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Victor S, Forbes B, Greenough A, Edwards AD. PPAR Gamma Receptor: A Novel Target to Improve Morbidity in Preterm Babies. Pharmaceuticals (Basel) 2023; 16:1530. [PMID: 38004396 PMCID: PMC10675178 DOI: 10.3390/ph16111530] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Worldwide, three-quarters of a million babies are born extremely preterm (<28 weeks gestation) with devastating outcomes: 20% die in the newborn period, a further 35% develop bronchopulmonary dysplasia (BPD), and 10% suffer from cerebral palsy. Pioglitazone, a Peroxisome Proliferator Activated Receptor Gamma (PPARγ) agonist, may reduce the incidence of BPD and improve neurodevelopment in extreme preterm babies. Pioglitazone exerts an anti-inflammatory action mediated through Nuclear Factor-kappa B repression. PPARγ signalling is underactive in preterm babies as adiponectin remains low during the neonatal period. In newborn animal models, pioglitazone has been shown to be protective against BPD, necrotising enterocolitis, and lipopolysaccharide-induced brain injury. Single Nucleotide Polymorphisms of PPARγ are associated with inhibited preterm brain development and impaired neurodevelopment. Pioglitazone was well tolerated by the foetus in reproductive toxicology experiments. Bladder cancer, bone fractures, and macular oedema, seen rarely in adults, may be avoided with a short treatment course. The other effects of pioglitazone, including improved glycaemic control and lipid metabolism, may provide added benefit in the context of prematurity. Currently, there is no formulation of pioglitazone suitable for administration to preterm babies. A liquid formulation of pioglitazone needs to be developed before clinical trials. The potential benefits are likely to outweigh any anticipated safety concerns.
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Affiliation(s)
- Suresh Victor
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London SE1 7EH, UK;
| | - Ben Forbes
- Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK;
| | - Anne Greenough
- Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, Neonatal Intensive Care Centre, Floor 4, Golden Jubilee Wing, King’s College Hospital, Denmark Hill, Brixton, London SE5 9RS, UK;
| | - A. David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London SE1 7EH, UK;
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Bedwell C, Actis Danna V, Lyangenda K, Tuwele K, Kuzenza F, Kimaro D, Shayo H, Petross C, Chisuse I, Heazell A, Victor S, Vwalika B, Lavender T. ‘Moving towards understanding’, acceptability of investigations following stillbirth in
sub‐Saharan
Africa: a grounded theory study. BJOG 2022; 130:59-67. [PMID: 36209462 PMCID: PMC10092083 DOI: 10.1111/1471-0528.17319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/08/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the views of women, partners, families, health workers and community leaders of potential investigations to determine the cause(s) of stillbirth, in Malawi, Tanzania and Zambia. DESIGN Grounded theory. SETTING Tertiary facilities and community settings in Blantyre, Malawi, Mwanza, Tanzania and Mansa, Zambia. SAMPLE Purposive and theoretical sampling was used to recruit 124 participants: 33 women, 18 partners, 19 family members, 29 health workers and 25 community leaders, across three countries. METHODS Semi-structured interviews were conducted using a topic guide for focus. Analysis was completed using constant comparative analysis. Sampling ceased at data saturation. RESULTS Women wanted to know the cause of stillbirth, but this was tempered by their fear of the implications of this knowledge; in particular, the potential for them to be blamed for the death of their baby. There were also concerns about the potential consequences of denying tradition and culture. Non-invasive investigations were most likely to be accepted on the basis of causing less 'harm' to the baby. Parents' decision-making was influenced by type of investigation, family and cultural influences and financial cost. CONCLUSIONS Parents want to understand the cause of death, but face emotional, cultural and economic barriers to this. Offering investigations will require these barriers to be addressed, services to be available and a no-blame culture developed to improve outcomes. Community awareness, education and support for parents in making decisions are vital prior to implementing investigations in these settings.
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Affiliation(s)
- Carol Bedwell
- Centre for Childbirth, Women’s and Newborn Health, International Public Health Liverpool School of Tropical Medicine Liverpool UK
| | - Valentina Actis Danna
- Centre for Childbirth, Women’s and Newborn Health, International Public Health Liverpool School of Tropical Medicine Liverpool UK
| | - Kutemba Lyangenda
- Department of Public Health and Research, Ministry of Health Lusaka Zambia
| | - Khuzuet Tuwele
- Department of Public Health and Research, Ministry of Health Lusaka Zambia
| | - Flora Kuzenza
- Archbishop Antony Mayala School of Nursing Catholic University of Health and Allied Sciences Bugando Mwanza Tanzania
| | - Debora Kimaro
- Archbishop Antony Mayala School of Nursing Catholic University of Health and Allied Sciences Bugando Mwanza Tanzania
| | - Happiness Shayo
- Archbishop Antony Mayala School of Nursing Catholic University of Health and Allied Sciences Bugando Mwanza Tanzania
| | | | | | - Alexander Heazell
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - Suresh Victor
- Perinatal Imaging and Health, King’s College London London UK
| | | | - Tina Lavender
- Centre for Childbirth, Women’s and Newborn Health, International Public Health Liverpool School of Tropical Medicine Liverpool UK
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3
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Lautarescu A, Bonthrone AF, Pietsch M, Batalle D, Cordero-Grande L, Tournier JD, Christiaens D, Hajnal JV, Chew A, Falconer S, Nosarti C, Victor S, Craig MC, Edwards AD, Counsell SJ. Maternal depressive symptoms, neonatal white matter, and toddler social-emotional development. Transl Psychiatry 2022; 12:323. [PMID: 35945202 PMCID: PMC9363426 DOI: 10.1038/s41398-022-02073-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Maternal prenatal depression is associated with increased likelihood of neurodevelopmental and psychiatric conditions in offspring. The relationship between maternal depression and offspring outcome may be mediated by in-utero changes in brain development. Recent advances in magnetic resonance imaging (MRI) have enabled in vivo investigations of neonatal brains, minimising the effect of postnatal influences. The aim of this study was to examine associations between maternal prenatal depressive symptoms, infant white matter, and toddler behaviour. 413 mother-infant dyads enrolled in the developing Human Connectome Project. Mothers completed the Edinburgh Postnatal Depression Scale (median = 5, range = 0-28, n = 52 scores ≥ 11). Infants (n = 223 male) (median gestational age at birth = 40 weeks, range 32.14-42.29) underwent MRI (median postmenstrual age at scan = 41.29 weeks, range 36.57-44.71). Fixel-based fibre metrics (mean fibre density, fibre cross-section, and fibre density modulated by cross-section) were calculated from diffusion imaging data in the left and right uncinate fasciculi and cingulum bundle. For n = 311, internalising and externalising behaviour, and social-emotional abilities were reported at a median corrected age of 18 months (range 17-24). Statistical analysis used multiple linear regression and mediation analysis with bootstrapping. Maternal depressive symptoms were positively associated with infant fibre density in the left (B = 0.0005, p = 0.003, q = 0.027) and right (B = 0.0006, p = 0.003, q = 0.027) uncinate fasciculus, with left uncinate fasciculus fibre density, in turn, positively associated with social-emotional abilities in toddlerhood (B = 105.70, p = 0.0007, q = 0.004). In a mediation analysis, higher maternal depressive symptoms predicted toddler social-emotional difficulties (B = 0.342, t(307) = 3.003, p = 0.003), but this relationship was not mediated by fibre density in the left uncinate fasciculus (Sobel test p = 0.143, bootstrapped indirect effect = 0.035, SE = 0.02, 95% CI: [-0.01, 0.08]). There was no evidence of an association between maternal depressive and cingulum fibre properties. These findings suggest that maternal perinatal depressive symptoms are associated with neonatal uncinate fasciculi microstructure, but not fibre bundle size, and toddler behaviour.
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Affiliation(s)
- Alexandra Lautarescu
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK.
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - J-Donald Tournier
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Joseph V Hajnal
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suresh Victor
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Neonatal Unit, Evelina London Children's Hospital, London, UK
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Female Hormone Clinic, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Neonatal Unit, Evelina London Children's Hospital, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- EPSRC/Wellcome Centre for Medical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
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Victor S, Rocha-Ferreira E, Rahim A, Hagberg H, Edwards D. New possibilities for neuroprotection in neonatal hypoxic-ischemic encephalopathy. Eur J Pediatr 2022; 181:875-887. [PMID: 34820702 PMCID: PMC8897336 DOI: 10.1007/s00431-021-04320-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022]
Abstract
Around 0.75 million babies worldwide suffer from moderate or severe hypoxic-ischemic encephalopathy (HIE) each year resulting in around 400,000 babies with neurodevelopmental impairment. In 2010, neonatal HIE was associated with 2.4% of the total Global Burden of Disease. Therapeutic hypothermia (TH), a treatment that is now standard of care in high-income countries, provides proof of concept that strategies that aim to improve neurodevelopment are not only possible but can also be implemented to clinical practice. While TH is beneficial, neonates with moderate or severe HIE treated with TH still experience devastating complications: 48% (range: 44-53) combined death or moderate/severe disability. There is a concern that TH may not be effective in low- and middle-income countries. Therapies that further improve outcomes are desperately needed, and in high-income countries, they must be tested in conjunction with TH. We have in this review focussed on pharmacological treatment options (e.g. erythropoietin, allopurinol, melatonin, cannabidiol, exendin-4/exenatide). Erythropoietin and allopurinol show promise and are progressing towards the clinic with ongoing definitive phase 3 randomised placebo-controlled trials. However, there remain global challenges for the next decade. Conclusion: There is a need for more optimal animal models, greater industry support/sponsorship, increased use of juvenile toxicology, dose-ranging studies with pharmacokinetic-pharmacodynamic modelling, and well-designed clinical trials to avoid exposure to harmful medications or abandoning putative treatments. What is Known: • Therapeutic hypothermia is beneficial in neonatal hypoxic-ischemic encephalopathy. • Neonates with moderate or severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia still experience severe sequelae. What is New: • Erythropoietin, allopurinol, melatonin, cannabidiol, and exendin-4/exenatide show promise in conjunction with therapeutic hypothermia. • There is a need for more optimal animal models, greater industry support/sponsorship, increased use of juvenile toxicology, dose-ranging studies with pharmacokinetic-pharmacodynamic modelling, and well-designed clinical trials.
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Affiliation(s)
- Suresh Victor
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, 1st Floor, South Wing, St Thomas’ Hospital, Westmister Bridge Road, London, UK
| | - Eridan Rocha-Ferreira
- Centre for Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ahad Rahim
- UCL School of Pharmacy, University College London, London, UK
| | - Henrik Hagberg
- Centre for Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King’s College London, 1st Floor, South Wing, St Thomas’ Hospital, Westmister Bridge Road, London, UK
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5
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Lautarescu A, Victor S, Lau-Zhu A, Counsell SJ, Edwards AD, Craig MC. The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London. Arch Womens Ment Health 2022; 25:157-169. [PMID: 34244862 PMCID: PMC8784492 DOI: 10.1007/s00737-021-01153-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression ("Perinatal Stress Study"), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample ("developing Human Connectome Project"). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.
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Affiliation(s)
- Alexandra Lautarescu
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK. .,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London, SE1 7EH UK
| | - Alex Lau-Zhu
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, UK ,Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London, SE1 7EH UK
| | - A. David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London, SE1 7EH UK
| | - Michael C. Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,National Female Hormone Clinic, South London and Maudsley National Health Service Foundation Trust, London, UK
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6
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Victor S, Chew A, Falconer S. Pro12Ala polymorphism of peroxisome proliferator activated receptor gamma 2 may be associated with adverse neurodevelopment in European preterm babies. Brain Behav 2021; 11:e2256. [PMID: 34152086 PMCID: PMC8413715 DOI: 10.1002/brb3.2256] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/28/2021] [Accepted: 06/06/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Prematurity is the leading cause of death and disability in children under 5 years of age. Understanding the molecular mechanisms of the biological processes involved in preterm brain injury may help develop novel neuroprotective treatment strategies. A growing body of evidence suggest that peroxisome proliferator-activated receptor gamma (PPARγ) signaling is associated with inhibited brain development in preterm babies. The Ala allele of the Pro12Ala polymorphism of PPARγ2 decreases receptor binding affinity and consequently induces a reduction of PPARγ signaling. METHODS In this study, we carried out a preliminary analysis of existing datasets to test the hypothesis that reduced transactivation capacity of PPARγ in the presence of the Ala variant of PPARγ2 may be associated with adverse neurodevelopment in preterm babies. The association between PPAR-γ2 Pro12Ala polymorphism and neurodevelopment at 18-24 months of age was assessed in two groups of European infants, 155 born before 33 weeks' gestation and 180 born later than 36 weeks' gestation using a linear regression model. The Bayley Scales of Infant and Toddler Development-3rd edition was administered to assess neurodevelopment at 18-24 months of age. RESULTS We observed the Ala allele of the Pro12Ala polymorphism in 25% preterm infants and 20% term infants. The Ala allele of PPARγ2 was significantly associated with adverse cognitive (p = .019), language (p = .03), and motor development (p = 0.036) at 18-24 months of age after taking into consideration the duration of ventilation, gender, and index of multiple deprivation scores, but without correction for potential shared ancestry. There was no association between the PPAR-γ2 Pro12Ala polymorphism and neurodevelopment in term infants. CONCLUSIONS These preliminary data suggest that PPARγ signaling in the presence of the Ala variant of PPARγ2 may be associated with adverse neurodevelopment in preterm infants suggesting that further studies are warranted.
