The Vulnerable Newborn Brain: Imaging Patterns of Acquired Perinatal Injury

Abstract

Background: Over the past two decades, imaging techniques have allowed for better visualization of the newborn brain. This has enabled us to detect patterns, understand mechanisms and guide diagnosis and treatment. Objectives: The purpose of this review is to discuss imaging characteristics of acquired perinatal brain injury. Methods: Through literature review and the author's research, this review assesses published data on the distinct imaging patterns that occur in the neonatal period due to acquired brain insults. Results: In the term brain, susceptibility to hypoxia-ischemia, hypoglycemia and hyperbilirubinemia results in unique patterns of injury. Stroke commonly occurs in the newborn period. Infections, especially viral, have distinct patterns of white matter injury. In the preterm brain, white matter injury occurs commonly and is affected by postnatal growth, stress and infection. The cerebellum is uniquely vulnerable during this period, with resultant hemorrhages in almost half of preterm infants. Cerebellar growth is affected by intraventricular hemorrhage, drugs and placental pathology. Periventricular hemorrhagic infarction is the most serious consequence of the spectrum of intraventricular hemorrhage and results in profound disabilities. Conclusions: Taken together, the acquired perinatal brain injuries can have lifelong devastating consequences, so the search for therapies must continue.

MRI Differences Associated with Intrauterine Growth Restriction in Preterm Infants

“…In addition, selective injury to the thalamus and basal ganglion has been reported after exposure of the neonatal brain to hypoxia and ischemia [25,26,27]. The cerebellum is also particularly vulnerable to injury in states of hypoxia and ischemia, hypoglycemia, and hyperbilirubinemia [28]. …”

Factores Asociados a Hemorragia Intraventricular En Neonatos Atendidos En Un Hospital de Segundo Nivel

“…De manera clásica se ha utilizado la escala de Papile para describir la severidad de la HIV (Ferriero, 2016). Grado I: hemorragia limitada en el surco caudotalámico.…”

“…El riesgo de PC está claramente asociado con el grado de HIV (50% en HIV IV vs 8% en HIV I) (Wusthofff, 2016). El IHP es la complicación más grave de la hemorragia intraventricular y resulta en grave discapacidad (Ferriero, 2016). La relación patogénica del IHP con la HIV se base en: 80-90% de las lesiones en parénquima se asocian a HIV extensas y asimétricas, las lesiones homolaterales donde está la HIV extensa y, en algunos casos, las lesiones en parénquima aparecen y progresan al producirse una HIV.…”

Sharing Progress in Neonatal (SPIN) Lung and Brain

“…Donna M. Ferreiro from San Francisco, USA, discussed imaging of neonates with acquired perinatal brain injury in an insightful talk entitled ‘The Vulnerable Newborn Brain: Imaging Patterns of Acquired Perinatal Injury' [4]. In the past two decades imaging techniques have improved to allow much better visualisation of the newborn brain, enabling understanding of mechanisms of injury and guiding diagnosis and treatment.…”

“…This presentation was a logical continuation of Ferreiro's talk, who had set the scene by explaining the vulnerability of the neonatal brain [4]. Stem cell therapy is a promising novel therapy for neonatal brain injury resulting from intraventricular haemorrhage and hypoxia-ischaemia.…”