Preterm Neuroimaging and School-Age Cognitive Outcomes

Abstract

Background and Objectives: Children born extremely preterm (EPT) are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial US (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6–7 years among children born EPT, and assess their prognostic value. Methods: A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6–7 years including FSIQ <70 and moderate-severe disability (FSIQ<70, moderate-severe cerebral palsy, or severely vision or hearing impaired) in a subgroup of SUPPORT enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. Results: 386 children had follow up at 6–7 years. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI, and adverse CUS findings were associated with 6–7 year outcomes. In full regression models, both adverse late CUS findings (OR 27.9, 95%CI 6.0–129) and significant cerebellar lesions on MRI (OR 2.71, 95% CI 1.1–6.7) remained associated with moderate-severe disability, but only adverse late CUS findings (OR 20.1, 95%CI 3.6–110.8) with FSIQ<70. Predictive accuracy of stepwise models was not substantially improved with addition of neuroimaging. Conclusions: Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school-age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of FSIQ<70 or moderate-severe disability at early school age.

Head Growth and Intelligence from Birth to Adulthood in Very Preterm and Term Born Individuals

“…Model fit values indicated that the developmental pathways included in this study accurately reflect the true neurodevelopmental mechanisms in the two populations studied. Thus, our results confirm previous evidence suggesting that repeated early head circumference measurements are a valuable and easy screening tool for long-term neurocognitive risk assessment after preterm birth, in particular in light of recent findings refuting the diagnostic benefits of routine MRI on preterm infants (Edwards et al, 2018; Hintz et al, 2018).…”

Applying a data-driven approach to quantify EEG maturational deviations in preterms with normal and abnormal neurodevelopmental outcomes

“…After Linking brain-age trajectories with neurodevelopmental outcome. Figure 3 shows the overall test performance on 2 after training on the entirety of 1  . The trajectory summary metrics are shown for all values of N f , and compared between the normal and abnormal outcome groups.…”

“…Two separate cohorts of patients were recruited, resulting in two separate EEG datasets referred to as 1  and 2  in this study, respectively. 1  consisted of 89 EEG recordings from 26 patients with PMA range 27.3-42.0 weeks (median recording duration (IQR): 4 h 23 m (3 h 53 m-5 h 46 m), median number of recordings per patient: 3 (3-4)) and were recruited in the period February 2013 -September 2014. These were preselected based on a normal neurodevelopmental outcome at nine and 24 months of corrected age, clinically defined according to Pillay et al 32 and Dereymaeker et al 33 and based on the Bayley Scores of Infant mental and motor Development II (BSID-II).…”

“…Preterm birth gives children an increased risk of neurodevelopmental impairments resulting in motor, cognitive, functional or emotional disabilities. Susceptibility for, and the severity of, these complications rise with decreasing gestational age (GA = the age at birth since the last menstrual cycle of the mother) and with an acquired injury to the developing brain 1 . Increased survival, especially from the most extreme preterm infants, requires efforts to improve the early prediction of abnormal neurodevelopmental outcome.…”

Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm

“…2,3 Each of these neonatal morbidities is predictive of adverse neurodevelopmental impairment. [3][4][5][6][7][8][9][10][11] To the extent that neonatal morbidities lie on a causal pathway connecting extremely preterm birth to adverse child health and neurodevelopmental outcomes, interventions that target antecedents of BPD, NEC, sepsis, severe brain injury, and ROP have the potential for increasing the likelihood that an extremely preterm birth will remain free from chronic health or developmental problems.…”