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Medicina Sep 2023Premature births are an important health indicator for a country. These children have a higher risk of mortality and morbidity. The main brain injuries in preterm... (Review)
Review
Premature births are an important health indicator for a country. These children have a higher risk of mortality and morbidity. The main brain injuries in preterm infants include white matter injuries, intracranial hemorrhages, and cerebellar injuries. These injuries can be detected through brain ultrasound and magnetic resonance imaging (MRI), with MRI being the most sensitive technique. Perinatal brain injuries may have long-term consequences on the neurodevelopment of preterm infants, with an increased risk of cerebral palsy, cognitive, behavioral, sensory, and learning disorders, among others. It is key to implement prevention strategies and early intervention to reduce the negative consequences of brain injuries associated with prematurity. Key words: prematurity, periventricular leukomalacia, intracranial hemorrhage, neurodevelopmental disorders, cerebral palsy.
Topics: Infant, Newborn; Child; Infant; Female; Pregnancy; Humans; Cerebral Palsy; Infant, Premature; Brain; Brain Injuries; Cerebellum
PubMed: 37714118
DOI: No ID Found -
JAMA Network Open Apr 2023Interventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Interventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.
OBJECTIVE
To evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.
DATA SOURCES
MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.
STUDY SELECTION
Randomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.
DATA EXTRACTION AND SYNTHESIS
Two co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.
MAIN OUTCOMES AND MEASURES
The 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.
RESULTS
A total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], -1% [95% CI, -2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, -5% [95% CI, -8% to -3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, -9% [95% CI, -13% to -5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, -3% [95% CI, -4% to -1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, -4% [95% CI, -7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, -30 [95% CI, -368 to -16]).
CONCLUSIONS AND RELEVANCE
Results of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Ethamsylate; Parturition; Adrenal Cortex Hormones; Cerebral Hemorrhage; Indomethacin; Brain Injuries
PubMed: 37052920
DOI: 10.1001/jamanetworkopen.2023.7473 -
Indian Journal of Pediatrics Jun 2022
Topics: Brain; Humans; Infant, Newborn; Leukomalacia, Periventricular
PubMed: 35347637
DOI: 10.1007/s12098-022-04134-y -
Medical Journal, Armed Forces India Apr 2021Periventricular leukomalacia (PVL) is a common magnetic resonance imaging (MRI) finding in cases of hypoxic ischemic encephalopathy. PVL, in MRI, is identified by the... (Review)
Review
Periventricular leukomalacia (PVL) is a common magnetic resonance imaging (MRI) finding in cases of hypoxic ischemic encephalopathy. PVL, in MRI, is identified by the increased signal intensity of periventricular white matter on T2-weighted sequences which is more conspicuous in the posterior cortex. It occurs because of perinatal damage to the cerebral cortex. This insult is in the form of hypoxia, metabolic insults, prematurity, seizures, or infection. Periventricular area is most prone to damage owing to its immaturity and vascular supply. PVL is proven to affect vision in children. Depending on the area and cause of affection, PVL is associated with variable ophthalmic manifestations. It is known that visual function is closely linked to the overall neurodevelopment of a child. A multidisciplinary approach is required to promote the growth and development of these children, and in the midst of multiple disabilities, visual function should not be overlooked. A comprehensive knowledge of the ophthalmological presentation in the developing world can aid us in an early and accurate diagnosis and in intervention for better therapeutic recovery and rehabilitation of these children.
PubMed: 33867629
DOI: 10.1016/j.mjafi.2020.05.013 -
Antioxidants (Basel, Switzerland) Oct 2021Preterm babies are highly susceptible to oxidative stress (OS) due to an imbalance between the oxidant and antioxidant systems. The generation of free radicals (FR)... (Review)
Review
Preterm babies are highly susceptible to oxidative stress (OS) due to an imbalance between the oxidant and antioxidant systems. The generation of free radicals (FR) induces oxidative damage to multiple body organs and systems. OS is the main factor responsible for the development of typical premature infant diseases, such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia, kidney damage, eryptosis, and also respiratory distress syndrome and patent ductus arteriosus. Many biomarkers have been detected to early identify newborns at risk of developing a free radical-mediated disease and to investigate new antioxidant strategies. This review reports the current knowledge on OS in the preterm newborns and the newest findings concerning the use of OS biomarkers as diagnostic tools, as well as in implementing antioxidant therapeutic strategies for the prevention and treatment of these diseases and their sequelae.
