Emma G Duerden1, Ruth E Grunau1, Vann Chau1, Floris Groenendaal1, Ting Guo1, M Mallar Chakravarty1, Manon Benders1, Nienke Wagenaar1, Rian Eijsermans1, Corine Koopman1, Anne Synnes1, Linda de Vries1, Steven P Miller2. 1. From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada. 2. From the Department of Paediatrics (E.G.D., V.C., T.G., S.P.M.), the Hospital for Sick Children and the University of Toronto; Faculty of Education (E.G.D.), Western University, London; Department of Pediatrics (R.E.G., A.S.), University of British Columbia, Vancouver, Canada; Department of Neonatology (F.G., M.B., N.W., C.K., L.d.V.), Utrecht Brain Center (F.G., M.B., L.d.V.), and Child Development and Exercise Center (R.E.), University Medical Center Utrecht, Utrecht University, the Netherlands; Cerebral Imaging Centre (M.M.C.), Douglas Institute, Verdun; and Departments of Psychiatry (M.M.C.) and Biological and Biomedical Engineering (M.M.C.), McGill University, Montreal, Canada. steven.miller@sickkids.ca.
Abstract
OBJECTIVE: To test the hypothesis that a strategy of prolonged arterial line (AL) and central venous line (CVL) use is associated with reduced neonatal invasive procedures and improved growth of the thalamus in extremely preterm neonates (<28 weeks' gestation). METHODS: Two international cohorts of very preterm neonates (n = 143) with prolonged (≥14 days) or restricted (<14 days) use of AL/CVL were scanned serially with MRI. General linear models were used to determine the association between skin breaks and thalamic volumes, accounting for clinical confounders and site differences. Children were assessed at preschool age on standardized tests of motor and cognitive function. Outcome scores were assessed in relation to neonatal thalamic growth. RESULTS: Prolonged AL/CVL use in neonates (n = 86) was associated with fewer skin breaks (median 34) during the hospital stay compared to restricted AL/CVL use (n = 57, median 91, 95% confidence interval [CI] 60.35-84.89). Neonates with prolonged AL/CVL use with fewer skin breaks had significantly larger thalamic volumes early in life compared to neonates with restricted line use (B = 121.8, p = 0.001, 95% CI 48.48-195.11). Neonatal thalamic growth predicted preschool-age cognitive (B = 0.001, 95% CI 0.0003-0.001, p = 0.002) and motor scores (B = 0.01, 95% CI 0.001-0.10, p = 0.02). Prolonged AL/CVL use was not associated with greater incidence of sepsis or multiple infections. CONCLUSIONS: Prolonged AL/CVL use in preterm neonates may provide an unprecedented opportunity to reduce invasive procedures in preterm neonates. Pain reduction in very preterm neonates is associated with optimal thalamic growth and neurodevelopment.
OBJECTIVE: To test the hypothesis that a strategy of prolonged arterial line (AL) and central venous line (CVL) use is associated with reduced neonatal invasive procedures and improved growth of the thalamus in extremely preterm neonates (<28 weeks' gestation). METHODS: Two international cohorts of very preterm neonates (n = 143) with prolonged (≥14 days) or restricted (<14 days) use of AL/CVL were scanned serially with MRI. General linear models were used to determine the association between skin breaks and thalamic volumes, accounting for clinical confounders and site differences. Children were assessed at preschool age on standardized tests of motor and cognitive function. Outcome scores were assessed in relation to neonatal thalamic growth. RESULTS: Prolonged AL/CVL use in neonates (n = 86) was associated with fewer skin breaks (median 34) during the hospital stay compared to restricted AL/CVL use (n = 57, median 91, 95% confidence interval [CI] 60.35-84.89). Neonates with prolonged AL/CVL use with fewer skin breaks had significantly larger thalamic volumes early in life compared to neonates with restricted line use (B = 121.8, p = 0.001, 95% CI 48.48-195.11). Neonatal thalamic growth predicted preschool-age cognitive (B = 0.001, 95% CI 0.0003-0.001, p = 0.002) and motor scores (B = 0.01, 95% CI 0.001-0.10, p = 0.02). Prolonged AL/CVL use was not associated with greater incidence of sepsis or multiple infections. CONCLUSIONS: Prolonged AL/CVL use in preterm neonates may provide an unprecedented opportunity to reduce invasive procedures in preterm neonates. Pain reduction in very preterm neonates is associated with optimal thalamic growth and neurodevelopment.
Authors: Nienke Wagenaar; Vann Chau; Floris Groenendaal; Karina J Kersbergen; Kenneth J Poskitt; Ruth E Grunau; Anne Synnes; Emma G Duerden; Linda S de Vries; Steven P Miller; Manon J N L Benders Journal: J Pediatr Date: 2017-01-04 Impact factor: 4.406
Authors: Juliane Schneider; Emma G Duerden; Ting Guo; Karin Ng; Patric Hagmann; Myriam Bickle Graz; Ruth E Grunau; M Mallar Chakravarty; Petra S Hüppi; Anita C Truttmann; Steven P Miller Journal: Pain Date: 2018-03 Impact factor: 6.961
Authors: Gillian C Smith; Jordan Gutovich; Christopher Smyser; Roberta Pineda; Carol Newnham; Tiong H Tjoeng; Claudine Vavasseur; Michael Wallendorf; Jeffrey Neil; Terrie Inder Journal: Ann Neurol Date: 2011-10-04 Impact factor: 10.422
Authors: Ting Guo; Julie L Winterburn; Jon Pipitone; Emma G Duerden; Min Tae M Park; Vann Chau; Kenneth J Poskitt; Ruth E Grunau; Anne Synnes; Steven P Miller; M Mallar Chakravarty Journal: Neuroimage Clin Date: 2015-08-24 Impact factor: 4.881
Authors: Christopher McPherson; Adam Frymoyer; Cynthia M Ortinau; Steven P Miller; Floris Groenendaal Journal: Semin Fetal Neonatal Med Date: 2021-06-23 Impact factor: 3.926