 and 4 months - a shift from familiarity to novelty preferences - in their expression of this link between language and core cognitive processes. Here, we capitalize on this tightly-timed developmental shift in fullterm infants to assess (a) whether it also appears in preterm infants and (b) whether it reflects infants' maturational status or the duration of their postnatal experience. Healthy late preterm infants (N = 22) participated in an object categorization task while listening to language. Their performance, coupled with that of fullterm infants, reveals that this developmental shift is evident in preterm infants and unfolds on the same maturational timetable as in their fullterm counterparts.
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Affiliation(s)
| | - Brock Ferguson
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Sandra R Waxman
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institue for Policy Research, Northwestern University, Evanston, IL, USA
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17
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Carrara VI, Darakomon MC, Thin NWW, Paw NTK, Wah N, Wah HG, Helen N, Keereecharoen S, Paw NTM, Jittamala P, Nosten FH, Ricci D, McGready R. Evaluation and Acceptability of a Simplified Test of Visual Function at Birth in a Limited-Resource Setting. PLoS One 2016; 11:e0157087. [PMID: 27300137 PMCID: PMC4907442 DOI: 10.1371/journal.pone.0157087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
Neurological examination, including visual fixation and tracking of a target, is routinely performed in the Shoklo Malaria Research Unit postnatal care units on the Thailand-Myanmar border. We aimed to evaluate a simple visual newborn test developed in Italy and performed by non-specialized personnel working in neonatal care units. An intensive training of local health staff in Thailand was conducted prior to performing assessments at 24, 48 and 72 hours of life in healthy, low-risk term singletons. The 48 and 72 hours results were then compared to values obtained to those from Italy. Parents and staff administering the test reported on acceptability. One hundred and seventy nine newborns, between June 2011 and October 2012, participated in the study. The test was rapidly completed if the infant remained in an optimal behavioral stage (7 ± 2 minutes) but the test duration increased significantly (12 ± 4 minutes, p < 0.001) if its behavior changed. Infants were able to fix a target and to discriminate a colored face at 24 hours of life. Horizontal tracking of a target was achieved by 96% (152/159) of the infants at 48 hours. Circular tracking, stripe discrimination and attention to distance significantly improved between each 24-hour test period. The test was easily performed by non-specialized local staff and well accepted by the parents. Healthy term singletons in this limited-resource setting have a visual response similar to that obtained to gestational age matched newborns in Italy. It is possible to use these results as a reference set of values for the visual assessment in Karen and Burmese infants in the first 72 hours of life. The utility of the 24 hours test should be pursued.
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Affiliation(s)
- Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- * E-mail:
| | - Mue Chae Darakomon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Nant War War Thin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Naw Ta Kaw Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Naw Wah
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Hser Gay Wah
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Naw Helen
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Suporn Keereecharoen
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Naw Ta Mlar Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Podjanee Jittamala
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François H. Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniela Ricci
- Paediatric Neurology Unit, Catholic University, Rome, Italy
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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18
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Petkovic M, Chokron S, Fagard J. Visuo-manual coordination in preterm infants without neurological impairments. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:76-88. [PMID: 26812594 DOI: 10.1016/j.ridd.2016.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 06/05/2023]
Abstract
The extent of and reasons for visuo-manual coordination deficits in moderate and late preterm born infants without neurological impairments are not well known. This paper presents a longitudinal study on the visuo-manual development of twelve preterm infants, born after 33-36 weeks of gestation without neurological complications, between the ages of 6 and 12 months. Visuo-manual integration and grasping were assessed using the Peabody Developmental Motor Scales, along with bimanual coordination and handedness tests. Visual function was examined once prior to the beginning of the study. Gross motor development was also evaluated every month. Preterm infants were compared to a control group of ten full-term infants according to corrected age. Compared to full-terms, the visual perception of preterm infants was close to normal, with only a measure of visual fixation lower than in full-terms. In contrast, preterm infants had delayed development of visuo-manual integration, grasping, bimanual coordination, and handedness even when compared using corrected age. Tonicity and gestational age at birth were the main variables associated to the delays. These results are discussed in terms of the possible factors underlying such delays. They need to be confirmed on a larger sample of preterm born children, and to be correlated with later development. This would allow developing markers of future neuropsychological impairments during childhood.
