Changing Pattern of Perinatal Brain Injury in Term Infants in Recent Years

Abstract Background: Preterm infants and infants with perinatal brain injury show higher incidence of neurodevelopmental disorders (NDD). The Infant Motor Profile (IMP) is a clinical assessment which evaluates the complexity of early motor behaviour. More data are needed to confirm its predictive ability and concurrent validity with other common and valid assessments such as the Alberta Infant Motor Profile (AIMS) and the Prechtl’s General Movement Assessment (GMA). The present study aims to evaluate the concurrent validity of IMP with AIMS, to assess its association with GMA, to evaluate how IMP reflects the severity of the brain injury and to compare the ability of IMP and AIMS to predict abnormal outcome in 5-months infants at risk of NDD.Methods: 86 infants at risk of NDD were retrospectively recruited among the participants of two clinical trials. Preterm infants with or without perinatal brain injury and term infants with brain injury were assessed at 3 months corrected age (CA) using GMA and at 5 months CA using IMP and AIMS. Neurodevelopmental outcome was established at 18 months.Results: Results confirm a solid concurrent validity between IMP and AIMS (Spearman’s ρ 0.76; p<.001) and significant association between IMP and GMA. Unlike AIMS, IMP Total score accurately reflects the severity of neonatal brain injury (p<.001) and results to be the strongest predictor of NDD (p<.001). Confrontation of areas under receiver operating characteristic curves (AUC) confirms that IMP Total score has the highest diagnostic accuracy at 5 months (AUC 0.92). For an optimal IMP cut-off value of 70, the assessment shows high sensitivity (93%) and specificity (81%) (PPV 84%; NPV 90%).Conclusions: Early motor behaviour assessed with IMP is strongly associated with middle-term neurodevelopmental outcome. The present study confirms the concurrent validity of IMP with AIMS, its association with GMA and its ability to reflect brain lesion load contributing to the construct validity of the assessment.Trial registration: NCT01990183 and NCT03234959 (clinicaltrials.gov)

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Recent advances in perinatal neuroprotection

F1000Research ◽

10.12688/f1000research.20722.1 ◽

2019 ◽

Vol 8 ◽

pp. 2031

Author(s):

Samata Singhi ◽

Michael Johnston

Keyword(s):

Brain Injury ◽

Cell Therapy ◽

Therapeutic Hypothermia ◽

Preterm Delivery ◽

Recombinant Erythropoietin ◽

Perinatal Brain Injury ◽

Delayed Cord Clamping ◽

Term Infants ◽

Antenatal Steroids ◽

Cord Clamping

Perinatal brain injury is a major cause of neurological disability in both premature and term infants. In this review, we summarize the evidence behind some established neuroprotective practices such as administration of antenatal steroids, intrapartum magnesium for preterm delivery, and therapeutic hypothermia. In addition, we examine emerging practices such as delayed cord clamping, postnatal magnesium administration, recombinant erythropoietin, and non-steroidal anti-inflammatory agents and finally inform the reader about novel interventions, some of which are currently in trials, such as xenon, melatonin, topiramate, allopurinol, creatine, and autologous cord cell therapy.

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Outcome at Age Five Years or Older for Children with Perinatal Brain Injury Treated with Neurohabilitation or Neurodevelopmental Therapy

SSRN Electronic Journal ◽

10.2139/ssrn.3335873 ◽

2019 ◽

Author(s):

Nicolás Garófalo-Gómez ◽

Jesús Barrera-Reséndiz ◽

María Elena Juárez-Colín ◽

María del Consuelo Pedraza-Aguilar ◽

Cristina Carrillo-Prado ◽

...

Keyword(s):

Brain Injury ◽

Perinatal Brain Injury

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Perinatal brain injury and regulation of transcription

Current Opinion in Neurology ◽

10.1097/01.wco.0000218229.73678.a8 ◽

2006 ◽

Vol 19 (2) ◽

pp. 141-147 ◽

Cited By ~ 42

Author(s):

Ying-Chao Chang ◽

Chao-Ching Huang

Keyword(s):

Brain Injury ◽

Regulation Of Transcription ◽

Perinatal Brain Injury

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299 PRE-084, A Sigma-1 Receptor Ligand, Protects Against Excitotoxic Perinatal Brain Injury in Newborn Mice

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302724.0299 ◽

2012 ◽

Vol 97 (Suppl 2) ◽

pp. A87-A88

Author(s):

E. Griesmaier ◽

A. Posod ◽

M. Gross ◽

V. Neubauer ◽

K. Wegleiter ◽

...

