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Published on: September 12, 2011
Diffusion Tensor Imaging Changes Do Not Affect Long-Term Neurodevelopment following Early Erythropoietin among
Janessa B Law1, Bryan A Comstock2, Todd L Richards3
1Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
Insights
Diffusion tensor imaging (DTI) revealed microstructural brain changes in extremely preterm infants treated with erythropoietin (Epo). However, these DTI findings did not impact long-term neurodevelopmental outcomes at two years of age.
Area of Science:
- Neuroimaging
- Neonatal Medicine
- Developmental Neuroscience
Background:
- Extremely preterm infants face risks of brain injury and developmental delays.
- Erythropoietin (Epo) is being investigated for neuroprotective effects in this population.
- Diffusion tensor imaging (DTI) offers insights into white matter microstructure.
Purpose of the Study:
- To evaluate DTI in extremely preterm infants.
- To determine Epo's effect on DTI parameters.
- To correlate DTI findings with neurodevelopmental outcomes at 2 years.
Main Methods:
- MRI with DTI was performed at 36 weeks postmenstrual age in infants from the PENUT Trial.
- Neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development (BSID-III).
- Generalized linear models analyzed associations between DTI, Epo treatment, and neurodevelopmental scores.
Main Results:
- Lower mean diffusivity (MD) in cingulate and occipital white matter was observed in placebo-treated infants compared to Epo-treated infants.
- Lower fractional anisotropy (FA) in occipital white matter was noted in infants born earlier (24-25 weeks) versus later (26-27 weeks).
- These DTI changes did not correlate with lower BSID-III scores; however, decreased clustering coefficients trended towards lower scores.
Conclusions:
- Erythropoietin treatment did not alter DTI-derived white matter microstructure in extremely preterm infants.
- Despite observed microstructural differences on DTI, Epo treatment showed no impact on long-term neurodevelopmental outcomes.
- DTI may detect subtle microstructural changes, but these do not necessarily predict neurodevelopmental trajectories in Epo-treated preterm infants.
Abstract:
We aimed to evaluate diffusion tensor imaging (DTI) in infants born extremely preterm, to determine the effect of erythropoietin (Epo) on DTI, and to correlate DTI with neurodevelopmental outcomes at 2 years of age for infants in the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Infants who underwent MRI with DTI at 36 weeks postmenstrual age were included. Neurodevelopmental outcomes were evaluated by Bayley Scales of Infant and Toddler Development (BSID-III). Generalized linear models were used to assess the association between DTI parameters and treatment group, and then with neurodevelopmental outcomes. A total of 101 placebo- and 93 Epo-treated infants underwent MRI. DTI white matter mean diffusivity (MD) was lower in placebo- compared to Epo-treated infants in the cingulate and occipital regions, and occipital white matter fractional isotropy (FA) was lower in infants born at 24-25 weeks vs. 26-27 weeks. These values were not associated with lower BSID-III scores. Certain decreases in clustering coefficients tended to have lower BSID-III scores. Consistent with the PENUT Trial findings, there was no effect on long-term neurodevelopment in Epo-treated infants even in the presence of microstructural changes identified by DTI.
