Early Ultrasonic Monitoring of Brain Growth and Later Neurodevelopmental Outcome in Very Preterm Infants

Abstract

BACKGROUND AND PURPOSE:In infants born very preterm, monitoring of early brain growth could contribute to prediction of later neurodevelopment. Therefore, our aim was to investigate associations between 2 early cranial ultrasound markers (corpus callosum-fastigium and corpus callosum length) and neurodevelopmental outcome and the added value of both markers in the prediction of neurodevelopmental outcome based on neonatal risk factors and head circumference in very preterm infants. MATERIALS AND METHODS:This prospective observational study included 225 infants born at ,30 weeks' gestational age, of whom 153 were without any brain injury on cranial ultrasound. Corpus callosum-fastigium and corpus callosum length and head circumference were measured at birth, 29 weeks' gestational age, transfer from the neonatal intensive care unit to a level II hospital, and 2 months' corrected age. We analyzed associations of brain markers and their growth with cognitive, motor, language, and behavioral outcome at 2 years' corrected age. RESULTS:In infants without brain injury, greater corpus callosum-fastigium length at 2 months was associated with better cognitive outcome. Corpus callosum length at 2 months was positively associated with cognitive, motor, and language outcome. Faster growth of the corpus callosum length between birth and 2 months was associated with better cognitive and motor function. Prediction of neurodevelopmental outcome based on neonatal risk factors with or without head circumference was significantly improved by adding corpus callosum length.

Associations of preterm and early-term birth with suspected developmental coordination disorder: a national retrospective cohort study in children aged 3–10 years

“…Our study showed that very and moderately preterm preschoolers aged 3-6 years old were at a higher risk of DCD, which is similar to previous studies that showed poor motor performance was common in very preterm children with very low birth weight [39,40]. Consistent with other reports, an increased risk of motor impairment was reported in children born very preterm at or before 32 weeks [10,[41][42][43].…”

“…Preterm infants are born during a particularly vulnerable phase of brain development and are therefore at a significantly higher risk of suboptimal brain development and adverse neurodevelopmental outcomes, including motor, neurosensory, cognitive, and behavioral deficits [40,46]. Previous studies have consistently reported an association of brain microstructure with motor impairments in preterm populations [39,[47][48][49]. Impaired cerebellar development is an important determinant of adverse motor outcomes in very preterm infants [48], and studies have reported an association between fine motor skills and the volume and maturity of the cerebellum, brainstem and gray matter [50].…”

Relationships between early postnatal cranial ultrasonography linear measures and neurodevelopment at 2 years in infants born at <30 weeks’ gestational age without major brain injury

“…cUS studies of very preterm infants have shown positive relationships between the CCL at birth, TEA and 2 months’ post-term and motor development, and between the CCL at TEA and cognitive development, at 2 years 28 29. Anderson et al showed that slower CCL growth between 2 and 6 weeks’ PNA was predictive of motor delay and cerebral palsy at 2 years, and Beunders et al showed that slower CCL growth between birth and 2 months’ post-term was related to poorer motor development 24 29. In the current study, we found no evidence to support relationships between the CCL and motor development.…”

“…We excluded infants with major brain injury, in contrast to the study by Anderson et al , which is more likely to predict motor impairment 24 28. The study by Beunders et al excluded infants with any brain injury, although it examined brain growth over a longer period (up to 24 weeks after birth) compared with the first 8 weeks after birth in our study 29…”

“…A thinner and/or shorter corpus callosum at TEA reflects poorer brain growth and maturation, and has been associated with adverse neurodevelopment 5 6. cUS studies of very preterm infants have shown positive relationships between the CCL at birth, TEA and 2 months’ post-term and motor development, and between the CCL at TEA and cognitive development, at 2 years 28 29. Anderson et al showed that slower CCL growth between 2 and 6 weeks’ PNA was predictive of motor delay and cerebral palsy at 2 years, and Beunders et al showed that slower CCL growth between birth and 2 months’ post-term was related to poorer motor development 24 29.…”