The Discrepancy Between Maturation of Visual-Evoked Potentials and Cognitive Outcome at Five Years in Very Preterm Infants With and Without Hemodynamic Signs of Fetal Brain-Sparing

Scherjon, Sicco A.; Briët, Judy M.; Oosting, Hans; Kok, Joke H.

doi:10.1542/peds.105.2.385

Cited by 160 publications

(121 citation statements)

References 43 publications

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“…Several studies of infants born prematurely evaluated by quantitative volumetric MRI in late childhood have shown reductions in brain volumes and also correlations of these reductions with impaired neurodevelopmental outcome (50,51) and deficits in everyday memory (52) and global cognitive functioning. In outcome studies of IUGR infants with documented signs of placental insufficiency, neurodevelopmental outcome has been characterized predominantly by cognitive impairment at 5, 7, and 9 y of age (2,(53)(54)(55). Hence, our data support the hypothesis that the principal alterations in brain development in IUGR preterm infants occur in cerebral cortex, persist to term age, and disrupt behavioral function at term.…”

Section: Discussionsupporting

confidence: 70%

Early Alteration of Structural and Functional Brain Development in Premature Infants Born with Intrauterine Growth Restriction

Tolsa¹,

et al. 2004

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Placental insufficiency with fetal intrauterine growth restriction (IUGR) is an important cause of perinatal mortality and morbidity and is subsequently associated with significant neurodevelopmental impairment in cognitive function, attention capacity, and school performance. The underlying biologic cause for this association is unclear. Twenty-eight preterm infants (gestational age 32.5 Ϯ 1.9 wk) were studied by early and term magnetic resonance imaging (MRI). An advanced quantitative volumetric three-dimensional MRI technique was used to measure brain tissue volumes in 14 premature infants with placental insufficiency, defined by abnormal antenatal Doppler measurements and mean birth weights Ͻ10 th percentile (1246 Ϯ 299 g) (IUGR) and in 14 preterm infants matched for gestational age with normal mean birth weights 1843 Ϯ 246 g (control). Functional outcome was measured at term in all infants by a specialized assessment scale of preterm infant behavior. Premature infants with IUGR had a significant reduction in intracranial volume (mean Ϯ SD: 253.7 Ϯ 29.9 versus 300.5 Ϯ 43.5 mL, p Ͻ 0.01) and in cerebral cortical gray matter (mean Ϯ SD: 77.2 Ϯ 16.3 versus 106.8 Ϯ 24.6 mL, p Ͻ 0.01) when measured within the first 2 wk of life compared with control premature infants. These findings persisted at term with intracranial volume (mean Ϯ SD: 429.3 Ϯ 47.9 versus 475.9 Ϯ 53.4 mL, p Ͻ 0.05) and cerebral cortical gray matter (mean Ϯ SD: 149.3 Ϯ 29.2 versus 189 Ϯ 34.2 mL, p Ͻ 0.01). Behavioral assessment at term showed a significantly less mature score in the subsystem of attention-interaction availability in IUGR infants (p Ͻ 0.01). Cerebral cortical gray matter volume at term correlated with attention-interaction capacity measured at term (r ϭ 0.45, p Ͻ 0.05). These results suggest that placental insufficiency with IUGR have specific structural and functional consequences on cerebral cortical brain development. These findings may provide insight into the structural-functional correlate for the developmental deficits associated with IUGR. An increasing number of developmental disorders (1, 2) and diseases (3, 4) in child and adult life are thought to have their origin in the fetal period. Central to this predisposition is fetal growth (5). The fetus receives its nutrients from the maternal/ uterine circulation via the placenta. Any disturbance in the placental-fetal circulation will therefore have severe consequences on the supply of important nutrients such as oxygen, glucose, and amino acids (6). The placenta itself is also an active endocrine organ and, therefore, changes in nutrient availability will also affect placental and, potentially, fetal endocrine function, in particular, the modification of the hypothalamo-pituitary-adrenal axis (7,8). Placental insufficiency, which is the most common cause of IUGR, has further been shown to be associated with a considerable perinatal mortality

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Section: Discussionsupporting

confidence: 70%

Early Alteration of Structural and Functional Brain Development in Premature Infants Born with Intrauterine Growth Restriction

