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Zhongguo Dang Dai Er Ke Za Zhi =... May 2013Periventricular white matter damage is one of the characteristics of brain damage in preterm infants, and it is the most important type of encephalopathy. The... (Review)
Review
Periventricular white matter damage is one of the characteristics of brain damage in preterm infants, and it is the most important type of encephalopathy. The pathological changes including the white matter of coagulation necrosis, oligodendrocyte damage, myelin damage, axonal injury and reactive gliosis and microglia infiltration in necrotic areas. All of these lesions are closely related to the nervous system sequelae in later-neonatal period. The pathogenesis of periventricular leukomalacia in premature infants are mainly cause by its immature brain vascular, and precursor oligodendrocytes of the attack of hypoxia, ischemia, infection, oxygen free radicals, inflammatory cytokines, increasing glutamate, and other high-risk factors. In this paper, an overview of progress in the study of the pathogenesis of periventricular white matter damage in premature infants through literature review to provide a theoretical support for clinical prevention, diagnosis and treatment.
Topics: Apoptosis; Cerebrovascular Circulation; Cytokines; Excitatory Amino Acids; Humans; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Risk Factors
PubMed: 23676948
DOI: No ID Found -
Journal of Ultrasonography Jun 2014An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain... (Review)
Review
An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain the character of such an anomaly (a congenital defect, destructive effect of intrauterine infection or abnormality with reasons that are difficult to explain). Knowledge of normal development sequence of the fetal brain, which is discussed in this paper, is the basis for correct interpretation of imaging findings. Together with the increase in survival of preterm neonates, a high risk of early brain damage is still a problem in this extremely immature population. Therefore, imaging examinations become necessary. The paper presents intrauterine and postnatal risk factors of early brain damage as well as classification of such lesions, of hemorrhagic and hypoxic-ischemic etiology. The diagnosis of the cerebellum damage, which is currently believed to be a significant cause of autism, is emphasized. The evolution of lesions over time is also presented. Moreover, the elements of diagnosis important for prognosis are stressed. The standards of imaging examinations of the central nervous system include the schedule of ultrasound examinations and provide indications for extended diagnosis with the use of magnetic resonance imaging.
PubMed: 26672743
DOI: 10.15557/JoU.2014.0020 -
Journal of Visualized Experiments : JoVE May 2010We describe a protocol for establishing mouse models of periventricular leukomalacia (PVL). PVL is the predominant form of brain injury in premature infants and the most...
We describe a protocol for establishing mouse models of periventricular leukomalacia (PVL). PVL is the predominant form of brain injury in premature infants and the most common antecedent of cerebral palsy. PVL is characterized by periventricular white matter damage with prominent oligodendroglial injury. Hypoxia/ischemia with or without systemic infection/inflammation are the primary causes of PVL. We use P6 mice to create models of neonatal brain injury by the induction of hypoxia/ischemia with or without systemic infection/inflammation with unilateral carotid ligation followed by exposure to hypoxia with or without injection of the endotoxin lipopolysaccharide (LPS). Immunohistochemistry of myelin basic protein (MBP) or O1 and electron microscopic examination show prominent myelin loss in cerebral white matter with additional damage to the hippocampus and thalamus. Establishment of mouse models of PVL will greatly facilitate the study of disease pathogenesis using available transgenic mouse strains, conduction of drug trials in a relatively high throughput manner to identify candidate therapeutic agents, and testing of stem cell transplantation using immunodeficiency mouse strains.
Topics: Animals; Brain Ischemia; Disease Models, Animal; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Leukomalacia, Periventricular; Mice; Mice, Transgenic; Myelin Basic Protein
PubMed: 20485263
DOI: 10.3791/1951 -
AJNR. American Journal of Neuroradiology 1990Periventricular leukomalacia and germinal matrix hemorrhages are major causes of neurodevelopmental abnormalities in the premature neonate. Although sonography is widely...
Periventricular leukomalacia and germinal matrix hemorrhages are major causes of neurodevelopmental abnormalities in the premature neonate. Although sonography is widely used to detect these abnormalities and is thought to be sensitive for hemorrhages and the later cystic stages of periventricular leukomalacia, its sensitivity for the more acute phase of periventricular leukomalacia remains to be determined. It has been difficult to study this issue because periventricular leukomalacia often is not lethal, and in postmortem studies there is usually a considerable interval between the time of in vivo imaging, if any, and the death of the patient. A "prospective" autopsy study was performed on brain specimens from infants who died at less than 1 year of age during a 10-month period. Thirty-five formalin-fixed brains were studied and sonographic images of these specimens were compared with histologic findings in whole brain sections to determine the sensitivity and specificity of sonography for the detection of germinal matrix hemorrhage and periventricular leukomalacia. Sonography identified germinal matrix hemorrhages as small as 5 mm, although smaller lesions were not visualized. Postmortem sonography had a sensitivity of 27% and specificity of 88% for all germinal matrix hemorrhages, but a sensitivity of 100% and specificity of 91% for hemorrhages larger than 5 mm. Periventricular leukomalacia, seen as hyperechoic areas in the periventricular white matter, was not detected as readily. For periventricular leukomalacia, the overall sensitivity and specificity were 50% and 87%, respectively. We conclude that sonography is useful for detecting the larger germinal matrix hemorrhages, but has more limited sensitivity in the early diagnosis of periventricular leukomalacia.
