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Changes in Liver Shear Wave Elastography of Preterm Infants during Hospitalization
Takahiro Kemmotsu1,2, Tomoyuki Shimokaze1, Yusuke Morita1
1Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan.
Insights
Liver shear wave elastography (SWE) in preterm infants remains constant regardless of gestational age or birth weight. Elevated liver SWE values may indicate cholestasis, suggesting its potential as a new standard for liver evaluation in this population.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Medical Imaging Physics
Background:
- Liver evaluation is critical in preterm infants due to organ immaturity and exposure to hepatotoxic drugs and parenteral nutrition.
- The clinical utility of shear wave elastography (SWE), a non-invasive method for measuring tissue elasticity, remains unclear in preterm neonates.
Purpose of the Study:
- To investigate the postnatal course of liver shear wave elastography (SWE) values in preterm infants.
- To identify factors influencing changes in liver SWE values throughout the neonatal period.
Main Methods:
- Prospective measurement of liver SWE values every other week in 37 preterm infants (23-35 weeks gestation) and 12 term infants (≥36 weeks gestation).
- Analysis of correlations between liver SWE values and gestational age, birth weight, and serum markers of liver function (direct bilirubin, alanine aminotransferase).
Main Results:
- Median early postnatal liver SWE was 1.22 m/s, showing no significant correlation with gestational age (r=-0.18, p=0.23) or birth weight (r=-0.21, p=0.157).
- Liver SWE values remained constant over time and across different gestational age groups, and were similar between small-for-gestational-age and appropriate-for-gestational-age infants.
- An elevated liver SWE value showed a correlation with high direct bilirubin levels (r=0.37, p=0.041), suggesting a link to cholestasis.
Conclusions:
- Liver SWE values are stable in preterm infants, independent of gestational age, birth weight, or postnatal age until term.
- Elevated liver SWE values in preterm infants may serve as an indicator of cholestasis.
- Liver SWE shows promise as a reliable, non-invasive tool for liver evaluation in preterm infants, potentially becoming a new standard of care.
Abstract:
Liver evaluation is essential in preterm infants because of exposure to hepatotoxic drugs, the effects of parenteral nutrition, and their organ immaturity. The clinical significance of shear wave elastography (SWE) which measures tissue elasticity, is unclear in preterm infants. For SWE application to liver evaluation in preterm infants, we examined the postnatal course and factors associated with changes.We prospectively measured liver SWE values every other week in 37 preterm infants born at 23 to 35 weeks gestation and 12 term infants born after 36 weeks gestation.The median early postnatal liver SWE value was 1.22 (interquartile range, 1.19-1.26) m/s. The correlations of liver SWE values with gestational age and birth weight were r = -0.18 (p = 0.23) and r = -0.21 (p = 0.157), respectively. The median liver SWE values from birth to 36 to 38 postmenopausal weeks were 1.22 (1.17-1.24) m/s at <28 weeks gestation (n = 9), 1.21 (1.18-1.25) m/s at 28 to 29 weeks gestation (n = 11), 1.24 (1.21-1.28) m/s at 30 to 31 weeks gestation (n = 8), and 1.21 (1.20-1.24) m/s at ≥32 weeks gestation (n = 9). There was no change over time in any gestational age group (p = 0.158). The median liver SWE values were 1.22 (1.17-1.25) m/s (n = 10) and 1.22 (1.19-1.25) m/s (n = 27) for small- and appropriate-for-gestational-age infants, respectively (p = 0.93). The correlations of abnormally high serum concentrations of direct bilirubin (>1.0 mg/dL) and alanine aminotransferase (>12 IU/L) with liver SWE values were r = 0.37 (p = 0.041) and r = 0.21 (p = 0.35), respectively.Liver SWE values may be useful for the evaluation of liver damage with cholestasis in preterm infants because they remain constant regardless of gestational age and birth weight and do not change over time or with a deviation of body size. · Liver SWE was prospectively performed in preterm infants.. · Liver SWE was constant until term regardless of gestational age or birth weight.. · Liver SWE values of preterm infants ranged from 1.2 to 1.3 m/s.. · For preterm infants, elevation of liver SWE values reflected cholestasis.. · Liver SWE may become the new standard for liver evaluation in preterm infants..
