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Investigating Cerebral Anomalies in Preterm Infants and Associated Risk Factors With Magnetic Resonance Imaging at
Nicolas Elbaz1, Valérie Biran2, Chloé Ghozland3
1Service d'Imagerie Pédiatrique, Hôpital Robert-Debré AP-HP, Université Paris-Cité, Paris, France.
Insights
Mechanical ventilation increases cerebral anomalies in preterm infants, while prolonged nutrition may protect white matter. Brain lesion severity and being small for gestational age also impact brain development.
Area of Science:
- Neonatal neurology
- Pediatric radiology
- Neurodevelopmental disorders
Background:
- Preterm birth (<32 weeks gestation) is linked to cerebral anomalies and neurodevelopmental disorders.
- Perinatal factors significantly influence the occurrence of these conditions.
- Cerebral MRI at term-equivalent age (TEA) can elucidate these relationships.
Purpose of the Study:
- To examine the association between perinatal factors, cerebral anomalies, and brain volumetry using MRI at TEA.
- To identify specific risk and protective factors influencing brain development in preterm infants.
Main Methods:
- A cohort of 110 preterm infants (<32 weeks gestation) underwent cerebral MRI at TEA.
- Cerebral anomalies were assessed using the Kidokoro scoring system.
- Cerebral volumetry was performed to quantify brain volumes.
- Relationships between 9 clinical factors, Kidokoro scores, and brain volumes were analyzed.
Main Results:
- Only 6% of preterm infants showed moderate-to-severe brain anomalies.
- Mechanical ventilation was a risk factor for anomalies (aOR=4.6).
- Prolonged parenteral nutrition was protective for white matter anomalies (aOR=0.2).
- Mechanical ventilation and being small for gestational age were risk factors for reduced cerebral volumes.
- Increased brain lesion severity correlated with decreased cerebral volumes.
Conclusions:
- Treatment-related perinatal factors significantly impact cerebral anomaly occurrence in preterm infants.
- Both qualitative (Kidokoro scoring) and quantitative (volumetry) MRI are valuable tools for assessing preterm brain development.
Background:
Being born very or extreme preterm is a major source of cerebral anomalies and neurodevelopmental disorders, whose occurrence depends on many perinatal factors. A better understanding of these factors could be provided by cerebral magnetic resonance imaging (MRI) at term-equivalent age (TEA).
Objective:
To investigate, through cerebral TEA-MRIs, the relationship between the main perinatal factors, the occurrence of cerebral anomalies, and cerebral volumetry.
Methods:
We assembled a cohort of preterm babies born before 32 weeks of gestation who underwent a cerebral TEA-MRI. We assessed cerebral anomalies using a radiological scoring system - the Kidokoro scoring - and performed cerebral volumetry. We investigated the relationships between 9 clinical factors (birth characteristics, resuscitation treatments…), Kidokoro scores, and brain volumes.
Results:
Among 110 preterms who underwent a cerebral MRI at TEA, only 6% suffered moderate-to-severe brain anomalies. We identified mechanical ventilation as a risk factor for cerebral anomalies (adjusted odds ratio = 4.6, 95% confidence interval [1.7-12.8]) and prolonged parenteral nutrition as a protective factor for white matter anomalies (adjusted odds ratio = 0.2, 95% confidence interval [0.1-0.8]). Mechanical ventilation (P = 0.01) and being born small for gestational age (P < 0.001) were risk factors for the reduction of cerebral volumes. An increase in brain lesion severity was associated with decreased cerebral volumes (P = 0.016).
Conclusions:
Our study highlights the importance of treatment-related perinatal factors on the occurrence of cerebral anomalies in very and extreme preterms, and the interest in using both qualitative (Kidokoro scoring) and quantitative (volumetry) MRI-tools.
