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Tractography-based quantitation of corticospinal tract development in premature newborns
Elysia Adams1, Vann Chau1, Kenneth J Poskitt2
1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Early brain injury and neonatal infection impair corticospinal tract (CST) development in premature infants. Diffusion tensor imaging reveals slower microstructural development in these vulnerable newborns.
Area of Science:
- Neonatal neurology
- Neurodevelopmental imaging
- Pediatric neurosurgery
Background:
- Premature birth poses risks for neonatal brain injury.
- Corticospinal tract (CST) development is crucial for motor function.
- Understanding early injury impacts on CST is vital for intervention.
Purpose of the Study:
- To assess how early brain injury and illness affect CST development in premature infants.
- To use diffusion tensor tractography (DTT) for serial evaluation.
Main Methods:
- Fifty-five premature newborns underwent serial MRI scans.
- Diffusion tensor tractography measured CST microstructural parameters (FA, Dav).
- Multivariate regression analyzed the impact of brain abnormalities and infection.
Main Results:
- Abnormal MRI findings were present in 38% of newborns.
- Newborns with brain abnormalities showed slower FA increase and higher Dav.
- Postnatal infection was associated with slower FA increase, independent of MRI findings.
Conclusions:
- Early brain injury and postnatal infection significantly impair CST microstructural development.
- Diffusion changes suggest impaired glial cell development in affected infants.
- Serial DTT can identify developmental deficits in high-risk neonates.
Objective:
To evaluate the impact of early brain injury and neonatal illness on corticospinal tract (CST) development in premature newborns serially studied with diffusion tensor tractography.
Study Design:
Fifty-five premature newborns (median 27.6 weeks postmenstrual age) were scanned with magnetic resonance imaging (MRI) early in life and at term-equivalent age. Moderate-severe brain abnormalities (abnormal-MRI) were characterized by moderate-severe white matter injury or ventriculomegaly. Diffusion tensor tractography was used to measure CST diffusion parameters which reflect microstructural development: fractional anisotropy (FA) and average diffusivity (D(av)). The effect of abnormal-MRI and neonatal illness on FA and D(av) were assessed with multivariate regression for repeated measures adjusting for age at scan.
Results:
Twenty-one newborns (38%) had abnormal-MRI on either scan. FA increased with age significantly slower in newborns with abnormal-MRI (0.008/week) relative to newborns without these MRI abnormalities (0.011/wk) (interaction term P = .05). D(av) was higher in newborns with abnormal-MRI (1.5 x 10(-5) mm(2)/sec; P < .001) for any given age at scan. In the 23 newborns (42%) with postnatal infection, FA increased more slowly (interaction term P = .04), even when adjusting for the presence of abnormal-MRI.
Conclusions:
CST microstructural development is significantly impaired in premature newborns with abnormal-MRI or postnatal infection, with a pattern of diffusion changes suggesting impaired glial cell development.
