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Kyozuka H, Yasuda S, Murata T, Fukuda T, Furukawa S, Fujimori K. Changes in fetal baroreceptor sensitivity during intrauterine inflammation in preterm fetal sheep. J Matern Fetal Neonatal Med 2023; 36:2150392. [PMID: 36443245 DOI: 10.1080/14767058.2022.2150392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Baroreflex is a regulatory mechanism that slows the fetal heart rate. This study aimed to investigate the effects of lipopolysaccharide (LPS)-induced endotoxemia on fetal baroreceptor sensitivity in preterm fetal sheep. METHODS The changes in fetal baroreceptor sensitivity were measured in seven chronically instrumented preterm fetal sheep. Fetal baroreceptor sensitivity was measured in three phases: (A) control phase, defined as the 24 h before the first injection of LPS; (B) acute phase, defined as the 24 h between the first and second injections of LPS; and (C) fetal acidosis phase, defined as the time from the second LPS injection until intrauterine fetal death. Histological examinations of the fetal membrane and umbilical cord were also conducted. RESULTS Each fetus developed metabolic acidosis after the second injection of LPS. The fetuses died 24.7 (SD = 6.1) hours after the second injection of LPS. Both the umbilical cord and fetal membranes showed histological evidence of severe inflammation. In total, 163 fetal baroreceptor measurements were performed in this experiment (A, n = 77 times; B, n = 60 times; C, n = 26 times). Fetal baroreceptor sensitivity showed significant differences in all three phases (A: 2.7 [SD = 0.2]; B: 2.5 [SD = 0.2]; and C: 1.5 [SD = 0.2]). Post hoc tests showed that baroreceptor sensitivity in the acidosis phase had decreased significantly compared to that in the control and acute phases (p<.001 and p=.002, respectively). CONCLUSIONS Fetal baroreceptor sensitivity decreased during fetal acidosis induced by LPSs.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Jiang ZD, Wang C, Ping LL. Brainstem auditory pathway function at four months of corrected postnatal age in preterm infants born below 30 week gestation. Brain Dev 2020; 42:496-502. [PMID: 32336484 DOI: 10.1016/j.braindev.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Functional status of the brainstem auditory pathway was examined at four months of corrected postnatal age in infants born below 30 week gestation to assess the effect of very or extremely preterm birth on postnatal development of the pathway. METHODS Thirty-four preterm infants born at 24-29 week gestation (GA24-29w) were studied at four months of corrected postnatal age. Normal controls were 38 postnatal age-matched term infants. Maximum length sequence brainstem auditory evoked response (MLS BAER) were recorded and analysed with 60 dB nHL clicks. RESULTS Compared with term control group, GA24-29w group manifested higher BAER threshold (p < 0.05), longer MLS BAER wave latencies at all click rates 91-910/s (p < 0.01-0.001), and lower wave amplitudes at most click rates (p < 0.05-0.01). No significant differences were found between the two groups in I-V interval at any click rates. I-III interval was shorter while III-V interval was longer in GA24-29w group than in term group at higher rates (all p < 0.05). III-V/I-III interval ratio in GA24-29w group was greater at 455 and 910/s clicks (p < 0.05 and 0.01). These interval variables showed similar changes when 4 GA24-29w infants with threshold elevation were excluded. CONCLUSIONS At four months of corrected postnatal age, infants born below 30 week gestation manifested elevated BAER threshold, increased wave latencies, and reduced amplitude. They also manifested a small decrease in I-III interval but a small increase in III-V interval at high rates. Very or extremely preterm birth exerts a mild or moderate effect on postnatal development of the brainstem auditory pathway.