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Affiliation(s)
- Maja Petkovic
- Djecji vrtic Sopot, V.Kovacica 18c, Zagreb, 10000, Zagreb Croatia; Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS UMR 8158, Centre Biomédical des Saints-Pères, 75006, Paris France.
| | - Sylvie Chokron
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS UMR 8158, Centre Biomédical des Saints-Pères, 75006, Paris France; Unité Vision & Cognition, Fondation Ophtalmologique Rothschild, 25 rue Manin, 75019, Paris France
| | - Jacqueline Fagard
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS UMR 8158, Centre Biomédical des Saints-Pères, 75006, Paris France
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19
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Zores C, Dufour A, Pebayle T, Langlet C, Astruc D, Kuhn P. Very preterm infants can detect small variations in light levels in incubators. Acta Paediatr 2015; 104:1005-11. [PMID: 26080896 DOI: 10.1111/apa.13085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/25/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
AIM This prospective observational study was designed to improve our understanding of the responses of very preterm infants to light level variations in incubators and to evaluate what determined those reactions. METHODS The physiological responses of 27 very preterm infants were analysed following variations in the light level environments of their incubators over 10 hours. Heart and respiratory rates, systemic oxygen saturation and regional cerebral oxygen saturations were recorded using near-infrared spectroscopy, and the variation of each parameter was analysed. RESULTS We analysed 332 light level changes. Heart rate increased by 3.8 beats per minute (range -2.6 to 12.6), respiratory rate by six cycles per minute (-1.5 to 26) and regional cerebral oxygen saturation by 1.1% (-0.5% to 3.9%) (p < 0.05 each) when delta lux was over 50. Only respiratory rate decreased significantly, by -8.4 cycles per minute (-28 to -0.4), when delta lux was 50 or lower (p < 0.05). The initial level of illumination altered the very preterm infants' responses, with higher reactivity for higher ambient light levels. CONCLUSION Very preterm infants reacted to moderate variations in illumination in their incubator, within recommended ranges of light levels, suggesting that they may detect even small light level variations.
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Affiliation(s)
- Claire Zores
- Laboratoire de Neurosciences Cognitives et Adaptatives; UMR 7364 CNRS/Université de Strasbourg; Strasbourg France
- Médecine et Réanimation du nouveau-né; Service de Pédiatrie 2; Pôle Médico-Chirurgical Pédiatrique; Hôpital de Hautepierre; Centre Hospitalier Universitaire de Strasbourg; Strasbourg France
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives; UMR 7364 CNRS/Université de Strasbourg; Strasbourg France
| | - Thierry Pebayle
- Laboratoire de Neurosciences Cognitives et Adaptatives; UMR 7364 CNRS/Université de Strasbourg; Strasbourg France
| | - Claire Langlet
- Médecine et Réanimation du nouveau-né; Service de Pédiatrie 2; Pôle Médico-Chirurgical Pédiatrique; Hôpital de Hautepierre; Centre Hospitalier Universitaire de Strasbourg; Strasbourg France
| | - Dominique Astruc
- Médecine et Réanimation du nouveau-né; Service de Pédiatrie 2; Pôle Médico-Chirurgical Pédiatrique; Hôpital de Hautepierre; Centre Hospitalier Universitaire de Strasbourg; Strasbourg France
| | - Pierre Kuhn
- Laboratoire de Neurosciences Cognitives et Adaptatives; UMR 7364 CNRS/Université de Strasbourg; Strasbourg France
- Médecine et Réanimation du nouveau-né; Service de Pédiatrie 2; Pôle Médico-Chirurgical Pédiatrique; Hôpital de Hautepierre; Centre Hospitalier Universitaire de Strasbourg; Strasbourg France
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20
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George JM, Boyd RN, Colditz PB, Rose SE, Pannek K, Fripp J, Lingwood BE, Lai MM, Kong AHT, Ware RS, Coulthard A, Finn CM, Bandaranayake SE. PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome. BMC Pediatr 2015; 15:123. [PMID: 26377791 PMCID: PMC4572671 DOI: 10.1186/s12887-015-0439-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12-24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age. METHODS/DESIGN This prospective cohort study will recruit 80 preterm infants born ≤ 30 week's gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women's Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay). DISCUSSION Earlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.
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Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Stephen E Rose
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Kerstin Pannek
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Jurgen Fripp
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Barbara E Lingwood
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Melissa M Lai
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Annice H T Kong
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia.
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Australia.
| | - Alan Coulthard
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Academic Discipline of Medical Imaging, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Christine M Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sasaka E Bandaranayake
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
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Developmental synergy between thalamic structure and interhemispheric connectivity in the visual system of preterm infants. NEUROIMAGE-CLINICAL 2015; 8:462-72. [PMID: 26106571 PMCID: PMC4474422 DOI: 10.1016/j.nicl.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/22/2022]
Abstract
Thalamic structural co-variation with cortical regions has been demonstrated in preterm infants, but its relationship to cortical function and severity of non-cystic white matter injury (non-cystic WMI) is unclear. The relationship between thalamic morphology and both cortical network synchronization and cortical structural connectivity has not been established. We tested the hypothesis that in preterm neonates, thalamic volume would correlate with primary cortical visual function and microstructural integrity of cortico-cortical visual association pathways. A total of 80 term-equivalent preterm and 44 term-born infants underwent high-resolution structural imaging coupled with visual functional magnetic resonance imaging or diffusion tensor imaging. There was a strong correlation between thalamic volume and primary visual cortical activation in preterms with non-cystic WMI (r = 0.81, p-value = 0.001). Thalamic volume also correlated strongly with interhemispheric cortico-cortical connectivity (splenium) in preterm neonates with a relatively higher severity of non-cystic WMI (p-value < 0.001). In contrast, there was lower correlation between thalamic volume and intrahemispheric cortico-cortical connectivity, including the inferior longitudinal fasciculus and inferior frontal orbital fasciculus. This study shows distinct temporal overlap in the disruption of thalamo-cortical and interhemispheric cortico-cortical connectivity in preterm infants suggesting developmental synergy between thalamic morphology and the emergence of cortical networks in the last trimester.
