Diffusion Weighted Imaging of the Neonatal Brain

Although in the last decades advances in fetal and neonatal medicine have reduced mortality in neonatal intensive care units in the Western world, the morbidity due to brain injury remains high. Patterns of neonatal brain injury can be roughly divided in (1) term and (2) preterm patterns. Table 1 shows the number of infants admitted to the NICU in the Sophia Children’s Hospital between March 2008 and March 2010 with a typical ‘neurological’ diagnosis. The table highlights differences in diagnoses between preterm and term infants in relation to gender. In preterm infants the most common diagnoses are: persistent flaring (hypersignal intensity seen in periventricluar white matter using cranial ultrasound), intraventricular haemorrhage and venous infarction. In term infants perinatal asphyxia and perinatal stroke are most often reported

Does a narrative retelling task improve the assessment of language proficiency in school-aged children born very preterm?

Almost half of the children born very preterm (VP) experience language difficulties at school-age, specifically with more complex language tasks. Narrative retelling is such a task. Therefore, we explored the value of narrative retelling assessment in school-aged children born VP, compared to item-based language assessment. In 63 children born VP and 30 age-matched full-term (FT) controls Renfrew’s Bus Story Test and Clinical Evaluation of Language Fundamentals were assessed. The retelling of the Bus Story was transcribed and language complexity and content measures were analyzed with Computerised Language Analysis software. Narrative outcomes of the VP group were worse than that of the FT group. Group differences were significant for the language complexity measures, but not for the language content measures. However, the mean narrative composite score of the VP group was significantly better than their mean item-based language score, while in the FT group the narrative score was worse than the item-based score. Significant positive correlations between narrative and item-based language scores were found only in the VP group. In conclusion, in VP children narrative retelling appears to be less sensitive to detecting academic language problems than item-based language assessment. This might be related to the mediating role of attention in item-based tasks, that appears not to affect more spontaneous language tasks such as retelling. Therefore, in school-aged children born VP we recommend using narrative assessment, in addition to item-based assessments, because it is more related to spontaneous language and less sensitive to attention problems

The relationship between interhemispheric synchrony, morphine and microstructural development of the corpus callosum in extremely preterm infants

Publisher Copyright: © 2022 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.The primary aim of this study is to examine whether bursting interhemispheric synchrony (bIHS) in the first week of life of infants born extremely preterm, is associated with microstructural development of the corpus callosum (CC) on term equivalent age magnetic resonance imaging scans. The secondary aim is to address the effects of analgesics such as morphine, on bIHS in extremely preterm infants. A total of 25 extremely preterm infants (gestational age [GA] .5). ASI was positively associated with the administration of morphine (p <.05). Early cortical synchrony may be affected by morphine and is not associated with the microstructural development of the CC. More studies are needed to evaluate the long-term effects of neonatal morphine treatment to optimize sedation in this high-risk population.Peer reviewe

Unobtrusive cot side sleep stage classification in preterm infants using ultra-wideband radar

Background: Sleep is an important driver of development in infants born preterm. However, continuous unobtrusive sleep monitoring of infants in the neonatal intensive care unit (NICU) is challenging.Objective: To assess the feasibility of ultra-wideband (UWB) radar for sleep stage classification in preterm infants admitted to the NICU.Methods: Active and quiet sleep were visually assessed using video recordings in 10 preterm infants (recorded between 29 and 34 weeks of postmenstrual age) admitted to the NICU. UWB radar recorded all infant's motions during the video recordings. From the baseband data measured with the UWB radar, a total of 48 features were calculated. All features were related to body and breathing movements. Six machine learning classifiers were compared regarding their ability to reliably classify active and quiet sleep using these raw signals.Results: The adaptive boosting (AdaBoost) classifier achieved the highest balanced accuracy (81%) over a 10-fold cross-validation, with an area under the curve of receiver operating characteristics (AUC-ROC) of 0.82.Conclusions: The UWB radar data, using the AdaBoost classifier, is a promising method for non-obtrusive sleep stage assessment in very preterm infants admitted to the NICU

