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Published on: August 25, 2014
Neurodevelopmental Outcome at 3 Years of Age in Very Low Birth Weight Infants According to Brain Development and
Mariya Malova1, Alessandro Parodi1, Mariasavina Severino2
1Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Insights
Even mild brain lesions in very low birth weight (VLBW) infants negatively impact neurodevelopmental outcomes at three years. This study analyzed MRI findings and developmental assessments in a modern VLBW cohort.
Area of Science:
- Neonatal neurology
- Neurodevelopmental pediatrics
- Infant brain imaging
Background:
- Severe brain lesions in very low birth weight (VLBW) infants are increasingly replaced by milder lesions with uncertain prognoses.
- Understanding the impact of these milder lesions is crucial for predicting neurodevelopmental outcomes.
Purpose of the Study:
- To define the type, frequency, and 3-year neurodevelopmental outcomes of prematurity-related brain lesions in a contemporary cohort of VLBW infants.
- To correlate brain lesion characteristics and early brain measurements with long-term neurodevelopmental status.
Main Methods:
- Brain MRI at term-equivalent age was performed on 407 VLBW infants.
- White matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH) were identified and graded.
- Neurodevelopmental outcomes were assessed using Griffiths Scale at 3 years; correlations with lesion type/grade and brain measurements were explored.
Main Results:
- 46% of VLBW infants had at least one brain lesion; 9% had severe lesions.
- IVH (28%), WML (21%), and CBH (17%) were the most common lesions.
- Mild/severe IVH, moderate/severe WML, and all CBH grades were associated with poorer 3-year outcomes.
Conclusions:
- Even mild brain lesions in VLBW infants are linked to negative neurological outcomes at 3 years.
- Early identification and monitoring of brain lesions are essential for VLBW infants.
Background:
During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses.
Objective:
The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants.
Methods:
VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored.
Results:
Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome.
Conclusion:
We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.
