Relationships between sequential MRI in the neonatal period and early motor repertoire in very preterm infants
Joanne M George1, Amanda K L Kwong2, Kerstin Pannek3
1Child Health Research Centre, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia; Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
Insights
Very preterm infants’ brain MRI scores correlate with motor assessments. Term-equivalent age MRI global scores independently predict motor optimality scores (MOS-R) at corrected age, aiding early intervention for neurodevelopmental challenges.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Infants born very preterm face significant neurodevelopmental challenges.
- Early detection and intervention are crucial for improving outcomes in this population.
- While neonatal MRI and corrected age motor assessments are prognostic, their structure-function relationship is not well understood.
Purpose of the Study:
- To investigate the relationship between early brain MRI findings and motor function assessments in very preterm infants.
- To establish structure-function correlations between MRI scores and the Prechtl Motor Optimality Score - revised (MOS-R) and general movements.
Main Methods:
- MRI scans were performed at 32-weeks postmenstrual age and term-equivalent age (TEA) in infants born <31 weeks' gestation.
- Modified Kidokoro MRI scoring generated white matter, grey matter, and cerebellar scores, summed into a global score.
- Motor function was assessed using the MOS-R from videos at 3-4 months corrected age, alongside general movements assessment.
Main Results:
- Both early (32-week) and TEA MRI global scores correlated significantly with MOS-R and absent fidgety movements.
- In multivariable analysis, TEA MRI global scores remained independently associated with MOS-R at 3-4 months corrected age.
- Poorer MRI scores were linked to lower MOS-R and absent fidgety movements, indicating potential structural brain changes.
Conclusions:
- Neonatal and term-equivalent age MRI findings are significantly related to motor outcomes in very preterm infants.
- Term-equivalent age MRI global scores provide independent prognostic information for corrected age motor function.
- These findings support prioritizing infants with concerning MRI scores for early neurodevelopmental assessment and intervention.
Background:
Infants born very preterm frequently experience neurodevelopmental challenges. Early detection enables provision of targeted interventions to improve outcomes. Early neonatal and term-equivalent age (TEA) MRI and 3-5-month corrected age (CA) Prechtl Motor Optimality Score - revised (MOS-R) are useful prognostic tools, however structure-function relationships between them are not well established.
Methods:
Infants born <31 weeks' gestation underwent MRI at 32-weeks postmenstrual age and TEA. Modified Kidokoro MRI scoring generated white matter, cortical grey matter, deep grey matter and cerebellar scores which were summed to produce a global score. Infant MOS-R was assessed from videos recorded at 3-4 months' CA. Relationships between MRI abnormality scores and MOS-R and absent fidgety general movements were modelled using regression analysis.
Results:
Brain MRI was performed at 32-weeks in 249 infants, of whom 221 had TEA MRI and 225 had a MOS-R. For 32-week MRI, white matter, deep grey matter and global scores were related to MOS-R (global βMOS-R = -0.27, 95% confidence interval [CI] -0.46, -0.08; p = 0.006) and absent fidgety movements (global odds ratio = 1.23, 95%CI 1.07, 1.40; p = 0.003). For TEA MRI, white matter and global scores were related to MOS-R (global βMOS-R = -0.26, 95%CI -0.47, -0.06; p = 0.01) and absent fidgety movements (global odds ratio = 1.23, 95%CI 1.05, 1.42; p = 0.008). In multivariable model including global scores from both timepoints, term equivalent MRI scores remained related to MOS-R (βMOS-R = -0.41, 95%CI -0.72, 0.10; p = 0.009).
Conclusion:
Early and TEA MRI are related to MOS-R and general movements assessment. Term MRI global scores are independently related to MOS-R at 3-4 months' corrected age. This has implications for prioritising infants with poorer MRI scores for early assessment and that poorer MOS-R scores may be a manifestation of changes to brain structure and due to preterm birth.
