Elsevier

The Journal of Pediatrics

Volume 193, February 2018, Pages 54-61.e2
The Journal of Pediatrics

Original Articles
Altered Cerebral Perfusion in Infants Born Preterm Compared with Infants Born Full Term

https://doi.org/10.1016/j.jpeds.2017.09.083Get rights and content

Objectives

To compare regional cerebral cortical blood flow (CBF) in infants born very preterm at term-equivalent age (TEA) and healthy newborns born full term and to examine the impact of clinical risk factors on CBF in the cohort born preterm.

Study design

This prospective, cross-sectional study included infants born very preterm (gestational age at birth <32 weeks; birth weight <1500 g) and healthy infants born full term. Using noninvasive 3T arterial spin labeling magnetic resonance imaging, we quantified regional CBF in the cerebral cortex: sensorimotor/auditory/visual cortex, superior medial/dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)/posterior cingulate cortex, insula, and lateral posterior parietal cortex, as well as in the brainstem, and deep gray matter. Analyses were performed controlling for sex, gestational age, and age at magnetic resonance imaging.

Results

We studied 202 infants: 98 born preterm and 104 born full term at TEA. Infants born preterm demonstrated greater global CBF (β = 9.03; P < .0001) and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, ACC and auditory cortex were decreased significantly in infants born preterm compared with their peers born at full term (P < .0001; P = .026; P = .036, respectively). In addition, the presence of parenchymal brain injury correlated with lower global and regional CBF (insula, ACC, sensorimotor, auditory, and visual cortices) whereas the need for cardiac vasopressor support correlated with lower regional CBF in the insula and visual cortex.

Conclusions

Altered regional cortical CBF in infants born very preterm at TEA may reflect early brain dysmaturation despite the absence of cerebral cortical injury. Furthermore, specific cerebral cortical areas may be vulnerable to early hemodynamic instability and parenchymal brain injury.

Section snippets

Methods

Infants were prospectively enrolled at Children's National Health System (Washington, DC) from June 2012 to December 2015.5 Infants born preterm were eligible if born before 32 weeks of gestation with a birth weight <1500 g. Exclusion criteria included chromosomal anomalies, dysmorphic features, congenital brain malformations, central nervous system infection, metabolic disorders, severe brain injury (defined using brain scoring classification),21 and residual active analgesic/sedative

Results

Of the 128 infants born preterm scanned at TEA, 30 (23%) infants born preterm were excluded: 9 (7%) infants had residual analgesic/sedative effects at the time of MRI, 13 (10%) had severe brain injury, 5 (3%) exceeded our TEA window (38-44 weeks of postmenstrual age [PMA]), and 3 (2%) had unusable data as the result of excessive motion. Of the 115 healthy infants born at full term with ASL data, 6 (5%) were scanned after 44 weeks PMA and 5 (4%) presented with motion corrupted data and were

Discussion

In this prospective, observational study, we demonstrated that global and regional CBF was altered in a large cohort of infants born very preterm assessed at TEA compared with healthy newborns born full term. We found that relative CBF in the insula, ACC, and auditory cortex was lower in infants born preterm. Within the cohort born preterm, there was an association between parenchymal brain injury, cardiac vasopressor support, and decreased regional CBF. Collectively, these results suggest

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    Supported by the Canadian Institutes of Health Research (MOP-81116), the SickKids Foundation (XG 06-069), and the National Institutes of Health (R01 HL116585-01). M.B.-K. is a PhD student in the Molecular Medicine Program of the Institute for Biomedical Sciences at the George Washington University. This work is from a dissertation to be presented to the aforementioned program in partial fulfillment of the requirements for the PhD degree. The authors declare no conflicts of interest.

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