In the human brain, the morphology of cortical gyri and sulci is complex and variable among individuals, and it may reflect pathological functioning with specific abnormalities observed in certain developmental and neuropsychiatric disorders. Since cortical folding occurs early during brain development, these structural abnormalities might be present long before the appearance of functional symptoms. So far, the precise mechanisms responsible for such alteration in the convolution pattern during intra-uterine or post-natal development are still poorly understood. Here we compared anatomical and functional brain development in vivo among 45 premature newborns who experienced different intra-uterine environments: 22 normal singletons, 12 twins and 11 newborns with intrauterine growth restriction (IUGR). Using magnetic resonance imaging (MRI) and dedicated post-processing tools, we investigated early disturbances in cortical formation at birth, over the developmental period critical for the emergence of convolutions (26-36 weeks of gestational age), and defined early 'endophenotypes' of sulcal development. We demonstrated that twins have a delayed but harmonious maturation, with reduced surface and sulcation index compared to singletons, whereas the gyrification of IUGR newborns is discordant to the normal developmental trajectory, with a more pronounced reduction of surface in relation to the sulcation index compared to normal newborns. Furthermore, we showed that these structural measurements of the brain at birth are predictors of infants' outcome at term equivalent age, for MRI-based cerebral volumes and neurobehavioural development evaluated with the assessment of preterm infant's behaviour (APIB).

BACKGROUND AND PURPOSE: WM injury is associated with different disabilities that children born prematurely may experience during their lives. The aim of this study was to use TBSS to test the hypothesis that WM microstructure at TEA in preterm infants is correlated with cognitive and motor outcome at 2-year corrected age.

Twin anemia-polycythemia sequence (TAPS) results from slow intertwin blood transfusion through minuscule placental vascular anastomoses and is characterized by large intertwin hemoglobin differences in the absence CASE REPORTA 28-year-old primigravida was referred to our institution at 15 + 6 weeks' gestation owing to suspected twin-twin transfusion syndrome (TTTS). Serial ultrasoundCorrespondence to: Dr E. Lopriore, Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands (e-mail: e.lopriore@lumc.nl) Accepted: 19 September 2012examination showed normal amniotic fluid volume in both sacs and normal bladder filling in both fetuses, without signs of TTTS. Routine measurements of middle cerebral artery peak systolic velocity (MCA-PSV) with Doppler ultrasound were performed on a weekly or biweekly basis. MCA-PSV in Twin A (recipient) was low (< 0.8 multiples of the median (MoM)), suggesting the presence of polycythemia, whereas MCA-PSV in Twin B (donor) was often increased (> 1.5 MoM), suggesting the presence of anemia (Figure 1), indicative of twin anemia-polycythemia sequence (TAPS). After counseling, the parents opted for a conservative management approach.At 30 weeks' gestation, the patient was referred back to her own obstetrician. At 34 + 5 weeks, a Cesarean section was performed owing to signs of fetal distress in the recipient. The first-born twin (recipient) was plethoric and weighed 2065 g and the second-born twin (donor) was pale and weighed 1805 g. Umbilical cord pH in the first and second twins was 7.21 and 7.20, respectively and Apgar scores (at 1 and 5 min) were 8/9 and 9/9, respectively. Hemoglobin levels and reticulocyte counts in recipient and donor were 25.4 and 4.3 g/dL (difference, 21.1 g/dL) and 12.3 and 66.4% (reticulocyte count ratio of 5.4), respectively, fulfilling the postnatal criteria for severe TAPS stage 5 1 .A partial exchange transfusion was performed in the recipient twin, who also had thrombocytopenia at birth (platelet count, 98 × 10 9 /L). Soon after the partial exchange transfusion, the recipient developed respiratory insufficiency with apnea and was transferred to the neonatal intensive care unit for mechanical ventilation. The infant subsequently developed disseminated intravascular coagulation (DIC) and worsening thrombocytopenia, for which he received several fresh frozen plasma and platelet

BACKGROUND AND PURPOSE:Signal-intensity abnormalities in the PLIC and thinning of the CC are often seen in preterm infants and associated with poor outcome. DTI is able to detect subtle abnormalities. We used FT to select bundles of interest (CC and PLIC) to acquire additional information on the WMI.

