Seminars in Fetal & Neonatal Medicine最新文献

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Brain care bundles applied over each and successive generations 在每一代和连续几代人身上应用大脑护理捆绑包。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101558

Mark S. Scher , Susan Ludington , Valerie Smith , Stina Klemming , Betsy Pilon

Worldwide polycrises continue to challenge the World Health Organization's proposed 2030 sustainable development goals. Continuity of brain care bundles helps attain these goals by sustaining brain health over successive generations. Factors representing social drivers of health must incorporate transdisciplinary care into equitable intervention choices. Drivers are more effectively addressed by combining maternal and pediatric assessments to address morbidity and mortality across each lifespan. Care bundles comprise at least three evidenced-based interventions collectively implemented during a clinical experience to achieve a desired outcome. Synergy among stakeholders prioritize communication, responsibility, compliance and trust when choosing bundles in response to changing clinical conditions. A prenatal transdisciplinary model continues after birth with infant and family-centered developmental care practices through discharge to supplement essential skin-to-skin contact. Fetal-neonatal neurology training encourages participation in this model of brain health care to more effectively choose neurodiagnostic and neuroprotective options. Shared clinical decisions evaluate interventions from conception through the first 1000 days. At least eighty percent of brain connectivity will have been completed during this first critical/sensitive period of neuroplasticity. The developmental origins of health and disease concept offers neurology subspecialists a life-course perspective when choosing brain health strategies. Toxic stressor interplay from reproductive and pregnancy diseases and adversities potentially impairs embryonic, fetal and neonatal brain development. Continued exposures throughout maturation and aging worsen outcome risks, particularly during adolescence and reproductive senescence. Intragenerational and transgenerational use of care bundles will guide neuromonitoring and neuroprotection choices that strengthen preventive neurology strategies.

世界范围内的多重危机继续对世界卫生组织提出的 2030 年可持续发展目标构成挑战。持续性的脑护理捆绑服务有助于通过维持一代又一代人的脑健康来实现这些目标。健康的社会驱动因素必须将跨学科护理纳入公平的干预选择中。将孕产妇和儿科评估结合起来，更有效地应对各种驱动因素，以解决每个生命周期的发病率和死亡率问题。护理捆绑包括至少三种以证据为基础的干预措施，在临床实践中共同实施，以达到预期效果。在根据不断变化的临床条件选择护理包时，利益相关者之间的协同作用将优先考虑沟通、责任、合规性和信任。产前跨学科模式在婴儿出生后继续开展以婴儿和家庭为中心的发育护理实践，直至出院，以补充必要的肌肤接触。胎儿-新生儿神经病学培训鼓励参与这种脑健康护理模式，以便更有效地选择神经诊断和神经保护方案。共同临床决策可评估从受孕到出生后 1000 天内的干预措施。在神经可塑性的第一个关键/敏感时期，至少有 80% 的大脑连接已经完成。健康和疾病的发展起源概念为神经病学亚专科医生在选择大脑健康策略时提供了一个生命过程的视角。生殖和妊娠期疾病及逆境造成的有毒压力相互作用可能会损害胚胎、胎儿和新生儿的大脑发育。在整个成熟和衰老过程中持续暴露于有毒物质会使结果风险恶化，尤其是在青春期和生殖衰老期。代内和跨代使用护理捆绑将指导神经监测和神经保护的选择，从而加强预防性神经病学战略。

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引用次数: 0

A review of neurogenetics in fetal and neonatal clinical medicine 胎儿和新生儿临床医学中的神经遗传学回顾。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101550

Amitha L. Ananth , Michael A. Lopez

This review of neurogenetics serves as a primer for clinicians practicing in fetal-neonatal medicine. The review provides an update on neurogenetics, understanding the language of genetics, genetic testing approaches, and interpretation of genetic test results. Common examples of neurogenetic disease in fetal-neonatal medicine are used to enhance basic concepts. The results of genetic testing and their implications for patients and families are outlined. Genetics is becoming foundational to clinical practice across specialties. The advances are improving the speed of diagnosis, facilitating early treatments, and improving outcomes in neurogenetic disorders. A basic understanding of genetics is foundational to appropriate clinical-decision making and interpretation of those results to describe common fetal-neonatal neurological phenotypes.