PubMed: 34829543
DOI: 10.3390/antiox10111672 -
Journal of Ultrasound Jun 2020Nowadays, cranial ultrasonography (US) of the newborn represents the first imaging method in brain damage study and its possible outcomes. This exam is performed using... (Review)
Review
Nowadays, cranial ultrasonography (US) of the newborn represents the first imaging method in brain damage study and its possible outcomes. This exam is performed using the natural fontanelles, especially the anterior one. It is fast, non-invasive and does not produce any side effect. Ultrasonographic examination is usually performed in cases of prematurity, especially in children with birth weight less than 1500 g, because important informations about the possible presence of pathologies such as cerebral hemorrhage and hypoxic-ischemic encephalopathy are given. This approach can be useful also in the study of pre- and post-natal infections, for example, type II Herpes Simplex virus or Cytomegalovirus infections, or pointing out vascular malformations such as vein of Galen aneurysm. Although less important than methods such as computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of trauma and tumors, ultrasound can provide useful informations or be used in first instance in the suspicion of a brain mass.
Topics: Brain; Brain Diseases; Echoencephalography; Female; Humans; Infant; Infant, Newborn; Male
PubMed: 30552663
DOI: 10.1007/s40477-018-0349-7 -
Research in Developmental Disabilities Apr 2023Thanks to Magnetic Resonance Imaging (MRI) it is now possible to diagnose lesions of the central nervous system (CNS) such as periventricular leukomalacia (PVL) from the... (Review)
Review
BACKGROUND
Thanks to Magnetic Resonance Imaging (MRI) it is now possible to diagnose lesions of the central nervous system (CNS) such as periventricular leukomalacia (PVL) from the first days of life. However, there are still few studies aimed at describing the relationship between MRI and the outcome of visual function in patients with PVL.
AIM
To systematically review and investigate the relationship between MRI neuroimaging and visual impairment arising from PVL.
METHODS AND PROCEDURES
Three electronic databases (PubMed, SCOPUS, Web of Science) were consulted from 15 June 2021-30 September 2021. Of the 81 records identified, 10 were selected for the systematic review. The STROBE Checklist was used to assess the quality of the observational studies.
OUTCOME AND RESULTS
PVL on MRI was found to have a strong association with visual impairment in the various aspects of visual function (visual acuity, ocular motility, visual field); in 60% of these articles, the selected subjects also reported damage to optical radiations.
CONCLUSION AND IMPLICATIONS
there is a clear need for more extensive and detailed studies on the correlation between PVL and visual impairment, in order to set up a personalized early therapeutic-rehabilitation plan. WHAT THIS PAPER ADDS?: Over the past decades numerous studies have reported increasing evidence that one of the most frequent sequelae in subjects with PVL, in addition to motor impairment, is the impairment of visual function even if it is still not clear what different authors mean with the term visual impairment. This systematic review presents an overview of the relationship between structural correlates of MRI and visual impairment in children with periventricular leukomalacia. Interesting correlations emerge between MRI radiological finding and consequences on visual function especially between damage to the periventricular white matter and the impairment of various aspects of visual function and also between the impairment of optical radiation and visual acuity. Thanks to this literature revision, it is now clear that MRI plays an important role in the screening and diagnosis of significant intracranial brain changes in very young children in particular about the outcome of visual function. This is of great relevance since that visual function represents one of the main adaptive functions in the development of the child.