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Affiliation(s)
- Ze Dong Jiang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China.
| | - Cui Wang
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
| | - Li Li Ping
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China; Department of Neonatology, Han Dan Central Hospital, Hebei, China
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Pagida MA, Konstantinidou AE, Chrysanthou-Piterou MA, Patsouris ES, Panayotacopoulou MT. Apoptotic Markers in the Midbrain of the Human Neonate After Perinatal Hypoxic/Ischemic Injury. J Neuropathol Exp Neurol 2020; 79:86-101. [PMID: 31803912 DOI: 10.1093/jnen/nlz114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/01/2019] [Accepted: 10/23/2019] [Indexed: 11/13/2022] Open
Abstract
Our previous postmortem studies on neonates with neuropathological injury of perinatal hypoxia/ischemia (PHI) showed a dramatic reduction of tyrosine hydroxylase expression (dopamine synthesis enzyme) in substantia nigra (SN) neurons, with reduction of their cellular size. In order to investigate if the above observations represent an early stage of SN degeneration, we immunohistochemically studied the expression of cleaved caspase-3 (CCP3), apoptosis inducing factor (AIF), and DNA fragmentation by using terminal deoxynucleotidyltransferase-mediated dUTP-biotin 3'-end-labeling (TUNEL) technique in the SN of 22 autopsied neonates (corrected age ranging from 34 to 46.5 gestational weeks), in relation to the severity/duration of PHI injury, as estimated by neuropathological criteria. No CCP3-immunoreactive neurons and a limited number of apoptotic TUNEL-positive neurons with pyknotic characteristics were found in the SN. Nuclear AIF staining was revealed only in few SN neurons, indicating the presence of early signs of AIF-mediated degeneration. By contrast, motor neurons of the oculomotor nucleus showed higher cytoplasmic AIF expression and nuclear translocation, possibly attributed to the combined effect of developmental processes and increased oxidative stress induced by antemortem and postmortem factors. Our study indicates the activation of AIF, but not CCP3, in the SN and oculomotor nucleus of the human neonate in the developmentally critical perinatal period.
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Affiliation(s)
- Marianna A Pagida
- 1st Department of Psychiatry (MPag, MC-P, MPan); Laboratory of Neurobiology and Histochemistry, University Mental Health Research Institute (MPag, MC-P, MPan); and 1st Department of Pathology (AK, EP), National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia E Konstantinidou
- 1st Department of Psychiatry (MPag, MC-P, MPan); Laboratory of Neurobiology and Histochemistry, University Mental Health Research Institute (MPag, MC-P, MPan); and 1st Department of Pathology (AK, EP), National and Kapodistrian University of Athens, Athens, Greece
| | - Margarita A Chrysanthou-Piterou
- 1st Department of Psychiatry (MPag, MC-P, MPan); Laboratory of Neurobiology and Histochemistry, University Mental Health Research Institute (MPag, MC-P, MPan); and 1st Department of Pathology (AK, EP), National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios S Patsouris
- 1st Department of Psychiatry (MPag, MC-P, MPan); Laboratory of Neurobiology and Histochemistry, University Mental Health Research Institute (MPag, MC-P, MPan); and 1st Department of Pathology (AK, EP), National and Kapodistrian University of Athens, Athens, Greece
| | - Maria T Panayotacopoulou
- 1st Department of Psychiatry (MPag, MC-P, MPan); Laboratory of Neurobiology and Histochemistry, University Mental Health Research Institute (MPag, MC-P, MPan); and 1st Department of Pathology (AK, EP), National and Kapodistrian University of Athens, Athens, Greece
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Galli L, Dall'Asta A, Whelehan V, Archer A, Chandraharan E. Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses. J Obstet Gynaecol Res 2019; 45:2343-2350. [PMID: 31621146 DOI: 10.1111/jog.14133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/07/2019] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the cardiotocography (CTG) features observed in suspected intrapartum chorioamnionitis in term fetuses according to the recently suggested criteria for the pathophysiological interpretation of the fetal heart rate and their correlation with perinatal outcomes. METHODS Retrospective analysis of nonconsecutive CTG traces. 'CTG chorioamnionitis' was diagnosed either based on a persistent rise in the baseline for the given gestation or on a persistent increase in the baseline fetal heart rate during labor >10% without preceding CTG signs of hypoxia and in the absence of maternal pyrexia. Perinatal outcomes were compared among cases with no sign of chorioamnionitis, in those with only CTG features suspicious for chorioamnionitis and in those who developed clinical chorioamnionitis. RESULTS Two thousand one hundred and five CTG traces were analyzed. Of these, 356 fulfilled the criteria for "CTG chorioamnionitis". Higher rates of Apgar <7 at 1 and 5 min (21.6% vs 9.0% and 9.8% vs 2.0%, respectively, P < 0.01 for both) and lower umbilical artery pH (7.14 ± 0.11 vs 7.19 ± 0.11, P < 0.01) and an over fivefold higher rate of neonatal intensive care unit admission (16.6% vs 2.9%, P < 0.01) were noted in the 'CTG chorioamnionitis' group. Differences in the incidence of abnormal CTG patterns were noted between cases who eventually had clinical evidence of chorioamnionitis (89/356) and those showing CTG features suspicious for chorioamnionitis in the absence of clinical evidence of chorioamnionitis (267/356). CONCLUSION Intrapartum CTG features of suspected chorioamnionitis are associated with adverse perinatal outcomes.
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Affiliation(s)
- Letizia Galli
- St George's University Hospitals NHS Foundation Trust, London, UK.,Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy.,Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.,Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | - Abigail Archer
- St George's University Hospitals NHS Foundation Trust, London, UK
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Lei J, Zhong W, Almalki A, Zhao H, Arif H, Rozzah R, Al Yousif G, Alhejaily N, Wu D, McLane M, Burd I. Maternal Glucose Supplementation in a Murine Model of Chorioamnionitis Alleviates Dysregulation of Autophagy in Fetal Brain. Reprod Sci 2018; 25:1175-1185. [PMID: 29017418 PMCID: PMC6346301 DOI: 10.1177/1933719117734321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fetal brain injury induced by intrauterine inflammation is a major risk factor for adverse neurological outcomes, including cerebral palsy, cognitive dysfunction, and behavioral disabilities. There are no adequate therapies for neuronal protection to reduce fetal brain injury, especially new strategies that may apply promptly and conveniently. In this study, we explored the effect of maternal glucose administration in a mouse model of intrauterine inflammation at term. Our results demonstrated that maternal glucose supplementation significantly increased survival birth rate and improved the neurobehavioral performance of pups exposed to intrauterine inflammation. Furthermore, we demonstrated that maternal glucose administration improved myelination and oligodendrocyte development in offspring exposed to intrauterine inflammation. Though the maternal blood glucose concentration was temporally prevented from decrease induced by intrauterine inflammation, the glucose concentration in fetal brain was not recovered by maternal glucose supplementation. The adenosine triphosphate (ATP) level and autophagy in fetal brain were regulated by maternal glucose supplementation, which may prevent dysregulation of cellular metabolism. Our study is the first to provide evidence for the role of maternal glucose supplementation in the cell survival of fetal brain during intrauterine inflammation and further support the possible medication with maternal glucose treatment.
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Affiliation(s)
- Jun Lei
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wenyu Zhong
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmad Almalki
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hongxi Zhao
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hattan Arif
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rayyan Rozzah
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ghada Al Yousif
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nader Alhejaily
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dan Wu
- 2 Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael McLane
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- 1 Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 3 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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OH KJ, PARK JY, LEE J, HONG JS, ROMERO R, YOON BH. The combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates. J Perinat Med 2018; 46:9-20. [PMID: 28672753 PMCID: PMC5848500 DOI: 10.1515/jpm-2016-0348] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/12/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the impact of combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome (RDS) on the development of intraventricular hemorrhage (IVH) in preterm neonates. METHODS This retrospective cohort study includes 207 consecutive preterm births (24.0-33.0 weeks of gestation). Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. According to McMenamin's classification, IVH was defined as grade II or higher when detected by neurosonography within the first weeks of life. RESULTS (1) IVH was diagnosed in 6.8% (14/207) of neonates in the study population; (2) IVH was frequent among newborns exposed to intra-amniotic inflammation when followed by postnatal RDS [33% (6/18)]. The frequency of IVH was 7% (8/115) among neonates exposed to either of these conditions - intra-amniotic inflammation or RDS - and 0% (0/64) among those who were not exposed to these conditions; and (3) Neonates exposed to intra-amniotic inflammation and postnatal RDS had a significantly higher risk of IVH than those with only intra-amniotic inflammation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.1-19.3] and those with RDS alone (OR 5.6, 95% CI 1.0-30.9), after adjusting for gestational age. CONCLUSION The combined exposure to intra-amniotic inflammation and postnatal RDS markedly increased the risk of IVH in preterm neonates.
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Affiliation(s)
- Kyung Joon OH
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Jee Yoon PARK
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - JoonHo LEE
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Joon-Seok HONG
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Roberto ROMERO
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Bo Hyun YOON
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Jiang ZD, Ping LL. Reduced wave amplitudes of brainstem auditory response in high-risk babies born at 28-32week gestation. Brain Dev 2016; 38:885-892. [PMID: 27287666 DOI: 10.1016/j.braindev.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/11/2016] [Accepted: 05/25/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine brainstem auditory electrophysiology in high-risk babies born at 28-32week gestation by analysing the amplitudes of wave components in maximum length sequence brainstem auditory evoked response (MLS BAER). METHODS 94 preterm babies, ranging in gestation 28-32weeks, with perinatal problems (high-risk) were recruited. The amplitudes of MLS BAER wave components were studied at term age (37-42weeks postconceptional age). RESULTS Compared with normal term controls, the amplitude in the high-risk preterm babies was significantly smaller at the highest click rate 910/s for wave I (p<0.01), at all 91-910/s for wave III (all p<0.01) and at 455 and 910/s (p<0.05 and 0.01) for wave V. Compared with age-matched low-risk preterm controls, the amplitude was significantly smaller at 455 and 910/s for wave I (p<0.05 and 0.05), 91-910/s for wave III (p<0.05-0.001), and 227-910/s (p<0.05 and 0.01) for wave V. No differences in the V/I and V/III amplitude ratios were found between the high-risk preterm babies and the controls. CONCLUSIONS The amplitudes of MLS BAER wave components, mainly more central components, were reduced in the high-risk preterm babies born at 28-32week gestation. Electrophysiological activity of the brainstem auditory neuron in such babies is depressed, mainly attributed to or related to the associated perinatal problems.
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Affiliation(s)
- Ze Dong Jiang
- Children's Hospital, Shanghai Medical University, Shanghai, China.
| | - Li Li Ping
- Children's Hospital, Shanghai Medical University, Shanghai, China
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Jiang ZD, Ping LL. Functional integrity of rostral regions of the immature brainstem is impaired in babies born extremely preterm. Clin Neurophysiol 2016; 127:1581-8. [PMID: 26481063 DOI: 10.1016/j.clinph.2015.09.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Babies born extremely preterm are predisposed to brain damage. We test the hypothesis that functional integrity of the auditory brainstem, particularly the rostral regions, is impaired in extremely preterm babies. METHODS We recruited 68 babies who were born at 23-27 weeks of gestation. At term date, these babies were studied by recording and analysing maximum length sequence brainstem auditory evoked response (MLS BAER) with click rates 91-910/s. Detailed data analysis was performed in 65 babies from whom reliable MLS BAER measurements were obtained. RESULTS Compared with normal term controls, the extremely preterm babies showed a significant increase in wave V latency, and I-V interval at all rates 91-910/s (p<0.01-0.001). Of two small intervals, I-III interval showed no apparent abnormality, but III-V interval was significantly increased at all rates, which was supported by a significant increase in III-V/I-III interval ratio (all p<0.001). These abnormalities were more significant at higher than at lower rates. The slopes of wave V latency-, I-V interval- and particularly III-V interval-rate functions were all increased. The same was true for the slope of III-V/I-III interval ratio-rate function. CONCLUSIONS MLS BAER variables that mainly reflect central neural conduction in the extremely preterm babies were abnormally increased. The most important abnormality was a significant increase in III-V interval and its click rate-dependent change. The abnormalities tended to be more significant than those previously reported in late and very preterm babies. SIGNIFICANCE Babies born extremely preterm have a major impairment or maturational delay in functional integrity of the rostral regions of the immature brainstem, which is more significant than in less preterm babies.
