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Updated: Jul 4, 2026
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Head growth in preterm infants: correlation with magnetic resonance imaging and neurodevelopmental outcome
Jeanie L Y Cheong1, Rod W Hunt, Peter J Anderson
1Royal Women's Hospital, Department of Neonatal Services, 132 Grattan St, Carlton 3053, Melbourne, Australia. jeanie.cheong@rwh.org.au
Insights
Head size in preterm infants is linked to brain volume at term. Poor head growth by age two correlates with developmental delays and cerebral palsy, indicating selective vulnerability in deep nuclear gray matter.
Area of Science:
- Neuroscience
- Pediatrics
- Radiology
Background:
- Extremely preterm birth poses risks for neurodevelopmental issues.
- Head circumference is a common proxy for brain growth.
- Limited data exists on the relationship between head circumference and MRI findings in preterm infants.
Purpose of the Study:
- To determine the association between head circumference and brain MRI at term-equivalent age.
- To investigate the link between head circumference and neurodevelopmental outcomes at two years corrected age.
Main Methods:
- 227 preterm infants (<1250g or <30 weeks gestation) were studied.
- Head circumference was measured at birth, term, and 2 years; microcephaly defined as z-score <-2.
- MRI scans at term assessed white/gray matter abnormalities and tissue volumes; neurodevelopment evaluated using Bayley Scales at 2 years.
Main Results:
- Microcephaly prevalence increased from 7.5% at term to 29.7% at 2 years.
- Head circumference strongly correlated with brain volume at term but not with white/gray matter abnormalities.
- Microcephalic infants at term had reduced brain tissue volumes, particularly deep nuclear gray matter, even after adjusting for intracranial volume.
Conclusions:
- Brain volume is a key factor in head size at term in preterm infants.
- Microcephaly in preterm infants is linked to reduced brain tissue volumes, suggesting selective vulnerability of deep nuclear gray matter.
- Delayed postnatal head growth in preterm infants by age two is significantly associated with adverse neurodevelopmental outcomes, including cerebral palsy.
Objective:
Extremely preterm birth is associated with adverse neurodevelopmental sequelae. Head circumference has been used as a measure of brain growth. There are limited data relating head circumference to MRI. The purpose of this work was to establish the relationship between head circumference with brain MRI at term-equivalent age and to relate head circumference with neurodevelopmental outcome at 2 years.
Patients And Methods:
Two hundred and twenty-seven preterm infants (birth weight of <1250 g or <30 weeks' gestation) were recruited. Head circumference was measured at birth, term, and 2 years' corrected age, and z scores were computed. Microcephaly was defined as a head circumference z score of less than -2 SDs for age and gender. MRI scans at term (n = 214) were graded for white and gray matter abnormalities, and segmented volumes were calculated for different tissue types. Outcome at 2 years' corrected age (n = 202) included scores on the Bayley Scales of Infant Development II.
Results:
Microcephaly increased from 7.5% at term to 29.7% at 2 years. There was no significant relationship between head circumference and white or gray matter abnormalities on MRI. There was a strong correlation between head circumference and brain volume at term. At term, microcephalic infants had significantly decreased volumes for total brain tissue and most segmented volumes compared with infants with normal head circumference, but only deep nuclear gray matter volume remained significantly lower when adjusted for total intracranial volume. At 2 years, microcephaly was associated with poorer cognitive and motor development and an increased rate of cerebral palsy.
Conclusions:
Brain volume is a determinant of head size at term. Microcephaly is associated with a reduction of brain tissue volumes, especially deep nuclear gray matter, which suggests a selective vulnerability. Poor postnatal head growth in preterm infants becomes more evident by 2 years and is strongly associated with poor neurodevelopmental outcome and cerebral palsy.
