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Updated: Mar 1, 2026
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Neuroimaging in former preterm children who received erythropoiesis stimulating agents
John Phillips1, Ronald A Yeo2, Arvind Caprihan3
1Department of Neurology, University of New Mexico, Albuquerque, New Mexico.
Insights
Erythropoiesis-stimulating agents (ESAs) may enhance brain development in premature children, particularly white matter organization in girls. Further research is needed to understand cognitive outcome mechanisms.
Area of Science:
- Neuroscience
- Developmental Biology
- Pediatrics
Background:
- Premature infants may benefit from erythropoiesis-stimulating agents (ESAs) for improved developmental outcomes.
- The precise mechanisms by which ESAs influence brain development remain unclear.
- Advanced neuroimaging techniques like MRI and DTI can elucidate long-term effects of ESAs on brain structure.
Purpose of the Study:
- To investigate the long-term effects of erythropoiesis-stimulating agents (ESAs) on brain structure and white matter organization in former preterm infants.
- To correlate brain imaging metrics with cognitive outcomes in children treated with ESAs.
Main Methods:
- High-resolution MRI and diffusion tensor imaging (DTI) were used to assess brain structure and white matter integrity.
- Scans were performed at 3.5-4 years of age on former preterm infants (treated with ESAs or placebo) and healthy term controls.
- Cortical thickness, surface area, and fractional anisotropy (FA) were measured and correlated with IQ scores.
Main Results:
- No significant differences in cortical thickness, surface area, or overall fractional anisotropy (FA) were observed between ESA-treated and placebo groups.
- A notable increase in FA was observed in girls treated with ESAs compared to controls.
- Significant correlations were found between FA and Full-Scale IQ and Verbal IQ in the overall group.
Conclusions:
- Erythropoiesis-stimulating agent (ESA) treatment may preferentially benefit white matter development in preterm girls.
- Cognitive outcomes in former preterm infants are influenced by factors beyond whole-brain fractional anisotropy (FA).
- Further investigation is warranted to fully understand the neurodevelopmental impact of ESAs.
Abstract:
BackgroundIn premature children, erythropoiesis-stimulating agents (ESAs) may improve developmental outcome. It is not clear which of the several potential mechanisms are responsible for this improvement. High-resolution MRI and diffusion tensor imaging characterize brain structure and white matter organization, offering possible insight into the long-term effect of ESAs on brain development.MethodsMRI scans were performed at 3.5-4 years of age on former preterm infants treated with ESAs or placebo, and on healthy term controls. Mean cortical thickness, surface area, and fractional anisotropy (FA) were compared across study groups, and were correlated with general IQ measures.ResultsUnivariate analysis found no significant effect of ESAs on cortical thickness (P=0.366), surface area (P=0.940), or FA (P=0.150); however, there was a greater increase in FA among ESA-treated girls. Group analysis found significant correlations between FA and Full-Scale IQ (P=0.044) and Verbal IQ (P=0.036), although there was no significant relationship between Full-Scale IQ and FA among just the preterm children.ConclusionESA treatment may have a preferential effect on white matter development in girls, although factors other than just whole-brain FA are involved in mediating cognitive outcome.