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Affiliation(s)
- Suresh Victor
- Department of Perinatal Imaging and HealthCentre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Andrew Chew
- Department of Perinatal Imaging and HealthCentre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Shona Falconer
- Department of Perinatal Imaging and HealthCentre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
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Bedwell C, Blaikie K, Actis Danna V, Sutton C, Laisser R, Tembo Kasengele C, Wakasiaka S, Victor S, Lavender T. Authors' reply re: Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study. BJOG 2021; 128:2057. [PMID: 34312975 DOI: 10.1111/1471-0528.16832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Carol Bedwell
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kieran Blaikie
- School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Chris Sutton
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Rose Laisser
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Health Sciences, Mwanza, Tanzania
| | - Chowa Tembo Kasengele
- Department of Public Health and Research, Ministry of Health Headquarters, Lusaka, Zambia
| | | | - Suresh Victor
- Perinatal Imaging and Health, King's College London, London, UK
| | - Tina Lavender
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Lautarescu A, Hadaya L, Craig MC, Makropoulos A, Batalle D, Nosarti C, Edwards AD, Counsell SJ, Victor S. Exploring the relationship between maternal prenatal stress and brain structure in premature neonates. PLoS One 2021; 16:e0250413. [PMID: 33882071 PMCID: PMC8059832 DOI: 10.1371/journal.pone.0250413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Exposure to maternal stress in utero is associated with a range of adverse outcomes. We previously observed an association between maternal stress and white matter microstructure in a sample of infants born prematurely. In this study, we aimed to investigate the relationship between maternal trait anxiety, stressful life events and brain volumes. METHODS 221 infants (114 males, 107 females) born prematurely (median gestational age = 30.43 weeks [range 23.57-32.86]) underwent magnetic resonance imaging around term-equivalent age (mean = 42.20 weeks, SD = 1.60). Brain volumes were extracted for the following regions of interest: frontal lobe, temporal lobe, amygdala, hippocampus, thalamus and normalized to total brain volume. Multiple linear regressions were conducted to investigate the relationship between maternal anxiety/stress and brain volumes, controlling for gestational age at birth, postmenstrual age at scan, socioeconomic status, sex, days on total parenteral nutrition. Additional exploratory Tensor Based Morphometry analyses were performed to obtain voxel-wise brain volume changes from Jacobian determinant maps. RESULTS AND CONCLUSION In this large prospective study, we did not find evidence of a relationship between maternal prenatal stress or trait anxiety and brain volumes. This was the case for both the main analysis using a region-of-interest approach, and for the exploratory analysis using Jacobian determinant maps. We discuss these results in the context of conflicting evidence from previous studies and highlight the need for further research on premature infants, particularly including term-born controls.
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Affiliation(s)
- Alexandra Lautarescu
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Laila Hadaya
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Michael C. Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- National Female Hormone Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Antonis Makropoulos
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Dafnis Batalle
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Chiara Nosarti
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - A. David Edwards
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Serena J. Counsell
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Suresh Victor
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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Bonthrone AF, Dimitrova R, Chew A, Kelly CJ, Cordero-Grande L, Carney O, Egloff A, Hughes E, Vecchiato K, Simpson J, Hajnal JV, Pushparajah K, Victor S, Nosarti C, Rutherford MA, Edwards AD, O’Muircheartaigh J, Counsell SJ. Individualized brain development and cognitive outcome in infants with congenital heart disease. Brain Commun 2021; 3:fcab046. [PMID: 33860226 PMCID: PMC8032964 DOI: 10.1093/braincomms/fcab046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Infants with congenital heart disease are at risk of neurodevelopmental impairments, the origins of which are currently unclear. This study aimed to characterize the relationship between neonatal brain development, cerebral oxygen delivery and neurodevelopmental outcome in infants with congenital heart disease. A cohort of infants with serious or critical congenital heart disease (N = 66; N = 62 born ≥37 weeks) underwent brain MRI before surgery on a 3T scanner situated on the neonatal unit. T2-weighted images were segmented into brain regions using a neonatal-specific algorithm. We generated normative curves of typical volumetric brain development using a data-driven technique applied to 219 healthy infants from the Developing Human Connectome Project (dHCP). Atypicality indices, representing the degree of positive or negative deviation of a regional volume from the normative mean for a given gestational age, sex and postnatal age, were calculated for each infant with congenital heart disease. Phase contrast angiography was acquired in 53 infants with congenital heart disease and cerebral oxygen delivery was calculated. Cognitive and motor abilities were assessed at 22 months (N = 46) using the Bayley scales of Infant and Toddler Development-Third Edition. We assessed the relationship between atypicality indices, cerebral oxygen delivery and cognitive and motor outcome. Additionally, we examined whether cerebral oxygen delivery was associated with neurodevelopmental outcome through the mediating effect of brain volume. Negative atypicality indices in deep grey matter were associated with both reduced neonatal cerebral oxygen delivery and poorer cognitive abilities at 22 months across the whole sample. In infants with congenital heart disease born ≥37 weeks, negative cortical grey matter and total tissue volume atypicality indices, in addition to deep grey matter structures, were associated with poorer cognition. There was a significant indirect relationship between cerebral oxygen delivery and cognition through the mediating effect of negative deep grey matter atypicality indices across the whole sample. In infants born ≥37 weeks, cortical grey matter and total tissue volume atypicality indices were also mediators of this relationship. In summary, lower cognitive abilities in toddlers with congenital heart disease were associated with smaller grey matter volumes before cardiac surgery. The aetiology of poor cognition may encompass poor cerebral oxygen delivery leading to impaired grey matter growth. Interventions to improve cerebral oxygen delivery may promote early brain growth and improve cognitive outcomes in infants with congenital heart disease.
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Affiliation(s)
- Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, 28040 Madrid, Spain
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children’s Healthcare, London SE1 7EH, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Kuberan Pushparajah
- Paediatric Cardiology Department, Evelina London Children’s Healthcare, London SE1 7EH, UK
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
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10
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Bedwell C, Blaikie K, Actis Danna V, Sutton C, Laisser R, Tembo Kasengele C, Wakasiaka S, Victor S, Lavender T. Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study. BJOG 2021; 128:1206-1214. [PMID: 33319470 PMCID: PMC8248405 DOI: 10.1111/1471-0528.16629] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/10/2023]
Abstract
Objective To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia. Design Mixed‐methods study. Setting Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania. Sample Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities. Methods Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach. Results A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23–2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families. Conclusions The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care. Tweetable abstract Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited. Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.
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Affiliation(s)
- C Bedwell
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Blaikie
- School of Health Sciences, University of Manchester, Manchester, UK
| | - V Actis Danna
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C Sutton
- School of Health Sciences, University of Manchester, Manchester, UK
| | - R Laisser
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Health Sciences, Mwanza, Tanzania
| | - C Tembo Kasengele
- Department of Public Health and Research, Ministry of Health Headquarters, Lusaka, Zambia
| | | | - S Victor
- Perinatal Imaging and Health, King's College London, London, UK
| | - T Lavender
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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11
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Bonthrone AF, Chew A, Kelly CJ, Almedom L, Simpson J, Victor S, Edwards AD, Rutherford MA, Nosarti C, Counsell SJ. Cognitive function in toddlers with congenital heart disease: The impact of a stimulating home environment. Infancy 2021; 26:184-199. [PMID: 33210418 PMCID: PMC7894304 DOI: 10.1111/infa.12376] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
Infants born with congenital heart disease (CHD) are at increased risk of neurodevelopmental difficulties in childhood. The extent to which perioperative factors, cardiac physiology, brain injury severity, socioeconomic status, and home environment influence early neurodevelopment is not clear. Sixty-nine newborns with CHD were recruited from St Thomas' Hospital. Infants underwent presurgical magnetic resonance imaging on a 3-Tesla scanner situated on the neonatal unit. At 22 months, children completed the Bayley Scales of Infant and Toddler Development-3rd edition and parents completed the cognitively stimulating parenting scale to assess cognitive stimulation at home. Level of maternal education and total annual household income were also collected. Hospital records were reviewed to calculate days on the intensive care unit post-surgery, time on bypass during surgery, and days to corrective or definitive palliative surgical intervention. In the final analysis of 56 infants, higher scores on the cognitively stimulating parenting scale were associated with higher cognitive scores at age 22 months, correcting for gestational age at birth, sex, and maternal education. There were no relationships between outcome scores and clinical factors; socioeconomic status; or brain injury severity. Supporting parents to provide a stimulating home environment for children may promote cognitive development in this high-risk population.
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Affiliation(s)
- Alexandra F. Bonthrone
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Andrew Chew
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Christopher J. Kelly
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Leeza Almedom
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - John Simpson
- Paediatric Cardiology DepartmentEvelina London Children’s HealthcareLondonUK
| | - Suresh Victor
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - A. David Edwards
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Mary A. Rutherford
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Chiara Nosarti
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Serena J. Counsell
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
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12
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Zhao T, Aetesam-Ur-Rahman M, Sage A, Lu Y, Victor S, Kurian R, Fielding S, Hoole S, Mallat Z. Rituximab in patients with acute ST-elevation myocardial infarction (RITA-MI). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
Background
In pre-clinical models of acute myocardial infarction (MI), mature B cells selectively mobilise inflammatory monocytes into the heart, leading to increased infarct size and deterioration of myocardial function. Anti-CD20 antibody-mediated depletion of B cells limited infarct size and improved cardiac function. Rituximab is a monoclonal antibody targeted against human B cells and has been used in the treatment of autoimmune diseases and cancers. However, its use in cardiovascular disease is untested and is currently contraindicated.
Purpose
We assessed the safety, feasibility and pharmacodynamic effect of rituximab given acutely to patients with ST-elevation MI (STEMI).
Method
RITA-MI was a prospective, open-label, dose-escalation, single-arm, phase 1/2a clinical trial, which tested rituximab administered as a single intravenous dose in patients with STEMI within 48 hours of symptom onset. Four escalating doses (200, 500, 700 and 1000mg) were used with 6 patients in each group. Follow-up was performed during initial inpatient stay; on days 6 and 14; and at 3 and 6 months. The primary endpoint was safety, whilst secondary endpoints were changes in B cells and their subsets, immune cell subsets, and cardiac and inflammatory biomarkers. [NCT:03072199]
Results
Overall, rituximab was well tolerated across all doses with the most common adverse event being gastrointestinal disturbance. This was due to the concomitant oral secondary prevention medication started after a STEMI. Five severe adverse events were reported, none of which were assessed as being related. Rituximab caused a mean 96.3% (95% CI 93.8–98.8%) depletion of B cell within 30 mins of the infusion starting across all dose groups. At 6 hours a rebound in B cells was seen in the 200, 500 and 700mg doses, likely related to the emigration of B cells from secondary lymphoid tissues. Maximal B cell depletion was seen at day 6, which was lower than baseline for all doses (p<0.001) (figure 1). B cell repopulation at 6months was dose-dependent. In addition, there was modulation of returning B cell subsets characterised by increased transitional B cells (figure 1C). Immunoglobulin (IgG, IgM and IgA) levels were not affected during follow-up. Rituximab also caused an acute and transient decrease in lymphocytes (both CD4+ and CD8+ T cells) and monocytes, whilst transiently increasing neutrophils at the 6-hour timepoint. Cardiac biomarkers showed a decrease in CRP and BNP. Clinical echocardiogram showed an increase in ejection fraction at follow up (mean increase in EF of 7.8% (95% CI 3.11–12.6)).
