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Pediatric Radiology Mar 2021Neurosonography is an essential imaging modality for assessing the neonatal brain, particularly as a screening tool to evaluate intracranial hemorrhage, hydrocephalus... (Review)
Review
Neurosonography is an essential imaging modality for assessing the neonatal brain, particularly as a screening tool to evaluate intracranial hemorrhage, hydrocephalus and periventricular leukomalacia. The primary advantages of neurosonography include portability, accessibility and lack of ionizing radiation. Its main limitations are intrinsic operator dependence and the need for an open fontanelle. Neurosonographic imaging acquisition is typically performed by placing a sector transducer over the anterior fontanelle and following sagittal and coronal sweeps. The sensitivity of neurosonography has markedly improved thanks to the adoption of modern imaging equipment, the use of dedicated head probes, and the employment of advanced diagnostic US techniques. These developments have facilitated more descriptive identification of specific cerebral anatomical details, improving understanding of the cerebral anatomy by conventional US. Such knowledge is fundamental for enhanced diagnostic sensitivity and is a key to understanding pathological states. Furthermore, familiarity with normal anatomy is crucial for understanding pathological states. Our primary goal in this review was to supplement these technological developments with a roadmap to the cerebral landscape. We accomplish this by presenting a systematic approach to using routine US for consistent identification of the most crucial cerebral landmarks, reviewing their relationship with adjacent structures, and briefly describing their primary function.
Topics: Brain; Cerebrum; Humans; Hydrocephalus; Infant, Newborn; Leukomalacia, Periventricular
PubMed: 33026469
DOI: 10.1007/s00247-020-04794-y -
Pediatrics and Neonatology Jan 2022
Topics: Aspirin; Epilepsy; Humans; Infant, Newborn; Leukomalacia, Periventricular; Protein S Deficiency; Seizures
PubMed: 34836816
DOI: 10.1016/j.pedneo.2021.08.017 -
Indian Pediatrics Oct 2021To determine the incidence and risk factors of preterm white matter injury [WMI; periventricular-intraventricular hemorrhage (PIVH) and/or periventricular leukomalacia...
OBJECTIVE
To determine the incidence and risk factors of preterm white matter injury [WMI; periventricular-intraventricular hemorrhage (PIVH) and/or periventricular leukomalacia (PVL)].
DESIGN
Prospective cohort study.
SETTING
Level-3 neonatal intensive care unit.
PATIENTS
Inborn preterm neonates (n=140) delivered at <32 weeks gestation or birthweight <1500 g.
METHODS
Serial cranial ultrasounds were performed at postnatal ages of 3 days (±12 hour), 7 (±1) days, 21 (±3) days and 40 (±1) weeks postmenstrual age (PMA). PIVH and PVL were graded as per Volpe and De-Vries criteria, respectively. Univariate followed by multivariate analysis was done to evaluate risk factors for PIVH and PVL.
OUTCOME MEASURES
The primary outcome was the incidence of preterm WMI. The secondary outcomes were evaluation of risk factors and natural course of WMI.
RESULTS
The mean (range) gestation and birth weight of enrolled neonates were 29.7 (24-36) weeks and 1143 (440-1887) g, respectively. PIVH occurred in 25 (17.8%) neonates. PVL occurred in 34 (24.3%) neonates. None of them were grade III or IV PVL. Preterm WMI (any grade PIVH and/or PVL) occurred in 52 (37.1%) neonates. Severe PIVH (grade III) and cystic PVL occurred in 7 (5%) and 5 (3.6%) neonates, respectively. On multivariate analysis, none of the presumed risk factors were associated with PIVH. However, hemodynamically significant patent ductus arteriosus, and apnea of prematurity were significantly associated with increased risk of PVL.
CONCLUSIONS
Significant WMI occurred only in one-third of the cohort, which is comparable to that described in literature from the developed countries.
Topics: Cohort Studies; Humans; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Prospective Studies; White Matter
PubMed: 34302328
DOI: No ID Found -
Journal of Inflammation Research 2016Periventricular leukomalacia (PVL) is a frequent consequence of hypoxic-ischemic injury. Functional cytokine gene variants that result in altered production of...