Background: Previous studies have shown a disrupted development of cerebral blood vessels at term-equivalent age in prematurely born infants. Objective: To assess the anatomy of the circle of Willis in preterm neonates (gestational age 25–31 weeks) at term-equivalent age and to evaluate the relation between anatomic variations and blood flow through the internal carotid arteries (ICAs) and basilar artery (BA). Methods: In 72 preterm neonates, flow measurements (ml/min) were obtained with 2-D phase-contrast magnetic resonance angiography (MRA) at term-equivalent age. Time-of-flight MRA was used to assess the circle of Willis for a dominant A1 segment of the anterior cerebral artery or a fetal-type posterior cerebral artery. Differences in flow were assessed with ANOVA. Results: In our cohort, 53/72 (74%) neonates showed a variant type of the circle of Willis. The flow in the ICA at the side of a dominant A1 segment (43.3 ml/min) was significantly increased compared to the flow in the contralateral ICA (33.0 ml/min; p = 0.009) and tended to be higher than in the ICA in children with a normal anterior anatomy (38.4 ml/min; p = 0.1). The flow in the BA was highest in neonates with a normal configuration of the posterior part of the circle of Willis (32.6 ml/min) compared to children with a unilateral (25.3 ml/min; p = 0.002) or bilateral fetal-type posterior cerebral artery (18.6 ml/min; p < 0.001). Conclusion: Preterm neonates show a high prevalence of variant types of the circle of Willis at term-equivalent age. A relation could be demonstrated between variations in the circle of Willis and the flow in the ICA and BA.

Left ventricular output (LVO), left pulmonary artery blood flow (LPA) and patency of the ductus arteriosus (PDA) were studied with 2D/pulsed Doppler ultrasound before, during and after phototherapy treatment in 27 preterm infants (gestational age ≤ 32 wk), who were exposed for a minimum of 12 h to phototherapy for non‐haemolytic hyperbilirubinemia. In 14 infants (52%) the ductus arteriosus reopened during phototherapy, but ductal patency was not of haemodynamic importance. LVO initially decreased in preterm infants in whom the ductus did not reopen. From 12 h until discontinuation of phototherapy, LVO and LPA were higher than before phototherapy in all infants. After withdrawal of phototherapy, LVO and LPA returned to pre‐phototherapy values. □Cardiac output, patent ductus arteriosus, phototherapy, preterm

Delay in development after open-heart surgery in infants has frequently been reported. Inadequate brain perfusion and oxygenation during deep hypothermic cardiopulmonary bypass (CPB) may play an important role. We investigated the effect of CPB on cerebral perfusion and oxygenation in 12 neonates and infants (age 0–11 months) undergoing open-heart surgery. Changes in cerebral blood volume (ΔCBV; in ml/100 g brain tissue) and oxidation level of the intracerebral mitochondrial enzyme cytochrome aa₃ (ΔCytaa₃; in µmol/l) were measured with near infrared spectroscopy. Nasopharyngeal temperature (T_nas) for assessment of changes in brain temperature, and mean arterial blood pressure (MAP) were monitored continuously. CBV lowered during cooling and increased during rewarming. These changes were only related with changes in Tnas (p < 0.001; 0.07 ml·100 g^-1/°C). No relation was found with changes in MAP or pump flow rate of the heart-lung machine. During steady-state hypothermic CPB, changes in CBV were only related to changes in MAP (p < 0.001). The individual regression lines between ΔCBV and MAP became steeper at lower absolute T_nas. Cytaa₃ showed an increase shortly after the initiation of CPB in 9 patients, with a sustained decrease to baseline values in 8 patients towards the end of the CPB period. Two patients who had a circulatory arrest during CPB had a sharp decrease in Δcytaa₃ after cessation of the heart-lung pump and showed no complete recovery of ΔCytaa₃ to baseline at the end of the CPB period. We conclude that changes in CBV during CPB are related to changes in T_nas. During deep hypothermic steady-state CPB, changes in CBV and MAP were related to each other, suggesting lack of cerebral autoregulation. The large decrease in Cytaa₃ in 2 patients with circulatory arrest suggests that this procedure compromises energy metabolism of the brain cell.

Cerebral blood flow velocity was studied with two‐dimensional/pulsed Doppler ultrasound before, during and after discontinuation of phototherapy in 22 preterm infants (gestational age ≤ 32 weeks), who were treated for a minimum of 12 h with blue‐light phototherapy for non‐haemolytic hyperbilirubinaemia. Before the cerebral blood flow velocity measurements, patency of the ductus arteriosus was diagnosed by Doppler echocardiography. All infants had normal brain ultrasound scans. Mean cerebral blood flow velocity increased significantly after initiation of phototherapy in all infants. Only in “healthy” (non‐ventilated) infants did cerebral blood flow velocity return to pre‐phototherapy values (baseline) after discontinuation of phototherapy, whereas in “unhealthy” (ventilated) infants cerebral blood flow velocity did not return to baseline. In 10 infants the ductus arteriosus reopened during phototherapy. In those infants, mean cerebral blood flow velocity returned to pre‐phototherapy values after 2 h of phototherapy prior to its discontinuation.