Utilising recorded music to reduce stress and enhance infant neurodevelopment in neonatal intensive care units.

AIM: This paper summarises published evidence on the use of recorded music in high-risk infants to reduce stress and improve neurodevelopment, forming recommendations for proposed clinical applications in neonatal intensive care units. METHODS: We searched two comprehensive library catalogues and two databases for articles evaluating the impact of recorded music interventions on hospitalised preterm infants. Original and review papers published in English in the 10 years prior to this search were selected if the study included a component of recorded music interventions. RESULTS: Most original studies (80.95%) and all literature reviews (100%) reported positive effects of recorded music interventions for preterm infants, primarily in the short term. No negative effects were reported. Evidence is emerging regarding the neurobiological mechanisms of recorded music on longer-term effects on preterm infant neurodevelopment. Clinical applications were suggested drawing upon available evidence. Due to generally small sample sizes and variability in study design, unanswered questions remain. CONCLUSION: Carefully designed recorded music interventions appear to be safe, feasible and effective in reducing stress and improving neurodevelopment of hospitalised infants. Additional rigorous, well-powered trials with relevant outcomes are needed to further refine specific elements for recorded music interventions to better inform practice.

A randomized controlled trial investigating the impact of maternal dietary supplementation with pomegranate juice on brain injury in infants with IUGR.

Animal studies have demonstrated the therapeutic potential of polyphenol-rich pomegranate juice. We recently reported altered white matter microstructure and functional connectivity in the infant brain following in utero pomegranate juice exposure in pregnancies with intrauterine growth restriction (IUGR). This double-blind exploratory randomized controlled trial further investigates the impact of maternal pomegranate juice intake on brain structure and injury in a second cohort of IUGR pregnancies diagnosed at 24-34 weeks' gestation. Ninety-nine mothers and their eligible fetuses (n = 103) were recruited from Brigham and Women's Hospital and randomly assigned to 8 oz pomegranate (n = 56) or placebo (n = 47) juice to be consumed daily from enrollment to delivery. A subset of participants underwent fetal echocardiogram after 2 weeks on juice with no evidence of ductal constriction. 57 infants (n = 26 pomegranate, n = 31 placebo) underwent term-equivalent MRI for assessment of brain injury, volumes and white matter diffusion. No significant group differences were found in brain volumes or white matter microstructure; however, infants whose mothers consumed pomegranate juice demonstrated lower risk for brain injury, including any white or cortical grey matter injury compared to placebo. These preliminary findings suggest pomegranate juice may be a safe in utero neuroprotectant in pregnancies with known IUGR warranting continued investigation.Clinical trial registration: NCT04394910, https://clinicaltrials.gov/ct2/show/NCT04394910 , Registered May 20, 2020, initial participant enrollment January 16, 2016.

Longitudinal growth of the basal ganglia and thalamus in very preterm children.

The impact of very preterm (VP) birth on the development of individual basal ganglia nuclei and the thalamus during childhood remains unclear. We first aimed to compare (1a) the volumes of individual basal ganglia nuclei (nucleus accumbens, caudate nucleus, pallidum, putamen) and the thalamus at age 7 years, and (1b) their volumetric change from infancy to 7 years, in VP children with term-born children. Secondly, we aimed to (2a) determine whether basal ganglia and thalamic volumes at 7 years, or (2b) basal ganglia and thalamic growth rates from infancy to 7 years were associated with neurodevelopmental outcomes at 7 years, and whether these associations differed between the VP and term-born children. One hundred and fifty-four VP (<30 weeks' gestational age or birth weight < 1250 g) and 35 term-born children had useable magnetic resonance imaging (MRI) scans that could be analyzed at 7 years. Of these, 149 VP and 30 term-born infants also had useable MRI scans at term-equivalent age. Volumes of the individual basal ganglia nuclei and the thalamus were automatically generated from the MRI scans. Compared with the term-born group, the VP group had smaller basal ganglia and thalamic volumes at 7 years and slower growth rates from birth to 7 years. After controlling for overall brain size, VP children still had smaller thalamic volumes but the deep grey matter volume growth rates from birth to 7 years were similar between groups. Reduced basal ganglia and thalamic volumes and slower growth rates in the VP group were associated with poorer cognition, academic achievement and motor function at 7 years. After controlling for overall brain size, the nucleus accumbens and pallidum were the deep grey matter structures most strongly associated with 7-year neurodevelopmental outcomes. In conclusion, basal ganglia and thalamic growth is delayed during early childhood in VP children, with delayed development contributing to poorer functional outcomes.

Basal ganglia and thalamic tract connectivity in very preterm and full-term children; associations with 7-year neurodevelopment.

BACKGROUND: Altered basal ganglia and thalamic connectivity may be critical for cognitive, motor and behavioural impairments common to very preterm (<32 weeks' gestational age) children. This study aims to (1) compare corticostriatal and thalamocortical tract connectivity between very preterm and term-born children at 7 years of age; (2) explore tract connectivity associations with 7-year neurodevelopmental outcomes, and whether these relationships differed between groups. METHODS: Eighty-three very preterm and 19 term-born (≥37 weeks' gestational age) children underwent structural and diffusion magnetic resonance imaging and had a neuropsychological assessment at 7 years. Corticostriatal and thalamocortical tracts were reconstructed and white matter connectivity was estimated with apparent fibre density. RESULTS: Compared with term-born controls, very preterm children had decreased connectivity in tracts linking the caudate to right motor areas (-10%, p = 0.03) and the thalamus with left motor areas (-5.7%, p = 0.03). Reduced connectivity in corticostriatal and thalamocortical tracts was associated with adverse motor functioning in both groups (p = 0.06). Decreased connectivity of the left caudate and putamen with the lateral prefrontal cortex was associated with lower reading performance for controls (p = 0.06). CONCLUSION: Corticostriatal and thalamocortical tracts are vulnerable to very preterm birth. Poorer connectivity in these tracts may underlie the motor impairments observed in very preterm children.

Neonatal basal ganglia and thalamic volumes: very preterm birth and 7-year neurodevelopmental outcomes.

BackgroundThis study aims to (i) compare volumes of individual basal ganglia nuclei (caudate nucleus, pallidum, and putamen) and the thalamus between very preterm (VP) and term-born infants at term-equivalent age; (ii) explore neonatal basal ganglia and thalamic volume relationships with 7-year neurodevelopmental outcomes, and whether these relationships differed between VP and term-born children.Methods210 VP (<30 weeks' gestational age) and 39 term-born (≥37 weeks' gestational age) infants underwent brain magnetic resonance imaging at term-equivalent age, and deep gray matter volumes of interest were automatically generated. 186 VP and 37 term-born children were assessed for a range of neurodevelopmental measures at age 7 years.ResultsAll deep gray matter structures examined were smaller in VP infants compared with controls at term-equivalent age; ranging from (percentage mean difference (95% confidence intervals) -6.2% (-10.2%, -2.2%) for the putamen, to -9.5% (-13.9%, -5.1%) for the caudate nucleus. Neonatal basal ganglia and thalamic volumes were positively related to motor, intelligence quotient, and academic outcomes at age 7 years, with mostly similar relationships in the VP and control groups.ConclusionVP birth results in smaller basal ganglia and thalamic volumes at term-equivalent age, and these smaller volumes are related to a range of 7-year neurodevelopmental deficits in VP children.