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  • Clinical Research Article
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Ultrasonographic evaluation of the early brain growth pattern in very low birth weight infants

Pediatric Research volume 94, pages 296–303 (2023)Cite this article

Summary

Background

Preterm infants develop smaller brain volumes compared to term newborns. Our aim is to study early brain growth related to perinatal factors in very low birth weight infants (VLBWI).

Methods

Manual segmentation of total brain volume (TBV) was performed in weekly 3D-ultrasonographies in our cohort of VLBWI. We studied the brain growth pattern related to term magnetic resonance image (term-MRI).

Results

We found different brain growth trajectories, with smaller brain volumes and a decrease in brain growth rate in those VLBWI who would later have an abnormal term-MRI (mean TBV 190.68 vs. 213.9 cm3; P = 0.0001 and mean TBV growth rate 14.35 (±1.27) vs. 16.94 (±2.29) cm3/week; P = 0.0001). TBV in those with normal term-MRI was related to gestational age (GA), being small for gestational age (SGA), sex, and duration of parenteral nutrition (TPN) while in those with abnormal term-MRI findings it was related to GA, SGA, TPN, and comorbidities. We found a deceleration in brain growth rate in those with ≥3 comorbidities.

Conclusions

An altered brain growth pattern in VLBWI who subsequently present worst scores on term-MRI is related to GA, being SGA and comorbidities. Early ultrasonographic monitoring of TBV could be useful to detect deviated patterns of brain growth.

Impact statement

  • We describe the brain growth pattern in very low birth weight infants during their first postnatal weeks.

  • Brain growth may be affected in the presence of certain perinatal factors and comorbidities, conditioning a deviation of the normal growth pattern.

  • The serial ultrasound follow-up of these at-risk patients allows identifying these brain growth patterns early, which offers a window of opportunity for implementing earlier interventions.

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Fig. 1: Flow diagram of the included patients.
Fig. 2: Total brain volume trajectories by postmenstrual age related to term-magnetic resonance image findings.
Fig. 3: Brain growth rate by postmenstrual age related to term-magnetic resonance image (MRI) findings.
Fig. 4: Brain growth rate by postmenstrual age intervals in patients with normal/mild (blue) and moderate/severe (red) findings in term-MRI.
Fig. 5: Total brain volume trajectories by postmenstrual age related to perinatal factors and comorbidities.
Fig. 6: Brain growth rate by postmenstrual age intervals in moderate/severe term-MRI group related to comorbidities.

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Data availability

The datasets generated and analyzed during the current study are available in the OSF repository: https://osf.io/hm9y7/?view_only=accdb3061be04b7b867512f29850cc39.

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Funding

This study was funded by the Cadiz integrated territorial initiative for biomedical research European Regional Development Fund (ERDF) 2014–2020. Andalusian Ministry of Health and Families, Spain. (PI-0052-2017 and ITI-0019-2019).

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain

    Estefanía Ruiz-González, Isabel Benavente-Fernández, Antonio Segado-Arenas, Pamela Zafra-Rodríguez, Paula Méndez-Abad & Simón P. Lubián-López

  2. Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain

    Estefanía Ruiz-González, Isabel Benavente-Fernández, Manuel Lubián-Gutiérrez, Antonio Segado-Arenas, Pamela Zafra-Rodríguez, Paula Méndez-Abad & Simón P. Lubián-López

  3. Area of Paediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, C/Doctor Marañon, 3, Cádiz, Spain

    Isabel Benavente-Fernández

  4. Division of Neurology, Department of Paediatrics, Puerta del Mar University Hospital, Cádiz, Spain

    Manuel Lubián-Gutiérrez

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  1. Estefanía Ruiz-González
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Contributions

E.R.G. and I.B.F. have played a fundamental role in the conception and design of the work, in the analysis and interpretation of the study data, in the editing of the paper and in the approval of its final version. M.L.G. has actively contributed to the data acquisition, interpretation/measurement of images, and has been involved in the approval of the final version of the paper. A.S.A. has actively contributed to the data acquisition, medical assistance in the performance of MRI scans, and has been involved in the approval of the final version of the document. P.Z.R. has actively contributed to the data acquisition, medical assistance in the performance of MRI scans, and has been involved in the approval of the final version of the document. P.M.A. has actively contributed to the data acquisition, medical assistance in the performance of MRI scans, and has been involved in the approval of the final version of the document. S.P.L.L. has played a fundamental role in the conception and design of the work, in the interpretation of the study data, and in the correction of the paper and approval of its final version.

Corresponding author

Correspondence to Isabel Benavente-Fernández.

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Ruiz-González, E., Benavente-Fernández, I., Lubián-Gutiérrez, M. et al. Ultrasonographic evaluation of the early brain growth pattern in very low birth weight infants. Pediatr Res 94, 296–303 (2023). https://doi.org/10.1038/s41390-022-02425-w

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