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Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Brain MRI before and at term equivalent age predicts motor and cognitive outcomes in very preterm infants
Alex M Pagnozzi1, Kerstin Pannek1,2, Roslyn N Boyd3
1The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
Insights
Early brain MRI in high-risk infants can predict developmental outcomes like Cerebral Palsy (CP) and inform early intervention strategies. Structural brain biomarkers from neonatal MRI are key predictors of 2-year neurodevelopmental assessments.
Area of Science:
- Neuroimaging
- Developmental Pediatrics
- Neonatology
Background:
- Neonatal brain Magnetic Resonance Imaging (MRI) is crucial for detecting brain injuries and predicting outcomes in high-risk infants.
- Current clinical practice often delays MRI until Term Equivalent Age (TEA), necessitating repeat hospital visits for families of preterm infants.
- Early prognostication of neurodevelopmental outcomes, such as Cerebral Palsy (CP), is essential for timely intervention.
Purpose of the Study:
- To evaluate the predictive accuracy of structural brain biomarkers from early neonatal and Term Equivalent Age (TEA) MRIs for 2-year neurodevelopmental outcomes.
- To determine if early MRI, TEA MRI, or a combination of both provides better prediction of outcomes.
- To identify specific brain structural biomarkers associated with early childhood neurodevelopmental assessments.
Main Methods:
- Structural biomarkers were extracted from brain MRIs of 100 very preterm infants from the PPREMO and PREBO studies.
- MRIs were acquired both in the neonatal period (from 26 weeks postmenstrual age) and at TEA.
- Multivariable regression was used to assess the association between MRI biomarkers and 2-year outcomes (Bayley-III and NSMDA).
Main Results:
- Moderately strong and statistically significant associations were found between brain structure on both early and TEA MRIs and 2-year outcomes (r = 0.37-0.56).
- Key predictive biomarkers included white and grey matter volumes, deep grey matter and cerebellar volumes, and cortical gyrification and surface area.
- Early MRI demonstrated the highest prognostic accuracy, comparable to combining early and TEA timepoints.
Conclusions:
- Early neonatal MRI provides valuable prognostic information for neurodevelopmental outcomes in very preterm infants.
- Structural brain biomarkers from early MRI can predict outcomes at 2 years, potentially reducing the need for later imaging.
- Integrating early MRI findings into clinical practice may enhance early detection and management of adverse neurodevelopmental outcomes, including Cerebral Palsy.
Abstract:
Brain Magnetic Resonance Imaging (MRI) of high-risk infants in the neonatal period (from 26 weeks postmenstrual age to Term Equivalent Age (TEA)) is increasingly being used for the detection of brain injuries, and the early prognostication of adverse outcomes such as Cerebral Palsy (CP). While most imaging is performed around TEA in clinical practice for infants born preterm (<37 weeks of gestation), this would often require families to return to hospital for imaging. In this work, we extract structural biomarkers from MRI acquired both before and at TEA in a cohort of very preterm infants from the PPREMO and PREBO studies (n = 100), to determine if either time-point, or both combined, are predictive of both Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) and the Neuro-sensory Motor Developmental Assessment (NSMDA) at 2 years. Using multivariable regression, moderately strong and statistically significant associations were found between brain structure on both early and TEA MRIs with 2-year outcomes (r = 0.39-0.55 for early MRI, r = 0.37-0.49 for Term MRI, r = 0.37-0.56 for early and TEA MRI combined). Importantly, brain biomarkers associated with early childhood outcomes from MRIs were identified, including white and grey matter volumes, deep grey matter and cerebellar volumes, and gyrification and surface area across the whole cortex. Early MRI showed the best prognostic accuracy along with combining timepoints, indicating the potential clinical benefit of Early MRI in predicting adverse outcomes.
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