Prediction of neurodevelopment and neuromotor trajectories in very preterm born children up to 11 years of age: PIPARI Study

Very preterm birth is a risk for brain injury and abnormal neurodevelopment. While the incidence of cerebral palsy has decreased due to advances in perinatal and neonatal care, the rate of less severe neuromotor problems continues to be high in very prematurely born children. Neonatal brain imaging can aid in identifying children for closer follow-up and in providing parents information on developmental risks. This thesis aimed to study the predictive value of structural brain magnetic resonance imaging (MRI) at term age, serial neonatal cranial ultrasound (cUS), and structured neurological examinations during the longitudinal follow-up for the neurodevelopment of very preterm born children up to 11 years of age as a part of the PIPARI Study (The Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age). A further aim was to describe the associations between regional brain volumes and long-term neuromotor profile. The prospective follow-up comprised of the assessment of neurosensory development at 2 years of corrected age, cognitive development at 5 years of chronological age, and neuromotor development at 11 years of age. Neonatal brain imaging and structured neurological examinations predicted neurodevelopment at all age-points. The combination of neurological examination and brain MRI or cUS improved the predictive value of neonatal brain imaging alone. Decreased brain volumes associated with neuromotor performance. At the age of 11 years, the majority of the very preterm born children had age-appropriate neuromotor development and after-school sporting activities. Long-term clinical follow-up is recommended at least for all very preterm infants with major brain pathologies.Pikkukeskosten neuromotorinen pitkäaikaiskehitys 11 vuoden ikään saakka ja sitä ennustavat tekijät: PIPARI-tutkimus Pikkukeskosuus on riski aivovauriolle ja poikkeavalle kehitykselle. Vaikka CP-vamman esiintyvyys on alkuvaiheen tehohoidon kehittymisen myötä vähentynyt, lievempiä neuromotorisia ongelmia esiintyy edelleen merkittävästi pikkukeskosina syntyneillä lapsilla. Varhaiset aivojen kuvantamistutkimukset voivat auttaa tunnistamaan pitkäaikaisseurantaa tarvitsevat lapset sekä antamaan vanhemmille tietoa kehitykseen liittyvistä riskeistä. Tämän väitöskirjatyön tavoitteena oli selvittää lasketun ajan aivojen rakenteellisen magneettitutkimuksen, sarjoittaisen aivojen ultraäänitutkimuksen, ja pitkäaikaisseurannan aikana tehtyjen yksityiskohtaisten neurologisten tutkimusten ennustearvo pikkukeskosten kehitykselle 11 vuoden ikään asti osana PIPARI–tutkimusta (Pienipainoisten riskilasten käyttäytyminen ja toimintakyky imeväisiästä kouluikään). Tavoitteena oli myös kuvailla aivotilavuuksien yhteys neuromotoriseen pitkäaikaiskehitykseen. Prospektiivinen seuranta sisälsi neurosensorisen kehityksen arvioinnin 2 vuoden korjatussa iässä, kognitiivisen kehityksen arvioinnin 5 vuoden kronologisessa iässä, sekä neuromotorisen kehityksen arvioinnin 11-vuotiaana. Varhaiset aivojen kuvantamistutkimukset sekä yksityiskohtaiset neurologiset tutkimukset ennustivat pikkukeskosten pitkäaikaiskehitystä kaikissa ikäpisteissä. Neurologisten tutkimustulosten yhdistäminen aivojen magneettitutkimuksen tai ultraäänitutkimusten löydöksiin paransi yksittäisen kuvantamistutkimuksen ennustearvoa. Pienemmät aivotilavuudet liittyivät heikompaan neuromotoriseen suoriutumiseen. Suurimmalla osalla pikkukeskosina syntyneistä lapsista oli ikätasoinen neuromotorinen kehitys ja liikuntaharrastus 11-vuotiaana. Pitkäaikaista kliinistä seurantaa suositellaan ainakin kaikille niille pikkukeskosille, joilla on todettu vaikea aivovaurio.Siirretty Doriast

Neurobehaviour between birth and 40 weeks’ gestation in infants born <30 weeks’ gestation and parental psychological wellbeing: predictors of brain development and child outcomes

