Brain Injury In Preterm Infants Research Articles

Intrauterine inflammation and postnatal intravenous dopamine alter the neurovascular unit in preterm newborn lambs

BackgroundIntrauterine inflammation is considered a major cause of brain injury in preterm infants, leading to long-term neurodevelopmental deficits. A potential contributor to this brain injury is dysregulation of neurovascular coupling. We have shown that intrauterine inflammation induced by intra-amniotic lipopolysaccharide (LPS) in preterm lambs, and postnatal dopamine administration, disrupts neurovascular coupling and the functional cerebral haemodynamic responses, potentially leading to impaired brain development. In this study, we aimed to characterise the structural changes of the neurovascular unit following intrauterine LPS exposure and postnatal dopamine administration in the brain of preterm lambs using cellular and molecular analyses.MethodsAt 119–120 days of gestation (term = 147 days), LPS was administered into the amniotic sac in pregnant ewes. At 126-7 days of gestation, the LPS-exposed lambs were delivered, ventilated and given either a continuous intravenous infusion of dopamine at 10 µg/kg/min or isovolumetric vehicle solution for 90 min (LPS, n = 6; LPSDA, n = 6). Control preterm lambs not exposed to LPS were also administered vehicle or dopamine (CTL, n = 9; CTLDA, n = 7). Post-mortem brain tissue was collected 3–4 h after birth for immunohistochemistry and RT-qPCR analysis of components of the neurovascular unit.ResultsLPS exposure increased vascular leakage in the presence of increased vascular density and remodelling with increased astrocyte “end feet” vessel coverage, together with downregulated mRNA levels of the tight junction proteins Claudin-1 and Occludin. Dopamine administration decreased vessel density and size, decreased endothelial glucose transporter, reduced neuronal dendritic coverage, increased cell proliferation within vessel walls, and increased pericyte vascular coverage particularly within the cortical and deep grey matter. Dopamine also downregulated VEGFA and Occludin tight junction mRNA, and upregulated dopamine receptor DRD1 and oxidative protein (NOX1, SOD3) mRNA levels. Dopamine administration following LPS exposure did not exacerbate any effects induced by LPS.ConclusionLPS exposure and dopamine administration independently alters the neurovascular unit in the preterm brain. Alterations to the neurovascular unit may predispose the developing brain to further injury.

Hypotension: a modifiable risk factor impacting surgical NEC-associated AKI and brain injury in preterm infants.

Hypotension: a modifiable risk factor impacting surgical NEC-associated AKI and brain injury in preterm infants.

Early versus late caffeine and/or non-steroidal anti-inflammatory drugs (NSAIDS) for prevention of intermittent hypoxia-induced neuroinflammation in the neonatal rat.

Preterm infants often experience frequent intermittent hypoxia (IH) episodes which are associated with neuroinflammation. We tested the hypotheses that early caffeine and/or non-steroidal inflammatory drugs (NSAIDs) confer superior therapeutic benefits for protection against IH-induced neuroinflammation than late treatment. Newborn rats were exposed to IH or hyperoxia (50% O2) from birth (P0) to P14. For early treatment, the pups were administered: 1) daily caffeine (Caff) citrate (Cafcit, 20 mg/kg IP loading on P0, followed by 5mg/kg from P1-P14); 2) ketorolac (Keto) topical ocular solution in both eyes from P0 to P14; 3) ibuprofen (Ibu, Neoprofen, 10mg/kg loading dose on P0 followed by 5mg/kg/day on P1 and P2); 4) Caff+Keto co-treatment; 5) Caff+Ibu co-treatment; or 6) equivalent volume saline (Sal). On P14, animals were placed in room air (RA) with no further treatment until P21. For late treatment, pups were exposed from P0 to P14, then placed in RA during which they received similar treatments from P15-P21 (Sal, Caff, and/or Keto), or P15-P17 (Ibu). RA controls were similarly treated. At P21, whole brains were assessed for histopathology, apoptosis, myelination, and biomarkers of inflammation. IH caused significant brain injury and hemorrhage, inflammation, reduced myelination, and apoptosis. Early treatment with Caff alone or in combination with NSAIDs conferred better neuroprotection against IH-induced damage than late treatment. Early postnatal treatment during a critical time of brain development, may be preferable for the prevention of IH-induced brain injury in preterm infants.

