Neuroimaging and neurodevelopmental outcome in extremely preterm infants

Susan R. Hintz, Patrick D. Barnes, Dorothy Bulas, Thomas L. Slovis, Neil N. Finer, Lisa A. Wrage, Abhik Das, Jon E. Tyson, David K. Stevenson, Waldemar A. Carlo, Michele C. Walsh, Abbot R. Laptook, Bradley A. Yoder, Krisa P. Van Meurs, Roger G. Faix, Wade Rich, Nancy S. Newman, Helen Cheng, Roy J. Heyne, Betty R. Vohr & 13 others Michael J. Acarregui, Yvonne E. Vaucher, Athina Pappas, Myriam Peralta-Carcelen, Deanne E. Wilson-Costello, Patricia W. Evans, Ricki F. Goldstein, Gary J. Myers, Brenda B. Poindexter, Elisabeth C. McGowan, Ira Adams-Chapman, Janell Fuller, Rosemary D. Higgins

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age.

METHODS: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors.

RESULTS: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes.

CONCLUSIONS: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.

Original languageEnglish (US)
Pages (from-to)e32-e42
JournalPediatrics
Volume135
Issue number1
DOIs
StatePublished - Jan 1 2015

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Extremely Premature Infants
Neuroimaging
Odds Ratio
Confidence Intervals
Vision Disorders
Brain
Hearing Loss
Pregnancy
Ultrasound
Research
Impairment
White Matter

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Hintz, S. R., Barnes, P. D., Bulas, D., Slovis, T. L., Finer, N. N., Wrage, L. A., ... Higgins, R. D. (2015). Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics, 135(1), e32-e42. https://doi.org/10.1542/peds.2014-0898

Neuroimaging and neurodevelopmental outcome in extremely preterm infants. / Hintz, Susan R.; Barnes, Patrick D.; Bulas, Dorothy; Slovis, Thomas L.; Finer, Neil N.; Wrage, Lisa A.; Das, Abhik; Tyson, Jon E.; Stevenson, David K.; Carlo, Waldemar A.; Walsh, Michele C.; Laptook, Abbot R.; Yoder, Bradley A.; Van Meurs, Krisa P.; Faix, Roger G.; Rich, Wade; Newman, Nancy S.; Cheng, Helen; Heyne, Roy J.; Vohr, Betty R.; Acarregui, Michael J.; Vaucher, Yvonne E.; Pappas, Athina; Peralta-Carcelen, Myriam; Wilson-Costello, Deanne E.; Evans, Patricia W.; Goldstein, Ricki F.; Myers, Gary J.; Poindexter, Brenda B.; McGowan, Elisabeth C.; Adams-Chapman, Ira; Fuller, Janell; Higgins, Rosemary D.

In: Pediatrics, Vol. 135, No. 1, 01.01.2015, p. e32-e42.

Research output: Contribution to journalArticle

Hintz, SR, Barnes, PD, Bulas, D, Slovis, TL, Finer, NN, Wrage, LA, Das, A, Tyson, JE, Stevenson, DK, Carlo, WA, Walsh, MC, Laptook, AR, Yoder, BA, Van Meurs, KP, Faix, RG, Rich, W, Newman, NS, Cheng, H, Heyne, RJ, Vohr, BR, Acarregui, MJ, Vaucher, YE, Pappas, A, Peralta-Carcelen, M, Wilson-Costello, DE, Evans, PW, Goldstein, RF, Myers, GJ, Poindexter, BB, McGowan, EC, Adams-Chapman, I, Fuller, J & Higgins, RD 2015, 'Neuroimaging and neurodevelopmental outcome in extremely preterm infants', Pediatrics, vol. 135, no. 1, pp. e32-e42. https://doi.org/10.1542/peds.2014-0898
Hintz SR, Barnes PD, Bulas D, Slovis TL, Finer NN, Wrage LA et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics. 2015 Jan 1;135(1):e32-e42. https://doi.org/10.1542/peds.2014-0898
Hintz, Susan R. ; Barnes, Patrick D. ; Bulas, Dorothy ; Slovis, Thomas L. ; Finer, Neil N. ; Wrage, Lisa A. ; Das, Abhik ; Tyson, Jon E. ; Stevenson, David K. ; Carlo, Waldemar A. ; Walsh, Michele C. ; Laptook, Abbot R. ; Yoder, Bradley A. ; Van Meurs, Krisa P. ; Faix, Roger G. ; Rich, Wade ; Newman, Nancy S. ; Cheng, Helen ; Heyne, Roy J. ; Vohr, Betty R. ; Acarregui, Michael J. ; Vaucher, Yvonne E. ; Pappas, Athina ; Peralta-Carcelen, Myriam ; Wilson-Costello, Deanne E. ; Evans, Patricia W. ; Goldstein, Ricki F. ; Myers, Gary J. ; Poindexter, Brenda B. ; McGowan, Elisabeth C. ; Adams-Chapman, Ira ; Fuller, Janell ; Higgins, Rosemary D. / Neuroimaging and neurodevelopmental outcome in extremely preterm infants. In: Pediatrics. 2015 ; Vol. 135, No. 1. pp. e32-e42.
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abstract = "BACKGROUND: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age.METHODS: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors.RESULTS: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95{\%} confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95{\%} confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes.CONCLUSIONS: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.",
author = "Hintz, {Susan R.} and Barnes, {Patrick D.} and Dorothy Bulas and Slovis, {Thomas L.} and Finer, {Neil N.} and Wrage, {Lisa A.} and Abhik Das and Tyson, {Jon E.} and Stevenson, {David K.} and Carlo, {Waldemar A.} and Walsh, {Michele C.} and Laptook, {Abbot R.} and Yoder, {Bradley A.} and {Van Meurs}, {Krisa P.} and Faix, {Roger G.} and Wade Rich and Newman, {Nancy S.} and Helen Cheng and Heyne, {Roy J.} and Vohr, {Betty R.} and Acarregui, {Michael J.} and Vaucher, {Yvonne E.} and Athina Pappas and Myriam Peralta-Carcelen and Wilson-Costello, {Deanne E.} and Evans, {Patricia W.} and Goldstein, {Ricki F.} and Myers, {Gary J.} and Poindexter, {Brenda B.} and McGowan, {Elisabeth C.} and Ira Adams-Chapman and Janell Fuller and Higgins, {Rosemary D.}",
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T1 - Neuroimaging and neurodevelopmental outcome in extremely preterm infants

AU - Hintz, Susan R.

AU - Barnes, Patrick D.

AU - Bulas, Dorothy

AU - Slovis, Thomas L.

AU - Finer, Neil N.

AU - Wrage, Lisa A.

AU - Das, Abhik

AU - Tyson, Jon E.

AU - Stevenson, David K.

AU - Carlo, Waldemar A.

AU - Walsh, Michele C.

AU - Laptook, Abbot R.

AU - Yoder, Bradley A.

AU - Van Meurs, Krisa P.

AU - Faix, Roger G.

AU - Rich, Wade

AU - Newman, Nancy S.

AU - Cheng, Helen

AU - Heyne, Roy J.

AU - Vohr, Betty R.

AU - Acarregui, Michael J.

AU - Vaucher, Yvonne E.

AU - Pappas, Athina

AU - Peralta-Carcelen, Myriam

AU - Wilson-Costello, Deanne E.

AU - Evans, Patricia W.

AU - Goldstein, Ricki F.

AU - Myers, Gary J.

AU - Poindexter, Brenda B.

AU - McGowan, Elisabeth C.

AU - Adams-Chapman, Ira

AU - Fuller, Janell

AU - Higgins, Rosemary D.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age.METHODS: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors.RESULTS: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes.CONCLUSIONS: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.

AB - BACKGROUND: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age.METHODS: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors.RESULTS: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes.CONCLUSIONS: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.

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