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Published on: September 6, 2017
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Head circumference, total cerebral volume and neurodevelopment in preterm neonates
Thiviya Selvanathan1,2, Ting Guo1,2, Eddie Kwan3,4
1Paediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada.
Summary
Small head circumference at birth in very preterm infants is linked to poorer neurodevelopment. However, normal head growth during neonatal intensive care unit (NICU) stay may reduce this risk.
Area of Science:
- Neonatal neurodevelopmental outcomes
- Pediatric neurology
- Perinatal medicine
Background:
- Head circumference (HC) is a key indicator of brain growth in neonates.
- Very preterm infants (24-32 weeks' gestational age) are at high risk for neurodevelopmental impairments.
- The association of HC with neurodevelopmental outcomes, particularly in relation to changes during neonatal intensive care unit (NICU) stay, requires further investigation.
Purpose of the Study:
- To evaluate the association between small head circumference (HC) at birth and discharge from the NICU and neurodevelopmental outcomes in very preterm neonates.
- To compare the predictive value of HC and total cerebral volume (TCV) for neurodevelopmental outcomes.
Main Methods:
- Prospective cohort study including 168 very preterm neonates.
- Head circumference (HC) measured at birth and NICU discharge.
- Brain MRI obtained at term-equivalent age (TEA) for semiautomatically segmented TCV and manually segmented white matter injury (WMI) volumes.
- Neurodevelopmental assessments (motor, cognitive, language) at 4.5 years using M-ABC and WISC-III.
- Multivariable regression analyses controlling for gestational age, WMI, and postnatal illness.
Main Results:
- Small HC at birth was associated with lower scores on the Movement Assessment Battery for Children (M-ABC) and Wechsler Preschool and Primary Scale of Intelligence (WISC-III) Full Scale IQ (FSIQ).
- In infants with small birth HC, small HC at NICU discharge correlated with poorer motor, FSIQ, and Verbal IQ (VIQ) outcomes.
- Normal HC at discharge mitigated the association between small birth HC and adverse neurodevelopmental outcomes.
- HC showed a strong correlation with TCV at TEA, whereas TCV did not correlate with neurodevelopmental outcomes.
Conclusions:
- Small HC at birth is an independent predictor of poorer neurodevelopment in very preterm infants.
- Head circumference normalization during NICU care may act as a protective factor, moderating the risk of adverse neurodevelopmental outcomes.
- HC measurements, particularly changes during NICU stay, may be a valuable clinical tool for monitoring neurodevelopmental risk in preterm infants.
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