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Neonatal cranial ultrasound abnormalities: association with developmental delay at age one in low birth weight
A Whitaker1, J Johnson, S Sebris
1Division of Child Psychiatry, Columbia University College of Physicians and Surgeons, New York 10032.
Insights
Neonatal brain abnormalities detected by cranial ultrasound significantly increase the risk of severe developmental delay in low birth weight (LBW) infants. However, LBW infants with normal ultrasounds have a low risk of developmental issues.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging
Background:
- Low birth weight (LBW) infants are at increased risk for neurodevelopmental impairments.
- Neonatal cranial ultrasound is a key tool for assessing brain injury in LBW infants.
Purpose of the Study:
- To investigate the relationship between neonatal cranial ultrasound findings and cognitive development at one year in LBW infants.
- To determine if specific ultrasonographic abnormalities predict developmental outcomes.
Main Methods:
- Serial cranial ultrasounds were performed on 153 LBW infants.
- Cognitive development was assessed at one year using the Bayley Mental Development Index.
- Statistical analyses adjusted for birth weight, gestational age, head circumference, and social class.
Main Results:
- Infants with complex brain injury (persistent echogenicity, lucency, or ventricular enlargement) had significantly lower Mental Development Index scores.
- Nine of 11 infants with complex injury exhibited severe developmental delay, compared to 3/110 non-injured infants.
- Complex brain injury increased the likelihood of severe delay by 33 times, independent of other factors.
Conclusions:
- Neonatal brain injury identified via ultrasound is a strong predictor of severe developmental delay in LBW infants.
- The risk of severe delay in LBW infants is largely mediated through the development of ultrasonographic abnormalities.
- Very LBW infants with normal neonatal ultrasounds demonstrate a negligible risk for severe developmental delay at one year of age.
Abstract:
Relationships between abnormalities on neonatal serial cranial ultrasound and cognitive development at age one year were examined in 153 low birth weight (LBW) infants. Infants with complex injury (persistent parenchymal echogenicity, lucency, or persistent ventricular enlargement) scored significantly lower on the Bayley Mental Development Index than noninjured infants. Nine of 11 infants with complex injury had severe developmental delay in contrast to 3/110 of the noninjured. Adjusting for birth weight, gestational age, head circumference and social class, infants with complex injury were 33 times more likely to be severely delayed than noninjured infants. Risk for severe delay associated with LBW appeared to be indirect, through increased probability of ultrasonographic abnormality. The poorest developmental outcome was seen in infants with both complex perinatal brain injury and either very LBW or very young gestational age. However, very LBW infants with normal neonatal ultrasounds were at negligible risk for severe delay at age one.