Impacts on prenatal development of the human cerebellum: a systematic review

Purpose: The cerebellum is essential for normal neurodevelopment and is particularlysusceptible for intra-uterine disruptions. Although some causal prenatal exposures havebeen identified, the origin of neurodevelopmental disorders remains mostly unclear. Therefore,a systematic literature search was conducted to provide an overview of parental environmentalexposures and intrinsic factors influencing prenatal cerebellar growth and development inhumans. Materials and methods: The literature search was limited to human studies in the Englishlanguage and was conducted in Embase, Medline, Cochrane, Web of Science, Pubmed andGoogleScholar. Eligible studies were selected by three independent reviewers and study qualitywas scored by two independent reviewers. Results: The search yielded 3872 articles. We found 15 eligible studies reporting associationsbetween cerebellar development and maternal smoking (4), use of alcohol (3),in vitrofertilization mediums (1), mercury (1), mifepristone (2), aminopropionitriles (1), ethnicity (2) andcortisol levels (1). No studies reported on paternal factors. Conclusions: Current literature on associations between parental environmental exposures,intrinsic factors and human cerebellar development is scarce. Yet, this systematic reviewprovided an essential overview of human studies demonstrating the vulnerability of thecerebellum to the intra-uterine environment

Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review

INTRODUCTION: Very and extremely preterm infants frequently have brain injury-related long-term neurodevelopmental problems. Altered perfusion, for example, seen in the context of a hemodynamically significant patent ductus arteriosus (PDA), has been linked to injury of the immature brain. However, a direct relation with outcome has not been reviewed systematically. METHODS: A systematic review was conducted to provide an overview of the value of different cerebral arterial blood flow parameters assessed by Doppler ultrasound, in relation to brain injury, to predict long-term neurodevelopmental outcome in preterm infants. RESULTS: In total, 23 studies were included. Because of heterogeneity of studies, a meta-analysis of results was not possible. All included studies on resistance index (RI) showed significantly higher values in subjects with a hemodynamically significant PDA. However, absolute differences in RI values were small. Studies using Doppler parameters to predict brain injury and long-term neurodevelopmental outcome were inconsistent. DISCUSSION: There is no clear evidence to support the routine determination of RI or other Doppler parameters in the cerebral arteries to predict brain injury and long-term neurodevelopmental outcome in the preterm infant. However, there is evidence that elevated RI can point to the presence of a hemodynamically significant PDA

Neonatal critical illness and development: white matter and hippocampus alterations in school-age neonatal ECMO survivors

Aim: Examine the neurobiology of long-term neuropsychological deficits following neonatal extracorporeal membrane oxygenation (ECMO). Method: This cross-sectional study assessed white matter integrity and hippocampal volume of ECMO survivors (8-15yrs) and healthy controls (8-17yrs) using Diffusion Tensor Imaging and structural MRI, respectively. Neuropsychological outcome was evaluated in patients. Included clinical predictors of white matter integrity: age start ECMO, ECMO duration, highest oxygenation index before ECMO, highest mean airway pressure and mechanical ventilation duration. Results: Patients (n=23) had lower global fractional anisotropy than controls (n=54)(patients=.368; controls=.381; p=.02), but similar global mean diffusivity (p=.41). Patients had lower fractional anisotropy in the left cingulum bundle (patients=.345; controls=.399; p<.001) and higher mean diffusivity in a region of the left parahippocampal cingulum (patients=.916; controls=.871; p<.001). Higher global mean diffusivity predicted worse verbal memory in patients (n=17)(β=-.74, p=.01). Patients (n=23) had smaller bilateral hippocampal volume than controls (n=43)(left: p< .001; right: p< .001). In patients, this was related to worse verbal memory (left: β=.65, p=.02; right: β=.71, p=.01). Interpretation: Neonatal ECMO survivors are at risk for long-term brain alterations, which may partly explain long-term neuropsychological impairments. Neuroimaging may contribute to better risk stratification of long-term impairments

Ultra-wideband radar for simultaneous and unobtrusive monitoring of respiratory and heart rates in early childhood:A Deep Transfer Learning Approach

Unobtrusive monitoring of children’s heart rate (HR) and respiratory rate (RR) can be valuable for promoting the early detection of potential health issues, improving communication with healthcare providers and reducing unnecessary hospital visits. A promising solution for wireless vital sign monitoring is radar technology. This paper presents a novel approach for the simultaneous estimation of children’s RR and HR utilizing ultra-wideband (UWB) radar using a deep transfer learning algorithm in a cohort of 55 children. The HR and RR are calculated by processing radar signals via spectrogram from time epochs of 10 s (25 sample length of hamming window with 90% overlap) and then transforming the resultant representation into 2-dimensional images. These images were fed into a pre-trained Visual Geometry Group-16 (VGG-16) model (trained on ImageNet dataset), with weights of five added layers fine-tuned using the proposed data. The prediction on the test data achieved a mean absolute error (MAE) of 7.3 beats per minute (BPM &lt; 6.5% of average HR) and 2.63 breaths per minute (BPM &lt; 7% of average RR). We also achieved a significant Pearson’s correlation of 77% and 81% between true and extracted for HR and RR, respectively. HR and RR samples are extracted every 10 s.</p