Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study

Inder, Terrie E.; Wells, Scott J.; Mogridge, N; Spencer, Carole A.; Volpe, Joseph J.

doi:10.1067/s0022-3476(03)00357-3

Cited by 455 publications

(213 citation statements)

References 40 publications

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“…In addition, most studies included only cases of cystic PVL, which is now estimated to constitute less than 10% of all cases of white matter damage. Cerebral non-cystic white matter injury has been related to perinatal infection, particularly maternal fever and infant sepsis [22]. The role of proven sepsis, independent of other risk factors, in the development of neurological impairment in extremely preterm infants has also been shown by others [23].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Rodrigo

Henríquez²,

Aloy³

et al. 2014

Neonatology

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Background: Chorioamnionitis is a recognized risk factor of preterm delivery; however, controversy still persists concerning the relationship between maternal inflammation and neonatal morbidity and mortality. Objective: To determine the incidence of clinical chorioamnionitis and its relationship to morbidity and mortality among very-low-birth-weight (VLBW) infants. Methods: This was a retrospective analysis of prospectively collected data of VLBW neonates ≤32 weeks' gestational age (GA) admitted to collaborating units in the Spanish SEN1500 Network between January 2008 and December 2011. Clinical chorioamnionitis was defined by obstetricians based on clinical findings, and neonatal outcomes were compared between exposed and non-exposed infants by multivariate logistic regression analysis. Results: During the study period, 11,464 VLBW newborns were admitted to our units and 10,026 were ≤32 weeks' GA. Among them, 8,330 (83.1%) had complete data and were included. Of these, 1,480 (17.8%) were exposed to maternal clinical chorioamnionitis. The incidence was higher at lower GA and, after adjusting for confounding factors, exposed infants had higher risks of early-onset neonatal sepsis (EONS) (10.0 vs. 2.8%; aOR 3.102; 95% CI 2.306-4.173; p < 0.001) and necrotizing enterocolitis (NEC) (11.2 vs. 7.7%; aOR 1.300; 95% CI 1.021-1.655; p < 0.033), but lower risks of patent ductus arteriosus (PDA) (43.2 vs. 34.9%; aOR 0.831; 95% CI 0.711-0.971; p < 0.02) and late-onset bacterial sepsis (LONS) (36.6 vs. 32.5%; aOR 0.849; 95% CI 0.729-0.989; p < 0.035). There were no differences in mortality between the groups. Conclusions: The incidence of maternal clinical chorioamnionitis is inversely related to GA at delivery, and in VLBW infants ≤32 weeks' GA it is associated with higher risks of EONS and NEC, but lower risks of PDA and LONS. We did not found differences in survival.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Rodrigo

Henríquez²,

Aloy³

et al. 2014

Neonatology

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“…Low-grade intraventricular hemorrhages (IVH grades 1 and 2) were accepted. In addition, all scans were evaluated according to a scoring system for WM abnormalities regarding MRI signal abnormalities, reduction in WM volume, cysts, ventriculomegaly, myelination, and thinning of the corpus callosum (43). Only infants with normal WM according to the scoring system were included in the study (44).…”

