The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: Jan. 30, 2024

Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman’s health influence evaluations maternal-placental-fetal (MPF) triad, neonate, child. A dual cognitive process integrates “fast thinking-slow thinking” to reach shared that minimize bias maintain trust. Assessing science uncertainty with uncertainties in improves diagnostic choices across developmental-aging continuum. Three case vignettes highlight challenges illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended terminate her pregnancy based on an incorrect diagnosis encephalocele. meningocele was subsequently identified when she sought second opinion normal outcome for vignette two pregnancies during which fetal cardiac rhabdomyoma identified, suggesting tuberous sclerosis complex (TSC). One out-of-state termination without confirmation using brain MRI or postmortem examination. requested care postnatal evaluations. Her adult child experiences associated TSC sequelae. third prenatal open neural tube defect arthrogryposis multiplex congenita. family surgical closure at another institution their personal expense despite receiving grave prognosis. subsequent Management Myelomeningocele Study (MOMS) would not have procedure. Their requires medical global developmental delay, intractable epilepsy, autism. These three requiring clinical among all stakeholders. Falsely negative misleading positive interpretation results reduced chances optimal outcomes. FNN skills require understanding dynamic gene-environment interactions affecting reproductive followed exposomes MPF triad neuroplasticity consequences. Toxic stressor interplay can impair exposome, expressed as anomalous and/or destructive lesions. Functional improvements permanent sequelae may be lifespan. Equitable compassionate healthcare women families preserve health, guided person-specific racial-ethnic, religious, bio-social perspectives. Applying origins theory neurologic principles practice supports capital strategy persons each generation.

Language: Английский

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Particulate matter 2.5 (PM _2.5 ) - associated cognitive impairment and morbidity in humans and animal models: a systematic review

Journal of Toxicology and Environmental Health Part B, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 31

Published: Jan. 18, 2025

Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) is one the criteria air pollutants that (1) serve as essential carrier airborne toxicants arising from combustion-related events including emissions industries, automobiles, and wildfires (2) play important role in transient to long-lasting cognitive dysfunction well several other neurological disorders. A systematic review was conducted address differences study design various biochemical molecular markers employed elucidate disorders PM2.5 -exposed humans animal models. Out 340,068 scientific publications screened 7 databases, 312 studies were identified targeted relationship between exposure dysfunction. Equivocal evidence pre-clinical (animal model) human contributes dementia, Parkinson disease, multiple sclerosis, stroke, depression, autism spectrum disorder, attention deficit hyperactivity neurodevelopment. In addition, there substantial also associated Alzheimer's anxiety, neuropathy, brain tumors. The exposome characterizing neurobehavioral anomalies opportunities available leverage neuroexposome initiative for conducting longitudinal discussed. Our provided some areas warrant consideration, which unraveling microbiome, climate change exposure-induced

Language: Английский

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Season of conception and neurodevelopmental outcomes in singleton preterm infants less than 29 weeks gestation

Frontiers in Pediatrics, Journal Year: 2025, Volume and Issue: 13

Published: March 27, 2025

Background Environmental factors vary with the seasons and affect fetal development. Our objective was to assess impact of season conception on neurodevelopmental outcomes at 18–21 months corrected age in singleton infants <29 weeks’ gestation. Methods A retrospective cohort study born between 2006 2015 a tertiary-level neonatal intensive care unit conducted. The date calculated as birth minus gestational plus 14 days, dates were then divided into winter non-winter months. primary composite score <85 any cognitive, language, or motor components Bayley Scales Infant Toddler Development, 3rd edition (Bayley-III), age, scores individual components. Multivariate logistic regression used confounders. Results Of 493 eligible infants, 162 (32.8%) conceived winter. There no difference adjusted odds ratios (aORs) Bayley-III two groups. aORs cognitive language group significantly higher [2.78, 95% confidence interval (CI) 1.37–5.65 1.97, CI 1.07–3.62, respectively]. Conclusion Singleton gestation have worse outcomes. results need validation other larger cohorts.

