Associations between Neonatal Magnetic Resonance Imaging and Short- and Long-Term Neurodevelopmental Outcomes in a Longitudinal Cohort of Very Preterm Children

Jansen, Lisette; Berg-Huysmans, Annette A. van den; Bruine, Sica T. Wiggers-de; Rijken, Monique; Vries, Linda S. de; Vermeiren, Robert; Peeters-Scholte, Cacha; Steggerda, Sylke J.

doi:10.1016/j.jpeds.2021.02.005

Cited by 23 publications

(18 citation statements)

References 44 publications

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“…It is possible that there are more subtle effects of hypercapnia on brain development that are not clinically apparent on the Bayley Scales at 2 years of age or that the effects seen on MRI at term equivalent age are transient. This would be consistent with a recently published study using a similar MRI scoring system, in which Jansen et al [17] found that MRI abnormalities at term equivalent age were independently associated with cognition, motor skills, and behavior…”

Section: Accepted Manuscriptsupporting

confidence: 92%

Hypercapnia: An Added Culprit in Gray Matter Injury in Preterm Neonates

et al. 2022

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Over the last decade, there has been increased recognition of diverse forms of primary gray matter injury (GMI) in postpreterm neonates. In this study, we aimed to assess whether early neonatal hypercapnia in the preterm infant was associated with GMI on magnetic resonance imaging (MRI) at term equivalent age (TEA). All blood gases taken during the first 2 weeks of life were analyzed for hypercapnia. MRI was performed at TEA postpreterm infants using a unique neonatal MRI 1T scanner. The neonatal MRI scans were assessed using a standardized scoring system, the Kidokoro scoring system, a method used to assess abnormal brain metrics and the presence and severity of brain abnormalities. Subscores are assigned for different regions of the brain. Twenty-nine infants were studied, about half of whom had evidence of some gray matter abnormality. Fifteen of the infants were hypercapnic. The hypercapnic infants had significantly higher deep gray matter abnormality readings as compared with the nonhypercapnic infants (12 [11; 12] vs. 10 [8; 11], respectively; p = 0.0106). Correlations were observed between peak pCO2 over the first 2 weeks of life and the overall gray matter abnormality score (GMAS) at TEA, and between the percentage of hypercapnic blood gases during the first 2 weeks of life and the GMAS. All of the infants in our population who had severe GMI at TEA were hypercapnic in the first 2 weeks of life. In conclusion, our data show a correlation between early hypercapnia in preterm neonates and GMI at TEA.

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Section: Accepted Manuscriptsupporting

confidence: 92%

Hypercapnia: An Added Culprit in Gray Matter Injury in Preterm Neonates

et al. 2022

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“…PIH was significantly associated with severe functional disability, while PVL was less frequent and not associated with a poor outcome, probably due to the small number of children included in the study. Recent studies show that neonatal brain injury, assessed by a standardized magnetic resonance imaging (MRI) scoring system, is associated with short-term neurodevelopmental outcomes, but environmental factors are also important for cognitive development, especially for children with mild neonatal brain injury ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Neuroprem 2: An Italian Study of Neurodevelopmental Outcomes of Very Low Birth Weight Infants

Lugli¹,

Bedetti

Guidotti³

et al. 2021

Front. Pediatr.

