Brain White Matter Development Over the First 13 Years in Very Preterm and Typically Developing Children Based on the T1-W/T2-W Ratio

Objective:To investigate brain regional white matter development in full-term (FT) and very preterm (VP) children at term-equivalent, 7 and 13 years of age based on the ratio of T1-weighted and T2-weighted magnetic resonance images (T1-w/T2-w), including: (1) whether longitudinal changes differ between birth groups or sexes; (2) associations with perinatal risk factors in VP children, and; (3) relationships with neurodevelopmental outcomes at 13 years.Methods:Prospective longitudinal cohort study of VP (born <30 weeks’ gestation or <1250 g) and FT infants born between 2001-2004 and followed up at term-equivalent age, 7 years of age and 13 years of age, including magnetic resonance imaging studies and neurodevelopmental assessments. T1-w/T2-w images were parcellated into 48 white matter regions of interest.Results:Of 224 VP participants and 76 FT participants, 197 VP and 55 FT participants had usable T1-w/T2-w data from at least one timepoint. T1-w/T2-w values increased between term-equivalent and 13 years of age, with little evidence that longitudinal changes varied between birth groups or sexes. VP birth, neonatal brain abnormalities, being small for gestational age and postnatal infection were associated with reduced regional T1-w/T2-w values in childhood and adolescence. Increased T1-w/T2-w values across the white matter at 13 years were associated with better motor and working memory function for all children. Within the FT group only, larger increases in T1-w/T2-w values from term-equivalent to 7 years were associated with poorer attention and executive function, and higher T1-w/T2-w values at 7 years were associated with poorer mathematics.Conclusion:VP birth and multiple known perinatal risk factors are associated with long-term reductions in the T1-w/T2-w ratio in white matter regions in childhood and adolescence, which may relate to alterations in microstructure and myelin content. Furthermore, increased T1-w/T2-w ratio at 13 years appeared to be associated with better motor and working memory function, and there appeared to be developmental differences between VP and FT children in the associations for attention, executive functioning and mathematics.

Prenatal and Perinatal Factors Associated with Pediatric Autism Spectrum Disorder in East China

Background Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by persistent challenges in social communication and interaction and restricted/repetitive patterns of behavior, interests or activities. An increasing number of studies have revealed that environmental exposure is a potential risk factor for ASD. The relationship between prenatal and perinatal risk factors and ASD has rarely been studied in large samples in China. Therefore, in this study, we compared children with ASD with typical developing (TD) children to assess the ASD-associated prenatal and perinatal risk factors and provide effective information for ASD prevention. Methods A case-control study of 709 children with autism spectrum disorder (ASD) and 709 gender-matched children with typical development was conducted to investigate the prenatal and perinatal risk factors of children with ASD compared with children with typical development ( TD). Through a self-developed general information questionnaire, the basic information (name, age, gender), prenatal factors (parents’ age at the child’s birth, parents’ education levels, use of assisted reproductive technology, history of miscarriage, gestational diabetes mellitus, gestational hypertension), and perinatal factors (delivery mode, full-term birth, parity, birth weight) of the children in the two groups were examined. Results The prenatal and perinatal factors of the groups were submitted to univariate analysis, the parent’s age at childbirth, education level, history of miscarriage, use of ART, pregnancy-induced hypertension, and GDM differed significantly between the two groups (P<0.05), and that among perinatal factors, infant parity and maturity also differed significantly between the two groups (P<0.05). These statistically significant factors were included in a binary logistic regression model. The results showed that the prenatal factors of young maternal age at the child’s birth (≤24 years vs 25-29 years, OR=2.408,95%CI:1.335~4.345), old paternal age at the childbirth(≥45years vs≤24years, OR=4.744, 95%CI:1.281~17.570 ), pregnancy induced hypertension (OR=6.178, 95%CI:2.311~16.517) and GDM(OR=0.220,95%CI:0.149~0.324), the perinatal factors of preterm birth(OR=4.434, 95%CI:2.872~6.846) and non-firstborn child(OR=1.387, 95%CI:1.029~1.869) are likely risk factors for ASD. Conclusion We show that some prenatal and perinatal factors are associated with a high prevalence of ASD in children.

An exploratory study of EEG connectivity during the first year of life in preterm and full-term infants

Aim: to evaluate EEG connectivity during the first year of age in healthy full-term infants and preterm infants with prenatal and perinatal risk factors for perinatal brain damage. Methods: Three groups of infants were studied: healthy at full-term infants (n = 71), moderate and late preterm infants (n = 54), and very preterm infants (n = 56). All preterm infants had perinatal or/and perinatal risk factors for brain damage. EEG was obtained during phase II of natural NREM sleep. EEG analysis was performed in 24 segments of 2.56 s free of artifacts. For the calculation of EEG sources, the spectral Structured Sparse Bayesian Learning (sSSBL) was used. Connectivity was computed by the phase-lag index. Results: In healthy full-term infants, EEG interhemispheric connectivity in the different frequency bands followed similar trends with age to those reported in each frequency band: delta connectivity decreases, theta increases at the end of the year, in the alpha band, different trends were observed according to the region studied, and beta interhemispheric connectivity decreases with age. EEG connectivity in preterm infants showed differences from the results of the term group. Discussion: Important structural findings may explain the differences observed in EEG connectivity between the term and preterm groups. Conclusion: The study of EEG connectivity during the first year of age gives essential information on normal and abnormal brain development.