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Cilla A, Arnaez J, Suarez J, Megias G, Cabrerizo M, Garcia-Alix A. Perinatal infection and hypoxic-ischemic encephalopathy: a pilot study. J Matern Fetal Neonatal Med 2014; 29:140-2. [PMID: 25423183 DOI: 10.3109/14767058.2014.991303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies suggest a synergic effect of infection and hypoxia-ischemia in the causation of perinatal brain damage. We conducted a prospective pilot study on the presence of infection in hypoxic-ischemic encephalopathy (HIE), focusing on neurotropic viruses. Sixteen newborns with HIE were included in the study. There were no confirmed cases of viral infection. There was a case of bacterial early onset sepsis and four cases of suspected sepsis due to clinical and/or analytical signs, but with negative cultures. Our results do not support universal screening for viral infection in cases of HIE.
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Affiliation(s)
| | | | | | - Gregoria Megias
- c Department of Microbiology , Burgos University Hospital , Burgos , Spain
| | - María Cabrerizo
- d National Centre of Microbiology, Instituto de Salud Carlos III , Madrid , Spain , and
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Basu S, Dewangan S, Barman S, Anupurba S, Shukla RC, Kumar A. Cerebral blood flow velocity in asymptomatic premature neonates exposed to clinical chorioamnionitis. Clinical Epidemiology and Global Health 2014. [DOI: 10.1016/j.cegh.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jiang ZD, Chen C. Impaired neural conduction in the auditory brainstem of high-risk very preterm infants. Clin Neurophysiol 2014; 125:1231-7. [DOI: 10.1016/j.clinph.2013.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/12/2013] [Accepted: 11/19/2013] [Indexed: 10/26/2022]
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Zhao J, Chen Y, Xu Y, Pi G. Effect of intrauterine infection on brain development and injury. Int J Dev Neurosci 2013; 31:543-9. [DOI: 10.1016/j.ijdevneu.2013.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 06/23/2013] [Accepted: 06/23/2013] [Indexed: 01/01/2023] Open
Affiliation(s)
- Jing Zhao
- Department of NeonatologyAffiliated Hospital of North Sichuan Medical CollegeNanchong637000China
- Department of PediatricsAffiliated Hospital of North Sichuan Medical CollegeNanchong637000China
| | - Yurong Chen
- Department of NeonatologyAffiliated Hospital of North Sichuan Medical CollegeNanchong637000China
- Department of PediatricsAffiliated Hospital of North Sichuan Medical CollegeNanchong637000China
| | - Yuxia Xu
- Department of PediatricsAffiliated Hospital of North Sichuan Medical CollegeNanchong637000China
| | - Guanghuan Pi
- Department of PediatricsAffiliated Hospital of North Sichuan Medical CollegeNanchong637000China
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Ugwumadu A. Understanding cardiotocographic patterns associated with intrapartum fetal hypoxia and neurologic injury. Best Pract Res Clin Obstet Gynaecol 2013; 27:509-36. [PMID: 23702579 DOI: 10.1016/j.bpobgyn.2013.04.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/04/2013] [Indexed: 12/17/2022]
Abstract
Widespread use of fetal heart rate monitoring for intrapartum fetal surveillance preceded our detailed understanding of the behaviour and regulation of the fetal cardiovascular system during labour. The fetal heart rate is sensitive to fetal hypoxaemia and hypoxia, but lacks specificity for fetal acidosis, the end point of unmitigated hypoxaemia and hypoxia. Original interpretations of fetal heart rate patterns equated decelerations to 'fetal distress' and mandated operative intervention. Since then, obstetricians have been trained to focus on the morphological appearances of fetal heart rate decelerations rather than to understand the underlying physiological mechanisms, how the fetus compensates and defends itself, and those patterns that suggest progressive loss of compensation. Consequently, operative interventions are commonly undertaken to 'rescue' fetuses that display benign signs of fetal heart rate adaption to events in labour. Failure to recognise abnormal fetal heart rate patterns remains the leading cause of avoidable brain injury and litigation. In this chapter the general characteristics of the fetal heart rate, the changes in fetal heart rate pattern that may occur during labour, and the patterns that suggest failure of the fetal compensatory mechanisms leading to injury are discussed.
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Affiliation(s)
- Austin Ugwumadu
- Department of Obstetrics & Gynaecology, St George's Hospital and University of London, Blackshaw Road, London SW17 0QT, UK.
