OC6.02: Growth rate of corpus callosum in very premature infants

Abstract

Objective: A bedside method for assessing the effectiveness of strategies to improve cerebral development in very premature infants is desirable. The aim of this study was to compare the growth trajectory of the corpus callosum on cranial ultrasound in very premature infants and compare it with the growth rate seen antenatally. Methods: We recruited 100 very low birth weight infants admitted to a single regional Level III neonatal intensive care unit from November 1998 to November 2000. Sixty-four (32 boys) infants, mean gestational age 28 weeks (range 23-33 weeks), had cranial ultrasound images of the corpus callosum adequate for measurement obtained in the first week of life and at term equivalent. The length of corpus callosum was identified as the most reproducible measurement in a subgroup of 16 infants. The growth rate of the corpus callosum was compared in the 64 study infants to the expected growth rate of 0.20-0.27 mm/day from antenatal data; and correlated with clinical outcome at two years of age in 55 infants using Mental Development Index and Psychomotor Development Index. Results: The average growth rate of the corpus callosum was half the rate expected from antenatal data. Mean growth rates were similar for all age ranges (p = 0.4); 0.12 mm/day (0.07-0.17) for the 9 infants born at 23-25 weeks' gestation; 0.11 mm/day (0.06-0.18) for the 35 infants born at 26-29 weeks; 0.11 mm/day (0.05-0.29) for the 20 born at 30-33 weeks. Growth rate of the corpus callosum was greater in infants who had antenatal steroids (p = 0.02) or who were born IUGR (p = 0.04). There was no correlation with gender, PROM, multiple birth; or BPD or indomethicin postnatally. There was poor correlation with mental and psychomotor outcome. Conclusion: Measurement of the length of the corpus callosum at cranial ultrasound is reproducible. The length of corpus callosum grows at a much lower rate postnatally than in utero among very premature infants.

A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth

“…27 In accordance with previous studies, we showed satisfactory reproducibility for CC length. 7 CCF reproducibility was excellent too; this finding suggests that both measurements are feasible for longitudinal evaluation of brain growth. Increasing lengths with increasing ages and weights, as shown in the growth charts, support the use of these markers in clinical practice.…”

“…[7][8][9][10] One explanation for this is that the brain has few easily recognizable and consistent landmarks for reliable measurements on CUS. The CC, a flat bundle of white matter that connects the left and right hemispheres, is one of the brain structures that is easily visualized and recognizable on CUS.…”

“…A few sonographic markers of brain growth have been used in the past, mainly measuring the corpus callosum (CC) or cerebellum, thereby reflecting growth of a small part of the brain only. [7][8][9][10][11] In addition to currently available markers of preterm brain development, we propose that the length between the genu of the CC and the fastigium (roof of the fourth ventricle) could serve as a new marker for brain growth. The aim of this study was to evaluate the usefulness of corpus callosum-fastigium (CCF) length and CC length, an existing marker, as markers for monitoring brain growth in preterm infants during the NICU stay.…”

Pontine Hypoplasia in Children with Periventricular Leukomalacia

“…13,14 In addition, in sonography studies regarding very premature infants, the length of the corpus callosum at term equivalency was significantly shorter than that in control infants, and the growth rate of corpus callosal length has significant correlation with clinical outcome. 15,16 We then consider that the length of the corpus callosum, as well as its size and shape, reflects the volume of the myelinated white matter. Consequently, the significant correlation between whole pontine diameter and corpus callosal length may reflect the volume of the cerebral myelinated white matter.…”

Pediatric MRI Brain: Normal or abnormal, that is the question.

“…It will reach an adult appearance by approximately 9 to 10 months of age [44]. One should also be aware that growth of the corpus callosum is typically slower in premature infants compared to infants of the same gestational age [45].…”