GSK-3β inhibitor TWS119 promotes neuronal differentiation after hypoxic-ischemic brain damage in neonatal rats.

Brain injury in preterm infants is a major cause of disability and mortality in children. GSK-3β is a common pathogenic factor for cognitive dysfunction and involves in neuronal proliferation and differentiation. However, GSK-3β affected neuronal differentiation and its molecular pathogenesis after hypoxic-ischemic brain damage in neonatal rats remains unclear. This study investigated the effects of GSK-3β inhibitor (TWS119) on cell cycle regulatory proteins, a neuronal differentiation factor (CEND1), maturation neurons, T-box brain transcription factor 1 (TBR1)-positive neurons to clarify the mechanisms of hypoxic-ischemic brain damage in neonatal rats. We used hypoxic-ischemic Sprague-Dawley neonatal rats with brain damage as models. These rats were used for investigating the effect of GSK-3β on cell cycle regulatory proteins, neuronal differentiation factor (CEND1), maturation neurons, TBR1-positive neurons by western blot and immunofluorescence. Cyclin D1 (a positive cell cycle regulator) expression decreased, and p21 (a negative cell cycle regulator) expression increased in the TWS119 group compared to the hypoxia-ischemia (HI) group 7 days after HI. Additionally, compared to the HI group, TWS119 treatment up-regulated CEND1 expression and promoted neuronal differentiation and cortex development based on NeuN and TBR1 expression. Our study suggests that the GSK-3β inhibitor TWS119 promotes neuronal differentiation after hypoxic-ischemic brain damage in neonatal rats by inhibiting cell cycle pathway.

Risk factors for brain injury in premature infants with twin-to-twin transfusion syndrome: a retrospective cohort study.

Brain injury (BI) is prevalent in premature infants with twin-to-twin transfusion syndrome (TTTS), while risk factors of BI in these patients remains unknown. Our study aims to discern potential risk factors that contribute to BI in premature infants with TTTS. We conducted a retrospective cohort and analyzed clinical data of premature infants diagnosed with TTTS at the Northwest Women's and Children's Hospital between January 1, 2015 and January 1, 2020. Data included the infants' perinatal information, key postnatal examinations, laboratory tests, and treatments. Of the 84 patients enrolled in the study, 22 (26.2%) were categorized in the BI group and 62 (73.8%) in the non-BI group, based on cranial imaging. No significant differences were found at baseline between the groups in relation to the proportion of males (40.9% vs. 35.5%, P=0.845), median gestational age (weeks) [31.9 (31.5, 33.4) vs. 34.2 (31.6, 35.4), P=0.061], average weight (g) (1,676.4±567.5 vs. 1,845.2±511.7, P=0.200), maternal age (years) [29.5 (26.0, 31.0) vs. 28.5 (27.8, 31.0), P=0.656], the proportion of in-vitro fertilization (9.1% vs. 16.1%, P=0.648), cesarean sections (86.4% vs. 93.5%, P=0.549) or TTTS donor infants (50.0% vs. 51.6%, P=0.897). Multivariate logistic regression analysis indicated that invasive mechanical ventilation [invasive mechanical ventilation (IMV); odds ratio (OR) =4.365; 95% confidence interval (CI): 1.066-17.870; P=0.040], [necrotizing enterocolitis (NEC); OR =8.632; 95% CI: 1.542-48.318; P=0.014], [single intrauterine fetal demise (sIUFD); OR =14.067; 95% CI: 1.298-224.421; P=0.031], and a 5-minute Apgar score <9 (OR =4.663; 95% CI: 1.015-21.419; P=0.048) were strongly associated with BI in TTTS premature infants. Our study identifies IMV, NEC, sIUFD, and a 5-minute Apgar score <9 as independent risk factors for BI in premature infants with TTTS.

