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A systematic review on brain injury and altered brain development in moderate-late preterm infants
Vivian Boswinkel1, Jacqueline Nijboer-Oosterveld2, Ingrid M Nijholt2
1Department of Neonatology, Isala Women and Children's hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
Insights
Moderate-late preterm infants show varied rates of brain injury, including intraventricular hemorrhage and white matter injury. Evidence comparing these rates to very preterm or term infants is limited due to study quality.
Area of Science:
- Neonatal neurology
- Developmental neuroscience
- Pediatric neuroimaging
Background:
- Moderate-late preterm (MLPT) infants represent a distinct group with potential for unique neurodevelopmental outcomes.
- Understanding brain injury and development in MLPT infants is crucial for optimizing long-term health.
- Comparisons with very preterm and term infants provide essential benchmarks for assessing MLPT neurodevelopment.
Purpose of the Study:
- To systematically review brain injury and altered brain development in MLPT infants.
- To compare findings in MLPT infants with those in very preterm and term infants.
Main Methods:
- Systematic search of five databases (January 2020) for original research.
- Inclusion of studies on brain injury incidence and quantitative brain development data in MLPT infants.
- Quality appraisal using the Johanna Briggs Institute checklist; data extraction on imaging, injury incidence, and brain development metrics.
Main Results:
- Twenty-four studies were eligible, mostly of moderate quality.
- Incidence of intraventricular hemorrhage (IVH) in MLPT infants ranged from 0.0% to 23.5%; white matter injury (WMI) ranged from 0.5% to 10.8%.
- Limited evidence suggests potential differences in brain development between MLPT and term infants, with weak comparative data on brain injury incidence.
Conclusions:
- Incidences of IVH and WMI in MLPT infants exhibit wide variation.
- Methodological limitations in current studies weaken conclusions regarding comparative brain injury rates.
- Further high-quality research is needed to clarify brain development and injury risks in MLPT infants.
Objectives:
To provide a systematic review of brain injury and altered brain development in moderate-late preterm (MLPT) infants as compared to very preterm and term infants.
Study Design:
A systematic search in five databases was performed in January 2020. Original research papers on incidence of brain injury and papers using quantitative data on brain development in MLPT infants were selected. The Johanna Briggs Institute 'Critical Appraisal Checklist for Studies Reporting Prevalence Data' was used for quality appraisal. Data extraction included: imaging modality, incidences of brain injury, brain volumes, 2D-measurements and diffusivity values.
Results:
In total, 24 studies were eligible. Most studies had a moderate quality. Twenty studies reported on the incidence of brain injury in MLPT infants. The incidence of intraventricular hemorrhage (IVH) ranged from 0.0% to 23.5% and of white matter injury (WMI) from 0.5% to 10.8%. One study reported the incidence of arterial infarction (0.3%) and none of cerebellar hemorrhage. Eleven studies compared incidences of brain injury between MLPT infants and very preterm or term infants. Five studies reported signs of altered brain development in MLPT infants.
Conclusions:
The incidences of IVH and WMI in MLPT infants varied widely between studies. Other abnormalities were sparsely reported. Evidence regarding a higher or lower incidence of brain injury in MLPT infants compared to very preterm or term infants is weak due to moderate methodological quality of reported studies. There is limited evidence suggesting a difference in brain development between MLPT and term infants.
