Timing Of Brain Injury Research Articles

Neonatal wellbeing and timing of brain injury in term and late preterm cerebral palsy.

https://onlinelibrary.wiley.com/doi/10.1111/dmcn.15829

Neonatal well-being and timing of brain injury in persons with cerebral palsy born at term or late preterm.

To describe the distribution of neuroimaging patterns in a term/late preterm population-based cohort with cerebral palsy (CP), ascertain associations between neuroimaging patterns and neonatal well-being, estimate the proportion with antenatal or perinatal timing of neuropathology, and apply this information to the understanding of common mechanisms of brain injury and causal pathways. The cohort for this observational study comprised 1348 persons born between 1999 and 2017 in Victoria, Australia. Using algorithms designed for the study, neonatal well-being and timing of brain injury were tabulated for the whole cohort and across neuroimaging patterns and birth epochs. Clinical and demographic profiles, neonatal well-being, and timing of brain injury differed across neuroimaging patterns. An estimated 57% of the cohort had a complicated neonatal period. Timing of brain injury was antenatal in 57% and perinatal in 41%. A decrease in the relative proportions of perinatal timing of brain injury was observed over a period when the rates of CP in live births at term decreased. This study begins to bridge the knowledge gap about causation in CP, moving towards better description of the main mechanisms of brain injury and their contribution within CP cohorts, and facilitating the ability to monitor changes over time and the success of preventive measures. In a population-based, term/late preterm cohort with cerebral palsy, 57% had a complicated neonatal period. In the same cohort, 57% had presumed antenatal timing of brain injury. The relative proportion with perinatal injury decreased over time.

Developmental Trajectories of Early Higher‐Order Thinking Talk Differ for Typically Developing Children and Children With Unilateral Brain Injuries

ABSTRACTThe use of higher‐order thinking talk (HOTT), where speakers identify relations between representations (e.g., comparison, causality, abstraction) is examined in the spontaneous language produced by 64 typically developing (TD) and 46 brain‐injured children, observed from 14–58 months at home. HOTT is less frequent in lower‐income children and children with brain injuries, but effects differed depending on HOTT complexity and type of brain injury. Controlling for income, children with larger and later‐occurring cerebrovascular infarcts produce fewer surface (where relations are more perceptual) and structure (where relations are more abstract) HOTT utterances than TD children. In contrast, children with smaller and earlier occurring periventricular lesions produce HOTT at comparable rates to TD children. This suggests that examining HOTT development may be an important tool for understanding the impacts of brain injury in children. Theoretically, these data reveal that both neurological (size and timing of brain injury) and environmental (family income) factors contribute to these skills.

Brain magnetic resonance imaging is a predictor of bimanual performance and executive function in children with unilateral cerebral palsy.

To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.

Motor Impairments Related to Brain Injury Timing in Early Hemiparesis. Part II

Background. Extensive neuromotor development occurs early in human life, and the timing of brain injury may affect the resulting motor impairment. In Part I of this series, it was demonstrated that the distribution of weakness in the upper extremity depended on the timing of brain injury in individuals with childhood-onset hemiparesis. Objective. The goal of this study was to characterize how timing of brain injury affects joint torque synergies, or losses of independent joint control. Method. Twenty-four individuals with hemiparesis were divided into 3 groups based on the timing of their injury: before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), and after 6 months of age (POST-natal, n = 8). Individuals with hemiparesis and 8 typically developing peers participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks while their efforts were recorded by a multiple degree-of-freedom load cell. Motor output in 4 joints of the upper extremity was concurrently measured during 8 primary torque generation tasks to quantify joint torque synergies. Results. There were a number of significant coupling patterns identified in individuals with hemiparesis that differed from the typically developing group. POST-natal differences were most noted in the coupling of shoulder abductors with elbow, wrist, and finger flexors, while the PRE-natal group demonstrated significant distal joint coupling with elbow flexion. Conclusion. The torque synergies measured provide indirect evidence for the use of bulbospinal pathways in the POST-natal group, while those with earlier injury may use relatively preserved ipsilateral corticospinal motor pathways.