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Background: Despite the increased survival of preterm newborns worldwide, the risk of neurodevelopmental disabilities remains high. Analyzing the outcomes of the preterm population can identify risk factors and enable specific early interventions.Aims: Neuroprem is a prospective cohort study of very low birth weight (VLBW) infants that aims to evaluate the neurodevelopmental outcomes and risk factors for severe functional disability at 2 years of corrected age.Methods: Nine Italian neonatal intensive care units participated in the network. The Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and a neuro-functional evaluation (according to the International Classification of Disability and Health and Neuro-Functional Assessment, or NFA ICF-CY) were administered to VLBW infants at 24 months of corrected age. The primary outcome measure was severe functional disability, defined as cerebral palsy, bilateral blindness, deafness, an NFA ICF-CY of >2, a BSDI III cognitive composite score of <2 SD, or a GMDS-R global quotient score of <2 SD. Perinatal risk factors for severe functional disability were assessed through multivariate logistic regression analysis.Results: Among 502 VLBW survivors who completed the 24-month follow-up, 48 (9.6%) presented severe functional disability, of whom 27 had cerebral palsy (5.4%). Rates of severe functional disability and cerebral palsy were higher in neonates with a lower gestational age (p < 0.001). Overall, 147 infants (29.3%) were referred to neuromotor intervention. In the multivariate regression model, gestational age at birth OR 0.79; 95% CI 0.67–0.90; p = 0.001) and periventricular-intraventricular hemorrhage (OR 2.51; 95% CI 1.19–5.26; p = 0.015) were significantly associated with severe functional disability.Conclusion: Neuroprem 2 provides updated information on the neurodevelopmental outcomes of VLBW infants in a large Italian cohort. The overall rate of neurodevelopmental disabilities was quite lower than reported in the previous literature. These data indicate the need for structured follow-up programs from a national neonatal network perspective.

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“…The typical pattern of brain injury experienced by preterm neonates is well described and includes intraventricular hemorrhage, venous infarction, periventricular echogenicity and leukomalacia, post-hemorrhagic ventricular dilatation, and hypoxic ischemic injury (Inder et al, 2021;Ortinau and Neil, 2015). However, only the more severe lesions evident on neuroimaging translate into longer term outcomes, with environmental factors exerting a greater influence on outcomes over time, especially in those with milder brain injury on imaging (Jansen et al, 2021). Furthermore, developmental delay in the preschool years does not necessarily portend later neurodevelopmental impairment in later years, particularly in the absence of neurosensory impairment or motor disability such as cerebral palsy (Hack et al, 2005).…”

Section: Brain Injury In Preterm Infantsmentioning

confidence: 99%

Impact of Comorbid Prematurity and Congenital Anomalies: A Review

Gunn-Charlton

2022

Front. Physiol.

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Preterm infants are more likely to be born with congenital anomalies than those who are born at full-term. Conversely, neonates born with congenital anomalies are also more likely to be born preterm than those without congenital anomalies. Moreover, the comorbid impact of prematurity and congenital anomalies is more than cumulative. Multiple common factors increase the risk of brain injury and neurodevelopmental impairment in both preterm babies and those born with congenital anomalies. These include prolonged hospital length of stay, feeding difficulties, nutritional deficits, pain exposure and administration of medications including sedatives and analgesics. Congenital heart disease provides a well-studied example of the impact of comorbid disease with prematurity. Impaired brain growth and maturity is well described in the third trimester in this population; the immature brain is subsequently more vulnerable to further injury. There is a colinear relationship between degree of prematurity and outcome both in terms of mortality and neurological morbidity. Both prematurity and relative brain immaturity independently increase the risk of subsequent neurodevelopmental impairment in infants with CHD. Non-cardiac surgery also poses a greater risk to preterm infants despite the expectation of normal in utero brain growth. Esophageal atresia, diaphragmatic hernia and abdominal wall defects provide examples of congenital anomalies which have been shown to have poorer neurodevelopmental outcomes in the face of prematurity, with associated increased surgical complexity, higher relative cumulative doses of medications, longer hospital and intensive care stay and increased rates of feeding difficulties, compared with infants who experience either prematurity or congenital anomalies alone.

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Associations between Neonatal Magnetic Resonance Imaging and Short- and Long-Term Neurodevelopmental Outcomes in a Longitudinal Cohort of Very Preterm Children

Cited by 23 publications

References 44 publications

Hypercapnia: An Added Culprit in Gray Matter Injury in Preterm Neonates

Hypercapnia: An Added Culprit in Gray Matter Injury in Preterm Neonates

Neuroprem 2: An Italian Study of Neurodevelopmental Outcomes of Very Low Birth Weight Infants

Impact of Comorbid Prematurity and Congenital Anomalies: A Review

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