Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments

Pineda, Roberta; Neil, Jeff; Dierker, Donna L.; Smyser, Christopher D.; Wallendorf, Michael; Kidokoro, Hiroyuki; Reynolds, L.; Walker, Stephanie; Rogers, Cynthia; Mathur, Amit M.; Essen, David C. Van; Inder, Terrie E.

doi:10.1016/j.jpeds.2013.08.047

Cited by 282 publications

(231 citation statements)

References 48 publications

Supporting

Mentioning

220

Contrasting

Unclassified

Order By: Relevance

“…Stressors associated with neonatal intensive care, including respiratory management, social isolation, and nutrition, can also impact negatively on brain development (52)(53)(54). Our data suggest that exposure to the extrauterine environment following preterm birth subtly alters the macrostructural development of the whole-brain structural connectome during the third trimester by reducing the network capacity of the deep gray matter.…”

Section: Discussionmentioning

confidence: 82%

Rich-club organization of the newborn human brain

Ball

Aljabar

Zebari

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

312

326

View full text Add to dashboard Cite

Combining diffusion magnetic resonance imaging and network analysis in the adult human brain has identified a set of highly connected cortical hubs that form a "rich club"-a high-cost, highcapacity backbone thought to enable efficient network communication. Rich-club architecture appears to be a persistent feature of the mature mammalian brain, but it is not known when this structure emerges during human development. In this longitudinal study we chart the emergence of structural organization in mid to late gestation. We demonstrate that a rich club of interconnected cortical hubs is already present by 30 wk gestation. Subsequently, until the time of normal birth, the principal development is a proliferation of connections between core hubs and the rest of the brain. We also consider the impact of environmental factors on early network development, and compare term-born neonates to preterm infants at term-equivalent age. Though rich-club organization remains intact following premature birth, we reveal significant disruptions in both in cortical-subcortical connectivity and short-distance corticocortical connections. Rich club organization is present well before the normal time of birth and may provide the fundamental structural architecture for the subsequent emergence of complex neurological functions. Premature exposure to the extrauterine environment is associated with altered network architecture and reduced network capacity, which may in part account for the high prevalence of cognitive problems in preterm infants.connectome | brain development | tractography | preterm birth T o understand the functional properties of a complex network it is necessary to examine its structural organization and topological properties. In the human brain this can be achieved at a macroscale by tracing white matter connections between brain regions with diffusion MRI; this enables the interrogation of structural network topology in vivo with millimeter-scale spatial resolution, providing complementary evidence to experimental studies (1, 2).Network analysis of the adult human structural connectome has revealed a set of highly connected cortical "hubs" predominantly located in heteromodal association cortex, that provide a foundation for coherent neuronal activation across distal cortical regions (3-5). Further, some hub regions tend to be densely connected to each other, forming a "rich club" comprised of frontal and parietal cortex, precuneus, cingulate and the insula, as well as the hippocampus, thalamus, and putamen (6). Rich-club organization has been identified in a number of complex networks (7) and represents an attractive feature for investigation in the brain because rich-club connections tend to dominate network topology (8). Rich-club architecture appears to be a fundamental feature of the mature mammalian brain with similar organization identified in animal models (9, 10).It has been suggested that the emergence of complex neurological function is associated with the integration of major hubs across the cortex (11,...

show abstract

Section: Discussionmentioning

confidence: 82%

Rich-club organization of the newborn human brain

Ball

Aljabar

Zebari

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

312

326

View full text Add to dashboard Cite

show abstract

“…Furthermore, use of recorded maternal voice as a stimulus may overcome potential lack of appropriate stimulation in single-patient rooms in modern NICUs that may contribute to neurodevelopmental abnormalities and delays. 20 …”

