Objectives: Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This... Show moreObjectives: Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This study aimed to compare cerebellar growth in premature infants who received dexamethasone or hydrocortisone to premature infants who did not receive postnatal corticosteroids. Study Design: Retrospective case-control study in infants born at a gestational age of <29 weeks and admitted to two level 3 neonatal intensive care units. Exclusion criteria were severe congenital anomalies and cerebellar or severe supratentorial lesions. Infants were treated with dexamethasone (unit 1) or hydrocortisone (unit 2) for chronic lung disease. Controls (unit 1) did not receive postnatal corticosteroids. Sequential head circumference (HC) and ultrasound measurements of transcerebellar diameter (TCD), biparietal diameter (BPD), and corpus callosum-fastigium length (CCFL) were performed until 40 weeks' postmenstrual age (PMA). Growth was assessed using linear mixed models correcting for PMA at measurement, sex, HC z-score at birth, and a propensity score indicating illness severity. Group differences before treatment were assessed using linear regression. Results: 346 infants were included (68 dexamethasone, 37 hydrocortisone, 241 controls). Before starting corticosteroids, TCD, BPD, and HC measurements did not differ between patients and controls at a comparable PMA. After starting treatment, both types of corticosteroid had a negative association with TCD growth. BPD, CCFL, and HC growth were not negatively affected. Conclusion: Administration of dexamethasone and hydrocortisone are both associated with impaired cerebellar growth in premature infants without evident negative associations with cerebral growth. Show less
Boswinkel, V.; Sok, F.I.; Kruse-Ruijter, M.F.; Nijholt, I.M.; Jansen, F.A.R.; Haak, M.C.; ... ; Wezel-Meijler, G. van 2021
Background: Brain growth in moderate preterm (MP; gestational age (GA) 32(+0)-33(+6) weeks) and late preterm infants (LP; GA 34(+0)-36+6 weeks) may be impaired, even in the absence of brain injury... Show moreBackground: Brain growth in moderate preterm (MP; gestational age (GA) 32(+0)-33(+6) weeks) and late preterm infants (LP; GA 34(+0)-36+6 weeks) may be impaired, even in the absence of brain injury.Aims: The aims of this study were to assess brain measurements of MP and LP infants, and to compare these with full-term infants (GA > 37 weeks) using linear cranial ultrasound (cUS) at term equivalent age (TEA).Study design: cUS data from two prospective cohorts were combined. Two investigators performed offline measurements on standard cUS planes. Eleven brain structures were compared between MP, LP and full-term infants using uni-and multivariable linear regression.Results were adjusted for postmenstrual age at cUS and corrected for multiple testing. Results: Brain measurements of 44 MP, 54 LP and 52 full-term infants were determined on cUS scans at TEA. Biparietal diameter and basal ganglia-insula width were smaller in MP (-9.1 mm and -1.7 mm, p < 0.001) and LP infants (-7.0 mm and -1.7 mm, p < 0.001) compared to full-term infants. Corpus callosum - fastigium length was larger in MP (+2.2 mm, p < 0.001) than in full-term infants. No significant differences were found between MP and LP infants.Conclusions: These findings suggest that brain growth in MP and LP infants differs from full-term infants. Whether these differences have clinical implications remains to be investigated. Show less
Background and aim: To investigate whether neonates with prenatally detected congenital heart defects (CHD) demonstrate cerebral abnormalities on early preoperative cranial ultrasound (CUS),... Show moreBackground and aim: To investigate whether neonates with prenatally detected congenital heart defects (CHD) demonstrate cerebral abnormalities on early preoperative cranial ultrasound (CUS), compared to healthy neonates, and to measure brain structures to assess brain growth and development in both groups.Study design, subjects and outcome measures: Prospective cohort study with controls. Between September 2013 and May 2016 consecutive cases of prenatally detected severe isolated CHD were included. Neonatal CUS was performed shortly after birth, before surgery and in a healthy control group. Blinded images were reviewed for brain abnormalities and various