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International Journal of Developmental... Jun 2011Brain injury in the premature infant, a problem of enormous importance, is associated with a high risk of neurodevelopmental disability. The major type of injury... (Review)
Review
Brain injury in the premature infant, a problem of enormous importance, is associated with a high risk of neurodevelopmental disability. The major type of injury involves cerebral white matter and the principal cellular target is the developing oligodendrocyte. The specific phase of the oligodendroglial lineage affected has been defined from study of both human brain and experimental models. This premyelinating cell (pre-OL) is vulnerable because of a series of maturation-dependent events. The pathogenesis of pre-OL injury relates to operation of two upstream mechanisms, hypoxia-ischemia and systemic infection/inflammation, both of which are common occurrences in premature infants. The focus of this review and of our research over the past 15-20 years has been the cellular and molecular bases for the maturation-dependent vulnerability of the pre-OL to the action of the two upstream mechanisms. Three downstream mechanisms have been identified, i.e., microglial activation, excitotoxicity and free radical attack. The work in both experimental models and human brain has identified a remarkable confluence of maturation-dependent factors that render the pre-OL so exquisitely vulnerable to these downstream mechanisms. Most importantly, elucidation of these factors has led to delineation of a series of potential therapeutic interventions, which in experimental models show marked protective properties. The critical next step, i.e., clinical trials in the living infant, is now on the horizon.
Topics: Animals; Brain Injuries; Glutamic Acid; Humans; Hypoxia-Ischemia, Brain; Immunity, Innate; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Leukomalacia, Periventricular; Microglia; Oligodendroglia; Reactive Oxygen Species
PubMed: 21382469
DOI: 10.1016/j.ijdevneu.2011.02.012 -
Archives of Disease in Childhood Dec 1986The brains of 30 infants who died after at least one real time ultrasound scan were examined after fixation. The ultrasound diagnosis of either periventricular...
The brains of 30 infants who died after at least one real time ultrasound scan were examined after fixation. The ultrasound diagnosis of either periventricular haemorrhage or periventricular leucomalacia was compared with the macroscopic and histological appearances. Each hemisphere was considered separately for both periventricular haemorrhage and periventricular leucomalacia. The accuracy of ultrasound diagnosis for periventricular haemorrhage was 88%, with sensitivity of 91% and specificity of 85%. The accuracy for periventricular leucomalacia was 90%, with sensitivity of 85% and specificity of 93%. Ultrasound was shown to diagnose the entire range of periventricular leucomalacia lesions. Three hemispheres showed the appearance of prolonged flare, and this correlated with extensive spongiosis and microcalcification of the periventricular white matter, although no macroscopic lesion was seen.
Topics: Brain; Cerebral Hemorrhage; Diagnosis, Differential; Encephalomalacia; Humans; Infant, Newborn; Leukomalacia, Periventricular; Prognosis; Prospective Studies; Ultrasonography
PubMed: 3545096
DOI: 10.1136/adc.61.12.1203 -
Applied Sciences (Basel, Switzerland) Dec 2021This paper is concerned with the prediction of the occurrence of periventricular leukomalacia (PVL) in neonates after heart surgery. Our prior work shows that the...
This paper is concerned with the prediction of the occurrence of periventricular leukomalacia (PVL) in neonates after heart surgery. Our prior work shows that the Support Vector Machine (SVM) classifier can be a powerful tool in predicting clinical outcomes of such complicated and uncommon diseases, even when the number of data samples is low. In the presented work, we first illustrate and discuss the shortcomings of the traditional automatic machine learning (aML) approach. Consequently, we describe our methodology for addressing these shortcomings, while utilizing the designed interactive ML (iML) algorithm. Finally, we conclude with a discussion of the developed method and the results obtained. In sum, by adding an additional (Genetic Algorithm) optimization step in the SVM learning framework, we were able to (a) reduce the dimensionality of an SVM model from 248 to 53 features, (b) increase generalization that was confirmed by a 100% accuracy assessed on an unseen testing set, and (c) improve the overall SVM model's performance from 65% to 100% testing accuracy, utilizing the proposed iML method.
PubMed: 37885926
DOI: 10.3390/app112311156 -
Archives of Disease in Childhood. Fetal... Sep 1994One hundred sixty seven survivors among very low birthweight infants with a gestational age of less than 35 weeks have been studied prospectively. The purpose of this...
One hundred sixty seven survivors among very low birthweight infants with a gestational age of less than 35 weeks have been studied prospectively. The purpose of this study was to clarify the relationship of severe prenatal and perinatal complications and hypocarbic alkalosis, defined as a carbon dioxide tension (PaCO2) of less than or equal to 2.67 kPa and a pH of 7.50 or greater during the first 24 hours of life, to cystic periventricular leukomalacia (PVL) depicted by serial cranial ultrasonographic examinations. Complications occurred in 16 infants, five of whom presented with PVL, while eight of 151 infants without complications had PVL. Twenty six of the infants had hypocarbic alkalosis, six with evidence of PVL, and seven of the 136 infants without hypocarbic alkalosis had PVL. These results suggest a significant relationship of complications and hypocarbic alkalosis to PVL. Mechanical ventilation should be managed carefully in premature infants to avoid PaCO2 of lower than 2.67 kPa.
