Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 536-548 (doi:10.1542/peds.2005-1866)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (16)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dyet, L. E.
Right arrow Articles by Edwards, A. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dyet, L. E.
Right arrow Articles by Edwards, A. D.
Related Collections
Right arrow Premature & Newborn

ARTICLE

Natural History of Brain Lesions in Extremely Preterm Infants Studied With Serial Magnetic Resonance Imaging From Birth and Neurodevelopmental Assessment

Leigh E. Dyet, MRCPCHa, Nigel Kennea, MRCPa, Serena J. Counsell, PhDb, Elia F. Maalouf, MDa, Morenike Ajayi-Obe, MRCPa, Philip J. Duggan, MRCPa, Michael Harrison, MRCPa, Joanna M. Allsop, DCRb, Joseph Hajnal, PhDb, Amy H. Herlihy, PhDb, Bridget Edwards, FRCPa, Sabrina Laroche, MDa, Frances M. Cowan, PhDa, Mary A. Rutherford, FRCRb and A. David Edwards, FMedScia,b

a Departments of Paediatrics
b Imaging Sciences, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom

OBJECTIVES. The aim was to survey the range of cerebral injury and abnormalities of cerebral development in infants born between 23 and 30 weeks’ gestation using serial MRI scans of the brain from birth, and to correlate those findings with neurodevelopmental outcome after 18 months corrected age.

METHODS. Between January 1997 and November 2000, consecutive infants born at <30 weeks’ gestational age underwent serial MRI brain scans from birth until term-equivalent age. Infants were monitored after 18 months of age, corrected for prematurity, with the Griffiths Mental Development Scales and neurologic assessment.

RESULTS. A total of 327 MRI scans were obtained from 119 surviving infants born at 23 to 30 weeks of gestation. Four infants had major destructive brain lesions, and tissue loss was seen at term for the 2 survivors. Fifty-one infants had early hemorrhage; 50% of infants with term scans after intraventricular hemorrhage had ventricular dilation. Twenty-six infants had punctate white matter lesions on early scans; these persisted for 33% of infants assessed at term. Early scans showed cerebellar hemorrhagic lesions for 8 infants and basal ganglia abnormalities for 17. At term, 53% of infants without previous hemorrhage had ventricular dilation and 80% of infants had diffuse excessive high signal intensity within the white matter on T2-weighted scans. Complete follow-up data were available for 66% of infants. Adverse outcomes were associated with major destructive lesions, diffuse excessive high signal intensity within the white matter, cerebellar hemorrhage, and ventricular dilation after intraventricular hemorrhage but not with punctate white matter lesions, hemorrhage, or ventricular dilation without intraventricular hemorrhage.

CONCLUSIONS. Diffuse white matter abnormalities and post–hemorrhagic ventricular dilation are common at term and seem to correlate with reduced developmental quotients. Early lesions, except for cerebellar hemorrhage and major destructive lesions, do not show clear relationships with outcomes.


Key Words: premature infants • brain imaging • magnetic resonance imaging • neurodevelopment

Abbreviations: GA—gestational age • HPI—hemorrhagic parenchymal infarction • GLH—germinal layer hemorrhage • IVH—intraventricular hemorrhage • DEHSI—diffuse excessive high signal intensity • DQ—developmental quotient • IUGR—intrauterine growth restriction • CP—cerebral palsy • SDS—SD score • ECS—extracerebral space


Accepted Mar 24, 2006.




This article has been cited by other articles:


Home page
PediatricsHome page
H. C. Glass, S. L. Bonifacio, V. Chau, D. Glidden, K. Poskitt, A. J. Barkovich, D. M. Ferriero, and S. P. Miller
Recurrent Postnatal Infections Are Associated With Progressive White Matter Injury in Premature Infants
Pediatrics, August 1, 2008; 122(2): 299 - 305.
[Abstract] [Full Text] [PDF]


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
J Atkinson, O Braddick, S Anker, M Nardini, D Birtles, M A Rutherford, E Mercuri, L E Dyet, A D Edwards, and F M Cowan
Cortical vision, MRI and developmental outcome in preterm infants
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2008; 93(4): F292 - F297.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
A. J. Spittle, N. C. Brown, L. W. Doyle, R. N. Boyd, R. W. Hunt, M. Bear, and T. E. Inder
Quality of General Movements Is Related to White Matter Pathology in Very Preterm Infants
Pediatrics, May 1, 2008; 121(5): e1184 - e1189.
[Abstract] [Full Text] [PDF]


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
O Khwaja and J J Volpe
Pathogenesis of cerebral white matter injury of prematurity
Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2008; 93(2): F153 - F161.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
R. T. Constable, L. R. Ment, B. R. Vohr, S. R. Kesler, R. K. Fulbright, C. Lacadie, S. Delancy, K. H. Katz, K. C. Schneider, R. J. Schafer, et al.
Prematurely Born Children Demonstrate White Matter Microstructural Differences at 12 Years of Age, Relative to Term Control Subjects: An Investigation of Group and Gender Effects
Pediatrics, February 1, 2008; 121(2): 306 - 316.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
M. L. Krishnan, L. E. Dyet, J. P. Boardman, O. Kapellou, J. M. Allsop, F. Cowan, A. D. Edwards, M. A. Rutherford, and S. J. Counsell
Relationship Between White Matter Apparent Diffusion Coefficients in Preterm Infants at Term-Equivalent Age and Developmental Outcome at 2 Years
Pediatrics, September 1, 2007; 120(3): e604 - e609.
[Abstract] [Full Text] [PDF]