-
Frontiers in Neurology 2023Brain injury is the main factor affecting the development and prognosis of the nervous system in premature infants. Early diagnosis and treatment are of great... (Review)
Review
Brain injury is the main factor affecting the development and prognosis of the nervous system in premature infants. Early diagnosis and treatment are of great significance in reducing mortality and disability and improving the prognosis of premature infants. Craniocerebral ultrasound has become an important medical imaging method for evaluating the brain structure of premature infants due to its advantages of being non-invasive, cheap, simple, and bedside dynamic monitoring since it was applied to neonatal clinical practice. This article reviews the application of brain ultrasound to common brain injuries in premature infants.
PubMed: 36860577
DOI: 10.3389/fneur.2023.1095280 -
Handbook of Clinical Neurology 2021As we live in a dynamic world, motion is a fundamental aspect of our visual experience. The advent of computerized stimuli has allowed controlled study of a wide array...
As we live in a dynamic world, motion is a fundamental aspect of our visual experience. The advent of computerized stimuli has allowed controlled study of a wide array of motion phenomena, including global integration and segmentation, speed and direction discrimination, motion aftereffects, the optic flow that accompanies self-motion, perception of object form derived from motion cues, and point-light biological motion. Animal studies first revealed the existence of a motion-selective region, the middle temporal (MT) area, also known as V5, located in the lateral occipitotemporal cortex, followed by areas such as V5A (also known as MST, the middle superior temporal area), V6/V6A, the ventral intraparietal area, and others. In humans there are rare cases of bilateral lesions of the V5/V5A complex causing cerebral akinetopsia, a severe impairment of motion perception. Unilateral V5/V5A lesions are more common but cause milder asymptomatic deficits, often limited to the contralateral hemifield, while parietal lesions can impair perception of point-light biological motion or high-level motion tasks that are attentionally demanding. Impairments of motion perception have also been described in optic neuropathy, particularly glaucoma, as well as Alzheimer's disease, Parkinson's disease with dementia, and dementia with Lewy body disease. Prematurity with or without periventricular leukomalacia and developmental syndromes such as Williams' syndrome, autism, and dyslexia have also been associated with impaired motion perception, suggesting a developmental vulnerability of the dorsal pathway.
Topics: Animals; Brain Diseases; Brain Mapping; Cerebral Cortex; Humans; Motion Perception; Photic Stimulation; Visual Perception
PubMed: 33832680
DOI: 10.1016/B978-0-12-821377-3.00013-1 -
European Journal of Paediatric... Jan 2023To analyse the motor phenotype with a focus on bradykinesia in children with Cerebral Palsy (CP) in the setting of periventricular leukomalacia (PVL).
OBJECTIVE
To analyse the motor phenotype with a focus on bradykinesia in children with Cerebral Palsy (CP) in the setting of periventricular leukomalacia (PVL).
METHODOLOGY
Analysis of a cohort of 25 children with CP and PVL. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the severity of motor function. Spasticity was rated using the Modified Ashworth Scale (MAS), dystonia was rated using the Burke-Fahn-Marsden Scale (BFMS), and bradykinesia was rated using the Unified Parkinson's disease rating scale (UPDRS). All patients were video-recorded following a standard protocol.
RESULTS
Bradykinesia was observed in 96% of patients. It was noted mainly in the limbs, and it was moderate-to-severe in the legs and mild-to-moderate in the arms. Bradykinesia correlated with functional level, as classified by GMFCS and MACS; also with dystonia, as rated by BFMS but did not correlate with a measure of spasticity (MAS).
CONCLUSIONS
This study confirms the existence of bradykinesia in patients with CP in the setting of PVL. Bradykinesia and dystonia appear to be important interrelated factors influencing the level of gross and fine motor skills in patients with PVL.
