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Neonatal Neuroimaging Among Children Born Extremely Preterm and Motor Coordination Impairment at School-Age
Susan R Hintz1, Carla M Bann2, Betty R Vohr3
1Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
Insights
Motor coordination impairment affects many extremely preterm infants, regardless of early brain imaging results. Consistent long-term follow-up and intervention are crucial for these children.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging
Background:
- Extremely preterm infants face risks for neurodevelopmental deficits.
- Cranial ultrasound (CUS) and MRI are used to assess brain development in neonates.
- White matter abnormalities (WMA) on imaging are potential markers for later motor impairments.
Purpose of the Study:
- To investigate the association between neonatal neuroimaging findings (CUS and MRI) and motor coordination impairment at school age in extremely preterm children.
- To determine if WMA on brain MRI are predictive of motor deficits.
- To assess the prevalence of motor impairment in relation to neuroimaging results.
Main Methods:
- Prospective, longitudinal study of infants born 24-27 weeks estimated gestational age (EGA).
- Neonatal CUS and near-term MRI were performed.
- Motor function assessed at 6-7 years using the Movement Assessment Battery for Children (MABC-2).
- Logistic regression analyzed associations between neuroimaging and motor outcomes.
Main Results:
- Nearly one-third of extremely preterm children exhibited significant motor impairment.
- Motor impairment rates increased with lower EGA.
- Adverse late CUS findings and WMA severity were associated with higher impairment rates.
- Importantly, significant motor impairment was also prevalent in children with normal late CUS (29%) and no WMA on MRI (22%).
- Motor impairment was independently linked to adverse late CUS and moderate-severe WMA in children without cerebral palsy.
Conclusions:
- Motor coordination impairment is common in extremely preterm infants, irrespective of neonatal neuroimaging abnormalities.
- Neonatal brain imaging findings are associated with, but do not fully predict, motor deficits.
- Emphasizes the necessity for ongoing developmental surveillance and early intervention for all extremely preterm infants.
Objectives:
To examine, among children born extremely preterm, initial and late cranial ultrasound (CUS) findings and magnetic resonance imaging (MRI) findings of the brain at near term, including white matter abnormalities (WMA) as markers for motor coordination impairment at school age.
Study Design:
This was a prospective, longitudinal study of neonatal CUS and conventional MRI at near term among infants born 24-276/7 weeks of estimated gestational age (EGA) to predict outcomes in a subgroup of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT). Outcome measures at 6-7 years included Movement Assessment Battery for Children (MABC-2) to determine significant motor impairment (total test score ≤5th %ile). Logistic regression was used to evaluate associations with near-term neuroimaging, adjusting for perinatal-neonatal factors.
Results:
Total test score on MABC-2 was available for 320 children. Nearly 1 in 3 children had significant motor impairment, with rates increasing with decreasing EGA (24 weeks: 41%; 25 weeks: 41%; 26 weeks: 31%; 27 weeks: 21%). Greater rates of impairment were seen with adverse late CUS findings and increasing WMA severity, but importantly, high rates also were seen among those with normal late CUS (29%) and without WMA on MRI (22%). Motor impairment was independently associated with adverse late CUS in the group overall (aOR 5.00, 95% CI 1.53-16.29) and with moderate-severe WMA among those without CP (aOR 2.29, 95%CI 1.08-4.87).
Conclusions:
Although motor coordination impairment was associated with abnormal neonatal neuroimaging, there was a high prevalence among all infants born extremely preterm, whether with or without neuroimaging abnormalities. These findings indicate the need for consistent long-term follow-through and intervention.
