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Nijman M, van der Meeren LE, Nikkels PGJ, Stegeman R, Breur JMPJ, Jansen NJG, ter Heide H, Steenhuis TJ, de Heus R, Bekker MN, Claessens NHP, Benders MJNL. Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e033189. [PMID: 38420785 PMCID: PMC10944035 DOI: 10.1161/jaha.123.033189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Neonates with congenital heart disease are at risk for impaired brain development in utero, predisposing children to postnatal brain injury and adverse long-term neurodevelopmental outcomes. Given the vital role of the placenta in fetal growth, we assessed the incidence of placental pathology in fetal congenital heart disease and explored its association with total and regional brain volumes, gyrification, and brain injury after birth. METHODS AND RESULTS Placentas from 96 term singleton pregnancies with severe fetal congenital heart disease were prospectively analyzed for macroscopic and microscopic pathology. We applied a placental pathology severity score to relate placental abnormalities to neurological outcome. Postnatal, presurgical magnetic resonance imaging was used to analyze brain volumes, gyrification, and brain injuries. Placental analyses revealed the following abnormalities: maternal vascular malperfusion lesions in 46%, nucleated red blood cells in 37%, chronic inflammatory lesions in 35%, delayed maturation in 30%, and placental weight below the 10th percentile in 28%. Severity of placental pathology was negatively correlated with cortical gray matter, deep gray matter, brainstem, cerebellar, and total brain volumes (r=-0.25 to -0.31, all P<0.05). When correcting for postmenstrual age at magnetic resonance imaging in linear regression, this association remained significant for cortical gray matter, cerebellar, and total brain volume (adjusted R2=0.25-0.47, all P<0.05). CONCLUSIONS Placental pathology occurs frequently in neonates with severe congenital heart disease and may contribute to impaired brain development, indicated by the association between placental pathology severity and reductions in postnatal cortical, cerebellar, and total brain volumes.
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Affiliation(s)
- Maaike Nijman
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Lotte E. van der Meeren
- Department of PathologyErasmus Medical Center RotterdamRotterdamthe Netherlands
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Peter G. J. Nikkels
- Department of PathologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Raymond Stegeman
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of PediatricsBeatrix Children’s Hospital, University Medical Center GroningenGroningenthe Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Nicolaas J. G. Jansen
- Department of PediatricsBeatrix Children’s Hospital, University Medical Center GroningenGroningenthe Netherlands
| | - Henriette ter Heide
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Trinette J. Steenhuis
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Roel de Heus
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtthe Netherlands
- Department of Obstetrics and GynecologySt. Antonius HospitalUtrechtthe Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Nathalie H. P. Claessens
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of PediatricsWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Manon J. N. L. Benders
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
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2
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Neukomm A, Claessens NHP, Bonthrone AF, Stegeman R, Feldmann M, Nijman M, Jansen NJG, Nijman J, Groenendaal F, de Vries LS, Benders MJNL, Breur JMPJ, Haas F, Bekker MN, Logeswaran T, Reich B, Kottke R, Dave H, Simpson J, Pushparajah K, Kelly CJ, Arulkumaran S, Rutherford MA, Counsell SJ, Chew A, Knirsch W, Sprong MCA, van Schooneveld MM, Hagmann C, Latal B. Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease: Results from a European Collaboration. J Pediatr 2024; 266:113838. [PMID: 37995930 DOI: 10.1016/j.jpeds.2023.113838] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To examine the relationship between perioperative brain injury and neurodevelopment during early childhood in patients with severe congenital heart disease (CHD). STUDY DESIGN One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up. RESULTS Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = -0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = -0.35). CONCLUSION Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.
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Affiliation(s)
- Astrid Neukomm
- Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Raymond Stegeman
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Feldmann
- Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maaike Nijman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Joppe Nijman
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Felix Haas
- Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thushiha Logeswaran
- Pediatric Heart Center, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bettina Reich
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - John Simpson
- Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom
| | - Kuberan Pushparajah
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Maaike C A Sprong
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique M van Schooneveld
- Department of Pediatric Psychology, Neuropsychology Section, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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3
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Stegeman R, Sprong MCA, Breur JMPJ, Groenendaal F, de Vries LS, Haas F, van der Net J, Jansen NJG, Benders MJNL, Claessens NHP. Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury. Dev Med Child Neurol 2022; 64:192-199. [PMID: 34416027 PMCID: PMC9290970 DOI: 10.1111/dmcn.15024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/23/2023]
Abstract
AIM To assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD). METHOD Neonatal brain magnetic resonance imaging was performed after open-heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery. RESULTS Fifty-one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5-11d) and 15 days (IQR 12-21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15-0.86; cerebellum regression coefficient=3.08, 95% CI=1.07-5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47-5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference -0.8SD, 95% CI=-1.5 to -0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy (n=3) was preceded by severe ischaemic brain injury. INTERPRETATION Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.
