Elsevier

The Journal of Pediatrics

Volume 160, Issue 4, April 2012, Pages 559-566.e1
The Journal of Pediatrics

Original Article
Neonatal Magnetic Resonance Imaging and Outcome at Age 30 Months in Extremely Preterm Infants

https://doi.org/10.1016/j.jpeds.2011.09.053Get rights and content

Objective

To examine associations between brain white matter abnormalities, including diffuse excessive high signal intensities, detected on neonatal magnetic resonance imaging (MRI) with neurodevelopmental outcome at age 30 months.

Study design

This was a prospective, population-based study of infants born at <27 weeks gestation (n = 117) undergoing conventional MRI at term equivalent age (n = 107). At age 30 months corrected, 91 of the preterm infants (78%) and 85 term-born controls were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III).

Results

Cerebral palsy (CP) was present in 7% of the preterm group. On the BSID-III, mean composite scores were 96 ± 9.5 for the cognitive scale, 97 ± 14 for language scales, and 103 ± 15 for motor scales, all within the normal range for age. Compared with the term-born controls, however, the preterm infants did not perform as well on all 3 scales, also when MRI was normal. Significant associations were seen between moderate to severe white matter abnormalities and CP (P < .001). The presence of diffuse excessive high signal intensities was not associated with performance on the BSID-III or with CP.

Conclusion

This 3-year cohort of extremely preterm infants had low rates of major brain injury and impaired outcome. Neonatal MRI provides useful information, but this information needs to be treated with caution when predicting outcome.

Section snippets

Methods

The Regional Ethics Committee in Stockholm approved the study and informed consent was obtained from all parents of the participating infants. All infants born in Stockholm with a gestational age (GA) of <27 weeks 0 days were included in the study. During the 3-year study period from January 1, 2004, to March 31, 2007, 192 infants were born alive and 129 (69%) survived to term age (mean GA, 25 weeks 4 days ± 1 day; mean birth weight, 808 ± 160 g). Children with malformations, chromosome

MRI

The incidence rates of white matter abnormalities in this cohort have been published previously.19 Moderate-severe white matter abnormalities were present in 14%; thus, 86% of the infants had no-mild white matter abnormalities on MRI at term equivalent age. DEHSI were seen in 56%, in infants with all grades of white matter abnormalities.

Neurodevelopmental Follow-Up

At age 30 months corrected, 91 of the 117 children (78%) attended follow-up. Of the 107 extremely preterm infants who underwent MRI, 85 (79%) attended follow-up

Discussion

We have reported neurodevelopmental outcomes at age 30 months corrected in a population-based cohort of extremely preterm infants. In this cohort, 7% had CP, only 2% had severe cognitive delay, and 5% had severe language delay. As a group, the preterm infants demonstrated performance within the normal range for age on all 3 BSID-III scales. These promising findings should be interpreted with caution, however.

Previous studies have shown an overall decline in CP rates over the last several

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    Supported by the Swedish Medical Research Council (grant 2006-6151), a regional agreement for medical training and clinical research (ALF 20090177) between the Stockholm County Council and the Karolinska Institute, the Linnea and Josef Carlsson Foundation, the Swedish Order of Freemasons, the Swedish Medical Society, the Jerring Foundation, and Sällskapet Barnavård. B.V. was supported by a Marie Curie Individual Intra-European Fellowship within the EU FP6 Framework Program. The authors declare no conflicts of interest.

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