Neuroimaging of the Preterm Brain: Review and Recommendations

Inder, Terrie E.; Vries, Linda S. de; Ferriero, Donna M.; Grant, P. Ellen; Ment, Laura R.; Miller, Steven P.; Volpe, Joseph J.

doi:10.1016/j.jpeds.2021.06.014

Cited by 44 publications

(42 citation statements)

References 115 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The more preterm an infant is at birth, the higher the risk of brain injury, such that every extra day in utero is of benefit in minimizing events leading to injury, as long as both the in utero environment and the fetus themself is healthy (Ophelders et al, 2020;Cheong et al, 2021). The typical pattern of brain injury experienced by preterm neonates is well described and includes intraventricular hemorrhage, venous infarction, periventricular echogenicity and leukomalacia, post-hemorrhagic ventricular dilatation, and hypoxic ischemic injury (Inder et al, 2021;Ortinau and Neil, 2015). However, only the more severe lesions evident on neuroimaging translate into longer term outcomes, with environmental factors exerting a greater influence on outcomes over time, especially in those with milder brain injury on imaging (Jansen et al, 2021).…”

Section: Brain Injury In Preterm Infantsmentioning

confidence: 99%

Impact of Comorbid Prematurity and Congenital Anomalies: A Review

Gunn-Charlton

2022

Front. Physiol.

View full text Add to dashboard Cite

Preterm infants are more likely to be born with congenital anomalies than those who are born at full-term. Conversely, neonates born with congenital anomalies are also more likely to be born preterm than those without congenital anomalies. Moreover, the comorbid impact of prematurity and congenital anomalies is more than cumulative. Multiple common factors increase the risk of brain injury and neurodevelopmental impairment in both preterm babies and those born with congenital anomalies. These include prolonged hospital length of stay, feeding difficulties, nutritional deficits, pain exposure and administration of medications including sedatives and analgesics. Congenital heart disease provides a well-studied example of the impact of comorbid disease with prematurity. Impaired brain growth and maturity is well described in the third trimester in this population; the immature brain is subsequently more vulnerable to further injury. There is a colinear relationship between degree of prematurity and outcome both in terms of mortality and neurological morbidity. Both prematurity and relative brain immaturity independently increase the risk of subsequent neurodevelopmental impairment in infants with CHD. Non-cardiac surgery also poses a greater risk to preterm infants despite the expectation of normal in utero brain growth. Esophageal atresia, diaphragmatic hernia and abdominal wall defects provide examples of congenital anomalies which have been shown to have poorer neurodevelopmental outcomes in the face of prematurity, with associated increased surgical complexity, higher relative cumulative doses of medications, longer hospital and intensive care stay and increased rates of feeding difficulties, compared with infants who experience either prematurity or congenital anomalies alone.

show abstract

Section: Brain Injury In Preterm Infantsmentioning

confidence: 99%

Impact of Comorbid Prematurity and Congenital Anomalies: A Review

Gunn-Charlton

2022

Front. Physiol.

View full text Add to dashboard Cite

show abstract

“…Cystic periventricular leukomalacia is well diagnosed by both ultrasound and MRI. On the contrary, punctuate WM lesions representative of gliosis are only delineated by MRI scans as ischemic signals and less frequently hemorrhagic [11]. Finally, diffusive and excessive signal intensity of the WM may also be described in T2-weighted images.…”

Section: Conventional Mrimentioning

confidence: 99%

“…Children 2022, 9, 356 2 of 17 MRI studies in the early 2000s have identified white matter (WM) signal abnormalities as nodular periventricular leukomalacia in favor of gliosis lesions and predictive of neurodevelopmental outcomes [1,9,10]. Therefore, cerebral MRI at term equivalent age has been suggested to become part of a routine imaging protocol in PT [11]. Furthermore, advanced MRI techniques have brought great insights in PT brain development.…”

