Punctate White Matter Lesions Associated With Altered Brain Development And Adverse Motor Outcome In Preterm Infants

Abstract

Preterm infants who develop neurodevelopmental impairment do not always have recognized abnormalities on cerebral ultrasound, a modality routinely used to assess prognosis. In a high proportion of infants, MRI detects punctate white matter lesions that are not seen on ultrasonography. To determine the relation of punctate lesions to brain development and early neurodevelopmental outcome we used multimodal brain MRI to study a large cohort of preterm infants. Punctate lesions without other focal cerebral or cerebellar lesions were detected at term equivalent age in 123 (24.3%) (59 male) of the 506 infants, predominantly in the centrum semiovale and corona radiata. Infants with lesions had higher gestational age, birth weight, and less chronic lung disease. Punctate lesions showed a dose dependent relation to abnormalities in white matter microstructure, assessed with tract-based spatial statistics, and reduced thalamic volume (p < 0.0001), and predicted unfavourable motor outcome at a median (range) corrected age of 20.2 (18.4–26.3) months with sensitivity (95% confidence intervals) 71 (43–88) and specificity 72 (69–77). Punctate white matter lesions without associated cerebral lesions are common in preterm infants currently not regarded as at highest risk for cerebral injury, and are associated with widespread neuroanatomical abnormalities and adverse early neurodevelopmental outcome.

Phenotyping the preterm brain: characterising individual deviations from normative volumetric development in two large infant cohorts

“…In agreement with group mean studies reporting reduced thalamic size at TEA [38][39][40] , we showed a subset of preterm infants with thalamic volumes significantly below the model mean (Z<-2.6). These infants had a high load of PWMLs, further supporting previous suggestions of a close link between thalamic development and white matter abnormalities, including a previous group analysis of the EPrime dataset 38,41,42 . The cerebellum is one of the most rapidly growing structures during the perinatal period, but altered cerebellar development in preterm infants and its relation to supratentorial brain injury is complex and poorly characterized [43][44][45][46] .…”

Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study

“…WMI was distributed throughout the white matter, in contrast to preterm infants where WMI is predominantly observed in the centrum semiovale and corticospinal tracts 66 67. While inflammatory and hypoxic–ischaemic injury to susceptible premyelinating oligodendrocytes68 may be responsible in both groups, it is possible that spatial differences in lesion distribution reflect developmental differences in the regional vulnerability of premyelinating oligodendrocytes between preterm infants and term infants with CHD.…”

White Matter Injury and Structural Anomalies in Infants with Prenatal Opioid Exposue

“…19 Neurodevelopmental sequelae of punctate white matter lesions are variable, with some preterm infants with small isolated lesions (as in our cohort) reported as healthy, while others with more extensive lesion burden displaying motor and cognitive delays. 20,21 Diffuse non-necrotic white matter injury is also commonly seen in preterm infants and also reflects disruption of the normal maturation of preoligodendrocytes. 15,16,22 Outcomes after this diffuse mild injury are also variable.…”