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. 2014 Mar;133(3):412-21.
doi: 10.1542/peds.2013-1863. Epub 2014 Feb 17.

Invasive procedures in preterm children: brain and cognitive development at school age

Jillian Vinall  1 , Steven P Miller, Bruce H Bjornson, Kevin P V Fitzpatrick, Kenneth J Poskitt, Rollin Brant, Anne R Synnes, Ivan L Cepeda, Ruth E Grunau
Affiliations

Invasive procedures in preterm children: brain and cognitive development at school age

Jillian Vinall et al. Pediatrics. 2014 Mar.

Abstract

Background: Very preterm infants (born 24-32 weeks' gestation) undergo numerous invasive procedures during neonatal care. Repeated skin-breaking procedures in rodents cause neuronal cell death, and in human preterm neonates higher numbers of invasive procedures from birth to term-equivalent age are associated with abnormal brain development, even after controlling for other clinical risk factors. It is unknown whether higher numbers of invasive procedures are associated with long-term alterations in brain microstructure and cognitive outcome at school age in children born very preterm.

Methods: Fifty children born very preterm underwent MRI and cognitive testing at median age 7.6 years (interquartile range, 7.5-7.7). T1- and T2-weighted images were assessed for the severity of brain injury. Magnetic resonance diffusion tensor sequences were used to measure fractional anisotropy (FA), an index of white matter (WM) maturation, from 7 anatomically defined WM regions. Child cognition was assessed using the Wechsler Intelligence Scale for Children-IV. Multivariate modeling was used to examine relationships between invasive procedures, brain microstructure, and cognition, adjusting for clinical confounders (eg, infection, ventilation, brain injury).

Results: Greater numbers of invasive procedures were associated with lower FA values of the WM at age 7 years (P = .01). The interaction between the number of procedures and FA was associated with IQ (P = .02), such that greater numbers of invasive procedures and lower FA of the superior WM were related to lower IQ.

Conclusions: Invasive procedures during neonatal care contribute to long-term abnormalities in WM microstructure and lower IQ.

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Figures

FIGURE 1
FIGURE 1
Participant flow chart. aRecruitment stopped after the goal of 100 very preterm children seen at 7 years follow-up was reached. bResearch scans were available only on weekdays after 4 pm, and booking limitations affected study consents for MRI.
FIGURE 2
FIGURE 2
Regions of interest obtained within the WM. A, Superior WM: (a) anterior, (b) middle, and (c) posterior subcortical WM. B, WM tracts: (d) genu of the corpus callosum, (e) posterior limb of the internal capsule, (f) splenium of the corpus callosum, and (g) optic radiations.
FIGURE 3
FIGURE 3
Number of invasive procedures and brain microstructure predicts FSIQ. Higher numbers of invasive procedures (above median: red) and lower FA values of the superior WM were associated with lower FSIQ after adjustment for neonatal and clinical confounders, age at scan, and concurrent brain injury.
See this image and copyright information in PMC

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