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Abstract
In the present article the putative role of environmental factors in schizophrenia is reviewed and synthesized. Accumulating evidence from recent studies suggests that environmental exposures may play a more significant role in the etiopathogenesis of this disorder than previously thought. This expanding knowledge base is largely a consequence of refinements in the methodology of epidemiologic studies, including birth cohort investigations, and in preclinical research that has been inspired by the evolving literature on animal models of environmental exposures. This paper is divided into four sections. In the first, the descriptive epidemiology of schizophrenia is reviewed. This includes general studies on incidence, prevalence, and differences in these measures by urban-rural, neighborhood, migrant, and season of birth status, as well as time trends. In the second section, we discuss the contribution of environmental risk factors acting during fetal and perinatal life; these include infections [e.g. rubella, influenza, Toxoplasma gondii (T. gondii), herpes simplex virus type 2 (HSV-2)], nutritional deficiencies (e.g., famine, folic acid, iron, vitamin D), paternal age, fetal/neonatal hypoxic and other obstetric insults and complications, maternal stress and other exposures [e.g. lead, rhesus (Rh) incompatibility, maternal stress]. Other putative neurodevelopmental determinants, including cannabis, socioeconomic status, trauma, and infections during childhood and adolescence are also covered. In the third section, these findings are synthesized and their implications for prevention and uncovering biological mechanisms, including oxidative stress, apoptosis, and inflammation, are discussed. Animal models, including maternal immune activation, have yielded evidence suggesting that these exposures cause brain and behavioral phenotypes that are analogous to findings observed in patients with schizophrenia. In the final section, future studies including new, larger, and more rigorous epidemiologic investigations, and research on translational and clinical neuroscience, gene-environment interactions, epigenetics, developmental trajectories and windows of vulnerability, are elaborated upon. These studies are aimed at confirming observed risk factors, identifying new environmental exposures, elucidating developmental mechanisms, and shedding further light on genes and exposures that may not be identified in the absence of these integrated approaches. The study of environmental factors in schizophrenia may have important implications for the identification of causes and prevention of this disorder, and offers the potential to complement, and refine, existing efforts on explanatory neurodevelopmental models.
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Affiliation(s)
- Alan S Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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15
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Abstract
AIM To examine the association between genitourinary infection during pregnancy and cerebral palsy (CP) in children. METHOD Medicaid and birth certificate data were obtained for 135 835 pregnant women with singleton births paid for by Medicaid from 1996 to 2002. Linked Medicaid billing data were obtained for their children in 2007. The association between maternal genitourinary infection and CP was modeled using generalized estimating equations. RESULTS Maternal genitourinary infection was significantly associated with CP (odds ratio [OR]=1.27, p=0.007). Additional analyses revealed that the association was strongly significant for preterm or low birthweight infants when maternal infection was diagnosed in the first two trimesters of pregnancy (OR=1.62, p<0.001). This association remained (OR=1.72, p<0.001) when the model was limited to cases of CP diagnosed by at least two different clinicians. Infection was not significantly associated with CP in term or normal-birthweight infants. INTERPRETATION Maternal genitourinary infection occurring in the first two trimesters was associated with increased risk of CP in preterm or low-birthweight children. Additional research is needed to determine whether this association is affected by antimicrobial treatment.
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Affiliation(s)
- Joshua R Mann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203, USA.
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16
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Abstract
More accurate documentation of a neonate's specific hypertonic state could be helpful as part of serial neurologic examinations. The clinician would then be in a more advantageous position to choose the appropriate neuroprotective drug or the procedure that best fits with the etiology, localization, and timing of injury. Ideally, choices for neuroprotection will integrate history, examination, and diagnostic findings before considering options for prophylaxis, neurorescue, or neurorepair. Measuring the efficacy of a neuroprotection protocol should include a complete list of life-course challenges, including motor, epileptic, cognitive, and behavioral outcomes as expressed at successively older ages.
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Affiliation(s)
- Mark S Scher
- Program in Fetal and Neonatal Neurology, Division of Pediatric Neurology, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-6090, USA.
