BackgroundMore than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12–24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age.Methods/designThis prospective cohort study will recruit 80 preterm infants born ≤30 week’s gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women’s Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay).DiscussionEarlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0439-z) contains supplementary material, which is available to authorized users.
Background: Very preterm infants are at risk of neurodevelopmental impairments including visual and cognitive deficits. Early identification and prognostication of at-risk infants may enable early intervention and support, thus optimising outcomes. Electroencephalography (EEG) and Magnetic Resonance Imaging (MRI) are methods sensitive to aspects of brain maturation and may provide potential predictive biomarkers of deficits.Aims: To investigate the associations between EEG or MRI at term equivalent age (TEA) and: 1) visual function at TEA;2) visual function at 3 months corrected age (CA); and3) cognitive function at 12 months CA.Methods: Very preterm infants (n=146, born ≤30weeks gestational age, GA) without any major congenital or chromosomal abnormality were recruited. EEG was recorded at TEA and artefact-free data during active sleep were extracted for quantitative analyses. Power spectral, coherence and partial directed coherence (PDC) analyses were conducted in each frequency band at chosen electrodes. Frequency ranges analysed were: delta (0.5-2Hz), theta (2-6Hz), alpha (3-13Hz), and beta (13-30Hz). Parietal and occipital electrodes were chosen for vision-related analyses and frontal and central electrodes for cognitionrelated analyses.Brain MRI was carried out at TEA. Diffusion tensor model was used to estimate the fractional anisotropy (FA) and mean diffusivity (MD). Constrained spherical deconvolution and whole brain probabilistic tractography were computed. Tracts of interest were optic radiation (OR) for vision-related analyses and corpus callosum (CC) for cognition-related analyses. Mean FA and MD for each tract were calculated.
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