Seminars in perinatology最新文献

英文中文

Neonatal neuroimaging: from research to bedside practice 新生儿神经影像学：从研究到临床实践。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152125

Mehmet N. Cizmeci , Mohamed El-Dib , Linda S. de Vries

Neonatal neuroimaging is essential in research and clinical practice, offering important insights into brain development and neurologic injury mechanisms. Visualizing the brain enables researchers and clinicians to improve neonatal care and parental counselling through better diagnosis and prognostication of disease. Common neuroimaging modalities used in the neonatal intensive care unit (NICU) are cranial ultrasonography (cUS) and magnetic resonance imaging (MRI). Between these modalities, conventional MRI provides the optimal image resolution and detail about the developing brain, while advanced MRI techniques allow for the evaluation of tissue microstructure and functional networks. Over the last two decades, medical imaging techniques using brain MRI have rapidly progressed, and these advances have facilitated high-quality extraction of quantitative features as well as the implementation of novel devices for use in neurological disorders. Major advancements encompass the use of low-field dedicated MRI systems within the NICU and trials of ultralow-field portable MRI systems at the bedside. Additionally, higher-field magnets are utilized to enhance image quality, and ultrafast brain MRI is employed to decrease image acquisition time. Furthermore, the implementation of advanced MRI sequences, the application of machine learning algorithms, multimodal neuroimaging techniques, motion correction techniques, and novel modalities are used to visualize pathologies that are not visible to the human eye. In this narrative review, we will discuss the fundamentals of these neuroimaging modalities, and their clinical applications to explore the present landscape of neonatal neuroimaging from bench to bedside.

新生儿神经影像学在研究和临床实践中是必不可少的，为大脑发育和神经损伤机制提供了重要的见解。大脑可视化使研究人员和临床医生能够通过更好的疾病诊断和预测来改善新生儿护理和父母咨询。新生儿重症监护病房（NICU）常用的神经成像方式是颅超声（cu）和磁共振成像（MRI）。在这些模式之间，传统的MRI提供了关于发育中的大脑的最佳图像分辨率和细节，而先进的MRI技术允许评估组织微观结构和功能网络。在过去的二十年中，使用脑MRI的医学成像技术已经迅速发展，这些进步促进了高质量的定量特征提取以及用于神经系统疾病的新型设备的实施。主要的进步包括在新生儿重症监护室使用低场专用MRI系统和在床边试用超低场便携式MRI系统。此外，利用高场磁体来提高图像质量，并采用超快脑MRI来缩短图像采集时间。此外，先进的MRI序列的实现、机器学习算法的应用、多模态神经成像技术、运动校正技术和新模式被用于可视化人眼不可见的病理。在这篇叙述性的综述中，我们将讨论这些神经成像模式的基本原理，以及它们的临床应用，以探索新生儿神经成像从工作台到床边的现状。

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引用次数: 0

Genetic and epigenetic contributors and mimickers of phenotypic hypoxic-ischemic encephalopathy (HIE) 表现型缺氧缺血性脑病（HIE）的遗传和表观遗传因素和模拟因子。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152112

Ulrike Mietzsch , Janessa B. Law , Basel Thayyil , Danny E. Miller , Thomas R. Wood , Niranjana Natarajan , Khorshid Mohammad

Hypoxic-ischemic encephalopathy (HIE) remains one of the leading causes of neonatal morbidity and mortality despite advancement in care. Over 60 % of infants presenting with phenotypic HIE lack a clear identifiable acute sentinel event. Clinical genetic testing in neonates with suspected HIE has uncovered an increasing number of genetic conditions and epigenetic modifications that impair their ability to tolerate the stress of labor and delivery or exacerbate the severity of clinical symptoms following a hypoxic-ischemic insult. While most of those conditions are rare, many of the identified alterations involve common biological pathways and organ systems - particularly those affecting energy metabolism or the function of cells and organs of high energy demand such as brain, heart, and skeletal muscle - as well as genetic epilepsies. Here we provide an overview of the genetic makeup and epigenetic signatures associated with HIE and the insights they have provided into distinguishing genetic etiologies from true HIE. By outlining modern genetic testing modalities and their clinical applications, we provide a structured diagnostic approach for clinicians evaluating neonates with phenotypic HIE and highlight the clinical and therapeutic implications of early genetic diagnosis. This review underscores the critical importance of recognizing that HIE may not always represent a purely hypoxic-ischemic etiology, but rather a final common pathway influenced by underlying genetic predisposition and environmental factors that highlight the potential for precision medicine approaches to improve outcomes in this vulnerable population.

