Objective: To investigate the changes of dynamic functional connectivity (DFC) in late preterm infants, and assess whether these changes are associated with the indicators measuring the maturity of neonates. Methods: Resting-state fMRI (rs-fMRI) data of eligible neonates was acquired with a 3.0-T MRI scanner in the Department of Radiology, Daping Hospital, Army Medical University (Chongqing, China). After the selection of functional connectivity networks obtained by independent component analysis (ICA), a sliding-window approach was used to cluster all the windows into different states. Then the differences of temporal properties of DFC between groups were compared, and the association between these temporal properties and the degree of maturity was also explored in each state. Results: Eventually, 34 late preterm and 37 term neonates were included in the final analysis. Based on their data, 5 components were located in 5 networks: default-mode (DMN), dorsal attention (DAN), auditory (AUD), sensorimotor (SMN), and visual (VN). Then four reoccurring state patterns of functional connectivity were identified with the k-means clustering method. The late preterm group dwelled significantly longer in State III (late preterm: 33.57 ± 37.64 s, term: 18.50 ± 11.71 s; P = 0.03), which was characterized by general weaker connectivity between networks. Also, the correlation analysis shows the degree of maturity is negatively correlated to the dwell time and fractional windows in State III. Conclusion: Our findings suggested that compared with term infants, late preterm infants preferred to stay in a state with general weak connectivity between networks, but this preference declined as maturity increased.
Many seizures in neonates are due to early-onset epilepsy, which is often difficult to diagnose, especially to explore the causes. Recently, the development of next-generation sequencing (NGS) has led to the discovery of a large number of genes involved in epilepsy. This may improve prompt detection of early-onset epilepsy in neonates. This study aimed at analyzing the genotype-phenotype correlations in neonates with seizures in a bid to improve the understanding of genetic diagnosis of early-onset epilepsy. Clinical features and prognosis of 15 children who underwent genetic testing having had unexplained seizures from February 2016 to May 2018 in Children's Hospital of Chongqing Medical University were analyzed retrospectively. The salient findings were: poor response to stimulus and abnormal electroencephalogram (EEG) in the initial period were observed in the group with concomitant genetic abnormalities. Despite the recent progress in genetic technology, molecular diagnosis for neonatal-onset epilepsy can be challenging due to genetic and phenotypic heterogeneities. However, some genotypes are associated with specific clinical manifestations and EEG patterns. Therefore, in-depth understanding of genotype-phenotype correlations would be useful to clinicians managing neonates with early-onset seizures.
: Preterm infants are at high risk of brain injury. With more understanding of the preterm brain injury's pathogenesis, neuroscientists are looking for more effective methods to prevent and treat it, among which erythropoietin (Epo) is considered as a prime candidate. This review tries to clarify the possible mechanisms of Epo in preterm neuroprotection and summarize updated evidence considering Epo as a pharmacological neuroprotective strategy in animal models and clinical trials. To date, various animal models have validated that Epo is an anti-apoptotic, anti-inflammatory, anti-oxidant, anti-excitotoxic, neurogenetic, erythropoietic, angiogenetic, and neurotrophic agent, thus preventing preterm brain injury. However, although the scientific rationale and preclinical data for Epo's neuroprotective effect are promising, when translated to bedside, the results vary in different studies, especially in its long-term efficacy. Based on existing evidence, it is still too early to recommend Epo as the standard treatment for preterm brain injury.
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