Early Brain Injury in Premature Newborns Detected with Magnetic Resonance Imaging is Associated with Adverse Early Neurodevelopmental Outcome

doi:10.1016/j.jpeds.2005.06.033

The Journal of Pediatrics

Volume 147, Issue 5, November 2005, Pages 609-616

https://doi.org/10.1016/j.jpeds.2005.06.033 Get rights and content

Objective

To determine the neurodevelopmental outcome of prematurely born newborns with magnetic resonance imaging (MRI) abnormalities.

Study design

A total of 89 prematurely born newborns (median age 28 weeks postgestation) were studied with MRI when stable for transport to MRI (median age, 32 weeks postgestation); 50 newborns were studied again near term age (median age, 37 weeks). Neurodevelopmental outcome was determined at 18 months adjusted age (median) using the Mental Development Index (Bayley Scales Infant Development II) and a standardized neurologic exam.

Results

Of 86 neonatal survivors, outcome was normal in 51 (59%), borderline in 22 (26%), and abnormal in 13 (15%). Moderate/severe MRI abnormalities were common on the first (37%) and second (32%) scans. Abnormal outcome was associated with increasing severity of white matter injury, ventriculomegaly, and intraventricular hemorrhage on MRI, as well as moderate/severe abnormalities on the first (relative risk [RR] = 5.6; P = .002) and second MRI studies (RR = 5.3; P = .03). Neuromotor abnormalities on neurologic examination near term age (RR = 6.5; P = .04) and postnatal infection (RR = 4.0; P = .01) also increased the risk for abnormal neurodevelopmental outcome.

Conclusions

In premature newborns, brain abnormalities are common on MRI early in life and are associated with adverse neurodevelopmental outcome.

Section snippets

Methods

Prematurely born neonates (< 34 weeks gestational age) born in or transferred to our institution's intensive care nursery between April 1998 and March 2003 were approached for enrollment in a prospective cohort study evaluating the detection of brain injury by MRI. Gestational age was calculated based on the last menstrual period or early ultrasound (< 24 weeks); if the difference between the 2 methods exceeds 7 days, then the ultrasound date was used. Criteria for excluding a newborn from

Clinical Characteristics and Neurodevelopmental Outcome

Newborns (n = 89) with a median gestational age at birth of 28 weeks (range, 24 to 34 weeks) were studied. None of the newborns had a serious adverse event related to the MRI. Three of the newborns died in the neonatal period, of multisystem failure. Of the survivors, outcome was normal in 51 (59%), borderline in 22 (26%), and abnormal in 13 (15%). The age at follow-up was similar in the newborns with normal (median, 18.2 [interquartile range, 13.1 to 19.2]), borderline (18.2 [13.3 to 21.4]),

Discussion

We have documented that brain abnormalities in premature newborns are safely and reliably detected with MRI well before term-equivalent age, and that the severity of these abnormalities is associated with adverse early neurodevelopmental outcome. Because brain abnormalities can be safely detected early in life in premature newborns, it is not necessary to delay MRI to term-equivalent age to obtain prognostic information. In our cohort, noncystic white matter injury, ventriculomegaly, and IVH

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: Supported by the National Institutes of Health (grants NS35902, NS40117, and NS046432). S.P.M. is supported by the Canadian Institutes of Health Research Clinician Scientist Program (Phase 1). This study was carried out in part in the Pediatric Clinical Research Center, Moffitt Hospital, University of California San Francisco, with funds provided by the U.S. Public Health Service, National Center for Research Resources (grant 5 M01 RR-01271).

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Original ArticleEarly Brain Injury in Premature Newborns Detected with Magnetic Resonance Imaging is Associated with Adverse Early Neurodevelopmental Outcome

Objective

Study design

Results

Conclusions

Section snippets

Methods

Clinical Characteristics and Neurodevelopmental Outcome

Discussion

Brain Dev

J Pediatr

J Pediatr

J Pediatr

Am J Obstet Gynecol

J Pediatr

J Pediatr

Am J Obstet Gynecol

Lancet

Neurology of the newborn

Province-based study of neurologic disability of children weighing 500 through 1249 grams at birth in relation to neonatal cerebral ultrasound findings

Pediatrics

Predictors of long-term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound

Pediatrics

Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants

Pediatrics

White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term

AJNR Am J Neuroradiol

Comparing the diagnosis of white matter injury in premature newborns with serial MR imaging and transfontanel ultrasonography findings

AJNR Am J Neuroradiol

Limitations of ultrasonography for diagnosing white matter damage in preterm infants

Arch Dis Child Fetal Neonatal Ed

Magnetic resonance imaging of the infant brain: anatomical characteristics and clinical significance of punctate lesions

Arch Dis Child Fetal Neonatal Ed

Original Article
Early Brain Injury in Premature Newborns Detected with Magnetic Resonance Imaging is Associated with Adverse Early Neurodevelopmental Outcome