Clinical Implications of Diffuse Excessive High Signal Intensity (DEHSI) on Neonatal MRI in School Age Children Born Extremely Preterm

Broström, Lina; Bolk, Jenny; Padilla, Nelly; Skiöld, Béatrice; Eklöf, Eva; Mårtensson, Gustaf; Vollmer, Brigitte; Ådén, Ulrika

doi:10.1371/journal.pone.0149578

Cited by 24 publications

(21 citation statements)

References 37 publications

(59 reference statements)

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“…22 Diffuse white matter hyperintensities are reported in over 50% of cranial MRI scans at term equivalent in extremely preterm (<28 weeks' gestation) infants, 23,24 although the long-term implications are uncertain. 23,25 In the three cases documented here, focal white matter hyperintensities were commented on in the clinical report and the possibility of multiple sclerosis was questioned.…”

Section: Discussionmentioning

confidence: 88%

Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls

2019

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INTRODUCTIONYoung adults are often reluctant to seek medical attention. Compared with full-term controls, very low birthweight (<1500 g; VLBW) young adults may have more health problems. AIMTo assess the frequency of unrecognised or unmet physical health needs during a comprehensive health and welfare assessment of a national cohort of VLBW adults born in 1986 compared with full-term controls. METHODSThe VLBW cohort (n = 229; 71% of those alive) and controls (n = 100) aged 27–29 years were assessed in one University Hospital over 2 days. Physical health assessments included growth, respiratory function, blood pressure, echocardiogram, renal function, blood tests and an interview. Cranial MRI scans were performed on 150 VLBW adults and 50 controls. Significant unrecognised or unmet health needs were defined as including a body mass index (BMI) >30 plus raised fasting insulin >80 pmol/L; any two of moderate respiratory obstruction, or reduced diffusing capacity, or being a regular smoker; cardiovascular: hypertension or abnormal echocardiogram. RESULTSAmong the VLBW cohort and controls; 61% versus 73% (P < 0.05) rated their overall health as very good or excellent. A general practitioner (GP) referral letter was sent for 44% VLBW adults and 38% controls, concerning metabolic problems in 20% and 17% respectively; respiratory problems in 12% and 4% (P < 0.05) respectively; cardiovascular problems in 14% and 12% respectively; abnormal renal function in 7% in both groups; and anaemia in 3% and 5% respectively. DISCUSSIONUnrecognised or unmet health needs were frequent in both VLBW young adults and controls. Respiratory problems and hypertension were more frequent in the former. Continuity of care is important for VLBW adults who require a regular GP. GPs should routinely ask about gestation and birthweight and VLBW graduates should volunteer this information.

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Section: Discussionmentioning

confidence: 88%

Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls

2019

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“…15,16,22 Outcomes after this diffuse mild injury are also variable. Studies that used qualitative diagnosis of diffuse signal abnormalities report normal developmental outcomes, [23][24][25] while studies that quantify it objectively or follow children with extensive hyperintensity report later cognitive and language delays. 26,27 In our cohort of infants with prenatal opioid exposure, the etiology of the white matter injury is unclear.…”

Section: Discussionmentioning

confidence: 99%

White Matter Injury and Structural Anomalies in Infants with Prenatal Opioid Exposue

Merhar

Parikh

Braimah

et al. 2019

AJNR Am J Neuroradiol

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Previous studies have not found structural injury or brain malformations in infants and children with prenatal opioid exposure. As part of an ongoing study evaluating neuroimaging in infants with prenatal opioid exposure, we reviewed structural brain MR imaging in 20 term infants with prenatal opioid exposure and 20 term controls at 4-8 weeks of age. We found that 8 of the 20 opioid-exposed infants had punctate white matter lesions or white matter signal abnormality on structural MR imaging, and 2 of the opioid-exposed infants had a septopreoptic fusion anomaly. No controls had white matter injury or structural malformations. Our findings underscore the importance of clinical neurodevelopmental follow-up and the need for more comprehensive imaging and long-term outcomes research following prenatal opioid exposure.Indicates open access to non-subscribers at www.ajnr.org http://dx.

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“…But those studies have varied in design, with some considering only high grade ICH or cPVL rather than later CUS findings (20), or showing that qualitative conventional term MRI reveals little additional data than CUS done on the same day to predict adverse outcomes at 2 or 6 years (25, 26). Some previous school age studies also focus narrowly on predictive capabilities of MRI findings without a goal of comparison to CUS (9, 27).…”

Section: Discussionmentioning

confidence: 99%

Preterm Neuroimaging and School-Age Cognitive Outcomes

et al. 2018

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Background and Objectives: Children born extremely preterm (EPT) are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial US (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6–7 years among children born EPT, and assess their prognostic value. Methods: A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6–7 years including FSIQ <70 and moderate-severe disability (FSIQ<70, moderate-severe cerebral palsy, or severely vision or hearing impaired) in a subgroup of SUPPORT enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. Results: 386 children had follow up at 6–7 years. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI, and adverse CUS findings were associated with 6–7 year outcomes. In full regression models, both adverse late CUS findings (OR 27.9, 95%CI 6.0–129) and significant cerebellar lesions on MRI (OR 2.71, 95% CI 1.1–6.7) remained associated with moderate-severe disability, but only adverse late CUS findings (OR 20.1, 95%CI 3.6–110.8) with FSIQ<70. Predictive accuracy of stepwise models was not substantially improved with addition of neuroimaging. Conclusions: Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school-age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of FSIQ<70 or moderate-severe disability at early school age.

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Clinical Implications of Diffuse Excessive High Signal Intensity (DEHSI) on Neonatal MRI in School Age Children Born Extremely Preterm

Cited by 24 publications

References 37 publications

Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls

Unrecognised and unmet physical health problems in a national cohort of very low birthweight young adults and controls

White Matter Injury and Structural Anomalies in Infants with Prenatal Opioid Exposue

Preterm Neuroimaging and School-Age Cognitive Outcomes

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