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Hemimou C, Streri A. Déficience visuelle chez le nourrisson : comparaison entre une atteinte visuelle d’origine corticale et une atteinte visuelle d’origine périphérique (observations préliminaires). ANNEE PSYCHOLOGIQUE 2015. [DOI: 10.3917/anpsy.152.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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23
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Early childhood development of visual texture segregation in full-term and preterm children. Vision Res 2015; 112:1-10. [PMID: 25976298 DOI: 10.1016/j.visres.2015.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/20/2022]
Abstract
To date, very little is known about the normal development trajectory of visual texture segregation, or how it is affected by preterm birth. The goal of this study was to characterize the development of visual texture segregation using texture segregation visual evoked potentials (tsVEPs) in children born full-term and children born preterm without major neurological impairment. Forty-five full-term and 43 preterm children were tested at either 12, 24 or 36 months of age (corrected age for prematurity at 12 and 24 months old). VEPs were obtained using two lower-level stimuli defined by orientation (oriVEP) and two higher-level stimuli defined by texture (texVEP). TsVEP was obtained by dividing by two the subtraction of oriVEP from texVEP. Results show a clear maturation of the processes underlying visual texture segregation in the full-term group, with a significant N2 latency reduction between 12 and 36 months of age for all conditions. Significant N2 amplitude reduction was observed for oriVEP between 12 and 24 months, as well as for texVEP between 12 and 24 months, and 12 and 36 months. Comparison between full-term and preterm children indicated significantly lower N2 amplitude for the preterm group at 12 months for oriVEP and texVEP. These differences were no longer apparent at 24 months of age, suggesting that children born preterm catch up with their full-term counterparts somewhere between 12 and 24 months of age. Our results appear to reflect a maturational delay in preterm children in both lower-level and higher-level visual processing during, at least, early childhood.
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Guyer C, Huber R, Fontijn J, Bucher HU, Nicolai H, Werner H, Molinari L, Latal B, Jenni OG. Very preterm infants show earlier emergence of 24-hour sleep-wake rhythms compared to term infants. Early Hum Dev 2015; 91:37-42. [PMID: 25460255 DOI: 10.1016/j.earlhumdev.2014.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies show contradictory results about the emergence of 24-h rhythms and the influence of external time cues on sleep-wake behavior in preterm compared to term infants. AIMS To examine whether very preterm infants (<32 weeks of gestational age) differ in their emergence of the 24-h sleep-wake rhythm at 5, 11 and 25 weeks corrected age compared to term infants and whether cycled light conditions during neonatal intermediate care affects postnatal 24-h sleep-wake rhythms in preterm infants. STUDY DESIGN Prospective cohort study with nested interventional trial. SUBJECTS 34 preterm and 14 control term infants were studied. During neonatal hospitalization, preterm infants were randomly assigned to cycled light [7 am-7 pm lights on, 7 pm-7 am lights off, n=17] or dim light condition [lights off whenever the child is asleep, n=17]. OUTCOME MEASURES Sleep and activity behavior recorded by parental diary and actigraphy at 5, 11 and 25 weeks corrected age. RESULTS Sleep at nighttime and the longest consolidated sleep period between 12 pm-6 am was longer (mixed model analysis, factor group: p=0.02, resp. p=0.01) and activity at nighttime was lower (p=0.005) at all ages in preterm compared to term infants. Cycled light exposed preterm infants showed the longest nighttime sleep duration. Dim light exposed preterm infants were the least active. CONCLUSIONS Preterm infants show an earlier emergence of the 24-h sleep-wake rhythm compared to term infants. Thus, the length of exposure to external time cues such as light may be important for the maturation of infant sleep-wake rhythms. Trial registry number: This trial has been registered at www.clinicaltrials.gov (identifier NCT01513226).
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Affiliation(s)
- Caroline Guyer
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Reto Huber
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Children's Research Center (CRC), University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Jehudith Fontijn
- Clinic Neonatology, University Hospital Zürich, CH-8091 Zürich, Switzerland
| | - Hans Ulrich Bucher
- Clinic Neonatology, University Hospital Zürich, CH-8091 Zürich, Switzerland
| | - Heide Nicolai
- Clinic Neonatology, University Hospital Zürich, CH-8091 Zürich, Switzerland
| | - Helene Werner
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Luciano Molinari
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Beatrice Latal
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Children's Research Center (CRC), University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Oskar G Jenni
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Children's Research Center (CRC), University Children's Hospital Zürich, CH-8032 Zürich, Switzerland.