BACKGROUND
Periventricular leukomalacia (PVL) is a frequent consequence of hypoxic-ischemic injury. Functional cytokine gene variants that result in altered production of inflammatory (tumor necrosis factor-alpha [TNF-α] and interleukin-1beta [IL-1β]) or anti-inflammatory (interleukin-10 [IL-10]) cytokines may modify disease processes, including PVL.
OBJECTIVE
The aim of this study was to evaluate if there is a relationship between the two proinflammatory polymorphisms (TNF-α-1031T/C and IL-1β-511C/T) and the anti-inflammatory polymorphism IL-10-1082G/A and PVL risk in Brazilian newborns with and without this injury.
MATERIALS AND METHODS
A cross-sectional case-control study performed at the Neonatal Intensive Care Unit of the Children's Hospital and Maternity of the São José do Rio Preto Medical School (FAMERP). Fifty preterm and term newborns were examined as index cases and 50 term newborns as controls, of both sexes for both groups. DNA was extracted from peripheral blood leukocytes, and the sites that encompassed the three polymorphisms were amplified by polymerase chain reaction-restriction fragment length polymorphism.
RESULTS
Gestational age ranged from 25 to 39 weeks, in the case group, and in the control group it ranged from 38 to 42.5 weeks (P<0.0001). Statistically significant association was found between TNF-α-1031T/C high expression genotype TC (odds ratio [OR], 2.495; 95% confidence interval [CI], 1.10-5.63; P=0.043) as well as between genotypes (TC + CC) (OR, 2.471; 95% CI, 1.10-5.55; P=0.044) and risk of PVL. Statistically significant association was found between IL-1β-511C/T high expression genotypes (CT + TT) (OR, 23.120; 95% CI, 1.31-409.4; P=0.003) and risk of PVL. Statistically significant association between IL-10-1082G/A high expression genotype GG (OR, 0.07407; 95% CI, 0.02-0.34; P<0.0001) as well as between IL-10-1082G high expression allele (OR, 0.5098; 95% CI, 0.29-0.91; P=0,030) and PVL reduced risk was observed. There was a statistically significant association between TC/CT/GA genotype combination and the risk of PVL (OR, 6.469; 95% CI, 2.00-20.92; P=0.001).
CONCLUSION
There is evidence of an association between the polymorphisms TNF-α-1031T/C, IL-1β-511C/T, and IL-10-1082G/A and PVL risk in this Brazilian newborn population studied.
PubMed: 27217792
DOI: 10.2147/JIR.S103697 -
Laboratory Animal Research Jun 2011Periventricular leukomalacia, specifically characterized as white matter injury, in neonates is strongly associated with the damage of pre-myelinating oligodendrocytes....
Periventricular leukomalacia, specifically characterized as white matter injury, in neonates is strongly associated with the damage of pre-myelinating oligodendrocytes. Clinical data suggest that hypoxia-ischemia during delivery and intrauterine or neonatal infection-inflammation are important factors in the etiology of periventricular leukomalacia including cerebral palsy, a serious case exhibiting neurobehavioral deficits of periventricular leukomalacia. In order to explore the pathophysiological mechanisms of white matter injury and to better understand how infectious agents may affect the vulnerability of the immature brain to injury, novel animal models have been developed using hypoperfusion, microbes or bacterial products (lipopolysaccharide) and excitotoxins. Such efforts have developed rat models that produce predominantly white matter lesions by adopting combined hypoxia-ischemia technique on postnatal days 1-7, in which unilateral or bilateral carotid arteries of animals are occluded (ischemia) followed by 1-2 hour exposure to 6-8% oxygen environment (hypoxia). Furthermore, low doses of lipopolysaccharide that by themselves have no adverse-effects in 7-day-old rats, dramatically increase brain injury to hypoxic-ischemic challenge, implying that inflammation sensitizes the immature central nervous system. Therefore, among numerous models of periventricular leukomalacia, combination of hypoxia-ischemia-lipopolysaccharide might be one of the most-acceptable rodent models to induce extensive white matter injury and ensuing neurobehavioral deficits for the evaluation of candidate therapeutics.