BACKGROUND: Infants born <30 weeks’ gestation are at increased risk of long term neurodevelopmental problems compared with term born peers. The predictive value of neurobehavioural examinations at term equivalent age in very preterm infants has been reported for subsequent impairment. Yet there is little knowledge surrounding earlier neurobehavioural development in preterm infants prior to term equivalent age, and how it relates to perinatal factors, cerebral structure, and later developmental outcomes. In addition, maternal psychological wellbeing has been associated with child development. Given the high rate of psychological distress reported by parents of preterm children, it is vital we understand maternal and paternal wellbeing in the early weeks and months after preterm birth and how this influences the parent–child relationship and children’s outcomes. Therefore this study aims to examine how 1) early neurobehaviour and 2) parental mental health relate to developmental outcomes for infants born preterm compared with infants born at term. METHODS/DESIGN: This prospective cohort study will describe the neurobehaviour of 150 infants born at <30 weeks’ gestational age from birth to term equivalent age, and explore how early neurobehavioural deficits relate to brain growth or injury determined by magnetic resonance imaging, perinatal factors, parental mental health and later developmental outcomes measured using standardised assessment tools at term, one and two years’ corrected age. A control group of 150 healthy term-born infants will also be recruited for comparison of outcomes. To examine the effects of parental mental health on developmental outcomes, both parents of preterm and term-born infants will complete standardised questionnaires related to symptoms of anxiety, depression and post-traumatic stress at regular intervals from the first week of their child’s birth until their child’s second birthday. The parent–child relationship will be assessed at one and two years’ corrected age. DISCUSSION: Detailing the trajectory of infant neurobehaviour and parental psychological distress following very preterm birth is important not only to identify infants most at risk, further understand the parental experience and highlight potential times for intervention for the infant and/or parent, but also to gain insight into the effect this has on parent–child interaction and child development

Origins of neonatal intensive care in the UK

Chaired by Professor Robert Boyd, this seminar reviewed the development and changes in care of the newborn in the UK over the past 50 years. Advances in techniques were described, such as mechanical ventilation, total parenteral nutrition and continuous monitoring of vital signs, to care for ill or vulnerable newborn infants. Diagnostic techniques that were developed and introduced in the 1970s and early 1980s were discussed, such as ultrasound imaging, magnetic resonance spectroscopy and imaging and near infrared spectroscopy, for the non-invasive investigation of the brain, as well as the setting up of neonatal intensive care units. Witnesses include: Professor Eva Alberman, Dr Herbert Barrie, Professor Richard Cooke, Dr Beryl Corner, Dr Pamela Davies, Professor John Davis, Professor David Delpy, Professor Victor and Dr Lilly Dubowitz, the late Professor Harold Gamsu, Professor David Harvey, Professor Colin Normand, Professor Tom Oppé, Professor Osmund Reynolds, Dr Jean Smellie, Professor Maureen Young and nurses, including Miss Anthea Blake, Miss Caroline Dux and Miss Mae Nugent. Introduction by Professor Peter Dunn, viii, 84pp, 1 chart, glossary, subject and name index

Intelligent wearable allows out-of-the-lab tracking of developing motor abilities in infants

Peer reviewe

Design considerations for delivering e-learning to surgical trainees

Copyright © 2011, IGI Global. Distributed with permission.Challenges remain in leveraging e-health technologies for continuous medical education/professional development. This study examines the interface design and learning process features related to the use of multimedia in providing effective support for the knowledge and practice of surgical skills. Twenty-one surgical trainees evaluated surgical content on a CD-ROM format based on 14 interface design and 11 learning process features using a questionnaire adapted from an established tool created to assess educational multimedia. Significant Spearman’s correlations were found for seven of the 14 interface design features – ‘Navigation’, ‘Learning demands’, ‘Videos’, ‘Media integration’, ‘Level of material’, ‘Information presentation’ and ‘Overall functionality’, explaining ratings of the learning process. The interplay of interface design and learning process features of educational multimedia highlight key design considerations in e-learning. An understanding of these features is relevant to the delivery of surgical training, reflecting the current state of the art in transferring static CD-ROM content to the dynamic web or creating CD/web hybrid models of education

Spontaneous movements as prognostic tool of neurodevelopmental outcomes in preterm infants: a narrative review

An estimated 15 million infants are born prematurely each year. Although the survival rate of preterm infants has increased with advances in perinatal and neonatal care, many still experience various complications. Since improving the neurodevelopmental outcomes of preterm births is a crucial topic, accurate evaluations should be performed to detect infants at high risk of cerebral palsy. General movements are spontaneous movements involving the whole body as the expression of neural activity and can be an excellent biomarker of neural dysfunction caused by brain impairment in preterm infants. The predictive value of general movements with respect to cerebral palsy increases with continuous observation. Automated approaches to examining general movements based on machine learning can help overcome the limited utilization of assessment tools owing to their qualitative or semiquantitative nature and high dependence on assessor skills and experience. This review covers each of these topics by summarizing normal and abnormal general movements as well as recent advances in automatic approaches based on infantile spontaneous movements