Section: Methodsmentioning

confidence: 99%

Resting-state networks in the infant brain

Fransson

Skiöld²,

Horsch³

et al. 2007

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

587

519

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In the absence of any overt task performance, it has been shown that spontaneous, intrinsic brain activity is expressed as systemwide, resting-state networks in the adult brain. However, the route to adult patterns of resting-state activity through neuronal development in the human brain is currently unknown. Therefore, we used functional MRI to map patterns of resting-state activity in infants during sleep. We found five unique resting-states networks in the infant brain that encompassed the primary visual cortex, bilateral sensorimotor areas, bilateral auditory cortex, a network including the precuneus area, lateral parietal cortex, and the cerebellum as well as an anterior network that incorporated the medial and dorsolateral prefrontal cortex. These results suggest that resting-state networks driven by spontaneous signal fluctuations are present already in the infant brain. The potential link between the emergence of behavior and patterns of resting-state activity in the infant brain is discussed.development ͉ functional MRI ͉ spontaneous activity R ecent research on functional connectivity in the brain, in particular during resting-state conditions, has come to focus on low-frequency (Ͻ0.1 Hz), spontaneous fluctuations in the functional MRI (fMRI) signal. Discovered by Biswal et al. (1), it has been shown that systemwide networks in the resting brain are synchronized in time through intrinsic low-frequency signal fluctuations. Whereas early fMRI studies demonstrated synchronicity of intrinsic brain activity across hemispheres in primary sensory cortices (2, 3), succeeding studies have shown temporal synchronization in a resting-state network encompassing higher-order cortices (4). A systematic investigation of resting-state activity in the adult human brain was recently presented by Damoiseaux et al. (5). Using independentcomponent analysis (ICA), a data-driven explorative data analysis approach, they showed that there are numerous networks in the brain that are driven by spontaneous activity. Besides networks that are in part or fully described by the previously reported default mode (6) and task-positive network (7, 8), they found consistent patterns of resting-state activity in the visual cortex, sensorimotor areas, auditory areas, as well as extrastriate brain regions. These findings together with previous investigations on spontaneous activity suggest that the assumption that the brain during rest is idle and waiting to be triggered and respond to changes in the environment is not strictly valid. Rather, in addition to responding to changes in external stimuli or tasks, the brain is characterized by intrinsic dynamics in the form of coherent and spontaneous fluctuations, clustered together in networks that are credible from an anatomical and functional perspective.Interestingly, recent studies have presented evidence that spontaneous activity is relevant for human behavior. Momentary lapses of attention, affecting goal-oriented behavior on a global/ local selective attention task, were related to a fai...

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“…Cerebral white matter (WM) injury is the predominant neuropathological and magnetic resonance imaging finding associated with cerebral palsy [4,5,6]. The two key pathways that contribute to neonatal WM injury are impaired cerebral haemodynamics and localized cerebral inflammation [7].…”

Section: Introductionmentioning

confidence: 99%

Human Amnion Epithelial Cells Modulate Ventilation-Induced White Matter Pathology in Preterm Lambs

et al. 2015

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Background: Preterm infants can be inadvertently exposed to high tidal volumes (V_T) during resuscitation in the delivery room due to limitations of available equipment. High V_T ventilation of preterm lambs produces cerebral white matter (WM) pathology similar to that observed in preterm infants who develop cerebral palsy. We hypothesized that human amnion epithelial cells (hAECs), which have anti-inflammatory and regenerative properties, would reduce ventilation-induced WM pathology in neonatal late preterm lamb brains. Methods: Two groups of lambs (0.85 gestation) were used, as follows: (1) ventilated lambs (Vent; n = 8) were ventilated using a protocol that induces injury (V_T targeting 15 ml/kg for 15 min, with no positive end-expiratory pressure) and were then maintained for another 105 min, and (2) ventilated + hAECs lambs (Vent+hAECs; n = 7) were similarly ventilated but received intravenous and intratracheal administration of 9 × 10⁷ hAECs (18 × 10⁷ hAECs total) at birth. Oxygenation and ventilation parameters were monitored in real time; cerebral oxygenation was measured using near-infrared spectroscopy. qPCR (quantitative real-time PCR) and immunohistochemistry were used to assess inflammation, vascular leakage and astrogliosis in both the periventricular and subcortical WM of the frontal and parietal lobes. An unventilated control group (UVC; n = 5) was also used for qPCR analysis of gene expression. Two-way repeated measures ANOVA was used to compare physiological data. Student's t test and one-way ANOVA were used for immunohistological and qPCR data comparisons, respectively. Results: Respiratory parameters were not different between groups. Interleukin (IL)-6 mRNA levels in subcortical WM were lower in the Vent+hAECs group than the Vent group (p = 0.028). IL-1β and IL-6 mRNA levels in periventricular WM were higher in the Vent+hAECs group than the Vent group (p = 0.007 and p = 0.001, respectively). The density of Iba-1-positive microglia was lower in the subcortical WM of the parietal lobes (p = 0.010) in the Vent+hAECs group but not in the periventricular WM. The number of vessels in the WM of the parietal lobe exhibiting protein extravasation was lower (p = 0.046) in the Vent+hAECs group. Claudin-1 mRNA levels were higher in the periventricular WM (p = 0.005). The density of GFAP-positive astrocytes was not different between groups. Conclusions: Administration of hAECs at the time of birth alters the effects of injurious ventilation on the preterm neonatal brain. Further studies are required to understand the regional differences in the effects of hAECs on ventilation-induced WM pathology and their net effect on the developing brain.

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Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study

Cited by 455 publications

References 40 publications

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Resting-state networks in the infant brain

Human Amnion Epithelial Cells Modulate Ventilation-Induced White Matter Pathology in Preterm Lambs

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