Hellevi Rikalainen

Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia.

Objective. The aim of this study was to investigate sequential neuroradiologic changes in the brains of infants after transient neonatal hypoglycemia. We used magnetic resonance imaging (MRI) and ultrasonography (US) head scans. Methods. Eighteen symptomatic full-term infants whose serum glucose concentrations were ≤45 mg/dL (2.5 mmol/L) without any other diseases were included in the hypoglycemic group. MRI and US head scans were performed at full-term age and at the age of 2 months. The imaging results were compared with the findings of MRI and US scans in 19 healthy normoglycemic term newborn infants at the respective ages. The neurologic outcome was followed in the both groups. Results. MRI or US showed evidence of abnormality in 39% the hypoglycemic infants. MRI detected more abnormalities in the brains than US. Four infants showed patchy hyperintensity lesions either in the occipital periventicular white matter or the thalamus on T1-weighted images. These lesions had a good tendency to recover and only 1 of these infants appeared to be neurologically affected. Of the 19 controls, 10% (2 of 19) had caudothalamic cysts, which were detected both with MRI and US. The relative risk of the hypoglycemic child compared with nonhypoglycemic child, to have any abnormality detected in the brain, was 3.7, with a 90% confidence interval from 1.11 to 12.28. Conclusions. Postnatal full-term MRI and US scans showed abnormalities four times more often after transient neonatal hypoglycemia than in the healthy control group. However, most often lesions were absent 2 months later. The clinical relevance of these abnormal findings remains to be clarified with detailed neurologic examinations and follow-up.

Radiological parameters of the bony nasopharynx and the adenotonsillar size compared with sleep apnea episodes in children

The role of enlarged adenoids and tonsils in recurrent respiratory infections and upper airway obstruction has become well-established earlier. In this study we investigated the relationship between the X-ray properties of the nasopharynx and the sleep quality by using a new sleep registration method: The Static Charge Sensitive Bed (SCSB). The estimation of the bony nasopharyngeal dimensions, the measurement of adenotonsillar volume and the sleep recordings were performed as adenoidectomy, tonsillectomy or adenotonsillectomy in hospitalized children. A surprisingly high frequency of sleep apnea episodes was found in sleep recordings of about 8 h. No correlations could be established between the X-ray anatomical estimates and sleep apnea episodes.

Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006.

Aim:  To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data.

Does Placental Inflammation Relate to Brain Lesions and Volume in Preterm Infants

OBJECTIVES To evaluate the association between histologic inflammation of placenta and brain findings in ultrasound examinations and regional brain volumes in magnetic resonance imaging in very-low-birth-weight (VLBW) or in very preterm infants. STUDY DESIGN VLBW or very preterm infants (n = 121) were categorized into 3 groups according to the most pathologic brain finding on ultrasound examinations until term. The brain magnetic resonance imaging performed at term was analyzed for regional brain volumes. The placentas were analyzed for histologic inflammatory findings. RESULTS Histologic chorioamnionitis on the fetal side correlated to brain lesions in univariate but not in multivariate analyses. Low gestational age was the only significant risk factor for brain lesions in multivariate analysis (P < .0001). Histologic chorioamnionitis was not associated with brain volumes in multivariate analyses. Female sex, low gestational age, and low birth weight z score correlated to smaller volumes in total brain tissue (P = .001, P = .0002, P < .0001, respectively) and cerebellum (P = .047, P = .003, P = .001, respectively). In addition, low gestational age and low-birth-weight z score correlated to a smaller combined volume of basal ganglia and thalami (P = .0002). CONCLUSIONS Placental inflammation does not appear to correlate to brain lesions or smaller regional brain volumes in VLBW or in very preterm infants at term age.

Brain and Ventricles in Very Low Birth Weight Infants at Term: A Comparison Among Head Circumference, Ultrasound, and Magnetic Resonance Imaging

