Punctate white-matter lesions in the full-term newborn: Underlying aetiology and outcome

Hayman, Michael J.; Wezel‐Meijler, Gerda van; Straaten, Henrica van; Brilstra, Eva H.; Groenendaal, Floris; Vries, Linda S. de

doi:10.1016/j.ejpn.2019.01.005

Cited by 24 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly there were no reported PWMLs in the recent study of incidental MRI findings where the majority were born via SVD [2] . An earlier study by Hayman and colleagues (2019) reviewed 42 (near) term infants with PWMLs on MRI performed in the first 28 postnatal days [21] . The lesion load was high (>6) in 71% (versus 13/61 = 21% with >6 PWMLs in our results) but, unlike our study, their study was not a cohort of low risk neonates.…”

Section: Discussionmentioning

confidence: 99%

Incidental findings on brain MR imaging of asymptomatic term neonates in the Developing Human Connectome Project

et al. 2021

View full text Add to dashboard Cite

Background Interpretation of incidental findings on term neonatal MRI brain imaging can be challenging as there is a paucity of published normative data on asymptomatic term neonates. Reporting radiologists and clinicians need to be familiar with these incidental findings to avoid over-investigation and misinterpretation particularly in relation to neurodevelopmental outcome. This study aimed to determine the prevalence of incidental findings in a large group of asymptomatic term neonates participating in the Developing Human Connectome Project (dHCP) who were invited for neurodevelopmental assessment at 18 months. Methods We retrospectively reviewed MRI brain scans performed on 500 term neonates enrolled in the dHCP study between 2015 and 2019 with normal clinical examination. We reviewed the results of the Bayley Scales of Infant and Toddler Development (Bayley III) applied to participants who attended for neurodevelopmental follow-up at 18 months. Scores considered “delayed” if <70 on language, cognitive or motor scales. Findings Incidental findings were observed in 47% of term infants. Acute cerebral infarcts were incidentally noted in five neonates (1%). More common incidental findings included punctate white matter lesions (PWMLs) (12%) and caudothalamic subependymal cysts (10%). The most frequent incidental finding was intracranial haemorrhage (25%), particularly subdural haemorrhage (SDH). SDH and PWMLs were more common in infants delivered with ventouse-assistance versus other delivery methods. Neurodevelopmental results were available on 386/500 (77%). 14 infants had a language score < 70 (2 SD below the mean). Of the 386 infants with neurodevelopmental follow up at 18 months, group differences in motor and language scores between infants with and without incidental findings were not significant ( p = 0·17 and p = 0·97 respectively). Group differences in cognitive scores at 18 months between infants with (median (interquartile range) -100 (95–105)) and without (100 (95–110)) incidental findings were of small effect size to suggest clinical significance (Cliff's d = 0·15; p <0·05). Interpretation Incidental findings are relatively common on brain MRI in asymptomatic term neonates, majority are clinically insignificant with normal neurodevelopment at 18 months. Funding This work was supported by the European Research Council under the European Union's Seventh Framework Programme (FP7/20072013/ERC grant agreement no. [319456] dHCP project), by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z] and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas’ NHS Foundation Trust and King's College London and/or the NIHR Clinical Research Facility. The views expressed are thos...

show abstract

Section: Discussionmentioning

confidence: 99%

Incidental findings on brain MR imaging of asymptomatic term neonates in the Developing Human Connectome Project

et al. 2021

View full text Add to dashboard Cite

show abstract

“…16 Punctate white matter lesions have also been reported in term and late-preterm infants with congenital heart disease, hypoxic-ischemic encephalopathy, and genetic disorders, and following neonatal surgery. 17 In term infants with congenital heart disease, punctate white matter lesions are thought to be due to abnormal brain maturation due to disrupted blood flow and hypoxia from the cardiac lesion, 18 leading to a delay in the maturation of preoligodendrocytes. 19 Neurodevelopmental sequelae of punctate white matter lesions are variable, with some preterm infants with small isolated lesions (as in our cohort) reported as healthy, while others with more extensive lesion burden displaying motor and cognitive delays.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Before the wide usage of MRI, periventricular leukomalacia was a common type of white matter lesions in surviving premature infants, and its incidence has declined over the past decades; with the popular application of MRI, punctate white matter lesion is another commonly identified pathologic white matter lesion, and it may evolve into gliosis. 23 Wagenaar et al 24 observed intraventricular hemorrhage to be one of the predictors of punctate white matter lesions and both may share a common origin mechanism. Interestingly, other articles have also found that iron in intraventricular hemorrhage not only damage preoligodendrocytes, but also damage the ventricular wall, which may lead to periventricular leukomalacia and hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Hydrocephalus in Neonatal Purulent Meningitis: A Single-Center Retrospective Analysis

et al. 2021

View full text Add to dashboard Cite

Objective: Hydrocephalus is a potentially lethal complication of neonatal purulent meningitis. Early detection of hydrocephalus helps to determine optimal treatment, improve prognosis, and reduce financial burden. We aimed to analyze the risk factors for hydrocephalus in neonates with purulent meningitis and discuss the characteristics of the disease. Methods: The records of neonatal purulent meningitis admitted to the Children Hospital of Fudan University from January 2013 to September 2019 were retrospectively included in the study cohort. The data of clinical, laboratory, and cranial magnetic resonance images (MRIs) were collected and analyzed (except discharge data) by univariate analysis, and P values <.05 were further analyzed by multivariate logistic regression. Results: A total of 197 children who met the inclusion criteria were enrolled in the study cohort. Overall, 39.6% (78/197) of the patients had positive pathogen cultures, and 60.4% (119/197) of patients had clinical diagnosis of meningitis with negative pathogen cultures. Among 197 children, 67 of them experienced hydrocephalus, and the factors that were significantly associated with hydrocephalus in multivariate analysis were female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema. Children with hydrocephalus had a lower cure rate of meningitis (31.3% vs 75.4%), and poor discharge outcomes. In addition, they had longer length of hospital stay and higher hospital cost. Conclusions: Female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema were identified as risk factors for hydrocephalus in neonatal purulent meningitis. Children with hydrocephalus had poor discharge outcomes and increased financial burden on their families.

show abstract

Punctate white-matter lesions in the full-term newborn: Underlying aetiology and outcome

Cited by 24 publications

References 22 publications

Incidental findings on brain MR imaging of asymptomatic term neonates in the Developing Human Connectome Project

Incidental findings on brain MR imaging of asymptomatic term neonates in the Developing Human Connectome Project

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

Risk Factors for Hydrocephalus in Neonatal Purulent Meningitis: A Single-Center Retrospective Analysis

Contact Info

Product

Resources

About