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Brain lesions in preterms: origin, consequences and compensation
I Krägeloh-Mann1, P Toft, J Lunding
1Department of Child Neurology, Children's Hospital University of Tübingen, Germany.
Insights
Neonatal hypoxia-ischemia is linked to brain abnormalities in high-risk preterm children. Magnetic resonance imaging (MRI) revealed periventricular lesions and cerebellar atrophy correlating with disabilities.
Area of Science:
- Neuroscience
- Pediatrics
- Radiology
Background:
- High-risk preterm infants face neurological challenges.
- Cerebral blood flow (CBF) in early life may predict later outcomes.
- Periventricular leucomalacia (PVL) is a common brain injury in preterm infants.
Purpose of the Study:
- To investigate the relationship between early CBF, neonatal hypoxia-ischemia, and neurodevelopmental outcomes in high-risk preterm children.
- To identify specific brain structural correlates of neurological and neuropsychological deficits using MRI.
- To compare neurological and neuropsychological assessments with control children.
Main Methods:
- Prospective follow-up of 29 high-risk preterm children at 5.5-7 years.
- Neurological, neuropsychological, and MRI assessments.
- Comparison with 57 control children.
Main Results:
- Abnormal MRI findings in 19/29 preterm children.
- Neonatal hypoxia-ischemia identified in 63% of those with abnormal MRI vs. 12.5% with normal MRI.
- MRI abnormalities included periventricular lesions (PVL) and cerebellar atrophy, correlating with spastic cerebral palsy, intellectual disability, and visual impairment.
- Attention deficit hyperactivity disorder symptoms linked to mild MRI abnormalities.
Conclusions:
- Neonatal hypoxia-ischemia is a significant factor in brain abnormalities and long-term disabilities in preterm children.
- Specific MRI findings correlate with major neurodevelopmental deficits.
- Mild or unilateral lesions may be compensated, but other chronic factors may also influence cognitive function, as evidenced by lower IQ in preterm children compared to controls.
Abstract:
Twenty-nine high-risk preterm born children, from a cohort with cerebral blood flow (CBF) measurements in the first 2 d of life, were examined prospectively at the age of 5.5-7 y neurologically, neuropsychologically and by magnetic resonance imaging (MRI). They were compared to 57 control children in terms of neurology and neuropsychology. Abnormal MRI was found in 19 children. Low oxygen delivery to the brain was found in 63% of them, in contrast to 12.5% in those with normal MRI, indicating neonatal hypoxia-ischemia as an important factor. The MRI abnormalities were mainly periventricular lesions (n = 19), especially periventricular leucomalacia (PVL, n = 17). Three of the very preterm children had severe cerebellar atrophy in addition to relatively mild periventricular abnormalities. MRI showed specific morphological correlates for the major disabilities, e.g. spastic CP (involvement of motor tracts), mental retardation (bilateral extensive white matter reduction or cerebellar atrophy) and severe visual impairment (severe optic radiation involvement). A morphological correlate for minor disabilities, i.e. functional variations in motor performance or intelligence, was not found, with the exception that symptoms of attention deficit hyperactivity disorder were related to mild MRI abnormalities. This could mean that with respect to cognitive functions, mild or unilateral periventricular MRI lesions could be compensated. However, as among preterms without mental retardation (n = 19), IQ was generally and significantly lower than in the control group; other, more chronic pathogenetic factors, not detectable by MRI alone, may play a role.