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Published on: November 20, 2015
Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely
Ulana Pogribna1, Xintian Yu, Katrina Burson
1Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, Texas, USA.
Insights
Perinatal factors like chorioamnionitis and mechanical ventilation are linked to white matter abnormalities in extremely preterm infants. Antenatal steroids and human milk use show protective effects on brain development.
Area of Science:
- Neonatal neuroscience
- Developmental neurobiology
- Medical imaging
Background:
- Extremely preterm infants face significant risks of brain injury and developmental impairments.
- White matter microstructural abnormalities are a common consequence of preterm birth.
- Identifying perinatal antecedents is crucial for targeted interventions.
Purpose of the Study:
- To identify perinatal clinical factors associated with white matter microstructural abnormalities in extremely preterm infants.
- To investigate the relationship between specific clinical exposures and brain development in this vulnerable population.
Main Methods:
- A prospective cohort study comparing extremely preterm infants (N=86) with healthy term controls (N=16).
- Diffusion tensor imaging (DTI) was used at term equivalent age to assess white matter microstructure (fractional anisotropy, mean diffusivity).
- Multivariable linear regression analyzed associations between clinical factors and microstructural abnormalities.
Main Results:
- Preterm infants showed widespread white matter microstructural abnormalities compared to controls.
- Adverse factors included chorioamnionitis, necrotizing enterocolitis, white matter injury on ultrasound, and prolonged mechanical ventilation.
- Favorable factors included antenatal steroids, female sex, caffeine therapy, and human milk use.
Conclusions:
- Diffusion tensor imaging effectively detects delayed maturation and brain damage in extremely preterm infants.
- Clinical factors such as antenatal steroids and human milk use positively influence brain development.
- This study identified key perinatal antecedents of brain injury and neurodevelopmental impairments.
Objective:
To identify perinatal clinical antecedents of white matter microstructural abnormalities in extremely preterm infants.
Methods:
A prospective cohort of extremely preterm infants (N = 86) and healthy term controls (N = 16) underwent diffusion tensor imaging (DTI) at term equivalent age. Region of interest-based measures of white matter microstructure - fractional anisotropy and mean diffusivity - were quantified in seven vulnerable cerebral regions and group differences assessed. In the preterm cohort, multivariable linear regression analyses were conducted to identify independent clinical factors associated with microstructural abnormalities.
Results:
Preterm infants had a mean (standard deviation) gestational age of 26.1 (1.7) weeks and birth weight of 824 (182) grams. Compared to term controls, the preterm cohort exhibited widespread microstructural abnormalities in 9 of 14 regional measures. Chorioamnionitis, necrotizing enterocolitis, white matter injury on cranial ultrasound, and increasing duration of mechanical ventilation were adversely correlated with regional microstructure. Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors. White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.
Conclusions:
Diffusion tensor imaging is sensitive in detecting the widespread cerebral delayed maturation and/or damage increasingly observed in extremely preterm infants. In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.
