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Published on: November 20, 2015
Size and Location of Preterm Brain Injury and Associations With Neurodevelopmental Outcomes
Thiviya Selvanathan1, Ting Guo1, Steven Ufkes1
1From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada.
Insights
Brain injury volume and location in preterm infants predict motor, not cognitive, outcomes. Maternal education is linked to cognitive development, highlighting distinct pathways for neurodevelopmental outcomes.
Area of Science:
- Neonatal neurology
- Developmental neuroscience
- Pediatric neuroimaging
Background:
- Very preterm infants are at high risk for neurodevelopmental impairments.
- White matter injury (WMI) and periventricular hemorrhagic infarction (PVHI) are common brain injuries in this population.
- Understanding the impact of injury volume and location is crucial for predicting outcomes.
Purpose of the Study:
- To examine associations between WMI and PVHI volume/location and 18-month neurodevelopment in very preterm infants.
- To investigate the influence of socioeconomic status on neurodevelopmental outcomes.
- To identify predictors of adverse neurodevelopmental outcomes.
Main Methods:
- Prospective recruitment of 254 infants born <32 weeks' gestational age.
- MRI for WMI and PVHI quantification in 92 infants.
- Bayley Scales of Infant and Toddler Development, Third Edition for 18-month neurodevelopmental assessment.
- Multivariable linear regression and voxel-wise lesion symptom mapping.
Main Results:
- Greater brain injury volume correlated with lower 18-month motor scores (p=0.002).
- Higher maternal education was associated with higher cognitive scores (p=0.03).
- Brain injury in central and parietal white matter predicted poorer motor outcomes.
Conclusions:
- Brain injury volume and location are significant predictors of motor outcomes in preterm infants.
- Cognitive outcomes appear more influenced by socioeconomic factors, such as maternal education.
- Assessing lesion characteristics aids in identifying high-risk infants for targeted interventions.
Background And Objectives:
We examined associations of white matter injury (WMI) and periventricular hemorrhagic infarction (PVHI) volume and location with 18-month neurodevelopment in very preterm infants.
Methods:
A total of 254 infants born <32 weeks' gestational age were prospectively recruited across 3 tertiary neonatal intensive care units (NICUs). Infants underwent early-life (median 33.1 weeks) and/or term-equivalent-age (median 41.9 weeks) MRI. WMI and PVHI were manually segmented for quantification in 92 infants. Highest maternal education level was included as a marker of socioeconomic status and was defined as group 1 = primary/secondary school; group 2 = undergraduate degree; and group 3 = postgraduate degree. Eighteen-month neurodevelopmental assessments were completed with Bayley Scales of Infant and Toddler Development, Third Edition. Adverse outcomes were defined as a score of less than 85 points. Multivariable linear regression models were used to examine associations of brain injury (WMI and PVHI) volume with neurodevelopmental outcomes. Voxel-wise lesion symptom maps were developed to assess relationships between brain injury location and neurodevelopmental outcomes.
Results:
Greater brain injury volume was associated with lower 18-month Motor scores (β = -5.7, 95% CI -9.2 to -2.2, p = 0.002) while higher maternal education level was significantly associated with higher Cognitive scores (group 3 compared 1: β = 14.5, 95% CI -2.1 to 26.9, p = 0.03). In voxel-wise lesion symptom maps, brain injury involving the central and parietal white matter was associated with an increased risk of poorer motor outcomes.
Discussion:
We found that brain injury volume and location were significant predictors of motor, but not cognitive outcomes, suggesting that different pathways may mediate outcomes across domains of neurodevelopment in preterm infants. Specifically, assessing lesion size and location may allow for more accurate identification of infants with brain injury at highest risk of poorer motor outcomes. These data also highlight the importance of socioeconomic status in cognitive outcomes, even in preterm infants with brain injury.