Section: Discussionmentioning

confidence: 99%

A Pacifier-Activated Music Player With Mother’s Voice Improves Oral Feeding in Preterm Infants

et al. 2014

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Preterm infants must develop oral feeding skills before successfully transitioning to home. Pacifier-activated devices playing selected music can improve nonnutritive sucking in preterm infants. A mother' s voice is a positive auditory stimulus for infants. WHAT THIS STUDY ADDS:A brief intervention with a pacifieractivated music player using mother' s voice can decrease tube feeding duration without adverse effects on stress or growth. Operant conditioning with positive reinforcement is an effective developmental strategy to improve preterm infants' feeding skills.abstract OBJECTIVES: We conducted a randomized trial to test the hypothesis that mother' s voice played through a pacifier-activated music player (PAM) during nonnutritive sucking would improve the development of sucking ability and promote more effective oral feeding in preterm infants. METHODS:Preterm infants between 34 0/7 and 35 6/7 weeks' postmenstrual age, including those with brain injury, who were taking at least half their feedings enterally and less than half orally, were randomly assigned to receive 5 daily 15-minute sessions of either PAM with mother' s recorded voice or no PAM, along with routine nonnutritive sucking and maternal care in both groups. Assignment was masked to the clinical team.RESULTS: Ninety-four infants (46 and 48 in the PAM intervention and control groups, respectively) completed the study. The intervention group had significantly increased oral feeding rate (2.0 vs 0.9 mL/min, P , .001), oral volume intake (91.1 vs 48.1 mL/kg/d, P = .001), oral feeds/ day (6.5 vs 4.0, P , .001), and faster time-to-full oral feedings (31 vs 38 d, P = .04) compared with controls. Weight gain and cortisol levels during the 5-day protocol were not different between groups. Average hospital stays were 20% shorter in the PAM group, but the difference was not significant (P = .07).CONCLUSIONS: A PAM using mother' s voice improves oral feeding skills in preterm infants without adverse effects on hormonal stress or growth.

show abstract

“…8 Alterations in brain structure and function have also been reported among infants in private NICU rooms in a NICU with poor family involvement. 12 Two critical issues have not been systematically addressed: (1) the effect of the SFR NICU on neurodevelopmental outcome of the infant and (2) how and why positive and negative effects of the SFR NICU occur. Unraveling these processes will enable us to design NICUs that improve clinical care.…”

mentioning

confidence: 99%

Single-Family Room Care and Neurobehavioral and Medical Outcomes in Preterm Infants

et al. 2014

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT:The single-family room (SFR) NICU is a major response to improve care and reduce developmental morbidity in preterm infants. However, no studies have examined how and why this model is associated with changes in medical and neurobehavioral outcome. WHAT THIS STUDY ADDS:This study shows improved medical and neurodevelopmental outcome in infants hospitalized in the SFR model of care. More important, improvements occurred specifically in relation to increases in maternal involvement and developmental support afforded by the SFR environment. abstract OBJECTIVE: To determine whether a single-family room (SFR) NICU, including factors associated with the change to a SFR NICU, is associated with improved medical and neurobehavioral outcomes. METHODS:Longitudinal, prospective, quasi-experimental cohort study conducted between 2008 and 2012 comparing medical and neurobehavioral outcomes at discharge in infants born ,1500 g. Participants included 151 infants in an open-bay NICU and 252 infants after transition to a SFR NICU. Structural equation modeling was used to determine the role of mediators of relations between type of NICU and medical and neurobehavioral outcomes. RESULTS:Statistically significant results (all Ps #.05) showed that infants in the SFR NICU weighed more at discharge, had a greater rate of weight gain, required fewer medical procedures, had a lower gestational age at full enteral feed and less sepsis, showed better attention, less physiologic stress, less hypertonicity, less lethargy, and less pain. NICU differences in weight at discharge, and rate of weight gain were mediated by increased developmental support; differences in number of medical procedures were mediated by increased maternal involvement. NICU differences in attention were mediated by increased developmental support. Differences in stress and pain were mediated by maternal involvement. Nurses reported a more positive work environment and attitudes in the SFR NICU. CONCLUSIONS:The SFR is associated with improved neurobehavioral and medical outcomes. These improvements are related to increased developmental support and maternal involvement. Pediatrics 2014;134:754-760

show abstract

Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments

Cited by 282 publications

References 48 publications

Rich-club organization of the newborn human brain

Rich-club organization of the newborn human brain

A Pacifier-Activated Music Player With Mother’s Voice Improves Oral Feeding in Preterm Infants

Single-Family Room Care and Neurobehavioral and Medical Outcomes in Preterm Infants

Contact Info

Product

Resources

About