Topics: Cerebral Hemorrhage; Encephalomalacia; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Leukomalacia, Periventricular; Ultrasonography
PubMed: 2114748
DOI: No ID Found -
Journal of Perinatology : Official... Nov 2018Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic... (Review)
Review
Intraventricular hemorrhage in the setting of prematurity remains the most common cause of acquired hydrocephalus. Neonates with progressive post-hemorrhagic hydrocephalus are at risk for adverse neurodevelopmental outcomes. The goal of this review is to describe the distinct and often overlapping types of brain injury in the preterm neonate, with a focus on neonatal hydrocephalus, and to connect injury on imaging to neurodevelopmental outcome risk. Head ultrasound and magnetic resonance imaging findings are described separately. The current state of the literature is imprecise and we end the review with recommendations for future radiologic and neurodevelopmental research.
Topics: Cerebral Hemorrhage; Echoencephalography; Gestational Age; Humans; Hydrocephalus; Hypoxia-Ischemia, Brain; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Magnetic Resonance Imaging; Neuroimaging; Prognosis; White Matter
PubMed: 30166622
DOI: 10.1038/s41372-018-0209-5 -
Archives of Disease in Childhood Apr 1985The evolution of severe periventricular leukomalacia was followed by ultrasonography in three newborn infants, and the subsequent myelination of the brain was assessed...
The evolution of severe periventricular leukomalacia was followed by ultrasonography in three newborn infants, and the subsequent myelination of the brain was assessed by nuclear magnetic resonance imaging. Four stages of periventricular leukomalacia could be identified by ultrasonography; (1) initial congestion, followed by (2) relative normalisation, (3) development of cysts, and (4) resolution of cysts but development of ventricular enlargement. All infants exhibited abnormal neurological signs from 36 weeks conceptual age and had unequivocal signs of cerebral palsy by 6 to 9 months of age. One infant became cortically blind but the other two seemed to have normal vision. Nuclear magnetic resonance imaging showed some abnormality of the ventricular system and delayed myelination in all three infants. The delay was most noticeable in the opticothalamic region, which was also the site of the most extensive lesions observed on ultrasonography. Progress in myelination was observed in the infants where a repeat scan was performed.
Topics: Brain Diseases; Cerebral Infarction; Cerebral Ventricles; Cysts; Humans; Infant, Newborn; Magnetic Resonance Spectroscopy; Myelin Sheath; Nervous System Diseases; Prospective Studies; Ultrasonography
PubMed: 3890765
DOI: 10.1136/adc.60.4.349 -
Developmental Neuroscience 2007The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what... (Review)
Review
The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact (potential vs. factual causation), (3) if X, then invariably Y (determinism vs. probabilism), (4) co-occurrence in individuals vs. association in populations, (5) one cause is all that is needed (single cause attribution vs. multicausal constellations), (6) drawing causal inferences from very small numbers of observations (the tendency to generalize), (7) unstated causal inferences, (8) ignoring heterogeneity, and (9) failing to consider alternative explanations for what is observed. We hope that our critical discussion will contribute to fruitful research and help reduce the burden of perinatal brain damage.
Topics: Abruptio Placentae; Birth Injuries; Causality; Cerebral Hemorrhage, Traumatic; Female; Humans; Hypoxia, Brain; Infant, Newborn; Leukomalacia, Periventricular; Pregnancy
PubMed: 17762196
DOI: 10.1159/000105469 -
Journal of Korean Medical Science Jul 2022We aimed to determine the current survival rate and short-term outcomes of very-low-birth-weight infants (VLBWIs) in Korea, as well as whether the survival rate and...
BACKGROUND
We aimed to determine the current survival rate and short-term outcomes of very-low-birth-weight infants (VLBWIs) in Korea, as well as whether the survival rate and short-term outcomes have improved over time since 2013, which was when the Korean Neonatal Network (KNN) was launched.
METHODS
This study used data from the annual reports of the KNN from 2013 to 2020. A total of 16,351 VLBWIs born at gestational age (GA) ≥ 22 weeks between January 1, 2013, and December 31, 2020, and who were registered in the KNN were enrolled. Serial outcomes were analyzed according to era (2013-14, 2015-16, 2017-18, and 2019-20).