Recombinant erythropoietin protective and related effects on brain injury in premature infants.

The aim of this study was to investigate the protective effect of recombinant erythropoietin at different doses on brain injury in premature infants and the related effects on blood routine, liver function, intellectual development, mental development index (MDI), psychomotor development index (PDI), etc. PATIENTS AND METHODS: A total of 120 premature infants were divided into four groups, including experimental group A (n=30), experimental group B (n=30), experimental group C (n=30) and control group (n=30). The experimental group was treated with different doses of recombinant erythropoietin for brain injury protection of premature infants, while the control group with conventional methods. There was no statistical significance in all test indicators of the four groups of patients before the intervention. After the intervention experiment, the S-100B index was p<0.05, and the erythropoietin (EPO) index was p<0.05. In the comparison of IL-6 indicators, the indicators of the experimental group were reduced after the comparison experiment, and there were significant differences, p<0.05. In neonatal behavior evaluation, there was a statistical difference between groups A and B and the control group (p<0.05), and no statistical significance was shown between group C and the control group (p>0.05). In the intelligence test comparison, the F value of the experimental group was 3.113 three months after treatment. After six months, the F value was 3.654. After nine months, the F value was 3.392 with p<0.05. In the comparison of blood routine indicators, the p-values of four indicators between groups were more than 0.05. In the comparison of liver function indexes, the indexes of groups A, B, and C were significantly changed before and after treatment, and the data after treatment were significantly different from those before treatment, p<0.05. In the comparison of development, there were no significant differences observed in the p-values of the two indicators of vigorous exercise and language in the experimental group. Recombinant erythropoietin has a protective effect on infants with brain injury and can improve the intellectual development of premature infants, but has no significant effect on blood routine indicators. It can effectively improve the MDI, PDI, and related cytokines of premature infants, and has certain significance for the treatment of brain injury.

Association of aEEG and brain injury severity on MRI at term-equivalent age in preterm infants.

Measures to detect and monitor brain injury in preterm infants are amplitude-integrated electroencephalography (aEEG) and magnetic resonance imaging (MRI). To investigate the association between aEEG and MRI in a large cohort of preterm infants. Five hundred and twenty-three preterm infants were included in the study. AEEG was interpreted for the total maturation score (TMS) according to Burdjalov. Cerebral MRI was evaluated using a validated scoring system by Kidokoro. One hundred and forty-six infants (27.9%) showed some form of brain injury, with 111 infants (21.2%) showing mild injury and 35 (6.7%) showing severe injury. TMS were significantly higher in infants without injury compared to severe injury. When comparing infants with isolated intraventricular haemorrhage to infants without brain injury, TMS were significantly lower. Prediction of adverse outcome is an important aspect of neonatal care. The combination of diagnostic measures evaluating brain injury might enhance our abilities in neonatal care to provide accurate information about later outcome. Early aEEG is predictive for the severity of brain injury detected by MRI at term-equivalent age. Whether aEEG is also predictive for neurodevelopmental outcome needs to be further investigated in relation to the various patterns of preterm brain injury.

Editorial: Quantitative analysis of cranial ultrasound for brain injury in premature infants

Editorial: Quantitative analysis of cranial ultrasound for brain injury in premature infants

Clinical impact of analgesic-sedative agents and peri-operative clinical status on white matter brain injury in preterm infants following surgical NEC.