Treatment of the Term Newborn With Brain Injury: Simplicity As the Mother of Invention

Neonatal brain injury remains a common cause of developmental disability, despite tremendously enhanced obstetrical and neonatal care. The timing of brain injury occurs throughout gestation, labor, and delivery, providing an evolving form of brain injury and a moving target for therapeutic intervention. Nonetheless, markedly improved methods are available to identify those infants injured at birth, via clinical presentation with neonatal encephalopathy and neuroimaging techniques. Postischemic hypothermia has been shown to be of tremendous clinical promise in several completed and ongoing trials. As part of this approach to the treatment of the newborn, other parameters of physiologic homeostasis can and should be attended to, with strong animal and clinical evidence that their correction will have dramatic influence on the outcome of the newborn infant. This review addresses aspects of newborn care to which we can direct our attention currently, and which should result in a safe and efficacious improvement in the prognosis of the newborn with neonatal encephalopathy.

WHITE MATTER INJURY IN NEWBORNS WITH CARDIAC DISEASE

Objective : Neurodevelopmental impairment is common in term newborns with congenital heart disease (CHD), yet the mechanism and timing of brain injury in this population is largely unknown.

Cognitive development in children born preterm: implications for theories of brain plasticity following early injury.

The human brain is functionally altered through experience, a phenomenon known as plasticity. Relevant experiences may be negative, as in brain injury. Adult brain injury results in permanent impairment. However, it has been assumed that early injury leads to substantial functional recovery. Animal studies suggest several predictions regarding whether this principle generally holds true. These studies indicate that the timing of brain injury, relative to the expected course of neurodevelopment, impacts the extent of recovery. Injuries occurring during the period of cell migration are particularly detrimental. However, outcome must be assessed longitudinally because apparent recovery in childhood may reverse as the brain matures. Moreover, recovery of one function may come at the expense of others. Whether these findings characterize outcome following preterm birth is the focus of this review. Preterm birth is associated with high rates of neurodevelopmental disability, primarily due to hypoxic-ischemic events. Periventricular brain structures and white matter tracts are particularly vulnerable to damage. Through school age, preterm children exhibit diminished levels of global intellectual function, attention, memory, and reasoning skills relative to full-term peers. It is questionable whether these deficits persist. Because few studies have followed recent cohorts into young adulthood, it is argued that outcome cannot be reliably described based on the available literature. Moreover, important contributors to later development have been neglected, including both genetic and experiential factors. With improved assessment, it may be possible to develop interventions based on the individual child's constellation of genetic, biological, and sociodemographic risks.

Timing of brain injury in periventricular leukomalacia (PVL) studied with serial neonatal EEGS

Timing of brain injury in periventricular leukomalacia (PVL) studied with serial neonatal EEGS

DOCUMENTATION OF PRENATAL BRAIN INJURY

The timing of brain injury which leads to neurologic handicap in infants is difficult to establish. However, in infants who die it is possible to estimate the duration of injury by neuropathologic assessment of the state of necrosis, gliosis, alteration of extravascular red cells and calcification.We reviewed the neuropathologic findings, birth history, and clinical course of neonates autopsied at our center during 1982. Five of the 6 term infants and 10 of the 25 premature infants who died at less than 7 days of age were shown to have brain lesions which predated their time of delivery. Two of the 5 term infants and 7 of the 10 preterm infants had Apgar scores of <3 at 1 min and <5 at 5 min of age. Fetal distress was usually unrecognized and only 1 term and 3 preterm infants were delivered by C-section. Clinical characteristics observed did not suggest a recognizable syndrome of prenatal brain injury. However, the gut and lungs had also been affected prenatally in several cases. Respiratory failure was the usual cause of death.We conclude that a number of infants dying at less than one week of age have evidence of prenatal brain injury. Birth asphyxia is frequently associated with this finding and this suggests that such infants do not tolerate labor. The probability of prenatal brain injury in surviving neurologically damaged infants with similar birth histories seems high. The medicolegal implications are important and we recommend careful neuropathological evaluation of all such infants who die.