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Punctate White Matter Abnormality in Moderate-to-Late Preterm Infants

Eleanor Kennedy1, Ting Guo2, Sian Williams1

  • 1Liggins Institute, University of Auckland, Auckland, New Zealand.

Annals of Neurology
|June 9, 2025
PubMed

Insights

White matter abnormality (WMA) is common in moderate-to-late preterm infants, often missed on later scans. This study maps WMA distribution, highlighting its prevalence and characteristic topology in this population.

Area of Science:

  • Neonatal neurology
  • Neuroimaging
  • Developmental neuroscience

Background:

  • Moderate-to-late preterm (MLP) infants represent a significant proportion of children with neurodevelopmental impairments.
  • White matter injury (WMI) is a known predictor of adverse outcomes in very preterm (VP) infants, but WMA in MLP infants is poorly understood.

Purpose of the Study:

  • To investigate the prevalence, burden, and topographical distribution of white matter abnormality (WMA) in moderate-to-late preterm (MLP) infants.

Main Methods:

  • Brain MRI was performed on MLP infants shortly after birth and at term-equivalent age (TEA).
  • Manual segmentation of WMA was conducted, calculating total and regional volumes and percentage of WMA relative to total cerebral volume.
  • Probabilistic WMA maps were generated and compared with WMI in VP infants and term infants with congenital heart disease.

Main Results:

  • Of 101 MLP infants, 39.6% exhibited WMA on at least one MRI scan.
  • In infants with WMA, lesions often decreased in visibility or became undetectable between early-life and TEA scans.
  • Probabilistic mapping revealed a distinct WMA topology, predominantly in posterior brain regions, with trigonal areas showing vulnerability across neonatal populations.

Conclusions:

  • White matter abnormality (WMA) is more prevalent in moderate-to-late preterm infants than previously recognized and follows a characteristic distribution.
  • WMA may be subtle or missed on term-equivalent age MRI scans.
  • The clinical significance and relationship of WMA with neurodevelopmental outcomes in MLP infants require further investigation.
Abstract

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