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Magnetic Resonance Imaging Findings in Preterm Infants With Bilirubin Encephalopathy Beyond Three Years Corrected Age
Akihisa Okumura1, Yukihiro Kitai2, Hiroshi Arai2
1Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
Insights
Magnetic resonance imaging (MRI) abnormalities in preterm infants with bilirubin encephalopathy (BE) persist into childhood, with globus pallidus lesions being common. These MRI findings become less apparent with age in children with preterm BE.
Area of Science:
- Neonatal neurology
- Pediatric radiology
- Neurodevelopmental disorders
Background:
- Bilirubin encephalopathy (BE) in preterm infants can lead to neurological deficits.
- Magnetic resonance imaging (MRI) findings in preterm infants with BE are often dynamic and change with age.
- Assessing long-term neuroimaging in this population is crucial for understanding developmental outcomes.
Purpose of the Study:
- To evaluate the persistence and characteristics of MRI abnormalities in children with preterm bilirubin encephalopathy (BE) beyond 36 months corrected age (CA).
- To determine the prevalence and types of globus pallidus (GP) lesions in older children with a history of preterm BE.
- To investigate the relationship between MRI findings and corrected age in this cohort.
Main Methods:
- Retrospective review of head MRI scans from 28 patients with preterm BE, older than 36 months CA.
- MRI scans were analyzed by three pediatric neurology specialists.
- Findings were classified into: no abnormalities, partial globus pallidus (GP) lesions, or diffuse GP lesions.
Main Results:
- 33 MRI scans were analyzed from patients with a median gestational age of 26 weeks and birth weight of 824g.
- MRI abnormalities were present in 100% of patients aged 37-48 months CA, decreasing with age.
- Partial GP lesions were more frequent than diffuse GP lesions across all age groups.
Conclusions:
- Globus pallidus (GP) lesions are detectable on MRI in the majority of children with preterm bilirubin encephalopathy (BE) even after 36 months corrected age (CA).
- While MRI abnormalities may become less apparent with increasing age, partial GP lesions appear characteristic of older children with preterm BE.
- These findings highlight the long-term impact of bilirubin neurotoxicity on brain development.
Background:
Magnetic resonance imaging (MRI) abnormalities in preterm infants with bilirubin encephalopathy (BE) become less clear as the infants age. We assessed MRI findings in children with preterm BE older than 36 months corrected age (CA).
Methods:
In a previous questionnaire survey, hospitals were asked to provide head MRI data of patients older than 36 months CA. MRI findings were reviewed by three pediatric neurology specialists and classified as no abnormalities, partial globus pallidus (GP) lesions, or diffuse GP lesions.
Results:
In total, 33 MRI scans were available from 28 patients. The median gestational age and birth weight were 26 weeks and 824 g, respectively. The prevalence of MRI abnormalities was 100% in patients at 37 to 48 months CA, 71% in those at 49 to 60 months CA, 50% in those at 61 to 72 months CA, 67% in those at 73 to 84 months CA, and 38% in those at 85 months CA or older. Partial GP lesions were more common than diffuse GP lesions at all ages. No significant differences in sex, gestational age, birth weight, or gross motor function impairment were observed among lesion groups.
Conclusions:
GP lesions were detected on MRI in most children with preterm BE when studied after 36 months CA, although MRI abnormalities became less apparent along with age. Partial GP lesions may be a characteristic of older children with preterm BE.
