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White Matter Injury and General Movements in High-Risk Preterm Infants
C Peyton1, E Yang2, M E Msall2
1From the Departments of Therapy Services (C.P.) colleen.peyton@uchospitals.edu.
Insights
General Movement Assessment in preterm infants can predict adverse neurodevelopmental outcomes. Aberrant movements correlate with white matter abnormalities, indicating potential for early detection of cognitive and motor delays.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Very preterm infants (<1500 g) face heightened risks of cognitive and motor impairments, such as cerebral palsy.
- White matter abnormalities on MR imaging at term-equivalent age are linked to these adverse neurodevelopmental outcomes.
- General Movement Assessment (GMA) of spontaneous movements shows promise in predicting cerebral palsy.
Purpose of the Study:
- To evaluate the efficacy of GMA in predicting adverse cognitive, language, and motor outcomes in very preterm infants.
- To identify brain imaging markers associated with both adverse outcomes and aberrant general movements.
Main Methods:
- Prospective study of 47 preterm infants (24-30 weeks' gestation).
- Brain MR imaging (T1/T2, DTI) at term-equivalent age.
- GMA at 10-15 weeks' postterm; neurodevelopmental outcomes assessed at 2 years using Bayley Scales III.
Main Results:
- Nine infants exhibited aberrant general movements and were more prone to adverse neurodevelopmental outcomes.
- Tract-Based Spatial Statistics revealed significantly lower fractional anisotropy in widespread white matter tracts for infants with aberrant movements.
- A subset with both aberrant movements and abnormal neurodevelopmental outcomes showed significantly reduced fractional anisotropy in specific brain regions.
Conclusions:
- Aberrant general movements in preterm infants at 10-15 weeks' postterm are predictive of adverse neurodevelopmental outcomes.
- These aberrant movements are associated with specific white matter microstructure abnormalities, correlating with cognitive, language, and motor delays.
Background And Purpose:
Very preterm infants (birth weight, <1500 g) are at increased risk of cognitive and motor impairment, including cerebral palsy. These adverse neurodevelopmental outcomes are associated with white matter abnormalities on MR imaging at term-equivalent age. Cerebral palsy has been predicted by analysis of spontaneous movements in the infant termed "General Movement Assessment." The goal of this study was to determine the utility of General Movement Assessment in predicting adverse cognitive, language, and motor outcomes in very preterm infants and to identify brain imaging markers associated with both adverse outcomes and aberrant general movements.
Materials And Methods:
In this prospective study of 47 preterm infants of 24-30 weeks' gestation, brain MR imaging was performed at term-equivalent age. Infants underwent T1- and T2-weighted imaging for volumetric analysis and DTI. General movements were assessed at 10-15 weeks' postterm age, and neurodevelopmental outcomes were evaluated at 2 years by using the Bayley Scales of Infant and Toddler Development III.
Results:
Nine infants had aberrant general movements and were more likely to have adverse neurodevelopmental outcomes, compared with infants with normal movements. In infants with aberrant movements, Tract-Based Spatial Statistics analysis identified significantly lower fractional anisotropy in widespread white matter tracts, including the corpus callosum, inferior longitudinal and fronto-occipital fasciculi, internal capsule, and optic radiation. The subset of infants having both aberrant movements and abnormal neurodevelopmental outcomes in cognitive, language, and motor skills had significantly lower fractional anisotropy in specific brain regions.
Conclusions:
Aberrant general movements at 10-15 weeks' postterm are associated with adverse neurodevelopmental outcomes and specific white matter microstructure abnormalities for cognitive, language, and motor delays.