Conclusion
Rituximab appears safe and feasible when given in acute STEMIs. We have shown for the first time that depletion of B cells within 30mins of starting rituximab which demonstrates the biological plausibility of our treatment paradigm. Additional new insight into the mechanism of action of rituximab was found. This has led directly to the setting up of a phase 2b trial.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union Research Council
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Affiliation(s)
- T.X Zhao
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - M Aetesam-Ur-Rahman
- Royal Papworth Hospital NHS Foundation Trust, Department of Cardiology, Cambridge, United Kingdom
| | - A Sage
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - Y Lu
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - S Victor
- Royal Papworth Hospital NHS Foundation Trust, Department of Cardiology, Cambridge, United Kingdom
| | - R Kurian
- Royal Papworth Hospital NHS Foundation Trust, Department of Cardiology, Cambridge, United Kingdom
| | - S Fielding
- Royal Papworth Hospital NHS Foundation Trust, Department of Cardiology, Cambridge, United Kingdom
| | - S.P Hoole
- Royal Papworth Hospital NHS Foundation Trust, Department of Cardiology, Cambridge, United Kingdom
| | - Z Mallat
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
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13
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Ng IHX, Bonthrone AF, Kelly CJ, Cordero-Grande L, Hughes EJ, Price AN, Hutter J, Victor S, Schuh A, Rueckert D, Hajnal JV, Simpson J, Edwards AD, Rutherford MA, Batalle D, Counsell SJ. Investigating altered brain development in infants with congenital heart disease using tensor-based morphometry. Sci Rep 2020; 10:14909. [PMID: 32913193 PMCID: PMC7483731 DOI: 10.1038/s41598-020-72009-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance (MR) imaging studies have demonstrated reduced global and regional brain volumes in infants with congenital heart disease (CHD). This study aimed to provide a more detailed evaluation of altered structural brain development in newborn infants with CHD compared to healthy controls using tensor-based morphometry (TBM). We compared brain development in 64 infants with CHD to 192 age- and sex-matched healthy controls. T2-weighted MR images obtained prior to surgery were analysed to compare voxel-wise differences in structure across the whole brain between groups. Cerebral oxygen delivery (CDO2) was measured in infants with CHD (n = 49) using phase contrast MR imaging and the relationship between CDO2 and voxel-wise brain structure was assessed using TBM. After correcting for global scaling differences, clusters of significant volume reduction in infants with CHD were demonstrated bilaterally within the basal ganglia, thalami, corpus callosum, occipital, temporal, parietal and frontal lobes, and right hippocampus (p < 0.025 after family-wise error correction). Clusters of significant volume expansion in infants with CHD were identified in cerebrospinal fluid spaces (p < 0.025). After correcting for global brain size, there was no significant association between voxel-wise brain structure and CDO2. This study localizes abnormal brain development in infants with CHD, identifying areas of particular vulnerability.
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Affiliation(s)
- Isabel H X Ng
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Emer J Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
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14
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Kelly CJ, Christiaens D, Batalle D, Makropoulos A, Cordero-Grande L, Steinweg JK, O'Muircheartaigh J, Khan H, Lee G, Victor S, Alexander DC, Zhang H, Simpson J, Hajnal JV, Edwards AD, Rutherford MA, Counsell SJ. Abnormal Microstructural Development of the Cerebral Cortex in Neonates With Congenital Heart Disease Is Associated With Impaired Cerebral Oxygen Delivery. J Am Heart Assoc 2020; 8:e009893. [PMID: 30821171 PMCID: PMC6474935 DOI: 10.1161/jaha.118.009893] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Abnormal macrostructural development of the cerebral cortex has been associated with hypoxia in infants with congenital heart disease ( CHD ). Animal studies have suggested that hypoxia results in cortical dysmaturation at the cellular level. New magnetic resonance imaging techniques offer the potential to investigate the relationship between cerebral oxygen delivery and cortical microstructural development in newborn infants with CHD . Methods and Results We measured cortical macrostructural and microstructural properties in 48 newborn infants with serious or critical CHD and 48 age-matched healthy controls. Cortical volume and gyrification index were calculated from high-resolution structural magnetic resonance imaging. Neurite density and orientation dispersion indices were modeled using high-angular-resolution diffusion magnetic resonance imaging. Cerebral oxygen delivery was estimated in infants with CHD using phase contrast magnetic resonance imaging and preductal pulse oximetry. We used gray matter-based spatial statistics to examine voxel-wise group differences in cortical microstructure. Microstructural development of the cortex was abnormal in 48 infants with CHD , with regions of increased fractional anisotropy and reduced orientation dispersion index compared with 48 healthy controls, correcting for gestational age at birth and scan (family-wise error corrected for multiple comparisons at P<0.05). Regions of reduced cortical orientation dispersion index in infants with CHD were related to impaired cerebral oxygen delivery ( R2=0.637; n=39). Cortical orientation dispersion index was associated with the gyrification index ( R2=0.589; P<0.001; n=48). Conclusions This study suggests that the primary component of cerebral cortex dysmaturation in CHD is impaired dendritic arborization, which may underlie abnormal macrostructural findings reported in this population, and that the degree of impairment is related to reduced cerebral oxygen delivery.
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Affiliation(s)
- Christopher J Kelly
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Daan Christiaens
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Dafnis Batalle
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Antonios Makropoulos
- 2 Biomedical Image Analysis Group Department of Computing Imperial College London London United Kingdom
| | - Lucilio Cordero-Grande
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Johannes K Steinweg
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Jonathan O'Muircheartaigh
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom.,3 Department of Forensic and Neurodevelopmental Sciences King's College London Institute of Psychiatry, Psychology and Neuroscience London United Kingdom.,4 Department of Neuroimaging King's College London Institute of Psychiatry, Psychology and Neuroscience London United Kingdom.,5 MRC Centre for Neurodevelopmental Disorders King's College London London United Kingdom
| | - Hammad Khan
- 6 Neonatal Intensive Care Unit St Thomas' Hospital London United Kingdom
| | - Geraint Lee
- 6 Neonatal Intensive Care Unit St Thomas' Hospital London United Kingdom
| | - Suresh Victor
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Daniel C Alexander
- 7 Department of Computer Science and Centre for Medical Image Computing University College London London United Kingdom
| | - Hui Zhang
- 7 Department of Computer Science and Centre for Medical Image Computing University College London London United Kingdom
| | - John Simpson
- 8 Paediatric Cardiology Department Evelina London Children's Hospital St Thomas' Hospital London United Kingdom
| | - Joseph V Hajnal
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - A David Edwards
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom.,5 MRC Centre for Neurodevelopmental Disorders King's College London London United Kingdom
| | - Mary A Rutherford
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
| | - Serena J Counsell
- 1 Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London St Thomas' Hospital London United Kingdom
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15
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Gale-Grant O, Christiaens D, Cordero-Grande L, Chew A, Falconer S, Makropoulos A, Harper N, Price AN, Hutter J, Hughes E, Victor S, Counsell SJ, Rueckert D, Hajnal JV, Edwards AD, O'Muircheartaigh J, Batalle D. Parental age effects on neonatal white matter development. Neuroimage Clin 2020; 27:102283. [PMID: 32526683 PMCID: PMC7284122 DOI: 10.1016/j.nicl.2020.102283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 12/29/2022]
Abstract
Advanced paternal age is associated with a range of later negative outcomes. It is not known if these negative outcomes are due to genetics or environment. We use neonatal diffusion MRI to demonstrate paternal age effect on white matter. The babies of older fathers had reduced fractional anisotropy in multiple areas. These changes correlated with cognitive outcome at 18 months.
Objective Advanced paternal age is associated with poor offspring developmental outcome. Though an increase in paternal age-related germline mutations may affect offspring white matter development, outcome differences could also be due to psychosocial factors. Here we investigate possible cerebral changes prior to strong environmental influences using brain MRI in a cohort of healthy term-born neonates. Methods We used structural and diffusion MRI images acquired soon after birth from a cohort (n = 275) of healthy term-born neonates. Images were analysed using a customised tract based spatial statistics (TBSS) processing pipeline. Neurodevelopmental assessment using the Bayley-III scales was offered to all participants at age 18 months. For statistical analysis neonates were compared in two groups, representing the upper quartile (paternal age ≥38 years) and lower three quartiles. The same method was used to assess associations with maternal age. Results In infants with older fathers (≥38 years), fractional anisotropy, a marker of white matter organisation, was significantly reduced in three early maturing anatomical locations (the corticospinal tract, the corpus callosum, and the optic radiation). Fractional anisotropy in these locations correlated positively with Bayley-III cognitive composite score at 18 months in the advanced paternal age group. A small but significant reduction in total brain volume was also observed in in the infants of older fathers. No significant associations were found between advanced maternal age and neonatal imaging. Conclusions The epidemiological association between advanced paternal age and offspring outcome is extremely robust. We have for the first time demonstrated a neuroimaging phenotype of advanced paternal age before sustained parental interaction that correlates with later outcome.
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Affiliation(s)
- Oliver Gale-Grant
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Daan Christiaens
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | | | - Nicholas Harper
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - Daniel Rueckert
- Department of Computing, Imperial College London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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Lautarescu A, Pecheva D, Nosarti C, Nihouarn J, Zhang H, Victor S, Craig M, Edwards AD, Counsell SJ. Maternal Prenatal Stress Is Associated With Altered Uncinate Fasciculus Microstructure in Premature Neonates. Biol Psychiatry 2020; 87:559-569. [PMID: 31604519 PMCID: PMC7016501 DOI: 10.1016/j.biopsych.2019.08.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Maternal prenatal stress exposure (PNSE) increases risk for adverse psychiatric and behavioral outcomes in offspring. The biological basis for this elevated risk is poorly understood but may involve alterations to the neurodevelopmental trajectory of white matter tracts within the limbic system, particularly the uncinate fasciculus. Additionally, preterm birth is associated with both impaired white matter development and adverse developmental outcomes. In this study we hypothesized that higher maternal PNSE was associated with altered uncinate fasciculus microstructure in offspring. METHODS In this study, 251 preterm infants (132 male, 119 female) (median gestational age = 30.29 weeks [range, 23.57-32.86 weeks]) underwent brain magnetic resonance imaging including diffusion-weighted imaging around term-equivalent age (median = 42.43 weeks [range, 37.86-45.71 weeks]). Measures of white matter microstructure were calculated for the uncinate fasciculus and the inferior longitudinal fasciculus, a control tract that we hypothesized was not associated with maternal PNSE. Multiple regressions were used to investigate the relationship among maternal trait anxiety scores, stressful life events, and white matter microstructure indices in the neonatal brain. RESULTS Adjusting for gestational age at birth, postmenstrual age at scan, maternal age, socioeconomic status, sex, and number of days on parenteral nutrition, higher stressful life events scores were associated with higher axial diffusivity (β = .177, q = .007), radial diffusivity (β = .133, q = .026), and mean diffusivity (β = .149, q = .012) in the left uncinate fasciculus, and higher axial diffusivity (β = .142, q = .026) in the right uncinate fasciculus. CONCLUSIONS These findings suggest that PNSE is associated with altered development of specific frontolimbic pathways in preterm neonates as early as term-equivalent age.
