Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

Haastert, Ingrid C. van; Groenendaal, Floris; Uiterwaal, Cuno S.P.M.; Termote, J.; Heide-Jalving, Marja van der; Eijsermans, Maria J.C.; Gorter, Jan Willem; Helders, Paul J. M.; Jongmans, Marian J.; Vries, Linda S. de

doi:10.1016/j.jpeds.2010.12.053

Cited by 166 publications

(111 citation statements)

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“…A neonatológia fejlődése az utóbbi években csökkentette a PVL incidenciáját [60]. A vérnyomás monitorozása lehetővé vált, az alattomos hypotensiós epizódok felismerésének esélye javult, ezáltal hatékonyabban kontrollálhatóvá vált.…”

Section: Periventricularis Leukomalacia (Pvl)unclassified

Chronic morbidities of premature newborns

Balla

Szabó

2013

Orvosi Hetilap

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A retinopathia prematurorum, a bronchopulmonalis dysplasia, az intraventricularis haemorrhagia és a periventricularis leukomalacia a koraszülöttek legfontosabb krónikus utóbetegségei, amelyek alapvetően befolyásolják a gyermekek életminőségét. Mivel Magyarországon a koraszülés gyakorisága az elmúlt években nem csökkent, és a kialakult kórképek nehezen kezelhetők, a megelőzés jelentősége óriási. Kockázatifaktor-elemzések bebizonyították, hogy mindegyik kórkép multifaktoriális, a számos közös kóroki tényező közül a fejlődő szervek angiogenesise az egyik legfontosabb. A koraszülés következtében számos stresszhatás miatt károsodhat az érfejlődés. A megszületés után, a méhen belüli élethez viszonyítva, a relatív hyperoxia és a csökkenő vascularis növekedési faktorok szintje érsérü-lést, akár vascularis apoptózist okozhat. Mindezek következtében, a folyamat későbbi fázisában, a hypoxia által indukált gének aktiválódnak, óriási mértékű és kóros neovascularisatio, krónikus szervkárosodás alakul ki. A normális angiogenesis megtartása és a reaktív neovascularisatio gátlása a koraszülöttek jobb életminőségét eredményezheti. Orv. Hetil., 2013, 154, 1498-1511 Kulcsszavak: retinopathia prematurorum, bronchopulmonalis dysplasia, intraventricularis haemorrhagia, periventricularis leukomalacia Chronic morbidities of premature newbornsThe most important chronic morbidities of premature newborns, deeply infl uencing quality of life, are retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage and periventricular leukomalacia. Since the rate of premature birth has not decreased in recent years in Hungary, and treatments of these end stage disorders are extremely diffi cult, prevention gains tremendous signifi cance. Effective prevention is based on detailed knowledge of the pathophysiological mechanisms of these special diseases having multifactorial nature sharing several common risk factors, and one is the pathological angiogenesis. This sensitive system is affected by several stress situations which are the consequences of prematurity leading to abnormal vascular growth. After birth, relative hyperoxia, compared to intrauterine life, and decreasing concentrations of vascular growth factors result in vascular injury, moreover, may cause vessel apoptosis. The consequence of this phenomenon is the activation of hypoxia responsible genes resulting in robust pathological neovascularization and organ damage during the later phase. Saving normal angiogenesis and inhibiting reactive neovascularization may lead to better quality of life in these premature infants. Orv. Hetil., 2013, 154, 1498-1511 Keywords: retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia (Beérkezett: 2013. augusztus 6.; elfogadva: 2013. augusztus 22.) A szerkesztőség felkérésére készült közlemény. Rövidítések ANGPT-2 = angiopoetin-2; β-ARs = béta-adrenerg receptorok; BPD = bronchopulmonalis dysplasia; CP = cerebral palsy; ELBW = (extremely low birthweight) extrém kis születés...

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Section: Periventricularis Leukomalacia (Pvl)unclassified

Chronic morbidities of premature newborns

Balla

Szabó

2013

Orvosi Hetilap

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“…Despite the decreasing incidence of cerebral palsy in children born prematurely [1], motor impairments, such as developmental coordination disorder, remain a considerable problem in this population [2]. In a prospective cohort of 55 premature newborns (24-32 weeks gestational age), we used serial diffusion tensor tractography to identify that altered development during the neonatal period of the major voluntary motor pathway, the corticospinal tract, was related to moderate-severe brain injuries and postnatal infection [3].…”

Section: Introductionmentioning

confidence: 99%

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Zwicker¹,

Grunau²,

Adams³

et al. 2013

Pediatric Neurology

115

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Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of ante-, peri-, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks gestational age) underwent serial brain imaging near birth and at term-equivalent age. Using diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development.The perinatal risk factor of greater early illness severity [as measured by the Score for Neonatal Acute Physiology-II (SNAP-II)] was associated with a slower rise in fractional anisotropy of the corticospinal tract (p=0.02), even after correcting for gestational age at birth and postnatal risk factors (p=0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (p=0.03 and 0.02 respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.

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“…espite advances in neonatal intensive care that have led to a decline in morbidity, preterm birth is still associated with neurological sequelae (1). Brain injury in preterm infants is often caused by disturbances in cerebral blood flow (CBF) and oxygenation (2)(3)(4).…”

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confidence: 99%

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

et al. 2015

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ArticlesBackground: Currently, reliable reference values of regional cerebral oxygen saturation (rScO 2 ) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO 2 ) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO 2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO 2 − rScO 2 )/SaO 2 ) for small adult and neonatal NIRS sensors. Methods: In this study, 999 infants born preterm (GA <32 wk) were monitored with NIRS during the first 72 h of life. Mixed modeling was used to generate reference curves grouped per 2 wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. results: Average rScO 2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. conclusion: rScO 2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care. d espite advances in neonatal intensive care that have led to a decline in morbidity, preterm birth is still associated with neurological sequelae (1). Brain injury in preterm infants is often caused by disturbances in cerebral blood flow (CBF) and oxygenation (2-4). Evidence is accumulating that monitoring blood pressure alone is not enough to ensure adequate (cerebral) perfusion and oxygenation (5,6).Near-infrared spectroscopy (NIRS) is a technique that can be used to monitor regional cerebral oxygen saturation (rScO 2 ), being both a measure of cerebral oxygenation as well as a surrogate of CBF. NIRS monitoring can be applied for prolonged periods of time, even in the most vulnerable infants (7). It uses multiple wavelengths of NIR light and relies on the distinct absorption spectra of oxygenated (O 2 Hb) and deoxygenated (HHb) hemoglobin to calculate relative concentrations of O 2 Hb and HHb, which are then used to calculate the rScO 2 (O 2 Hb/(O 2 Hb + HHb)). Where pulse-oximetry only measures the oxygen saturation in arterial blood (SaO 2 ), NIRS makes no distinction between different (cerebral) blood volume compartments; therefore, the rScO 2 represents the oxygen saturation in a mixed arterial-capillary-venous compartment in an approximate 20:5:75 distribution (8).NIRS is increasingly being used as a trend monitor of cerebral oxygen supply in neonates admitted to the neonatal intensive care unit (NICU). Readily interpretable reference values could provide another way of using NIRS in neonates by identifying neonates at risk. In other words, to identify neonates whose rScO 2 resides at the outskirts (high or low) of what is considered "normal. " Furthermore, reliable reference values could benefit NIRS research by...

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Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

Cited by 166 publications

References 27 publications

Chronic morbidities of premature newborns

Chronic morbidities of premature newborns

Score for Neonatal Acute Physiology–II and Neonatal Pain Predict Corticospinal Tract Development in Premature Newborns

Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates

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