Neurologic outcomes of the premature lamb in an extrauterine environment for neonatal development

Neurologic injury remains the most important morbidity of prematurity. Those born at the earliest gestational ages can face a lifetime of major disability. Perinatal insults result in developmental delay, cerebral palsy, and other profound permanent neurologic impairments. The EXTracorporeal Environ...

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Bibliographic Details
Published in:Journal of pediatric surgery 2020-10, Vol.55 (10), p.2115-2123
Main Authors: McGovern, Patrick E., Hornick, Matthew A., Mejaddam, Ali Y., Lawrence, Kendall, Schupper, Alexander J., Rossidis, Avery C., Baumgarten, Heron, Vossough, Arastoo, Didier, Ryne A., Kim, Aimee, Partridge, Emily A., Hwang, Grace, Young, Kathleen, Peranteau, William H., Davey, Marcus G., Flake, Alan W.
Format: Article
Language:English
Subjects:
Animals
Animals, Newborn
Brain - diagnostic imaging
Brain - physiology
Fetus - physiology
Intensive Care, Neonatal - methods
Magnetic Resonance Imaging
Myelin Sheath - chemistry
Myelin Sheath - physiology
Neurologic injury
Premature Birth - therapy
Prematurity
Preterm birth
Sheep
Sheep, Domestic
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Summary:Neurologic injury remains the most important morbidity of prematurity. Those born at the earliest gestational ages can face a lifetime of major disability. Perinatal insults result in developmental delay, cerebral palsy, and other profound permanent neurologic impairments. The EXTracorporeal Environment for Neonatal Development (EXTEND) aims to transition premature neonates through this sensitive period, but it's impact on neurologic development requires analysis. Fetal sheep were maintained in a fluid-filled environment for up to 28 days. Physiologic parameters were measured continuously; tissues were subsequently fixed and preserved for myelin quantification, glial cell staining, and structural assessment via magnetic resonance. Surviving animals were functionally assessed. No evidence of fetal brain ischemia or white matter tract injury associated with the EXTEND system was detected, and the degree of myelination was regionally appropriate and consistent with age matched controls. No evidence of neurologic injury or immaturity was visible on magnetic resonance; animals that transitioned from the system had no persistent neurologic deficits. No evidence of major neurologic morbidity was found in animals supported on the EXTEND system, though more work needs to be done in order to verify its safety during critical periods of neurologic development.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2019.12.026