Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage – Intraventricular Hemorrhage [GMH-IVH grade 3–4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal–axonal injury and GMH-IVH grade 1–2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.

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Background: Preterm birth is one of the world’s critical health problems, with an incidence of 5% to 18% of living newborns according to various countries. White matter injuries due to preoligodendrocytes deficits cause hypomyelination in children born preterm. Preterm infants also have multiple neurodevelopmental sequelae due to prenatal and perinatal risk factors for brain damage. The purpose of this work was to explore the effects of the brain risk factors and MRI volumes and abnormalities on the posterior motor and cognitive development at 3 years of age. Methods: A total of 166 preterm infants were examined before 4 months and clinical and MRI evaluations were performed. MRI showed abnormal findings in 89% of the infants. Parents of all infants were invited to receive the Katona neurohabilitation treatment. The parents of 128 infants accepted and received Katona’s neurohabilitation treatment. The remaining 38 infants did not receive treatment for a variety of reasons. At the three-year follow-up, Bayley’s II Mental Developmental Index (MDI) and the Psychomotor Developmental Index (PDI) were compared between treated and untreated subjects. Results: The treated children had higher values of both indices than the untreated. Linear regression showed that the antecedents of placenta disorders and sepsis as well as volumes of the corpus callosum and of the left lateral ventricle significantly predicted both MDI and PDI, while Apgar < 7 and volume of the right lateral ventricle predicted the PDI. Conclusions: (1) The results indicate that preterm infants who received Katona’s neurohabilitation procedure exhibited significantly better outcomes at 3 years of age compared to those who did not receive the treatment. (2) The presence of sepsis and the volumes of the corpus callosum and lateral ventricles at 3–4 months were significant predictors of the outcome at 3 years of age.

El desarrollo infantil comprende la adquisición gradual de habilidades en las áreas sensoriomotora, lenguaje y social, desde el nacimiento hasta los 12 años; éstas son mediadas por la maduración de estructuras del sistema nervioso que permiten al niño relacionarse con su entorno. Lo anterior se lleva a cabo de manera eficaz cuando existe un óptimo procesamiento sensoriomotor, en donde el sistema nervioso central organiza e interpreta la información del exterior a través de los sentidos, y posteriormente ejecutar una respuesta adecuada. En esta línea, la estimulación del sistema vestibular favorece al área de desarrollo motriz; sin embargo, también se ha comprobado que, a partir de esto, se benefician las otras áreas a través de las dos funciones básicas vestibulares (equilibrio y orientación espacial), lo que le posibilita al niño aprender, regular y adaptar el movimiento, al transformar la información sensorial en respuestas posturales que promueven el comienzo de la verticalización del eje axial hasta consolidar la bipedestación, es decir, permiten al niño cumplir gradualmente sus necesidades de interactuar con el medio a través del movimiento en busca de nuevos aprendizajes que conllevan a un desarrollo óptimo para su independencia. Este artículo tuvo como objetivo, a través de la revisión bibliográfica, enfatizar la importancia de la estimulación del sistema vestibular para la regulación del movimiento, favoreciendo el desarrollo infantil en sus diferentes áreas. LUXMÉDICA AÑO 14, NÚMERO 40, ENERO-ABRIL 2019 PP 41-51.