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Randomized Controlled Trial
. 2015 Jan;135(1):e32-42.
doi: 10.1542/peds.2014-0898. Epub 2014 Dec 1.

Neuroimaging and neurodevelopmental outcome in extremely preterm infants

Susan R Hintz  1 , Patrick D Barnes  2 , Dorothy Bulas  3 , Thomas L Slovis  4 , Neil N Finer  5 , Lisa A Wrage  6 , Abhik Das  7 , Jon E Tyson  8 , David K Stevenson  2 , Waldemar A Carlo  9 , Michele C Walsh  10 , Abbot R Laptook  11 , Bradley A Yoder  12 , Krisa P Van Meurs  2 , Roger G Faix  12 , Wade Rich  13 , Nancy S Newman  10 , Helen Cheng  6 , Roy J Heyne  14 , Betty R Vohr  11 , Michael J Acarregui  15 , Yvonne E Vaucher  16 , Athina Pappas  17 , Myriam Peralta-Carcelen  9 , Deanne E Wilson-Costello  10 , Patricia W Evans  8 , Ricki F Goldstein  18 , Gary J Myers  19 , Brenda B Poindexter  20 , Elisabeth C McGowan  21 , Ira Adams-Chapman  22 , Janell Fuller  23 , Rosemary D Higgins  24 ; SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Randomized Controlled Trial

Neuroimaging and neurodevelopmental outcome in extremely preterm infants

Susan R Hintz et al. Pediatrics. 2015 Jan.

Abstract

Background: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age.

Methods: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors.

Results: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes.

Conclusions: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.

Trial registration: ClinicalTrials.gov NCT00233324.

Keywords: MRI; neurodevelopmental; neuroimaging; preterm infant; ultrasound.

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References

    1. Ment LR, Bada HS, Barnes P, et al. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society . Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;58(12):1726–1738 - PubMed
    1. De Vries LS, Van Haastert IL, Rademaker KJ, Koopman C, Groenendaal F. Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. J Pediatr. 2004;144(6):815–820 - PubMed
    1. Kuban KC, Allred EN, O’Shea TM, et al. ELGAN study investigators . Cranial ultrasound lesions in the NICU predict cerebral palsy at age 2 years in children born at extremely low gestational age. J Child Neurol. 2009;24(1):63–72 - PMC - PubMed
    1. O’Shea TM, Allred EN, Kuban KCK, et al. ELGAN Study Investigators . Intraventricular hemorrhage and developmental outcomes at 24 months of age in extremely preterm infants. J Child Neurol. 2012;27(1):22–29 - PMC - PubMed
    1. Pinto-Martin JA, Whitaker AH, Feldman JF, Van Rossem R, Paneth N. Relation of cranial ultrasound abnormalities in low-birthweight infants to motor or cognitive performance at ages 2, 6, and 9 years. Dev Med Child Neurol. 1999;41(12):826–833 - PubMed

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