The potential influence of exposure to analgesic-sedative agents (ASA) before, during, and after surgical NEC and peri-operative clinical status on white matter injury (WMI) in preterm infants has not been fully defined, and a comprehensive evaluation may inform future research and clinical interventions. A retrospective study comparing ASA exposure before/during /after surgical NEC and peri-operative clinical status in neonates with and without WMI. Infants with any WMI (grade 2-4, n = 36/67, 53.7%) had a higher number of surgical procedures receiving ASA (5 [IQR: 3, 8] vs. 3 [2, 4]; p = 0.002) and had a longer duration of hypotension during their first (48.0 hours [26.0, 48.0] vs. 15.5 [6, 48]; p = 0.009) and second surgery (20 hours [0, 48h] vs. 0 [0, 22]; p = 0.017), received more hydrocortisone (35% vs.13.3%,p = 0.04) than those without any WMI. There were no differences in fentanyl/morphine/midazolam exposure before/during/after the NEC onset in the two groups.Infants with severe WMI (19/67, 28.3%, grade 3/4) had a higher incidence of AKI (P = 0.004), surgical morbidity (p = 0.047), more surgical procedures (6.5 [3, 10] vs. 4 [2, 5]; p = 0.012), and received higher mean fentanyl doses(p = 0.03) from birth until NEC onset than those without severe WMI. The univariate associations between these factors and severe WMI remained insignificant after multivariable logistic regression. Infants with WMI had more surgical procedures receiving ASA and had a longer duration of hypotension during surgeries. A large multicenter prospective study is needed to understand the full impact of ASA.

Retracted: Early Diagnosis of Brain Injury in Premature Infants Based on Amplitude-Integrated EEG Scoring System.

[This retracts the article DOI: 10.1155/2021/6684818.].

Inhibition of the proteoglycan receptor PTPσ promotes functional recovery on a rodent model of preterm hypoxic-ischemic brain injury

BackgroundPreterm white matter injury (WMI) is the most common brain injury in preterm infants and is associated with long-term adverse neurodevelopmental outcomes. Protein tyrosine phosphatase sigma (PTPσ) was discovered as chondroitin sulfate proteoglycan (CSPG) receptor that played roles in inhibiting myelin regeneration in spinal injury, experimental autoimmune encephalomyelitis, and stroke models. However, the role of PTPσ in perinatal WMI is not well understood. AimsThis study examines the effect of PTPσ inhibition on neurodevelopmental outcomes, myelination, and neuroinflammation in a mouse model of preterm WMI. Materials and methodsModified Rice-Vannucci model was performed on postnatal day 3 (P3) C57BL/6 mice. Intracellular Sigma Peptide (ISP) or vehicle was administrated subcutaneously one hour after injury for an additional 14 consecutive days. A battery of behavioral tests was performed to evaluate the short- and long-term effects of ISP on neurobehavioral deficit. Real time qPCR, western blot, immunofluorescence, and transmission electron microscopy were performed to assess white matter development. qPCR and flow cytometry were performed to evaluate neuroinflammation and microglia/macrophage phenotype. ResultsThe expression of PTPσ was increased after preterm WMI. ISP improved short-term neurological outcomes and ameliorated long-term motor and cognitive function of mice after preterm WMI. ISP promoted oligodendrocyte differentiation, maturation, myelination, and improved microstructure of myelin after preterm WMI. Furthermore, ISP administration fostered a beneficial inflammatory response in the acute phase after preterm WMI, inhibited the infiltration of peripheral macrophages, and promoted anti-inflammatory phenotype of microglia/macrophages. ConclusionPTPσ inhibition can ameliorate neurofunctional deficit, promote white matter development, modulate neuroinflammation and microglia/macrophage phenotype after preterm WMI. Thus, ISP administration may be a potential therapeutic strategy to improve neurodevelopmental outcomes of perinatal WMI.

Oligodendrocyte Progenitor Cell Transplantation Ameliorates Preterm Infant Cerebral White Matter Injury in Rats Model.

Cerebral white matter injury (WMI) is the most common brain injury in preterm infants, leading to motor and developmental deficits often accompanied by cognitive impairment. However, there is no effective treatment. One promising approach for treating preterm WMI is cell replacement therapy, in which lost cells can be replaced by exogenous oligodendrocyte progenitor cells (OPCs). This study developed a method to differentiate human neural stem cells (hNSCs) into human OPCs (hOPCs). The preterm WMI animal model was established in rats on postnatal day 3, and OLIG2+/NG2+/PDGFRα+/O4+ hOPCs were enriched and transplanted into the corpus callosum on postnatal day 10. Then, histological analysis and electron microscopy were used to detect lesion structure; behavioral assays were performed to detect cognitive function. Transplanted hOPCs survived and migrated throughout the major white matter tracts. Morphological differentiation of transplanted hOPCs was observed. Histological analysis revealed structural repair of lesioned areas. Re-myelination of the axons in the corpus callosum was confirmed by electron microscopy. The Morris water maze test revealed cognitive function recovery. Our study showed that exogenous hOPCs could differentiate into CC1+ OLS in the brain of WMI rats, improving their cognitive functions.

Overexpression of miR-199a-5p improves brain injury in newborn rats with intrauterine infection via inhibition of astrocyte activation

White matter injury is the most common form of brain injury in preterm infants. In addition to hypoxia ischemia, intrauterine infection is most closely related to brain white matter injury. Our study aimed to explore the mechanism of the miR-199a-5p/HIF-1α axis on astrocyte activation and brain injury in newborn rats caused by intrauterine infection.The animal/cell model was established via escherichia coli infection/lipopolysaccharide induction, followed by the measurement of body weight, brain weight, and the pathological changes in brain tissues of newborn rats, and the pathological changes in placenta and uterus wall of pregnant rats. Also, the levels of GFAP, TNF-α, MDA, GSH, SOD, miR-199a-5p, and HIF-1α were detected though corresponding assays or kits. In vitro, cell viability and apoptosis and the levels of IL-6 and TNF-α were evaluated in astrocytes. Moreover, the targeting relationship between miR-199a-5p and HIF-1α was verified.miR-199a-5p was lowly expressed in the brain tissues of newborn rats with intrauterine infection. Overexpression of miR-199a-5p relieved the injury of placenta and uterus wall in pregnant rats and brain injury in newborn rats, accompanied by decreased HIF-1α, GFAP, TNF-α, and MDA levels and increased GSH and SOD levels. Results from cell models showed that miR-199a-5p overexpression inhibited astrocyte activation, shown by enhanced cell viability, weakened cell apoptosis, and decreased GFAP, IL-6, and TNF-α. Mechanistically, miR-199a-5p targeted HIF-1α to decrease its expression.Collectively, miR-199a-5p inhibited astrocyte activation and alleviated brain injury in newborn rats with intrauterine infection by reducing HIF-1α expression.

Effect of Early Nursing Intervention under Amplitude-Integrated Electroencephalography and Magnetic Resonance Images on Brain Injury in Premature Infants

To investigate the effects of early nursing intervention on brain injury among premature infants, 100 premature infants diagnosed with brain injury were included in the research and randomly divided into the control group (50 cases) and the experimental group (50 cases). The patients in the two groups were performed with the same conventional comprehensive treatment. The patients in the control group received conventional nursing while those in the experimental group underwent early nursing intervention. During follow-up, neurodevelopment, motor behavior, the incidence rate of brain injury, and nursing satisfaction of the infants in the two groups were compared. It was demonstrated that the five neurodevelopment scores of the experimental group were all higher than those of the control group. The differences showed statistical significance ( P &lt; 0.05 ). The total effective rate of motor development of the experimental group reached 94%, while that of the control group amounted to 80%. Obviously, the total effective rate of motor development of the experimental group was higher than that of the control group. The difference was statistically significant ( P &lt; 0.05 ). The nursing satisfaction of the experimental group reached 98%, which was apparently higher than that of the control group (74%). The difference suggested statistical significance ( P &lt; 0.05 ). The rates of brain injury at 1 and 2 years after the birth of the experimental group were 6% and 2%, respectively. The rates of brain injury at 1 and 2 years after the birth of the control group amounted to 18% and 14%, respectively. The rates of brain injury at 1 and 2 years after the birth of the experimental group were lower than those of the control group. The difference revealed statistical significance ( P &lt; 0.05 ). Hence, the early nursing intervention of premature infants with brain injury could promote brain development, improve neurological function, reduce the incidence of brain injury, and achieve an ideal nursing effect.

The influence of nutrition on white matter development in preterm infants: a scoping review.

