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Núñez C, Stephan-Otto C, Arca G, Agut T, Arnaez J, Cordeiro M, Benavente-Fernández I, Boronat N, Lubián-López SP, Valverde E, Hortigüela M, García-Alix A. Neonatal arterial stroke location is associated with outcome at 2 years: a voxel-based lesion-symptom mapping study. Arch Dis Child Fetal Neonatal Ed 2022; 107:45-50. [PMID: 33990386 DOI: 10.1136/archdischild-2020-320400] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In contrast to motor impairments, the association between lesion location and cognitive or language deficits in patients with neonatal arterial ischaemic stroke remains largely unknown. We conducted a voxel-based lesion-symptom mapping cross-sectional study aiming to reveal neonatal arterial stroke location correlates of language, motor and cognitive outcomes at 2 years of age. DESIGN Prospective observational multicentre study. SETTING Six paediatric university hospitals in Spain. PARTICIPANTS We included 53 patients who had a neonatal arterial ischaemic stroke with neonatal MRI and who were followed up till 2 years of age. MAIN OUTCOME MEASURES We analysed five dichotomous clinical variables: speech therapy (defined as the need for speech therapy as established by therapists), gross motor function impairment, and the language, motor and cognitive Bayley scales. All the analyses were controlled for total lesion volume. RESULTS We found that three of the clinical variables analysed significantly correlated with neonatal stroke location. Speech therapy was associated with lesions located mainly at the left supramarginal gyrus (p=0.007), gross motor function impairment correlated with lesions at the left external capsule (p=0.044) and cognitive impairment was associated with frontal lesions, particularly located at the left inferior and middle frontal gyri (p=0.012). CONCLUSIONS The identification of these susceptible brain areas will allow for more precise prediction of neurological impairments on the basis of neonatal brain MRI.
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Affiliation(s)
- Christian Núñez
- Departament de Psiquiatria, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Gemma Arca
- Departament de Neonatologia, Hospital Clínic, IDIBAPS, Barcelona, Spain.,NeNe Foundation, Madrid, Spain
| | - Thais Agut
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.,NeNe Foundation, Madrid, Spain.,Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Juan Arnaez
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Universitario de Burgos, Burgos, Spain
| | - Malaika Cordeiro
- Departamento de Neonatología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Nuria Boronat
- Departamento de Neonatología, Hospital Universitario y Politécnico La Fe. Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Simón Pedro Lubián-López
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Puerta del Mar, Cádiz, Spain
| | - Eva Valverde
- NeNe Foundation, Madrid, Spain.,Departamento de Neonatología, Hospital Universitario La Paz, Madrid, Spain
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Arnaez J, Vega-Del-Val C, Hortigüela M, Benavente-Fernández I, Martínez-Biarge M, Ochoa Sangrador C, Garcia-Alix A. Usefulness of video recordings for validating neonatal encephalopathy exams: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2021; 106:522-528. [PMID: 33597228 DOI: 10.1136/archdischild-2020-320791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the usefulness of video recordings for validating neonatal encephalopathy (NE) exams. DESIGN Population-based prospective cohort study. NE was assessed and recorded at 1, 3 and 5 hours after birth by the attending physician. Recordings were reviewed blindly after the recruitment period by two specialists. Outcome was assessed at 36 months of age. SETTING Twelve intensive care units in Spain. PATIENTS Infants of ≥35 weeks' gestational age with perinatal asphyxia. MAIN OUTCOMES MEASURES Weighted kappa to measure disagreement between the two specialists and between the attending physician and the specialists' classification agreed on by consensus. Regression models to test the association of disagreement on NE assessment and outcome. RESULTS Of the 32 325 liveborn infants, 217 met the inclusion criteria. Video-recordings were not available for 43 infants (20%). Weighted kappa statistic was 0.74 (95% CI 0.67 to 0.81) between the specialists and the attending physicians. Disagreement occurred in 93 of the 417 (22%) videos, specifically in 39 (14%), 43 (47%), 11 (34%) and 0 exams categorised as no, mild, moderate and severe NE, respectively. According to the specialist consensus assessment, there was disagreement on the therapeutic hypothermia decision in 10 infants.When there was consensus among the specialists assessing a more severe NE degree compared with the attending physicians in 170 infants, those infants had lower cognitive scores with a median of -5.33 points (95% CI -9.85 to -8.16; p=0.02). CONCLUSIONS This study supports the feasibility and benefit of using video recordings to identify NE in infants with perinatal asphyxia.
