Specific Neuroimaging Findings May Predict School-Age Cognitive Disability in Preterm Infants

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The presence of grade III or IV cystic periventricular leukomalacia on either or both sides or intracranial hemorrhage defined a composite adverse finding on early CUS.
The presence of grade III or IV cystic periventricular leukomalacia on either or both sides or intracranial hemorrhage defined a composite adverse finding on early CUS.

Severe and adverse late findings on neonatal cranial ultrasound (CUS) and magnetic resonance imaging (MRI) in preterm infants, including cerebellar lesions and white matter abnormalities, may predict cognitive impairment and disability at 6 to 7 years of age, a study in Pediatrics found. In addition, the presence of significant cerebellar lesions on MRI analysis may also provide greater insight into future disability risk in these patients.

Investigators obtained early and late CUS at 4 to 14 days of age and 35 to 42 weeks' postmenstrual age, respectively, for study participants (N=386). The presence of grade III or IV cystic periventricular leukomalacia on either or both sides or intracranial hemorrhage defined a composite adverse finding on early CUS, whereas a composite late CUS adverse finding was defined as the presence of cystic periventricular leukomalacia or porencephalic cyst, shunt, or moderate-to-severe ventricular enlargement on either or both sides. The early and late CUS and near-term conventional MRI findings were used to predict cognitive (full scale IQ [FSIQ] <70) and disability (FSIQ <70, moderate-to-severe cerebral palsy or severe vision or hearing impairment) outcomes.

Follow-up assessments for cognitive status and disability, consisting of a battery of assessments and questionnaires, occurred at approximately 6 to 7 years of age. In the crude analysis, increasing white matter abnormality severity as well as the presence of cerebellar lesions on MRI were associated with lower mean FSIQ (P <.0001), higher FSIQs of <70 and <85 (P <.0001), higher moderate-to-severe disability rates (P <.0001), and lower minimal or no disability rates (P <.0001). The regression analysis found that adverse late CUS findings were significantly associated with disability (odds ratio 27.9; 95% CI, 6.0-129) and FSIQ <70 (odds ratio 20.1; 95% CI, 3.6-111).

The reliance on questionnaire results for assessing cognitive and disability outcomes at follow-up is a potential limitation of the analysis.

Neonatologists who make clinical “decisions regarding the need for near-term conventional brain MRI should be cognizant of the complexities of outcomes and limitations to predict them, the incremental benefits relative to increased costs, and the varying perspectives of the meaning of outcomes to patients and families, physicians, and investigators.”

Reference

Hintz SR, Vohr BR, Bann CM, et al; for the SUPPORT study group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neuroimaging and school-age cognitive outcomes. Pediatrics. 2018;142(1).

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