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      Socioeconomic status and brain injury in children born preterm: modifying neurodevelopmental outcome

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          Abstract

          Improved intensive care therapies have increased the survival of children born preterm. Yet, many preterm children experience long-term neurodevelopmental sequelae. Indeed, preterm birth remains a leading cause of lifelong neurodevelopmental disability globally, posing significant challenges to the child, family, and society. Neurodevelopmental disability in children born preterm is traditionally linked to acquired brain injuries such as white matter injury and to impaired brain maturation resulting from neonatal illness such as chronic lung disease. Socioeconomic status (SES) has long been recognized to contribute to variation in outcome in children born preterm. Recent brain imaging data in normative term-born cohorts suggest that lower SES itself predicts alterations in brain development, including the growth of the cerebral cortex and subcortical structures. Recent evidence in children born preterm suggests that the response to early-life brain injuries is modified by the socioeconomic circumstances of children and families. Exciting new data points to the potential of more favorable SES circumstances to mitigate the impact of neonatal brain injury. This review addresses emerging evidence suggesting that SES modifies the relationship between early-life exposures, brain injury, and neurodevelopmental outcomes in children born preterm. Better understanding these relationships opens new avenues for research with the ultimate goal of promoting optimal outcomes for those children born preterm at highest risk of neurodevelopmental consequence.

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          Most cited references71

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          Neurogenesis occurs in the dentate gyrus of the hippocampus throughout the life of a rodent, but the function of these new neurons and the mechanisms that regulate their birth are unknown. Here we show that significantly more new neurons exist in the dentate gyrus of mice exposed to an enriched environment compared with littermates housed in standard cages. We also show, using unbiased stereology, that the enriched mice have a larger hippocampal granule cell layer and 15 per cent more granule cell neurons in the dentate gyrus.
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            Neuronal plasticity is a central theme of modern neurobiology, from cellular and molecular mechanisms of synapse formation in Drosophila to behavioural recovery from strokes in elderly humans. Although the methods used to measure plastic responses differ, the stimuli required to elicit plasticity are thought to be activity-dependent. In this article, we focus on the neuronal changes that occur in response to complex stimulation by an enriched environment. We emphasize the behavioural and neurobiological consequences of specific elements of enrichment, especially exercise and learning.
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              Neonatal MRI to predict neurodevelopmental outcomes in preterm infants.

              Very preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population. We studied 167 very preterm infants (gestational age at birth, 30 weeks or less) to assess the associations between qualitatively defined white-matter and gray-matter abnormalities on MRI at term equivalent (gestational age of 40 weeks) and the risks of severe cognitive delay, severe psychomotor delay, cerebral palsy, and neurosensory (hearing or visual) impairment at 2 years of age (corrected for prematurity). At two years of age, 17 percent of infants had severe cognitive delay, 10 percent had severe psychomotor delay, 10 percent had cerebral palsy, and 11 percent had neurosensory impairment. Moderate-to-severe cerebral white-matter abnormalities present in 21 percent of infants at term equivalent were predictive of the following adverse outcomes at two years of age: cognitive delay (odds ratio, 3.6; 95 percent confidence interval, 1.5 to 8.7), motor delay (odds ratio, 10.3; 95 percent confidence interval, 3.5 to 30.8), cerebral palsy (odds ratio, 9.6; 95 percent confidence interval, 3.2 to 28.3), and neurosensory impairment (odds ratio, 4.2; 95 percent confidence interval, 1.6 to 11.3). Gray-matter abnormalities (present in 49 percent of infants) were also associated, but less strongly, with cognitive delay, motor delay, and cerebral palsy. Moderate-to-severe white-matter abnormalities on MRI were significant predictors of severe motor delay and cerebral palsy after adjustment for other measures during the neonatal period, including findings on cranial ultrasonography. Abnormal findings on MRI at term equivalent in very preterm infants strongly predict adverse neurodevelopmental outcomes at two years of age. These findings suggest a role for MRI at term equivalent in risk stratification for these infants. Copyright 2006 Massachusetts Medical Society.
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                Author and article information

                Journal
                Pediatric Research
                Pediatr Res
                Springer Science and Business Media LLC
                0031-3998
                1530-0447
                October 30 2019
                Article
                10.1038/s41390-019-0646-7
                31666689
                791c1a95-0589-4905-bc1d-2ee15e2f5258
                © 2019

                http://www.springer.com/tdm

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