这篇神经遗传学综述是胎儿-新生儿医学临床医生的入门读物。综述介绍了神经遗传学的最新进展、对遗传学语言的理解、基因检测方法以及基因检测结果的解读。通过胎儿-新生儿医学中神经遗传病的常见实例来强化基本概念。概述了基因检测的结果及其对患者和家属的影响。遗传学正在成为各专科临床实践的基础。这些进展提高了诊断速度，促进了早期治疗，并改善了神经遗传疾病的治疗效果。对遗传学的基本了解是做出适当临床决策和解释这些结果以描述常见胎儿-新生儿神经表型的基础。

引用次数: 0

Advances in prenatal surgical management of congenital aqueductal stenosis: A bench to bedside approach 先天性导水管狭窄产前手术治疗的进展：从工作台到床边的方法。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101540

Emrah Aydın, Soner Duru, Marc Oria, Jose L. Peiro

Congenital aqueduct stenosis AS is a significant cause of fetal obstructive hydrocephalus, characterized by the obliteration of the cerebral aqueduct, leading to cerebrospinal fluid (CSF) accumulation in the ventricular system and secondary brain damage and cerebral maldevelopment. This review explores the progression from basic science to clinical applications of antenatal surgical interventions for AS, emphasizing historical efforts, current research, and translational studies. Despite advances in prenatal imaging and genetic screening, challenges remain in achieving appropriate fetal candidates, consistent ventricular decompression, and standardized surgical protocols. This review highlights the need for further research and innovation to improve prenatal treatment and outcomes for AS-affected fetuses.

先天性导水管狭窄（AS）是导致胎儿梗阻性脑积水的重要原因，其特点是大脑导水管阻塞，导致脑脊液（CSF）在脑室系统积聚，继发脑损伤和脑发育不良。本综述探讨了产前手术干预治疗强直性脊柱炎从基础科学到临床应用的进展，强调了历史努力、当前研究和转化研究。尽管在产前成像和基因筛查方面取得了进展，但在实现合适的胎儿人选、一致的心室减压和标准化手术方案方面仍存在挑战。本综述强调了进一步研究和创新的必要性，以改善受强直性脊柱炎影响的胎儿的产前治疗和预后。

引用次数: 0

Cerebral palsy as a childhood-onset neurological disorder caused by both genetic and environmental factors 脑瘫是一种由遗传和环境因素引起的儿童期神经系统疾病。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101551

Nandini G. Sandran , Nadia Badawi , Jozef Gecz , Clare L. van Eyk

Cerebral palsy (CP) is a clinical term used to describe a spectrum of movement and posture disorders resulting from non-progressive disturbances in the developing fetal brain. The clinical diagnosis of CP does not include pathological or aetiological defining features, therefore both genetic and environmental causal pathways are encompassed under the CP diagnostic umbrella. In this review, we explore several genetic causal pathways, including both monogenic and polygenic risks, and present evidence supporting the multifactorial contributions to CP. Historically, CP has been associated with various risk factors such as pre-term birth, multiple gestation, intrauterine growth restriction (IUGR), maternal infection, and perinatal asphyxia. Thus, we also examine genetic predispositions that may contribute to these risk factors. Understanding the specific aetiology of CP enables more tailored treatments, especially with the increasing potential for early genetic testing.

脑性瘫痪（CP）是一个临床术语，用于描述胎儿大脑发育过程中出现的非进行性障碍所导致的一系列运动和姿势障碍。CP 的临床诊断并不包括病理学或病因学的定义特征，因此 CP 诊断的范围包括遗传和环境致病途径。在这篇综述中，我们探讨了几种遗传致病途径，包括单基因风险和多基因风险，并提出了支持多因素导致 CP 的证据。从历史上看，CP 与早产、多胎妊娠、宫内生长受限（IUGR）、母体感染和围产期窒息等各种风险因素有关。因此，我们还研究了可能导致这些风险因素的遗传倾向。了解了 CP 的具体病因，就能采取更有针对性的治疗措施，尤其是随着早期基因检测的潜力不断增加。

引用次数: 0

Neonatal tone management 新生儿音调管理。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101562

Roshirl Francisco , Stacey Hall , Geetanjali Rathore , Nivedita Thakur

Neonatal tone abnormalities can often be the first indication of cerebral palsy (CP) and need regular developmental assessments by a multidisciplinary team. The need for early diagnosis and treatment during the height of neural plasticity is crucial. Currently, the number of clinical practice guidelines and the quality of evidence for treatment of tone in neonates is insufficient. In this review, we discuss the physiology of tone abnormalities including structural-functional components of motor control and time-dependent etiology of injury. We provide a guideline for assessment of a neonate with concern for tone abnormalities including a discussion on available diagnostic and functionality rating scales. Lastly, we describe the importance of a multidisciplinary care team involving the patient's caregiver as well as non-pharmacological, pharmacological, and surgical treatment options for tone abnormalities. We stress the importance of regular, serial examinations for tone as these neonates get older to assess eligibility for additional interventions.

