Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. Study design: We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. Results: Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P <.0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. Conclusion: Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.

Original languageEnglish (US)
Pages (from-to)66-72.e3
JournalJournal of Pediatrics
Volume195
DOIs
StatePublished - Apr 1 2018

Fingerprint

Premature Infants
Gestational Age
Intracranial Hemorrhages
Periventricular Leukomalacia
Chorioamnionitis
Steroids
Birth Weight
Surface-Active Agents
Resuscitation
Registries
Logistic Models
Regression Analysis
Parturition
Pregnancy
Research
Therapeutics

Keywords

  • intracranial hemorrhage
  • moderate preterm
  • periventricular leukomalacia
  • ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2018). Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. Journal of Pediatrics, 195, 66-72.e3. https://doi.org/10.1016/j.jpeds.2017.11.036

Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. / Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

In: Journal of Pediatrics, Vol. 195, 01.04.2018, p. 66-72.e3.

Research output: Contribution to journalArticle

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2018, 'Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants', Journal of Pediatrics, vol. 195, pp. 66-72.e3. https://doi.org/10.1016/j.jpeds.2017.11.036
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. Journal of Pediatrics. 2018 Apr 1;195:66-72.e3. https://doi.org/10.1016/j.jpeds.2017.11.036
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. / Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. In: Journal of Pediatrics. 2018 ; Vol. 195. pp. 66-72.e3.
@article{9fb1a6405c9d41e7a3dec6808b549ac2,
title = "Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants",
abstract = "Objectives: To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. Study design: We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. Results: Among 7021 infants, 4184 (60{\%}) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P <.0001). Imaging abnormalities noted in 15{\%} of the infants included any intracranial hemorrhage (13.2{\%}), grades 3-4 intracranial hemorrhage (1.7{\%}), cystic periventricular leukomalacia (2.6{\%}), and ventriculomegaly (6.6{\%}). Histologic chorioamnionitis (OR, 1.47; 95{\%} CI, 1.19-1.83), gestational age (0.95; 95{\%} CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95{\%} CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95{\%} CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95{\%} CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. Conclusion: Among the 60{\%} of moderately preterm infants with cranial imaging, 15{\%} had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.",
keywords = "intracranial hemorrhage, moderate preterm, periventricular leukomalacia, ultrasound",
author = "{Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network} and Girija Natarajan and Seetha Shankaran and Shampa Saha and Abbot Laptook and Abhik Das and Rosemary Higgins and Stoll, {Barbara J.} and Bell, {Edward F.} and Carlo, {Waldemar A.} and Carl D'Angio and DeMauro, {Sara B.} and Pablo Sanchez and {Van Meurs}, Krisa and Betty Vohr and Nancy Newman and Ellen Hale and Michele Walsh and Polin, {Richard A.} and Martin Keszler and Hensman, {Angelita M.} and Elisa Vieira and Hibbs, {Anna Marie} and Siner, {Bonnie S.} and Pallotto, {Eugenia K.} and Kilbride, {Howard W.} and Cheri Gauldin and Anne Holmes and Kathy Johnson and Kallapur, {Suhas G.} and Cathy Grisby and Barbara Alexander and Fischer, {Estelle E.} and Lenora Jackson and Kristin Kirker and Jennifer Jennings and Sandra Wuertz and Greg Muthig and Goldberg, {Ronald N.} and Joanne Finkle and Fisher, {Kimberley A.} and Laughon, {Matthew M.} and Bose, {Carl L.} and Janice Bernhardt and Cindy Clark and Carlton, {David P.} and Yvonne Loggins and Bottcher, {Diane I.} and Archer, {Stephanie Wilson} and Myra Wyckoff and Brion, {Luc P.}",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.jpeds.2017.11.036",
language = "English (US)",
volume = "195",
pages = "66--72.e3",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants

AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

AU - Natarajan, Girija

AU - Shankaran, Seetha

AU - Saha, Shampa

AU - Laptook, Abbot

AU - Das, Abhik

AU - Higgins, Rosemary

AU - Stoll, Barbara J.

AU - Bell, Edward F.

AU - Carlo, Waldemar A.

AU - D'Angio, Carl

AU - DeMauro, Sara B.

AU - Sanchez, Pablo

AU - Van Meurs, Krisa

AU - Vohr, Betty

AU - Newman, Nancy

AU - Hale, Ellen

AU - Walsh, Michele

AU - Polin, Richard A.

AU - Keszler, Martin

AU - Hensman, Angelita M.

AU - Vieira, Elisa

AU - Hibbs, Anna Marie

AU - Siner, Bonnie S.

AU - Pallotto, Eugenia K.

AU - Kilbride, Howard W.

AU - Gauldin, Cheri

AU - Holmes, Anne

AU - Johnson, Kathy

AU - Kallapur, Suhas G.

AU - Grisby, Cathy

AU - Alexander, Barbara

AU - Fischer, Estelle E.

AU - Jackson, Lenora

AU - Kirker, Kristin

AU - Jennings, Jennifer

AU - Wuertz, Sandra

AU - Muthig, Greg

AU - Goldberg, Ronald N.

AU - Finkle, Joanne

AU - Fisher, Kimberley A.

AU - Laughon, Matthew M.

AU - Bose, Carl L.

AU - Bernhardt, Janice

AU - Clark, Cindy

AU - Carlton, David P.

AU - Loggins, Yvonne

AU - Bottcher, Diane I.

AU - Archer, Stephanie Wilson

AU - Wyckoff, Myra

AU - Brion, Luc P.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objectives: To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. Study design: We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. Results: Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P <.0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. Conclusion: Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.

AB - Objectives: To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. Study design: We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. Results: Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P <.0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. Conclusion: Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.

KW - intracranial hemorrhage

KW - moderate preterm

KW - periventricular leukomalacia

KW - ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85040770637&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040770637&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2017.11.036

DO - 10.1016/j.jpeds.2017.11.036

M3 - Article

VL - 195

SP - 66-72.e3

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -