I. C. van Haastert

Neonatal tract-based spatial statistics findings and outcome in preterm infants.

BACKGROUND AND PURPOSE: WM injury is associated with different disabilities that children born prematurely may experience during their lives. The aim of this study was to use TBSS to test the hypothesis that WM microstructure at TEA in preterm infants is correlated with cognitive and motor outcome at 2-year corrected age. MATERIALS AND METHODS: Sixty-three preterm infants, born at a mean gestational age of 28.7 weeks, underwent MR imaging and DTI at TEA. Neurodevelopmental performance was assessed by using the BSITD-III. Voxelwise analysis of the DTI data was performed by using TBSS to assess the relationship among FA, AD, and RD at TEA, and cognitive, fine-motor, and gross-motor scores at 2-year corrected age. RESULTS: Cognitive scores were correlated with FA values in the CC. Fine-motor scores were correlated with FA and RD throughout the WM. Gross-motor scores were associated with RD in the CC, fornix, and internal and external capsule. CONCLUSIONS: WM microstructure in preterm infants at TEA was associated with cognitive, fine-motor, and gross-motor performance at 2-year corrected age. This study suggests that TBSS of DTI data at TEA has the potential to be used as a biomarker for subsequent neurodevelopment.

Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm

Aim: To examine the correlation between neonatal cranial ultrasound and school age magnetic resonance imaging (MRI) and neurodevelopmental outcome. Methods: In a prospective 2 year cohort study, 221 children (gestational age ⩽32 weeks and/or birth weight ⩽1500 g) participated at a median age of 8.1 years (inclusion percentage 78%). Conventional MRI, IQ (subtests of the WISC), and motor performance (Movement Assessment Battery for Children) at school age were primary outcome measurements. Results: Overall, there was poor correspondence between ultrasound group classifications and MRI group classifications, except for the severe group (over 70% agreement). There was only a 1% chance of the children with a normal cranial ultrasound having a major lesion on MRI. Mean IQ (standard deviation) was significantly lower in children with major ultrasound or MRI lesions, but was also lower in children with minor lesions on MRI compared to children with a normal MRI (91±16, 100±13, 104±13 for major lesions, minor lesions, and normal MRI, respectively). Median total impairment score (TIS) was significantly higher in children with major lesions on ultrasound or MRI as well as in children with minor lesions on MRI (TIS 4.0 and 6.25 for normal and minor lesions on MRI, respectively; p<0.0001). Conclusions: A normal neonatal cranial ultrasound excluded a severe lesion on MRI in 99% of cases. MRI correlated more strongly with mean IQ and median TIS than ultrasound. Subtle white matter lesions are better detected with MRI which could explain the stronger correlation of MRI with IQ and motor performance.

Ultrasound diagnosis and neurodevelopmental outcome of localised and extensive cystic periventricular leucomalacia

AIMS To compare the ultrasound (US) evolution and neurodevelopmental outcome of infants with localised (grade II) and extensive (grade III) cystic periventricular leucomalacia (c-PVL). METHODS Over a nine year period, c-PVL was diagnosed in 96/3451 (2.8%) infants in two hospital cohorts. Eighteen were excluded from the study. Thirty nine infants with grade II PVL were compared with 39 infants with grade III PVL. RESULTS The two populations were comparable for gestational age and birth weight. In infants with grade II PVL, cysts were noted to develop more often after the first month of life (53%) in contrast with grade III PVL (22%) (odds ratio (OR) 3.81 (95% confidence interval (CI) 1.19 to 12.63)). Cysts were also more often unilateral in grade II (54%) than in grade III PVL (0%) (OR indefinite; RR 3.17 (95% CI 2.16 to 4.64)). At 40 weeks postmenstrual age (PMA), cysts were no longer seen on US in 13/38 infants with grade II PVL, with ventriculomegaly being the only visible sequel in nine cases. In grade III PVL, cysts were still present in 25 of the 27 surviving infants. Nine infants with grade II PVL were free of motor sequelae at follow up compared with one infant with grade III PVL (OR 8.07 (95% CI 0.92 to 181.66)). Twenty two out of 29 children with grade II PVL who developed cerebral palsy achieved independent walking compared with 3/26 with grade III PVL (OR 75 (95% CI 11.4 to 662)). CONCLUSIONS In the cohort studied, 50% of the infants with c-PVL had a more localised form (grade II). In grade II PVL, the cysts developed beyond the first month of life in more than half of the cases and were often no longer visible, on US, at 40 weeks PMA. In order not to miss this diagnosis, sequential US should also be performed beyond the first month of life. Mild ventriculomegaly noted at term can sometimes be due to grade II c-PVL. Cerebral palsy was slightly less common and tended to be less severe in infants with grade II PVL than in those with grade III PVL.