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Affiliation(s)
- Alexandra Lautarescu
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Diliana Pecheva
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Chiara Nosarti
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Julie Nihouarn
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Suresh Victor
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Michael Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,National Female Hormone Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - A. David Edwards
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Serena J. Counsell
- Department of Perinatal Imaging and Health, Centre for Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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17
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Cooke A, Victor S, Cork M, Lavender T. Topical oils for the prevention or treatment of dry skin in term infants. Hippokratia 2019. [DOI: 10.1002/14651858.cd011100.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alison Cooke
- The University of Manchester; Division of Nursing, Midwifery and Social Work, School of Health Sciences; Room 4.338, Jean McFarlane Building, Oxford Road Manchester UK M13 9PL
| | - Suresh Victor
- Neonatal Medical Unit, 5th Floor, St Mary's Hospital; Maternal and Fetal Health Research Group; Whitworth Park Manchester UK M13 0JH
| | - Michael Cork
- The University of Sheffield; Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease; Beech Hill Road Sheffield UK S10 2RX
| | - Tina Lavender
- The University of Manchester; Division of Nursing Midwifery and Social Work; Oxford Road Manchester UK M13 9PL
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18
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Kelly CJ, Arulkumaran S, Tristão Pereira C, Cordero-Grande L, Hughes EJ, Teixeira RPAG, Steinweg JK, Victor S, Pushparajah K, Hajnal JV, Simpson J, Edwards AD, Rutherford MA, Counsell SJ. Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study. Arch Dis Child 2019; 104:1042-1048. [PMID: 31243012 PMCID: PMC6801127 DOI: 10.1136/archdischild-2018-314822] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/17/2019] [Accepted: 04/26/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury. STUDY DESIGN Prospective observational study. SETTING Single centre UK tertiary neonatal intensive care unit. PATIENTS 70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery. MAIN OUTCOME MEASURES Prevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage. RESULTS Brain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not. CONCLUSIONS Cerebral injury in newborns with CHD prior to surgery is common.
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Affiliation(s)
- Christopher J Kelly
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Catarina Tristão Pereira
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Emer J Hughes
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Johannes K Steinweg
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Suresh Victor
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Kuberan Pushparajah
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK,Paediatric Cardiology Department, Evelina London Children’s Healthcare, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - John Simpson
- Congenital Heart Disease, Evelina London Children’s Hospital, London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
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Ciarrusta J, O'Muircheartaigh J, Dimitrova R, Batalle D, Cordero-Grande L, Price A, Hughes E, Steinweg JK, Kangas J, Perry E, Javed A, Stoencheva V, Akolekar R, Victor S, Hajnal J, Murphy D, Edwards D, Arichi T, McAlonan G. Social Brain Functional Maturation in Newborn Infants With and Without a Family History of Autism Spectrum Disorder. JAMA Netw Open 2019; 2:e191868. [PMID: 30951164 PMCID: PMC6450332 DOI: 10.1001/jamanetworkopen.2019.1868] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE What is inherited or acquired in neurodevelopmental conditions such as autism spectrum disorder (ASD) is not a fixed outcome, but instead is a vulnerability to a spectrum of traits, especially social difficulties. Identifying the biological mechanisms associated with vulnerability requires looking as early in life as possible, before the brain is shaped by postnatal mechanisms and/or the experiences of living with these traits. Animal studies suggest that susceptibility to neurodevelopmental disorders arises when genetic and/or environmental risks for these conditions alter patterns of synchronous brain activity in the perinatal period, but this has never been examined in human neonates. OBJECTIVE To assess whether alternation of functional maturation of social brain circuits is associated with a family history of ASD in newborns. DESIGN, SETTING, AND PARTICIPANTS In this cohort study of 36 neonates with and without a family history of ASD, neonates underwent magnetic resonance imaging at St Thomas Hospital in London, England, using a dedicated neonatal brain imaging system between June 23, 2015, and August 1, 2018. Neonates with a first-degree relative with ASD (R+) and therefore vulnerable to autistic traits and neonates without a family history (R-) were recruited for the study. Synchronous neural activity in brain regions linked to social function was compared. MAIN OUTCOMES AND MEASURES Regions responsible for social function were selected with reference to a published meta-analysis and the level of synchronous activity within each region was used as a measure of local functional connectivity in a regional homogeneity analysis. Group differences, controlling for sex, age at birth, age at scan, and group × age interactions, were examined. RESULTS The final data set consisted of 18 R+ infants (13 male; median [range] postmenstrual age at scan, 42.93 [40.00-44.86] weeks) and 18 R- infants (13 male; median [range] postmenstrual age at scan, 42.50 [39.29-44.58] weeks). Neonates who were R+ had significantly higher levels of synchronous activity in the right posterior fusiform (t = 2.48; P = .04) and left parietal cortices (t = 3.96; P = .04). In addition, there was a significant group × age interaction within the anterior segment of the left insula (t = 3.03; P = .04) and cingulate cortices (right anterior: t = 3.00; P = .03; left anterior: t = 2.81; P = .03; right posterior: t = 2.77; P = .03; left posterior: t = 2.55; P = .03). In R+ infants, levels of synchronous activity decreased over 39 to 45 weeks' postmenstrual age, whereas synchronous activity levels increased in R- infants over the same period. CONCLUSIONS AND RELEVANCE Synchronous activity is required during maturation of functionally connected networks. This study found that in newborn humans, having a first-degree relative with ASD was associated with higher levels of local functional connectivity and dysmaturation of interconnected regions responsible for processing higher-order social information.
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Affiliation(s)
- Judit Ciarrusta
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| | - Ralica Dimitrova
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Anthony Price
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Johannes Klaus Steinweg
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Johanna Kangas
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
| | - Emily Perry
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
| | - Ayesha Javed
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
| | - Vladimira Stoencheva
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| | | | - Suresh Victor
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Joseph Hajnal
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Declan Murphy
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - David Edwards
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Tomoki Arichi
- Centre for the Developing Brain, School Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Grainne McAlonan
- Institute of Psychiatry, Psychology & Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Denmark Hill, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Bastiani M, Andersson JLR, Cordero-Grande L, Murgasova M, Hutter J, Price AN, Makropoulos A, Fitzgibbon SP, Hughes E, Rueckert D, Victor S, Rutherford M, Edwards AD, Smith SM, Tournier JD, Hajnal JV, Jbabdi S, Sotiropoulos SN. Automated processing pipeline for neonatal diffusion MRI in the developing Human Connectome Project. Neuroimage 2018; 185:750-763. [PMID: 29852283 PMCID: PMC6299258 DOI: 10.1016/j.neuroimage.2018.05.064] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/29/2022] Open
Abstract
The developing Human Connectome Project is set to create and make available to the scientific community a 4-dimensional map of functional and structural cerebral connectivity from 20 to 44 weeks post-menstrual age, to allow exploration of the genetic and environmental influences on brain development, and the relation between connectivity and neurocognitive function. A large set of multi-modal MRI data from fetuses and newborn infants is currently being acquired, along with genetic, clinical and developmental information. In this overview, we describe the neonatal diffusion MRI (dMRI) image processing pipeline and the structural connectivity aspect of the project. Neonatal dMRI data poses specific challenges, and standard analysis techniques used for adult data are not directly applicable. We have developed a processing pipeline that deals directly with neonatal-specific issues, such as severe motion and motion-related artefacts, small brain sizes, high brain water content and reduced anisotropy. This pipeline allows automated analysis of in-vivo dMRI data, probes tissue microstructure, reconstructs a number of major white matter tracts, and includes an automated quality control framework that identifies processing issues or inconsistencies. We here describe the pipeline and present an exemplar analysis of data from 140 infants imaged at 38–44 weeks post-menstrual age. A comprehensive and automated pipeline to consistently analyse neonatal dMRI data. Optimised motion and distortions correction to address newborn specific challenges. The automated QC framework allows to detect issues and to quantify data quality. Automated white matter segmentation allows to extract tract-specific masks. Preliminary data analysis of 140 infants imaged at 38–44 weeks post-menstrual age.
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Affiliation(s)
- Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, UK.
| | - Jesper L R Andersson
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, UK
| | | | | | - Jana Hutter
- Centre for the Developing Brain, King's College London, UK
| | | | | | - Sean P Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, UK
| | - Emer Hughes
- Centre for the Developing Brain, King's College London, UK
| | | | - Suresh Victor
- Centre for the Developing Brain, King's College London, UK
| | | | | | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, UK
| | | | | | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, UK
| | - Stamatios N Sotiropoulos
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, UK; Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, UK
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21
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Garner SL, Killingsworth E, Bradshaw M, Raj L, Johnson SR, Abijah SP, Parimala S, Victor S. The impact of simulation education on self-efficacy towards teaching for nurse educators. Int Nurs Rev 2018; 65:586-595. [PMID: 29571221 DOI: 10.1111/inr.12455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/29/2022]
Abstract
AIM The objective of this study was to assess the impact of a simulation workshop on self-efficacy towards teaching for nurse educators in India. Additionally, we sought to revise and validate a tool to measure self-efficacy in teaching for use with a global audience. BACKGROUND Simulation is an evidence-based teaching and learning method and is increasingly used in nursing education globally. INTRODUCTION As new technology and teaching methods such as simulation continue to evolve, it is important for new as well as experienced nurse educators globally to have confidence in their teaching skills and abilities. METHODS The study included (1) instrument revision, and measures of reliability and validation, (2) an 8-h faculty development workshop intervention on simulation, (3) pre- and post-survey of self-efficacy among nurse educators, and (4) investigation of relationship between faculty socio-demographics and degree of self-efficacy. RESULTS The modified tool showed internal consistency (r = 0.98) and was validated by international faculty experts. There were significant improvements in total self-efficacy (P < 0.001) and subscale scores among nurse educators after the simulation workshop intervention when compared to pre-survey results. No significant relationships were found between socio-demographic variables and degree of self-efficacy. DISCUSSION Strong self-efficacy in teaching among nurse educators is crucial for effective learning to occur. CONCLUSIONS AND IMPLICATIONS FOR NURSING Results indicated the simulation workshop was effective in significantly improving self-efficacy towards teaching for nurse educators using an internationally validated tool. IMPLICATIONS FOR NURSING POLICY The Minister of Health in India recently called for improvements in nursing education. Introducing nursing education on simulation as a teaching method in India and globally to improve self-efficacy among teachers is an example of a strategy towards meeting this call.
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Affiliation(s)
- S L Garner
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - E Killingsworth
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - M Bradshaw
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - L Raj
- Nursing Institute, Bangalore Baptist Hospital, Bangalore, Karnataka, India
| | - S R Johnson
- Nursing Institute, Bangalore Baptist Hospital, Bangalore, Karnataka, India
| | - S P Abijah
- Nursing Institute, Bangalore Baptist Hospital, Bangalore, Karnataka, India
| | - S Parimala
- Nursing Institute, Bangalore Baptist Hospital, Bangalore, Karnataka, India
| | - S Victor
- Nursing Institute, Bangalore Baptist Hospital, Bangalore, Karnataka, India
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22
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Makropoulos A, Robinson EC, Schuh A, Wright R, Fitzgibbon S, Bozek J, Counsell SJ, Steinweg J, Vecchiato K, Passerat-Palmbach J, Lenz G, Mortari F, Tenev T, Duff EP, Bastiani M, Cordero-Grande L, Hughes E, Tusor N, Tournier JD, Hutter J, Price AN, Teixeira RPAG, Murgasova M, Victor S, Kelly C, Rutherford MA, Smith SM, Edwards AD, Hajnal JV, Jenkinson M, Rueckert D. The developing human connectome project: A minimal processing pipeline for neonatal cortical surface reconstruction. Neuroimage 2018. [PMID: 29409960 DOI: 10.1101/125526] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 02/06/2023] Open
Abstract
The Developing Human Connectome Project (dHCP) seeks to create the first 4-dimensional connectome of early life. Understanding this connectome in detail may provide insights into normal as well as abnormal patterns of brain development. Following established best practices adopted by the WU-MINN Human Connectome Project (HCP), and pioneered by FreeSurfer, the project utilises cortical surface-based processing pipelines. In this paper, we propose a fully automated processing pipeline for the structural Magnetic Resonance Imaging (MRI) of the developing neonatal brain. This proposed pipeline consists of a refined framework for cortical and sub-cortical volume segmentation, cortical surface extraction, and cortical surface inflation, which has been specifically designed to address considerable differences between adult and neonatal brains, as imaged using MRI. Using the proposed pipeline our results demonstrate that images collected from 465 subjects ranging from 28 to 45 weeks post-menstrual age (PMA) can be processed fully automatically; generating cortical surface models that are topologically correct, and correspond well with manual evaluations of tissue boundaries in 85% of cases. Results improve on state-of-the-art neonatal tissue segmentation models and significant errors were found in only 2% of cases, where these corresponded to subjects with high motion. Downstream, these surfaces will enhance comparisons of functional and diffusion MRI datasets, supporting the modelling of emerging patterns of brain connectivity.
