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Elevated brain oxygen extraction fraction in preterm newborns with anemia measured using noninvasive MRI

Journal of Perinatology volume 38, pages 1636–1643 (2018)Cite this article

Subjects

Abstract

Objective

To test the hypothesis that cerebral oxygen extraction fraction (OEF) is elevated and inversely related to hematocrit level in anemic former very-low-birth-weight infants near term.

Study design

Prospective study of non-sedated preterm infants (post-menstrual age = 36 ± 2 weeks) over a range of hematocrits (0.23–0.49). Anatomical (T1-W, T2-W, and diffusion-weighted), cerebral blood flow (CBF), and OEF 3-T MRI were utilized. Statistical analysis included Spearman's rank-order correlation testing between study variables and intraclass correlation coefficients (ICC) calculated between consecutively acquired OEF scans.

Results

Consecutive OEF measurements showed moderate-to-good agreement (ICC = 0.71; 95% CI = 0.40–0.87). OEF increased with worsening anemia (ρ = −0.58; p = 0.005), and OEF and basal ganglia CBF were positively correlated (ρ = 0.49; p = 0.023).

Conclusion

Noninvasive OEF MRI has moderate-to-good repeatability in non-sedated former preterm infants nearing term-equivalent age. Strong correlation of elevated OEF with anemia suggests hemodynamic compensation for anemia and could establish OEF as a useful biomarker of transfusion threshold for preterm infants.

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Acknowledgements

The study was supported by a grant from the Vanderbilt Institute for Clinical and Translational Research and the Department of Pediatrics at Vanderbilt University Medical Center. We are grateful to our subjects’ families for allowing participation in this study.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA

    Emily A. Morris

  2. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Meher R. Juttukonda, Sumit Pruthi & Manus J. Donahue

  3. Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

    Chelsea A. Lee, Niral J. Patel & Lori C. Jordan

  4. Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

    Manus J. Donahue & Lori C. Jordan

  5. Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA

    Manus J. Donahue

  6. Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA

    Manus J. Donahue

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  1. Emily A. Morris
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Correspondence to Emily A. Morris.

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MJD received research-related support from Philips North America. The remaining authors declare no conflicts of interest.

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Morris, E.A., Juttukonda, M.R., Lee, C.A. et al. Elevated brain oxygen extraction fraction in preterm newborns with anemia measured using noninvasive MRI. J Perinatol 38, 1636–1643 (2018). https://doi.org/10.1038/s41372-018-0229-1

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