Related Experiment Videos
Neuroimaging in the high-risk infant: relationship to outcome
1Department of Developmental Pediatrics, Johns Hopkins University School of Medicine, Kennedy Krieger Institute, Baltimore, MD 21205, USA.
Insights
Neuroimaging detects early brain damage in infants, correlating specific abnormalities with risks for cerebral palsy. This helps clinicians understand injury timing and patient prognosis.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Early brain development is a precise sequence disrupted by prenatal/perinatal events, causing impairments like cerebral palsy.
- Traditional neuropathology relied on post-mortem analysis; modern neuroimaging aids in assessing living high-risk infants.
- Neuroimaging provides insights into the timing and nature of brain insults, correlating with clinical findings.
Purpose of the Study:
- To review the relationship between neuroimaging findings and patient outcomes.
- To aid clinicians in interpreting neuroimaging results for high-risk infants.
- To enhance understanding of risks associated with specific brain abnormalities.
Main Methods:
- Review of neuroimaging studies (ultrasonography, CT, MRI) in preterm and term infants.
- Correlation of identified brain lesions with clinical outcomes, particularly cerebral palsy.
- Analysis of specific ultrasonographic markers in very low birth weight infants.
Main Results:
- In very low birth weight infants, white matter damage on ultrasonography strongly correlates with cerebral palsy.
- Persistent ventricular enlargement or echodensities indicate a 50% cerebral palsy risk.
- Periventricular white matter cysts carry a 75-95% risk of cerebral palsy.
Conclusions:
- Neuroimaging is crucial for identifying brain lesions and assessing risks in infants.
- Specific findings in preterm and term infants predict developmental outcomes like cerebral palsy.
- Clinicians can use these correlations to better manage and understand patient prognosis.
Abstract:
Early brain development involves a genetically programmed, spatially organized, and temporally orchestrated cascade of events. Deleterious prenatal perinatal events may disrupt this sequence and lead to a spectrum of developmental impairments including cerebral palsy and mental retardation. Before the advent of cranial ultrasonography, cranial tomography, and magnetic resonance imaging, neuropathologic correlations were usually established post mortem. These neuroimaging modalities have improved the identification of brain lesions in surviving high-risk preterm and term infants. This has permitted inferences as to timing and pathophysiologic condition of the insult(s) and has facilitated correlations with clinical examination. In very low birth weight infants ultrasonographic abnormalities reflecting white matter damage have the strongest correlations with cerebral palsy: (1) persistent ventricular enlargement or persistent parenchymal echodensities carry a 50% risk for cerebral palsy, and (2) large bilateral cysts in periventricular white matter carry a risk approaching 75% to 95%. In term infants neuroimaging studies show selective vulnerability in cerebral cortex and basal ganglia. This article reviews relationships between neuroimaging findings and outcome to help clinicians interpret the results and to gain an understanding of risk in their patients.