Complicaciones neurológicas de la prematuridad / Neurological consequences of prematurity

Resumen Los nacimientos prematuros representan un in dicador importante de salud de un país. Estos niños tienen un mayor riesgo de mortalidad y morbilidad. Las principales lesiones encefálicas en los prematuros incluyen lesiones de la sustancia blanca, hemorragias intracraneanas y lesiones cerebelosas, que pueden ser detectadas mediante ecografía encefálica y resonancia magnética, siendo esta última la técnica más sensible. Estas lesiones pueden tener repercusión a largo plazo en el neurodesarrollo de los prematuros, con un mayor riesgo de parálisis cerebral, trastornos cognitivos, con ductuales, sensoriales y del aprendizaje, entre otros. Es fundamental aplicar estrategias de prevención y aten ción temprana para reducir las consecuencias negativas de las lesiones encefálicas asociadas a la prematuridad.

Abstract Premature births are an important health indicator for a country. These children have a higher risk of mor tality and morbidity. The main brain injuries in preterm infants include white matter injuries, intracranial hem orrhages, and cerebellar injuries. These injuries can be detected through brain ultrasound and magnetic reso nance imaging (MRI), with MRI being the most sensitive technique. Perinatal brain injuries may have long-term consequences on the neurodevelopment of preterm infants, with an increased risk of cerebral palsy, cogni tive, behavioral, sensory, and learning disorders, among others. It is key to implement prevention strategies and early intervention to reduce the negative consequences of brain injuries associated with prematurity.

Corioamnionitis histológica y neurodesarrollo en niños prematuros menores de 34 semanas, Lima-Perú

Para determinar los efectos de la corioamnionitis histológica en el neurodesarrollo de los prematuros menores de 34 semanas evaluados a los 2 años de edad corregida se realizó un estudio secundario de casos y controles. Fueron analizados los datos clínicos, hallazgos histológicos de la placenta e índices del desarrollo medidos por la Escala Bayley III de 38 niños expuestos y 53 niños no expuestos. Las infecciones genitourinarias de la madre y la sepsis precoz fueron más frecuentes en el grupo expuesto (p<0,005). Las dimensiones del desarrollo cognitivo, motor y lenguaje fueron normales en ambos grupos. Los expuestos al subtipo subcorionitis obtuvieron menor desempeño en las tres dimensiones. La corioamnionitis histológica no mostró influencia sobre el neurodesarrollo en prematuros menores de 34 semanas a los 2 años de edad. Se recomienda estudios longitudinales y multicéntricos para definir los efectos a largo plazo.

SUMMARY The objective of this study was to determine the effects of histologically diagnosed chorioamnionitis on neurodevelopment of premature babies born with less than 34-week gestational age who were assessed at two-year corrected age. A secondary case-control study was carried out. Clinical data, placental histological findings, and development indexes assessed using the Bayley III scale were analyzed in 38 exposed children and 53 non-exposed children. Genitourinary infections in mothers and early sepsis were more frequent in the exposed group (p<0.005). Cognitive development, motor development and language were normal in both groups. Those children exposed to the chorionitis subtype had lower scores in the aforementioned variables. Histologically diagnosed chorioamnionitis did not show any influence on neurodevelopment in premature babies born with less than 34-week gestational age when they were assessed at two years. Longitudinal and multicenter studies are advised in order to define the long-term effects.

Tamaño del léxico en niños(as) muy prematuros y prematuros extremos de 24 meses: un estudio transversal / Vocabulary size in very preterm and extremely preterm infants: a cross-sectional study