OBJECTIVES. The aim of this study was to assess the relationship among the size of the lateral ventricles, head-circumference measure, and brain volumes. In addition, the association between ventricular dilatation and various brain lesions was defined. PATIENTS AND METHODS. A total of 257 preterm very low birth weight (≤1500 g) infants who met the inclusion criteria were born in Turku University Central Hospital between 2001 and 2006. A total of 209 (84.8%) of 218 survivors participated in the study. The measurements at term included the ventricular brain ratio, the widths of the frontal and occipital horns of the lateral ventricles by ultrasound, total and regional brain volumes by MRI, and head circumference. Brain lesions were defined by ultrasound at 3 to 5, 7 to 10, and 30 days of age monthly until discharge and by MRI and ultrasound at term. RESULTS. An abnormal ventricular brain ratio (>0.35), an increasing number of dilated ventricular horns, and smaller head circumference were significantly associated with smaller total brain tissue volume. The abnormal ventricular brain ratio and the increasing number of dilated ventricular horns in ultrasound associated with larger ventricular volumes in MRI, and a smaller head circumference was associated significantly with reduced regional brain tissue volumes. Brain lesions were more common in infants with ventriculomegaly. CONCLUSIONS. The ventricular brain ratio, widths of the lateral ventricular horns, and head circumference are appropriate measures for the estimation of both total and regional brain tissue volumes. Ventriculomegaly is strongly associated with brain lesions.

Ventricular dilatation in relation to outcome at 2 years of age in very preterm infants: a prospective Finnish cohort study.

Aim  The aim of this study was to analyse the relation between ventricular dilatation at term and neurodevelopmental outcome at 2 years corrected age in infants of very low birthweight (VLBW) or very low gestational age (VLGA).

Relation of prematurity and brain injury to crying behavior in infancy.

OBJECTIVES. The objective of this study was to assess crying behavior during infancy in very preterm infants with or without brain injury. METHODS. A total of 125 very low birth weight infants survived during January 2001 to July 2004 in Turku University Hospital, Finland. They were categorized according to the most pathologic brain finding either in ultrasound or MRI. Baby Day Diary was used to assess crying behavior at term, 6 weeks, and 5 months of corrected age. The behavior of a group of term control infants (n = 49) was assessed at 5 months. RESULTS. Severe brain injuries in very low birth weight infants did not affect the duration of fussing or crying. In very low birth weight infants, brain injuries did not affect the frequency of fussing or crying bouts or the development of circadian rhythm in crying behavior. At 5 months of corrected age, fussing bouts were more frequent in very low birth weight infants compared with term control infants (6.4 per day vs 4.5 per day), and very low birth weight infants were held more (169 minutes [97] vs 130 minutes [69], respectively). CONCLUSIONS. This prospective study using a validated cry diary showed that brain injuries that are related to prematurity do not have major effects on crying behavior or development of circadian rhythm. Prematurity does not increase the duration but increases the frequency of fussing and crying at 5 months of corrected age compared with term control infants. It also seems that prematurity and brain pathology may increase caregiving activity in the form of holding.

Apolipoprotein E, brain injury and neurodevelopmental outcome of children.

Apolipoprotein E plays an important role in neurodegenerative processes in adulthood, whereas its neurodevelopmental role is uncertain. We aimed to study the effect of apolipoprotein E on neurodevelopment in a cohort liable to neurodevelopmental changes. The cohort consisted of very preterm (<32 gestational weeks) and/or very low birth weight (<1500 g) children, and the longitudinal follow-up protocol included sequential cranial ultrasounds during infancy, brain magnetic resonance imaging at term-equivalent age, neurological and cognitive assessment (Mental Developmental Index) at the corrected age of 2 years and cognitive and neuropsychological assessments (Wechsler Preschool and Primary Scale of Intelligence and Developmental NEuroPSYchological Assessment) at the chronological age of 5 years. Apolipoprotein E genotypes were determined from 322 children. Ultrasound and magnetic resonance imaging data were available for 321 (99.7%) and 151 (46.9%) children, respectively. Neurodevelopmental assessment data were available for 138 (42.9%) to 171 (53.1%) children. Abnormal findings in ultrasounds and magnetic resonance imaging were found in 163 (50.8%) and 64 (42.4%) children, respectively. Mild cognitive delay at the corrected age of 2 years and the chronological age of 5 years was suspected in 21 (12.3%) of 171 and 19 (13.8%) of 138 children, respectively. In the Developmental NEuroPSYchological Assessment, 47 (32.6%) of 144 children had significantly impaired performances in more than one study subtest. No associations between the apolipoprotein E genotypes and imaging findings or measured neurodevelopmental variables were found. Apolipoprotein E genotypes do not appear to have major impact on brain vulnerability or neurodevelopment in children.

Coincidental Radiographic Findings in Severe External Otitis in Nonimmunocompromised Patients

We present the cases of 3 previously healthy patients who became ill with a very sudden and painful external otitis due to Pseudomonas aeruginosa. At the acute stage, diagnosis was difficult in all these patients because of marked periauricular swelling and radiological mastoiditis. The latter sign has not been reported earlier in association with external otitis in nonimmunocompromised patients. All patients made a full recovery with appropriate treatment.