measurements of intracranial structures were compared.Results: CUS was performed in 59 healthy controls and 50 CHD cases. Physiological CUS variants were present in 54% of controls and in 52% of CHD cases. Abnormalities requiring additional monitoring (both significant and minor) were identified in four controls (7%) and five CHD neonates (10%). Significant abnormalities were only identified in four CHD neonates (8%) and never in controls. A separate analysis of an additional 8 CHD neonates after endovascular intervention demonstrated arterial stroke in two cases that underwent balloon atrioseptostomy (BAS). Cerebral measurements were smaller in CHD neonates, except for the cerebrospinal fluid measurements, which were similar to the controls.Conclusions: The prevalence of significant preoperative CUS abnormalities in CHD cases was lower than previously reported, which may be partially caused by a guarding effect of a prenatal diagnosis. Arterial stroke occurred only in cases after BAS. As expected, neonates with CHD display slightly smaller head size and cerebral growth. Show less
Newborn infants requiring intensive care treatment are at risk of cerebellar injury. This can have important consequences for long-term neurodevelopmental outcome. The aim of this thesis was to... Show moreNewborn infants requiring intensive care treatment are at risk of cerebellar injury. This can have important consequences for long-term neurodevelopmental outcome. The aim of this thesis was to study the incidence and characteristics of cerebellar injury, and to investigate the role of different neuroimaging techniques (cranial ultrasound (CUS) with additional mastoid fontanelle (MF) views and MRI) for its detection in both preterm and high-risk term infants. Part I describes the standard CUS procedure and supplementary imaging techniques to optimize its performance, including the use of additional acoustic windows. Part II focuses on the detection, risk factors and prognostic implications of cerebellar injury in preterm infants. Part III focuses on CUS and MRI findings of posterior fossa abnormalities in full-term infants with various neonatal disorders. Part VI reviews the main findings and conclusions of this thesis, and discusses future perspectives and proposals for further research. Based on the findings of this thesis, we conclude that in both preterm and critically ill full-term infants CUS protocols should include MF views. This enables early detection of most major and clinically relevant posterior fossa abnormalities. Routine MRI for the detection of small hemorrhagic lesions is not warranted, as these lesions have a favorable prognosis Show less
Steggerda, S.J.; Bruine, F.T. de; Berg-Huysmans, A.A. van den; Rijken, M.; Leijser, L.M.; Walther, F.J.; Wezel-Meijler, G. van 2013
Infants born very prematurely (gestational age <32 weeks) are at risk of brain injury and neurodevelopmental problems. Imaging the preterm infant__s brain during the neonatal period, using... Show moreInfants born very prematurely (gestational age <32 weeks) are at risk of brain injury and neurodevelopmental problems. Imaging the preterm infant__s brain during the neonatal period, using cranial ultrasonography (cUS) and magnetic resonance imaging (MRI), is important. Our aim was to study and describe brain findings in very preterm infants using modern, high-quality imaging techniques. Part I reviews brain maturation and injury, and imaging thereof, in very preterm infants. Part II discusses our experience on neonatal cUS (Chapters 2-3) and MRI (Chapter 4), and addresses indications, technical aspects, protocols and safety. Part III gives an overview of findings (incidence and evolution) on frequent, sequential neonatal cUS and term-equivalent MRI (Chapter 5), and their relation with perinatal factors (Chapter 6). Part IV focuses on imaging of white matter (Chapters 7-9), describing both normal maturational phenomena and pathological changes and assessing the accuracy of cUS and MRI for these changes. Part V focuses on imaging of deep grey matter (Chapters 10-12), describing both normal maturational phenomena and pathological changes on cUS and assessing their relation with clinical and MRI findings. Part VI reviews the main findings and conclusions of this thesis, and discusses future perspectives and proposals for further research (Chapter 13). Show less