Las investigaciones muestran que un número importante de niños nacidos prematuros (antes de las 37 semanas de gestación) presentan dificultades en su desarrollo, entre ellas el desarrollo lingüístico. Las investigaciones previas indican que algunas complicaciones biomédicas, como la hemorragia intraventricular (los grados III y IV), la leucomalacia periventricular y la displasia broncopulmonar, incrementan la probabilidad de presentar alteraciones en el desarrollo de la cognición y/o del lenguaje, por lo que se hace necesario realizar investigaciones que proporcionen más información y con ello poder anticiparse a posibles consecuencias en los aprendizajes futuros de estos niños nacidos bajo la condición de prematuridad. Es así, que los objetivos de este estudio fueron medir el tamaño del léxico temprano en niños muy prematuros y prematuros extremos (con y sin complicaciones biomédicas) a los 24 meses de edad corregida, así como también determinar la asociación entre número de complicaciones biomédicas presentes y el tamaño del léxico. Para ello, se trabajó con 108 niños divididos en tres grupos: 39 niños prematuros de alto riesgo (con complicaciones biomédicas), 36 niños prematuros de bajo riesgo (sin complicaciones biomédicas asociadas a alteraciones del lenguaje y /o cognición) y 33 niños nacidos de término. Todos fueron evaluados con el Inventario II de Desarrollo de Habilidades Comunicativas MacArthur-Bates. Los resultados muestran que los niños nacidos de término tienen significativamente mayor tamaño del léxico que los prematuros, no existiendo diferencias en los resultados entre prematuros de bajo riesgo y los prematuros de alto riesgo. Por otra parte, el tamaño del léxico no presenta correlación con las complicaciones biomédicas.

Research shows that a significant number of children born preterm (before 37 weeks of gestation) have developmental difficulties, among them disturbances in language development. Studies indicate that some biomedical complications such as intraventricular hemorrhage (grades III and IV), periventricular leukomalacia, and bronchopulmonary dysplasia increase the probability of cognitive and/or language development disorders. Therefore, there is a need to conduct more studies that provide information that allows anticipating possible consequences in the learning process of children born prematurely. The aims of this study were to measure the early vocabulary size in very preterm and extremely preterm children (with and without biomedical complications) at 24 months of corrected age and to determine the association between the number of biomedical complications and vocabulary size. To that effect, we worked with 108 children divided into three groups: 39 high-risk preterm children (with biomedical complications), 36 low-risk preterm children (without biomedical complications associated with language and/or cognitive disturbances), and 33 full-term children. All children were evaluated using the MacArthur-Bates Communicative Development Inventory II. The results show that the vocabulary size of full-term children is significantly larger than that of preterm children and that no differences exist between the group of high-risk versus low-risk preterm children. On the other hand, vocabulary size does not correlate withbiomedical complications.

Ocular signs, visual and general developmental outcome in Indian children with radiologically proven periventricular leukomalacia

Purpose: Owing to the paucity of literature on Indian children with periventricular leukomalacia (PVL), this retrospective study aimed to describe the visual and associated developmental abnormalities in a series of affected children attending a tertiary level eye care facility. Methods: Children with radiologically confirmed PVL who attended the Pediatric Department of a tertiary eye hospital were included and underwent a detailed ocular and general developmental assessment. Results: Of the 75 children, the mean age was 2.3 years, the mean follow?up was 3.1 years, 68% were males and 43% were born preterm. Grade I PVL was identified in 13 children (17%), Grade 2 PVL in 39 (52%), and Grade 3 PVL in 23 (31%). Premies with ?2 kg (72.5%) and term babies with >2 kg (75%) had a greater association of PVL occurrence with a preponderance to severe PVL; 46% of the children were visually impaired which was significantly higher in the children with Grade 3 PVL (74%) than those with Grade 2 PVL (15%). Strabismus was common (80%) with a change in deviation over time. Seventy?one percent of the children had a refractive error, frequently myopic astigmatism. All the children except two had a delay in one or more general developmental milestones. Conclusion: PVL occurrence is observed both in the babies born at term and premies, resulting in significant ocular and systemic morbidities. We recommend a system in place for early identification and referral to initiate an early intervention program which goes a long way toward improving the quality of life in these children

The correlation between γδ-T lymphocyte subset in early postnatal peripheral blood and brain injury of preterm infants / 中华实用儿科临床杂志

