Abstract
Background. The neural substrate for adverse neurodevelopmental outcome in extremely preterm infants remains incompletely determined.
Aims. To determine the spectrum of brain abnormalities in the preterm population using serial magnetic resonance (MR) imaging from birth to term age and make preliminary correlations with neurodevelopmental outcome.
Methods. Serial MR brain scans were acquired prospectively from birth until term age from a consecutive cohort of preterm infants. Neurodevelopmental assessments were made after 18 months of age using Griffiths Mental Development Scales with calculation of a developmental quotient.
Results. Three hundred and twenty seven MR studies were obtained from 119 surviving infants born at 23 to 29 weeks gestation. Initial MR scan acquisition was at a median of 2 days after delivery. Four infants had major destructive brain lesions (haemorrhagic parenchymal infarction, n=2; cystic periventricular leucomalacia, n=2); tissue loss was seen at term in the two survivors. Fifty one infants had haemorrhage (germinal layer, n=47; intraventricular (IVH), n=29; extracerebral, n=6) with 42% of survivors having ventricular dilatation at term. Twenty six infants had punctate white matter lesions, 40% of which persisted to term. Cerebellar haemorrhage occurred in 8 infants and basal ganglia lesions occurred in 17 infants. At term 53% of infants without prior haemorrhage had ventricular dilatation and 80% of infants had diffuse excessive high signal intensity (DEHSI) within the white matter. Complete follow-up is available in 67% of infants. Adverse outcome, characterized by low developmental quotient, is associated with major destructive lesions, cerebellar haemorrhage, DEHSI and ventricular dilatation after IVH, but not with punctate white matter lesions, haemorrhage or ventricular dilatation without IVH.
Conclusions. Diffuse white matter abnormalities and post-haemorrhagic ventricular dilatation are common at term and correlate with reduced developmental quotient. Early lesions, except for cerebellar haemorrhage and major destructive lesions, do not show clear relationships with outcome.
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Dyet, L., Kennea, N., Maalouf, E. et al. 103 Serial Magnetic Resonance Imaging of the Preterm Brain: The Natural History of Early Lesions, Abnormalities at Term Age and Relation to Outcome. Pediatr Res 58, 372 (2005). https://doi.org/10.1203/00006450-200508000-00132
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DOI: https://doi.org/10.1203/00006450-200508000-00132