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Affiliation(s)
- Raymond Stegeman
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Maaike C A Sprong
- Center for Child Development, Exercise and Physical LiteracyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Johannes M P J Breur
- Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Floris Groenendaal
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Linda S de Vries
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Felix Haas
- Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Janjaap van der Net
- Center for Child Development, Exercise and Physical LiteracyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Nicolaas J G Jansen
- Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Department of PediatricsUniversity Medical Center GroningenGroningenthe Netherlands
| | - Manon J N L Benders
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Nathalie H P Claessens
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
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4
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Stegeman R, Feldmann M, Claessens NHP, Jansen NJG, Breur JMPJ, de Vries LS, Logeswaran T, Reich B, Knirsch W, Kottke R, Hagmann C, Latal B, Simpson J, Pushparajah K, Bonthrone AF, Kelly CJ, Arulkumaran S, Rutherford MA, Counsell SJ, Benders MJNL. A Uniform Description of Perioperative Brain MRI Findings in Infants with Severe Congenital Heart Disease: Results of a European Collaboration. AJNR Am J Neuroradiol 2021; 42:2034-2039. [PMID: 34674999 PMCID: PMC8583253 DOI: 10.3174/ajnr.a7328] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Received: 04/06/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE A uniform description of brain MR imaging findings in infants with severe congenital heart disease to assess risk factors, predict outcome, and compare centers is lacking. Our objective was to uniformly describe the spectrum of perioperative brain MR imaging findings in infants with congenital heart disease. MATERIALS AND METHODS Prospective observational studies were performed at 3 European centers between 2009 and 2019. Brain MR imaging was performed preoperatively and/or postoperatively in infants with transposition of the great arteries, single-ventricle physiology, or left ventricular outflow tract obstruction undergoing cardiac surgery within the first 6 weeks of life. Brain injury was assessed on T1, T2, DWI, SWI, and MRV. A subsample of images was assessed jointly to reach a consensus. RESULTS A total of 348 MR imaging scans (180 preoperatively, 168 postoperatively, 146 pre- and postoperatively) were obtained in 202 infants. Preoperative, new postoperative, and cumulative postoperative white matter injury was identified in 25%, 30%, and 36%; arterial ischemic stroke, in 6%, 10%, and 14%; hypoxic-ischemic watershed injury in 2%, 1%, and 1%; intraparenchymal cerebral hemorrhage, in 0%, 4%, and 5%; cerebellar hemorrhage, in 6%, 2%, and 6%; intraventricular hemorrhage, in 14%, 6%, and 13%; subdural hemorrhage, in 29%, 17%, and 29%; and cerebral sinovenous thrombosis, in 0%, 10%, and 10%, respectively. CONCLUSIONS A broad spectrum of perioperative brain MR imaging findings was found in infants with severe congenital heart disease. We propose an MR imaging protocol including T1-, T2-, diffusion-, and susceptibility-weighted imaging, and MRV to identify ischemic, hemorrhagic, and thrombotic lesions observed in this patient group.
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Affiliation(s)
- R Stegeman
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - N H P Claessens
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - N J G Jansen
- Pediatric Intensive Care (R.S., N.H.P.C., N.J.G.J.)
- Department of Pediatrics (N.J.G.J.), Beatrix Children's Hospital, UMC Groningen, Groningen, the Netherlands
| | - J M P J Breur
- Pediatric Cardiology (R.S., N.H.P.C., J.M.P.J.B.), Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - L S de Vries
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T Logeswaran
- Pediatric Heart Center (T.L., B.R.), University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - B Reich
- Pediatric Heart Center (T.L., B.R.), University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - W Knirsch
- Division of Pediatric Cardiology (W.K.), Pediatric Heart Center
| | - R Kottke
- Department of Diagnostic Imaging (R.K.)
| | - C Hagmann
- Department of Neonatology and Pediatric Intensive Care (C.H.), University Children's Hospital Zurich, Zurich, Switzerland
| | - B Latal
- Child Development Center (M.F., B.L.)
| | - J Simpson
- Department of Pediatric Cardiology (J.S., K.P.), Evelina Children's Hospital London, London, UK
| | - K Pushparajah
- Department of Pediatric Cardiology (J.S., K.P.), Evelina Children's Hospital London, London, UK
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - A F Bonthrone
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - C J Kelly
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - S Arulkumaran
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - M A Rutherford
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - S J Counsell
- Centre for the Developing Brain (K.P., A.F.B., C.J.K., S.A., M.A.R., S.J.C.), School of Biomedical Engineering and Imaging Sciences, King.s College London, London, UK
| | - M J N L Benders
- From the Departments of Neonatology (R.S., N.H.P.C., L.S.d.V., M.J.N.L.B.)