Keyword(s):

Brain Injury ◽

Perinatal Brain Injury ◽

Receptor Ligand ◽

Newborn Mice ◽

Sigma 1 Receptor ◽

Sigma 1

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Abstract TP406: Ipsilesional Myelination is Impaired in Children With Perinatal Arterial Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp406 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sabrina Yu ◽

Helen Carlson ◽

Adam Kirton

Keyword(s):

Brain Injury ◽

Neurological Disorders ◽

Repeated Measures ◽

Population Based ◽

T Test ◽

Biological Processes ◽

Typically Developing ◽

Inclusion Criteria ◽

Perinatal Brain Injury ◽

Perinatal Stroke

Introduction: Stroke is a leading cause of perinatal brain injury and cerebral palsy. Current therapeutic efforts focus on optimizing developmental curves but the biological processes dictating these outcomes are poorly understood. Alterations in myelination are recognized as a major determinant of outcome in preterm brain injury but are unexplored in perinatal stroke (PS). Hypothesis: Ipsilesional delays in myelination occur in children with PS and are associated with poor developmental outcome. Methods: Participants were identified through the Alberta Perinatal Stroke Project, a population-based research cohort. Inclusion criteria were: 1) MRI-confirmed, unilateral arterial PS, 2) T1-weighted MRI >6mo, 3) absence of other neurological disorders, 4) neurological outcome (Pediatric Stroke Outcome Measure, PSOM), and 5) motor assessments (Assisting Hand Assessment, AHA; Melbourne Assessment). FreeSurfer software measured hemispheric asymmetry in myelination intensity. A second method using ImageJ validated the detection of myelination asymmetry. Overall PSOM scores were classified as poor (>1) or not. Repeated measures ANOVA compared perilesional, ipsilesional remote, and contralesional homologous regions. Myelination ratios for stroke cases were compared to typically developing controls (t-test), PSOM scores (t-test), and motor assessments (Pearson’s correlation). Results: Nineteen arterial stroke cases (mean age: 13.73±4.0yo) and 27 controls (mean age: 12.52±3.7yo) were studied. Stroke cases showed a greater degree of asymmetry with lower myelination in the lesioned hemisphere, compared to controls (p<0.001). Myelination in perilesional regions was decreased compared to ipsilesional remote (p<0.001) and contralesional homologous areas (p<0.001). Ipsilesional remote regions were decreased compared to homologous regions on the contralesional hemisphere (p=0.009). Contralesional myelination was also less than controls (p<0.001). Myelination ratios were not associated with PSOM, AHA, or Melbourne scores (p=0.144, 0.218, 0.366 respectively). Conclusion: Myelination of uninjured brain in the lesioned hemisphere is altered in children with PS. Further study is required to determine clinical significance.

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Glial cell responses in a murine multifactorial perinatal brain injury model

Brain Research ◽

10.1016/j.brainres.2017.12.020 ◽

2018 ◽

Vol 1681 ◽

pp. 52-63 ◽

Cited By ~ 5

Author(s):

Miriam Domowicz ◽

Natasha L. Wadlington ◽

Judith G. Henry ◽

Kasandra Diaz ◽

Miranda J. Munoz ◽

...

Keyword(s):

Brain Injury ◽

Glial Cell ◽

Perinatal Brain Injury ◽

Cell Responses ◽

Injury Model

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Placental Pathology in Full-Term Infants with Hypoxic-Ischemic Neonatal Encephalopathy and Association with Magnetic Resonance Imaging Pattern of Brain Injury

The Journal of Pediatrics ◽

10.1016/j.jpeds.2013.06.010 ◽

2013 ◽

Vol 163 (4) ◽

pp. 968-975.e2 ◽

Cited By ~ 48

Author(s):

Johanna C. Harteman ◽

Peter G.J. Nikkels ◽

Manon J.N.L. Benders ◽

Anneke Kwee ◽

Floris Groenendaal ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Injury ◽

Magnetic Resonance ◽

Full Term ◽

Placental Pathology ◽

Resonance Imaging ◽

Neonatal Encephalopathy ◽

Term Infants ◽

Magnetic Resonance Imaging Pattern

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The Role of Extracellular Vesicles in the Developing Brain: Current Perspective and Promising Source of Biomarkers and Therapy for Perinatal Brain Injury

Frontiers in Neuroscience ◽

10.3389/fnins.2021.744840 ◽

2021 ◽

Vol 15 ◽

Author(s):

Teena K. J. B. Gamage ◽

Mhoyra Fraser

Keyword(s):

Stem Cell ◽

Brain Injury ◽

Extracellular Vesicles ◽

Inflammatory Responses ◽

Brain Structures ◽

Developing Brain ◽

Long Term Effects ◽

Perinatal Brain Injury ◽

Current Perspective ◽

Promising Source

This comprehensive review focuses on our current understanding of the proposed physiological and pathological functions of extracellular vesicles (EVs) in the developing brain. Furthermore, since EVs have attracted great interest as potential novel cell-free therapeutics, we discuss advances in the knowledge of stem cell- and astrocyte-derived EVs in relation to their potential for protection and repair following perinatal brain injury. This review identified 13 peer-reviewed studies evaluating the efficacy of EVs in animal models of perinatal brain injury; 12/13 utilized mesenchymal stem cell-derived EVs (MSC-EVs) and 1/13 utilized astrocyte-derived EVs. Animal model, method of EV isolation and size, route, timing, and dose administered varied between studies. Notwithstanding, EV treatment either improved and/or preserved perinatal brain structures both macroscopically and microscopically. Additionally, EV treatment modulated inflammatory responses and improved brain function. Collectively this suggests EVs can ameliorate, or repair damage associated with perinatal brain injury. These findings warrant further investigation to identify the optimal cell numbers, source, and dosage regimens of EVs, including long-term effects on functional outcomes.

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