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Affiliation(s)
- Juan Arnaez
- Neonatology, Hospital Universitario de Burgos, Burgos, Spain .,NeNe Foundation, Madrid, Spain
| | | | | | - Isabel Benavente-Fernández
- NeNe Foundation, Madrid, Spain.,Neonatology, Puerta del Mar Universtity Hospital, Cadiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Area of Paediatrics, Department of Child and Mother Health and Radiology, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | | | | | - Alfredo Garcia-Alix
- NeNe Foundation, Madrid, Spain.,Institut de Recerca Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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Arriaga-Redondo M, Arnaez J, Benavente-Fernández I, Lubián-López S, Hortigüela M, Vega-Del-Val C, Garcia-Alix A. Lack of Variability in Cerebral Oximetry Tendency in Infants with Severe Hypoxic-Ischemic Encephalopathy Under Hypothermia. Ther Hypothermia Temp Manag 2019; 9:243-250. [PMID: 30676288 DOI: 10.1089/ther.2018.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/27/2022] Open
Abstract
Cerebral oximetry using near-infrared spectroscopy (NIRS) provides continuous, noninvasive assessment of the degree of hemoglobin saturation of the brain tissue. Previous studies suggest that high values of regional cerebral tissue oxygen saturation (rScO2) during the first days in neonates with significant hypoxic-ischemic encephalopathy (HIE) are correlated with an adverse neurological outcome. However, the results are not consistent among the studies. To examine the correlation of rScO2 values and their variability over time with HIE severity, amplitude integrated electroencephalography (aEEG) background and seizure activity, neuron-specific enolase levels in cerebrospinal fluid, magnetic resonance imaging (MRI) findings, and neurological outcome. Retrospective study that included all consecutive infants with moderate-to-severe HIE born at ≥35 weeks gestational age admitted between January 2011 and December 2014. NIRS monitoring was initiated at admission and maintained during therapeutic hypothermia up to 12 hours after rewarming. To analyze rScO2, different periods (0-6, 6-24, 24-48, 48-72, and 72-100 hours of life) and three ranges (<55%, 55-90%, >90%) were considered. Variability in each patient was considered ≤5% when changes in rScO2 values in all periods were ≤5%. Twenty-three newborns were included. Infants who suffered from severe HIE, seizures, abnormal aEEG background, altered MRI or death, and abnormal outcome had rScO2 values >90% and with less variability (≤5%). rScO2 values >90% and a lack of variability over time in infants with HIE during cooling provide useful information about the severity of neurological status.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Division, Gregorio Marañón Hospital, Madrid, Spain.,Fundación NeNe, Madrid, Spain
| | - Juan Arnaez
- Fundación NeNe, Madrid, Spain.,Neonatology Division, Burgos University Hospital, Burgos, Spain
| | | | - Simón Lubián-López
- Fundación NeNe, Madrid, Spain.,Neonatology Division, Puerta del Mar University Hospital, Cádiz, Spain
| | | | | | - Alfredo Garcia-Alix
- Fundación NeNe, Madrid, Spain.,Institut de Recerca Pediatrica Sant Joan de Dèu, Sant Joan de Dèu Hospital, Passeig Sant Joan de Déu, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Raras (CIBERER), Madrid, Spain
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Hortigüela M, Fernández-Marmiesse A, Cantarín V, Gouveia S, García-Peñas JJ, Fons C, Armstrong J, Barrios D, Díaz-Flores F, Tirado P, Couce ML, Gutiérrez-Solana LG. Clinical and genetic features of 13 Spanish patients with KCNQ2 mutations. J Hum Genet 2016; 62:185-189. [DOI: 10.1038/jhg.2016.104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/09/2022]
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Cubo E, Hortigüela M, Jorge-Roldan S, Ciciliani SE, Lopez P, Velasco L, Sastre E, Ausin V, Delgado V, Saez S, Gabriel-Galán JT, Macarrón J. Prenatal and Perinatal Morbidity in Children with Tic Disorders: A Mainstream School-based Population Study in Central Spain. Tremor Other Hyperkinet Mov (N Y) 2014; 4:272. [PMID: 25562036 PMCID: PMC4268040 DOI: 10.7916/d8fn14w9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/11/2014] [Indexed: 01/22/2023]
Abstract
Background While current research suggests that genetic factors confer the greatest risk for the development of tic disorders, studies of environmental factors are relatively few, with a lack of consistent risk factors across studies. Our aim is to analyze the association of tic disorders with exposure to prenatal and perinatal morbidity. Methods This was a nested case–control study design. Cases and controls were selected and identified from a mainstream, school-based sample. The diagnosis of tic disorders was assigned by a movement disorder neurologist using ‘Diagnostic and statistical manual of mental disorders, 4th edition, text revision’ criteria, and neuropsychiatric comorbidities were screened using the Spanish computerized version of the Diagnostic Interview Schedule for Children Predictive Scale. Information regarding the exposure to pre-perinatal risk factors was collected by a retrospective review of the birth certificates. Logistic regression analyses were then performed to test the association of tic disorders with pre-perinatal risk factors. Results Out of 407 participants, complete pre-perinatal data were available in 153 children (64 with tics and 89 without tics). After adjusting for family history of tics, neonatal respiratory distress syndrome, body mass index, prenatal infection, and coexisting comorbid neuropsychiatric disturbances, tic disorders were associated with prenatal exposure to tobacco (odds ratio [OR] = 3.07, 95% confidence interval [CI] 1.24–7.60, p = 0.007), and cesarean section (OR = 5.78, 95% CI 1.60–20.91, p = 0.01). Discussion This nested case–control study of children with tic disorders demonstrates higher adjusted odds for tics in children with exposure to cesarean delivery and maternal smoking. Longitudinal, population-based samples are required to confirm these results.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | | | | | | | - Patricia Lopez
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Leticia Velasco
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Emilio Sastre
- Pediatrics Department; Hospital Universitario Burgos, Burgos, Spain
| | - Vanesa Ausin
- Research Unit, Hospital Universitario Burgos, Spain
| | | | - Sara Saez
- Research Unit, Hospital Universitario Burgos, Spain
| | | | - Jesús Macarrón
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
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