- Utrecht Brain Center (R.S., L.S.d.V., M.J.N.L.B.), UMC Utrecht, Utrecht University, Utrecht, the Netherlands
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5
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van Beek PE, Claessens NHP, Makropoulos A, Groenendaal F, de Vries LS, Counsell SJ, Benders MJNL. Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm. J Pediatr 2020; 223:57-63.e5. [PMID: 32389719 DOI: 10.1016/j.jpeds.2020.04.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the effect of early life nutrition on structural brain development in 2 cohorts of extremely preterm infants, before and after the implementation of a nutrition regimen containing more protein and lipid. STUDY DESIGN We included 178 infants retrospectively (median gestational age, 26.6 weeks; IQR, 25.9-27.3), of whom 99 received the old nutrition regimen (cohort A, 2011-2013) and 79 the new nutrition regimen (cohort B, 2013-2015). Intake of protein, lipids, and calories was calculated for the first 28 postnatal days. Brain magnetic resonance imaging (MRI) was performed at 30 weeks postmenstrual age (IQR, 30.3-31.4) and term-equivalent age (IQR, 40.9-41.4). Volumes of 42 (left + right) brain structures were calculated. RESULTS Mean protein and caloric intake in cohort B (3.4 g/kg per day [P < .001] and 109 kcal/kg per day [P = .038]) was higher than in cohort A (2.7 g/kg per day; 104 kcal/kg per day). At 30 weeks, 22 regions were significantly larger in cohort B compared with cohort A, whereas at term-equivalent age, only the caudate nucleus was significantly larger in cohort B compared with cohort A. CONCLUSIONS An optimized nutrition protocol in the first 28 days of life is associated with temporarily improved early life brain volumes.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Science & Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands.
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6
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Tataranno ML, Gui L, Hellström-Westas L, Toet M, Groenendaal F, Claessens NHP, Schuurmans J, Fellman V, Sävman K, de Vries LS, Huppi P, Benders MJNL. Morphine affects brain activity and volumes in preterms: An observational multi-center study. Early Hum Dev 2020; 144:104970. [PMID: 32276190 DOI: 10.1016/j.earlhumdev.2020.104970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/13/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We hypothesized that morphine has a depressing effect on early brain activity, assessed using quantitative aEEG/EEG parameter and depressed activity will be associated with brain volumes at term in extremely preterm infants. STUDY DESIGN 174 preterm infants were enrolled in 3 European tertiary NICUs (mean GA:26 ± 1wks) and monitored during the first 72 h after birth with continuous 2 channel aEEG. Six epochs of aEEG recordings were selected and minimum amplitude of aEEG (min aEEG), percentage of time amplitude <5 μV (% of time < 5 μV), spontaneous activity transients (SATrate) and interSAT interval (ISI) were calculated. For infants receiving morphine, the cumulative morphine dosage was calculated. In a subgroup of 58 infants, good quality MRI at term equivalent age (TEA) and the cumulative morphine dose until TEA were available. The effects of morphine administration and cumulative dose on aEEG/EEG measures and on brain volumes were investigated. RESULTS Morphine administration had a significant effect on all quantitative aEEG/EEG measures, causing depression of early brain activity [longer ISI (β 2.900), reduced SAT rate (β -1.386), decreased min aEEG (β -0.782), and increased % of time < 5 μV (β 14.802)] in all epochs. A significant effect of GA and postnatal age on aEEG/EEG measures was observed. Cumulative morphine dose until TEA had a significant negative effect on total brain volume (TBV) (β -8.066) and cerebellar volume (β -1.080). CONCLUSIONS Administration of sedative drugs should be considered when interpreting aEEG/EEG together with the negative dose dependent morphine impact on brain development.
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Affiliation(s)
- M L Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - L Gui
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - L Hellström-Westas
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - N H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - J Schuurmans
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - V Fellman
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Skåne University Hospital, Lund, Sweden
| | - K Sävman
- Department of Pediatrics, Perinatal Center, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - L S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - P Huppi
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - M J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
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van den Munckhof B, Zwart AF, Weeke LC, Claessens NHP, Plate JDJ, Leemans A, Kuijf HJ, van Teeseling HC, Leijten FSS, Benders MJN, Braun KPJ, de Vries LS, Jansen FE. Perinatal thalamic injury: MRI predictors of electrical status epilepticus in sleep and long-term neurodevelopment. Neuroimage Clin 2020; 26:102227. [PMID: 32182576 PMCID: PMC7076143 DOI: 10.1016/j.nicl.2020.102227] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 01/26/2023]
Abstract
The majority of patients with perinatal thalamic injury, will develop epilepsy with ESES after the age of two years. ESES is associated with neurodevelopmental deficits. Larger residual thalamic volume at the three months MRI correlates to higher total IQ/DQ during follow-up. MRI at three months appears to be useful to predict neurodevelopmental outcome in this population.
