Preterm Neuroimaging and School-Age Cognitive Outcomes.

Area of Science:

• Neonatal neurology
• Developmental pediatrics
• Neuroimaging

Background:

• Children born extremely preterm face risks for cognitive difficulties and disability.
• The prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes is not fully understood.

Purpose of the Study:

• To compare the predictive value of near-term brain MRI and early/late CUS for cognitive impairment and disability at school age in extremely preterm infants.
• To assess the prognostic capabilities of these neuroimaging techniques.

Main Methods:

• Prospective study of extremely preterm infants enrolled in a randomized trial.
• Evaluation of early and late CUS and near-term conventional MRI findings.
• Prediction of cognitive impairment (full-scale IQ <70) and disability at 6-7 years of age.
• Stepwise logistic regression analysis adjusted for perinatal-neonatal factors.

Main Results:

• Adverse late CUS findings (OR 20.1) were strongly associated with cognitive impairment (FSIQ <70).
• Both adverse late CUS findings (OR 27.9) and significant cerebellar lesions on MRI (OR 2.71) were associated with disability.
• Neuroimaging did not substantially improve the predictive accuracy of the models.

Conclusions:

• Severe, rare adverse late CUS findings are the strongest predictors of school-age cognitive impairment and disability.
• Significant cerebellar lesions on MRI predict disability, but not cognitive impairment alone.
• Near-term conventional MRI offers limited added value in predicting severe school-age outcomes in this population.