PubMed: 21826166
DOI: 10.5625/lar.2011.27.2.77 -
PloS One 2017Periventricular leukomalacia (PVL), a brain injury affecting premature infants is commonly associated with cerebral palsy. PVL results from hypoxia-ischemia (HI) with or...
Periventricular leukomalacia (PVL), a brain injury affecting premature infants is commonly associated with cerebral palsy. PVL results from hypoxia-ischemia (HI) with or without infection and is characterized by white matter necrotic lesions, hypomyelination, microglial activation, astrogliosis, and neuronal death. It is important to study a PVL mouse model that mimics human PVL in symptomatology, anatomic and molecular basis. In our neonate mice model, bilateral carotid arteries were temporary ligated at P5 followed by hypoxic exposure (FiO2 of 8% for 20 min.). At P5 in mice, the white matter is more vulnerable to HI injury than the grey matter. In our PVL model, mice suffer from significant hind limb paresis, incoordination and feeding difficulties. Histologically they present with ventriculomegally, white matter loss, microglial activation and neuronal apoptosis. HI injury increases proinflammtory cytokines, activates NF-kB, activates microglia and causes nitrative stress. All these inflammatory mediators lead to oligodendroglial injury and white matter loss. Neurobehavioral analysis in the PVL mice model at P60 showed that the HI group had a significant decrease in hind limb strength, worsening rotarod testing and worsening performance in the open field test. This new PVL model has great advantages far beyond just mimicking human PVL in clinical features and histopathology. Long term survival, the development of cerebral palsy and the ability of using this model in transgenic animals will increase our understanding of the mechanistic pathways underlying PVL and defining specific targets for the development of suitable therapeutics.
Topics: Animals; Animals, Newborn; Behavior, Animal; Cardiomegaly; Cerebral Palsy; Disease Models, Animal; Hindlimb; Humans; Hypoxia; Inflammation Mediators; Leukomalacia, Periventricular; Mice; Paresis
PubMed: 28406931
DOI: 10.1371/journal.pone.0175438 -
Indian Pediatrics Oct 2016Knowledge and skills of heart, head, lung, gut and basic abdominal ultrasound is of immense utility to clinicians in their day-to-day patient management, and in acute... (Review)
Review
CONTEXT
Knowledge and skills of heart, head, lung, gut and basic abdominal ultrasound is of immense utility to clinicians in their day-to-day patient management, and in acute events, in the absence of specialist service back-up. This review examines the potential role of clinician-performed ultrasound in the neonatal intensive care unit.
EVIDENCE ACQUISITION
The bibliographic search of English-language literature was performed electronically using PubMed and EMBASE databases for the different topics we have covered under this review.
RESULTS
Bedside head ultrasound can be used to identify and screen for intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic ventricular dilatation. It is also a useful adjuvant tool in the evaluation of hypoxic ischemic encephalopathy. The relatively new lung ultrasound technique is useful in identifying transient tachypnea, pneumonia, pneumothorax, fluid overload and pleural effusion. Gut ultrasound is useful in identifying necrotizing enterocolitis and probably is better than X-ray in prognostication. Ultrasound is also useful in identifying vascular line positions without radiation exposure.
MAIN CONCLUSIONS
Ultrasound performed by the clinician has an extensive role in the neonatal intensive care unit. Basic ultrasound knowledge of head, lung and gut is a useful supplement to clinical decision-making.
Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Neonatal Screening; Ultrasonography
PubMed: 27484449
DOI: 10.1007/s13312-016-0954-5 -
European Journal of Paediatric... Mar 2022To assess the prevalence and development of muscle tone impairments in infants at high risk of developmental disorders, and their associations with cerebral palsy (CP)...
AIM
To assess the prevalence and development of muscle tone impairments in infants at high risk of developmental disorders, and their associations with cerebral palsy (CP) and cystic periventricular leukomalacia (cPVL).
