Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study

Inder, Terrie E.; Wells, Scott J.; Mogridge, N; Spencer, Carole A.; Volpe, Joseph J.

doi:10.1067/s0022-3476(03)00357-3

Cited by 465 publications

(218 citation statements)

References 40 publications

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“…In addition, most studies included only cases of cystic PVL, which is now estimated to constitute less than 10% of all cases of white matter damage. Cerebral non-cystic white matter injury has been related to perinatal infection, particularly maternal fever and infant sepsis [22]. The role of proven sepsis, independent of other risk factors, in the development of neurological impairment in extremely preterm infants has also been shown by others [23].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Rodrigo

Henríquez²,

Aloy³

et al. 2014

Neonatology

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Background: Chorioamnionitis is a recognized risk factor of preterm delivery; however, controversy still persists concerning the relationship between maternal inflammation and neonatal morbidity and mortality. Objective: To determine the incidence of clinical chorioamnionitis and its relationship to morbidity and mortality among very-low-birth-weight (VLBW) infants. Methods: This was a retrospective analysis of prospectively collected data of VLBW neonates ≤32 weeks' gestational age (GA) admitted to collaborating units in the Spanish SEN1500 Network between January 2008 and December 2011. Clinical chorioamnionitis was defined by obstetricians based on clinical findings, and neonatal outcomes were compared between exposed and non-exposed infants by multivariate logistic regression analysis. Results: During the study period, 11,464 VLBW newborns were admitted to our units and 10,026 were ≤32 weeks' GA. Among them, 8,330 (83.1%) had complete data and were included. Of these, 1,480 (17.8%) were exposed to maternal clinical chorioamnionitis. The incidence was higher at lower GA and, after adjusting for confounding factors, exposed infants had higher risks of early-onset neonatal sepsis (EONS) (10.0 vs. 2.8%; aOR 3.102; 95% CI 2.306-4.173; p < 0.001) and necrotizing enterocolitis (NEC) (11.2 vs. 7.7%; aOR 1.300; 95% CI 1.021-1.655; p < 0.033), but lower risks of patent ductus arteriosus (PDA) (43.2 vs. 34.9%; aOR 0.831; 95% CI 0.711-0.971; p < 0.02) and late-onset bacterial sepsis (LONS) (36.6 vs. 32.5%; aOR 0.849; 95% CI 0.729-0.989; p < 0.035). There were no differences in mortality between the groups. Conclusions: The incidence of maternal clinical chorioamnionitis is inversely related to GA at delivery, and in VLBW infants ≤32 weeks' GA it is associated with higher risks of EONS and NEC, but lower risks of PDA and LONS. We did not found differences in survival.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Rodrigo

Henríquez²,

Aloy³

et al. 2014

Neonatology

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“…Low-grade intraventricular hemorrhages (IVH grades 1 and 2) were accepted. In addition, all scans were evaluated according to a scoring system for WM abnormalities regarding MRI signal abnormalities, reduction in WM volume, cysts, ventriculomegaly, myelination, and thinning of the corpus callosum (43). Only infants with normal WM according to the scoring system were included in the study (44).…”