White matter (WM) injury is the most common type of brain injury in preterm infants and is associated with impaired neurodevelopmental outcome (NDO). Currently, there are no treatments for WM injury, but optimal nutrition during early preterm life may support WM development. The main aim of this scoping review was to assess the influence of early postnatal nutrition on WM development in preterm infants. Searches were performed in PubMed, EMBASE, and COCHRANE on September 2022. Inclusion criteria were assessment of preterm infants, nutritional intake before 1 month corrected age, and WM outcome. Methods were congruent with the PRISMA-ScR checklist. Thirty-two articles were included. Negative associations were found between longer parenteral feeding duration and WM development, although likely confounded by illness. Positive associations between macronutrient, energy, and human milk intake and WM development were common, especially when fed enterally. Results on fatty acid and glutamine supplementation remained inconclusive. Significant associations were most often detected at the microstructural level using diffusion magnetic resonance imaging. Optimizing postnatal nutrition can positively influence WM development and subsequent NDO in preterm infants, but more controlled intervention studies using quantitative neuroimaging are needed. IMPACT: White matter brain injury is common in preterm infants and associated with impaired neurodevelopmental outcome. Optimizing postnatal nutrition can positively influence white matter development and subsequent neurodevelopmental outcome in preterm infants. More studies are needed, using quantitative neuroimaging techniques and interventional designs controlling for confounders, to define optimal nutritional intakes in preterm infants.

White Matter Segmentation in Brain MR Images of Premature Infants using Deep Learning Model

White matter injury is the most common form of brain injury in premature infants, which is highly associated with poor brain development. White matter segmentation in brain MR images is very important for early detection of brain injury in premature infants. In this paper, a deep learning based approach is proposed to segment the white matter region of premature infants. We retrospectively analyzed 63 preterm infants with gestational age < 37 weeks who underwent MRI examination. Firstly, the U-Net deep learning neural network model is used to automatically segment white matter, U-Net++ and ResU-Net are used as controlled experimental groups, and the Dice coefficient and Iou coefficient are used as evaluation indicators for white matter segmentation. In the above experiments, the U-Net network has the best experimental results. Segmenting white matter on the training set with a Dice coefficient of 0.90 and an Iou of 0.82, respectively. The test set was used to validate the performance of the proposed model, with a Dice coefficient of 0.83 and an Iou of 0.71, respectively. Secondly, we performed image binarization step on the segmented white matter, and used Gaussian filtering, flood filling and connected component analysis to process the automatically segmented white matter region, and finally obtain a white matter region with clear boundaries.

Effect of Placental Histological Chorioamnionitis and Prenatal Steroids on the Nervous System of Preterm Infants

Background: The placenta, as a link between mother and fetus, is closely related to the development of the fetal nervous system. Histological chorioamnionitis (HCA) is common placental inflammation and an important factor in triggering premature delivery. Anabolic steroid (AS) is an important medication to promote fetal lung maturity. Therefore, this study investigated the relationship between HCA, AS, and brain injury in premature infants. Objectives: This research aimed to explore the correlation of pathological changes in the placental HCA and the prenatal use of AS with brain injury in preterm infants. Methods: In total, 339 premature infants with a gestational age of under 34 weeks were taken as research subjects, and the placenta was examined by pathology after delivery. The samples were divided into HCA+ AS+, HCA+ AS-, HCA- AS+, and HCA- AS- groups based on the pathological results of the placenta and the prenatal use of steroid hormones. The occurrence of brain injury in preterm infants and the level of inflammatory indicators 2 h after birth were compared between the groups. Results: The incidence of brain injury in preterm infants in the HCA+ group was higher than in the HCA- group (χ2 = 5.713, P &lt; 0.05), and the AS- group than in the AS+ group (χ2 = 4.368, P &lt; 0.05); The incidence of brain injury in the HCA+ AS+, HCA+ AS- and HCA- AS-groups was significantly higher than in the HCA- AS+ group (χ2 = 6.105, P = 0.013; χ2 = 9.086, P = 0.003; χ2 = 4.848, P = 0.047, respectively). The incidence of brain injury in preterm infants was the highest in the group (30%). When the procalcitonin level 2 h after birth was 0.213 ng/mL, sensitivity to predict the occurrence of brain injury in preterm infants was 70.7%, and specificity was 80.2%. Conclusions: Brain damage in premature infants is related to HCA in the mother and insufficient AS treatment before delivery. Brain damage is more likely to occur when both factors exist.

