Precision of Ultrasound Diagnosis of Pathologically Verified Lesions in the Brains of Very Preterm Infants

Hope, P L; Gould, Stephen J.; Howard, S.; Hamilton, P A; Costello, A.; Reynolds, E. O. R.

doi:10.1111/j.1469-8749.1988.tb04773.x

Cited by 153 publications

(32 citation statements)

References 33 publications

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“…Although MRI is the optimal imaging modality to define WMI in preterm survivors [115][116][117][118], the histopathological features of MRI signal abnormalities have been mostly defined for WMI where periventricular leukomalacia predominates [64,[119][120][121][122][123]. With the pronounced shift to milder forms of human WMI defined by quantitative and diffusionweighted MRI, there is a need to define the cellular features of these lesions.…”

Section: Role Of High-field Mri To Define Pathological Features Of Wmimentioning

confidence: 99%

The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

et al. 2012

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Despite advances in neonatal intensive care, survivors of premature birth remain highly susceptible to unique patterns of developmental brain injury that manifest as cerebral palsy and cognitive-learning disabilities. The developing brain is particularly susceptible to cerebral white matter injury related to hypoxia-ischemia. Cerebral white matter development in fetal sheep shares many anatomical and physiological similarities with humans. Thus, the fetal sheep has provided unique experimental access to the complex pathophysiological processes that contribute to injury to the human brain during successive periods in development. Recent refinements have resulted in models that replicate major features of acute and chronic human cerebral injury and have provided access to complex clinically relevant studies of cerebral blood flow and neuroimaging that are not feasible in smaller laboratory animals. Here, we focus on emerging insights and methodologies from studies in fetal sheep that have begun to define cellular and vascular factors that contribute to white matter injury. Recent advances include spatially defined measurements of cerebral blood flow in utero, the definition of cellular maturational factors that define the topography of injury and the application of high-field magnetic resonance imaging to define novel neuroimaging signatures for specific types of chronic white matter injury. Despite the higher costs and technical challenges of instrumented preterm fetal sheep models, they provide powerful access to clinically relevant studies that provide a more integrated analysis of the spectrum of insults that appear to contribute to cerebral injury in human preterm infants.

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Section: Role Of High-field Mri To Define Pathological Features Of Wmimentioning

confidence: 99%

The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

et al. 2012

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“…Entretanto, a presença destes indicadores não assegura a confirmação do prejuízo para o desenvolvimento [17][18][19][20] .…”

Section: Introductionunclassified

Early diagnosis of abnormal development of preterm newborns: assessment instruments

Santos¹,

Araujo²,

Porto³

2008

J Pediatr (Rio J)

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ResumoObjetivo: Revisar criticamente os instrumentos de avaliação mais utilizados na atualidade na literatura para triagem e identificação precoce de anormalidades no desenvolvimento em crianças. Fontes dos dados:Foi realizado um levantamento bibliográfico nas bases de dados no SciELO, plataforma CAPES, PubMed e Google Scholar, com os unitermos "prematuridade", "atraso no desenvolvimento", "paralisia cerebral", "diagnóstico precoce" e "testes de avaliação". Síntese dos dados:Foram listados 455 títulos, sendo selecionados para esta revisão 174 artigos com base em título, relevância temática e resumo. Apenas artigos originais, disponíveis em meio eletrônico, a partir de 1985, com informação sobre a construção, aplicabilidade e propriedades psicométricas dos testes foram usados. Sources: A search on SciELO, PubMed and Google Scholar was performed using the terms "prematurity," "developmental delay," "cerebral palsy," "early diagnosis" and "evaluation tests." Conclusões Summary of the findings:A total of 455 references were listed, and 174 studies were selected for this review based on title,

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“…Because changes on MRI correspond closely to histopathologic changes found on postmortem examination, [45][46][47][48][49] MRI can be applied in vivo to better anticipate the neurodevelopmental outcome after neonatal brain injury. A number of investigators have found that the severity and pattern of brain injury in the term newborns after a hypoxic-ischemic insult are strongly predictive of neurodevelopmental outcomes.…”

Section: Mri As An Early Outcome Measurementioning

confidence: 99%

Preventing Brain Injury in Newborns With Congenital Heart Disease

Sherlock

McQuillen

Miller

2009

Stroke

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Miller, MDCM, MAS; on behalf of aCCENTBackground and Purpose-Newborns with congenital heart disease are at high risk for brain injury and adverse neurodevelopmental outcomes. MRI enables the objective determination of the severity of brain injury in critically ill newborns with congenital heart disease. We will rationalize the use of MRI as a surrogate for neurodevelopmental outcome and describe novel randomization techniques that can be used in trials in this population. Methods-This article describes the evidence for the use of MRI and the link with neurodevelopmental outcome established in newborns. We also discuss the use of adaptive randomization techniques for future clinical trials in newborns with congenital heart disease. These strategies will be highlighted using an example. Results-Brain injuries occur with high frequency in newborns with congenital heart disease. It is not until school age that the full extent of neurological sequelae becomes apparent and the rapid pace of innovation in neonatal cardiac surgery prevents timely evaluation of changes in care. MRI provides a timely, safe, and reliable outcome measure and has been extensively studied in newborns with other conditions in which the link between brain injury and neurodevelopmental outcome has been established. Clinical trials using MRI as an outcome measure as well as adaptive randomization can improve the efficiency of such trials. Conclusions-Clinical trials of brain protection are urgently needed in newborns with congenital heart disease given the unacceptable frequency of brain injury in this population; MRI provides an early surrogate marker of long-term neurodevelopmental outcome and adaptive randomization can be used to improve the efficiency of these clinical trials. Key Words: brain injury Ⅲ congenital heart disease Ⅲ MRI Ⅲ neurodevelopment Ⅲ randomized, controlled trials E xperts have called for large clinical trials in the prevention of pediatric strokes based on the example set by pediatric oncology groups; oncology clinical trials have vastly improved the survival and outcomes of pediatric oncology survivors. 1 The incidence of stroke in the newborn is 20 per 100 000 live births and leads to a high risk of significant long-term neurological impairments for survivors, 2 including cerebral palsy, 3 cognitive deficits, visual disturbances, and epilepsy. 4 MRI is increasingly being used to detect stroke in the newborn. A number of imaging features of stroke are now recognized as predictors of adverse neurodevelopmental outcome. 3,5 Newborns with congenital heart disease (CHD) are at increased risk for brain injury and adverse neurodevelopmental outcomes. High-resolution MRI and diffusion tensor imaging enable us to objectively determine the severity of brain injury in these newborns. Periventricular leukomalacia and neonatal strokes have both been reported to be the most significant lesions in terms of severity and incidence in infants that undergo CHD repair 6,7 ; modifiable risk factors have been identified for both giving the ho...

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Precision of Ultrasound Diagnosis of Pathologically Verified Lesions in the Brains of Very Preterm Infants

Cited by 153 publications

References 33 publications

The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

Early diagnosis of abnormal development of preterm newborns: assessment instruments

Preventing Brain Injury in Newborns With Congenital Heart Disease

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