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Déficience visuelle chez le nourrisson : comparaison entre une atteinte visuelle d’origine corticale et une atteinte visuelle d’origine périphérique (observations préliminaires). ANNEE PSYCHOLOGIQUE 2014. [DOI: 10.4074/s0003503314000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Chau V, Taylor MJ, Miller SP. Visual function in preterm infants: visualizing the brain to improve prognosis. Doc Ophthalmol 2013; 127:41-55. [PMID: 23761036 DOI: 10.1007/s10633-013-9397-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/05/2013] [Indexed: 11/28/2022]
Abstract
Considerable development of the visual system occurs in the third trimester of life, a time when very preterm-born infants are in a neonatal intensive care unit (NICU). Their very early birth during a period of rapid and marked neurodevelopment and their clinical course makes them a very high-risk population. A range of different events impacts brain development and the visual system, leading to significant long-term visual dysfunction. Improved neuroimaging techniques provide an important window on the early brain and visual system development of these vulnerable infants. Greater understanding of the etiology of visual impairment subsequent to preterm birth and the timing of critical processes will allow early recognition and the earlier implementations of interventions. In the longer term, this will help clinicians optimize NICU practice to reduce the incidence of visual dysfunction in these children.
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Affiliation(s)
- Vann Chau
- Department of Pediatrics (Neurology), University of British Columbia, Vancouver, Canada
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27
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Leonhardt M, Forns M, Calderón C, Reinoso M, Gargallo E. Visual performance in preterm infants with brain injuries compared with low-risk preterm infants. Early Hum Dev 2012; 88:669-75. [PMID: 22381046 DOI: 10.1016/j.earlhumdev.2012.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 11/04/2011] [Accepted: 02/06/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking. AIM To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age. STUDY DESIGN AND SUBJECTS Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants. OUTCOME MEASURES The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants. RESULTS The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life. CONCLUSION Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life.
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Affiliation(s)
- Merçè Leonhardt
- NICU, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues, Barcelona, Spain.
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28
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Early-onset binocularity in preterm infants reveals experience-dependent visual development in humans. Proc Natl Acad Sci U S A 2012; 109:11049-52. [PMID: 22711824 DOI: 10.1073/pnas.1203096109] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Although there is a great deal of knowledge regarding the phylo- and ontogenetic plasticity of the neocortex, the precise nature of environmental impact on the newborn human brain is still one of the most controversial issues of neuroscience. The leading model-system of experience-dependent brain development is binocular vision, also called stereopsis. Here, we show that extra postnatal visual experience in preterm human neonates leads to a change in the developmental timing of binocular vision. The onset age of binocular function, as measured by the visual evoked response to dynamic random dot correlograms (DRDC-VEP), appears to be at around the same time after birth in preterm (4.07 mo) and full-term (3.78 mo) infants. To assess the integrity of the visual pathway in the studied infants, we also measured the latency of the visual-evoked response to pattern reversal stimuli (PR-VEP). PR-VEP latency is not affected by premature birth, demonstrating that the maturation of the visual pathway follows a preprogrammed developmental course. Despite the immaturity of the visual pathway, clearly demonstrated by the PR-VEP latencies, our DRCD-VEP data show that the visual cortex is remarkably ready to accept environmental stimulation right after birth. This early plasticity makes full use of the available extra stimulation time in preterm human infants and results in an early onset of cortical binocularity. According to our data, the developmental processes preceding the onset of binocular function are not preprogrammed, and the mechanisms turning on stereopsis are extremely experience-dependent in humans.
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29
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30
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Visual function assessment in late-preterm newborns. Early Hum Dev 2012; 88:301-5. [PMID: 21955502 DOI: 10.1016/j.earlhumdev.2011.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/24/2011] [Accepted: 08/30/2011] [Indexed: 11/21/2022]
Abstract
AIM To describe the development of visual functions in a population of low-risk late preterm infants. SUBJECTS AND METHODS Eighty low-risk late preterm with a gestational age between 34.0 and 36.9 weeks were assessed at birth and at term equivalent age (TEA) using a structured visual assessment battery. The results were compared to those previously obtained in term born infants using the same battery. RESULTS For 5 items (spontaneous ocular motility, ocular motility with target, fixation, horizontal tracking and color tracking) the results were similar both at birth and TEA; for the other 4 (vertical and arc tracking, ability to discriminate striped black/white targets and attention at distance) visual findings at TEA were more mature than at birth. Comparing the responses in late preterm at TEA and term-born infants at 48 h of life, only 2 items (attention at distance, ability to discriminate black/white stripes) were different, with more mature findings in late preterm infants. CONCLUSIONS Our results show that in late preterm some aspects of visual functions have a progressive maturation infants between birth and TEA, confirming that the time between birth and term age appears to be crucial for the development of these abilities.
