BOOK
Advances in Neonatal Neurology, An Issue of Clinics in Perinatology, E-Book
(2014)
Additional Information
Book Details
Abstract
The 16 articles in this issue draw on the expertise of internationally recognized experts who have collectively provided cross-cutting reviews with a broad perspective on the current state of the field. The authors have provided succinct, up-to-date clinical perspectives and highlight current controversies and future challenges. As a result, this issue is a cutting-edge compendium of this complex and fast-moving field. Throughout the issue, the reader is encouraged to acquire a more comprehensive perspective by drawing connections between earlier and later articles that are thematically grouped around issues dealing with pathogenesis, diagnosis, and therapy. This issue underscores the vital importance of continued support to encourage and nurture collaboration among clinicians and scientists.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Advances in Neonatal\rNeurology | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Foreword\r | xv | ||
| Preface\r | xvii | ||
| Cerebral White and Gray Matter Injury in Newborns - New Insights into Pathophysiology and Management | 1 | ||
| Preterm survivors show an evolving spectrum of brain injury | 1 | ||
| What defines an insult to the developing brain and why does this matter? | 2 | ||
| A maturation-dependent role for H-I in the pathogenesis of cerebral injury | 3 | ||
| Do disturbances in cerebral autoregulation play a role in the pathogenesis of cerebral injury from H-I? | 4 | ||
| Do vascular end and border zones play a role in the pathogenesis of cerebral injury from H-I? | 5 | ||
| Relative contributions of H-I and oligodendrocyte lineage immaturity to WMI | 5 | ||
| The changing spectrum of human WMI | 7 | ||
| Current limitations for neuroimaging of WMI | 8 | ||
| Dysmaturation of glial progenitors in chronic WMI and myelination failure | 10 | ||
| Clinical implications of potential arrested white matter development | 12 | ||
| An emerging spectrum of gray matter injury and neuronal dysmaturation | 12 | ||
| Susceptibility of preterm cerebral gray matter to H-I | 13 | ||
| Impaired cerebral growth from preterm cerebral H-I can occur without neuronal loss | 13 | ||
| Summary | 15 | ||
| Acknowledgments | 16 | ||
| References | 16 | ||
| Brain Development in Preterm Infants Assessed Using Advanced MRI Techniques | 25 | ||
| Introduction | 25 | ||
| Neonatal brain templates and atlases | 26 | ||
| D-MRI | 26 | ||
| Diffusion tensor imaging | 28 | ||
| d-MRI data analysis | 28 | ||
| d-MRI of brain development | 29 | ||
| d-MRI of the preterm brain | 30 | ||
| Characterizing cortical maturity and thalamocortical connectivity with d-MRI | 30 | ||
| fMRI | 33 | ||
| Task-based fMRI | 33 | ||
| Resting state fMRI | 35 | ||
| Future directions | 38 | ||
| Acknowledgments | 38 | ||
| References | 38 | ||
| Pathogenesis and Prevention of Intraventricular Hemorrhage | 47 | ||
| Introduction | 47 | ||
| Pathogenesis of IVH | 48 | ||
| What Renders the Germinal Matrix Vasculature Fragile? | 49 | ||
| Overall Mechanism of Germinal Matrix Vascular Fragility | 52 | ||
| Disturbance in CBF | 54 | ||
| Genetic Factors and IVH | 56 | ||
| Prevention of IVH | 56 | ||
| Rationale of Preventive Therapies | 56 | ||
| Prenatal Pharmacologic Treatments to Prevent IVH | 57 | ||
| Post-natal Pharmacologic Treatment to Prevent IVH | 58 | ||
| Optimizing Care of Fetuses and Premature Newborns | 59 | ||
| Summary | 60 | ||
| Acknowledgments | 60 | ||
| References | 60 | ||
| Neuroimaging of White Matter Injury, Intraventricular and Cerebellar Hemorrhage | 69 | ||
| GMH-IVH | 70 | ||
| CBH | 71 | ||
| WMI | 72 | ||
| PWML | 74 | ||
| Summary | 78 | ||
| References | 79 | ||
| Chorioamnionitis in the Pathogenesis of Brain Injury in Preterm Infants | 83 | ||
| Chorioamnionitis and prematurity | 84 | ||
| Clinical and histologic chorioamnionitis | 84 | ||
| Cystic periventricular leukomalacia, noncystic focal white matter injury, and cerebral palsy | 85 | ||
| Proposed mechanisms of brain injury via FIRS | 87 | ||
| Chorioamnionitis and IVH | 93 | ||
| Relationship between chorioamnionitis and WMI | 93 | ||
| Chorioamnionitis: a risk factor for multiple complications in the preterm infant | 94 | ||
| Perspective and future directions | 95 | ||
| References | 96 | ||
| Fault and Blame, Insults to the Perinatal Brain may be Remote from Time of Birth | 105 | ||
| Introduction | 105 | ||
| Scientific versus legal perspective | 105 | ||
| Legal analogy | 106 | ||
| Single definable insult? | 106 | ||
| Emphasis on the birth period | 106 | ||
| Duration of prenatal insult versus injury | 107 | ||
| Magnetic resonance imaging biomarkers of fetal brain injury | 107 | ||
| Round-the-clock obstetric vigilance | 110 | ||
| Antenatal events | 112 | ||
| Asystole and death | 113 | ||
| Umbilical cord acidemia | 113 | ||
| H-I is not the only etiologic factor for CP | 113 | ||
