Inflammatory cytokines, placental pathology, and neurological outcomes in infants born to preterm preeclamptic mothers

Preeclampsia is both a vascular and inflammatory disorder. Since the placenta is a conduit for fetal development, preeclampsia should be a presumed cause of adverse infant outcomes. Yet, the relationship of placental pathology, inflammation and neurological outcomes after preeclampsia are understudied. We prospectively examined a cohort of maternal-infant dyads with preeclampsia for maternal inflammatory cytokines at time of preeclampsia diagnosis and delivery, and fetal cord blood cytokines (IL-1β, IL-6, IL-8, and TNF-α). Placentas were analyzed for inflammatory and vascular pathologies. Neurodevelopmental assessment of infants utilizing the Pediatric Stroke Outcome Measure (PSOM) was conducted at 6-month corrected gestational age. Eighty-one maternal-newborn dyads were examined. Worse neurological outcomes were not associated with elevated maternal / fetal cytokines. Early preterm birth (gestational age ≤ 32 weeks) was associated with worse neurological outcomes at 6-months regardless of maternal/ fetal cytokine levels, placental pathology, or cranial ultrasound findings (OR 1.70, [1.16–2.48], p = 0.006). When correcting for gestational age, elevated IL-6 approached significance as a predictor for worse developmental outcome (OR 1.025 [0.985–1.066], p = 0.221). Pathological evidence of maternal malperfusion and worse outcomes were noted in early preterm, although our sample size was small. Our study did not demonstrate an obvious association of inflammation and placental pathology in preeclampsia and adverse neurodevelopmental outcome at 6-month corrected age but does suggest maternal malperfusion at earlier gestational age may be a risk factor for worse outcome.

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Intraparenchymal hemorrhage after serial ventricular reservoir taps in neonates with hydrocephalus and association with neurodevelopmental outcome at 2 years of age

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.6.peds21120 ◽

2021 ◽

pp. 1-8

Author(s):

Mehmet N. Cizmeci ◽

Linda S. de Vries ◽

Maria Luisa Tataranno ◽

Alexandra Zecic ◽

Laura A. van de Pol ◽

...

Keyword(s):

Gestational Age ◽

Neurodevelopmental Outcome ◽

Ventricular Volume ◽

Mean Difference ◽

Cranial Ultrasound ◽

Intraparenchymal Hemorrhage ◽

Rapid Reduction ◽

Ventricular Volumes ◽

Fluid Removal ◽

Ventricular Reservoir

OBJECTIVE Decompressing the ventricles with a temporary device is often the initial neurosurgical intervention for preterm infants with hydrocephalus. The authors observed a subgroup of infants who developed intraparenchymal hemorrhage (IPH) after serial ventricular reservoir taps and sought to describe the characteristics of IPH and its association with neurodevelopmental outcome. METHODS In this multicenter, case-control study, for each neonate with periventricular and/or subcortical IPH, a gestational age-matched control with reservoir who did not develop IPH was selected. Digital cranial ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies were assessed. Ventricular measurements were recorded prior to and 3 days and 7 days after reservoir insertion. Changes in ventricular volumes were calculated. Neurodevelopmental outcome was assessed at 2 years corrected age using standardized tests. RESULTS Eighteen infants with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls were included. Reduction of the ventricular volumes relative to occipitofrontal head circumference after 7 days of reservoir taps was greater in infants with IPH (mean difference −0.19 [95% CI −0.37 to −0.004], p = 0.04). Cognitive and motor Z-scores were similar in infants with and those without IPH (mean difference 0.42 [95% CI −0.17 to 1.01] and 0.58 [95% CI −0.03 to 1.2]; p = 0.2 and 0.06, respectively). Multifocal IPH was negatively associated with cognitive score (coefficient −0.51 [95% CI −0.88 to −0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient −0.50 [95% CI −1.6 to −0.14], p = 0.02) after adjusting for age at the time of assessment. CONCLUSIONS This study reports for the first time that IPH can occur after a rapid reduction of the ventricular volume during the 1st week after the initiation of serial reservoir taps in neonates with hydrocephalus. Further studies on the use of cUS to guide the amount of cerebrospinal fluid removal are warranted.

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Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

Journal of Clinical Medicine ◽

10.3390/jcm8081226 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1226 ◽

Cited By ~ 2

Author(s):

Marjolijn S. Spruijt ◽

Enrico Lopriore ◽

Ratna N.G.B. Tan ◽

Femke Slaghekke ◽

Frans J.C.M. Klumper ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Motor Development ◽

Neurodevelopmental Outcome ◽

Disease Free Survival ◽

Cerebral Injury ◽

Cranial Ultrasound

Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7/241 (3%) survivors in the new cohort compared to 10/169 (6%) in the previous cohort (p = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both p < 0.01). Severe cerebral injury was related to decreased motor scores (B = −14.10; 95% CI −3.16, −25.04; p = 0.012). Children with severe NDI were born ≥32 weeks’ gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI.

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Extensive Perivillous Fibrin and Intervillous Histiocytosis in a SARS-CoV-2 Infected Placenta From an Uninfected Newborn: A Case Report Including Immunohistochemical Profiling

Pediatric and Developmental Pathology ◽

10.1177/10935266211025122 ◽

2021 ◽

pp. 109352662110251

Author(s):

James Roberts ◽

Jeanette D Cheng ◽

Elizabeth Moore ◽

Carla Ransom ◽

Minhui Ma ◽

...