A STUDY OF DEMOGRAPHIC AND RISK FACTORS OF CHILDREN WITH AUTISM SPECTRUM DISORDER

Background of the study: Various risk factors have been reported in the development of Autism spectrum Disorder. The aim of our study is to explore the demographic and perinatal risk factors implicated in the development of ASD. A retrospective study was conducted with data of 49 children with ASD and found that total 71.3% of children were male 73.5% were in rst birth order. Out of 49 children 53.1% had history of Lower Segment Caesarean Section (LSCS). Indication of LSCS due to various obstetric or perinatal risk factors were reported in 17 cases. Three children had history of low birth weight with history of admission into Neonatal ICU. The study also explore the various co morbidity and found that ADHD (20.4%) was most common comorbidity followed by Mental retardation(18.4%), ADHD and MR(12.2%), seizure disorder and MR (8.2 %). This study found that male gender, rst birth order and perinatal risk factors are implicated in the development of Autism spectrum Disorder and majority of them have one or more another neuro developmental disorder as a comorbidity.

Nghiên cứu một số yếu tố nguy cơ của nhiễm khuẩn sơ sinh sớm tại Bệnh viện Trường Đại học Y Dược Huế

TÓM TẮT Đặt vấn đề: Nhiễm khuẩn sơ sinh sớm là một trong những nguyên nhân gây tử vong cao ở giai đoạn sơ sinh nhưng việc chẩn đoán sớm còn gặp nhiều khó khăn. Vì thế, chúng tôi tiến hành nghiên cứu này nhằm mục đích tìm hiểu các yếu tố nguy cơ giúp thiết lập chẩn đoán nhiễm khuẩn sơ sinh sớm. Đối tượng, phương pháp: Nghiên cứu hồi cứu. Lấy mẫu toàn bộ gồm 295 trẻ sơ sinh được chẩn đoán nghi ngờ nhiễm khuẩn sơ sinh sớm trong 72 giờ đầu sau sinh. Sau đó, chia thành hai nhóm: nhóm nhiễm khuẩn (các trường hợp nhiễm khuẩn hay có khả năng nhiễm khuẩn) và nhóm không nhiễm khuẩn để so sánh. Địa điểm nghiên cứu: phòng Nhi sơ sinh, Bệnh viện Trường Đại học Y Dược Huế từ tháng 5/2019 đến tháng 5/2020. Kết quả: Tỷ lệ của nhóm nhiễm khuẩn là 57,3%. Các yếu tố liên quan giúp chẩn đoán nhiễm khuẩn sơ sinh sớm bao gồm: ối vỡ non (OR = 4,7), thời gian ối vỡ trên 18 giờ (OR = 2,5), da tái, nổi vân tím (OR = 14,9), trẻ có chỉ định thở máy (OR = 8,7), suy hô hấp bắt đầu sau 4 giờ tuổi (OR = 6,8), kém linh hoạt (OR = 6,6), bụng chướng (OR = 4,2), thở nhanh (OR = 2,7), nôn (OR = 2,3), số lượng bạch cầu trong máu ngoại vi > 25 x 109/L (OR = 5,7), tỷ lệ bạch cầu đa nhân trung tính > 65% (OR = 2,0) và nồng độ CRP huyết thanh > 10 mg/L (OR = 8,0). Kết luận: Việc phối hợp các yếu tố nguy cơ trong thai kỳ, triệu chứng lâm sàng và cận lâm sàng, giúp xác định chẩn đoán nhiễm khuẩn sơ sinh sớm, nhằm hạn chế tối đa việc sử dụng kháng sinh không cần thiết ở trẻ sơ sinh. Từ khóa: Sơ sinh, nhiễm khuẩn sơ sinh sớm, yếu tố nguy cơ trước sinh ABSTRACT RELATED FACTORS OF EARLY-ONSET NEONATAL INFECTION AT HUE UNIVERSITY OF MEDICINE AND PHARMARCY HOSPITAL Background: Early - onset neonatal infection is an important cause of morbidity and mortality in neonates and it’s diagnosis remains challenging. Therefore, this study aimed to describle the related factors that can help establish the diagnosis of early - onset neonatal infection. Methods: A retrospective study. A total sample of 295 neonates at Hue University of Medicine and Pharmacy Hospital, Hue, Viet Nam from 5/2019 - 5/2020, who were suspected to suffer from infection within the first 72 hours of life. Then, they were classified as infected group (confirmed or possible infected) and non - infected group to compare. Results: The prevalence of infected group is 57,3%. Some related factors of early - onset neonatal infection are: prelabour rupture of membranes (OR=4,7), rupture of membranes for more than 18 hours (OR = 2,5), pale or mottled skin (OR = 14,9), need for mechanical ventilation (OR = 8,7), respiratory distress starting more than 4 hours after birth (OR = 6,8), responsiveness (OR = 6,6), abdominal distension (OR = 4,2), tachypnoea (OR = 2,7),vomiting (OR = 2,3), white blood cell in peripheral circulation > 25 x 109/L (OR = 5,7), neutrophil ratio in peripheral circulation > 65% (OR = 2,0) and CRP concentrations > 10 mg/L (OR = 8,0). Conclusions: Combination of perinatal risk factors, clinical and subclinical characteristcs are highly suggestive for early - onset neonatal infection will help to reduce the numbers of babies given antibiotics unnecessarily. Key words: Neonate, early - onset infection, perinatal risk factors