RESUMEN

OBJECTIVE: To evaluate the relationship between brain volumes at term and neurodevelopmental outcome through early school age in preterm infants. STUDY DESIGN: One hundred twelve preterm infants (born mean gestational age 28.6 ± 1.7 weeks) were studied prospectively with magnetic resonance imaging (imaged at mean 41.6 ± 1.0 weeks). T2- and T1-weighted images were automatically segmented, and volumes of 6 tissue types were related to neurodevelopmental outcome assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (cognitive, fine, and gross motor scores) at 24 months corrected age (n = 112), Griffiths Mental Development Scales (developmental quotient) at age 3.5 years (n = 98), Movement Assessment Battery for Children, Second Edition (n = 85), and Wechsler Preschool and Primary Scale of Intelligence, Third Edition at age 5.5 years (n = 44). Corrections were made for intracranial volume, maternal education, and severe brain lesions. RESULTS: Ventricular volumes were negatively related to neurodevelopmental outcome at age 24 months and 3.5 years, as well as processing speed at age 5.5 years. Unmyelinated white matter (UWM) volume was positively associated with motor outcome at 24 months and with processing speed at age 5.5 years. Cortical gray matter (CGM) volume demonstrated a negative association with motor performance and cognition at 24 months and with developmental quotient at age 3.5 years. Cerebellar volume was positively related to cognition at these time points. Adjustment for brain lesions attenuated the relations between cerebellar and CGM volumes and cognition. CONCLUSIONS: Brain volumes of ventricles, UWM, CGM, and cerebellum may serve as biomarkers for neurodevelopmental outcome in preterm infants. The relationship between larger CGM volumes and adverse neurodevelopment may reflect disturbances in neuronal and/or axonal migration at the UWM-CGM boundary and warrants further investigation.

Asunto(s)

Encéfalo/anatomía & histología , Desarrollo Infantil , Recien Nacido Prematuro/crecimiento & desarrollo , Biomarcadores , Encéfalo/diagnóstico por imagen , Preescolar , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos

RESUMEN

OBJECTIVE: To assess whether there was an adverse effect on brain growth after hydrocortisone (HC) treatment for bronchopulmonary dysplasia (BPD) in a large cohort of infants without dexamethasone exposure. STUDY DESIGN: Infants who received HC for BPD between 2005 and 2011 and underwent magnetic resonance imaging at term-equivalent age were included. Control infants born in Geneva (2005-2006) and Utrecht (2007-2011) were matched to the infants treated with HC according to segmentation method, sex, and gestational age. Infants with overt parenchymal pathology were excluded. Multivariable analysis was used to determine if there was a difference in brain volumes between the 2 groups. RESULTS: Seventy-three infants treated with HC and 73 matched controls were included. Mean gestational age was 26.7 weeks, and mean birth weight was 906 g. After correction for gestational age, postmenstrual age at time of scanning, the presence of intraventricular hemorrhage, and birth weight z-score, no differences were found between infants treated with HC and controls in total brain tissue or cerebellar volumes. CONCLUSIONS: In the absence of associated parenchymal brain injury, no reduction in brain tissue or cerebellar volumes could be found at term-equivalent age between infants with or without treatment with HC for BPD.

Asunto(s)

Antiinflamatorios/efectos adversos , Encéfalo/efectos de los fármacos , Displasia Broncopulmonar/tratamiento farmacológico , Hidrocortisona/efectos adversos , Antiinflamatorios/uso terapéutico , Encéfalo/crecimiento & desarrollo , Cerebelo/efectos de los fármacos , Cerebelo/crecimiento & desarrollo , Esquema de Medicación , Femenino , Humanos , Hidrocortisona/uso terapéutico , Recién Nacido , Modelos Lineales , Imagen por Resonancia Magnética , Masculino , Análisis por Apareamiento , Análisis Multivariante , Tamaño de los Órganos/efectos de los fármacos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To assess the relation between patterns of brain injury on neonatal and childhood magnetic resonance imaging (MRI) and long-term neurodevelopmental outcome. STUDY DESIGN: Neonatal (n = 34) and childhood MRIs (n = 77) were analyzed for 80 children with neonatal encephalopathy and for 51 control subjects during childhood. MRIs were graded as normal, mildly abnormal (white matter lesions), or moderately/severely abnormal (watershed injury, lesions in basal ganglia/thalamus or focal infarction). Severity of brain injury was related to different aspects of neurologic outcome: Total impairment score of the Movement Assessment Battery for Children, intelligence quotient score, cerebral palsy, postneonatal epilepsy, and need for special education. Seven children with neonatal encephalopathy required extracorporeal membrane oxygenation treatment. RESULTS: Neonatal and childhood MRI were comparable in 25/33 children (75.8%, P < .001). Children with moderate/severe lesions on neonatal or childhood MRI more often had a total impairment score

Asunto(s)

Encefalopatías/diagnóstico , Lesiones Encefálicas/diagnóstico , Imagen por Resonancia Magnética/métodos , Asfixia Neonatal/fisiopatología , Encefalopatías/fisiopatología , Lesiones Encefálicas/fisiopatología , Estudios de Casos y Controles , Parálisis Cerebral/diagnóstico , Niño , Femenino , Humanos , Recién Nacido , Pruebas de Inteligencia , Masculino , Riesgo , Resultado del Tratamiento