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Mercuri E, Ricci D, Romeo DM. Neurological and visual assessments in very and late low-risk preterm infants. Early Hum Dev 2012; 88 Suppl 1:S31-3. [PMID: 22285782 DOI: 10.1016/j.earlhumdev.2011.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this review, we report our experience on early neurological and visual developments in preterm infants assessed during the neonatal period using the Dubowitz neonatal neurological assessment and a new battery for visual assessment. The assessments were performed in both very and late low-risk preterm infants and in healthy term-born infants. We report the findings in the three cohorts, evaluating the influence of gestational age and extrauterine exposure on both neurological and visual developments.
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Affiliation(s)
- Eugenio Mercuri
- Paediatric Neurology Unit, Catholic University, Rome, Italy.
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32
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Brodd KS, Grönqvist H, Holmström G, Grönqvist E, Rosander K, Ewald U. Development of smooth pursuit eye movements in very preterm born infants: 3. Association with perinatal risk factors. Acta Paediatr 2012; 101:164-71. [PMID: 21883450 DOI: 10.1111/j.1651-2227.2011.02449.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the association between perinatal risk factors and neonatal complications and early oculo-motor development in very preterm infants. METHODS Perinatal risk factors were identified, and the potential association with early oculo-motor development was evaluated by measuring smooth pursuit eye movements (SP) at 2 and 4 months' corrected age (CA) in a population of very preterm infants born in Uppsala County 2004-2007 (n = 113). RESULTS Among the 15 tested factors, eight showed significant association in univariate analysis with lower levels of SP at 4 months' CA, namely administration of prenatal corticosteroids, gestational age, birthweight, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, intraventricular haemorrhage >grade 2, and persistent ductus arteriosus. At 2 months' CA, only retinopathy of prematurity >stage 2 was associated with lower levels of SP. When all factors significant in the univariate tests were included in multiple regressions aimed to assess each factor's independent relation to SP, periventricular leukomalacia was the only significant independent factor. When adding 2-5 of the significant factors using multiple regression analysis, the levels of SP became lower. CONCLUSION Perinatal risk factors were associated with lower levels of SP. This could be interpreted as delayed or disturbed development of normal oculomotor ability.
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Maldonado RS, O'Connell RV, Sarin N, Freedman SF, Wallace DK, Cotten CM, Winter KP, Stinnett S, Chiu SJ, Izatt JA, Farsiu S, Toth CA. Dynamics of human foveal development after premature birth. Ophthalmology 2011; 118:2315-25. [PMID: 21940051 DOI: 10.1016/j.ophtha.2011.05.028] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine the dynamic morphologic development of the human fovea in vivo using portable spectral domain-optical coherence tomography (SD-OCT). DESIGN Prospective, observational case series. PARTICIPANTS Thirty-one prematurely born neonates, 9 children, and 9 adults. METHODS Sixty-two neonates were enrolled in this study. After examination for retinopathy of prematurity (ROP), SD-OCT imaging was performed at the bedside in nonsedated infants aged 31 to 41 weeks postmenstrual age (PMA) (= gestational age in weeks + chronologic age) and at outpatient follow-up ophthalmic examinations. Thirty-one neonates met eligibility criteria. Nine children and nine adults without ocular pathology served as control groups. Semiautomatic retinal layer segmentation was performed. Central foveal thickness, foveal to parafoveal (FP) ratio (central foveal thickness divided by thickness 1000 μm from the foveal center), and 3-dimensional thickness maps were analyzed. MAIN OUTCOME MEASURES In vivo determination of foveal morphology, layer segmentation, analysis of subcellular changes, and spatiotemporal layer shifting. RESULTS In contrast with the adult fovea, several signs of immaturity were observed in the neonates: a shallow foveal pit, persistence of inner retinal layers (IRLs), and a thin photoreceptor layer (PRL) that was thinnest at the foveal center. Three-dimensional mapping showed displacement of retinal layers out of the foveal center as the fovea matured and the progressive formation of the inner/outer segment band in the opposite direction. The FP-IRL ratios decreased as IRL migrated before term and minimally after that, whereas FP-PRL ratios increased as PRL subcellular elements formed closer to term and into childhood. A surprising finding was the presence of cystoid macular edema in 58% of premature neonates that appeared to affect inner foveal maturation. CONCLUSIONS This study provides the first view into the development of living cellular layers of the human retina and of subcellular specialization at the fovea in premature infant eyes using portable SD-OCT. Our work establishes a framework of the timeline of human foveal development, allowing us to identify unexpected retinal abnormalities that may provide new keys to disease activity and a method for mapping foveal structures from infancy to adulthood that may be integral in future studies of vision and visual cortex development. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ramiro S Maldonado
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina 27710, USA.