Language: Английский

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Neonatal Encephalopathy is a Complex Phenotype Representing Reproductive and Pregnancy Exposome Effects on the Maternal-Placental-Fetal Triad

Clinics in Perinatology, Journal Year: 2024, Volume and Issue: 51(3), P. 535 - 550

Published: May 16, 2024

Language: Английский

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Greater Neighborhood Disadvantage Is Associated with Alterations in Fetal Functional Brain Network Structure

The Journal of Pediatrics, Journal Year: 2024, Volume and Issue: 274, P. 114201 - 114201

Published: July 18, 2024

Language: Английский

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Fetal-neonatal neurology principles and practice: Current curriculum development

Seminars in Fetal and Neonatal Medicine, Journal Year: 2024, Volume and Issue: 29(1), P. 101519 - 101519

Published: Feb. 1, 2024

Language: Английский

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We need a formal framework based on neuroscience for training in developmental neurology

Developmental Medicine & Child Neurology, Journal Year: 2024, Volume and Issue: 66(8), P. 962 - 963

Published: May 15, 2024

This editorial is linked to Letter the editor by Gogou on pages 1106–1107 of this issue.

Language: Английский

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Single-Base Gene Variants in MIR-146A and SCN1A Genes Related to the Epileptogenic Process in Drug-Responsive and Drug-Resistant Temporal Lobe Epilepsy—A Preliminary Study in a Brazilian Cohort Sample

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(11), P. 6005 - 6005

Published: May 30, 2024

The drug-resistant temporal lobe epilepsy (TLE) has recently been associated with single nucleotide variants (SNVs) in microRNA(miR)-146a (

Language: Английский

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Interdisciplinary fetal-neonatal neurology training improves brain health across the lifespan

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: July 4, 2024

Integrated fetal, neonatal, and pediatric training constitute an interdisciplinary fetal-neonatal neurology (FNN) program. A dynamic neural exposome concept strengthens curriculum content. Trainees participate in mentoring committee selection for guidance during a proposed two-year Prenatal to postnatal clinical learning re-enforces early toxic stressor interplay that influences gene-environment interactions. Maternal-placental-fetal triad, or childhood diseases require diagnostic therapeutic decisions the first 1,000 days when 80 % of connections contribute life-course phenotypic expression. Pediatric follow-up through 3 years adjusts gestational ages preterm survivors. Cumulative reproductive, pregnancy, adult effects educational experiences emphasize principle-to-practice approach brain capital strategy across lifespan. More rigorous rotations will be offered full time trainees. Adult residents, medical students, trainees from diverse disciplines learn essential topics time-limited rotations. Curriculum content periodic re-assessments using science standards maintain competence while promoting creative collaborative problem-solving. Continued career-long by FNN graduates strengthen shared healthcare all stakeholders. Recognition adaptive maladaptive neuroplasticity mechanisms requires analytic skills identify phenotypes associated with disease pathways. Developmental origins concepts health developmental-aging continuum, applicable research collaborations. Social determinants recognize diversity, equity, inclusion priorities each neurological intervention, particularly those challenged disparities. Diagnostic strategies must address resource challenges throughout Global South effectively lower worldwide burden neurologic disease. Sustainable development goals World Health Organization offer universally guidelines response ongoing global regional polycrises. Gender, race, ethnicity, socio-economic equality promote effective preventive, rescue reparative neuroprotective interventions. synergistic efforts can enhanced establishing leadership within academic teaching hubs assist structure smaller facilities community improve practice, education objectives. Reduced mortality improved quality life prioritize maternal-pediatric well-being sustain lifespan transgenerational benefits.

Language: Английский

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Neonatal encephalopathy multiorgan scoring systems: systematic review

Frontiers in Pediatrics, Journal Year: 2024, Volume and Issue: 12

Published: Oct. 1, 2024

Introduction Neonatal encephalopathy (NE) is a condition with multifactorial etiology that causes multiorgan injury to neonates. The severity of dysfunction (MOD) in NE varies, therapeutic hypothermia (TH) as the standard care. aim identify current approaches used assess and determine an optimum scoring system for MOD NE. Methods systematic review conformed Preferred Reporting Items Systematic Reviews Meta-Analyses (PRISMA) guidelines. An electronic search was conducted using PubMed, EMBASE, MEDLINE, Cochrane Central Register Controlled Trials, Scopus, CINAHL studies systems Results yielded 628 articles which 12 were included data extraction analysis. Five found positive correlation between MOD. There significant heterogeneity across systems, including eligibility criteria participants, methods assessing specific organ length follow-up, adverse outcomes. neurological, hepatic, cardiovascular, respiratory, hematological, renal most while gastrointestinal only three studies. definitions renal, respiratory consistent cardiovascular varied most. Discussion A should ideally include systems. Despite studies, these provide potential candidates standardization Validation needed parameters adequate follow-up beyond neonatal period. Additionally, evaluation may be affected by TH considering its effects.

Language: Английский

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