Tolsa¹,

et al. 2004

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“…Initially the fetus adapts by means of an accelerated maturation of brain and lungs, but when the limits of compensation are reached, adaptation may be overruled which may result in neurological injury. 28 Yet the early favourable outcome induced by fetal stress may only be a transient phenomenon present in infancy, as Scherjon et al 29 reported that it is associated with less favourable development at school age. Our study indicated that MND is related not only to purely biological factors.…”

Section: Discussionmentioning

confidence: 99%

The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations

Hadders‐Algra

Heineman

Bos

et al. 2009

Develop Med Child Neuro

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AIM Little is known of minor neurological dysfunction (MND) in infancy. This study aimed to evaluate the inter-assessor reliability of the assessment of MND with the Touwen Infant Neurological Examination (TINE) and the construct and predictive validity of MND in infancy.METHOD Inter-assessor agreement was determined in a sample of 40 infants (24 males, 16 females) aged 3 to 12 months (25 born at term: gestational age 37-41wks, median 39; and 15 born preterm, gestational age 24-35wks, median 32). Thirty typically developing term infants (18 males, 12 females; gestational age 37-42wks, median 40) and 59 preterm infants (34 males, 25 females) born at <35 weeks' gestation (gestational age 25-34wks, median 29) participated in the validity study. They were neurologically assessed with the TINE at the corrected ages of 4, 6, 10, and 12 months and with the Hempel assessment at 18 months. RESULTSThe findings indicated that MND can be assessed reliably (inter-assessor agreement: kappa=0.83). MND during infancy was related to prenatal, perinatal, and social factors, and in particular to preterm birth. Neurological condition during infancy was prone to change, but was related to neurological condition at 18 months at all ages tested. INTERPRETATIONWe conclude that MND can be determined reliably in infancy. Important considerations in the construct of MND in infancy are its relation to prenatal and perinatal factors, its limited stability, and its moderate predictive value.Neurological assessment is one of the clinical tools used to monitor development in infants at risk for developmental disorders, such as infants born preterm. Multiple methods are available, such as the Amiel-Tison neurological examination, 1 the Touwen Infant Neurological Examination (TINE), 2 the Hammersmith Infant Neurological Examination (HINE), 3 and the neurofunctional assessment of Picciolini et al. 4 Little is known about the reliability of these widely used methods. 5 The validity of neurological assessments has been studied to some extent; marked neurological dysfunction during infancy has considerable power to predict developmental disability such as cerebral palsy (CP). [5][6][7] However, knowledge about the significance of signs of minor neurological dysfunction (MND) during infancy is scarce.Our knowledge of MND is based in particular on data of children above preschool age. Two distinct forms of MND have been distinguished: simple and complex MND.8 Before the onset of puberty the distinction is based on the number of dysfunctions present; after the onset of puberty classification is based on the type of dysfunction. Simple MND may be regarded as the expression of a normal but non-optimally functioning nervous system (minor neurological difference). In contrast, complex MND is the form of MND which is strongly related to pre-and perinatal adversities and to learning and behavioural disorders. From an aetiological point of view, this suggests that it may be considered as a borderline form of CP.8 It is uncertain whether the concept of simple ...

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“…8). Furthermore, it has also been extensively reported that the prediction of adverse outcome is improved using umbilical and cerebral parameters in a combined ratio, [68][69][70][71][72][73][74] with sensitivities of about 70% 64,69,75 ( Fig. 9).…”

Section: Iugr Versus Normal-sgamentioning

confidence: 99%

“…In addition, controversy exists whether cerebral vasodilatation is a merely protective mechanism or on the contrary is associated with suboptimal neurological development. 91 In a longitudinal cohort of infants born preterm (26-33 weeks), accelerated visual maturation was found using visual evoked cortical potentials at 3 years. At 5 years, these series demonstrated that both the changes in cerebral Doppler and the acceleration of visual maturation were associated with a deficit in cognitive scores.…”

Section: %mentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound and Doppler Management of Intrauterine Growth Restriction

Carrera¹,

Figueras²,

Meler³

2010

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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The Discrepancy Between Maturation of Visual-Evoked Potentials and Cognitive Outcome at Five Years in Very Preterm Infants With and Without Hemodynamic Signs of Fetal Brain-Sparing

Cited by 160 publications

References 43 publications

Early Alteration of Structural and Functional Brain Development in Premature Infants Born with Intrauterine Growth Restriction

Early Alteration of Structural and Functional Brain Development in Premature Infants Born with Intrauterine Growth Restriction

The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations

Ultrasound and Doppler Management of Intrauterine Growth Restriction

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