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