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Shirts BH, Wood J, Yolken RH, Nimgaonkar VL. Comprehensive evaluation of positional candidates in the IL-18 pathway reveals suggestive associations with schizophrenia and herpes virus seropositivity. Am J Med Genet B Neuropsychiatr Genet 2008; 147:343-50. [PMID: 18092318 DOI: 10.1002/ajmg.b.30603] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Interactions between genetic variation and environmental factors have been invoked in schizophrenia genesis, but pathways linking them are uncertain. We used a pathway-oriented approach to evaluate six genes mediating IL18 function (IL-18, IL18BP, IL18R1, IL18RAP, IL12B, and IL12A). The first five are also localized to regions previously linked with schizophrenia. Fifty-four representative tag SNPs were selected from comprehensive sequence data and genotyped in 478 patients with schizophrenia/schizoaffective disorder (DSM IV criteria) and 501 unscreened control individuals. Exposure to three herpes viruses previously suggested as risk factors for schizophrenia was estimated simultaneously among the cases. Five SNPs in four genes were associated with schizophrenia, most prominently rs2272127 at IL18RAP (P = 0.0007, odds ratio for C allele 1.49, 95% CI: 1.18-1.87; P = 0.03 following correction for multiple comparisons). Exploratory analysis revealed that rs2272127 was also associated with herpes simplex virus 1 (HSV1) seropositivity in cases (P = 0.04, OR for G allele 1.58, 95% CI: 1.04-2.39). Similar patterns were observed at another correlated SNP (rs11465702, P = 0.005 and 0.006, respectively for associations with schizophrenia and HSV1 seropositivity). We suggest plausible, testable hypotheses linking IL-18 signaling and HSV1 in schizophrenia pathogenesis.
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Affiliation(s)
- Brian H Shirts
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA
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19
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Morkos AA, Hopper AO, Deming DD, Yellon SM, Wycliffe N, Ashwal S, Sowers LC, Peverini RL, Angeles DM. Elevated total peripheral leukocyte count may identify risk for neurological disability in asphyxiated term neonates. J Perinatol 2007; 27:365-70. [PMID: 17443199 DOI: 10.1038/sj.jp.7211750] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present study investigated the relationship between neurologic outcome and total circulating white blood cell (WBC) and absolute neutrophil counts (ANCs) in the first week of life in term infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN Long-term neurologic outcome at 18 months was measured retrospectively in 30 term neonates with HIE using the Pediatric Cerebral Performance Category Scale (PCPCS) score with outcomes dichotomized as either good or poor. We then compared white blood cell and ANC levels during the first 4 days of life and magnetic resonance imaging (MRI) obtained within the first month life between the two PCPCS groups. MRI was quantified using a validated scoring system. RESULTS Neonates with good long-term outcomes had significantly lower MRI scores (indicating lesser injury) than neonates with poor outcomes. More importantly, neonates with poor outcomes had significantly higher WBC and ANC levels as early as12 h after birth and up to 96 h after birth compared to those with good outcomes. These data suggest that elevated peripheral neutrophil counts in the first 96 h of life may signal or predict adverse long-term outcome. CONCLUSIONS Our findings suggest that elevated peripheral neutrophil counts in the first 96 h of life in term infants with HIE may contribute to abnormal neurodevelopmental outcome.
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Affiliation(s)
- A A Morkos
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
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Siegmann AE. A classification of sociomedical health indicators: perspectives for health administrators and health planners. Int J Health Serv 1976; 6:521-38. [PMID: 955757 PMCID: PMC3004532 DOI: 10.2190/my7u-4bgm-9qfy-n0tn] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The conceptualization and operationalization of measures of health status are considered. Health indicators are conceived as a subset of social indicators, and therefore, as any social indicator, they are viewed as derivative from social issues. The interrelationships of different frames of reference for defining and measuring health that have accompained three distinct health problem patterns in the United States are viewed from a developmental perspective. Mortality and morbidity rates, the traditional health indicators, by themselves no longer serve to assess health status in developed nations. Their deficiencies as indicators serve as background for a classification schema for sociomedical health status indicators that relates health definition frames of reference, measures of health status, and health problems. The role of a group of health indicators-sociomedical heath indicators-in the current formulation of health status measures is assessed.
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