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Affiliation(s)
- Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Emma C Robinson
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Robert Wright
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Johannes Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Passerat-Palmbach
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Gregor Lenz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Filippo Mortari
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Tencho Tenev
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nora Tusor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Murgasova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
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Makropoulos A, Robinson EC, Schuh A, Wright R, Fitzgibbon S, Bozek J, Counsell SJ, Steinweg J, Vecchiato K, Passerat-Palmbach J, Lenz G, Mortari F, Tenev T, Duff EP, Bastiani M, Cordero-Grande L, Hughes E, Tusor N, Tournier JD, Hutter J, Price AN, Teixeira RPAG, Murgasova M, Victor S, Kelly C, Rutherford MA, Smith SM, Edwards AD, Hajnal JV, Jenkinson M, Rueckert D. The developing human connectome project: A minimal processing pipeline for neonatal cortical surface reconstruction. Neuroimage 2018; 173:88-112. [PMID: 29409960 DOI: 10.1016/j.neuroimage.2018.01.054] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 12/11/2022] Open
Abstract
The Developing Human Connectome Project (dHCP) seeks to create the first 4-dimensional connectome of early life. Understanding this connectome in detail may provide insights into normal as well as abnormal patterns of brain development. Following established best practices adopted by the WU-MINN Human Connectome Project (HCP), and pioneered by FreeSurfer, the project utilises cortical surface-based processing pipelines. In this paper, we propose a fully automated processing pipeline for the structural Magnetic Resonance Imaging (MRI) of the developing neonatal brain. This proposed pipeline consists of a refined framework for cortical and sub-cortical volume segmentation, cortical surface extraction, and cortical surface inflation, which has been specifically designed to address considerable differences between adult and neonatal brains, as imaged using MRI. Using the proposed pipeline our results demonstrate that images collected from 465 subjects ranging from 28 to 45 weeks post-menstrual age (PMA) can be processed fully automatically; generating cortical surface models that are topologically correct, and correspond well with manual evaluations of tissue boundaries in 85% of cases. Results improve on state-of-the-art neonatal tissue segmentation models and significant errors were found in only 2% of cases, where these corresponded to subjects with high motion. Downstream, these surfaces will enhance comparisons of functional and diffusion MRI datasets, supporting the modelling of emerging patterns of brain connectivity.
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Affiliation(s)
- Antonios Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Emma C Robinson
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Andreas Schuh
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Robert Wright
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Bozek
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Johannes Steinweg
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Passerat-Palmbach
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Gregor Lenz
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Filippo Mortari
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Tencho Tenev
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matteo Bastiani
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nora Tusor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jacques-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rui Pedro A G Teixeira
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Murgasova
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, United Kingdom
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25
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Victor S, Nayak VM. Erratum to: The evolution and genesis of supraventricular waltz & duet. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-002-0023-7] [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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Reynaud N, Mourthadoi F, Hocine H, Victor S, Piqueres S, Talji N, Cimier A, Mottet N. Surrénalectomie droite pour phéochromocytome. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.258] [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: 10/18/2022]
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Muniraman H, Gardner D, Skinner J, Paweletz A, Vayalakkad A, Chee YH, Clifford C, Sanka S, Venkatesh V, Curley A, Victor S, Turner MA, Clarke P. Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia. Eur J Pediatr 2017; 176:1295-1303. [PMID: 28741035 DOI: 10.1007/s00431-017-2956-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 04/05/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Therapeutic hypothermia (TH) is now provided as standard care to infants with moderate-severe hypoxic ischemic encephalopathy (HIE). The role of TH in limiting neuronal injury is well recognized, but its effect on hepatic injury which occurs frequently in neonatal HIE is not known. Our objective was to characterize biomarkers of liver injury and function in the setting of neonatal HIE and to describe whether HIE severity and provision of TH influence these hepatic biomarkers. We performed a multicenter retrospective study and compared hepatic biomarkers obtained during the first postnatal week, according to the severity of HIE and whether treated with TH. Of a total of 361 infants with HIE, 223 (62%) received TH and 138 (38%) were managed at normal temperature. Most hepatic biomarkers and C-reactive protein (CRP) were significantly associated with the severity of HIE (p < 0.001). Infants treated with TH had lower peak alanine aminotransferase (ALT) concentrations (p = 0.025) and a delay in reaching peak CRP concentration (p < 0.001). CONCLUSION We observed a significant association between the clinical grade of HIE and biomarkers of liver metabolism and function. Therapeutic hypothermia was associated with delayed CRP responses and with lower ALT concentrations and so may have the potential to modulate hepatic injury. What is Known: • Ischemic hepatic injury occurs frequently as a part of multiorgan dysfunction in infants with hypoxic ischemic encephalopathy (HIE). • The neuroprotective role of therapeutic hypothermia in management of infants with HIE is well recognized, but the potential hepato-protective effects of hypothermia are unclear. What is New/What this study adds: • Therapeutic hypothermia was associated with lower alanine aminotransferase and albumin concentrations and a delayed C-reactive protein (CRP) response and so may have the potential to modulate hepatic injury. • An elevated CRP concentration during the first postnatal week may be regarded as an expected finding in moderate and severe HIE and, in the overwhelming majority of cases, occurs secondary to hepatic hypoxia-ischemia in the absence of blood culture-positive sepsis.
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Affiliation(s)
- Hemananda Muniraman
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Division of Neonatology, Department of Pediatrics, Keck School of Medicine, Los Angeles County Medical Center, University of Southern California, Los Angeles, USA
| | - Danielle Gardner
- Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Jane Skinner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Anna Paweletz
- Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Anitha Vayalakkad
- Neonatal Unit, Central Manchester NHS Foundation Trust (St Mary's Hospital), Manchester, UK
| | - Ying Hui Chee
- Neonatal Unit, Cambridge University NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Clare Clifford
- Neonatal Unit, Central Manchester NHS Foundation Trust (St Mary's Hospital), Manchester, UK
| | - Sunil Sanka
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Vidheya Venkatesh
- Neonatal Unit, Cambridge University NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Anna Curley
- Neonatal Unit, Cambridge University NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK.,Neonatal Unit, National Maternity Hospital, Dublin, Ireland
| | - Suresh Victor
- Neonatal Unit, Central Manchester NHS Foundation Trust (St Mary's Hospital), Manchester, UK.,Centre for Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Mark A Turner
- Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. .,Norwich Medical School, University of East Anglia, Norwich, UK.
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Muniraman H, Gardner D, Skinner J, Paweletz A, Vayalakkad A, Chee YH, Clifford C, Sanka S, Venkatesh V, Curley A, Victor S, Turner MA, Clarke P. Erratum to: Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia. Eur J Pediatr 2017; 176:1305-1306. [PMID: 28785794 DOI: 10.1007/s00431-017-2980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hemananda Muniraman
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, Los Angeles County Medical Center, University of Southern California, Los Angeles, USA
| | - Danielle Gardner
- Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Jane Skinner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Anna Paweletz
- Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Anitha Vayalakkad
- Neonatal Unit, Central Manchester NHS Foundation Trust (St Mary's Hospital), Manchester, UK
| | - Ying Hui Chee
- Neonatal Unit, Cambridge University NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Clare Clifford
- Neonatal Unit, Central Manchester NHS Foundation Trust (St Mary's Hospital), Manchester, UK
| | - Sunil Sanka
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Vidheya Venkatesh
- Neonatal Unit, Cambridge University NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Anna Curley
- Neonatal Unit, Cambridge University NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
- Neonatal Unit, National Maternity Hospital, Dublin, Ireland
| | - Suresh Victor
- Neonatal Unit, Central Manchester NHS Foundation Trust (St Mary's Hospital), Manchester, UK
- Centre for Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Mark A Turner
- Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
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Victor S, Roberts SA, Mitchell S, Aziz H, Lavender T. Biphasic Positive Airway Pressure or Continuous Positive Airway Pressure: A Randomized Trial. Pediatrics 2016; 138:peds.2015-4095. [PMID: 27371758 DOI: 10.1542/peds.2015-4095] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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] [Accepted: 05/11/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is currently no clear evidence that nasal-biphasic positive airway pressure (n-BiPAP) confers any advantage over nasal-continuous positive airway pressure (n-CPAP). Our hypothesis was that preterm infants born before 30 weeks' gestation and <2 weeks old when extubated onto n-BiPAP will have a lower risk of extubation failure than infants extubated onto n-CPAP at equivalent mean airway pressure. METHODS We conducted an unblinded multicenter randomized trial comparing n-CPAP with n-BiPAP in infants born <30 weeks' gestation and <2 weeks old. The primary outcome variable was the rate of extubation failure within 48 hours after the first attempt at extubation. Block randomization stratified by center and gestation (<28 weeks or ≥28 weeks) was performed. RESULTS A total of 540 infants (270 in each group) were eligible to be included in the statistical analysis; 57 (21%) of n-BiPAP group and 55 (20%) of n-CPAP group failed extubation at 48 hours postextubation (adjusted odds ratio 1.01; 95% confidence interval 0.65-1.56; P = .97). Subgroup analysis of infants born before and after 28 weeks' gestation showed no significant differences between the 2 groups. There were no significant differences between arms in death; oxygen requirement at 28 days; oxygen requirement at 36 weeks' corrected gestation; or intraventricular hemorrhage, necrotizing enterocolitis requiring surgery, or pneumothorax. CONCLUSIONS This trial shows that there is no added benefit to using n-BIPAP over n-CPAP at equivalent mean airway pressure in preventing extubation failures in infants born before 30 weeks' gestation and <2 weeks old.
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Affiliation(s)
- Suresh Victor
- Newborn ICU, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, School of Biomedicine, Neonatology Center of Excellence, Sidra Medical and Research Center, Doha, Qatar; and
| | | | - Simon Mitchell
- Newborn ICU, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, School of Biomedicine, College of Health and Social Care, University of Salford, Manchester, United Kingdom
| | - Huma Aziz
- Newborn ICU, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, School of Biomedicine
| | - Tina Lavender
- School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom
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Chittock J, Cooke A, Lavender T, Brown K, Wigley A, Victor S, Cork MJ, Danby SG. Development of stratum corneum chymotrypsin-like protease activity and natural moisturizing factors from birth to 4 weeks of age compared with adults. Br J Dermatol 2016; 175:713-20. [PMID: 26994359 DOI: 10.1111/bjd.14568] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND From birth, the functional properties of the neonatal epidermal barrier mature whereby the stratum corneum (SC) hydrates and the skin surface acidifies. The identification of a thinner infant SC compared with adults suggests underdeveloped mechanisms underlying differentiation and desquamation. OBJECTIVES To assess the functional properties of the neonatal SC from birth, in conjunction with the quantification of superficial chymotrypsin-like protease activity [kallikrein-7 (KLK-7)] and filaggrin-derived natural moisturizing factors (NMF). METHODS A total of 115 neonates recruited to the Oil in Baby SkincaRE (OBSeRvE) randomized controlled trial underwent a full evaluation of the SC at birth (< 72 h old) and at 4 weeks of age (n = 39, no oil control group) using minimally invasive instrumentation and methodology. A cohort of 20 unrelated adults was recruited for comparison. RESULTS At birth NMF levels correlated with SC hydration (r = 0·50) and skin-surface pH (r = -0·54). From birth to 4 weeks, transepidermal water loss (TEWL), superficial KLK-7 activity and filaggrin-derived NMF significantly elevated. Impaired epidermal barrier function at birth (> 75th percentile TEWL) was accompanied by significantly elevated chymotrypsin-like protease activity and reduced levels of NMF. CONCLUSIONS The biophysical, biological and functional properties of the developing neonatal SC are transitional from birth to 4 weeks of age and differ significantly from adults. The presence of impaired barrier function with elevated protease activity and reduced NMF at birth suggests why certain infants are predisposed to epidermal barrier breakdown and the development of atopic dermatitis.
