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Clinical Implications of Diffuse Excessive High Signal Intensity (DEHSI) on Neonatal MRI in School Age Children Born
Lina Broström1, Jenny Bolk1,2, Nelly Padilla1
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Neonatal brain MRI showing diffuse excessive high signal intensity (DEHSI) in extremely preterm infants did not predict developmental outcomes at 6.5 years. This finding suggests DEHSI is not a reliable indicator of long-term impairment in this vulnerable population.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging
Background:
- Magnetic resonance imaging (MRI) reveals white matter diffuse excessive high signal intensity (DEHSI) in 55-80% of extremely preterm infants.
- Understanding the long-term impact of neonatal DEHSI is crucial for predicting developmental trajectories.
Purpose of the Study:
- To investigate differences in developmental outcomes at 6.5 years in extremely preterm children with and without neonatal DEHSI.
- To assess the predictive value of DEHSI for long-term neurodevelopmental impairments.
Main Methods:
- A prospective cohort study included 83 infants born before 27 weeks of gestation.
- Brain MRI was performed at term equivalent age, with 66 children assessed at 6.5 years using standardized neurological, motor, cognitive, and behavioral tests.
Main Results:
- DEHSI was present in 59% of the children assessed at 6.5 years.
- The presence of DEHSI was not significantly associated with neurological dysfunction, motor skills (M-ABC), cognition (WISC-IV), visual-motor integration (Beery VMI), or behavior (SDQ) at follow-up.
Conclusions:
- Qualitatively defined DEHSI on neonatal MRI is not a useful predictor of long-term impairment in extremely preterm children.
- Further research may be needed to identify more accurate biomarkers for predicting neurodevelopmental outcomes in this population.
Objective:
Magnetic resonance imaging (MRI) of the brain carried out during the neonatal period shows that 55-80% of extremely preterm infants display white matter diffuse excessive high signal intensity (DEHSI). Our aim was to study differences in developmental outcome at the age of 6.5 years in children born extremely preterm with and without DEHSI.
Study Design:
This was a prospective cohort study of 83 children who were born in Stockholm, Sweden, between 2004 and 2007, born at gestational age of < 27 weeks + 0 days and who underwent an MRI scan of their brain at term equivalent age. The outcome measures at 6.5 years included testing 66 children with the modified Touwen neurology examination, the Movement Assessment Battery for Children 2, the Wechsler Intelligence Scale for Children-Fourth Edition, Beery Visual-motor Integration test-Sixth Edition, and the Strengths and Difficulties Questionnaire. Group-wise comparisons were done between children with and without DEHSI using Student t-test, Mann Whitney U test, Chi square test and regression analysis.
Results:
DEHSI was detected in 39 (59%) of the 66 children who were assessed at 6.5 years. The presence of DEHSI was not associated with mild neurological dysfunction, scores on M-ABC assessment, cognition, visual-motor integration, or behavior at 6.5 years.
Conclusion:
The presence of qualitatively defined DEHSI on neonatal MRI did not prove to be a useful predictor of long-term impairment in children born extremely preterm.