Section: Methodsmentioning

confidence: 99%

Resting-state networks in the infant brain

Fransson

Skiöld²,

Horsch³

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

622

527

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In the absence of any overt task performance, it has been shown that spontaneous, intrinsic brain activity is expressed as systemwide, resting-state networks in the adult brain. However, the route to adult patterns of resting-state activity through neuronal development in the human brain is currently unknown. Therefore, we used functional MRI to map patterns of resting-state activity in infants during sleep. We found five unique resting-states networks in the infant brain that encompassed the primary visual cortex, bilateral sensorimotor areas, bilateral auditory cortex, a network including the precuneus area, lateral parietal cortex, and the cerebellum as well as an anterior network that incorporated the medial and dorsolateral prefrontal cortex. These results suggest that resting-state networks driven by spontaneous signal fluctuations are present already in the infant brain. The potential link between the emergence of behavior and patterns of resting-state activity in the infant brain is discussed.development ͉ functional MRI ͉ spontaneous activity R ecent research on functional connectivity in the brain, in particular during resting-state conditions, has come to focus on low-frequency (Ͻ0.1 Hz), spontaneous fluctuations in the functional MRI (fMRI) signal. Discovered by Biswal et al. (1), it has been shown that systemwide networks in the resting brain are synchronized in time through intrinsic low-frequency signal fluctuations. Whereas early fMRI studies demonstrated synchronicity of intrinsic brain activity across hemispheres in primary sensory cortices (2, 3), succeeding studies have shown temporal synchronization in a resting-state network encompassing higher-order cortices (4). A systematic investigation of resting-state activity in the adult human brain was recently presented by Damoiseaux et al. (5). Using independentcomponent analysis (ICA), a data-driven explorative data analysis approach, they showed that there are numerous networks in the brain that are driven by spontaneous activity. Besides networks that are in part or fully described by the previously reported default mode (6) and task-positive network (7, 8), they found consistent patterns of resting-state activity in the visual cortex, sensorimotor areas, auditory areas, as well as extrastriate brain regions. These findings together with previous investigations on spontaneous activity suggest that the assumption that the brain during rest is idle and waiting to be triggered and respond to changes in the environment is not strictly valid. Rather, in addition to responding to changes in external stimuli or tasks, the brain is characterized by intrinsic dynamics in the form of coherent and spontaneous fluctuations, clustered together in networks that are credible from an anatomical and functional perspective.Interestingly, recent studies have presented evidence that spontaneous activity is relevant for human behavior. Momentary lapses of attention, affecting goal-oriented behavior on a global/ local selective attention task, were related to a fai...

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“…Measuring actual tissue perfusion in preterm infants continuously, however, is currently unavailable for clinical use [7]. As some infants do develop brain and organ damage following mild or severe periods of hypotension while others do not [8,9], individual factors may be involved. One such factor may be the presence or absence of cerebrovascular autoregulation (CAR).…”

Section: Introductionmentioning

confidence: 99%

Volume Expansion Does Not Alter Cerebral Tissue Oxygen Extraction in Preterm Infants with Clinical Signs of Poor Perfusion

et al. 2013

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Background: Preterm infants with signs of poor perfusion are often treated with volume expansion, although evidence regarding its effect on cerebral perfusion is lacking. Moreover, the effect is questionable in preterm infants with an adequate cerebrovascular autoregulation (CAR). A useful measure to assess perfusion is cerebral fractional tissue oxygen extraction (cFTOE). Objectives: To assess the effect of volume expansion on cFTOE in preterm infants with signs of poor perfusion. Methods: In this observational study, we assessed cFTOE using near-infrared spectroscopy in preterm infants with signs of poor perfusion before, during and 1 h after volume expansion treatment. Simultaneously, we measured mean arterial blood pressure (MABP). We tested the effect of volume expansion on both cFTOE and MABP, using multi-level analyses. We intended to define a subgroup that responded to volume expansion with an increase in blood pressure and a decrease in cFTOE, suggesting absent CAR. Results: In 14 preterm infants, with a median gestational age of 26.7 weeks (25.0-28.7 weeks) and a median birth weight of 836 g (615-1,290 g), we found a small increase in MABP during (1.4 ± 1.4 mm Hg, p = 0.003) and after (1.8 ± 1.7 mm Hg, p = 0.001) volume expansion, but no change in cFTOE during (-0.19 ± 0.1% p = 0.44) or after (-0.53 ± 0.1% p = 0.34) volume expansion. We were unable to define a subgroup lacking CAR. Conclusions: Cerebral perfusion, as assessed by cFTOE, does not improve in preterm infants with signs of poor perfusion following volume expansion. In these infants, either CAR is present or volume expansion is inadequate to affect cFTOE.

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Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study

Cited by 465 publications

References 40 publications

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Resting-state networks in the infant brain

Volume Expansion Does Not Alter Cerebral Tissue Oxygen Extraction in Preterm Infants with Clinical Signs of Poor Perfusion

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