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Affiliation(s)
- J Chittock
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K..
| | - A Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, U.K
| | - T Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, U.K
| | - K Brown
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
| | - A Wigley
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
| | - S Victor
- Institute of Human Development, The University of Manchester, Manchester, U.K.,Sidra Neonatology Center of Excellence, Sidra Medical and Research Center, Doha, Qatar
| | - M J Cork
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K.,The Pediatric Dermatology Clinic, Sheffield Children's Hospital, Sheffield, U.K
| | - S G Danby
- The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K
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Cooke A, Cork MJ, Victor S, Campbell M, Danby S, Chittock J, Lavender T. Olive Oil, Sunflower Oil or no Oil for Baby Dry Skin or Massage: A Pilot, Assessor-blinded, Randomized Controlled Trial (the Oil in Baby SkincaRE [OBSeRvE] Study). Acta Derm Venereol 2016; 96:323-30. [PMID: 26551528 DOI: 10.2340/00015555-2279] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Topical oils on baby skin may contribute to development of childhood atopic eczema. A pilot, assessor-blinded, randomized controlled trial assessed feasibility of a definitive trial investigating their impact in neonates. One-hundred and fifteen healthy, full-term neonates were randomly assigned to olive oil, sunflower oil or no oil, twice daily for 4 weeks, stratified by family history of atopic eczema. We measured spectral profile of lipid lamellae, trans-epidermal water loss (TEWL), stratum corneum hydration and pH and recorded clinical observations, at baseline, and 4 weeks post-birth. Recruitment was challenging (recruitment 11.1%; retention 80%), protocol adherence reasonable (79-100%). Both oil groups had significantly improved hydration but significantly less improvement in lipid lamellae structure compared to the no oil group. There were no significant differences in TEWL, pH or erythema/skin scores. The study was not powered for clinical significance, but until further research is conducted, caution should be exercised when recommending oils for neonatal skin.
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Affiliation(s)
- Alison Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, M13 9PL Manchester, United Kingdom.
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Clarke P, Muniraman H, Gardner D, Venkatesh V, Curley A, Victor S, Turner MA. Investigation of Neonatal Encephalopathy: The Oft-Lost Placental "Black Box". Pediatr Dev Pathol 2015; 18:343-4. [PMID: 25826245 DOI: 10.2350/15-02-1611-let.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Hemananda Muniraman
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Danielle Gardner
- Neonatal Intensive Care Unit, Liverpool Women's Hospital, Liverpool, UK
| | | | - Anna Curley
- Neonatal Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Suresh Victor
- Neonatal Intensive Care Unit, Central Manchester University Hospital Foundation Trust, Manchester, UK.,Neonatology Center of Excellence, Sidra Medical and Research Center, Doha, Qatar
| | - Mark A Turner
- Neonatal Intensive Care Unit, Liverpool Women's Hospital, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
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Wilcock A, Begley P, Stevens A, Whatmore A, Victor S. The metabolomics of necrotising enterocolitis in preterm babies: an exploratory study. J Matern Fetal Neonatal Med 2015; 29:758-62. [PMID: 25786474 DOI: 10.3109/14767058.2015.1017462] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/24/2022]
Abstract
OBJECTIVE No single diagnostic investigation is currently available for necrotising enterocolitis (NEC). We implemented a novel, untargeted, exploratory study to determine whether metabolomics can reveal early biomarker(s) of NEC. The effect of gestational age on the metabolome was also investigated. METHODS Two serum samples were obtained from 12 preterm babies (born <30 weeks gestation) and eight term controls: sample "A" at ≤1 week of age and sample "B" once fully fed. Samples were subjected to gas chromatography-mass spectrometry. Metabolomic data was analysed by principal component analysis (PCA), univariate and network analysis. RESULTS Sixteen metabolite features significantly differed when B samples were compared between preterm babies who subsequently developed NEC and preterm/term controls (p value <0.05). Of these seven metabolites were linked to up-regulation of IL-1β. Significant differences in 54 metabolite features (p value <0.05) were observed between preterm and term metabolomes. Of these, 12 metabolite features were linked to one network involved in carbohydrate/lipid metabolism (p = 1 × 10(-30)). CONCLUSIONS Metabolomic differences were observed in preterm babies at risk of NEC. However, sample sizes were insufficient to confidently identify a biomarker. Network modelling of preterm and term metabolomes suggest possible nutritional deficiency and altered pro-insulin action in preterm babies.
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Affiliation(s)
- Amy Wilcock
- a Faculty of Medical and Human Sciences , University of Manchester , Manchester , UK
| | - Paul Begley
- b Faculty of Medical and Human Sciences , Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester , Manchester , UK .,c Centre for Advanced Discovery and Experimental Therapeutics (CADET), Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre , Manchester , UK
| | - Adam Stevens
- d Faculty of Medical and Human Sciences , Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester , Manchester , UK .,e Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK , and
| | - Andrew Whatmore
- d Faculty of Medical and Human Sciences , Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester , Manchester , UK .,e Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK , and
| | - Suresh Victor
- d Faculty of Medical and Human Sciences , Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester , Manchester , UK .,e Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK , and.,f Neonatology Center of Excellence, Sidra Medical and Research Center , Doha , Qatar
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Sutton R, Will A, Kuruvilla M, Victor S. Thrombotic, thrombocytopenic purpura (ADAMTS-13 deficiency): a rare neonatal presentation. Case Reports in Perinatal Medicine 2015. [DOI: 10.1515/crpm-2014-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Congenital ADAMTS-13 deficiency is rare, with only between 150 and 200 living cases described internationally. It can present in the neonatal period with thrombocytopenia that may be associated with thrombosis rather than haemorrhage, microangiopathic haemolytic anaemia (MAHA) and jaundice requiring exchange transfusion. We report a case of a large cerebral infarction resulting from severe ADAMTS-13 deficiency in the immediate neonatal period. The diagnosis of ADAMTS-13 deficiency should be considered in babies with haemolytic anaemia, jaundice, thrombocytopenia and a negative direct antiglobulin (Coombs) test (DAT). It is important to diagnose and treat early in order to prevent further brain and kidney damage.
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Affiliation(s)
- Rachael Sutton
- Newborn Intensive Care Centre, St Mary’s Hospital for Women and Children, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Andrew Will
- Department of Haematology, Royal Manchester Children’s Hospital, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Minju Kuruvilla
- Newborn Intensive Care Centre, St Mary’s Hospital for Women and Children, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Suresh Victor
- Newborn Intensive Care Centre, St Mary’s Hospital for Women and Children, Manchester Academic Health Sciences Centre, Manchester, UK
- Institute of Human Development, University of Manchester, Manchester, UK
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Abstract
The original authors of this review are unable to update it. The Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS) is seeking new authors to update and split the review into two separate reviews on young children (< 12 years) and adolescents (12‐17 years). If you are interested, please contact the Managing Editor of PaPaS (contact details provided under 'Contact Person'). At July 2014, this review has been withdrawn. This review is out of date although it is correct as of the date of publication. The latest version is available in the ‘Other versions’ tab on The Cochrane Library, and may still be useful to readers. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Suresh Victor
- Maternal and Fetal Health Research Group, Neonatal Medical Unit, 5th Floor, St Mary's Hospital, Whitworth Park, Manchester, UK, M13 0JH
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Naureen I, Waheed KAI, Rathore AW, Victor S, Mallucci C, Goodden JR, Chohan SN, Miyan JA. Fingerprint changes in CSF composition associated with different aetiologies in human neonatal hydrocephalus: inflammatory cytokines. Childs Nerv Syst 2014; 30:1155-64. [PMID: 24733414 DOI: 10.1007/s00381-014-2415-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/27/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Hydrocephalus (HC) has a multifactorial and complex picture of pathophysiology due to aetiology, age at and duration since onset. We have previously identified distinctions in markers of cell death associated with different aetiologies. Here, we examined cerebrospinal fluid (CSF) from human HC neonates for cytokines to identify further distinguishing features of different aetiologies. METHODS CSF was collected during routine lumbar puncture or ventricular tap from neonates with hydrocephalus, or with no neurological condition (normal controls). Total protein, Fas receptor, Fas ligand, stem cell factor (SCF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), insulin growth factor-1 (IGF-1), tumour necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) were measured and compared between 8 unaffected and 28 HC neonatal CSF samples. RESULTS Total protein was significantly (P < 0.05) raised in late-onset hydrocephalus (LOH). Fas receptor was raised (P < 0.05) in post-haemorrhagic hydrocephalus (PHH) and spina bifida with hydrocephalus (SB/HC), but no difference in Fas ligand was found. SCF was raised (P < 0.05) in SB/HC. HGF was found in all HC and was increased (P < 0.01) in PHH. Increased VEGF was found in PHH (P < 0.01) and SB/HC (P < 0.05). Variable levels of IL-6, TNF-α and IGF-1 were found in all HC groups compared with none in normal. CONCLUSIONS LOH was unusual with significantly raised total protein indicating an inflammatory state. Increased Fas receptor, VEGF, IGF-1 and HGF suggest anti-apoptotic and repair mechanism activation. By contrast, elevated TNF-α and IL-6 indicate inflammatory processes in these neonatal brains. Taken with our previous study, these data indicate that different pathophysiology, inflammation and repair are occurring in HC of different aetiologies and that additional treatment strategies may benefit these infants in addition to fluid diversion.
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Affiliation(s)
- Irum Naureen
- Faculty of Life Sciences, The University of Manchester, AV Hill Building, Oxford Road, Manchester, M13 9PT, UK
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Affiliation(s)
- Alison Cooke
- The University of Manchester; School of Nursing, Midwifery & Social Work; Room 4.338, Jean McFarlane Building, Oxford Road Manchester UK M13 9PL
| | - Suresh Victor
- Neonatal Medical Unit, 5th Floor, St Mary's Hospital; Maternal and Fetal Health Research Group; Whitworth Park Manchester UK M13 0JH
| | - Michael Cork
- The University of Sheffield; Academic Unit of Dermatology Research, Department of Infection and Immunity; Beech Hill Road Sheffield UK S10 2RX
| | - Tina Lavender
- The University of Manchester; School of Nursing, Midwifery and Social Work; Oxford Road Manchester UK M13 9PL
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Stevens A, Bonshek C, Whatmore A, Butcher I, Hanson D, De Leonibus C, Shaikh G, Brown M, O'Shea E, Victor S, Powell P, Settle P, Padmakumar B, Tan A, Odeka E, Cooper C, Birch J, Shenoy A, Westwood M, Patel L, Dunn BW, Clayton P. Insights into the pathophysiology of catch-up compared with non-catch-up growth in children born small for gestational age: an integrated analysis of metabolic and transcriptomic data. Pharmacogenomics J 2014; 14:376-84. [PMID: 24614687 DOI: 10.1038/tpj.2014.4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/07/2013] [Accepted: 01/09/2014] [Indexed: 12/11/2022]
Abstract
Small for gestational age (SGA) children exhibiting catch-up (CU) growth have a greater risk of cardiometabolic diseases in later life compared with non-catch-up (NCU) SGA children. The aim of this study was to establish differences in metabolism and gene expression profiles between CU and NCU at age 4-9 years. CU children (n=22) had greater height, weight and body mass index standard deviation scores along with insulin-like growth factor-I (IGF-I) and fasting glucose levels but lower adiponectin values than NCU children (n=11; all P<0.05). Metabolic profiling demonstrated a fourfold decrease of urine myo-inositol in CU compared with NCU (P<0.05). There were 1558 genes differentially expressed in peripheral blood mononuclear cells between the groups (P<0.05). Integrated analysis of data identified myo-inositol related to gene clusters associated with an increase in insulin, growth factor and IGF-I signalling in CU children (P<0.05). Metabolic and transcriptomic profiles in CU SGA children showed changes that may relate to cardiometabolic risk.
