Poor postnatal head growth was common in our study cohort. Both microcephaly and suboptimal head size were associated with impaired neurodevelopmental outcome. Suboptimal head size at 3 months was found to be particularly associated with adverse neurodevelopmental outcome.

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Aim:  To provide comprehensive data on potential sex differences in maternal and neonatal characteristics, short‐term morbidity and neurodevelopmental outcome within an entire geographically determined collective of infants born at a gestational age <32 weeks. Methods:  Between 2003 and 2008, we prospectively enrolled all infants born in Tyrol at <32 weeks of gestation; the association between sex, and a wide set of pre‐ and postnatal factors, post‐discharge morbidity and neurodevelopmental outcome was analysed. Results:  Girls less frequently suffered from early‐onset sepsis than boys (p = 0.030). After adjustment for multiple corrections (Bonferroni’s p = 0.003), no sex differences were seen within any maternal or neonatal parameter. Analysis of morbidity revealed a higher readmission rate in boys (p < 0.0001), which was primarily caused by a greater incidence of respiratory problems (p = 0.003). Boys did not show a greater adverse neurodevelopmental outcome at the age of 12 or 24 months. Conclusion:  Parents of boys should be prepared for a potentially higher frequency of readmission after initial discharge, but our data currently give no reason for parents of boys to be disproportionately anxious about their neurodevelopmental outcome. Whether boys also enjoy a rosy prognosis for developmental outcome at school age remains to be elucidated.

IntroductionIn recent years, significant investigation has been undertaken by means of magnetic resonance imaging (MRI) in an attempt to identify preterm infants at risk for adverse outcome. The primary objective is to provide a comprehensive characterization of cerebral injury detected by conventional MRI at term-equivalent age in an unselected, consecutive, contemporary cohort of preterm infants born <32 gestational weeks. Secondly, this study aims to identify risk factors for the different injury types in this population.MethodsData for all preterm infants born <32 gestational weeks and admitted to Innsbruck Medical University Hospital were prospectively collected (October 2010 to December 2015). Cerebral MRI was evaluated retrospectively using a validated scoring system that incorporates intraventricular haemorrhage (IVH), white matter disease (WMD) and cerebellar haemorrhage (CBH).Results300 infants were included in the study. MRI showed 24.7% of all infants to have some form of brain injury. The most common injury type was IVH (16.0%). WMD and CBH were seen in 10.0% and 8.0%. The prevalence of common neonatal risk factors was greater within the group of infants with CBH. In particular indicators for respiratory disease were observed more often: longer ventilation duration, more frequent need for supplemental oxygen at day 28, higher rates of hydrocortisone treatment. Catecholamine treatment was the only neonatal risk factor that was overrepresented in infants with WMDDiscussionCerebral MRI at term-equivalent age, as addition to cranial ultrasound, detected brain injury in 25% of preterm survivors. The diagnosis of IVH was already made by neonatal ultrasound in most cases. In contrast, only a minority of the CBH and none of the non-cystic WMD have been detected prior to MRI. Decreasing gestational age and neonatal complications involved with immaturity have been identified as risk factors for CBH, whereas WMD was found in relatively mature infants with circulatory disturbances.

Background: In recent years, cerebral magnetic resonance imaging (MRI) has been increasingly used to depict the wide spectrum of preterm brain injury. Furthermore, it has already been demonstrated by MRI at term-equivalent age (TEA) that preterm infants show delayed brain maturation as compared to term infants, and this delay has been related to neurobehavioral outcome. Objectives: The aim of the current study was to investigate the influence of prevalent neonatal risk factors for adverse outcome on structural brain maturation in very preterm infants at TEA. Methods: One hundred and thirty very preterm infants born at a mean gestational age of 29.7 weeks were included. MRI was performed at TEA and given a validated ‘total maturation score'. Brain maturation scores were compared with neonatal data. Results: In univariate analysis, bronchopulmonary dysplasia (BPD), late-onset sepsis and retinopathy of prematurity were significantly associated with delayed brain maturation. Furthermore, infants with delayed maturation had been ventilated significantly longer and more often suffered from severe arterial hypotension. In multivariate analysis, BPD remained significant as predictor of delayed brain maturation. Conclusions: This study is the first to show that delayed structural brain maturation as evaluated by MRI at TEA is preceded by BPD, which is known to be a predictor of adverse outcome in preterm infants. This finding adds further evidence to show that adverse outcome in preterm infants may have additional neural correlates that exceed common brain injury.

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A well-trained team is indispensable in obtaining best-quality images as a prerequisite for good counselling. From our experience, we worked out a guideline to ensure that scans in stable non-sedated preterm-born infants at TEA run smoothly and provide high-quality images.

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