| Intermediate end points often used | 114 | ||
| Postnatal events that contribute | 114 | ||
| Summary | 114 | ||
| Acknowledgments | 114 | ||
| References | 114 | ||
| Pharmacologic Neuroprotective Strategies in Neonatal Brain Injury | 119 | ||
| Mechanisms of brain injury: preterm versus term | 119 | ||
| The injury cascade | 120 | ||
| Targeting the injury response | 122 | ||
| Growth factors as neuroprotectants | 124 | ||
| References | 128 | ||
| Stem Cell Therapy for Neonatal Brain Injury | 133 | ||
| Introduction | 133 | ||
| Major types of stem cells | 134 | ||
| Stem cell therapy in animal models of neonatal brain damage | 138 | ||
| Combining hypothermia and stem cells | 139 | ||
| Clinical data and ongoing clinical trials | 139 | ||
| Issues to be addressed | 139 | ||
| Summary | 143 | ||
| References | 143 | ||
| Outcomes of Hypoxic-Ischemic Encephalopathy in Neonates Treated with Hypothermia | 149 | ||
| Outcomes of children with birth depression/encephalopathy before hypothermia therapy | 149 | ||
| Outcomes of children with moderate or severe encephalopathy at 18 months of age following hypothermia therapy | 150 | ||
| Meta-analysis of trials with 18 months’ outcome | 153 | ||
| Outcomes in childhood of neonates with hypothermia for moderate or severe HIE | 154 | ||
| The future of hypothermia therapy | 156 | ||
| Summary | 157 | ||
| References | 157 | ||
| Mechanisms of Hypothermic Neuroprotection | 161 | ||
| Introduction | 161 | ||
| The evolution of HI injury | 162 | ||
| What can be learned from the window of opportunity for hypothermia? | 162 | ||
| Mechanisms of action of hypothermia during HI | 162 | ||
| Cooling during reperfusion | 163 | ||
| Are excitotoxicity and free radicals relevant to postinsult cooling? | 164 | ||
| Cell death mechanisms in the latent phase | 164 | ||
| Hypothermia in the secondary phase | 168 | ||
| Summary | 170 | ||
| References | 170 | ||
| Neonatal Seizures | 177 | ||
| Introduction | 177 | ||
| Pathophysiology | 179 | ||
| Management goals | 179 | ||
| Pharmacologic strategies | 182 | ||
| Summary/Discussion | 185 | ||
| Acknowledgments | 185 | ||
| References | 185 | ||
| Steroids and Injury to the Developing Brain | 191 | ||
| Introduction | 191 | ||
| Overview of brain development | 192 | ||
| Neurotrophic effects of steroids | 192 | ||
| Neuroprotection by steroids | 193 | ||
| Antenatal steroids accelerate ontogenic changes in the developing CNS | 193 | ||
| Developmental stage at time of exposure and duration of exposure modulate steroid effects on the CNS | 193 | ||
| Pharmacodynamics of natural versus synthetic glucocorticoids in the brain | 194 | ||
| Glucocorticoid receptors in the brain | 195 | ||
| Hazards of GR occupancy | 196 | ||
| Glucocorticoids and recovery after brain injury | 196 | ||
| Unifying hypothesis | 196 | ||
| Clinical perspectives | 197 | ||
| Postnatal steroids: early administration | 198 | ||
| Postnatal steroids: administration after the first week of life | 198 | ||
| Postnatal steroids: moderately early versus delayed administration | 198 | ||
| Postnatal steroids: prolonged treatment | 199 | ||
| Hydrocortisone and the premature infant | 199 | ||
| Effect modification by risk of BPD | 200 | ||
| Predicting risk of BPD | 200 | ||
| Summary | 201 | ||
| References | 202 | ||
| Neonatal Pain Control and Neurologic Effects of Anesthetics and Sedatives in Preterm Infants | 209 | ||
| Introduction | 209 | ||
| Sucrose for minor procedural pain | 210 | ||
| Anesthetics for major procedural pain | 212 | ||
| Agents used for chronic pain and agitation | 215 | ||
| Conclusions | 220 | ||
| References | 220 | ||
| Neurogenesis and Maturation in Neonatal Brain Injury | 229 | ||
| Introduction | 229 | ||
| Recovery from hypoxic rearing in a mouse model of prematurity | 230 | ||
| Cortical neurogenesis in perinatal injury | 230 | ||
| Inhibitory neuron maturation in perinatal injury | 232 | ||
| Connectivity and cortical network integration in perinatal injury | 234 | ||
| Abnormal development of cortical excitatory/inhibitory networks in prematurity | 234 | ||
| Hypoxic injury induces a delay in maturation | 235 | ||
| Summary | 236 | ||
| Acknowledgments | 236 | ||
| References | 237 | ||
| Neurodevelopmental Outcomes of Extremely Preterm Infants | 241 | ||
| Challenges of interpreting neurodevelopmental outcome studies | 241 | ||
| Survival | 243 | ||
| Developmental and cognitive outcomes | 244 | ||
| Motor and CP outcomes | 250 | ||
| Hearing and vision | 251 | ||
| Summary | 251 | ||
| References | 251 | ||
| The Role of Neuroimaging in Predicting Neurodevelopmental Outcomes of Preterm Neonates | 257 | ||
| Introduction | 257 | ||
| Standard of care: cranial ultrasonography | 258 | ||
| Conventional MRI | 258 | ||
| Comparison of cUS and MR strategies | 269 | ||
| Promising new MRI strategies | 270 | ||
| MRS | 275 | ||
| Summary | 276 | ||
| References | 276 | ||
| Index | 285 |