Background Very preterm infants are at high risk for adverseneurodevelopmental outcomes. Magnetic resonance imaging (MRI)has been proposed as a means of predicting neurodevelopmentaloutcomes in this population.
Methods We studied 167 very preterm infants (gestational ageat birth, 30 weeks or less) to assess the associations betweenqualitatively defined white-matter and gray-matter abnormalitieson MRI at term equivalent (gestational age of 40 weeks) andthe risks of severe cognitive delay, severe psychomotor delay,cerebral palsy, and neurosensory (hearing or visual) impairmentat 2 years of age (corrected for prematurity).
Results At two years of age, 17 percent of infants had severecognitive delay, 10 percent had severe psychomotor delay, 10percent had cerebral palsy, and 11 percent had neurosensoryimpairment. Moderate-to-severe cerebral white-matter abnormalitiespresent in 21 percent of infants at term equivalent were predictiveof the following adverse outcomes at two years of age: cognitivedelay (odds ratio, 3.6; 95 percent confidence interval, 1.5to 8.7), motor delay (odds ratio, 10.3; 95 percent confidenceinterval, 3.5 to 30.8), cerebral palsy (odds ratio, 9.6; 95percent confidence interval, 3.2 to 28.3), and neurosensoryimpairment (odds ratio, 4.2; 95 percent confidence interval,1.6 to 11.3). Gray-matter abnormalities (present in 49 percentof infants) were also associated, but less strongly, with cognitivedelay, motor delay, and cerebral palsy. Moderate-to-severe white-matterabnormalities on MRI were significant predictors of severe motordelay and cerebral palsy after adjustment for other measuresduring the neonatal period, including findings on cranial ultrasonography.
Conclusions Abnormal findings on MRI at term equivalent in verypreterm infants strongly predict adverse neurodevelopmentaloutcomes at two years of age. These findings suggest a rolefor MRI at term equivalent in risk stratification for theseinfants.
Source Information
From the University of Canterbury and the Van der Veer Institute for Parkinson's and Brain Research (L.J.W.) and Christchurch Women's Hospital (N.C.A.) all in Christchurch, New Zealand; the Murdoch Childrens Research Institute (P.J.A., T.E.I.) and the Department of Psychology (K.H.), University of Melbourne, Melbourne, Australia; and the Department of Pediatrics, Neurology, and Radiology, St. Louis Children's Hospital, Washington University, St. Louis (T.E.I.).
Address reprint requests to Dr. Woodward at the Canterbury Child Development Research Group, Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand, or at lianne.woodward{at}canterbury.ac.nz.
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