Objective Perinatal thalamic injury is associated with epilepsy with electrical status epilepticus in sleep (ESES). The aim of this study was to prospectively quantify the risk of ESES and to assess neuroimaging predictors of neurodevelopment. Methods We included patients with perinatal thalamic injury. MRI scans were obtained in the neonatal period, around three months of age and during childhood. Thalamic and total brain volumes were obtained from the three months MRI. Diffusion characteristics were assessed. Sleep EEGs distinguished patients into ESES (spike-wave index (SWI) >85%), ESES-spectrum (SWI 50–85%) or no ESES (SWI < 50%). Serial Intelligence Quotient (IQ)/Developmental Quotient (DQ) scores were obtained during follow-up. Imaging and EEG findings were correlated to neurodevelopmental outcome. Results Thirty patients were included. Mean thalamic volume at three months was 8.11 (±1.67) ml and mean total brain volume 526.45 (±88.99) ml. In the prospective cohort (n = 23) 19 patients (83%) developed ESES (-spectrum) abnormalities after a mean follow-up of 96 months. In the univariate analysis, larger thalamic volume, larger total brain volume and lower SWI correlated with higher mean IQ/DQ after 2 years (Pearson's r = 0.74, p = 0.001; Pearson's r = 0.64, p = 0.005; and Spearman's rho -0.44, p = 0.03). In a multivariable mixed model analysis, thalamic volume was a significant predictor of IQ/DQ (coefficient 9.60 [p < 0.001], i.e., corrected for total brain volume and SWI and accounting for repeated measures within patients, a 1 ml higher thalamic volume was associated with a 9.6 points higher IQ). Diffusion characteristics during childhood correlated with IQ/DQ after 2 years. Significance Perinatal thalamic injury is followed by electrical status epilepticus in sleep in the majority of patients. Thalamic volume and diffusion characteristics correlate to neurodevelopmental outcome.
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Affiliation(s)
- Bart van den Munckhof
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Anne F Zwart
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost D J Plate
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Heleen C van Teeseling
- Department of Pediatric Neuropsychology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frans S S Leijten
- Department of Clinical Neurophysiology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manon J N Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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8
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Claessens NHP, Chau V, de Vries LS, Jansen NJG, Au-Young SH, Stegeman R, Blaser S, Shroff M, Haas F, Marini D, Breur JMPJ, Seed M, Benders MJNL, Miller SP. Brain Injury in Infants with Critical Congenital Heart Disease: Insights from Two Clinical Cohorts with Different Practice Approaches. J Pediatr 2019; 215:75-82.e2. [PMID: 31451185 DOI: 10.1016/j.jpeds.2019.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/06/2019] [Accepted: 07/10/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine prevalence and risk factors for brain injury in infants with critical congenital heart disease (CHD) from 2 sites with different practice approaches who were scanned clinically. STUDY DESIGN Prospective, longitudinal cohort study (2016-2017) performed at Hospital for Sick Children Toronto (HSC) and Wilhelmina Children's Hospital Utrecht (WKZ), including 124 infants with cardiac surgery ≤60 days (HSC = 77; WKZ = 47). Magnetic resonance imaging was performed per clinical protocol, preoperatively (n = 100) and postoperatively (n = 120). Images were reviewed for multifocal (watershed, white matter injury) and focal ischemic injury (stroke, single white matter lesion). RESULTS The prevalence of ischemic injury was 69% at HSC and 60% at WKZ (P = .20). Preoperative multifocal injury was associated with low cardiac output syndrome (OR, 4.6), which was equally present at HSC and WKZ (20% vs 28%; P = .38). Compared with WKZ, HSC had a higher prevalence of balloon-atrioseptostomy in transposition of the great arteries (83% vs 53%; P = .01) and more frequent preoperative focal injury (27% vs 6%; P = .06). Postoperatively, 30% of new multifocal injury could be attributed to postoperative low cardiac output syndrome, which was equally present at HSC and WKZ (38% vs 28%; P = .33). Postoperative focal injury was associated with intraoperative selective cerebral perfusion in CHD with arch obstruction at both sites (OR, 2.7). Compared with HSC, WKZ had more arch obstructions (62% vs 35%; P < .01) and a higher prevalence of new focal injury (36% vs 16%; P = .01). CONCLUSIONS Brain injury is common in clinical cohorts of infants with critical CHD and related to practice approaches. This study confirms that the high prevalence of brain injury in critical CHD is a clinical concern and does not simply reflect the inclusion criteria of published research studies.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Department of Pediatric Cardiology and Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
| | - Vann Chau
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Stephanie H Au-Young
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Raymond Stegeman
- Department of Pediatric Cardiology and Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Susan Blaser
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Felix Haas
- Department of Pediatric Cardiology and Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Davide Marini
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Johannes M P J Breur
- Department of Pediatric Cardiology and Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Steven P Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Khalili N, Turk E, Benders MJNL, Moeskops P, Claessens NHP, de Heus R, Franx A, Wagenaar N, Breur JMPJ, Viergever MA, Išgum I. Automatic extraction of the intracranial volume in fetal and neonatal MR scans using convolutional neural networks. Neuroimage Clin 2019; 24:102061. [PMID: 31835284 PMCID: PMC6909142 DOI: 10.1016/j.nicl.2019.102061] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 01/21/2023]
Abstract
Automatic intracranial volume segmentation. Fetal and neonatal MRI. Deep learning.