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34
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Strand-Brodd K, Ewald U, Grönqvist H, Holmström G, Strömberg B, Grönqvist E, von Hofsten C, Rosander K. Development of smooth pursuit eye movements in very preterm infants: 1. General aspects. Acta Paediatr 2011; 100:983-91. [PMID: 21332783 PMCID: PMC3123744 DOI: 10.1111/j.1651-2227.2011.02218.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 02/05/2011] [Accepted: 02/11/2011] [Indexed: 11/30/2022]
Abstract
AIM To investigate early oculo-motor development in a population-based cohort of very preterm infants. METHODS Early oculo-motor development was prospectively studied by measuring smooth pursuit eye movements at 2 and 4 months corrected age in a population of very preterm infants born in Uppsala County 2004-2007. Eighty-one preterm infants were studied, and 32 healthy term infants constituted the control group. RESULTS The study group consisted of infants with a mean gestational age of 28 + 5 weeks. At 2 and 4 months corrected age, infants born very preterm showed lower gain (p < 0.001) and proportion of smooth pursuit eye movements (p < 0.001) compared to the control group. The boys showed higher gain of smooth pursuit eye movements at both 2 and 4 months corrected age, compared to girls. CONCLUSIONS Oculo-motor development measured by smooth pursuit eye movements is delayed in very preterm infants at 2 and 4 months corrected age. This might be a risk factor or early indicator of later perceptual and behavioural impairment.
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Romeo DM, Ricci D, Brogna C, Cilauro S, Lombardo ME, Romeo MG, Mercuri E. Neurological examination of late-preterm infants at term age. Eur J Paediatr Neurol 2011; 15:353-60. [PMID: 21514859 DOI: 10.1016/j.ejpn.2011.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/17/2011] [Accepted: 03/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late-preterm infants represent 70% of the whole preterm population. AIMS To establish the range and frequency distribution of neonatal neurological scores in a large cohort of low risk late-preterm infants and the possible differences with full-term infants. METHODS Three hundred-seventy-five healthy infants born between 34 and 36 weeks gestational age (GA) without major brain lesions were assessed between 39 and 41 weeks post-menstrual age using the Hammersmith Neonatal Neurologic Assessment and compared to the scores obtained using the same examination in full-term infants. RESULTS Infants born at 35 and 36 weeks GA had similar median scores in 32 of the 34 items. Infants born at 34 weeks GA had a different profile of scores compared to those born at 35 and 36 weeks, mainly in the tone items. While in infants born at 34 weeks the assessment at term age showed similar median scores to those obtained in full-term infants in 25/34 items, in those born at 35 and 36 GA the number of scores similar to full-term infants increased to 29/34. The main differences involved the tone items, with more marked flexor tone in the limbs and better head control for those born at 35 and 36 weeks. CONCLUSIONS This data can help as reference data when examining late-preterm infants at term age to see where the individual child stands compared to age matched low risk infants and to identify signs that are outside the reported range in infants with lesions or other risk factors.
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Affiliation(s)
- Domenico M Romeo
- Department of Pediatrics, Child Neurology and Psychiatry, Catholic University, Rome, Italy
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36
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Ortibus EL, De Cock PP, Lagae LG. Visual perception in preterm children: what are we currently measuring? Pediatr Neurol 2011; 45:1-10. [PMID: 21723452 DOI: 10.1016/j.pediatrneurol.2011.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 02/28/2011] [Indexed: 11/16/2022]
Abstract
Over the past two decades, cerebral visual impairment has been recognized as a principal deficit in preterm children, and in particular those with cerebral palsy. We review the current knowledge of visual processing deficits in these children, and provide an overview of the tools for assessing cerebral visual impairment. Commercially available instruments are usually directed at evaluating visuospatial skills rather than detecting object recognition difficulties. Particularly in children aged 3 years or younger and in children with multiple handicaps, cerebral visual impairment is difficult to diagnose. This difficulty may be attributable to limitations specific to the instrument, such as a test that is inappropriate for age, or to child-specific limitations such as motor impairment or speech delay. We therefore include an overview of relevant neuroimaging findings reported in these children, focusing on the most recent imaging modalities. Novel techniques such as diffusion tensor imaging may provide sensitive markers of cerebral visual impairment in situations where clinical diagnosis is difficult, and such approaches may allow for early intervention.
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Affiliation(s)
- Els L Ortibus
- Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium.
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Ricci D, Romeo DM, Gallini F, Groppo M, Cesarini L, Pisoni S, Serrao F, Papacci P, Contaldo I, Perrino F, Brogna C, Bianco F, Baranello G, Sacco A, Quintiliani M, Ometto A, Cilauro S, Mosca F, Romagnoli C, Romeo MG, Cowan F, Cioni G, Ramenghi L, Mercuri E. Early visual assessment in preterm infants with and without brain lesions: correlation with visual and neurodevelopmental outcome at 12 months. Early Hum Dev 2011; 87:177-82. [PMID: 21237588 DOI: 10.1016/j.earlhumdev.2010.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 12/07/2010] [Accepted: 12/11/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have reported the development of various aspects of visual function in infancy and early childhood in both preterm and term-born infants, but only a few studies have focused on the predictive power of neonatal visual findings in infants with brain lesions. AIMS To explore visual findings at term age, and at 3 and 12 months corrected age in preterm infants (gestational age <33 weeks) with and without brain lesions; to compare the assessment at term age and at 12 months; and to assess the relationship between visual findings and neurodevelopmental outcome at 12 months. STUDY DESIGN Cranial ultrasound scans (US) were classified in normal, mild or major abnormalities. One-hundred and forty-five infants were assessed with age specific tests for visual function at term age, and at 3 and 12 months. Neurodevelopmental assessment (Griffiths' Scales) was performed at 12 months. RESULTS A good correlation was found between early and late visual assessment and neurodevelopment outcome. Of the 121 infants with normal neonatal visual assessment, 119 were also normal at 12 months and 116 had normal developmental quotient. Of the 24 infants with abnormal neonatal visual assessment, 12 were also abnormal at 12 months. All the false positives had normalised by 3 months. Of the 35 infants with major US abnormalities, 20 had normal and 15 abnormal scores on the neonatal assessment. At 1 year 17 had normal and 18 abnormal scores. CONCLUSION A normal visual assessment at term age is a good predictor of normal visual and neurodevelopmental outcome at 12 months. An abnormal visual examination in the neonatal period was a less reliable prognostic indicator, infant should be reassessed at 3 months.