Topics: Child; Humans; Infant, Newborn; Hypokinesia; Motor Skills; Dystonia; Cerebral Palsy; Leukomalacia, Periventricular; Dystonic Disorders; Muscle Spasticity; Severity of Illness Index
PubMed: 36580872
DOI: 10.1016/j.ejpn.2022.11.008 -
American Journal of Ophthalmology Aug 2022To determine whether rates of strabismus and associated visuomotor deficits differed among children with different severities of periventricular leukomalacia (PVL).
PURPOSE
To determine whether rates of strabismus and associated visuomotor deficits differed among children with different severities of periventricular leukomalacia (PVL).
DESIGN
Retrospective, case-control study.
METHODS
Brain magnetic resonance images (MRI) obtained from 98 children aged ≥2 years were analyzed using a standardized scoring system: 67 of 98 had PVL (mean GA 31 weeks) and 31 of 98 did not have PVL (mean GA 29 weeks). Severity of PVL was scored as degree of damage to the posterior optic radiations and the splenium of the corpus callosum on MRI. Ophthalmologic examination data were collated to assess the prevalence of visuomotor deficits and the relationship to PVL severity (grades 1-3, mild to severe).
RESULTS
Infantile strabismus was documented in 61% of children with mild, 74% with moderate, and 88% with severe PVL (esotropia: exotropia ratio 3.5:1). Associated ocular motor deficits also increased systematically with PVL severity: latent ("fusion maldevelopment") nystagmus (20%, 47%, and 40%, respectively), dissociated vertical deviation (13%, 28%, and 30%), and nasotemporal pursuit/optokinetic nystagmus asymmetry (23%, 38%, and 54%). Additionally, the prevalence of retrograde optic neuropathy increased with PVL severity (5%, 26%, and 38%). The prevalence of each of these signs was substantially lower in children who had no PVL.
CONCLUSIONS
Children who suffer PVL are likely to develop the deficits of the infantile strabismus complex. The deficits tend to increase systematically as a function of PVL severity. These findings provide evidence that infantile strabismus is linked to perinatal damage to cerebral vergence and gaze pathways.
Topics: Case-Control Studies; Child; Humans; Infant, Newborn; Leukomalacia, Periventricular; Magnetic Resonance Imaging; Nystagmus, Pathologic; Prevalence; Retrospective Studies; Strabismus
PubMed: 35381203
DOI: 10.1016/j.ajo.2022.03.028 -
Seminars in Fetal & Neonatal Medicine Aug 2020The fetal inflammatory response syndrome (FIRS) is a condition whereby the fetus mounts an inflammatory response to intrauterine infection/inflammation. Clinical... (Review)
Review
The fetal inflammatory response syndrome (FIRS) is a condition whereby the fetus mounts an inflammatory response to intrauterine infection/inflammation. Clinical consequences include preterm premature rupture of membranes (PPROM), spontaneous preterm delivery, neonatal sepsis, bronchopulmonary dysplasia, and brain and other organ injury. Mechanisms leading to brain injury in FIRS have been investigated in animal and human studies. We review the neuroimaging findings of brain injury in FIRS, which overlap those of hypoxic-ischemic injury, and clinical correlation is necessary for a correct diagnosis. FIRS should be considered the primary diagnosis when neuroimaging findings such as periventricular leukomalacia are identified in preterm children born as a consequence of PPROM and spontaneous preterm labor. Additionally, FIRS should be considered in term infants who do not have the most common features of HIE (e.g. a sentinel event). Systematic histopathologic examination of the placenta and umbilical cord and/or detection of characteristic inflammatory markers in such cases are needed to establish the correct diagnosis.