Objective:To investigate the correlation between preterm infants with brain injury and the proportion of lymphocyte subsets, especially γδ-T cells in the postnatal peripheral blood, and to determine the predictive potential of γδ-T cells in the early peripheral blood in brain injury.Methods:It was a prospective study involving 106 preterm infants with gestational age less than 34 weeks who were delivered in the Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University from January 1, to June 1, 2021.Relative levels of γδ-T , CD4 + T, CD8 + T, CD3 + T and total lymphocyte subsets in peripheral blood collected within the first 24 hours after birth were measured by flow cytometry.Recruited infants were divided into brain injury group (36 cases) and non-brain injury group (70 cases) according to serial cranial ultrasound and magnetic resonance imaging(MRI) at the corrected gestational age of 36-37 weeks.Differences in general conditions and the proportion of lymphocyte subsets between groups were compared by the t-test or Chi- square test.Patients in brain injury group were further divided into intracranial hemorrhage(ICH) group(8 cases), periventricular leukomalacia (PVL) group (6 cases)and diffuse white matter damage (WMD) group(22 cases). The proportion of lymphocyte subsets among the different groups was compared by One- Way ANOVA, followed by the LSD- t test. Results:The proportion of γδ-T cells in postnatal peripheral blood of preterm infants at 24 hours after birth in brain injury group was significantly lower than that of non-brain injury group [(0.09±0.12)% vs.0.15±0.13)%, t=-2.445, P=0.016]. No significant differences in the proportion of the CD4 + and CD8 + T cell subsets were found between them.Both preterm infants in PVL group and WMD group had a significantly lower proportion of γδ-T cells at 24 hours after birth compared to that of the non-brain injury group [(0.03±0.05)%, (0.07±0.09)% and (0.15±0.13)%], respectively, ( t=-2.190, -2.659, all P<0.05). Conclusions:γδ-T cells in early postnatal peripheral blood may be involved in the development of brain injury in preterm infants and they had early predictive value for preterm infants at high risk of brain injury, especially the leukomalacia and diffuse white matter injury.

Ecografía transfontanelar en la enfermedad hipóxico isquémica del recién nacido. Presentación de un caso / Transfontanellar ultrasound in hypoxic diseasenewborn ischemic. Presentation of a case

RESUMEN La enfermedad hipóxico-isquémica constituye una de las principales causas de morbi-mortalidad neurológica en el recién nacido. Las diferentes adaptacio-nes vasculares a la hipoxia tanto en el neonato pretérmino como en niño a término hacen que su presentación en neuroimagen, sobre todo en el ultrasonido (US) sea caracterizable según el territorio afectado y el momento de la enfermedad. El ultrasonido se ha convertido en una poderosa herramienta para la evaluación del recién nacido con sospecha de EHI, y el patrón de las lesiones tiene importantes implicaciones en el tratamiento y en el pronóstico neurológico a largo plazo. A continuación, presentamos el caso de un recién nacido masculino, prematuro extremo, que requirió reanimación cardiopulmonar avanzada en el nacimiento y que además presento dos episodios de parada cardiorrespiratoria en el segundo y tercer día de vida, en el cual se llegó al diagnóstico con patrones ecográficos característicos de lesión isquémica y además se detalla la evolución de los hallazgos en el tiempo.Palabras claves: Enfermedad hipóxico-isquémica, ultrasonido transfontanelar, matriz germinal, leucomalacia periventricular.

ABSTRACT Hypoxic-ischemic disease is one of the main causes of neurological morbidity and mortality in the newborn. The different vascular adaptations to hypoxia in both the preterm and term infants make their presentation on neuroimaging, especially on ultrasound (US), characterizable according to the affected terri-tory and the time of the disease. Ultrasound has become a powerful tool for evaluating the newborn with suspected IBD, and the pattern of the lesions has important implications for treatment and long-term neurological prognosis. Next, we present the case of a male newborn, extremely premature, who required advanced cardiopulmonary resuscitation at birth and who also presented two episodes of cardiorespiratory arrest on the second and third day of life, in which the diagnosis was reached with patterns sonographic characteristics of ischemic injury and also the evolution of the findings over time.Keywords: Hypoxic-ischemic disease, transfontanelar ultrasound, germ matrix, periventricular leukomalacia

