Abstract 2023 Neurology Platform, Sunday, 5/2

Objective: Many preterm infants with periventricular leukomalacia (PVL) who survive the neonatal period later exhibit a variety of cognitive deficits. Such deficits suggest the possibility that PVL could lead to an impairment of cerebral cortical development.

Design/Method: Twenty preterm infants were studied using an advanced quantitative volumetric 3D-MRI technique to quantify cerebral tissue volumes at term. An initial MRI scan was undertaken between 7 to 14 days of life in all premature infants to identify periventricular white matter abnormalities. Ten of the preterm infants had early ultrasonographic and MRI evidence of periventricular leukomalacia (PVL, mean GA at birth 28.7± 2.0 weeks). Ten preterm infants had normal neonatal imaging studies (no PVL, mean GA at birth 29.0±2.1 weeks). Fourteen healthy full term infants were also scanned within the first two days of life as controls (n=14).

Results: Quantitative 3D-MRI at term showed that preterm infants with PVL had a marked reduction of 32% in cerebral cortical gray matter when compared with either preterm infants without PVL or normal term infants (Table) (p=0.008). As expected, a reduction in the volume of total brain myelinated white matter was also noted (p=0.001). There was no significant difference in the volumes of the basal ganglia and unmyelinated white matter between the three groups. An increase in total CSF volume was found in both groups of preterm infants, being most marked in those infants with PVL. Correcting for total intracranial volume, the %cortical gray matter, %myelinated WM and % CSF remained significantly altered in preterm infants with PVL (ANOVA: %CGM p=0.01, %myelin p=0.04, %CSF p=0.01)

Table 1 Quantitative 3D-MRI volumes (mean±standard deviation (cc) of cerebral tissues at term in preterm infants with evidence of PVL, preterm infants with no evidence of PVL and control term infants.
Full size table

Conclusions: PVL in the premature infant is shown for the first time to be followed by a significant reduction in cerebral cortical gray matter volume. These findings may provide insight into the anatomical correlate for the intellectual deficits associated with PVL in the premature infant.