Topics: Brain Injuries; Child; Chorioamnionitis; Female; Fetal Blood; Humans; Infant; Infant, Newborn; Neuroimaging; Obstetric Labor, Premature; Placenta; Pregnancy; Premature Birth; Systemic Inflammatory Response Syndrome
PubMed: 32800654
DOI: 10.1016/j.siny.2020.101143 -
Pediatric Research Apr 2022There is no consensus on the optimal pCO levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates.... (Review)
Review
There is no consensus on the optimal pCO levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO levels that were found to increase the risk of neonatal disease. Although PaCO ranges were reported from 2.6 to 8.7 kPa (19.5-64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO 6.0-7.3 kPa: 45.0-54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO parameters and correlation with outcomes. IMPACT: There is no consensus on the optimal pCO levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO of 5-7 kPa was inferred following systematic review.
Topics: Carbon Dioxide; Humans; Hypercapnia; Hypocapnia; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Respiration, Artificial
PubMed: 34230621
DOI: 10.1038/s41390-021-01473-y -
Pediatric Neurology Nov 2023The development of the central nervous system can be directly disrupted by a variety of acquired factors, including infectious, inflammatory, hypoxic-ischemic, and toxic... (Review)
Review
The development of the central nervous system can be directly disrupted by a variety of acquired factors, including infectious, inflammatory, hypoxic-ischemic, and toxic insults. Influences external to the fetus also impact neurodevelopment, including placental health, maternal comorbidities, adverse experiences, environmental exposures, and social determinants of health. Acquired perinatal brain insults tend to affect the developing brain in a stage-specific manner that reflects the susceptible cell types, developmental processes, and risk factors present at the time of the insult. In this review, we discuss the pathophysiology, neurodevelopmental outcomes, and management of common acquired perinatal brain conditions. In the fetal brain, we divide insults based on trimester, and in the postnatal brain, we focus on common pathologies that have a presentation dependent on gestational age at birth: white matter injury and germinal matrix hemorrhage/intraventricular hemorrhage in preterm infants and hypoxic-ischemic encephalopathy in term infants. Although specific treatments for fetal and newborn brain disorders are currently limited, we emphasize therapies in preclinical or early clinical phases of the development pipeline. The growing number of novel cell type- and stage-specific emerging therapies suggests that in the near future we may have a dramatically improved ability to treat acquired perinatal brain disorders and to mitigate the associated neurodevelopmental consequences.
PubMed: 37625929
DOI: 10.1016/j.pediatrneurol.2023.08.001 -
Journal of Neurosciences in Rural... Jan 2022Hypoxic-ischemic encephalopathy (HIE) is the most commonly diagnosed neurological abnormality affecting children leading to severe neurological deficits and a cause...
Hypoxic-ischemic encephalopathy (HIE) is the most commonly diagnosed neurological abnormality affecting children leading to severe neurological deficits and a cause of neonatal mortality. HIE constitutes a diagnostic challenge in the prematurely born and full-term neonates. HIE causes severe neurological deficit in children and many a times goes unnoticed in early stages. The various patterns of central nervous system (CNS) involvement in HIE are dependent on factors, such as severity and duration of hypoxia, and brain maturity in preterm and full-term patients. Magnetic resonance imaging (MRI) has prognostic significance in detecting patterns of HIE secondary to mild-to-moderate and severe hypoxias and the imaging findings are highly dependent on the time at which imaging is done. MRI helps determine the prognosis of brain development in patients with HIE. This retrospective study elucidates the spectrum of MRI findings in preterm and full-term patients with HIE on MRI. This retrospective descriptive study was conducted at a tertiary care center between April 2017 and May 2019 on 50 patients with a clinical diagnosis of HIE using a General Electric (GE) 1.5-Tesla MRI scanner. Various patterns of HIE were evaluated on MRI in preterm and full-term patients. This retrospective study evaluated MRI findings in 50 infants diagnosed with HIE. Eighteen (36%) were preterm and 32 (64%) were full-term patients. Thirty-five (70%) were male and 15 (30%) were female patients. In the current study, developmental delay was the most commonly associated clinical entity in both preterm and full-term patients. In preterm patients, periventricular leukomalacia was the most prevalent MRI finding, and in full-term patients, subcortical and periventricular white matter hyperintensities on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences were most commonly encountered. MRI is the primary imaging modality of choice in preterm and full-term patients with HIE, as it helps determine the severity of hypoxic-ischemic injury by understanding the pattern of brain involvement. In the current study, distinguishable patterns of MRI findings secondary to birth asphyxia and ischemic insult were elucidated in both preterm and full-term patients who are highly dependent on the level of brain maturity at the time of imaging. Regular MRI follow-up has a prognostic significance in HIE with accurate prediction of neurodevelopmental outcome on follow-up studies.
