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. 2021 Jun:233:58-65.e3.
doi: 10.1016/j.jpeds.2020.11.058. Epub 2020 Nov 28.

Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age Magnetic Resonance Imaging in Infants Born Very Preterm

Nehal A Parikh  1 , Puneet Sharma  2 , Lili He  2 , Hailong Li  3 , Mekibib Altaye  4 , Venkata Sita Priyanka Illapani  3 ; Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS) Investigators
Collaborators, Affiliations

Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age Magnetic Resonance Imaging in Infants Born Very Preterm

Nehal A Parikh et al. J Pediatr. 2021 Jun.

Abstract

Objective: To identify perinatal clinical diseases and treatments that are associated with the development of objectively diagnosed diffuse white matter abnormality (DWMA) on structural magnetic resonance imaging (MRI) at term-equivalent age in infants born very preterm.

Study design: A prospective cohort of 392 infants born very preterm (≤32 weeks of gestational age) was enrolled from 5 level III/IV neonatal intensive care units between September 2016 and November 2019. MRIs of the brain were collected at 39 to 45 weeks of postmenstrual age to evaluate DWMA volume. A predefined list of pertinent maternal characteristics, pregnancy/delivery data, and neonatal intensive care unit data were collected for enrolled patients to identify antecedents of objectively diagnosed DWMA.

Results: Of the 392 infants in the cohort, 377 (96%) had high-quality MRI data. Their mean (SD) gestational age was 29.3 (2.5) weeks. In multivariable linear regression analyses, pneumothorax (P = .027), severe bronchopulmonary dysplasia (BPD) (P = .009), severe retinopathy of prematurity (P < .001), and male sex (P = .041) were associated with increasing volume of DWMA. The following factors were associated with decreased risk of DWMA: postnatal dexamethasone therapy for severe BPD (P = .004), duration of caffeine therapy for severe BPD (P = .009), and exclusive maternal milk diet at neonatal intensive care unit discharge (P = .049).

Conclusions: Severe retinopathy of prematurity and BPD exhibited the strongest adverse association with development of DWMA. We also identified treatments and nutritional factors that appear protective against the development of DWMA that also have implications for the clinical care of infants born very preterm.

Keywords: epidemiology; etiology; infant; magnetic resonance imaging; preterm.

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Conflict of interest statement

Conflict of Interest: None of the authors have any conflicts of interest to disclose. The funders played no role in the design, analysis, or presentation of the findings. The first author, NAP, wrote the first draft of the manuscript.

Figures

Figure 1.
Figure 1.. Semiautomated segmentation of diffuse white matter abnormality (DWMA) in the periventricular and central white matter.
A. Top three panels display raw axial T2-weighed magnetic resonance images through the central part of the brain from a 28 week very preterm boy. Higher signal intensity can be appreciated in the white matter from the surrounding gray matter. Bottom three panels display the segmented (yellow) moderate degree of DWMA white matter regions. B. Top three panels display raw axial T2-weighed MR images from a 30 week very preterm boy. Higher signal intensity can be appreciated in the periventricular and central white matter from the surrounding gray matter. Bottom three panels display the segmented (yellow) severe DWMA.
See this image and copyright information in PMC

Comment in

References

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