Cerebral Arterial Asymmetries in the Neonate: Insight into the Pathogenesis of Stroke

Neonatal and adult strokes are more common in the left than in the right cerebral hemisphere in the middle cerebral arterial territory, and adult extracranial and intracranial vessels are systematically left-dominant. The aim of the research reported here was to determine whether the asymmetric vascular ground plan found in adults was present in healthy term neonates (n = 97). A new transcranial Doppler ultrasonography dual-view scanning protocol, with concurrent B-flow and pulsed wave imaging, acquired multivariate data on the neonatal middle cerebral arterial structure and function. This study documents for the first-time systematic asymmetries in the middle cerebral artery origin and distal trunk of healthy term neonates and identifies commensurately asymmetric hemodynamic vulnerabilities. A systematic leftward arterial dominance was found in the arterial caliber and cortically directed blood flow. The endothelial wall shear stress was also asymmetric across the midline and varied according to vessels’ geometry. We conclude that the arterial structure and blood supply in the brain are laterally asymmetric in newborns. Unfavorable shearing forces, which are a by-product of the arterial asymmetries described here, might contribute to a greater risk of cerebrovascular pathology in the left hemisphere

Application of Neonatologist Performed Echocardiography in the assessment and management of neonatal heart failure unrelated to congenital heart disease

Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF

Recommendations for neonatologist performed echocardiography in Europe: Consensus Statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN)

Contains fulltext : 171351.pdf (Publisher’s version ) (Open Access

Echocardiographic assessment of left ventricular outflow tract diameter in preterm infants

Introduction: Left ventricular output (LVO) measurement is an important part of the echocardiographic assessment of cardiac function in preterm infants. The accurate measurement of left ventricular outflow tract diameter (LVOD) is key to the calculation of LVO. Given the lack of an appropriate gold standard, we used right ventricular output (RVO) as the comparator and sought to identify the most accurate method of determining LVO in preterm infants. Methods: We studied stable preterm infants without significant cardiac shunts. LVOD was measured at the aortic valve, the aortic sinus and at the sinotubular junction. LVOs were calculated and the precision and accuracy of each was determined relative to the RVO using the Bland-Altman method. Results: 52 infants were included in this analysis. The mean difference between RVO and LVO was largest when LVOD was measured at the aortic valve and aortic sinus, +106 and -115 ml/kg/min, respectively, and smallest when measured at the sinotubular junction, 9 ml/kg/min. Limits of agreement between RVO and LVO were narrowest when LVOD was measured at the STJ. Conclusion: LVOD measurement at the sinotubular junction provides more precise and accurate measurement of LVO, in comparison to RVO, than measurement at the aortic valve or the aortic sinus

Vascular Underpinnings of Cerebral Lateralisation in the Neonate

Traditionally, adult and neonatal cerebral perfusion have been presumed to be symmetrical. Contrary to this, our adult work shows that supra-aortic cerebral supply is systematically biased towards the left, in terms of both vessel geometry and blood flow volumes. Although this asymmetry is meaningfully related to hand preference, the developmental origins of this association remain unknown. Our detailed investigations of the cerebral vasculature confirm analogous asymmetries in term neonates. Specifically, we demonstrate that the structure and flow of neonatal middle cerebral vessels are consistently asymmetric and predominantly left-dominant. Building on our work from the same cohort, we now report further analyses of these new-found asymmetries. Namely, exploring for the first time, the relationship between arterial lateral biases and the neonatal head-turning response—a reliable early behavioural precursor of handedness that shows a systematic rightward bias in the population. Here, we demonstrate a contralateral relationship between vessel morphology and primitive expressions of lateralisation that predate the establishment of definitive handedness in the course of postnatal development. This relationship mimics patterns observed in adults and suggests that lateralising trends in angiogenesis may ultimately influence the emergence of human lateral preferences

Lung ultrasound outperforms oxygenation in estimating lung volume in mechanically ventilated preterm lambs ARRIVE Statement

ARRIVE STatement for mansucript entitled 'Lung ultrasound outperforms oxygenation in estimating lung volume in mechanically ventilated preterm lambs' </p

Application of neonatologist performed echocardiography in the assessment and management of neonatal heart failure unrelated to congenital heart disease

Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF