Abstract
BACKGROUND AND OBJECTIVES: Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. METHODS: A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. RESULTS: A total of 386 children had follow-up. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI and adverse CUS findings were associated with outcomes. In full regression models, both adverse late CUS findings (odds ratio [OR] 27.9; 95% confidence interval [CI] 6.0-129) and significant cerebellar lesions on MRI (OR 2.71; 95% CI 1.1-6.7) remained associated with disability, but only adverse late CUS findings (OR 20.1; 95% CI 3.6-111) were associated with FSIQ <70. Predictive accuracy of stepwise models was not substantially improved with the addition of neuroimaging. CONCLUSIONS: Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of severe early school-age outcomes.
| Original language | English |
|---|---|
| Article number | e20174058 |
| Journal | Pediatrics |
| Volume | 142 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2018 |
Bibliographical note
Publisher Copyright:Copyright © 2018 by the American Academy of Pediatrics. All rights reserved.
Funding
FUNDING: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Heart, Lung, and Blood Institute provided grant support for the Neonatal Research Network’s Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial Neuroimaging Secondary Protocol through cooperative agreements. Although the NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of the NICHD. A complete list of investigators by participating center can be found in the Acknowledgments. Dr Hintz received support for her efforts in this study as an Arline and Pete Harman Endowed Faculty Scholar at the Lucile Packard Children’s Hospital Stanford. Funded by the National Institutes of Health (NIH).
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | |
| National Heart, Lung, and Blood Institute (NHLBI) | |
| NIH National Institute of Child Health and Human Development National Center for Medical Rehabilitation Research | U10HD021385 |
| NIH National Institute of Child Health and Human Development National Center for Medical Rehabilitation Research | |
| Eunice Kennedy Shriver National Institute of Child Health and Human Development |
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health