Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study

doi:10.1067/S0022-3476(03)00357-3

The Journal of Pediatrics

Volume 143, Issue 2, August 2003, Pages 171-179

https://doi.org/10.1067/S0022-3476(03)00357-3 Get rights and content

Abstract

Objectives The aim of this study was to define qualitatively the nature and extent of white and gray matter abnormalities in a longitudinal population-based study of infants with very low birth weight. Perinatal factors were then related to the presence and severity of magnetic resonance imaging (MRI) abnormalities.

Methods From November 1998 to December 2000, 100 consecutive premature infants admitted to the neonatal intensive care unit at Christchurch Women's Hospital were recruited (98% eligible) after informed parental consent to undergo an MRI scan at term equivalent. The scans were analyzed by a single neuroradiologist experienced in pediatric MRI, with a second independent scoring of the MRI using a combination of criteria for white matter (cysts, signal abnormality, loss of volume, ventriculomegaly, corpus callosal thinning, myelination) and gray matter (gray matter signal abnormality, gyration, subarachnoid space). Results were analyzed against individual item scores as well as the presence of moderate-severe white matter score, total gray matter score, and total brain score.

Results The mean gestational age was 27.9±2.4 weeks (range, 23-32 weeks), and mean birth weight was 1063±292 g. The greatest univariate predictors for moderate-severe white matter abnormality were lower gestational age (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; P<.01), maternal fever (OR, 2.2; 95% CI, 1.1-4.6; P<.04), proven sepsis in the infant at delivery (OR, 1.8; 95% CI, 1.1-3.6; P = 0.03), inotropic support (OR, 2.7; 95% CI, 1.5-4.5; P<.001), patent ductus arteriosus (OR, 2.2; 95% CI, 1.2-3.8; P = .01), grade III/IV intraventricular hemorrhage (P = .015), and the occurrence of a pneumothorax (P = .05). There was a significant protective effect of intrauterine growth restriction (OR, 0.51; 95% CI, 0.23-0.99; P = .04). Gray matter abnormality was highly related to the presence and severity of white matter abnormality. A unique pattern of cerebral abnormality consisting of significant diffuse white matter atrophy, ventriculomegaly, immature gyral development, and enlarged subarachnoid space was found in 10 of 11 infants with birth gestation <26 weeks. Given the later outcome of these infants, this pattern may have very high risk for later global neurodevelopmental disability.

Conclusions This MRI study confirms a high incidence of cerebral white matter abnormality at term in an unselected population of premature infants, which is predominantly a result of noncystic injury in the extremely immature infant. We confirm that the major perinatal risk factors for white matter abnormality are related to perinatal infection, particularly maternal fever and infant sepsis, and hypotension with inotrope use. We have defined a distinct pattern of diffuse white and gray matter abnormality in the extremely immature infant.

Section snippets

Subjects

From November 1998 to December 2000, 100 consecutive premature infants admitted to the neonatal intensive care unit at Christchurch Women's Hospital were recruited after informed parental consent to undergo an MRI scan at term equivalent. These infants represented 98% of all eligible infants with VLBW admitted during that period. Ten healthy term infants were also scanned on their week of due date. MRI scanning was undertaken after the infants were fed and wrapped in a Vac Fix bean bag (S&S

Subject characteristics

The mean gestational age (±SD) was 27.9±2.4 weeks (range, 23-32 weeks), and the mean (±SD) birth weight was 1063±292 g (Table II). Thirty-two infants (32%) remained oxygen-dependent at 36 weeks' corrected gestational age.

Magnetic resonance imaging scores

The numbers of infants with abnormal scores in each category are shown in Table I. The total MRI scores ranged between 8 and 19 (range of possible scores, 5-25). The strongest correlations between scores were found between WM signal abnormality and WM reduction (r = .55) and

Discussion

This study has demonstrated a high incidence of cerebral abnormality, particularly in the cerebral WM, at term equivalent in an unselected regional population of VLBW infants. Noncystic WM injury was more common than cystic WM injury. The extremely immature infant of <26 weeks' gestational age exhibited a unique pattern of cerebral WM and gray matter abnormality, the former characterized by ventriculomegaly and a marked reduction in WM volume, without cystic WM injury or signal abnormality, and

Acknowledgements

We thank the Canterbury Radiology Group for their support and assistance.

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^☆: Supported by the Neurological Foundation of New Zealand, Lottery Health New Zealand, and the Health Research Council of New Zealand.

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Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study☆

Abstract

Section snippets

Subjects

Subject characteristics

Magnetic resonance imaging scores

Discussion

Acknowledgements

Clin Perinatol

Early Hum Dev

Pediatr Neurol

Semin Neonatol

Lancet

Lancet

Semin Perinatol

Perinatal brain injury in preterm infants and later neurobehavioral function

JAMA

Neurobehavioral deficits in premature graduates of intensive care—potential medical and neonatal environmental risk factors

Pediatrics

Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g

Arch Pediatr Adolesc Med

Ten year follow up of children born before 29 gestational weeks: health, cognitive development, behaviour and school achievement

Acta Paediatr

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

Pediatrics

Relationship between magnetic resonance images and histopathological findings of the brain in extremely sick preterm infants

AJNR

Predictive value of neonatal MRI as compared to ultrasound in premature infants with mild periventricular white matter changes

Neuropediatrics

Magnetic resonance imaging at term and neuromotor outcome in preterm infants

Acta Paediatr

MR imaging of perinatal brain damage: comparison of clinical outcome with initial and follow-up MR findings

Am J Neuroradiol

White matter injury in the premature infant: a comparison between serial cranial ultrasound and MRI at term

AJNR

Correlation between cerebral visual impairment and magnetic resonance imaging in children with neonatal encephalopathy

Dev Med Child Neurol

Gyral development of the human brain

Ann Neurol

Developmental stages of human brain: an MR study

J Comput Assist Tomogr

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

AJNR

Parenchymal brain injury in the preterm infant: comparison of cranial ultrasound, MRI and neurodevelopmental outcome

Neuropediatrics