Hemorragia intraventricular y leucomalacia periventricular en neonatos de bajo peso al nacer en tres hospitales de Lima, Perú / Intraventricular hemorrhage and periventricular leukomalacia in low birth-weight neonates in three hospitals in Lima, Peru

RESUMEN Con el objetivo de describir la frecuencia y severidad de la hemorragia intraventricular y leucomalacia periventricular en neonatos de bajo peso en tres hospitales de Lima, Perú se evaluaron 385 neonatos menores de 2000 g de peso al nacer durante mayo del 2012 a julio del 2014. Se obtuvo ultrasonidos cerebrales a las 40 semanas de gestación, 3-5 días de vida y 3-4 semanas de vida. Hemorragia intraventricular se presentó en 19,2% neonatos con menos de 1500 g y fue severa (grado III o con infarto hemorrágico periventricular) en 9,6% neonatos menores de 1500 g. La mortalidad en neonatos con hemorragia intraventricular fue de 47,1%, se encontró leucomalacia periventricular en 5,4% de los neonatos menores de 1500 g. Ambos diagnósticos fueron más frecuentes en neonatos con menor peso. La frecuencia de hemorragia intraventricular es similar a lo reportado en otros países; sin embargo, la severidad y mortalidad es mayor.

ABSTRACT To describe the frequency and severity of intraventricular hemorrhage and periventricular leukomalacia in low birth-weight neonates in three hospitals in Lima, Peru, 385 newborn babies weighing under 2,000 g at birth were evaluated between May 2012 and July 2014. Brain ultrasounds were obtained at 40 weeks' gestation, 3-5 days of life, and 3-4 weeks of life. Intraventricular hemorrhage occurred in 19.2% of neonates weighing under 1,500 g and was severe (grade III or with periventricular hemorrhagic infarction) in 9.6% of neonates under 1,500 g. Mortality in infants with intraventricular hemorrhage was 47.1%, while periventricular leukomalacia was found in 5.4% of neonates 1,500 g and under; both diagnoses were more frequent in lower-weight babies. The frequency of intraventricular hemorrhage is similar to that reported in other countries; however, severity and mortality are greater.

Mecanismos de lesión cerebral en niños prematuros / Mechanisms of brain injury of the premature baby

Los nacimientos prematuros son uno de los principales indicadores de salud de un país. Están asociados a una alta mortalidad e importante morbilidad en niños con parálisis cerebral y otros trastornos del neurodesarrollo, incluyendo problemas cognitivos y del aprendizaje. Los principales tipos de lesión encefálica en los recién nacidos prematuros son: a) las lesiones de la sustancia blanca, generalmente asociadas a alteraciones neuronales y axonales en la corteza cerebral y otras zonas de sustancia gris; b) hemorragias intracraneanas que incluyen las de la matriz germinal, intraventriculares e intraparenquimatosas y c) del cerebelo. Las lesiones de sustancia blanca incluyen la leucomalacia periventricular quística, no quística (con focos de necrosis microscópicos) y lesiones difusas de sustancia blanca, no necróticas. Estas lesiones tienen múltiples factores etiológicos. Las características anatómicas y fisiológicas de las estructuras vasculares periventriculares predisponen a la sustancia blanca a ser muy vulnerable a las situaciones de isquemia cerebral y, en interacción con factores infecciosos/inflamatorios, activan a las microglías generando estrés oxidativo (por liberación de radicales libres del oxígeno y del nitrógeno), liberación de citoquinas proinflamatorias, liberación de glutamato, fallo energético y alteración de la integridad vascular. Todo lo anteriormente mencionado genera una particular vulnerabilidad de los pre-oligodendrocitos que termina alterando la mielinización. La hipoxia-isquemia también puede producir necrosis neuronal selectiva en diferentes regiones encefálicas. La matriz germinal es un área altamente vascularizada en la región subependimaria periventricular con una estructura capilar muy frágil que la predispone a las hemorragias.