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Affiliation(s)
- A Stevens
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - C Bonshek
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - A Whatmore
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - I Butcher
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - D Hanson
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - C De Leonibus
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - G Shaikh
- Yorkhill Children's Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - M Brown
- 1] Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester, UK [2] Centre for Advanced Discovery and Experimental Therapeutics (CADET), Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - E O'Shea
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - S Victor
- St Mary's Hospital, CMFT, Manchester, UK
| | - P Powell
- Royal Bolton Hospital, Royal Bolton Hospital NHS Foundation Trust, Manchester, UK
| | - P Settle
- Hope Hospital, Salford Royal NHS Foundation Trust, Salford, UK
| | - B Padmakumar
- North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Crumpsall, UK
| | - A Tan
- North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Crumpsall, UK
| | - E Odeka
- North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Crumpsall, UK
| | - C Cooper
- Stepping Hill Hospital, Stockport NHS Foundation Trust, Manchester, UK
| | - J Birch
- Tameside General Hospital, Tameside Hospital NHS Foundation Trust, Manchester, UK
| | - A Shenoy
- Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - M Westwood
- Maternal and Fetal Health Research Centre, University of Manchester and St Mary's Hospital, CMFT, MAHSC, Manchester, UK
| | - L Patel
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - B W Dunn
- 1] Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester, UK [2] Centre for Advanced Discovery and Experimental Therapeutics (CADET), Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - P Clayton
- 1] Royal Manchester Children's Hospital (RMCH), Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester Academic Health Science Centre (MAHSC), Manchester, UK [2] Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
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Naureen I, Waheed KAI, Rathore AW, Victor S, Mallucci C, Goodden JR, Chohan SN, Miyan JA. Fingerprint changes in CSF composition associated with different aetiologies in human neonatal hydrocephalus: glial proteins associated with cell damage and loss. Fluids Barriers CNS 2013; 10:34. [PMID: 24351234 PMCID: PMC3878340 DOI: 10.1186/2045-8118-10-34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/14/2013] [Indexed: 01/20/2023] Open
Abstract
Background In hydrocephalus an imbalance between production and absorption of cerebrospinal fluid (CSF) results in fluid accumulation, compression and stretching of the brain parenchyma. In addition, changes in CSF composition have a profound influence on the development and function of the brain and together, these can result in severe life-long neurological deficits. Brain damage or degenerative conditions can result in release of proteins expressed predominantly in neurons, astroglia, or oligodendroglia into the brain interstitial fluid, CSF and blood. Determination of such products in the CSF might be of value in diagnosing cause, aetiology and/or assessing the severity of the neurological damage in patients with hydrocephalus. We therefore analysed CSF from human neonates with hydrocephalus for these proteins to provide an insight into the pathophysiology associated with different aetiologies. Methods CSF was collected during routine lumbar puncture or ventricular tap. Samples were categorized according to age of onset of hydrocephalus and presumed cause (fetal-onset, late-onset, post-haemorrhagic or spina bifida with hydrocephalus). Glial fibrillary acidic protein (GFAP), myelin basic protein (MBP), vimentin and 2′ , 3′-cyclic nucleotide 3′-phosphodiesterase (CNPase) were analysed through Western blotting of hydrocephalic CSF samples (n = 17) and compared with data from CSF of normal infants without neurological deficits (n = 8). Results GFAP was significantly raised only in CSF from post-haemorrhagic hydrocephalus while MBP was significantly raised in post-haemorrhagic and in spina bifida with hydrocephalus infants. Vimentin protein was only detected in some CSF samples from infants with late-onset hydrocephalus but not from other conditions. Surprisingly, CNPase was found in all neonatal CSF samples, including normal and hydrocephalic groups, although it was reduced in infants with late onset hydrocephalus compared with normal and other hydrocephalic groups. Conclusions Apart from CNPase, which is an enzyme, the markers investigated are intracellular intermediate filaments and would be present in CSF only if the cells are compromised and the proteins released. Raised GFAP observed in post-haemorrhagic hydrocephalus must reflect damage to astrocytes and ependyma. Raised MBP in post-haemorrhagic and spina bifida with hydrocephalus indicates damage to oligodendrocytes and myelin. Vimentin protein detected in some of the late-onset hydrocephalic samples indicates damage to glial and other progenitors and suggests this condition affects periventricular regions. The presence of CNPase in all CSF samples was unexpected and indicates a possible novel role for this enzyme in brain development/myelination. Less CNPase in some cases of late-onset hydrocephalus could therefore indicate changes in myelination in these infants. This study demonstrates differential glial damage and loss in the developing human neonatal hydrocephalic brain associated with different aetiologies.
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Affiliation(s)
| | | | | | | | | | | | | | - Jaleel A Miyan
- Faculty of Life Sciences, The University of Manchester, AV Hill Building, Oxford Road, Manchester M13 9PT, UK.
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Ng SM, Turner MA, Gamble C, Didi M, Victor S, Manning D, Settle P, Gupta R, Newland P, Weindling AM. An explanatory randomised placebo controlled trial of levothyroxine supplementation for babies born <28 weeks' gestation: results of the TIPIT trial. Trials 2013; 14:211. [PMID: 23841945 PMCID: PMC3711854 DOI: 10.1186/1745-6215-14-211] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 07/02/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Babies born before 28 weeks' gestation have lower plasma thyroid hormone concentrations than more mature infants. This may contribute to their risk of poor developmental outcome. Previous studies have suggested that thyroxine supplementation for extremely preterm neonates may be beneficial. The aim of this study was to investigate the effect of administration of supplemental thyroxine to very premature babies on brain size and somatic growth at 36 weeks' corrected gestational age (CGA). METHODS In this explanatory multicentre double blind randomised placebo controlled trial, 153 infants born below 28 weeks' gestation were randomised to levothyroxine (LT4) supplementation or placebo until 32 weeks' CGA. The primary outcome was brain size assessed by the width of the subarachnoid space measured by cranial ultrasound at 36 weeks' CGA. Lower leg length was measured by knemometry. RESULTS Babies in the LT4-supplemented and placebo groups had similar baseline characteristics. There were no significant differences between infants given LT4 (n=78) or placebo (n=75) for width of the subarachnoid space, head circumference at 36 weeks' CGA, body weight at 36 weeks' CGA or mortality. Infants who received LT4 had significantly shorter leg lengths at 36 weeks' CGA although adjusted analysis for baseline length did not find a statistical difference. There was a significant correlation between low FT4 and wider subarachnoid space. No unexpected serious adverse events were noted and incidence of adverse events did not differ between the two groups. CONCLUSION This is the only randomised controlled trial of thyroxine supplementation targeting extremely premature infants. Supplementing all babies below 28 weeks' gestation with LT4 had no apparent effect on brain size. These results do not support routine supplementation with LT4 for all babies born below 28 weeks' gestation. TRIAL REGISTRATION Current Controlled Trials ISRCTN89493983EUDRACT number: 2005-003-09939.
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Affiliation(s)
- Sze M Ng
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatrics, Southport and Ormskirk NHS Trust, Wigan Road, Ormskirk, Lancashire L39 2AZ, UK
| | - Mark A Turner
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children’s Foundation Trust, Liverpool, UK
| | - Suresh Victor
- Developmental Biomedicine Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Donal Manning
- Neonatal Unit, Wirral Teaching Hospital Foundation Trust, Wirral, UK
| | - Paul Settle
- Neonatal Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Richa Gupta
- Neonatal Unit, Royal Preston Hospital, Preston, UK
| | - Paul Newland
- Department of Biochemistry, Alder Hey Children’s Foundation Trust, Liverpool, UK
| | - Alan Michael Weindling
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Ng SM, Drury JA, Turner MA, Didi M, Victor S, Newland P, Weindling AM. A novel method of collection of saliva for estimation of steroid levels in extremely premature infants. Acta Paediatr 2013; 102:356-9. [PMID: 23289596 DOI: 10.1111/apa.12146] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 11/30/2022]
Abstract
AIM The major advantage of salivary cortisol sampling is that it is considerably less invasive than taking a blood sample. However, previous methods of obtaining saliva in premature infants have been poorly tolerated and inaccurate. We describe a simple, non-distressing technique for obtaining saliva samples to assess extremely premature infants' salivary cortisol status. METHODS We prospectively obtained early morning saliva samples from extremely premature infants. Their gestational age ranged between 23 and 27 weeks. Saliva was obtained using four standard universal swabs by placing one swab at a time in the infant's mouth for 1-2 min. No salivary stimulants were used. RESULTS There were 65 infants (36 males). Mean gestation was 25.3 ± 1.3 weeks. This technique had a success rate of 85% in obtaining a mean of 150 μL of saliva (range 50-350 μL) by trained staff. No adverse events were recorded. CONCLUSION We describe a novel, safe, non-distressing and effective method of saliva collection for salivary cortisol measurement in extremely premature infants.
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Affiliation(s)
- Sze M Ng
- Department of Women's and Children's Health; Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - Josephine A Drury
- Department of Women's and Children's Health; Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - Mark A Turner
- Department of Women's and Children's Health; Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - Mohammed Didi
- Department of Endocrinology; Alder Hey Children's Foundation Trust; Liverpool UK
| | - Suresh Victor
- Developmental Biomedicine Research Group; Manchester Academic Health Sciences Centre; University of Manchester; Manchester UK
| | - Paul Newland
- Department of Biochemistry; Alder Hey Children's Foundation Trust; Liverpool UK
| | - A Michael Weindling
- Department of Women's and Children's Health; Institute of Translational Medicine; University of Liverpool; Liverpool UK
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Lavender T, Furber C, Campbell M, Victor S, Roberts I, Bedwell C, Cork MJ. Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial. BMC Pediatr 2012; 12:59. [PMID: 22656391 PMCID: PMC3418152 DOI: 10.1186/1471-2431-12-59] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 06/01/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some national guidelines recommend the use of water alone for napkin cleansing. Yet, there is a readiness, amongst many parents, to use baby wipes. Evidence from randomised controlled trials, of the effect of baby wipes on newborn skin integrity is lacking. We conducted a study to examine the hypothesis that the use of a specifically formulated cleansing wipe on the napkin area of newborn infants (<1 month) has an equivalent effect on skin hydration when compared with using cotton wool and water (usual care). METHODS A prospective, assessor-blinded, randomised controlled equivalence trial was conducted during 2010. Healthy, term babies (n=280), recruited within 48 hours of birth, were randomly assigned to have their napkin area cleansed with an alcohol-free baby wipe (140 babies) or cotton wool and water (140 babies). Primary outcome was change in hydration from within 48 hours of birth to 4 weeks post-birth. Secondary outcomes comprised changes in trans-epidermal water loss, skin surface pH and erythema, presence of microbial skin contaminants/irritants at 4 weeks and napkin dermatitis reported by midwife at 4 weeks and mother during the 4 weeks. RESULTS Complete hydration data were obtained for 254 (90.7 %) babies. Wipes were shown to be equivalent to water and cotton wool in terms of skin hydration (intention-to-treat analysis: wipes 65.4 (SD 12.4) vs. water 63.5 (14.2), p=0.47, 95% CI -2.5 to 4.2; per protocol analysis: wipes 64.6 (12.4) vs. water 63.6 (14.3), p=0.53, 95% CI -2.4 to 4.2). No significant differences were found in the secondary outcomes, except for maternal-reported napkin dermatitis, which was higher in the water group (p=0.025 for complete responses). CONCLUSIONS Baby wipes had an equivalent effect on skin hydration when compared with cotton wool and water. We found no evidence of any adverse effects of using these wipes. These findings offer reassurance to parents who choose to use baby wipes and to health professionals who support their use. TRIAL REGISTRATION Current Controlled Trials ISRCTN86207019.
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Affiliation(s)
- Tina Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Sämann A, Pofahl S, Lehmann T, Voigt B, Victor S, Möller F, Müller UA, Wolf G. Diabetic nephropathy but not HbA1c is predictive for frequent complications of Charcot feet - long-term follow-up of 164 consecutive patients with 195 acute Charcot feet. Exp Clin Endocrinol Diabetes 2012; 120:335-9. [PMID: 22421981 DOI: 10.1055/s-0031-1299705] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 10/28/2022]
Abstract
AIMS To investigate the clinical characteristics, treatment and long-term outcome of patients with acute Charcot feet (CF). METHODS Single-center retrospective analysis. Treatment of CF: stage-dependent immobilization/weight-off therapy, orthopaedic/adjusted shoes, foot surgery. 164 consecutive participants (type 1 vs. type 2 diabetes): 12 vs. 150, non-diabetic peripheral neuropathy: n=2, presented with 195 (17 vs. 176) CF. Mean follow-up: 4.7 ± 2.5 (range 2.2-9.8) vs. 5.4 ± 2.9 (range 0.8-18.8) years, vital at follow-up: 100 vs. 88%. RESULTS Baseline characteristics: age: 43.7 ± 10.9 vs. 57.9 ± 8.9 years (p<0.001), male gender: 66.7 vs. 77.3%, diabetes duration: 19.2 ± 9.1 vs. 13 ± 8.6 years (p=0.018), GHb: 8.1 ± 2.4 vs. 7.6 ± 1.6%, BMI: 24 ± 5.3 vs. 33.7 ± 6.5 kg/m2 (p<0.001), Levine 1: 18.2 vs. 7.4%, Levine 2: 45.5 vs. 65.9%, Sanders 2: 58.3 vs. 68.5%, Sanders 3: 33.3 vs. 45%. THERAPY immobilization for 6 ± 4.2 vs. 5.4 ± 4.5 months, orthopaedic/adjusted shoes: 27.3 vs. 20.5%, foot surgery: 11.8 vs. 18.2%. Major complications: 50 vs. 56% (rocker bottom deformities: 23.5 vs. 46.3%, foot ulcerations: 17.6 vs. 24.6%, CF amputations: 0 vs. 6%), not CF amputations: 16.7 vs. 15.3%, second episodes of CF: 41.6 vs. 18.3% after 5-132 months. Diabetic nephropathy was associated with an increase, intensive antihypertensive therapy with a decrease of complications. CONCLUSIONS Patients with CF are middle-aged, overweight males with type 2 diabetes above 10 years. Patients with type 1 diabetes are younger, have normal BMI and longer diabetes duration. Major complications and second episodes of CF are frequent. Diabetic nephropathy could be a risk factor for CF related complications. The awareness for CF must be improved.The study was conducted due to the Declaration of Helsinki.