Topics: Infant, Newborn; Humans; Child; Child, Preschool; Leukomalacia, Periventricular; Brain; Magnetic Resonance Imaging; Vision, Low
PubMed: 36796269
DOI: 10.1016/j.ridd.2023.104439 -
Translational Pediatrics Apr 2021Cranial ultrasound (CUS) is an extremely valuable tool to evaluate the brain during the first year of life, in experienced hands. It is the initial screening imaging... (Review)
Review
Cranial ultrasound (CUS) is an extremely valuable tool to evaluate the brain during the first year of life, in experienced hands. It is the initial screening imaging tool to evaluate the infants' brain and complementary to the use of computed tomography (CT) and magnetic resonance imaging (MRI). It is an accessible, inexpensive and harmless technique that can be used bedside as frequently as needed. The aim of this article is to provide a guide for beginners about the indications, basic technical parameters, scanning technique, standardized planes, common variants and the most frequent abnormal findings visualized with this technique. This article will explain a systematic technique to adequately visualize and document all the relevant intracranial structures, using the anterior fontanelle, mastoid fontanelle and Doppler ultrasound. The variants described in this review include the normal sulcation of the premature baby, the peritrigonal echogenic "blush", lenticulostriate vasculopathy (LSV), benign enlargement of the subrarachnoid space in infancy, asymmetric lateral ventricles, connatal cysts, cavum septum pellucidum (CSP), cavum vergae (CV), cavum velum interpositum, megacisterna magna and choroid plexus cysts. This article will describe the sonographic appearance of different types of intracranial hemorrhage of the preterm and term baby, periventricular leukomalacia (PVL), central and peripheral hypoxic-ischemic events of the term baby, neonatal arterial infarction, cerebro-venous sinus thrombosis, congenital and neonatal cerebral infections, hydrocephalus, intracranial solid and cystic masses, and congenital brain malformations.
PubMed: 34012859
DOI: 10.21037/tp-20-399 -
Turk Pediatri Arsivi 2020Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity and inversely associated with gestational age and birth weight. The... (Review)
Review
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity and inversely associated with gestational age and birth weight. The hemorrhage originates from the germinal matrix with an immature capillary bed where vascularization is intense and active cell proliferation is high. It occurs in around 20% of very low-birth-weight preterm neonates. Germinal matrix-intraventricular hemorrhage is less common in females, the black race, and with antenatal steroid use, but is more common in the presence of mechanical ventilation, respiratory distress, pulmonary bleeding, pneumothorax, chorioamnionitis, asphyxia, and sepsis. Ultrasonography is the diagnostic tool of choice for intraventricular hemorrhage and its complications. Approximately 25-50% of the germinal matrix-intraventricular hemorrhage cases are asymptomatic and diagnosed during routine screening. These cases are usually patients with low-grade hemorrhage. Neurologic findings are prominent in severe intraventricular hemorrhage cases. The major complications of the germinal matrix-intraventricular hemorrhage in preterm babies are periventricular hemorrhagic infarction, posthemorrhagic ventricular dilatation, periventricular leukomalacia, and cerebellar hemorrhage. It is an important cause of mortality and morbidity. The management of hemodynamics and ventilation of patients, appropriate follow-up, and early diagnosis and treatment can minimize morbidity. Prognosis in intraventricular hemorrhage is related to the severity of bleeding, parenchymal damage, and the presence of seizures and shunt surgery. The main determinant of prognosis is periventricular hemorrhagic infarction and its severity. Moderate-severe intraventricular hemorrhage can cause posthemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Even mild germinal matrix-intraventricular hemorrhage can result in developmental disorders. Long-term problems such as neurodevelopmental disorders and cerebral palsy are as important as short-term problems. Improving the quality of life of these babies should be aimed through appropriate treatment and follow-up. In this review, intraventricular hemorrhage and complications are discussed.
PubMed: 33061747
DOI: 10.14744/TurkPediatriArs.2020.66742 -
Neurobiology of Disease Aug 2023Oligodendrocytes (OLs), the myelin-forming cells of the central nervous system, are integral to axonal integrity and function. Hypoxia-ischemia episodes can cause severe... (Review)
Review
Oligodendrocytes (OLs), the myelin-forming cells of the central nervous system, are integral to axonal integrity and function. Hypoxia-ischemia episodes can cause severe damage to these vulnerable cells through excitotoxicity, oxidative stress, inflammation, and mitochondrial dysfunction, leading to axonal dystrophy, neuronal dysfunction, and neurological impairments. OLs damage can result in demyelination and myelination disorders, severely impacting axonal function, structure, metabolism, and survival. Adult-onset stroke, periventricular leukomalacia, and post-stroke cognitive impairment primarily target OLs, making them a critical therapeutic target. Therapeutic strategies targeting OLs, myelin, and their receptors should be given more emphasis to attenuate ischemia injury and establish functional recovery after stroke. This review summarizes recent advances on the function of OLs in ischemic injury, as well as the present and emerging principles that serve as the foundation for protective strategies against OLs deaths.
Topics: Humans; Ischemic Stroke; Oligodendroglia; Myelin Sheath; Central Nervous System; Stroke
PubMed: 37321419
DOI: 10.1016/j.nbd.2023.106200