缺氧缺血性脑病（HIE）仍然是新生儿发病率和死亡率的主要原因之一，尽管护理进步。超过60%的婴儿表现为表现型HIE缺乏明确可识别的急性前哨事件。对疑似HIE新生儿的临床基因检测发现，越来越多的遗传条件和表观遗传修饰损害了他们耐受分娩和分娩压力的能力，或加剧了缺氧缺血性损伤后临床症状的严重程度。虽然这些情况大多罕见，但许多已确定的改变涉及常见的生物途径和器官系统-特别是那些影响能量代谢或高能量需求的细胞和器官（如大脑，心脏和骨骼肌）功能的改变-以及遗传性癫痫。在这里，我们概述了与HIE相关的遗传组成和表观遗传特征，以及它们为区分遗传病因和真正的HIE提供的见解。通过概述现代基因检测方式及其临床应用，我们为临床医生提供了一种结构化的诊断方法来评估表现型HIE新生儿，并强调早期基因诊断的临床和治疗意义。这篇综述强调了认识到HIE可能并不总是代表纯粹的缺氧缺血性病因的重要性，而是受潜在遗传易感性和环境因素影响的最终共同途径，这突出了精准医学方法改善这一弱势群体预后的潜力。

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引用次数: 0

The advantages and limitations of animal models for understanding acute neonatal brain injury 动物模型用于理解急性新生儿脑损伤的优势和局限性。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152129

Kelly Q. Zhou , Raymand Pang , Nicola J. Robertson , Justin M. Dean , Laura Bennet , Joanne O. Davidson , Alistair J. Gunn

Neonatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of death and disability around the world. Therapeutic hypothermia is now established to improve outcomes in term and near-term infants in high-income countries, but even in this setting, many infants still survive with disability. To further improve outcomes, experimental models are needed to test new interventions before clinical translation. In the present review, we discuss the strengths and weaknesses of a range of near-term and term models and their utility for understanding the pathophysiology of HIE and to test potential treatments. It is important to reflect that the strength of the evidence base for therapeutic hypothermia before it went to trial was that multiple groups using different and complementary models all showed benefit and that these models had been used to define the key parameters needed to achieve neuroprotection. We strongly advocate that this should be the expectation for all new neuroprotective interventions before large pragmatic randomized controlled trials are carried out.

新生儿缺氧缺血性脑病（HIE）仍然是世界各地死亡和残疾的主要原因。在高收入国家，治疗性低温疗法现已被用于改善足月婴儿和近期婴儿的预后，但即使在这种情况下，许多婴儿仍然存在残疾。为了进一步改善结果，在临床转化之前，需要实验模型来测试新的干预措施。在本综述中，我们讨论了一系列近期和长期模型的优缺点，以及它们在理解HIE病理生理学和测试潜在治疗方法方面的应用。重要的是要反映出，在进行试验之前，治疗性低温的证据基础的强度是，使用不同和互补模型的多个组都显示出益处，并且这些模型已用于定义实现神经保护所需的关键参数。我们强烈主张，在进行大规模实用的随机对照试验之前，这应该是对所有新的神经保护干预措施的期望。

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引用次数: 0

Neuroprotective therapies for neonatal hypoxic-ischemic brain injury – a contemporary update 新生儿缺氧缺血性脑损伤的神经保护疗法-当代更新。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152128

Hemmen Sabir

Neonatal encephalopathy of hypoxic-ischemic origin remains a leading cause of global neonatal mortality. Over the past decades, various neuroprotective strategies have been explored; however, therapeutic hypothermia remains the only clinically approved intervention to date. This review outlines emerging and adjunctive treatment modalities beyond therapeutic hypothermia and emphasizes the critical need for robust and reproducible translational research to bridge the gap between preclinical findings and clinical applications.