Origins of Neonatal Intensive Care

This is the edited transcript of a Witness Seminar held at the Wellcome Institute for the History of Medicine,London, on 27 April 1999. First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2001.©The Trustee of the Wellcome Trust, London, 2001.All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/Annotated and edited transcript of a Witness Seminar held on 27 April 1999. Introduction by Professor Peter Dunn.Annotated and edited transcript of a Witness Seminar held on 27 April 1999. Introduction by Professor Peter Dunn.Annotated and edited transcript of a Witness Seminar held on 27 April 1999. Introduction by Professor Peter Dunn.Annotated and edited transcript of a Witness Seminar held on 27 April 1999. Introduction by Professor Peter Dunn.Chaired by Professor Robert Boyd, this seminar reviewed the development and changes in care of the newborn in the UK over the past 50 years. Advances in techniques were described, such as mechanical ventilation, total parenteral nutrition and continuous monitoring of vital signs, to care for ill or vulnerable newborn infnts. Diagnostic techniques that were developed and introduced in the 1970s and early 1980s were discussed, such as ultrasound imaging, magnetic resonance spectroscopy and imaging and near infrared spectroscopy, for the non-invasive investigation of the brain, as well as the setting up of neonatal intensive care units. Witnesses include: Professor Eva Alberman, Dr Herbert Barrie, Professor Richard Cooke, Dr Beryl Corner, Dr Pamela Davies, Professor John Davis, Professor David Delpy, Professor Victor and Dr Lilly Dubowitz, the late Professor Harold Gamsu, Professor David Harvey, Professor Colin Normand, Professor Tom Oppé, Professor Osmund Reynolds, Dr Jean Smellie, Professor Maureen Young and nurses, including Miss Anthea Blake, Miss Caroline Dux and Miss Mae Nugent. Christie D A, Tansey E M. (eds) (2001) Origins of neonatal intensive care, Wellcome Witnesses to Twentieth Century Medicine, vol. 9. London: The Wellcome Trust Centre for the History of Medicine at UCL. IBSN 978 085484 0762The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183

Automated early prediction of cerebral palsy: interpretable pose-based assessment for the identification of abnormal infant movements

Cerebral Palsy (CP) is currently the most common chronic motor disability occurring in infants, affecting an estimated 1 in every 400 babies born in the UK each year. Techniques which can lead to an early diagnosis of CP have therefore been an active area of research, with some very promising results using tools such as the General Movements Assessment (GMA). By using video recordings of infant motor activity, assessors are able to classify an infant’s neurodevelopmental status based upon specific characteristics of the observed infant movement. However, these assessments are heavily dependent upon the availability of highly skilled assessors. As such, we explore the feasibility of the automated prediction of CP using machine learning techniques to analyse infant motion. We examine the viability of several new pose-based features for the analysis and classification of infant body movement from video footage. We extensively evaluate the effectiveness of the extracted features using several proposed classification frameworks, and also reimplement the leading methods from the literature for direct comparison using shared datasets to establish a new state-of-the-art. We introduce the RVI-38 video dataset, which we use to further inform the design, and establish the robustness of our proposed complementary pose-based motion features. Finally, given the importance of explainable AI for clinical applications, we propose a new classification framework which also incorporates a visualisation module to further aid with interpretability. Our proposed pose-based framework segments extracted features to detect movement abnormalities spatiotemporally, allowing us to identify and highlight body-parts exhibiting abnormal movement characteristics, subsequently providing intuitive feedback to clinicians. We suggest that our novel pose-based methods offer significant benefits over other approaches in both the analysis of infant motion and explainability of the associated data. Our engineered features, which are directly mapped to the assessment criteria in the clinical guidelines, demonstrate state-of-the-art performance across multiple datasets; and our feature extraction methods and associated visualisations significantly improve upon model interpretability

Multimodal image analysis of clinical influences on preterm brain development.

OBJECTIVE: Premature birth is associated with numerous complex abnormalities of white and gray matter and a high incidence of long-term neurocognitive impairment. An integrated understanding of these abnormalities and their association with clinical events is lacking. The aim of this study was to identify specific patterns of abnormal cerebral development and their antenatal and postnatal antecedents. METHODS: In a prospective cohort of 449 infants (226 male), we performed a multivariate and data-driven analysis combining multiple imaging modalities. Using canonical correlation analysis, we sought separable multimodal imaging markers associated with specific clinical and environmental factors and correlated to neurodevelopmental outcome at 2 years. RESULTS: We found five independent patterns of neuroanatomical variation that related to clinical factors including age, prematurity, sex, intrauterine complications, and postnatal adversity. We also confirmed the association between imaging markers of neuroanatomical abnormality and poor cognitive and motor outcomes at 2 years. INTERPRETATION: This data-driven approach defined novel and clinically relevant imaging markers of cerebral maldevelopment, which offer new insights into the nature of preterm brain injury. Ann Neurol 2017;82:233-246