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Published on: October 31, 2025
Predicting developmental outcomes in preterm infants: A simple white matter injury imaging rule
Dalit Cayam-Rand1, Ting Guo1, Ruth E Grunau1
1From the Departments of Paediatrics (Neurology) (D.C.-R., T.G., I.B.-F., V.C., S.P.M.) and Radiology (H.B.), The Hospital for Sick Children and the University of Toronto; BC Children's Hospital Research Institute (R.E.G., A.S.); Department of Pediatrics (Neonatology) (R.E.G., A.S.), University of British Columbia and BC Women's Hospital and Health Centre, Vancouver, Canada; Department of Pediatrics (Neonatology) (I.B.-F.), University Hospital Puerta del Mar, Cadiz, Spain; Department of Pediatrics (Child Development Center) (B.L.), University Children's Hospital Zurich, Switzerland; and Department of Pediatrics (P.M.), University of California, San Francisco.
Objective:
To develop a simple imaging rule to predict neurodevelopmental outcomes at 4.5 years in a cohort of preterm neonates with white matter injury (WMI) based on lesion location and examine whether clinical variables enhance prediction.
Methods:
Sixty-eight preterm neonates born 24-32 weeks' gestation (median 27.7 weeks) were diagnosed with WMI on early brain MRI scans (median 32.3 weeks). 3D T1-weighted images of 60 neonates with 4.5-year outcomes were reformatted and aligned to the posterior commissure-eye plane and WMI was classified by location: anterior or posterior-only to the midventricle line on the reformatted axial plane. Adverse outcomes at 4.5 years were defined as Wechsler Preschool and Primary Scale of Intelligence full-scale IQ <85, cerebral palsy, or Movement Assessment Battery for Children, second edition percentile <5. The prediction of adverse outcome by WMI location, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) was assessed using multivariable logistic regression.
Results:
Six children had adverse cognitive outcomes and 17 had adverse motor outcomes. WMI location predicted cognitive outcomes in 90% (area under receiver operating characteristic curve [AUC] 0.80) and motor outcomes in 85% (AUC 0.75). Adding IVH, BPD, and ROP to the model enhances the predictive strength for cognitive and motor outcomes (AUC 0.83 and 0.88, respectively). Rule performance was confirmed in an independent cohort of children with WMI.
Conclusions:
WMI on early MRI can be classified by location to predict preschool age outcomes in children born preterm. The predictive value of this WMI classification is enhanced by considering clinical factors apparent by term-equivalent age.
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