Preterm birth is one of the main country health indicators. It is associated with high mortality and significant morbidity in preterm newborns with cerebral palsy and potential long-term neurodevelopmental disabilities like cognitive and learning problems. The main lesions could be: a) white matter injuries, generally associated with cortical and other regions of grey matter neuronal-axonal disturbances; b) intracranial hemorrhage that includes germinal matrix, intraventricular and parenchymal, c) cerebellum injuries. The white matter lesions include cystic and non-cystic (with microscopic focal necrosis) periventricular leukomalacia and non-necrotic diffuse white matter injury. Multiple etiologic factors are associated with these injuries. Anatomical and physiological characteristics of periventricular vascular structures predispose white matter to cerebral ischemia and, interacting with infection/inflammation factors, activate microglia, generating oxidative stress (mediated by free oxygen and nitrogen radicals), pro-inflammatory cytokine and glutamate toxicity, energetic failure and vascular integrity disturbances. All these factors lead to a particular vulnerability of pre-oligodendrocytes that will affect myelination. Hypoxia-ischemia also may produce selective neuronal necrosis in different cerebral regions. Germinal matrix is a highly vascularized zone beneath ependymal or periventricular region that constitutes a capillary bed with a particular structural fragility that predispose it to hemorrhage.

Study on the relationship between Toll like receptor 4 expression and apoptosis in periventricular leukomalacia rat model induced by hypoxia-ischemia / 中华实用儿科临床杂志

Objective@#To investigate the correlation between Toll like receptor 4 (TLR4) expression and apoptosis in periventricular leukomalacia (PVL) rat model induced by hypoxia-ischemia.@*Methods@#One hundred and forty three-day-old sprague-dawley (SD) rats, which were divided into experimental group (ischemia-hypo-xia group) and control group (sham operation group) randomly, were used to establish a hypoxic model by ligating the right common carotid artery and inhaling gas mixtures with 60 mL/L oxygen and 940 mL/L nitrogen.The rats were killed 6 h, 12 h, 24 h, 3 d, 7 d after model reproducing and the brain tissues were used for the following experiments.The pathological changes and apoptosis of brain tissues were detected by way of hematoxylin and eosin (HE) staining and terminal deoxynucleotidyl transferase dUTP nick end labeling (Tunel) assay respectively, and TLR4 expression was detected by adopting immunohistochemistry and reverse-transcription polymerase chain reaction(RT-PCR). The data were analyzed by using the SPSS 19.0 software.@*Results@#TLR4 expression in the modeling rat brain commenced to increase in 6 hours (0.541±0.069, 0.166±0.058)and reached the peak in 3 days(1.932±0.161, 0.300±0.039), and then began to decline in 7 days (1.242±0.109, 0.220±0.025) post hypoxia-ischemia.Compared with the control group, there were statistical significances at 6 h, 12 h, 24 h, 3 d and 7 d (all P<0.05). The apoptosis of brain ti-ssue cells in the modeling rat brain started to increase at 6 hours(21.33±3.50) and reached the peak in 3 days (35.97±4.20), and then began to decline in 7 days (31.02±4.22) post hypoxia-ischemia.Compared with the control group, there were statistical significance at 6 h, 12 h, 24 h, 3 d and 7 d (all P<0.05). The TLR4 expression was positively correlated with cell apoptosis (r=0.774, 0.575, all P<0.05).@*Conclusions@#In the rat model of PVL induced by hypoxia-ischemia, TLR4 is likely to injure the neural cell through apoptosis.