Keyword(s):

Risk Factors ◽

Case Report ◽

Gestational Age ◽

Small For Gestational Age ◽

Immunohistochemical Staining ◽

Placental Pathology ◽

Fibrin Deposition ◽

Placental Infection ◽

Fetal Infection

Placental infection by SARS-CoV-2 with various pathologic alterations reported. Inflammatory findings, such as extensive perivillous fibrin deposition and intervillous histiocytosis, have been postulated as risk factors for fetal infection by SARS-CoV-2. We describe the placental findings in a case of a 31-year-old mother with SARS-CoV-2 infection who delivered a preterm female neonate who tested negative for SAR-CoV2 infection. Placental examination demonstrated a small for gestational age placenta with extensive intervillous histiocytosis, syncytiotrophoblast karyorrhexis, and diffuse intervillous fibrin deposition. Immunohistochemical staining demonstrated infection of the syncytiotrophoblasts by SARS-CoV-2 inversely related to the presence of intervillous histiocytes and fibrin deposition. Our case demonstrates that despite extensive placental pathology, no fetal transmission of SARS-CoV-2 occurred, as well as postulates a relationship between placental infection, inflammation, and fibrin deposition.

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The placental pathology of small-for-gestational age infants

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(75)90011-3 ◽

1975 ◽

Vol 121 (3) ◽

pp. 351-359 ◽

Cited By ~ 81

Author(s):

Geoffrey Altshuler ◽

Peter Russell ◽

Rufino Ermocilla

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Placental Pathology

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Effects of gestational age at birth on perinatal structural brain development in healthy term-born babies

10.1101/2021.05.02.442327 ◽

2021 ◽

Author(s):

Oliver Gale-Grant ◽

Sunniva Fenn-Moltu ◽

Lucas Franca ◽

Ralica Dimitrova ◽

Daan Christiaens ◽

...

Keyword(s):

Linear Regression ◽

Gestational Age ◽

Neurodevelopmental Outcome ◽

Magnetic Resonance Images ◽

Linear Regression Models ◽

Early Term ◽

Gestational Age At Birth ◽

The Impact ◽

Age At Birth ◽

Structural Brain

Multiple studies have demonstrated less favourable childhood outcomes in infants born in early term (37-38 weeks gestation) compared to those born at full term (40-41 weeks gestation). While this could be due to lower birthweight and greater perinatal morbidity, gestational age at birth may also have a direct effect on the brain and subsequent neurodevelopment in term-born babies. Here we characterise structural brain correlates of gestational age at birth in healthy term-born neonates and their relationship to later neurodevelopmental outcome. We used T2 and diffusion weighted Magnetic Resonance Images acquired in the neonatal period from a cohort (n=454) of healthy babies born at term age (>37 weeks gestation) and scanned between 1 and 41 days after birth. Images were analysed using tensor based morphometry (TBM) and tract based spatial statistics (TBSS). Neurodevelopment was subsequently assessed at age 18 months using the Bayley-III Scales of Infant and Toddler Development (n=281), and the effects of gestational age at birth and related neuroimaging findings on outcome were analysed with linear regression. Infants born earlier had areas of higher relative ventricular volume, and lower relative brain volume in the basal ganglia, cerebellum and brainstem. Earlier birth was also associated with lower fractional anisotropy, higher mean, axial and radial diffusivity in major white matter tracts. Gestational age at birth was positively associated with all Bayley-III subscales at age 18 months. Linear regression models predicting outcome from gestational age at birth were significantly improved by adding neuroimaging features associated with gestational age at birth. This work adds to the growing body of evidence of the impact of early term birth and highlights the importance of considering the effect of gestational age at birth in future neuroimaging studies including term-born babies.

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Cranial ultrasound in detection of neurological lesions in preterm neonates in a tertiary center in North Kerala, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171524 ◽

2017 ◽

Vol 4 (3) ◽

pp. 804 ◽

Cited By ~ 1

Author(s):

Kavya M. K. ◽

Radhamani K. V. ◽

Mahesh P.

Keyword(s):

Gestational Age ◽

Brain Injuries ◽

Radiology Department ◽

Preterm Neonates ◽

Cranial Ultrasound ◽

Medical College ◽

Non Invasive ◽

Tertiary Center ◽

The Central Nervous System ◽

Neurodevelopmental Abnormalities

Background: Incomplete formation and maturation of the central nervous system makes it extremely vulnerable to injury, in the case of premature neonates. This can result in a broad range of neurodevelopmental abnormalities. Cranial ultrasound is a sensitive tool for the early detection of these. Hence the present study was undertaken to assess the prevalence of neurosonological abnormality in preterm infants. The aims of the study were to identify and enumerate the neurosonographic features, to assess the severity of brain injuries by grading the neurosonographic findings and to correlate the clinical presentations with the neurosonographic findings.Methods: The present study was conducted in Department of Radiodiagnosis, Pariyaram Medical College. It consisted of all preterm neonates (less than 37 weeks of gestational age) referred to the Radiology department. The initial scan will be done as soon as possible (within 2 weeks of birth) followed by a repeat scan of the same infants at 36 weeks of corrected age, and at 8weeks post-partum.Results: A total of 100 neonates with gestational age varying from 29 to 37 weeks were studied, with the birth weight varying from 1.5 to 1.9 kg. The most common abnormality found on neurosonogram was germinal-matrix haemorrhage, followed by periventricular leukomalacia.Conclusions: Real time sonography is a sensitive non-invasive initial investigation for the detection of various brain lesions in the preterm neonates.

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