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Affiliation(s)
- Daniela Ricci
- Paediatric Neurology Unit, Catholic University, Rome, Italy
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Harel H, Gordon I, Geva R, Feldman R. Gaze Behaviors of Preterm and Full-Term Infants in Nonsocial and Social Contexts of Increasing Dynamics: Visual Recognition, Attention Regulation, and Gaze Synchrony. INFANCY 2010; 16:69-90. [DOI: 10.1111/j.1532-7078.2010.00037.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arpino C, Compagnone E, Montanaro ML, Cacciatore D, De Luca A, Cerulli A, Di Girolamo S, Curatolo P. Preterm birth and neurodevelopmental outcome: a review. Childs Nerv Syst 2010; 26:1139-49. [PMID: 20349187 DOI: 10.1007/s00381-010-1125-y] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Accepted: 03/03/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of preterm delivery and the survival rate of preterm newborns are rising, due to the increased use of assisted reproductive technology associated with multiple gestations and improved technology in obstetrics and neonatology, which allow saving preterm infants at earlier gestational ages. As a consequence, the risk of developmental disabilities in preterm children is high, and clinical pictures need to be fully defined. METHODS Narrative review including articles regarding neurodevelopmental disorders published in the international medical literature and reported in PubMed between the years 2000 and January 2010. RESULTS Although survival rates of extremely low birth weight infants (ELBW) significantly increased during the last decade, the substantial stability of disability trends in this population was disappointing. Late-preterm infants, who account for about 75% of all preterm births and had not been considered at risk for adverse long-term neurodevelopmental outcomes in the past, are now reconsidered as more likely to develop such events, though their risk remains lower than in ELBW. CONCLUSIONS The findings of the studies discussed in our article support the importance of early diagnosis in order to make decision about appropriate treatment of preterm infants.
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Affiliation(s)
- Carla Arpino
- Department of Neurosciences, Pediatric Neurology Unit, Tor Vergata University of Rome, Via Montpellier 1, Rome, Italy.
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O'Reilly M, Vollmer B, Vargha-Khadem F, Neville B, Connelly A, Wyatt J, Timms C, de Haan M. Ophthalmological, cognitive, electrophysiological and MRI assessment of visual processing in preterm children without major neuromotor impairment. Dev Sci 2010; 13:692-705. [PMID: 20712735 DOI: 10.1111/j.1467-7687.2009.00925.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle O'Reilly
- Developmental Cognitive Neuroscience Unit, UCL Institute of Child Health, London, UK.
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Ramenghi LA, Ricci D, Mercuri E, Groppo M, De Carli A, Ometto A, Fumagalli M, Bassi L, Pisoni S, Cioni G, Mosca F. Visual performance and brain structures in the developing brain of pre-term infants. Early Hum Dev 2010; 86 Suppl 1:73-5. [PMID: 20153942 DOI: 10.1016/j.earlhumdev.2010.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The presence of abnormal visual function has been related to overt lesions in the thalami, peritrigonal white matter (such as cavitational-necrotic periventricular leucomalacia) and optic radiations, and also to the extent of occipital cortex involvement. The normal development of visual function seems to depend on the integrity of a network that includes not only optic radiations and the primary visual cortex but also other cortical and subcortical areas, such as the frontal or temporal lobes or basal ganglia, which have been found to play a topical role in the development of vision. Therefore, the complex functions and functional connectivity of the developing brain of premature infants can be studied only with highly sophisticated techniques such as diffusion tensor tractography. The combined use of visual tests and neonatal structural and functional neuroimaging, which have become available for newborn infants, provides a better understanding of the correlation between structure and function from early life. This appears to be particularly relevant considering the essential role of early visual function in cognitive development. The identification of early visual impairment is also important, as it allows for early enrolment in intervention programmes. The association of clinical and functional studies to newer imaging techniques, which are being increasingly used also in neonates, are likely to provide further information on early aspects of vision and the mechanisms underlying brain plasticity, which are still not fully understood. Early exposure to a difficult postnatal environment together with early and unexpected removal from a protective milieu are exclusive and peculiar factors of prematurity that interfere with the normal development of the visual system in pre-term babies. The problem is further compounded by the influence of different perinatal brain lesions affecting the developing brain of premature babies. Nevertheless, in the last few decades, there have been considerable advances in our understanding of the development of vision in pre-term infants during early infancy. This has mainly been due to the development of age-specific tests assessing various aspects of visual function, from ophthalmological examination to more cortical aspects of vision, such as the ability to process orientation or different aspects of visual attention [1-7]. Improvements in understanding very early and specific neurological impairments in neurological functions have been reported in pre-term infants, known to be at risk of developing visual and visual-perceptual impairment. These impairments are due not only to retinopathy, a common finding in premature infants, but also to cerebral (central) visual impairment, secondary to brain lesions affecting the central visual pathway.