Section: Introductionmentioning

confidence: 99%

Advanced Brain Imaging in Preterm Infants: A Narrative Review of Microstructural and Connectomic Disruption

et al. 2022

View full text Add to dashboard Cite

Preterm birth disrupts the in utero environment, preventing the brain from fully developing, thereby causing later cognitive and behavioral disorders. Such cerebral alteration occurs beneath an anatomical scale, and is therefore undetectable by conventional imagery. Prematurity impairs the microstructure and thus the histological process responsible for the maturation, including the myelination. Cerebral MRI diffusion tensor imaging sequences, based on water’s motion into the brain, allows a representation of this maturation process. Similarly, the brain’s connections become disorganized. The connectome gathers structural and anatomical white matter fibers, as well as functional networks referring to remote brain regions connected one over another. Structural and functional connectivity is illustrated by tractography and functional MRI, respectively. Their organizations consist of core nodes connected by edges. This basic distribution is already established in the fetal brain. It evolves greatly over time but is compromised by prematurity. Finally, cerebral plasticity is nurtured by a lifetime experience at microstructural and macrostructural scales. A preterm birth causes a negative and early disruption, though it can be partly mitigated by positive stimuli based on developmental neonatal care.

show abstract

“…Premature birth impacts callosal growth and disturbs WM connectivity and the myelination process ( 20 ). Such alteration of callosal growth and microstructural disorganization has been correlated with a worse cognitive and motor outcome than a control population ( 20 , 22 , 25 ). In a cohort of very preterm infants <30 weeks, the majority of survivors did not have severe brain injuries but an altered biparietal diameter and IHD ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…The cerebellum is an area of particular interest in preterm infants because of its acute growth during the third trimester of the pregnancy. Cerebellar diameter at term equivalent age seems to be independently related to cognitive and motor outcomes ( 25 , 27 ). This finding was also supported by the correlation between cerebellar abnormal dimensions and motor function at 7 years old ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Assessment of brain two-dimensional metrics in infants born preterm at term equivalent age: Correlation of ultrasound scans with magnetic resonance imaging

et al. 2022

View full text Add to dashboard Cite

ContextDeveloping brain imaging is a critical subject for infants born preterm. Impaired brain growth is correlated with poor neurological outcomes, regardless of overt brain lesions, such as hemorrhage or leukomalacia. As magnetic resonance imaging (MRI) remains a research tool for assessing regional brain volumes, two-dimensional metrics (2D metrics) provide a reliable estimation of brain structures. In neonatal intensive care, cerebral ultrasound (cUS) is routinely performed to assess brain integrity. This prospective work has compared US and MRI accuracy for the measurement of 2D brain metrics and identification of overt injuries.MethodsMRI and cUS were performed at term equivalent age (TEA) in infants born before 32 weeks of gestation (GW). Demographical data and results of serial cUS (Neonatal Intensive Care Unit [NICU]-US) performed during hospitalization were gathered from medical charts. Blinded, experienced senior doctors reviewed the scans for both standard analysis and standardized, 2D measurements. The correlation of 2D metrics and inter-/intraobserver agreements were evaluated using Pearson’s coefficient, Bland-Altman plots, and intraclass coefficient (ICC), respectively.ResultsIn total, 102 infants born preterm were included. The performance of “TEA-cUS and NICU-cUS” when compared to “TEA-MRI and NICU-cUS” was identical for the detection of high-grade hemorrhages and close for low-grade ones. However, TEA-MRI only detected nodular lesions of the white matter (WM). No infant presented a cerebellar infarct on imaging. Intra- and inter-observer agreements were excellent for all 2D metrics except for the corpus callosum width (CCW) and anteroposterior vermis diameter. MRI and cUS showed good to excellent correlation for brain and bones biparietal diameters, corpus callosum length (CCL), transcerebellar diameters (TCDs), and lateral ventricle diameters. Measures of CCW and vermis dimensions were poorly correlated.Conclusion and perspectiveThe cUS is a reliable tool to assess selected 2D measurements in the developing brain. Repetition of these metrics by serial cUS during NICU stay would allow the completion of growth charts for several brain structures. Further studies will assess whether these charts are relevant markers of neurological outcome.

show abstract

Neuroimaging of the Preterm Brain: Review and Recommendations

Cited by 44 publications

References 115 publications

Impact of Comorbid Prematurity and Congenital Anomalies: A Review

Impact of Comorbid Prematurity and Congenital Anomalies: A Review

Advanced Brain Imaging in Preterm Infants: A Narrative Review of Microstructural and Connectomic Disruption

Assessment of brain two-dimensional metrics in infants born preterm at term equivalent age: Correlation of ultrasound scans with magnetic resonance imaging

Contact Info

Product

Resources

About