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Neonatal diseases II
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Brian P. Hackett, Jeffrey Dawson, Akshaya Vachharajani, Barbara Warner, F. Sessions Cole
Death is more common in late preterm infants than term infants: risk of early neonatal death (birth to 28 days of age) is 5.2-fold greater, late neonatal death (28 days to 1 year of life) is 2.9-fold greater, and total infant mortality (all deaths from birth to 1 year of age) is 2.5-fold greater (39,48). Risk for increased morbidity also persists as evidenced by increased emergency department visits and rehospitalizations (49–51). Studies by Kinney et al. suggest that although the brain is more mature in late preterm than very preterm infants, it is still immature and can be disrupted or damaged by late preterm delivery (52). Substantial brain growth occurs between 34 and 41 weeks of gestation in utero: brain size increases by 33% in the final 6 to 8 weeks of gestation accompanied by a fivefold increase in brain volume. Late preterm infants can also develop periventricular leukomalacia, a white matter injury marker for subsequent cerebral palsy. The exact prevalence of brain pathology is unknown as systematic brain imaging is not currently recommended at this gestational age (52). Longer term follow-up studies suggest that late preterm infants are at increased risk for lower reading and math scores from kindergarten through elementary school and for participation in special educational programs (53).
Fetal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Emily A. Partridge, Alan W. Flake
The Eurofetus trial was a multicenter randomized controlled trial that compared serial amnioreduction to SLPC for TTTS. The laser therapy group had higher survival of at least one fetus to at least 28 days of age, 76% versus 56% in the amniocentesis group. In addition, the laser group had a higher mean gestational age at delivery, with an average of 33 versus 29 weeks in the amniocentesis group. Most importantly, at 6-month follow-up, the laser group had improved neurologic outcomes, with a decreased risk of periventricular leukomalacia.
Cytomegalovirus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
CMV is the most frequent infectious cause of birth defects, with up to 40,000 infected infants born annually in the United States. Thus, about 1% of babies born in the United States have CMV infection acquired in utero, as evidenced by shedding of virus in the urine or saliva [20]. The vast majority of these babies are asymptomatic at birth, but the remaining 5%–10% have potentially devastating symptomatic cytomegalic inclusion disease [7,21]. Pathologic examination of the brain in cases of congenital infection will reveal ventriculoencephalitis. Neuropathologic findings may include cerebral necrosis or periventricular leukomalacia.
Emerging neuroprotective interventions in periventricular leukomalacia - A systematic review of preclinical studies
Published in Expert Opinion on Investigational Drugs, 2022
Thangaraj Abiramalatha, Viraraghavan Vadakkencherry Ramaswamy, Anand Kumar Ponnala, Venkat Reddy Kallem, Yogeshkumar V Murkunde, Alan Mathew Punnoose, Aravindhan Vivekanandhan, Abdul Kareem Pullattayil, Prakash Amboiram
Periventricular leukomalacia (PVL), a neurological adverse outcome seen in preterm infants, has long-lasting consequences on the developing brain [9]. Years of extensive research have yielded significant insights into its etiopathogenesis, that comprises hypoxia-ischemia and infection-inflammation mediated pathways culminating in microglial activation and pre-OL injury. Pre-emptive strategies such as those aimed at antenatal steroids, treatment of chorioamnionitis, measures to decrease the risk of intraventricular hemorrhage (a major antecedent of PVL) and avoiding hypoxia-hypocarbia during invasive mechanical ventilation have resulted in a decrease in the incidence of PVL over the past few decades [9]. However, with the improved survival of infants born at the threshold of viability including those who are born at 22–24 weeks of gestation, the typical morbidities associated with preterm birth including PVL are on the rise [203]. With this background, it is important that future research into targeted therapeutics aiming at preventing PVL or limiting the extent of its severity be given utmost emphasis.
Brain abnormalities in infantile esotropia as predictor for consecutive exotropia
Published in Strabismus, 2019
Feyza Calis, Huban Atilla, Pinar Bingol Kiziltunc, Cem Alay
Magnetic resonance imaging is the most sensitive imaging modality for WMDI and atrophic dilatation of the lateral ventricles, reduced amount of periventricular white matter often around the occipital horns and adjacent to the trigone are the main findings. The remaning white matter may have an abnormally increased signal on T2-weighted image, indicating permanent gliosis.6 Ohtsiku et al. investigated the differences in brain MRI findings between infantile esotropia patients and normal controls. They noted abnormal brain MRI findings in 7.9% of children with strabismus. These lesions were periventricular leukomalacia, enlargement of the lateral ventricles and myelinization delay. They suggested that brain lesions which disturb normal maturation of visuomotor system may be the reason of strabismus.13 In this study, we similarly demonstrated findings of WMDI with MRI in infantile esotropia patients that have consecutive exotropia.
An update on clinical, pathological, diagnostic, and therapeutic perspectives of childhood leukodystrophies
Published in Expert Review of Neurotherapeutics, 2020
Mahmoud Reza Ashrafi, Man Amanat, Masoud Garshasbi, Reyhaneh Kameli, Yalda Nilipour, Morteza Heidari, Zahra Rezaei, Ali Reza Tavasoli
Some special characteristics in brain MRI can also help to narrow the list of differential diagnoses. For example, cystic changes mostly seen in anterior temporal lobe are associated with AGS, MLC, RNASET2 deficient leukoencephalopathy, and mitochondrial encephalopathies [109–113]. This feature can also be detected in congenital cytomegalovirus infection as an acquired white matter disease [111]. Cystic white matter degeneration (cystic rarefaction) in imaging is another special characteristic and can be observed in VWM, mitochondrial leukoencephalopathies, AxD, and incontinentia pigmenti in neonates [114–117]. Periventricular leukomalacia and acute cortex degeneration in neonates are instances of acquired white matter disorders with this imaging feature [118].