新生儿音调异常往往是脑瘫（CP）的首发症状，需要由多学科团队进行定期发育评估。在神经可塑性高峰期，早期诊断和治疗至关重要。目前，针对新生儿张力治疗的临床实践指南数量和证据质量都不足。在这篇综述中，我们讨论了张力异常的生理学，包括运动控制的结构-功能成分和损伤的时间依赖性病因。我们提供了新生儿张力异常评估指南，包括对现有诊断和功能评级量表的讨论。最后，我们介绍了多学科护理团队的重要性，其中包括患者的护理人员以及针对张力异常的非药物、药物和手术治疗方案。我们强调，随着这些新生儿年龄的增长，必须对其进行定期、连续的声调检查，以评估是否有资格采取额外的干预措施。

引用次数: 0

Preventive, rescue and reparative neuroprotective strategies for the fetus and neonate 胎儿和新生儿神经保护的预防、挽救和修复策略。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101542

Benjamin A. Lear, Kelly Q. Zhou, Simerdeep K. Dhillon, Christopher A. Lear, Laura Bennet, Alistair J. Gunn

Neonatal encephalopathy remains a major contributor to death and disability around the world. Acute hypoxia-ischaemia before, during or after birth creates a series of events that can lead to neonatal brain injury. Understanding the evolution of injury underpinned the development of therapeutic hypothermia. This review discusses the determinants of injury, including maturity, the pattern of exposure to HI, impaired placental function, often associated with fetal growth restriction and in the long-term, socio-economic deprivation. Chorioamnionitis has been associated with the presence of NE, but it is important to note that experimentally, inflammation can either sensitize to greater neural injury after HI or alleviate injury, depending on its precise timing. As fetal surveillance tools improve it is likely that improved detection of specific pathways will offer future opportunities for preventive and reparative interventions in utero and after birth.

新生儿脑病仍然是世界各地导致死亡和残疾的一个主要因素。出生前、出生时或出生后的急性缺氧缺血会引发一系列事件，导致新生儿脑损伤。了解损伤的演变过程是治疗性低温疗法发展的基础。这篇综述讨论了损伤的决定因素，包括成熟度、暴露于 HI 的模式、胎盘功能受损（通常与胎儿生长受限有关）以及长期的社会经济贫困。绒毛膜羊膜炎与 NE 的存在有关，但需要注意的是，在实验中，炎症既可以使 HI 后的神经损伤加剧，也可以减轻损伤，这取决于其发生的确切时间。随着胎儿监测工具的改进，对特定通路的检测可能会为宫内和出生后的预防和修复干预提供机会。

引用次数: 0

Fetal-neonatal neurology principles and practice: Future curriculum topics discussing neuromonitoring and neuroprotection 胎儿新生儿神经学原理与实践：讨论神经监测和神经保护的未来课程主题。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101554

Mark S. Scher

引用次数: 0

Providing pediatric neurocritical education across the ages: Bridging of neonatal neurocritical care into pediatric neurocritical care training 提供跨年龄段的儿科神经重症教育：将新生儿神经重症护理纳入儿科神经重症护理培训。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101552

Laura A. Caligiuri , Lauren Beslow , Andrea C. Pardo

Pediatric neurocritical care is a field dedicated to providing specialized assessment and care of critically-ill children with neurologic disease or at risk of neurologic compromise. Fellowship programs for providers interested in specializing in pediatric neurocritical care are growing and developing to meet the needs of trainees and the patient populations that they serve. Fetal and neonatal neurocritical care fellowship remains a separate opportunity for training; however, inclusion of fetal and neonatal neurology education into pediatric neurocritical care broadens understanding of normal and pathologic anatomy and physiology, diagnostic interpretation of the developing brain, targeted management interventions, family counseling and prognostication, and long-term optimization of outcomes. For instance, the care of neurologic injury in congenital heart disease emphasizes the incorporation of medical education across the lifespan. Additionally, neonates requiring NICU admission and care are more likely to require future PICU care and be served by neurocritical care providers. Furthermore, neonates with neurologic injury or at risk for neurologic injury are not exclusively admitted to neonatal units. Education across the age-spectrum inclusive of fetal and neonatal neurology is valuable for trainees in understanding underlying disease processes, management, and sequelae and promotes the growth of the field of pediatric neurocritical care.

