Brain Injury and Pain Exposure are Associated with Alterations in Structural Connectivity and Neurodevelopment in Very Preterm Infants
Notice bibliographique
Résumé
Preterm infants undergo neonatal intensive care during a period of maturation of structural brain networks, which may be affected by clinical illness and exposures such as brain injury and pain. This thesis explores (1) the impacts of brain injury and pain on development of structural connectivity and neurodevelopmental outcomes, and (2) whether aberrations in structural connectivity are an important mediator of outcomes. A prospective cohort of very preterm infants underwent early-life and term-equivalent age brain MRI to assess brain injury and structural connectivity. Exposure to pain was quantified as number of invasive procedures. Neurodevelopmental outcomes were assessed at 18 months corrected age with the Bayley Scales of Infant and Toddler Development, Third edition. Brain injuries were segmented to quantify volumes and develop voxel-wise lesion-symptom maps to assess relationships between brain injury size and location with neurodevelopmental outcomes. These data were combined with data of structural connectivity to develop voxel-wise disconnection-symptom maps that assessed relationships between brain injury size and location with aberrations in structural connectivity and neurodevelopmental outcomes. These maps revealed that brain injury involving tracts passing through the basal ganglia, thalamus and pons were associated with poorer neurodevelopmental outcomes. This highlights the importance of considering brain injury relative to white matter tracts when predicting neurodevelopmental outcomes. Greater early-life pain was associated with poorer neurodevelopmental outcomes, and potentially mediated by alterations in neonatal structural connectivity. Specifically, greater invasive procedures were associated with widespread reductions in structural brain connectivity, and reduced connectivity was associated with poorer neurodevelopmental outcomes with specificity for the striatum. The relationship between greater early-life pain and adverse neurodevelopmental outcomes was modified by duration of morphine exposure. However, morphine exposure was not associated with neonatal structural connectivity suggesting that morphine may modify neurodevelopmental outcomes through alternative mechanisms. Finally, associations observed between pain and brain injury, aberrant connectivity within the striatum, and neurodevelopmental outcomes highlight a potential vulnerability of this region to clinical illness and exposures during early brain development in very preterm infants. These data also suggest that the striatum may play an important role in neurodevelopment in this population; this warrants further study.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».