Brain growth in the NICU: critical periods of tissue-specific expansion

Matthews, Lillian G.; Walsh, Brian H.; Knutsen, Clare; Smyser, Christopher D.; Rogers, Cynthia; Inder, Terrie E.

doi:10.1038/pr.2018.4

Cited by 35 publications

(38 citation statements)

References 38 publications

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“…The “gold standard” for measuring brain growth is with volumetric methods, which were employed here. As established by our group and others, comparisons of volumetric measures between groups and methodologies in fetal and neonatal populations standardly utilize manually-corrected segmentations generated by blinded personnel as the optimal reference ( Beare et al, 2016 ; Matthews et al, 2018 ; Habas et al, 2010 ; Makropoulos et al, 2014 ). Here, after an automated segmentation algorithm was used for the initial segmentation process, all data across all time points were subsequently manually modified in a blinded fashion and in a systematic manner to ensure the fidelity of results.…”

Section: Discussionmentioning

confidence: 99%

Prenatal to postnatal trajectory of brain growth in complex congenital heart disease

Ortinau

Mangin-Heimos

Moen

et al. 2018

NeuroImage: Clinical

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Altered brain development is a common feature of the neurological sequelae of complex congenital heart disease (CHD). These alterations include abnormalities in brain size and growth that begin prenatally and persist postnatally. However, the longitudinal trajectory of changes in brain volume from the prenatal to postnatal environment have not been investigated. We aimed to evaluate the trajectory of brain growth in a cohort of patients with complex CHD (n = 16) and healthy controls (n = 15) to test the hypothesis that patients with complex CHD would have smaller total brain volume (TBV) prenatally, which would become increasingly prominent by three months of age. Participants underwent fetal magnetic resonance imaging (MRI) at a mean of 32 weeks gestation, a preoperative/neonatal MRI shortly after birth, a postoperative MRI (CHD only), and a 3-month MRI to evaluate the trajectory of brain growth. Three-dimensional volumetric analysis was applied to the MRI data to measure TBV, as well as tissue-specific volumes of the cortical gray matter (CGM), white matter (WM), subcortical (deep nuclear) gray matter (SCGM), cerebellum, and cerebrospinal fluid (CSF). A random coefficients model was used to investigate longitudinal changes in TBV and demonstrated an altered trajectory of brain growth in the CHD population. The estimated slope for TBV from fetal to 3-month MRI was 11.5 cm3 per week for CHD infants compared to 16.7 cm3 per week for controls (p = 0.0002). Brain growth followed a similar trajectory for the CGM (p < 0.0001), SCGM (p = 0.002), and cerebellum (p = 0.005). There was no difference in growth of the WM (p = 0.30) or CSF (p = 0.085). Brain injury was associated with reduced TBV at 3-month MRI (p = 0.02). After removing infants with brain injury from the model, an altered trajectory of brain growth persisted in CHD infants (p = 0.006). These findings extend the existing literature by demonstrating longitudinal impairments in brain development in the CHD population and emphasize the global nature of disrupted brain growth from the prenatal environment through early infancy.

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Section: Discussionmentioning

confidence: 99%

Prenatal to postnatal trajectory of brain growth in complex congenital heart disease

Ortinau

Mangin-Heimos

Moen

et al. 2018

NeuroImage: Clinical

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“…5C). Normalization using total brain tissue is appropriate for understanding how CC size changes with respect to the brain as a whole 38 . LGEA with TEF, n (%) 0 5 (38%) 9 (69%)…”

Section: Surface Area (2-d) Segmentationmentioning

confidence: 99%

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

Sci Rep

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previous studies in preterm infants report white matter abnormalities of the corpus callosum (cc) as an important predictor of neurodevelopmental outcomes. our cross-sectional study aimed to describe qualitative and quantitative cc size in critically ill infants following surgical and critical care for longgap esophageal atresia (LGeA)-in comparison to healthy infants-using MRi. non-sedated brain MRi was acquired for full-term (n = 13) and premature (n = 13) patients following treatment for LGEA, and controls (n = 20) <1 year corrected age. A neuroradiologist performed qualitative evaluation of T1weighted images. ITK-SNAP was used for linear, 2-D and 3-D manual CC measures and segmentations as part of CC size quantification. Qualitative MRI analysis indicated underdeveloped CC in both patient groups in comparison to controls. We show no group differences in mid-sagittal CC length. Although 2-D results were inconclusive, volumetric analysis showed smaller absolute (F(2,42) = 20.40, p < 0.001) and normalized (F(2,42) = 16.61, p < 0.001) CC volumes following complex perioperative treatment for LGeA in both full-term and premature patients, suggesting delayed or diminished cc growth in comparison to controls, with no difference between patient groups. Future research should look into etiology of described differences, neurodevelopmental outcomes, and role of the CC as an early marker of neurodevelopment in this unique infant population.

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“…Similarly, the difference between total CSF and extra-axial space volumes represented ventricular space volume. Normalized values for T1-weighted CC volume were calculated as % of brain volume, since total brain tissue is appropriate for understanding how CC size changes with respect to the brain as a whole [40].…”

Section: Mri Data Volumetrymentioning

confidence: 99%

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

et al. 2019

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We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA.

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Brain growth in the NICU: critical periods of tissue-specific expansion

Cited by 35 publications

References 38 publications

Prenatal to postnatal trajectory of brain growth in complex congenital heart disease

Prenatal to postnatal trajectory of brain growth in complex congenital heart disease

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

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