儿科神经重症监护是一个专门为患有神经系统疾病或面临神经系统损伤风险的重症儿童提供专业评估和护理的领域。为有志于专攻儿科神经重症监护的医护人员提供的研究金计划正在不断发展壮大，以满足受训人员及其服务的患者群体的需求。胎儿和新生儿神经重症监护奖学金仍然是一个单独的培训机会；然而，将胎儿和新生儿神经病学教育纳入儿科神经重症监护中，可以拓宽对正常和病理解剖和生理学、发育中大脑的诊断解释、有针对性的管理干预、家庭咨询和预后以及长期疗效优化的理解。例如，先天性心脏病的神经损伤护理强调将医学教育贯穿于整个生命周期。此外，需要入住新生儿重症监护室（NICU）并接受护理的新生儿将来更有可能需要 PICU 护理，并由神经重症护理人员提供服务。此外，患有神经系统损伤或有神经系统损伤风险的新生儿并不只入住新生儿病房。包括胎儿和新生儿神经病学在内的跨年龄段教育对受训者了解潜在的疾病过程、管理和后遗症非常有价值，并能促进儿科神经重症监护领域的发展。

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引用次数: 0

Machine-learning based prediction of future outcome using multimodal MRI during early childhood 基于机器学习的幼儿期多模态磁共振成像未来结果预测。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101561

Minhui Ouyang , Matthew T. Whitehead , Sovesh Mohapatra , Tianjia Zhu , Hao Huang

The human brain undergoes rapid changes from the fetal stage to two years postnatally, during which proper structural and functional maturation lays the foundation for later cognitive and behavioral development. Multimodal magnetic resonance imaging (MRI) techniques, especially structural MRI (sMRI), diffusion MRI (dMRI), functional MRI (fMRI), and perfusion MRI (pMRI), provide unprecedented opportunities to non-invasively quantify these early brain changes at whole brain and regional levels. Each modality offers unique insights into the complex processes of both typical neurodevelopment and the pathological mechanisms underlying psychiatric and neurological disorders. Compared to a single modality, multimodal MRI enhances discriminative power and provides more comprehensive insights for understanding and improving neurodevelopmental and mental health outcomes, particularly in high-risk populations. Machine learning- and deep learning-based methods have demonstrated significant potential for predicting future outcomes using multimodal brain MRI acquired during early childhood. Here, we review the unique characteristics of various MRI techniques for imaging early brain development and describe the common approaches to analyze these modalities. We then discuss machine learning approaches in predicting future neurodevelopmental and clinical outcomes using multimodal MRI information during early childhood, highlighting the potential of identifying biomarkers for early detection and personalized interventions in atypical development.

人脑从胎儿阶段到出生后两年经历了快速变化，其间适当的结构和功能成熟为日后的认知和行为发展奠定了基础。多模态磁共振成像（MRI）技术，尤其是结构磁共振成像（sMRI）、弥散磁共振成像（dMRI）、功能磁共振成像（fMRI）和灌注磁共振成像（pMRI），为在全脑和区域层面无创量化这些早期大脑变化提供了前所未有的机会。每种模式都能为了解典型神经发育的复杂过程以及精神和神经疾病的病理机制提供独特的见解。与单一模式相比，多模式磁共振成像增强了鉴别力，为了解和改善神经发育和心理健康结果（尤其是高危人群）提供了更全面的见解。基于机器学习和深度学习的方法已证明，利用幼儿期获得的多模态脑磁共振成像预测未来结果具有巨大潜力。在此，我们回顾了用于早期大脑发育成像的各种 MRI 技术的独特性，并介绍了分析这些模式的常用方法。然后，我们讨论了利用幼儿期多模态磁共振成像信息预测未来神经发育和临床结果的机器学习方法，强调了识别生物标记物以用于早期检测和对非典型发育进行个性化干预的潜力。

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Brain health equity and the influence of social determinants across the life cycle 大脑健康公平性和整个生命周期中社会决定因素的影响。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101553

Ashley M. Bach , Mary Peeler , Michelle Caunca , Bolajoko O. Olusanya , Nicole Rosendale , Dawn Gano

Social determinants of health are social, economic and environmental factors known to influence health and development of infants, children and adults. Advancing equity in brain health relies upon interdisciplinary collaboration and recognition of the impact of social determinants on brain health through the lifespan and across generations. Critical periods of fetal, infant and early childhood development encompass intrinsic genetic and extrinsic environmental influences with complex gene-environment interactions. This review discusses the influence of social determinants on the continuum of brain health from preconception and pregnancy health, through fetal, infant and childhood neurodevelopment into adulthood. Opportunities for intervention to address the social determinants of brain health across the life cycle are highlighted.

健康的社会决定因素是已知的影响婴儿、儿童和成人健康和发展的社会、经济和环境因素。促进脑健康的公平有赖于跨学科合作，以及认识到社会决定因素对整个生命周期和各代人的脑健康的影响。胎儿、婴儿和幼儿发育的关键时期包括内在遗传和外在环境影响，以及复杂的基因-环境相互作用。本综述讨论了从孕前和孕期健康，到胎儿、婴儿和儿童期神经发育，直至成年期，社会决定因素对大脑健康连续性的影响。重点介绍了在整个生命周期中针对大脑健康的社会决定因素进行干预的机会。

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