PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome

Abstract

BackgroundMore than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12–24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age.Methods/designThis prospective cohort study will recruit 80 preterm infants born ≤30 week’s gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women’s Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay).DiscussionEarlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0439-z) contains supplementary material, which is available to authorized users.

Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age

“…Inclusion criteria for term-born infants were a gestational age at birth of 38 -41 weeks; birthweight above the 10th percentile; an uncomplicated pregnancy, delivery, and postpartum period; and normal neurologic examination findings. 26 …”

“…Preterm infants were eligible if they had no congenital abnormality, and their parents/caregivers were English-speaking who lived within a 200-km radius of the hospital. 26 A reference sample of healthy term-born infants was simultaneously recruited to generate reference values and cut-points for the regional brain measurements that form part of the scoring system. Inclusion criteria for term-born infants were a gestational age at birth of 38 -41 weeks; birthweight above the 10th percentile; an uncomplicated pregnancy, delivery, and postpartum period; and normal neurologic examination findings.…”

What is the Significance of Leftward Cradling Bias?

“…Several studies support positioning as an important component of the care of both premature and full term infants [31,[33][34][35]48]. Researchers have investigated handedness [39] and other hemispheric lateralization theories related to emotional processing both for the mother [8,9,49] and infant [14,[50][51][52]. The relationship of cradling bias to the neural substrates of face processing have also been a subject of study [19,21,[53][54][55][56][57].…”

Short-Term Effects of Hydrokinesiotherapy in Hospitalized Preterm Newborns

“…In recent decades, efforts have been made in multidisciplinary programs regarding the introduction of new concepts related to humanization and care in newborn development [17]. Paying special attention to pain, stress, and discomfort as well as techniques intended to reduce them can provide a starting point for improved quality of life for preterm newborns hospitalized in neonatal units.…”