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Published on: May 18, 2010
Severity of punctate white matter lesions in preterm infants: antecedents and cerebral palsy prediction
E Melinda Mahabee-Gittens1,2, Venkata Sita Priyanka Illapani3,4, Beth M Kline-Fath2,3,5
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Punctate white matter lesions (PWML) in preterm infants significantly increase cerebral palsy (CP) risk. Histologic chorioamnionitis and prenatal opioid use are risk factors, while antenatal corticosteroids are protective, aiding early identification and prevention strategies.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Developmental Pediatrics
Background:
- Punctate white matter lesions (PWML) are frequently observed in preterm infants' MRIs.
- Factors influencing PWML severity and their predictive capability for neurodevelopmental outcomes require further investigation.
Purpose of the Study:
- To identify antecedent factors associated with PWML severity in preterm infants.
- To assess the independent predictive ability of PWML for cerebral palsy (CP) at corrected age (CA).
Main Methods:
- Infants born at ≤32 weeks' gestational age underwent MRI at term CA.
- Neuromotor exams diagnosed CP, and Bayley Scales of Infant and Toddler Development-III (BSID-III) assessed development at 2 years CA.
- PWML volume was quantified, and correlations with >50 perinatal factors were analyzed.
Main Results:
- PWML were present in 7.1% of 392 infants; 11.6% developed CP.
- Moderate-severe acute histologic chorioamnionitis (HCA), prenatal opioid use, and antenatal corticosteroids were linked to PWML severity.
- Increased PWML severity predicted CP (OR 2.12) independently of other factors, but not BSID-III scores.
Conclusions:
- PWML burden is associated with a two-fold increased risk of CP in preterm infants.
- HCA and prenatal opioid use are risk factors, while antenatal corticosteroids are protective against PWML.
- Findings may enable earlier identification of infants at risk for PWML and CP.
Background:
The objectives were to investigate antecedent factors of punctate white matter lesions (PWML) severity on MRI at term-corrected age (CA) and to evaluate its ability to independently predict cerebral palsy (CP) in preterm infants.
Methods:
We studied infants born at ≤32 weeks' gestational age [GA] with brain MRI at term CA, a standardized neuromotor exam to determine CP diagnosis, and composite scores from Bayley Scales of Infant and Toddler Development-III(BSID-III) at 2 years CA. MRIs with PWML were manually segmented and volume quantified with high reliability. We correlated >50 perinatal antecedent factors with PWML severity and conducted multivariable regression analyses to assess PWML ability to independently predict neurodevelopmental outcomes at age 2.
Results:
Of 392 infants, 28 (7.1%) had PWML; 339 (86%) were assessed at age 2, 39 (11.6%) had CP. Moderate-severe acute histologic chorioamnionitis (HCA), prenatal opioid use, and antenatal corticosteroids were independently associated with PWML severity. Increasing PWML severity was significantly predictive of CP (OR 2.12; 95% CI:1.34,3.37), independent of known predictors, but not BSID-III scores.
Conclusions:
Increasing burden of PWML was associated with two-fold risk of CP in preterm infants. We also identified HCA, prenatal opioids, and antenatal corticosteroids as modifiable risk and protective factors for PWML that may be amenable to prevention efforts.
Impact:
Punctate white matter lesions (PWML) are commonly seen on MRI scans in preterm infants, yet the antecedent factors associated with PWML are not well characterized. While prior literature is conflicting on the ability of PWML to predict neurodevelopmental impairments, our study demonstrated that objectively quantified PWML are independently predictive of the development of cerebral palsy. We identified modifiable factors such as histologic chorioamnionitis as a risk factor and antenatal corticosteroids as a protective factor against PWML development. Our findings may facilitate earlier identification of infants at risk for PWML and cerebral palsy.