新生儿缺氧缺血性脑病仍然是全球新生儿死亡的主要原因。在过去的几十年里，人们探索了各种神经保护策略；然而，治疗性低温仍然是迄今为止唯一临床批准的干预措施。这篇综述概述了除治疗性低温之外的新兴和辅助治疗方式，并强调了对可靠和可重复的转化研究的迫切需要，以弥合临床前发现和临床应用之间的差距。

引用次数: 0

The role of sleep in neonatal neurocritical care and the influence on long-term outcome 睡眠在新生儿神经危重症护理中的作用及其对长期预后的影响。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152127

Leonie M. Paciello , Mirja Quante , Hendrik Rosewich , Renée A. Shellhaas

Prematurity, birth complications, and congenital brain abnormalities can lead to neurological conditions that require intensive monitoring and treatment. Ensuring healthy sleep is needed to help infants recover from these conditions and positively influence neurodevelopmental outcomes. Yet, achieving optimal sleep represents a challenge in the complex setting of neonatal neurocritical care.

In this narrative review, we examine the role of sleep within the context of neonatal neurocritical care. Specifically, we analyze the underlying physiological mechanisms of sleep and how these processes are altered by the intensive care environment and neurological pathology. We evaluate current evidence regarding the contribution of sleep to neurological recovery and its impact on long-term neurodevelopmental outcomes. Finally, we discuss existing and emerging strategies to monitor and optimize sleep in neonatal neurocritical care settings.

早产、出生并发症和先天性脑异常可导致需要密切监测和治疗的神经系统疾病。确保健康的睡眠是帮助婴儿从这些疾病中恢复并对神经发育结果产生积极影响的必要条件。然而，在新生儿神经危重症护理的复杂环境中，实现最佳睡眠是一项挑战。在这个叙述回顾，我们检查睡眠的新生儿神经危重症护理的背景下的作用。具体来说，我们分析了睡眠的潜在生理机制，以及这些过程如何被重症监护环境和神经病理学改变。我们评估了目前关于睡眠对神经恢复的贡献及其对长期神经发育结果的影响的证据。最后，我们讨论了现有的和新兴的策略来监测和优化新生儿神经危重症护理设置的睡眠。

引用次数: 0

Remote neonatal neurocritical care: from the bedside to the cloud 新生儿神经危重症远程护理：从床边到云端。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152124

Gabriel Fernando Todeschi Variane , Danieli Mayumi Kimura Leandro , Silvia Schoenau de Azevedo , Juliana Querino Teixeira , Marcelo Jenné Mimica

Neonatal neurocritical care (NNCC) has emerged as a specialized discipline to address the unique neurological needs of critically ill newborns. However, disparities in access to brain-focused expertise and neuromonitoring technologies remain a significant global challenge. Remote NNCC, supported by telemedicine and digital health tools, offers a promising approach to extend specialized neurological care beyond tertiary centers, particularly to underserved or resource-limited settings.

This review explores the current landscape, opportunities, and limitations of remote NNCC. Key applications include remote consulting and rounding, tele-interpretation of neurophysiological data, integration of multimodal monitoring, remote neuroimaging evaluation, and virtual neurological examinations. Additionally, telehealth platforms are increasingly used to support neurodevelopmental follow-up and therapeutic interventions after NICU discharge. These approaches can enhance diagnostic precision, enable timely intervention, reduce unnecessary transfers, and promote equity in care delivery.

Advancements in artificial intelligence, immersive reality, and digital twins modeling may further expand the capabilities of remote NNCC. These emerging technologies hold the potential to optimize real-time decision-making, personalize interventions, and foster large-scale collaboration through cloud-based data integration. However, significant barriers remain, including limitations in infrastructure, interoperability between systems, variability in training, and ethical concerns related to data privacy, algorithmic bias, and equitable access.

To ensure the safe and effective adoption of remote NNCC, standardized protocols, robust governance frameworks, and investments in workforce development and infrastructure are essential. Interdisciplinary collaboration and global partnerships will be critical in addressing these challenges and realizing the full potential of remote NNCC in improving neurological outcomes for high-risk neonates worldwide.

新生儿神经危重症护理（NNCC）已经成为一门专门的学科，以解决危重新生儿独特的神经学需求。然而，在获得以大脑为重点的专业知识和神经监测技术方面的差距仍然是一个重大的全球挑战。远程NNCC在远程医疗和数字卫生工具的支持下，提供了一种有希望的方法，将专业神经保健扩展到三级中心以外，特别是服务不足或资源有限的地区。这篇综述探讨了远程NNCC的现状、机遇和局限性。主要应用包括远程咨询和舍入、神经生理数据的远程解读、多模式监测的集成、远程神经成像评估和虚拟神经检查。此外，远程医疗平台越来越多地用于支持新生儿重症监护室出院后的神经发育随访和治疗干预。这些方法可以提高诊断准确性，实现及时干预，减少不必要的转移，并促进医疗服务的公平性。人工智能、沉浸式现实和数字双胞胎建模的进步可能会进一步扩展远程NNCC的功能。这些新兴技术具有优化实时决策、个性化干预以及通过基于云的数据集成促进大规模协作的潜力。然而，仍然存在重大障碍，包括基础设施的限制、系统之间的互操作性、培训的可变性以及与数据隐私、算法偏见和公平访问相关的道德问题。为了确保安全有效地采用远程NNCC，标准化协议、健全的治理框架以及对劳动力发展和基础设施的投资至关重要。跨学科合作和全球伙伴关系对于应对这些挑战和实现远程NNCC在改善全球高危新生儿神经预后方面的全部潜力至关重要。

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引用次数: 0

Leveraging neonatal neuroimaging for neuroprognostication in presumed hypoxic-ischemic encephalopathy: A framework for clinicians 利用新生儿神经影像学对假定的缺氧缺血性脑病的神经预后：临床医生的框架。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152126

Mehmet N. Cizmeci , Andrea van Steenis , Rhandi Christensen , Sylke Jeanne Steggerda , Linda S. de Vries

Brain magnetic resonance imaging (MRI) in neonates with presumed hypoxic-ischemic encephalopathy (HIE) offers a unique window into the extent and timing of injury, providing valuable insights for neuroprognostication. Brain MRI refines the prediction of functional outcomes, crucial for guiding family counseling and early interventions. The present article focuses on the role of post-rewarming brain MRI in this context, exploring specific MRI findings associated with diverse neurodevelopmental outcomes and highlights the potential of neuroimaging to improve the understanding and prediction of long-term functional outcomes. Utilizing a framework with likelihood categories, this work aims to enhance the accuracy of prediction of adverse outcomes within specific developmental domains, thereby refining neuroprognostication for informed discussions with caregivers.

新生儿缺氧缺血性脑病（HIE）的脑磁共振成像（MRI）为损伤的程度和时间提供了一个独特的窗口，为神经预后提供了有价值的见解。脑MRI改进了对功能结果的预测，对指导家庭咨询和早期干预至关重要。这篇文章的重点是在这种情况下重新加热后的脑MRI的作用，探索与不同神经发育结果相关的特定MRI结果，并强调神经成像在提高对长期功能结果的理解和预测方面的潜力。利用具有可能性分类的框架，这项工作旨在提高在特定发育领域预测不良结果的准确性，从而改进与护理人员进行知情讨论的神经预后。

引用次数: 0

Background EEG grading for the assessment of neonatal encephalopathy in full term neonates 背景：脑电图分级评估足月新生儿脑病。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-12-01 DOI: 10.1016/j.semperi.2025.152163

Aisling Fanning , Elisabetta Pegorer , Andreea M Pavel , Sean R Mathieson , Brian H Walsh , Geraldine B Boylan

Multichannel electroencephalography (EEG) is a well-established tool for detecting neonatal seizures and for the assessment of global brain function. Numerous classification and grading schemes for neonatal EEG in full term neonates have been proposed but no universally accepted framework exists, hindering international multicentre research and complicating clinical interpretation. This review summarises widely used classification schemes, compares their key features and argues for a consensus-based classification system.

多通道脑电图（EEG）是一种完善的工具，用于检测新生儿癫痫发作和评估整体脑功能。对于足月新生儿的脑电图，已经提出了许多分类和分级方案，但没有一个普遍接受的框架存在，这阻碍了国际多中心研究并使临床解释复杂化。本文总结了广泛使用的分类方案，比较了它们的主要特点，并提出了一个基于共识的分类系统。

引用次数: 0

Systems framework for post-hospital follow-up care of small and/or sick newborns: A pathway to sustainable and scalable quality care in low-resource, high-burden countries 小新生儿和/或患病新生儿院后随访护理系统框架：在资源低、负担高的国家实现可持续和可扩展的优质护理的途径。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-11-01 DOI: 10.1016/j.semperi.2025.152154

Samudragupta Bora

South Asian and Sub-Saharan African countries, disproportionately overrepresented in the World Bank’s low- and middle-income categories, bear a high burden of small and/or sick newborns. It is important to acknowledge that, in addition to reducing mortality, creating opportunities to enhance their health and well-being, thereby improving quality of life, is an essential metric for evaluating neonatal care success. With increased survival rates for small and/or sick newborns in most high-burden, resource-constrained settings, developing and strengthening specialized, structured neonatal follow-up programs to provide high-quality post-hospital care is imperative for optimizing outcomes and quality of life. This paper proposes a Systems Framework for Neonatal Follow-Up of small and/or sick newborns. While this framework applies to all settings, it is particularly pertinent in low-resource, high-burden countries, considering their unique contextual settings. This framework will provide a significant opportunity to foster meaningful engagement and partnership with a wide range of relevant local stakeholders, including families with small and/or sick newborns, as well as to identify areas for increased strategic investment. Furthermore, a multidimensional checklist aligned with the proposed framework provides a comprehensive tool for assessing neonatal follow-up readiness in health systems. The goal is to accelerate progress by transforming the delivery and accessibility of neonatal follow-up for small and/or sick newborns, thus improving the prospects for favorable long-term outcomes in this highly vulnerable population.

南亚和撒哈拉以南非洲国家在世界银行的低收入和中等收入类别中所占比例过高，因此承受着新生儿幼小和/或患病的沉重负担。必须承认，除了降低死亡率之外，创造机会增进他们的健康和福祉，从而改善生活质量，是评价新生儿护理成功与否的一个重要指标。在大多数高负担、资源受限的环境中，随着小新生儿和/或患病新生儿存活率的提高，制定和加强专业化、结构化的新生儿随访计划，以提供高质量的院后护理，对于优化结果和生活质量至关重要。本文提出了一个系统框架新生儿随访小和/或生病的新生儿。虽然这一框架适用于所有情况，但考虑到其独特的环境，它尤其适用于资源低、负担高的国家。该框架将提供一个重要机会，促进与广泛的相关地方利益攸关方（包括有小新生儿和/或患病新生儿的家庭）的有意义的参与和伙伴关系，并确定增加战略投资的领域。此外，与拟议框架相一致的多维检查表提供了评估卫生系统新生儿后续准备情况的综合工具。目标是通过改变新生儿的分娩方式和对小新生儿和/或患病新生儿随访的可及性来加速进展，从而改善这一高度脆弱人群获得良好长期结果的前景。

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引用次数: 0

Early detection of cerebral palsy in community settings: current state and a pathway forward 在社区环境中早期发现脑瘫：现状和未来的途径。

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology

Pub Date : 2025-11-01 DOI: 10.1016/j.semperi.2025.152147

Nathalie L. Maitre , Kanishka S. Baduni

We explore how and why early detection of cerebral palsy (CP) should occur in community settings across low and middle income countries (LMICs) and high income countries (HICs). Early diagnosis is best clinical practice and can happen in the first year of life using evidence-based tools such as the General Movements Assessment (GMA) and the Hammersmith Infant Neurological Examination (HINE). In HICs, primary care surveillance guided by published motor “red flags” can identify children who need prompt referral, yet uptake remains uneven. In LMICs, clinicians demonstrate high diagnostic accuracy when tools are available, but the main barrier is health system reach rather than clinical capability. Across settings, caregiver studies show that delayed diagnosis reduces empowerment, increases mental health burden, and erodes trust in services. The central implementation task is to build reliable pathways that connect families from home to timely diagnosis, aligning community surveillance with referral networks, provider training, and policy support. Strengthening these pathways is essential to improve participation, reduce comorbidity burden, and enhance wellbeing for children with CP and their families.

我们探讨了在中低收入国家（LMICs）和高收入国家（HICs）的社区环境中如何以及为什么应该早期发现脑瘫（CP）。早期诊断是最好的临床实践，可以在生命的第一年使用基于证据的工具，如一般运动评估（GMA）和哈默史密斯婴儿神经检查（HINE）。在高卫生保健国家，以公开的运动“危险信号”为指导的初级保健监测可以确定需要立即转诊的儿童，但接受情况仍然不均衡。在中低收入国家，当工具可用时，临床医生表现出较高的诊断准确性，但主要障碍是卫生系统的覆盖面，而不是临床能力。在各种情况下，对护理人员的研究表明，延迟诊断降低了赋权，增加了心理健康负担，并侵蚀了对服务的信任。实施的核心任务是建立可靠的途径，将家庭与及时诊断联系起来，使社区监测与转诊网络、提供者培训和政策支持保持一致。加强这些途径对于提高参与率、减少共病负担和提高CP儿童及其家庭的福祉至关重要。

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