Topics: Alkalosis; Carbon Dioxide; Echoencephalography; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Prospective Studies; Respiration, Artificial
PubMed: 7979462
DOI: 10.1136/fn.71.2.f107 -
Revista de Neurologia Oct 2006It is today well recognised that preterm infants are at risk of neurodevelopmental impairments later in life. The preterm brain is exposed to different stimuli that may... (Review)
Review
INTRODUCTION
It is today well recognised that preterm infants are at risk of neurodevelopmental impairments later in life. The preterm brain is exposed to different stimuli that may affect its normal development. Develoment. Magnetic resonance imaging (MRI) offers the possibility of monitoring normal brain development and pathology in the preterm brain. The most frequent lesions are germinal matrix/intraventricular haemorrhages, periventricular hemorrhagic infarction and periventricular leukomalacia. Other changes especially in the white matter, less well known from ultrasound studies, can be depicted with MRI. Furthermore, quantitative MRI techniques have demonstrated differences between the normal appearing preterm brain at term-equivalent age and the brain of term-born infants.
CONCLUSION
These studies confirm that the immature brain may develop differently in the extra uterine environment. Future studies with these techniques will improve our knowledge of the effects of prematurity on long term brain development.
Topics: Brain; Brain Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Magnetic Resonance Imaging
PubMed: 17061180
DOI: No ID Found -
Frontiers in Pediatrics 2014White matter disease in preterm infants comes along with focal destructions or with diffuse myelination disturbance. Recent experimental work with transgenic mice paves... (Review)
Review
White matter disease in preterm infants comes along with focal destructions or with diffuse myelination disturbance. Recent experimental work with transgenic mice paves the way for a unifying molecular model for both types of brain injury, placing oxygen sensing by oligodendrocyte precursor cells (OPCs) at the center stage. Mice genetically altered to mimic high local oxygen tension in oligodendroglia lineage cells (via deletion of hypoxia-inducible factor, HIF) develop white matter disease resembling cystic periventricular leukomalacia within the first 7 days of life. Mice in which local hypoxia is mimicked in oligodendroglial cells (via genetic inhibition of HIF decay) display arrested OPC maturation and subsequent hypomyelination, reminiscent of the diffuse white matter disease observed in preterm infants and infants with congenital heart disease. These recent experimental findings on oxygen sensing and myelination are awaiting integration into a clinical framework. Gene regulation in response to hyperoxia or hypoxia, rather than oxidative stress, may be an important mechanism underlying neonatal white matter disease.
PubMed: 25629025
DOI: 10.3389/fped.2014.00143 -
Italian Journal of Pediatrics Sep 2010Hypoxic-ischemic encephalopathy (HIE) is the most important cause of cerebral damage and long-term neurological sequelae in the perinatal period both in term and preterm... (Review)
Review
Hypoxic-ischemic encephalopathy (HIE) is the most important cause of cerebral damage and long-term neurological sequelae in the perinatal period both in term and preterm infant. Hypoxic-ischemic (H-I) injuries develop in two phases: the ischemic phase, dominated by necrotic processes, and the reperfusion phase, dominated by apoptotic processes extending beyond ischemic areas. Due to selective ischemic vulnerability, cerebral damage affects gray matter in term newborns and white matter in preterm newborns with the typical neuropathological aspects of laminar cortical necrosis in the former and periventricular leukomalacia in the latter. This article summarises the principal physiopathological and biochemical processes leading to necrosis and/or apoptosis of neuronal and glial cells and reports recent insights into some endogenous and exogenous cellular and molecular mechanisms aimed at repairing H-I cerebral damage.
Topics: Adipose Tissue; Animals; Animals, Newborn; Axons; Gestational Age; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Leukomalacia, Periventricular; Oligodendroglia; Phosphopyruvate Hydratase; Reperfusion Injury; S100 Proteins; Stromal Cells
PubMed: 20846380
DOI: 10.1186/1824-7288-36-63 -
Developmental Medicine and Child... May 2006The aim of this paper is to evaluate correlative magnetic resonance imaging (MRI) and histological parameters of development of cortical afferents during pathfinding and... (Review)
Review
The aim of this paper is to evaluate correlative magnetic resonance imaging (MRI) and histological parameters of development of cortical afferents during pathfinding and target selection in transient fetal cerebral laminas in human fetuses and preterm infants. The transient fetal subplate zone, situated between the fetal white matter (i.e. intermediate zone) and the cortical plate, is the crucial laminar compartment for development of thalamocortical and corticocortical afferents. The prolonged coexistence of transient (endogenously active) and permanent (sensory-driven) circuitry within the transient fetal zones is a salient feature of the fetal and preterm cortex; this transient circuitry is the substrate of cerebral functions in preterm infants. Another transient aspect of organization of developing fibre pathways is the abundance of extracellular matrix and guidance molecules in periventricular crossroads of projection and corticocortical pathways. Both the subplate zone and periventricular crossroads are visible on MRI in vivo and in vitro. Hypoxic-ischaemic lesions of periventricular crossroads are the substrate for motor, sensory, and cognitive deficits after focal periventricular leukomalacia (PVL). Lesions of distal portions of the white matter and the subplate zone are the substrate for diffuse PVL. The neuronal elements in transient fetal zones form a developmental potential for plasticity after perinatal cerebral lesions.
Topics: Axons; Cerebral Cortex; Extracellular Matrix; Fetal Development; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Magnetic Resonance Imaging; Nerve Net; Neuronal Plasticity; Receptors, GABA; Receptors, Glutamate; Time Factors
PubMed: 16608549
DOI: 10.1017/S0012162206000831 -
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