MR images of infants and fetuses allow non-invasive analysis of the brain. Quantitative analysis of brain development requires automatic brain tissue segmentation that is typically preceded by segmentation of the intracranial volume (ICV). Fast changes in the size and morphology of the developing brain, motion artifacts, and large variation in the field of view make ICV segmentation a challenging task. We propose an automatic method for segmentation of the ICV in fetal and neonatal MRI scans. The method was developed and tested with a diverse set of scans regarding image acquisition parameters (i.e. field strength, image acquisition plane, image resolution), infant age (23–45 weeks post menstrual age), and pathology (posthaemorrhagic ventricular dilatation, stroke, asphyxia, and Down syndrome). The results demonstrate that the method achieves accurate segmentation with a Dice coefficient (DC) ranging from 0.98 to 0.99 in neonatal and fetal scans regardless of image acquisition parameters or patient characteristics. Hence, the algorithm provides a generic tool for segmentation of the ICV that may be used as a preprocessing step for brain tissue segmentation in fetal and neonatal brain MR scans.
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Affiliation(s)
- Nadieh Khalili
- Image Sciences Institute, Utrecht University and University Medical Center Utrecht, Utrecht, the Netherlands.
| | - E Turk
- Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M J N L Benders
- Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P Moeskops
- Medical Image Analysis, Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - N H P Claessens
- Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R de Heus
- Department of Obstetrics, University Medical Center Utrecht, the Netherlands
| | - A Franx
- Department of Obstetrics, University Medical Center Utrecht, the Netherlands
| | - N Wagenaar
- Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J M P J Breur
- Department of Neonatology, Wilhelmina Childrens Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M A Viergever
- Image Sciences Institute, Utrecht University and University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - I Išgum
- Image Sciences Institute, Utrecht University and University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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10
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Cizmeci MN, Khalili N, Claessens NHP, Groenendaal F, Liem KD, Heep A, Benavente-Fernández I, van Straaten HLM, van Wezel-Meijler G, Steggerda SJ, Dudink J, Išgum I, Whitelaw A, Benders MJNL, de Vries LS, Woerdeman P, ter Horst H, Dijkman K, Ley D, Fellman V, de Haan T, Brouwer A, van ‘t Verlaat E, Govaert P, Smit B, Agut Quijano T, Barcik U, Mathur A, Graca A. Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled ELVIS Trial. J Pediatr 2019; 208:191-197.e2. [PMID: 30878207 DOI: 10.1016/j.jpeds.2018.12.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 08/31/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI. STUDY DESIGN In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis. RESULTS The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P < .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03). CONCLUSIONS More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation. TRIAL REGISTRATION ISRCTN43171322.