Complications affecting preterm neonates from 1991 to 2006: what have we gained?

Aim:  In this study, we determined whether outcome of preterm neonates has improved over a period of 16 years.

Gross motor functional abilities in preterm-born children with cerebral palsy due to periventricular leukomalacia.

To describe the impact of periventricular leukomalacia (PVL) on gross motor function, data on 59 children (37 males, 22 females) with a gestational age (GA) of 34 weeks or less with cerebral palsy (CP) due to PVL grade I (n=20), II (n=13), III (n=25), and IV (n=1) were studied; (mean GA 29wk 4d [SD 4wk 6d]; mean birthweight 1318g [SD 342]). Two independent raters used the Gross Motor Function Classification System (GMFCS) at four time points: T1, mean corrected age (CA) 9 months 15 days (SD 2mo 6d); T2, mean CA 16 months (SD 1mo 27d); T3, mean CA 24 months 27 days (SD 2mo 3d); and T4, median age 7 years 6 months (range 2y 2mo–16y 8mo). Interrater reliability and stability across time with respect to the total cohort were κ≥0.86 and ρ≥0.74 respectively. The association between PVL and gross motor outcome at T4 was strong (positive and negative predictive values 0.92 and 0.85 respectively). The proportion of children who remained in the same GMFCS level increased from 27% (T1–T4) to 53% (T2–T4) and 72% (T3–T4). PVL grade I to II, as diagnosed in the neonatal period, has a better functional mobility prognosis than PVL grade III–IV. These findings have implications for habilitation counselling and intervention strategies.

Neurodevelopmental outcome over time of preterm born children ≤750 g at birth.

BACKGROUND Extremely low birth weight (ELBW) infants are at risk of cognitive impairment and follow-up is therefore of major importance. The age at which their neurodevelopmental outcome (NDO) can reliably be predicted differs in the literature. AIMS To describe NDO at 2, 3.5 and 5.5 years in an ELBW cohort. To examine the value of NDO at 2 years corrected age (CA) for prediction of NDO at 3.5 and 5.5 years. STUDY DESIGN A retrospective cross-sectional and longitudinal cohort study. SUBJECTS 101 children with a BW≤750 g, born between 1996 and 2005, who survived NICU admission and were included in a follow-up program. OUTCOME MEASURES NDO, measured with different tests for general development and intelligence, depending on age of assessment and classified as normal (Z-score≥-1), mildly delayed (-2≤Z-score<-1) or severely delayed (Z-score<-2). RESULTS At 2, 3.5 and 5.5 years 74.3, 82.2 and 76.2% had a normal NDO. A normal NDO at 2 years CA predicted a normal NDO at 3.5 and 5.5 years in 92% and 84% respectively. Of the children with a mildly or severely delayed NDO at 2 years CA the majority showed an improved NDO at 3.5 (69.2%) and 5.5 years (65.4%) respectively. CONCLUSIONS The majority of the children with a BW≤750 g had a normal NDO at all ages. A normal NDO at 2 years CA is a good predictor for normal outcome at 3.5 and 5.5 years, whereas a delayed NDO at 2 years CA is subject to change with the majority of the children showing a better NDO at 3.5 and 5.5 years.

Placental pathology and outcome after perinatal asphyxia and therapeutic hypothermia.

Objective:To assess the relationship between placental pathology, pattern of brain injury and neurodevelopmental outcome in term infants with perinatal asphyxia receiving therapeutic hypothermia.Study design:Studies were performed in 76 infants. Death or survival with impairments at 18 to 24 months was used as a composite adverse outcome. Multivariable analysis was performed.Results:Among the 75 infants analyzed, the predominant pattern of brain injury was: no injury (n=27), a white matter/watershed pattern (n=14), basal-ganglia-thalamic injury (n=13) or near-total brain injury (n=21). An adverse outcome was seen in 35 of the 76 infants. Elevated nucleated red blood cells were associated with white matter involvement. Small placental infarcts were more common among infants without brain injury. All other placental abnormalities were not related to both outcome measures.Conclusion:In our population of term infants receiving therapeutic hypothermia, no type of placental pathology was related to extensive brain injury or adverse neurodevelopmental outcome.