RESULTS
More mothers delivered by cesarean section, had diabetes or hypertension during their pregnancy, and received antenatal steroids when analyzed by era. Fewer infants were intubated at birth and had air leaks when analyzed by era. The overall survival rate of VLBWIs between 2013 and 2020 was 87%. The rate of respiratory distress syndrome was 77% and that of bronchopulmonary dysplasia was 32% between 2013 and 2020. The rates of intraventricular hemorrhage (grade ≥ 3), periventricular leukomalacia, and sepsis decreased over time. The survival rate of infants with a GA of 26 weeks has improved serially according to era.
CONCLUSION
Since the launch of the KNN in 2013, the survival rates of infants with GA 26 weeks and short-term outcomes have improved, which implies a quality improvement in antenatal and delivery room care. Further studies on the long-term neurodevelopmental outcomes of these KNN registrants are warranted.
Topics: Cesarean Section; Female; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Very Low Birth Weight; Pregnancy; Republic of Korea
PubMed: 35880505
DOI: 10.3346/jkms.2022.37.e229 -
Frontiers in Neurology 2018Neurofilament light chain (NfL) is a highly promising biomarker of neuroaxonal injury that has mainly been studied in adult neurodegenerative disease. Its involvement...
Neurofilament light chain (NfL) is a highly promising biomarker of neuroaxonal injury that has mainly been studied in adult neurodegenerative disease. Its involvement in neonatal disease remains largely unknown. Our aim was to establish NfL plasma concentrations in preterm and term infants in the first week of life. Plasma NfL was measured by single molecule array immunoassay in two neonatal cohorts: cohort 1 contained 203 term and preterm infants, median gestational age (GA) 37.9 weeks (interquartile range [IQR] 31.9-39.4), in whom venous and arterial umbilical cord blood was sampled at birth and venous blood at day of life (DOL) 3; cohort 2 contained 98 preterm infants, median GA 29.3 weeks (IQR 26.9-30.6), in whom venous blood was sampled at DOL 7. Median NfL concentrations in venous blood increased significantly from birth (18.2 pg/mL [IQR 12.8-30.8, cohort 1]) to DOL 3 (50.9 pg/mL [41.3-100, cohort 1]) and DOL 7 (126 pg/mL [78.8-225, cohort 2]) ( < 0.001). In both cohorts NfL correlated inversely with birth weight (BW, Spearman's rho -0.403, < 0.001, cohort 1; R -0.525, < 0.001, cohort 2) and GA (R -0.271, < 0.001, cohort 1; R -0.487, < 0.001, cohort 2). Additional significant correlations were found for maternal age at delivery, preeclampsia, delivery mode, 5-min Apgar, duration of oxygen supplementation, sepsis, and brain damage (intraventricular hemorrhage or periventricular leukomalacia). Multivariable logistic regression analysis identified the independent predictors of NfL in cohort 1 as BW (beta = -0.297, = 0.003), delivery mode (beta = 0.237, = 0.001) and preeclampsia (beta = 0.183, = 0.022) and in cohort 2 as BW (beta = -0.385, = 0.001) and brain damage (beta = 0.222, = 0.015). Neonatal NfL levels correlate inversely with maturity and BW, increase during the first days of life, and relate to brain injury factors such as intraventricular hemorrhage and periventricular leukomalacia, and also to vaginal delivery.
PubMed: 30524361
DOI: 10.3389/fneur.2018.00984 -
Genetics and Molecular Research : GMR Apr 2015This study aims to explore the relation between changes in myelin basic protein (MBP) and S100 protein (S100B) serum levels and prognosis in premature infants with...
This study aims to explore the relation between changes in myelin basic protein (MBP) and S100 protein (S100B) serum levels and prognosis in premature infants with periventricular leukomalacia (PVL). In our hospital, 78 premature infants with PVL and 43 normal premature infants were studied from July 1, 2007 to December 31, 2008. MBP and S100B serum levels were detected at 1, 3, 7, and 14 days after birth by using enzyme-linked immunosorbent assay. All infants were followed four times (once every 3 months) after discharge from hospital. Their intelligence quotient and physical development index were tested by using Gesell developmental scales. The MBP serum levels were significantly higher in premature infants with PVL at any time point than in normal premature infants. S100B serum levels gradually increased at 1, 3, and 7 days; peaked on the 7th day; and then gradually decreased to the normal level on the 14th day. The intelligence quatient and physical development index of infants with increased S100B and MBP levels on the 7th day were lower than those of infants who had normal S100B and MBP levels and those of normal premature infants. A negative relation exists between S100B and MBP serum levels and prognosis in PVL infants. An increase of MBP and S100B levels lasting >7 days could cause poor prognosis.
Topics: Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Male; Myelin Basic Protein; Prognosis; S100 Proteins
PubMed: 25966206
DOI: 10.4238/2015.April.30.6