Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e662-e669 (doi:10.1542/peds.2008-0594)

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ARTICLE

Neonatal Cranial Ultrasound Lesions and Developmental Delays at 2 Years of Age Among Extremely Low Gestational Age Children

T. Michael O'Shea, MD, MPH^a, Karl C. K. Kuban, MD, SMEpi^b, Elizabeth N. Allred, MS^c,d, Nigel Paneth, MD, MPH^e, Marcello Pagano, PhD^d, Olaf Dammann, MD^f, Lisa Bostic, OTR/L^g, Kara Brooklier, PhD^h, Samantha Butler, PhDⁱ, Donald J. Goldstein, PhD^a, Gail Hounshell, PhD^a, Cecelia Keller, PT, MHA^f, Susan McQuiston, PhD^j, Alice Miller, PT, MS^k, Steve Pasternak, PhD^l, Susan Plesha-Troyke, OT^m, Joan Price, EdSⁿ, Elaine Romano, MSN^o, Katherine M. Solomon, PhD^h, Amanda Jacobson, PT^g, Sjirk Westra, MD^p, Alan Leviton, MD, MS^c for the Extremely Low Gestational Age Newborns Study Investigators

^a Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
^b Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University, Boston, Massachusetts
^c Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, Massachusetts
^d Department of Biostatistics, Harvard School of Public Health, Harvard University, Boston, Massachusetts
^e Department of Epidemiology, Michigan State University, East Lansing, Michigan
^f Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
^g Department of Occupational Therapy, University of North Carolina, Chapel Hill, North Carolina
^h Center for Human Development, William Beaumont Hospital, Royal Oak, Michigan
ⁱ Department of Psychiatry, Children's Hospital, Boston, Massachusetts
^j Baystate Medical Center, Springfield, Massachusetts
^k Department of Pediatrics, University of Massachusetts-Memorial Health Center, Worcester, Massachusetts
^l Pediatric Psychology, DeVos Children's Hospital, Grand Rapids, Michigan
^m Department of Pediatrics, University of Chicago, Chicago, Illinois
ⁿ Early Childhood Services/Referrals, Michigan State University-Sparrow Medical Center, Lansing, Michigan
^o Yale University Medical Center, New Haven, Connecticut
^p Department of Pediatric Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

BACKGROUND. Studies of the relationship between ultrasound images from preterm newborns and developmental delay most often are based on small samples defined by birth weight and exclude infants not testable with standardized assessments.

METHODS. We evaluated associations between ultrasound-defined lesions of the brain and developmental delays at 24 months’ corrected age in 1017 children born before the 28th postmenstrual week. Brain ultrasound scans were read for concordance on 4 lesions: intraventricular hemorrhage, moderate/severe ventriculomegaly, white matter echodense/hyperechoic lesions, and white matter echodense/hypoechoic lesions and 2 diagnoses–periventricular leukomalacia and periventricular hemorrhagic infarction. Certified examiners, who were not aware of the infants’ ultrasound findings, administered the Bayley Scales of Infant Development-Second Edition. Children with an impairment (eg., blindness) that precluded testing with the Bayley Scales and those for whom >2 test items were omitted were classified using the Vineland Adaptive Behavior Scales Motor Skills Domain instead of the Psychomotor Development Index and the Adaptive Behavior Composite instead of the Mental Development Index.

RESULTS. Fully 26% of all of the children had delayed mental development (ie, Mental Development Index < 70), and 31% had delayed psychomotor development (ie, Psychomotor Development Index < 70). Ultrasound abnormalities were more strongly associated with low Psychomotor Development Index than with low Mental Development Index. Children without cranial ultrasound abnormality had the lowest probability (23% and 26%) of delayed mental or psychomotor development. Moderate/severe ventriculomegaly was associated with a more than fourfold increase in the risk of psychomotor delay and an almost threefold increase in the risk of mental delay. Echolucency was the next best predictor of delayed mental and psychomotor development. The probability of low scores varied with the number of zones involved and with the location of echolucency. At particularly high risk were infants with bilateral cerebellar hemorrhage, co-occurring ventriculomegaly and echolucency bilateral echolucency, or echolucency located posteriorly.

CONCLUSIONS. Focal white matter damage, as characterized by echolucent/hypoechoic lesion, and diffuse damage, as suggested by late ventriculomegaly, are associated with delayed mental and psychomotor development.

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Key Words: prematurity • cognitive development • intraventricular hemorrhage • periventricular leukomalacia • neonatal follow-up • Bayley Scales of Infant Development

Abbreviations: ELGAN—Extremely Low Gestational Age Newborn • IVH—intraventricular hemorrhage • GMH—germinal matrix hemorrhage • BSID-II—Bayley Scales of Infant Development-Second Edition • MDI—Mental Development Index • PDI—Psychomotor Development Index • VABS—Vineland Adaptive Behavior Scales • ABC—Adaptive Behavior Composite • PVHI—periventricular hemorrhagic infarction • PVL—periventricular leukomalacia • CI—confidence interval • RR—risk ratio

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Accepted May 13, 2008.

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