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Affiliation(s)
- A Sämann
- Clinic for Nephrology, Saalfeld, Germany.
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Victor S. EXTUBATE: a randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial. Trials 2011; 12:257. [PMID: 22152592 PMCID: PMC3254079 DOI: 10.1186/1745-6215-12-257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 12/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory distress syndrome remains a significant problem among premature infants. Mechanical ventilation through an endotracheal tube remains the mainstay of respiratory support but may be associated with lung injury and the development of chronic lung disease of prematurity. Efforts are needed to reduce the duration of mechanical ventilation in favour of less invasive forms of respiratory support and to improve rates of successful extubation.Non-invasive respiratory support has been demonstrated to be less injurious to the premature lung. Standard practice is to use nasal continuous positive airway pressure (n-CPAP) following extubation to support the baby's breathing. Many clinicians also use nasal biphasic positive airway pressure (n-BiPAP) in efforts to improve rates of successful extubation. However, there is currently no evidence that this confers any advantage over conventional nasal continuous positive airway pressure. METHODS We propose an unblinded multi-centre randomised trial comparing n-CPAP with n-BiPAP in babies born before 30 weeks' gestation and less than two weeks old. Babies with congenital abnormalities and severe intra-ventricular haemorrhage will be excluded. 540 babies admitted to neonatal centres in England will be randomised at the time of first extubation attempt. The primary aim of this study is to compare the rate of extubation failure within 48 hours following the first attempt at extubation. The secondary aims are to compare the effect of n-BiPAP and n-CPAP on the following outcomes: 1. Maintenance of successful extubation for 7 days post extubation 2. Oxygen requirement at 28 days of age and at 36 weeks' corrected gestational age 3. Total days on ventilator, n-CPAP/n-BiPAP 4. Number of ventilator days following first extubation attempt 5. pH and partial pressure of carbon dioxide in the first post extubation blood gas 6. Duration of hospital stay 7. Rate of abdominal distension requiring cessation of feeds 8. Rate of apnoea and bradycardia 9. The age at transfer back to referral centre in days The trial will determine whether n-BiPAP is safe and superior to n-CPAP in preventing extubation failure in babies born before 30 weeks' gestation and less than two weeks old. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN18921778.
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Affiliation(s)
- Suresh Victor
- Ward 68, 2nd Floor, St Mary's Hospital for Women and Children, Manchester, UK.
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Abstract
The aim of this study was to generate reference ranges for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in preterm infants by describing the observed plasma concentration of these enzymes in babies born between 22 and 36 weeks' gestation. A service evaluation was conducted in babies admitted to two large neonatal intensive care units in the UK. 7006 blood samples from 1860 infants admitted to the two units between 2004 and 2008 were included. Extremely premature infants had high plasma enzyme activities when compared to babies at a later corrected gestational age. This may be due to more severe illness immediately after birth.
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Affiliation(s)
- S Victor
- Neonatal Medical Unit, St Mary's Hospital for Women and Children, Whitworth Park, Manchester, UK.
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46
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Ng SM, Turner MA, Gamble C, Didi M, Victor S, Malamateniou C, Parkes LM, Tietze A, Gregory L, Sluming V, Abernethy L, Weindling AM. TIPIT: a randomised controlled trial of thyroxine in preterm infants under 28 weeks gestation: magnetic resonance imaging and magnetic resonance angiography protocol. BMC Pediatr 2008; 8:26. [PMID: 18590560 PMCID: PMC2464591 DOI: 10.1186/1471-2431-8-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 06/30/2008] [Indexed: 11/10/2022] Open
Abstract
Background Infants born at extreme prematurity are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone described as hypothyroxinaemia, which is recognised to be a frequent phenomenon in these infants. Derangements of critical thyroid function during the sensitive window in prematurity when early development occurs, may have a range of long term effects for brain development. Further research in preterm infants using neuroimaging techniques will increase our understanding of the specificity of the effects of hypothyroxinaemia on the developing foetal brain. This is an explanatory double blinded randomised controlled trial which is aimed to assess the effect of thyroid hormone supplementation on brain size, key brain structures, extent of myelination, white matter integrity and vessel morphology, somatic growth and the hypothalamic-pituitary-adrenal axis. Methods The study is a multi-centred double blinded randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks corrected gestational age. The primary outcomes will be width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks corrected gestational age. The secondary outcomes will be thyroid hormone concentrations, the hypothalamic pituitary axis status and auxological data between birth and expected date of delivery; thyroid gland volume, brain size, volumes of key brain structures, extent of myelination and brain vessel morphology at expected date of delivery and markers of morbidity which include duration of mechanical ventilation and/or oxygen requirement and chronic lung disease. Trial registration Current Controlled Trials ISRCTN89493983
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Affiliation(s)
- Sze M Ng
- School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
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Ng SM, Turner MA, Gamble C, Didi M, Victor S, Weindling AM. TIPIT: A randomised controlled trial of thyroxine in preterm infants under 28 weeks' gestation. Trials 2008; 9:17. [PMID: 18366798 PMCID: PMC2335090 DOI: 10.1186/1745-6215-9-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 03/26/2008] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Infants born at extreme prematurity (below 28 weeks' gestation) are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone which is recognised to be a frequent phenomenon in these infants. At present it is unclear whether low levels of thyroid hormone are a cause of disability, or a consequence of concurrent adversity. METHODS We propose an explanatory multi-centre double blind randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks' corrected gestational age. The primary outcome will be brain growth. This will be assessed by the width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks' corrected gestational. The secondary outcomes will be (a) thyroid hormone concentrations measured at increasing postnatal age, (b) status of the hypothalamic pituitary axis, (c) auxological data between birth and 36 weeks' corrected gestational age, (d) thyroid gland volume, (e) volumes of brain structures (measured by magnetic resonance imaging), (f) determination of the extent of myelination and white matter integrity (measured by diffusion weighted MRI) and brain vessel morphology (measured by magnetic resonance angiography) at expected date of delivery and (g) markers of morbidity including duration of mechanical ventilation and chronic lung disease.We will also examine how activity of the hypothalamic-pituitary-adrenal axis modulates the effects of thyroid supplementation. This will contribute to decisions about which confounding variables to assess in large-scale studies. TRIAL REGISTRATION Current Controlled Trials ISRCTN89493983.
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Affiliation(s)
- Sze M Ng
- School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
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Victor S, Appleton RE, Beirne M, Marson AG, Weindling AM. The relationship between cardiac output, cerebral electrical activity, cerebral fractional oxygen extraction and peripheral blood flow in premature newborn infants. Pediatr Res 2006; 60:456-60. [PMID: 16940235 DOI: 10.1203/01.pdr.0000238379.67720.19] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac output is a determinant of systemic blood flow and its measurement may therefore be a useful indicator of abnormal hemodynamics and tissue oxygen delivery. The purpose of this study was to investigate in very premature newborn infants the relationships between cardiac output (left and right ventricular outputs), systemic blood pressure, peripheral blood flow (PBF) and two indicators of cerebral oxygen delivery (cerebral electrical activity and cerebral fractional oxygen extraction (CFOE)). This was a prospective observational study performed on 40 infants of less than 30 wk gestation. Digital electroencephalograms (EEGs) were recorded for one hour every day during the first four days after birth and subjected to qualitative and quantitative analysis. Left and right ventricular outputs, mean blood pressure (MBP), CFOE, PBF and arterial blood gases were measured at the same time. Within the ranges studied, there was no apparent relationship between left or right ventricular output (RVO), PBF and indicators of cerebral perfusion (cerebral electrical activity and CFOE). The EEG was normal in infants with low left and right ventricular outputs (<150 mL/kg/min) and MBP > 30 mm Hg. Infants with low cardiac output and normal MBP seem able to maintain cerebral perfusion, possibly through vasodilatation of the cerebral microvasculature.
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Affiliation(s)
- Suresh Victor
- Division of Child Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK.
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Victor S, Marson AG, Appleton RE, Beirne M, Weindling AM. Relationship between blood pressure, cerebral electrical activity, cerebral fractional oxygen extraction, and peripheral blood flow in very low birth weight newborn infants. Pediatr Res 2006; 59:314-9. [PMID: 16439599 DOI: 10.1203/01.pdr.0000199525.08615.1f] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is uncertainty about the level of systemic blood pressure required to maintain adequate cerebral oxygen delivery and organ integrity. This prospective, observational study on 35 very low birth weight infants aimed to determine the mean blood pressure (MBP) below which cerebral electrical activity, peripheral blood flow (PBF), and cerebral fractional oxygen extraction (CFOE) are abnormal. Digital EEG, recorded every day on the first 4 d after birth, were analyzed a) by automatic spectral analysis, b) by manual measurement of interburst interval, and c) qualitatively. CFOE and PBF measurements were performed using near-infrared spectroscopy and venous occlusion. MBP was measured using arterial catheters. The median (range) of MBP recorded was 32 mm Hg (16-46). The EEG became abnormal at MBP levels below 23 mm Hg: a) the relative power of the delta (0.5-3.5 Hz) frequency band was decreased, b) interburst intervals were prolonged, and c) all four qualitatively abnormal EEG (low amplitude and prolonged interburst intervals) from four different patients were recorded below this MBP level. The only abnormally high CFOE was measured at MBP of 20 mm Hg. PBF decreased at MBP levels between 23 and 33 mm Hg. None of the infants in this study developed cystic periventricular leukomalacia. One infant (MBP, 22 mm Hg) developed ventricular dilatation after intraventricular hemorrhage. The EEG and CFOE remained normal at MBP levels above 23 mm Hg. It would appear that cerebral perfusion is probably maintained at MBP levels above 23 mm Hg.
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Affiliation(s)
- Suresh Victor
- Division of Child Health, University of Liverpool, Liverpool Women's Hospital, Neonatal Unit, UK.
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Victor S, Appleton RE, Beirne M, Marson AG, Weindling AM. Effect of carbon dioxide on background cerebral electrical activity and fractional oxygen extraction in very low birth weight infants just after birth. Pediatr Res 2005; 58:579-85. [PMID: 16148077 DOI: 10.1203/01.pdr.0000169402.13435.09] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Decreased arterial carbon dioxide tension (PaCO2) results in decreased cerebral blood flow, which is associated with diminished cerebral electrical activity. In such a situation, cerebral fractional oxygen extraction (CFOE) would be expected to increase to preserve cerebral oxygen delivery. This study aimed to determine whether changes in blood gases in infants less than 30 wk' gestation were associated with changes in background electroencephalograms (EEG) and CFOE. Thirty-two very low birth weight infants were studied daily for the first three days after birth. Digital EEG recordings were performed for 75 min each day. CFOE, mean blood pressure and arterial blood gases were measured midway through each recording. EEG was analysed by (a) spectral analysis and (b) manual calculation of interburst interval. Blood pressure, pH and PaCO2 did not have any effect on the EEG. On day one, only PaCO2 showed a relationship with the relative power of the delta frequency band (0.5-3.5 Hz) and the interburst interval. The relative power of the delta band remained within normal limits when PaCO2 was between 24 and 55 mmHg on day one. There was a negative association between PaCO2 and CFOE. The associations between PaCO2 and EEG measurements were strongest on day one, weaker on day two, and absent on day three. The slowing of EEG and increased CFOE at lower levels of PaCO2 are likely to be due to decreased cerebral oxygen delivery induced by hypocarbia. When PaCO2 was higher, there was suppression of the EEG.
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Affiliation(s)
- Suresh Victor
- Neonatal Intensive Care Unit, Liverpool Women's Hospital, UK.
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