Predicting developmental outcomes in premature infants by term equivalent MRI: systematic review and meta-analysis

Abstract

Background: This study aims to determine the prognostic accuracy of term MRI in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes.

Methods: We performed a systematic review searching Central, Medline, Embase, and PsycInfo. Two independent reviewers performed study selection, data extraction, and quality assessment. We documented sensitivity and specificity for three different MRI findings (white matter abnormalities (WMA), brain abnormality (BA), and diffuse excessive high signal intensity (DEHSI)), related to developmental outcomes including cerebral palsy (CP), visual and/or hearing problems, motor, neurocognitive, and behavioral function. Using bivariate meta-analysis, we estimated pooled sensitivity and specificity and plotted summary receiver operating characteristic (sROC) curves for different cut-offs of MRI.

Results: We included 20 papers published between 2000 and 2013. Quality of included studies varied. Pooled sensitivity and specificity values (95 % confidence interval (CI)) for prediction of CP combining the three different MRI findings (using normal/mild vs. moderate/severe cut-off) were 77 % (53 to 91 %) and 79 % (51 to 93 %), respectively. For prediction of motor function, the values were 72 % (52 to 86 %) and 62 % (29 to 87 %), respectively. Prognostic accuracy for visual and/or hearing problems, neurocognitive, and/or behavioral function was poor. sROC curves of the individual MRI findings showed that presence of WMA provided the best prognostic accuracy whereas DEHSI did not show any potential prognostic accuracy.

Conclusions: This study shows that presence of moderate/severe WMA on MRI around term equivalent age can predict CP and motor function in very preterm or low-birth-weight infants with moderate sensitivity and specificity. Its ability to predict other long-term outcomes such as neurocognitive and behavioral impairments is limited. Also, other white matter related tests as BA and DEHSI demonstrated limited prognostic value.

Systematic review registration: PROSPERO CRD42013006362.

Fig. 1

Flowchart of study selection

Fig. 2

Quality assessment of included studies in meta-analysis (n = 20)

Fig. 3

Pooled sensitivity and specificity with sROC reporting four developmental outcomes detected by any MRI abnormality (including white matter abnormality, brain abnormality or diffuse excessive high signal intensity using ‘normal/mild vs. moderate/severe’ cut-off). a (n = seven studies): pooled sensitivity 77 % (53 to 91 %) and specificity 79 % (51 to 93 %). b (n = seven studies): pooled sensitivity 72 % (52 to 86 %) and specificity 62 % (29 to 87 %). c (n = seven studies): pooled sensitivity 66 % (41 to 84 %) and specificity 53 % (35 to 71 %). d (n = four studies): pooled sensitivity 61 % (34 to 83 %) and specificity 85 % (75 to 92 %). The individual studies are visualized as squares with the horizontal axis corresponding to the total non-diseased neonates and vertical axis the total diseased neonates of that particular study population, i.e., a flat square represents a low prevalence of the disease, and the surface of the square represents the size of the study population

Fig. 4

Pooled sensitivity and specificity with sROC corresponding to two different cut-offs of WMA for prediction of for various developmental outcomes/delays (cerebral palsy, IQ, working memory, visual and/or hearing, mental development, language and motor function delay). a Developmental delay in case of “normal vs. any” WMA (n = 13 studies). b Developmental delay in case of “normal/mild vs. moderate/severe” WMA (n = 15 studies). The line represents the sROC curve. The black dot represents the pooled sensitivity and specificity. The blank squares represents the individual studies, with the horizontal axis corresponding to the total non-diseased and vertical axis the total diseased of that particular study population