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Affiliation(s)
- Mehmet N Cizmeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nadieh Khalili
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kian D Liem
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel Heep
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, United Kingdom
| | | | | | - Gerda van Wezel-Meijler
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, The Netherlands; Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew Whitelaw
- Department of Neonatology, Southmead Hospital, School of Clinical Science, University of Bristol, Bristol, United Kingdom
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
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11
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Claessens NHP, Khalili N, Isgum I, Ter Heide H, Steenhuis TJ, Turk E, Jansen NJG, de Vries LS, Breur JMPJ, de Heus R, Benders MJNL. Brain and CSF Volumes in Fetuses and Neonates with Antenatal Diagnosis of Critical Congenital Heart Disease: A Longitudinal MRI Study. AJNR Am J Neuroradiol 2019; 40:885-891. [PMID: 30923087 DOI: 10.3174/ajnr.a6021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Fetuses and neonates with critical congenital heart disease are at risk of delayed brain development and neurodevelopmental impairments. Our aim was to investigate the association between fetal and neonatal brain volumes and neonatal brain injury in a longitudinally scanned cohort with an antenatal diagnosis of critical congenital heart disease and to relate fetal and neonatal brain volumes to postmenstrual age and type of congenital heart disease. MATERIALS AND METHODS This was a prospective, longitudinal study including 61 neonates with critical congenital heart disease undergoing surgery with cardiopulmonary bypass <30 days after birth and MR imaging of the brain; antenatally (33 weeks postmenstrual age), neonatal preoperatively (first week), and postoperatively (7 days postoperatively). Twenty-six had 3 MR imaging scans; 61 had at least 1 fetal and/or neonatal MR imaging scan. Volumes (cubic centimeters) were calculated for total brain volume, unmyelinated white matter, cortical gray matter, cerebellum, extracerebral CSF, and ventricular CSF. MR images were reviewed for ischemic brain injury. RESULTS Total fetal brain volume, cortical gray matter, and unmyelinated white matter positively correlated with preoperative neonatal total brain volume, cortical gray matter, and unmyelinated white matter (r = 0.5-0.58); fetal ventricular CSF and extracerebral CSF correlated with neonatal ventricular CSF and extracerebral CSF (r = 0.64 and 0.82). Fetal cortical gray matter, unmyelinated white matter, and the cerebellum were negatively correlated with neonatal ischemic injury (r = -0.46 to -0.41); fetal extracerebral CSF and ventricular CSF were positively correlated with neonatal ischemic injury (r = 0.40 and 0.23). Unmyelinated white matter:total brain volume ratio decreased with increasing postmenstrual age, with a parallel increase of cortical gray matter:total brain volume and cerebellum:total brain volume. Fetal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios decreased with increasing postmenstrual age; however, neonatal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios increased with postmenstrual age. CONCLUSIONS This study reveals that fetal brain volumes relate to neonatal brain volumes in critical congenital heart disease, with a negative correlation between fetal brain volumes and neonatal ischemic injury. Fetal brain imaging has the potential to provide early neurologic biomarkers.
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Affiliation(s)
- N H P Claessens
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.) .,Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.).,Pediatric Intensive Care (N.H.P.C., N.J.G.J.)
| | - N Khalili
- Image Sciences Institute (N.K., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - I Isgum
- Image Sciences Institute (N.K., I.I.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Ter Heide
- Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.)
| | - T J Steenhuis
- Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.)
| | - E Turk
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.)
| | - N J G Jansen
- Pediatric Intensive Care (N.H.P.C., N.J.G.J.).,Department of Pediatrics (N.J.G.J.), Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - L S de Vries
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.)
| | - J M P J Breur
- Pediatric Cardiology (N.H.P.C., H.t.H., T.J.S., J.M.P.J.B.)
| | - R de Heus
- Obstetrics (R.d.H.), Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - M J N L Benders
- From the Departments of Neonatology (N.H.P.C., E.T., L.S.d.V., M.J.N.L.B.)
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12
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Claessens NHP, Jansen NJG, Breur JMPJ, Algra SO, Stegeman R, Alderliesten T, van Loon K, de Vries LS, Haas F, Benders MJNL, Lemmers PMA. Postoperative cerebral oxygenation was not associated with new brain injury in infants with congenital heart disease. J Thorac Cardiovasc Surg 2019; 158:867-877.e1. [PMID: 30982585 DOI: 10.1016/j.jtcvs.2019.02.