PS-155 Comparison Of Clinical And Electrophysiological Signs Of Encephalopathy In Neonates With Perinatal Asphyxia Qualifying For Hypothermia

Background and aims Early prediction of neurodevelopmental outcome following hypoxic-ischaemic encephalopathy remains a challenge. The aim of this retrospective study was to evaluate the aEEG background patterns and Thompson score on admission in asphyxiated neonates receiving hypothermia regarding outcome and neonatal variables. Methods After excluding congenital malformations and muscle paralysis, 89 neonates (January 2008 to June 2012) were included (GA: 39.7 ± 1.8 wks; BW: 3504 ± 640 g). On admission the Thompson score and aEEG were recorded. aEEG was scored as Continuous Normal Voltage (CNV), Discontinuous Normal Voltage (DNV), Burst-Suppression (BS), Continuous Low Voltage (CLV) or Flat Trace (FT). The combination of one or more of the following event (s): death, cerebral palsy, and Griffiths DQ less than 85 at 18 months were considered an adverse outcome. ANOVA, correlation, and binary logistic regression analyses were performed. Results Thompson scores (in mean ± sd) were associated with aEEG pattern (CNV: 8.3 ± 1.7; DNV: 8.9 ± 1.9; BS: 11.6 ± 3.6; CLV: 12.0 ± 2.1; FT: 13.1 ± 3.2; p < 0.001). Also, both aEEG and Thompson score were statistically correlated with Apgar 1 and 5 min scores (p < 0.05). Using a logistic regression model, both Thompson score (OR = 1.43; 95% CI = [1.15;1.77]) and aEEG pattern (BS: OR = 4.06; 95% CI = [0.74;22.16]; CLV: OR = 11.10; 95% CI = [1.38;89.66]; FT: OR = 13.35; 95% CI = [1.87;95.31]; reference group: CNV+DNV) were significant predictors of an adverse outcome. Conclusions Both Thompson scores and aEEG are associated with outcome in neonates receiving hypothermia for perinatal asphyxia and with 1 min Apgar scores. Further studies are needed to identify which method is preferable for selection of neonates for hypothermia.

456 Change in Cerebral Palsy Incidence and Severity Among Children Born Preterm in 1990-2005: A Hospital-Based Cohort Study

456 Change in Cerebral Palsy Incidence and Severity Among Children Born Preterm in 1990-2005: A Hospital-Based Cohort Study

De rol van neonataal kernspinresonantieonderzoek bij het voorspellen van de ontwikkeling van voldragen kinderen met perinatale asfyxie

SummaryThe role of magnetic resonance imaging (mri) in the prediction of subsequent neurodevelopmental outcome was evaluated in 100 fullterm infants with perinatal asphyxia. mri was performed in all surviving infants within the first 2 weeks of life. mri was not always available in those who died, but in these infants a postmortem was available. Seventy-three infants survived and were seen in the follow-up clinic for at least 18 months. Of them, 26 developed cerebral palsy. All 20 infants with normal mri were normal at (early) follow-up. The risk of an abnormal outcome was greatest in those with severe lesions in the basal ganglia involving abnormal signal intensity of the posterior limb of the internal capsule. Cystic lesions in the white matter also carried a high risk for a poor outcome. mri plays an important role in the assessment of the fullterm infant with perinatal asphyxia.SamenvattingBij een groep van 100 voldragen pasgeborenen met perinatale asfyxie werd de rol van kernspinresonantie (mri) bij het voorspellen van de latere psychomotorische ontwikkeling geëvalueerd. Bij alle kinderen die in leven bleven, werd binnen 2 weken na de geboorte mri-onderzoek verricht. Bij een deel van de overleden kinderen werd geen mri, maar wel postmortaal onderzoek verricht. 73 Kinderen bleven in leven en werden ten minste 18 maanden poliklinisch gevolgd. 26 Kinderen ontwikkelden infantiele encefalopathie. Een normale mri (n = 20) ging altijd gepaard met een normale (vroege) ontwikkeling. Het risico op afwijkende ontwikkeling was het grootst wanneer er ernstige afwijkingen aanwezig waren in de basale kernen met een afwijkend signaal ter plaatse van het achterste been van de capsula interna. Cysteuze afwijkingen in de witte stof gingen ook met een slechte prognose gepaard. mri speelt een belangrijke rol bij de evaluatie van de voldragen pasgeborene met perinatale asfyxie.