Effect of Placental Histological Chorioamnionitis and Prenatal Steroids on the Nervous System of Preterm Infants

Background: The placenta, as a link between mother and fetus, is closely related to the development of the fetal nervous system. Histological chorioamnionitis (HCA) is common placental inflammation and an important factor in triggering premature delivery. Anabolic steroid (AS) is an important medication to promote fetal lung maturity. Therefore, this study investigated the relationship between HCA, AS, and brain injury in premature infants. Objectives: This research aimed to explore the correlation of pathological changes in the placental HCA and the prenatal use of AS with brain injury in preterm infants. Methods: In total, 339 premature infants with a gestational age of under 34 weeks were taken as research subjects, and the placenta was examined by pathology after delivery. The samples were divided into HCA+ AS+, HCA+ AS-, HCA- AS+, and HCA- AS- groups based on the pathological results of the placenta and the prenatal use of steroid hormones. The occurrence of brain injury in preterm infants and the level of inflammatory indicators 2 h after birth were compared between the groups. Results: The incidence of brain injury in preterm infants in the HCA+ group was higher than in the HCA- group (χ2 = 5.713, P &lt; 0.05), and the AS- group than in the AS+ group (χ2 = 4.368, P &lt; 0.05); The incidence of brain injury in the HCA+ AS+, HCA+ AS- and HCA- AS-groups was significantly higher than in the HCA- AS+ group (χ2 = 6.105, P = 0.013; χ2 = 9.086, P = 0.003; χ2 = 4.848, P = 0.047, respectively). The incidence of brain injury in preterm infants was the highest in the group (30%). When the procalcitonin level 2 h after birth was 0.213 ng/mL, sensitivity to predict the occurrence of brain injury in preterm infants was 70.7%, and specificity was 80.2%. Conclusions: Brain damage in premature infants is related to HCA in the mother and insufficient AS treatment before delivery. Brain damage is more likely to occur when both factors exist.

Review on the application of imaging examination for brain injury in premature infants.

Brain injury is the main factor leading to the decline of the quality of life in premature infants. The clinical manifestations of such diseases are often diverse and complex, lacking obvious neurological symptoms and signs, and the disease progresses rapidly. Due to missed diagnosis, it is easy to miss the best treatment opportunity. Brain ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and other imaging methods can help clinicians diagnose and assess the type and extent of brain injury in premature infants to some extent, but the three methods have their own characteristics. This article briefly reviews the diagnostic value of these three methods for brain injury in premature infants.

Cranial Ultrasound: A Novel Approach of Neuroimaging in Preterm Infants Suffering from Perinatal Birth Injury

Introduction: Preterm birth is a common cause of neonatal mortality with an additional burden of adverse neurodevelopmental outcomes. It is caused by different factors that can be either perinatal, natal or postnatal leading to white matter injury/intracranial hemorrhages. These lesions can be readily assessed by cranial ultrasound which provides cost-effective, radiation-free, bedside imaging. Conclusion: Cranial ultrasound is an innovative method to assess brain injury in preterm infants. Ultrasonographic evaluation of preterm brain is recommended as early as possible after birth with interval follow up. Three distinct patterns of brain injury can be seen in preterm infants: Periventricular leukomalacia (PVL), Germinal Matrix-Intraventricular hemorrhage (GMH-IVH) and cerebellar hemorrhages. Germinal matrix hemorrhage is found to be most common pattern with cystic PVL being next among three patterns of brain injury. Ultrasound is an operator-dependent technique with poor visualization of few abnormalities on two-dimensional images. The limitation of conventional ultrasonography opens up new aspects of 3 D scanning with better imaging outcomes