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 02/10/2019] [Accepted: 02/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postoperative indices of cerebral oxygenation and autoregulation in infants with critical congenital heart disease in relation to new postoperative ischemic brain injury. METHODS This prospective, clinical cohort included 77 infants with transposition of the great arteries (N = 19), left ventricular outflow tract obstruction (N = 30), and single ventricle physiology (N = 28) undergoing surgery at 30 days or less of life. Postoperative near-infrared spectroscopy and physiologic monitoring were applied to extract mean arterial blood pressure, regional cerebral oxygen saturation, fractional tissue oxygen extraction, and regional cerebral oxygen saturation mean arterial blood pressure correlation coefficient (≥0.5 considered sign of impaired cerebral autoregulation). New postoperative ischemic injury was defined as moderate-severe white matter injury or focal infarction on magnetic resonance imaging. Low cardiac output syndrome was measured as lactate greater than 4 mmol/L with pH less than 7.30. RESULTS After surgery, regional cerebral oxygen saturation was decreased in all congenital heart disease groups with a notable increase in regional cerebral oxygen saturation between 6 and 12 hours after surgery, on average with a factor of 1.4 (range, 1.1-2.4). Both single ventricle physiology and postoperative low cardiac output syndrome were associated with lower regional cerebral oxygen saturation and increased time with correlation coefficient of 0.5 or greater. New postoperative ischemic injury was seen in 39 patients (53%) and equally distributed across congenital heart disease groups. Postoperative regional cerebral oxygen saturation, fractional tissue oxygen extraction, and correlation coefficient were not independently associated with new postoperative white matter injury or focal infarction (mixed-model analysis, all F > 0.12). CONCLUSIONS Postoperative indices of cerebral oxygenation and cerebral autoregulation are not independent predictors of new ischemic brain injury in infants with critical congenital heart disease. Further exploration of the complex interplay among low regional cerebral oxygen saturation, low cardiac output syndrome, and heart defect is required to identify potential biomarkers enabling early intervention for ischemic brain injury.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Selma O Algra
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raymond Stegeman
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim van Loon
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Claessens NHP, Noorlag L, Weeke LC, Toet MC, Breur JMPJ, Algra SO, Schouten ANJ, Haas F, Groenendaal F, Benders MJNL, Jansen NJG, de Vries LS. Amplitude-Integrated Electroencephalography for Early Recognition of Brain Injury in Neonates with Critical Congenital Heart Disease. J Pediatr 2018; 202:199-205.e1. [PMID: 30144931 DOI: 10.1016/j.jpeds.2018.06.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 02/26/2018] [Revised: 05/07/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study perioperative amplitude-integrated electroencephalography (aEEG) as an early marker for new brain injury in neonates requiring cardiac surgery for critical congenital heart disease (CHD). STUDY DESIGN This retrospective observational cohort study investigated 76 neonates with critical CHD who underwent neonatal surgery. Perioperative aEEG recordings were evaluated for background pattern (BGP), sleep-wake cycling (SWC), and ictal discharges. Spontaneous activity transient (SAT) rate, inter-SAT interval (ISI), and percentage of time with an amplitude <5 µV were calculated. Routinely obtained preoperative and postoperative magnetic resonance imaging of the brain were reviewed for brain injury (moderate-severe white matter injury, stroke, intraparenchymal hemorrhage, or cerebral sinovenous thrombosis). RESULTS Preoperatively, none of the neonates showed an abnormal BGP (burst suppression or worse) or ictal discharges. Postoperatively, abnormal BGP was seen in 18 neonates (24%; 95% CI, 14%-33%) and ictal discharges was seen in 13 neonates (17%; 95% CI, 8%-26%). Abnormal BGP and ictal discharges were more frequent in neonates with new postoperative brain injury (P = .08 and .01, respectively). Abnormal brain activity (ie, abnormal BGP or ictal discharges) was the single risk factor associated with new postoperative brain injury in multivariable logistic regression analysis (OR, 4.0; 95% CI, 1.3-12.3; P = .02). Postoperative SAT rate, ISI, or time <5 µV were not associated with new brain injury. CONCLUSION Abnormal brain activity is an early, bedside marker of new brain injury in neonates undergoing cardiac surgery. Not only ictal discharges, but also abnormal BGP, should be considered a clear sign of underlying brain pathology.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Lotte Noorlag
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Pediatric Neurology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mona C Toet
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Selma O Algra
- Department of Radiology; University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antonius N J Schouten
- Department of Anesthesiology; University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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Claessens NHP, Algra SO, Ouwehand TL, Jansen NJG, Schappin R, Haas F, Eijsermans MJC, de Vries LS, Benders MJNL. Perioperative neonatal brain injury is associated with worse school-age neurodevelopment in children with critical congenital heart disease. Dev Med Child Neurol 2018; 60:1052-1058. [PMID: 29572821 DOI: 10.1111/dmcn.13747] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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] [Accepted: 02/06/2018] [Indexed: 12/18/2022]
Abstract
AIM To assess the impact of perioperative neonatal brain injury and brain volumes on neurodevelopment throughout school-age children with critical congenital heart disease (CHD). METHOD Thirty-four survivors of neonatal cardiac surgery (seven females, 27 males) were included. Neonatal preoperative and postoperative cerebral magnetic resonance imaging was performed and neurodevelopment was assessed at 24 months (SD 0.7, n=32, using Bayley Score of Infant and Toddler Development, Child Behavior Checklist) and 6 years (mean age 5y 11mo; SD 0.3, n=30, using Movement Assessment Battery for Children, Wechsler Preschool and Primary Scale of Intelligence, Child Behavior Checklist, Teacher Report Form). Brain injury, brain volumes, and cortical measures were related to outcome with adjustment for maternal educational level. RESULTS Two-year cognitive score and 6-year Full-scale IQ were poorer in children with neonatal white matter injury (n=21, all p<0.05), with higher teacher-reported attention problems (p=0.03). Five of six children with involvement of the posterior limb of the internal capsule showed motor problems (p=0.03). Children with a below-average Fulll-scale IQ (<85, n=9) showed smaller volumes of basal ganglia thalami (-8%, p=0.03) and brain stem (-7%, p=0.03). INTERPRETATION Our findings provide evidence of unfavourable outcome in school-age children with critical CHD who acquire perioperative neonatal brain injury. WHAT THIS PAPER ADDS This paper extends knowledge about neonatal brain injury and long-term outcome in congenital heart disease. Children with white matter injury show lower IQ and more attention problems at school age. Injury of the posterior limb of the internal capsule increases the risk of motor problems. This study provides evidence for worse outcomes in neonates acquiring brain injury around cardiac surgery.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.,Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.,Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands.,Brain Centre Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Selma O Algra
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom L Ouwehand
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Renske Schappin
- Department of Medical Psychology and Social Work, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Maria J C Eijsermans
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.,Child Development and Exercise Center, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.,Brain Centre Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.,Brain Centre Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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15
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Drost FJ, Keunen K, Moeskops P, Claessens NHP, van Kalken F, Išgum I, Voskuil-Kerkhof ESM, Groenendaal F, de Vries LS, Benders MJNL, Termote JUM. Severe retinopathy of prematurity is associated with reduced cerebellar and brainstem volumes at term and neurodevelopmental deficits at 2 years. Pediatr Res 2018; 83:818-824. [PMID: 29320482 DOI: 10.1038/pr.2018.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Received: 07/25/2017] [Accepted: 12/24/2017] [Indexed: 11/09/2022]
Abstract
BackgroundTo evaluate the association between severe retinopathy of prematurity (ROP), measures of brain morphology at term-equivalent age (TEA), and neurodevelopmental outcome.MethodsEighteen infants with severe ROP (median gestational age (GA) 25.3 (range 24.6-25.9 weeks) were included in this retrospective case-control study. Each infant was matched to two extremely preterm control infants (n=36) by GA, birth weight, sex, and brain injury. T2-weighted images were obtained on a 3 T magnetic resonance imaging (MRI) at TEA. Brain volumes were computed using an automatic segmentation method. In addition, cortical folding metrics were extracted. Neurodevelopment was formally assessed at the ages of 15 and 24 months.ResultsInfants with severe ROP had smaller cerebellar volumes (21.4±3.2 vs. 23.1±2.6 ml; P=0.04) and brainstem volumes (5.4±0.5 ml vs. 5.8±0.5 ml; P=0.01) compared with matched control infants. Furthermore, ROP patients showed a significantly lower development quotient (Griffiths Mental Development Scales) at the age of 15 months (93±15 vs. 102±10; P=0.01) and lower fine motor scores (10±3 vs. 12±2; P=0.02) on Bayley Scales (Third Edition) at the age of 24 months.ConclusionSevere ROP was associated with smaller volumes of the cerebellum and brainstem and with poorer early neurodevelopmental outcome. Follow-up through childhood is needed to evaluate the long-term consequences of our findings.
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Affiliation(s)
- Femke J Drost
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Kristin Keunen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Pim Moeskops
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Femke van Kalken
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | | | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jacqueline U M Termote
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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Claessens NHP, Kelly CJ, Counsell SJ, Benders MJNL. Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease. Dev Med Child Neurol 2017; 59:894-902. [PMID: 28542743 DOI: 10.1111/dmcn.13461] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 03/17/2017] [Indexed: 01/12/2023]
Abstract
This review integrates data on brain dysmaturation and acquired brain injury using fetal and neonatal magnetic resonance imaging (MRI), including the contribution of cardiovascular physiology to differences in brain development, and the relationship between brain abnormalities and subsequent neurological impairments in infants with congenital heart disease (CHD). The antenatal and neonatal period are critical for optimal brain development; the developing brain is particularly vulnerable to haemodynamic disturbances during this time. Altered cerebral perfusion and decreased cerebral oxygen delivery in the antenatal period can affect functional and structural brain development, while postnatal haemodynamic fluctuations may cause additional injury. In critical CHD, brain dysmaturation and acquired brain injury result from a combination of underlying cardiovascular pathology and surgery performed in the neonatal period. MRI findings in infants with CHD can be used to evaluate potential clinical risk factors for brain abnormalities, and aid prediction of functional outcomes at an early stage. In addition, information on timing of brain dysmaturation and acquired brain injury in CHD has the potential to be used when developing strategies to optimize neurodevelopment.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christopher J Kelly
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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