Progress in Neonatal Neurology with a Focus on Neuroimaging in the Preterm Infant

Abstract

There have been tremendous changes in the methods used to evaluate brain injury in the preterm infant in the past 30 years. In particular, major improvements have been made in how we use neuroimaging techniques and now magnetic resonance imaging (MRI) is used more often and considered complimentary to routine and sequential cranial ultrasound. The focus has shifted from severe lesions such as large intraventricular and parenchymal hemorrhages and cystic periventricular leukomalacia to assessing and understanding the etiology of more subtle noncystic white matter injury, punctate hemorrhage, and cerebellar lesions. The more severe lesions that dominated the early period of preterm neonatal brain imaging occur less frequently but are still associated with major disabilities, such as, cerebral palsy, while subtle white matter injury and cerebellar lesions are more often associated with cognitive and behavioral problems, which have become the most prevalent issues among the survivors of extremely preterm birth.

Clinical neuroimaging in the preterm infant: Diagnosis and prognosis

“…Cranial ultrasound (cUS) and conventional MRI (using a clinical/qualitative approach) are the main neuroimaging techniques used in hospital environments for the diagnosis and characterization of perinatal brain injury ( de Vries et al, 2015 , Rutherford et al, 2010 , Tusor et al, 2014 ). cUS is a noninvasive and low-cost means of study to examine infants at high risk for neurological damage without mobilizing them outside the neonatal intensive care unit (NICU) —even though the MRI global market is moving in this direction to get high-quality diagnostic imaging inside the NICU ( Tkach et al, 2014 ).…”

“…This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches (e.g., neuropathology, neuroimaging, and clinical findings). This is evident from the combination of intense pre-clinical ( Back and Miller, 2014 , Kinney and Volpe, 2012 , Palliser et al, 2016 , Riddle et al, 2011 , van Tilborg et al, 2016 , Volpe et al, 2011 ) and clinicopathologic research ( Counsell et al, 2008 , de Vries et al, 2015 , Harmony et al, 2016 , Ment et al, 2009a , Pierson et al, 2007 , Rutherford et al, 2010 , Volpe, 2009a ) along with neonatal neurology and quantitative neuroimaging research.…”

Preterm Birth during Influenza Season Is Associated with Adverse Outcome in Very Low Birth Weight Infants

“…Future studies need to include MRI technology in order to detect subtle white matter changes (punctuate lesions) and diffuse white matter injury (diffuse excessive high signal intensity, DEHSI) (26). …”

Opportunities for Prevention and Rehabilitation Treatment of the Consequences of Perinatal Central Nervous System Damage in Premature Infants

“…Другим механизмом развития тяжелых соматовегетативных нарушений являются внутрижелудочковые кровоизлияния (ВЖК), типичные для перинатальных поражений мозга у детей с ЭНМТ. Практически все геморрагические повреждения головного мозга обнаруживаются в конце раннего неонатального периода и только 10% -в более позднее время [28][29][30]. У недоношенных детей ВЖК возникают в 20-25% случаев, у детей с ЭНМТ -в 45% [31,32], как правило, при рождении или в первые 96 ч [33].…”

“…У 14% детей не было верифицировано каких-либо значительных моторных нарушений [31]. Геморрагические поражения в 3-15% случаев осложняются развитием геморрагического перивентрикулярного инфаркта с возможным формированием порэнцефалической кисты [29].…”