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Predicting developmental outcomes in premature infants by term equivalent MRI: systematic review and meta-analysis
Janneke Van't Hooft1, Johanna H van der Lee2, Brent C Opmeer3
1Department of Obstetrics and Gynecology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. j.vanthooft@gmail.com.
Insights
Term MRI can predict cerebral palsy (CP) and motor function in high-risk infants. However, its ability to forecast neurocognitive and behavioral outcomes is limited, with white matter abnormalities (WMA) showing the most promise.
Area of Science:
- Neonatal neuroimaging
- Developmental pediatrics
- Diagnostic accuracy studies
Background:
- Very preterm infants (≤32 weeks) and low-birth-weight infants (≤1500 g) are at high risk for long-term developmental issues.
- Early identification of these risks is crucial for timely intervention.
- Magnetic Resonance Imaging (MRI) at term equivalent age is a potential tool for prognostication.
Purpose of the Study:
- To systematically review and assess the prognostic accuracy of term MRI findings for long-term developmental outcomes in high-risk infants.
- To evaluate specific MRI findings, including white matter abnormalities (WMA), brain abnormality (BA), and diffuse excessive high signal intensity (DEHSI).
- To determine the predictive value of MRI for cerebral palsy (CP), motor, neurocognitive, and behavioral functions.
Main Methods:
- Systematic review of studies published between 2000-2013, searching multiple databases (Central, Medline, Embase, PsycInfo).
- Two independent reviewers conducted study selection, data extraction, and quality assessment.
- Bivariate meta-analysis and summary receiver operating characteristic (sROC) curves were used to estimate pooled sensitivity and specificity for MRI findings predicting developmental outcomes.
Main Results:
- Twenty studies were included, with varying quality.
- Moderate/severe white matter abnormalities (WMA) on term MRI showed moderate sensitivity (77%) and specificity (79%) for predicting cerebral palsy (CP).
- Prognostic accuracy for motor function was moderate, but poor for visual/hearing problems, neurocognitive, and behavioral outcomes. DEHSI showed no prognostic value.
Conclusions:
- Moderate to severe WMA on term equivalent age MRI can predict CP and motor function in very preterm or low-birth-weight infants.
- The predictive ability of MRI for neurocognitive and behavioral impairments is limited.
- Other MRI markers like BA and DEHSI have demonstrated limited prognostic value.
Background:
This study aims to determine the prognostic accuracy of term MRI in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes.
Methods:
We performed a systematic review searching Central, Medline, Embase, and PsycInfo. Two independent reviewers performed study selection, data extraction, and quality assessment. We documented sensitivity and specificity for three different MRI findings (white matter abnormalities (WMA), brain abnormality (BA), and diffuse excessive high signal intensity (DEHSI)), related to developmental outcomes including cerebral palsy (CP), visual and/or hearing problems, motor, neurocognitive, and behavioral function. Using bivariate meta-analysis, we estimated pooled sensitivity and specificity and plotted summary receiver operating characteristic (sROC) curves for different cut-offs of MRI.
Results:
We included 20 papers published between 2000 and 2013. Quality of included studies varied. Pooled sensitivity and specificity values (95 % confidence interval (CI)) for prediction of CP combining the three different MRI findings (using normal/mild vs. moderate/severe cut-off) were 77 % (53 to 91 %) and 79 % (51 to 93 %), respectively. For prediction of motor function, the values were 72 % (52 to 86 %) and 62 % (29 to 87 %), respectively. Prognostic accuracy for visual and/or hearing problems, neurocognitive, and/or behavioral function was poor. sROC curves of the individual MRI findings showed that presence of WMA provided the best prognostic accuracy whereas DEHSI did not show any potential prognostic accuracy.
Conclusions:
This study shows that presence of moderate/severe WMA on MRI around term equivalent age can predict CP and motor function in very preterm or low-birth-weight infants with moderate sensitivity and specificity. Its ability to predict other long-term outcomes such as neurocognitive and behavioral impairments is limited. Also, other white matter related tests as BA and DEHSI demonstrated limited prognostic value.
Systematic Review Registration:
PROSPERO CRD42013006362.