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Affiliation(s)
- Luca Antonio Ramenghi
- NICU, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, IRCCS, University of Milan, Milan, Italy.
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Ricci D, Cesarini L, Gallini F, Serrao F, Leone D, Baranello G, Cota F, Pane M, Brogna C, De Rose P, Vasco G, Alfieri P, Staccioli S, Romeo DM, Tinelli F, Molle F, Lepore D, Baldascino A, Ramenghi LA, Torrioli MG, Romagnoli C, Cowan F, Atkinson J, Cioni G, Mercuri E. Cortical visual function in preterm infants in the first year. J Pediatr 2010; 156:550-5. [PMID: 20056237 DOI: 10.1016/j.jpeds.2009.10.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/15/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess visual function in low-risk preterm infants at 3, 5, and 12 months corrected age to determine whether the maturation of visual function in the first year is similar to that reported in term-born infants. STUDY DESIGN Seventy-five low-risk infants (25.0-30.9 weeks gestation) underwent ophthalmological examinations and a battery of tests (fix and follow, visual fields, acuity, attention at distance, and fixation shift) designed to assess various aspects of visual function at 3, 5, and 12 months corrected age. RESULTS The results were comparable with normative data from term-born infants in all tests but fixation shift, suggesting that maturation of most aspects of visual function is not significantly affected by preterm birth. In contrast, >25% of preterm infants failed the fixation shift test at 3 months, with a higher percentage of failing at 5 and 12 months. CONCLUSIONS There is a specific profile of early visual behavior in low-risk preterm infants, with a high percentage of infants failing a test that specifically assesses visual attention and provides a measure of cortical processing.
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Affiliation(s)
- Daniela Ricci
- Paediatric Neurology Unit, Catholic University, Rome, Italy
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Early assessment of visual function in preterm infants: how early is early? Early Hum Dev 2010; 86:29-33. [PMID: 20056358 DOI: 10.1016/j.earlhumdev.2009.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/18/2009] [Accepted: 11/20/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several studies reported on various aspects of visual function at term age and in the first months after birth but less has been reported in preterm infants before they reach termequivalent age. AIMS To assess the suitability of a battery of tests of visual function for use in infants born at <33weeks gestation (GA) and assessed before 34weeks post-menstrual age (PMA); to evaluate the distribution of the findings according to GA, and to compare the data with those previously published on preterm infants assessed at 35weeks PMA. STUDY DESIGN Cross-sectional study. SUBJECTS Sixty-four preterm infants with a GA <33weeks were studied. OUTCOME MEASURES We used a battery of visual function tests previously validated at 35 and 40weeks PMA in low-risk preterm infants. All the infants in this current study underwent the same assessment before 34weeks PMA. RESULTS Before 31weeks PMA most infants could not be reliably assessed because of clinical instability, whilst after 31weeks PMA most infants could be assessed and they showed progressive maturation in their responses with PMA. Some items (spontaneous ocular motility, horizontal tracking, tracking a coloured stimulus, and ocular fixation) showed similar results at 32-33weeks PMA to those found in low-risk preterm at 35weeks PMA. Ocular movements to a target and arc tracking were the items with the most immature responses. CONCLUSIONS Our results provide further evidence that a structured assessment of visual function can be used in clinical routine and for research purposes in infants as young as 31weeks PMA.
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Abstract
Although functional magnetic resonance imaging is a technique that is widely used in adult populations, its use within a fetal environment has been extremely limited. Problems associated with movement and technical scanning issues have limited its effectiveness in providing reliable and spatially accurate details of fetal brain activity. However, initial research has indicated that it is a viable tool for assessing functional maturation in the fetus, and recent advances in echo-planar imaging sequences on the abdomen at 3-T provide the potential for more reliable activation detection and higher resolution spatial information. If the technique can be further developed such that a similar reliability in activity patterns is observed as in conventional functional MRI, then fetal functional MRI could offer a useful contribution at a clinical level as well as at a research one in the assessment of brain development and maturation.
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Affiliation(s)
- Jon Fulford
- Peninsula NIHR Clinical Research Facility, Magnetic Resonance Centre, University of Exeter, Exeter, Devon, United Kingdom.
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