Mechanism of ferroptosis and its role in neurological diseases / 中国药理学通报

Ferroptosis is distinct from apoptosis,autophagy,necrosis,cornification and other cell deaths from morphological,biochemical as well as genetic aspects.Ferroptosis plays a critical role in neurological diseases and cancers.Neurological diseases,such as Alzheimer's disease,Parkinson's disease,Huntington's disease,stroke,periventricular leukomalacia and so on,are characterized by multiple etiologies and mechanisms,and are potentially correlated with ferroptosis.Based on the recent researches on ferroptosis and neurological diseases,this review investigates ferroptosis and its role in neurological diseases.

Gardnerella vaginalis in perinatology: An overview of the clinicopathological correlation

@#Gardnerella vaginalis (GV) is a facultatively anaerobic gram-variable bacillus and is the major organism involved in bacterial vaginosis. GV-associated bacterial vaginosis has been associated with adverse pregnancy outcomes include preterm parturition and subclinical chorioamnionitis. Inflammatory response induced by GV presents paediatric problems as well. Studies had shown that increased levels of proinflammatory cytokines include TNF-α, IL-1β and IL-6 following fetal inflammatory response syndrome secondary to GV-induced intrauterine infection may result in the development of periventricular leukomalacia and bronchopulmonary dysplasia in the infected fetus. There is increasing evidence that GV-associated BV infection serves as a risk factor for long-term neurological complications, such as cerebral palsy and learning disability. GV is fastidious and could elude conventional detection methods such as bacterial cultures. With current more sophisticated molecular biology detection methods, its role and pathogenic effects have been shown to have a greater impact on intrauterine inflammation and fetal/neonatal infection. This review gives an overview on the characteristics of GV and its virulence properties. Its detrimental role in causing unfavourable GV-related perinatal outcomes, with emphasis on the possible mechanistic pathways is discussed. The discovery of disease mechanisms allows the building of a strong platform where further research on innovative therapies can be based on, for instance, an anti-TLR monoclonal antibody as therapeutic agent to halt inflammation-precipitate adverse perinatal outcomes.

Gardnerella vaginalis in perinatology: An overview of the clinicopathological correlation

@#Gardnerella vaginalis (GV) is a facultatively anaerobic gram-variable bacillus and is the major organism involved in bacterial vaginosis. GV-associated bacterial vaginosis has been associated with adverse pregnancy outcomes include preterm parturition and subclinical chorioamnionitis. Inflammatory response induced by GV presents paediatric problems as well. Studies had shown that increased levels of proinflammatory cytokines include TNF-α, IL-1β and IL-6 following fetal inflammatory response syndrome secondary to GV-induced intrauterine infection may result in the development of periventricular leukomalacia and bronchopulmonary dysplasia in the infected fetus. There is increasing evidence that GV-associated BV infection serves as a risk factor for long-term neurological complications, such as cerebral palsy and learning disability. GV is fastidious and could elude conventional detection methods such as bacterial cultures. With current more sophisticated molecular biology detection methods, its role and pathogenic effects have been shown to have a greater impact on intrauterine inflammation and fetal/neonatal infection. This review gives an overview on the characteristics of GV and its virulence properties. Its detrimental role in causing unfavourable GV-related perinatal outcomes, with emphasis on the possible mechanistic pathways is discussed. The discovery of disease mechanisms allows the building of a strong platform where further research on innovative therapies can be based on, for instance, an anti-TLR monoclonal antibody as therapeutic agent to halt inflammation-precipitate adverse perinatal outcomes.

Research progress of white matter injury following congenital heart disease / 国际儿科学杂志

Congenital heart disease is the most common birth defect.With the significant improvements of cardiac surgical techniques,the survival of newborns and infants with complex congenital heart disease(CHD) has obviously been increased.However,neurological sequelae are still common and up to 25 ％ ～50％.The most important lesion after CHD surgery is white matter(WM) injury.Recent studies show that periventricular leukomalacia disease characterized by WM injury is common in C-HD infants especially after cardiac surgery.It is previously thought to be due to the cardiopulmonary bypass and surgical operation.However,with the advances in surgery and medical diagnostic technology and development of basic research in recent years,it is discovered that WM injury in infants with CHD is a complex lesion influenced by preoperative,operating and postoperative factors.The movement disorders and the defects of attention,learning and other aspects in the late growth of these children bring a huge economic burden to the family and society,reducing the quality of the population.Therefore,exploring etiology,mechanisms and control methods of WM injury in infants with CHD becomes a hot topic in recent years,and it may also become an important direction for future research,aiming to the significant improvements in CHD children with neurodevelopmental damages.

