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Diffusion tensor imaging in extremely low birth weight infants managed with hypercapnic vs. normocapnic ventilation.

Xiawei Ou1, Charles M Glasier, Raghu H Ramakrishnaiah

  • 1Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, ouxiawei@uams.edu.

Pediatric Radiology
|March 28, 2014
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Summary

Normocapnic ventilation may improve white matter development in extremely low birth weight (ELBW) infants compared to permissive hypercapnia. This subtle difference was not visible on conventional MRI but warrants further investigation in larger studies.

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Area of Science:

  • Neonatal neurology
  • Pediatric critical care
  • Neuroimaging

Background:

  • Permissive hypercapnia is used to prevent lung injury in extremely low birth weight (ELBW) infants.
  • High CO2 levels (hypercapnia) have been retrospectively linked to brain injury in ELBW infants.

Purpose of the Study:

  • To compare brain white matter development at term-equivalent age.
  • To assess ELBW infants randomized to hypercapnic versus normocapnic ventilation.
  • To compare with healthy, non-ventilated term newborns.

Main Methods:

  • Utilized magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI).
  • Analyzed white matter injury using conventional MRI and diffusion tensor imaging (DTI) fractional anisotropy (FA).
  • Employed tract-based spatial statistics (TBSS) for DTI analysis in 22 ELBW infants and 10 controls.

Main Results:

  • No significant difference in conventional MRI white matter scores between hypercapnic and normocapnic ELBW groups.
  • TBSS revealed more widespread regions of lower FA in hypercapnic ELBW infants compared to controls.
  • Normocapnic ELBW infants showed fewer and smaller regions of lower FA compared to controls.

Conclusions:

  • Normocapnic ventilation may be associated with improved white matter development in ELBW infants.
  • The observed effect on white matter development was subtle and not detected by conventional MRI.
  • Larger studies are needed to confirm if permissive hypercapnia negatively impacts white matter development in ELBW infants.