PubMed: 35110925
DOI: 10.1055/s-0041-1742157 -
Scientific Reports Jul 2021Faces hold a substantial value for effective social interactions and sharing. Covering faces with masks, due to COVID-19 regulations, may lead to difficulties in using...
Faces hold a substantial value for effective social interactions and sharing. Covering faces with masks, due to COVID-19 regulations, may lead to difficulties in using social signals, in particular, in individuals with neurodevelopmental conditions. Daily-life social participation of individuals who were born preterm is of immense importance for their quality of life. Here we examined face tuning in individuals (aged 12.79 ± 1.89 years) who were born preterm and exhibited signs of periventricular leukomalacia (PVL), a dominant form of brain injury in preterm birth survivors. For assessing the face sensitivity in this population, we implemented a recently developed experimental tool, a set of Face-n-Food images bordering on the style of Giuseppe Arcimboldo. The key benefit of these images is that single components do not trigger face processing. Although a coarse face schema is thought to be hardwired in the brain, former preterms exhibit substantial shortages in the face tuning not only compared with typically developing controls but also with individuals with autistic spectrum disorders. The lack of correlations between the face sensitivity and other cognitive abilities indicates that these deficits are domain-specific. This underscores impact of preterm birth sequelae for social functioning at large. Comparison of the findings with data in individuals with other neurodevelopmental and neuropsychiatric conditions provides novel insights into the origins of deficient face processing.
Topics: Adolescent; Autism Spectrum Disorder; Brain; COVID-19; Child; Cognition; Cognitive Neuroscience; Facial Expression; Facial Recognition; Female; Humans; Leukomalacia, Periventricular; Pattern Recognition, Visual; Pregnancy; Premature Birth; Quality of Life; Recognition, Psychology; Sex Factors; Social Behavior; Social Cognition; Visual Perception
PubMed: 34262075
DOI: 10.1038/s41598-021-93709-4 -
Journal of Perinatal Medicine Jul 2023Cerebral palsy, the most common disability in childhood, is a devastating non-progressive ailment of the infants' brain with lifelong sequelae, e.g., spastic paresis,... (Review)
Review
Cerebral palsy, the most common disability in childhood, is a devastating non-progressive ailment of the infants' brain with lifelong sequelae, e.g., spastic paresis, chronic pain, inability to walk, intellectual disability, behavioral disorders, for which there is no cure at present. CP may develop after pediatric brain damage caused, e.g., by hypoxic-ischemia, periventricular leukomalacia, intracranial hemorrhage, hypoxic-ischemic encephalopathy, trauma, stroke, and infection. About 17 million people worldwide live with cerebral palsy as a result of pediatric brain damage. This reflects both the magnitude of the personal, medical, and socioeconomic global burden of this brain disorder and the overt unmet therapeutic needs of the pediatric population. This review will focus on recent preclinical, clinical, and regulatory developments in cell therapy for infantile cerebral palsy by transplantation of cord blood derived mononuclear cells from bench to bedside. The body of evidence suggests that cord blood cell therapy of cerebral palsy in the autologous setting is feasible, effective, and safe, however, adequately powered phase 3 trials are overdue.
Topics: Infant, Newborn; Humans; Child; Cerebral Palsy; Brain; Stem Cells; Brain Injuries; Leukomalacia, Periventricular; Hypoxia-Ischemia, Brain
PubMed: 36503655
DOI: 10.1515/jpm-2022-0505