Clinical Characteristics and Efficacy Analysis of Children with Cerebral Palsy and Neuronal Migration Disorders / 中国康复理论与实践

@#Objective To discuss the clinical characteristics and efficacy analysis of children with cerebral palsy and neuronal migration disorders (NMD) by retrospective analysis. Methods From June, 2005 to June, 2015, 32 children with cerebral palsy and NMD were en-rolled as NMD group, while 60 children with cerebral palsy with periventricular leukomalacia (PVL) as PVL group. Both groups received comprehensive rehabilitation for three months. Their clinical classification, complications of epilepsy or epileptiform discharges, the score of Gross Motor Function Measure (GMFM), and development quotient (DQ) were compared, as well as the follow-up results of six months. Results There was significant difference in the clinical classification of cerebral palsy between two groups (χ2=24.529, P<0.001). The inci-dence of epilepsy and epileptiform discharges was higher in NMD group than in PVL group (χ2>4.605, P<0.05). After treatment, the score of GMFM improved with time in both groups (Ftime=6.850, P=0.010), and was significantly lower in NMD group than in GMFM group (Fgroup=29.885, P<0.001);the scores of DQ in all the functional areas improved with time in both groups (Ftime>25.041, P<0.001), and were signifi-cantly lower in NMD group than in GMFM group (Fgroup>32.347, P<0.001). Conclusion Children with cerebral palsy and NMD are charac-terized by mental retardation, epilepsy and spastic hemiplegia, and poor outcome.

Effect of progesterone on the expression of O4 and O1 in the white matter of neonatal rat model with periventricular leukomalacia / 临床儿科杂志

Objective To explore the effect of progesterone on the expression of O4 and O1 in the white matter of neonatal rat model with periventricular leukomalacia (PVL). Methods 2-day-old neonatal SD rats were randomly divided into model group, experimental group, and sham operation group. Rats' left common carotid artery was ligated and exposed to hypoxia (8%O2+92%N2) for 0.5 h in both the model group and experimental group to build the PVL animal model. The rats in experimental group was injected intraperitoneally with progesterone 10 mg/(kg·d) immediately after cerebral hypoxia ischemia. In sham operation group, rats' left common carotid artery was only isolated without ligation and hypoxia. 1, 4, 7, and 14 days after operation, the pathological changes of brain tissue were compared among three groups. Immunohistochemical staining was used to detect the expression of O1 and O4 in the cerebral cortex of rats in three groups at different time points. Results There were no abnormal pathological changes in the white matter in the sham operation group at each time point. The left ventricular enlargement and periventricular leukomalacia were found in both model and experimental groups, while the pathological damages of white matter in experimental group were significantly lighter than those in model group at each time point. The integral optical density (IOD) of O1 and O4 positive cells in the cerebral cortex of the three groups was gradually increased at day 1, day 4, and day 7 after operation and reached the peak level at day 7 , then was decreased at day 14 after operation. There was statistically significant difference (P<0.01). At day 1, day 4, day 7, and day 14, the integral optical density (IOD) of O1 and O4 positive cells in the cerebral cortex of sham operation group was highest, followed by experimental group and model group, and there was significant difference (P<0.01). Conclusion Progesterone can reduce the pathological damage in the cerebral cortex in neonatal rats with PVL, and promote the expression of O1 and O4 in the periventricular white matter, which can promote the differentiation and maturation of oligodendrocytes.

