No abstract

Preterm birth frequently involves white matter injury and affects long-term neurologic and cognitive outcomes. Diffusion tensor imaging has been used to show that the white matter microstructure of newborn, preterm children is compromised in a regionally specific manner. However, until now it was not clear whether these lesions would persist and be detectible on longterm follow-up. Hence, we collected diffusion tensor imaging data on a 1.5-T scanner, and computed fractional anisotropy and coherence measures to compare the white matter integrity of children born preterm to that of control subjects. The subjects for the preterm group (10.9 Ϯ 0.29 y; n ϭ 9; birth weight Յ 1500 g; mean gestational age, 28.6 Ϯ 1.05 wk) possessed attention deficits, a common problem in preterms. They were compared with age-and sex-matched control children (10.8 Ϯ 0.33 y; n ϭ 10; birth weight Ն 2500; gestational age, Ն 37 wk). We found that the preterm group had lower fractional anisotropy values in the posterior corpus callosum and bilaterally in the internal capsules. In the posterior corpus callosum this difference in fractional anisotropy values may partially be related to a difference in white matter volume between the groups. An analysis of the coherence measure failed to indicate a group difference in the axonal organization. These results are in agreement with previous diffusion tensor imaging findings in newborn preterm children, and indicate that ex-preterm children with attention deficits have white matter disturbances that are not compensated for or repaired before 11 y of age. Preterm birth, and the early exposure to the extrauterine environment, increases the risks of perinatal brain injury (1, 2). Often these injuries involve the white matter (2, 3) and affect long-term neurologic and cognitive outcome, including problems with attention (4 -8). These long-term effects of perinatal complications are either a result of the inability to repair the original lesions, such as PVL, or caused by a disruption of the maturational processes.DTI is a relatively recent method of MRI. From the fact that the preferential direction of water diffusion within the white matter of the brain occurs along the axons, this technique identifies white matter and indicates the direction of the fiber bundles within (9). In the absence of restriction, water diffusion is spatially uniform (i.e. isotropic). However, depending on the number, size, arrangement, and density of axons, as well as on the extent of myelination, water diffusion in the brain deviates from spherical and approaches the shape of an ellipsoid (i.e. anisotropic diffusion) with the long axis pointing along the axons [for a review, see Westin et al. (10)]. Therefore DTI provides information on the microstructure of white matter. To estimate the extent of anisotropy we calculated FA, which ranges in value between 0 and 1 for isotropic and onedimensional diffusion, respectively (11).Several studies have used conventional MRI to investigate the immediate effects of brain injury in prete...

ObjectiveTo characterise pregnancies where the fetus or neonate was diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial haemorrhage (ICH), with special focus on time of bleeding onset.DesignObservational cohort study of all recorded cases of ICH caused by FNAIT from the international No IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010.Setting13 tertiary referral centres from nine countries across the world.Participants37 mothers and 43 children of FNAIT pregnancies complicated by fetal or neonatal ICH identified from the NOICH registry was included if FNAIT diagnosis and ICH was confirmed.Primary and secondary outcome measuresGestational age at onset of ICH, type of ICH and clinical outcome of ICH were the primary outcome measures. General maternal and neonatal characteristics of pregnancies complicated by fetal/neonatal ICH were secondary outcome measures.ResultsFrom a total of 592 FNAIT cases in the registry, 43 confirmed cases of ICH due to FNAIT were included in the study. The majority of bleedings (23/43, 54%) occurred before 28 gestational weeks and often affected the first born child (27/43, 63%). One-third (35%) of the children died within 4 days after delivery. 23 (53%) children survived with severe neurological disabilities and only 5 (12%) were alive and well at time of discharge. Antenatal treatment was not given in most (91%) cases of fetal/neonatal ICH.ConclusionsICH caused by FNAIT often occurs during second trimester and the clinical outcome is poor. In order to prevent ICH caused by FNAIT, at-risk pregnancies must be identified and prevention and/or interventions should start early in the second trimester.

SUMMARY Thirteen preterm children, aged 4 to 14 years, with visual impairment due to periventricular leukomalacia (PVL) were evaluated for visual function, intellectual level, cognitive profile and motor function. Their visual impairment was characterized by low acuity, crowding, visual field defects and ocular motility disturbances. Their cognitive profile was uneven, often with considerably higher scores on verbal than on visual‐spatial tasks. Nine children had normal intelligence, three had mild mental retardation and one had severe mental retardation. In all the children, visual impairment was complicated by visual perceptual difficulties, accounting for their greater visual handicap than would be expected from their visual acuities and strabismus alone. Though CT or MRI revealed bilateral PVL in all the children, six had no motor impairment consistent with cerebral palsy, which is an unexpected finding. RÉSUMÉ Troubles visuels chez le prématuré avec leacomalacie péri‐ventriculaire‐caractéristiques visuelles, cognitives el neuropédiatriques reliees àľimagerie cérébrale Une évaluation de la fonction visuelle, du niveau intellectuel, du profit cognitif et de la fonction motrice, a été effectuée chez treize prématurés âgés de 4 à 14 ans et présentant un trouble visuel liéà une leucomalacie périventriculaire (PVL). Le trouble visuel était caractérisé par une baisse de ľacuité, un décrochage du suivi, des défauts du champ visuel et des troubles de la motilité oculaire. Leur profil cognitif était dysharmonieux avec souvent des scores considérablement plus cleves aux taches verbales qu'aux taches visuo‐spatiales. Neuf enfants avaient une intelligence normale, trois un retard mental leger et un, un retard mental sévère. Chez tous les enfants, le trouble visuel était compliqué par des difficultés visuo‐perceptives, rendant compte ďun plus fort handicap visuel qu'on aurait pu attendre de leur acuité visuelle et du strabisme seuls. Bien que le scanner ct ľIRM. montraient une PVL bilatérale chez tous les enfants, six ne présentaient pas de déficit moteur de type IMC, ce qui est une découverte inattcndue. ZUSAMMENFASSUNG Visuelle Störungen bei Frühgeborenen mit perivenrikulärer Leukomalazie ‐ visuelle, kognitive und neuropädiatrisclie Clwrakleristika in. Relation zu CT und MRT Befunden Bei 13 Frühgeborenen mit visuellen Störungen aufgrund einer periventrikulären Leukomalazie (PVL) wurden im Alter von 4 bis 14 Jahren Sehfunktion, Intelligenzgrad, Wahrnehmungsprofil und Motorfunktion untersucht. Ihre visuelle Stöning war charakterisiert durch gcringe Sehschärfe, Crowding, Gesichtsfeldeinschränkungen und Augenmotilitätsstörungen. Ihr Wahnehmungsprofil war unterschiedlich, häufig mit erhcblich höheren Scores bei den verbalen als bei den visucllräumlichen Aufgaben. Neun hatten eine normale Intelligenz, drei warcn leicht retardiert und eins hatte eine schwere geistige Behinderung. Bei allen Kindern war die visuelle Befund durch eine visuelle Perzeptionsstörung kompliziert. die für ihre größere visuelle Behinderung verantwortlic...

Neuroradiological findings can be used to make a crude prediction of the future development of the use of the affected hand in young children with unilateral CP.