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Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury
Xue-Hua Zhang1, Shi-Jun Qiu2, Wen-Juan Chen3
1Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515; Department of Ultrasound, Hunan Children's Hospital, University of South China, Changsha, Hunan 410007, China.
Insights
Cranial ultrasound findings like germinal matrix hemorrhage, short hospitalization, and low weight predict poor neurodevelopment in very preterm infants. Severe brain injury, hydrocephaly, and cystic periventricular leukomalacia are linked to cerebral palsy.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Medical imaging
Background:
- Very preterm infants face heightened risks of mortality, injury, and long-term disability compared to full-term infants.
- Predicting neurodevelopmental outcomes in this vulnerable population using imaging is a critical research area.
- Cranial ultrasound (cUS) is a valuable tool for assessing brain development and injury in neonates.
Purpose of the Study:
- To investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes in very preterm infants.
- To identify early ultrasound markers that predict long-term neurological deficits.
- To correlate specific brain injuries visualized by cUS with developmental indices.
Main Methods:
- A retrospective study included 129 very preterm infants (gestational age ≤28 weeks).
- Serial cUS examinations were performed weekly before discharge and monthly thereafter, up to 6 months corrected age.
- Magnetic resonance imaging (MRI) was conducted at term-equivalent age, and neurodevelopmental outcomes (MDI, PDI) were assessed at ≥24 months corrected age.
Main Results:
- The consistency between cUS and MRI was 88%.
- Early cUS findings of germinal matrix hemorrhage (GMH) Grades 3-4, shorter hospitalization, and lower weight significantly correlated with poorer Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores.
- Later cUS findings, including extensive cystic periventricular leukomalacia (c-PVL) and moderate-to-severe hydrocephaly, were strongly associated with impaired MDI and PDI outcomes.
Conclusions:
- GMH Grades 3-4, short hospitalization, and low weight are indicators of poor neurodevelopmental prognosis in very preterm infants.
- Extensive c-PVL and moderate-to-severe hydrocephaly are significant predictors of cerebral palsy.
- Subtle white matter abnormalities detected by sustained, inhomogeneous echogenicity on cUS may indicate underlying brain injury.
Background:
Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.
Methods:
Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.
Results:
The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).
Conclusions:
Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.
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