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Neuroimaging and neurodevelopmental outcome in extremely preterm infants
Susan R Hintz1, Patrick D Barnes2, Dorothy Bulas3
1Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; srhintz@stanford.edu.
Pediatrics
|January 3, 2015
Summary
Near-term brain MRI and late cranial ultrasound (CUS) better predict neurodevelopmental impairment (NDI) in extremely preterm infants than early CUS. MRI cerebellar lesions and WMA, and late CUS findings are key indicators of adverse outcomes.
Area of Science:
- Neonatal neurology
- Neurodevelopmental outcomes
- Medical imaging in neonates
Background:
- Extremely preterm infants face high risks of neurodevelopmental impairment (NDI).
- Cranial ultrasound (CUS) is standard, but near-term brain MRI shows promise for predicting outcomes.
- This study evaluates MRI white matter abnormality (WMA) and cerebellar lesions, alongside serial CUS findings, as predictors of NDI.
Purpose of the Study:
- To compare the predictive value of near-term brain MRI and serial CUS for neurodevelopmental outcomes in extremely preterm infants.
- To identify specific neuroimaging markers associated with adverse outcomes.
Main Methods:
- Prospective evaluation of 480 infants <28 weeks' gestation surviving to near term.
- Masked central readers analyzed early/late CUS and brain MRI scans.
- Outcomes assessed at 18-22 months corrected age included NDI or death, and motor impairment or death.
Main Results:
- Increasing WMA severity and cerebellar lesions on MRI correlated with adverse outcomes.
- Cerebellar lesions were poorly detected by CUS.
- Both late CUS and MRI findings independently predicted NDI or death, with MRI cerebellar lesions (OR 3.0) and late CUS (OR 9.8) showing significant associations.
Conclusions:
- Near-term neuroimaging, including MRI and late CUS, offers significant prognostic value for extremely preterm infants.
- MRI findings, particularly cerebellar lesions and WMA, are crucial for predicting neurodevelopmental outcomes.
- These findings highlight the importance of advanced neuroimaging in managing high-risk neonates.
