Neuroanatomical correlates of sensory deficits in children with neonatal arterial ischemic stroke.

AIM: Our aim was to characterize the sensory processing outcome following neonatal arterial ischemic stroke (NAIS) and identify neuroanatomical correlates of abnormal sensory processing. METHOD: We evaluated children with NAIS longitudinally at 12 months, 18 months, and/or 30 months in areas of cognitive, motor, and language development. We gathered sensory processing data using the Sensory Profile-2 Caregiver Questionnaire. These data were analyzed against early magnetic resonance imaging using a voxel-based approach. RESULTS: Eighteen children (10 males, 8 females) with NAIS were evaluated longitudinally, of which six exhibited atypical sensory processing. Children with sensory processing deficits had lower overall developmental scores in motor, cognitive, and language domains. Neuroanatomical correlates were identified in the posterior periventricular white matter extending superiorly into the supramarginal gyrus, and inferiorly into the fusiform and inferior temporal gyri. INTERPRETATION: Our results provide new evidence that children with NAIS may experience difficulty processing sensory information, which is most likely associated with injuries in the posterior periventricular white matter, supramarginal gyrus, fusiform gyrus, and posterior thalamic radiation. WHAT THIS PAPER ADDS: Atypical sensory processing is common in children with neonatal arterial ischemic stroke (NAIS). NAIS territories in sensory areas were correlated with atypical sensory processing behaviors. Children with NAIS may benefit from early interventions targeted toward sensory processing. Future research mapping NAIS injuries using early magnetic resonance imaging may predict long-term outcomes.

CORRELACIÓN NEUROANATÓMICA DE LOS DÉFICITS SENSORIALES EN NIÑOS CON INFARTO ISQUÉMICO ARTERIAL NEONATAL: OBJETIVO: Nuestro objetivo fue caracterizar los efectos el procesamiento sensorial posterior a un ictus isquémico arterial neonatal (IIAN) e identificar la relación neuroanatómica del procesamiento sensorial anormal. MÉTODO: Evaluamos longitudinalmente a niños con IIAN a los 12, 18 y/o 30 meses en áreas de desarrollo cognitivo, motor y lingüístico. Recopilamos los datos del procesamiento sensorial usando el Perfil Sensorial. Estos datos fueron analizados contra las imágenes de resonancia magnética temprana utilizando la técnica de voxel-based morphometry. RESULTADOS: Fueron evaluados longitudinalmente 18 niños (10 varones, 8 mujeres) con IIAN, de los cuales seis mostraron un procesamiento sensorial atípico. Los niños con déficit del procesamiento sensorial tuvieron puntuaciones menores del desarrollo general en los dominios motor, cognitivo y lingüístico. La correlación neuroanatómica fue identificada en la sustancia blanca periventricular posterior extendiéndose superiormente hacia el giro supramarginal e inferiormente dentro del giro fusiforme y el giro temporal inferior. INTERPRETACIÓN: Nuestros resultados proporcionan nuevas evidencias que los niños con IIAN pueden experimentar dificultades en el procesamiento de información sensorial, que está probablemente asociado con lesiones en la sustancia blanca periventricular posterior, giro supramarginal, giro fusiforme y la radiación talámica posterior.

CORRELATOS NEUROANATÔMICOS DOS DÉFICITS SENSORIAIS EM CRIANÇAS COM ACIDENTE VASCULAR CEREBRAL ISQUÊMICO NEONATAL: OBJETIVOS: Nosso objetivo foi avaliar os resultados de processamento sensorial após acidente vascular cerebral isquêmico neonatal (AVC-IN) e identificar correlatos neuroanatômicos de processamentos sensoriais anormais. MÉTODO: Foram avaliadas crianças com AVC-IN longitudinalmente com 12 meses, 18 meses, e /ou 30 meses nas áreas do desenvolvimento cognitivo, motor e linguagem. Obtivemos os dados do processamento sensorial utilizando o Perfil Sensorial. Os dados foram analisados através de imagens de ressonância magnética precoce utilizando uma abordagem baseada em Voxel. RESULTADOS: Dezoito crianças (10 meninos e 8 meninas) com AVC-IN foram avaliadas longitudinalmente, das quais seis exibiram processamento sensorial atípico. Crianças com déficits de processamento sensorial tiveram menor pontuação total nos domínios de desempenho motor, cognitivo, e de linguagem. Correlatos neuroanatômicos foram identificados na substancia branca periventricular posterior, estendendo-se superiormente até o giro supramarginal e inferiormente até o giro fusiforme, e giro temporal inferior. INTERPRETAÇÃO: Estes resultados proporcionam novas evidencias de que crianças com AVC-I possam apresentar dificuldades de processar informações sensoriais, o que está provavelmente associado com danos ocorridos na substancia branca periventricular posterior, giro supramarginal, giro fusiforme, e projeções talâmicas posteriores.

Neurodevelopmental outcomes following two different treatment approaches (early ligation and selective ligation) for patent ductus arteriosus.

OBJECTIVE: To examine whether a change in the approach to managing persistent patent ductus arteriosus (PDA) from early ligation to selective ligation is associated with an increased risk of abnormal neurodevelopmental outcomes. STUDY DESIGN: In 2005, we changed our PDA treatment protocol for infants born at ≤27 6/7 weeks' gestation from an early ligation approach, with prompt PDA ligation if the ductus failed to close after indomethacin therapy (period 1: January 1999 to December 2004), to a selective ligation approach, with PDA ligation performed only if specific criteria were met (period 2: January 2005 to May 2009). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite abnormal neurodevelopmental outcome (Bayley Mental Developmental Index or Cognitive Score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at age 18-36 months (n = 224). RESULTS: During period 1, 23% of the infants in follow-up failed indomethacin treatment, and all underwent surgical ligation. During period 2, 30% of infants failed indomethacin, and 66% underwent ligation after meeting prespecified criteria. Infants treated with the selective ligation strategy demonstrated fewer abnormal outcomes than those treated with the early ligation approach (OR, 0.07; P = .046). Infants who underwent ligation before 10 days of age had an increased incidence of abnormal neurodevelopmental outcome. The significant difference in outcomes between the 2 PDA treatment strategies could be accounted for in part by the earlier age of ligation during period 1. CONCLUSION: A selective ligation approach for PDAs that fail to close with indomethacin therapy is not associated with worse neurodevelopmental outcomes at age 18-36 months.