Neurodevelopmental outcomes of children with cystic periventriculai leukomalacia / 国际儿科学杂志

Cystic periventricular leukomalacia( cPVL) is the main nerve pathological change that affects the long-term neurodevelopment outcome in preterm infants,which may result in cerebral palsy,epilepsy,cogni-tive and audio-visual disorder. cPVL lacks specific symptoms,the diagnosis of cPVL mainly depends on cranial ultrasound,CT and MRI. This review briefly introduces the changes of brain imaging of cPVL and the neurode-velopmental outcomes of cPVL.

Neurodevelopmental outcomes of children with cystic periventriculai leukomalacia / 国际儿科学杂志

Cystic periventricular leukomalacia( cPVL) is the main nerve pathological change that affects the long-term neurodevelopment outcome in preterm infants,which may result in cerebral palsy,epilepsy,cogni-tive and audio-visual disorder. cPVL lacks specific symptoms,the diagnosis of cPVL mainly depends on cranial ultrasound,CT and MRI. This review briefly introduces the changes of brain imaging of cPVL and the neurode-velopmental outcomes of cPVL.

Diffusion tensor imaging to assess recovery of white matter injury in periventricular leucomalacia with cerebral palsy after surgery / 实用放射学杂志

Objective To discuss the value of DTI on recovery of white matter injury in periventricular leucomalacia (PVL) with cerebral palsy after surgery.Methods 15 childrens suffered from PVL and 15 age-matched normal controls with normal MRI findings and no neurological abnormalities were recruited in this study.Conventional plain MRI scans and DTI sequence of brain were preformed in all subjects.FA maps of eight selected regions,which included the corpus callosum genu,splenium of corpus callosum,bilateral anterior limb of internal capsule,bilateral posterior limb of internal capsule,bilateral optic radiation,bilateral cerebral pedunculusand superior longitudinal fasciculus were compared between two groups.Results Significant differences of FA values were observed among the three group before and after the treatment and control groups(P＜0.05).FA value of the caudate nucleus and lenticular nucleus among three group was not statistically significant difference.Further pairwise comparison,FA values of the posterior limb of internal capsul,genu of corpus callosum and splenium of corpus callosum in three groups showed statistically significant differences,there was no statistically significant difference for FA value of the genu of capsulae internae,cerebral peduncle and pons among the three group.Compared to the contralateral normal areas,FA value of the genu of capsulae internae,cerebral peduncle and pons showed statistically significant differences (P＜0.05).Conclusion Quantitative DTI may show subtle changes in the structure of white matter,which has a certain reference value of FA values of white matter in periventricular leucomalacia with cerebral palsy after surgery,and help clinicians further reasonable treatment.

White Matter Injury of Prematurity: Its Mechanisms and Clinical Features

A developing central nervous system is vulnerable to various insults such as infection and ischemia. While increased understanding of the dynamic nature of brain development allows a deeper insight into the pathophysiology of perinatal brain injury, the precise nature of specific fetal and neonatal brain injuries and their short- and long-term clinical consequences need special attention and further elucidation. The current review will describe the pathophysiological aspects and clinical significance of white matter injury of prematurity, a main form of perinatal brain injury in premature newborns, with a particular emphasis on its potential antenatal components.

Periventricular leukomalacia in a preterm neonate with early onset Capnocytophaga sepsis

Capnocytophaga sputigena is a slow-growing, capnophilic, gram negative, anaerobic, fusiform bacilli residing in oropharyngeal cavity of mammals. In humans, it causes localized periodontal infections and sporadic invasive infections in immunocompromised persons. Infrequently, it does cause chorioamnionitis and perinatal infections and is generally of lower morbidity risk in fetus and neonates. We describe a rare case report of early-onset neonatal Capnocytophaga sepsis with culture negative meningitis in preterm infant who developed early cystic periventricular leukomalacia in second week of life. Though neonatal Capnocytophaga infection is probably under-reported due to its fastidious nature and subclinical infection in mother, this case reminds that Capnocytophaga may be responsible for some occult cases of early neonatal septicemia, and that the organism may be more virulent in premature neonates with possibility of development of periventricular leukomalacia and neurological morbidities.