METHOD
Longitudinal exploration of muscle tone in 39 infants at high risk of CP (LEARN2MOVE 0-2 project) mostly due to an early lesion of the brain. Muscle tone was assessed ≥4 times between 0 and 21 months corrected age (CA) with the Touwen Infant Neurological Examination. Diagnosis of CP was determined at 21 months CA. Neonatal neuro-imaging was available. Developmental trajectories were calculated using generalized linear mixed effect models.
RESULTS
Infants showed atypical muscle tone in three or four body parts in 93% (172/185) of the assessments. The most prevalent muscle tone pattern was hypotonia of neck and trunk with hypertonia of the limbs (28%). From 7 months CA onwards hypertonia of the arms was associated with CP. Asymmetric arm tone during infancy was associated with unilateral CP. At 18-21 months CA ankle hypertonia was associated with CP at 21 months; leg hypertonia in infancy was not associated with CP. Leg hypertonia was associated with cPVL, regardless of age.
INTERPRETATION
High-risk infants due to an early lesion of the brain often present with muscle tone impairment. In these infants, hypertonia and asymmetric muscle tone of the arms were from 7 months onwards associated with the diagnosis of CP at 21 months; hypertonia of the legs was not.
Topics: Brain; Cerebral Palsy; Humans; Infant; Infant, Newborn; Leukomalacia, Periventricular; Muscle Tonus; Neurologic Examination
PubMed: 35007848
DOI: 10.1016/j.ejpn.2021.12.015 -
Archives of Disease in Childhood. Fetal... Jul 2003Magnetic resonance imaging (MRI) has proved to be a valuable tool for monitoring development and pathology in the preterm brain. This imaging modality is useful for... (Review)
Review
Magnetic resonance imaging (MRI) has proved to be a valuable tool for monitoring development and pathology in the preterm brain. This imaging modality is useful for assessing numerous pathologies including periventricular leukomalacia, intraventricular haemorrhage/germinal layer haemorrhage, and periventricular haemorrhagic infarction, and can help to predict outcome in these infants. MRI has also allowed the detection of posterior fossa lesions, which are not easily seen with ultrasound. Additionally, and perhaps most relevant, quantitative MR studies have shown differences between the normal appearing preterm brain at term equivalent age and term born infants, confirming that the brain develops differently in the ex utero environment. Further studies using quantifiable MR techniques will improve our understanding of the effects of the ex utero environment, including aspects of neonatal intensive care on the developing brain.
Topics: Brain Injuries; Cerebral Infarction; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intracranial Hemorrhages; Magnetic Resonance Imaging
PubMed: 12819156
DOI: 10.1136/fn.88.4.f269 -
Developmental Medicine and Child... Jun 2021To determine the features cited by motor phenotyping experts when identifying dystonia in people with cerebral palsy (CP).
AIM
To determine the features cited by motor phenotyping experts when identifying dystonia in people with cerebral palsy (CP).
METHOD
Dystonia identification in CP, particularly when comorbid with spasticity, can be difficult. The dystonia diagnostic criterion standard remains subjective visual identification by expert consensus. For this qualitative study, we conducted an inductive thematic analysis of consensus-building discussions between three pediatric movement disorder physicians as they identified the presence or absence of dystonia in gait videos of 40 participants with spastic CP and periventricular leukomalacia.
RESULTS
Unanimous consensus about the presence or absence of dystonia was achieved for 34 out of 40 videos. Two main themes were present during consensus-building discussions as videos were evaluated for dystonia: (1) unilateral leg or foot adduction that was variable over time, and (2) difficulty in identifying dystonia. Codes contributing to the first theme were more likely to be cited by a discussant when they felt dystonia was present (as opposed to absent) in a video (χ test, p=0.004).
DISCUSSION
These results describe the gait features cited by experts during consensus-building discussion as they identify dystonia in ambulatory people with CP. Qualitative thematic analysis of these discussions could help codify the subjective process of dystonia diagnosis.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Dystonia; Female; Gait; Humans; Leukomalacia, Periventricular; Male; Muscle Spasticity; Young Adult
PubMed: 33411352
DOI: 10.1111/dmcn.14802