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Observational Study
. 2016 Nov;138(5):e20161640.
doi: 10.1542/peds.2016-1640.

Third Trimester Brain Growth in Preterm Infants Compared With In Utero Healthy Fetuses

Marine Bouyssi-Kobar  1   2 , Adré J du Plessis  3 , Robert McCarter  4 , Marie Brossard-Racine  5 , Jonathan Murnick  1 , Laura Tinkleman  1 , Richard L Robertson  6 , Catherine Limperopoulos  7
Affiliations
Observational Study

Third Trimester Brain Growth in Preterm Infants Compared With In Utero Healthy Fetuses

Marine Bouyssi-Kobar et al. Pediatrics. 2016 Nov.

Abstract

Background and objectives: Compared with term infants, preterm infants have impaired brain development at term-equivalent age, even in the absence of structural brain injury. However, details regarding the onset and progression of impaired preterm brain development over the third trimester are unknown. Our primary objective was to compare third-trimester brain volumes and brain growth trajectories in ex utero preterm infants without structural brain injury and in healthy in utero fetuses. As a secondary objective, we examined risk factors associated with brain volumes in preterm infants over the third-trimester postconception.

Methods: Preterm infants born before 32 weeks of gestational age (GA) and weighing <1500 g with no evidence of structural brain injury on conventional MRI and healthy pregnant women were prospectively recruited. Anatomic T2-weighted brain images of preterm infants and healthy fetuses were parcellated into the following regions: cerebrum, cerebellum, brainstem, and intracranial cavity.

Results: We studied 205 participants (75 preterm infants and 130 healthy control fetuses) between 27 and 39 weeks' GA. Third-trimester brain volumes were reduced and brain growth trajectories were slower in the ex utero preterm group compared with the in utero healthy fetuses in the cerebrum, cerebellum, brainstem, and intracranial cavity. Clinical risk factors associated with reduced brain volumes included dexamethasone treatment, the presence of extra-axial blood on brain MRI, confirmed sepsis, and duration of oxygen support.

Conclusions: These preterm infants exhibited impaired third-trimester global and regional brain growth in the absence of cerebral/cerebellar parenchymal injury detected by using conventional MRI.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Parcellation of preterm (top row) and fetal (lower row) brain. Anatomic T2-weighted images and corresponding parcellation maps in a preterm infant at 31 4/7 weeks GA (top row) and a fetus at 32 2/7 weeks’ GA (lower row). Dark gray: cerebrum; intermediate gray: cerebellum; light gray: brainstem; and white: cerebrospinal fluid.
FIGURE 2
FIGURE 2
Brain volumes plotted against GA at MRI in the preterm and fetal cohorts (controlling for sex).
See this image and copyright information in PMC

References

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