B.7 Nutrition in the first two weeks of life, neonatal brain growth and
                        cognitive outcomes in children born very preterm

Background: Nutrition in early life plays a critical role in the growth and neurodevelopment of preterm neonates. However, whether early nutrition modified the association of white matter injury (WMI) with brain maturation and neurodevelopmental outcomes remains unclear. Methods: In this prospective cohort study, very preterm neonates were recruited from the NICU at BC Women’s Hospital. MRI and measures of NAA/choline were obtained. Energy intake was recorded over the first two weeks of life and the cohort was dichotomized. Neurodevelopmental outcomes were assessed at 4.5 years of age using WPPSI-III. Results: Neonates in the high lipid group had higher levels of NAA/choline in the basal ganglia. When accounting for confounders, this relationship was only significant in neonates without WMI (p=0.04). Overall, neonates with larger WMI volumes had lower IQ scores at 4.5 years (p<0.001). However, this relationship was attenuated in the high lipid group (p=0.002) relative to the lower lipid intake group. Conclusions: In this cohort, higher energy intake is associated with increased brain maturation. Similarly, neonates with large WMI had higher full-scale IQ if they received greater lipid intake in the neonatal period, suggesting that greater early lipid intake may contribute to blunting the deleterious effects of WMI on neurodevelopmental outcomes.

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Predicting developmental outcomes in preterm infants

Neurology ◽

10.1212/wnl.0000000000008172 ◽

2019 ◽

Vol 93 (13) ◽

pp. e1231-e1240 ◽

Cited By ~ 4

Author(s):

Dalit Cayam-Rand ◽

Ting Guo ◽

Ruth E. Grunau ◽

Isabel Benavente-Fernández ◽

Anne Synnes ◽

...

Keyword(s):

Characteristic Curve ◽

Brain Mri ◽

Adverse Outcomes ◽

Preschool Age ◽

Cognitive Outcomes ◽

White Matter Injury ◽

Preterm Neonates ◽

Posterior Commissure ◽

Neurodevelopmental Outcomes ◽

Motor Outcomes

ObjectiveTo develop a simple imaging rule to predict neurodevelopmental outcomes at 4.5 years in a cohort of preterm neonates with white matter injury (WMI) based on lesion location and examine whether clinical variables enhance prediction.MethodsSixty-eight preterm neonates born 24–32 weeks' gestation (median 27.7 weeks) were diagnosed with WMI on early brain MRI scans (median 32.3 weeks). 3D T1-weighted images of 60 neonates with 4.5-year outcomes were reformatted and aligned to the posterior commissure–eye plane and WMI was classified by location: anterior or posterior-only to the midventricle line on the reformatted axial plane. Adverse outcomes at 4.5 years were defined as Wechsler Preschool and Primary Scale of Intelligence full-scale IQ <85, cerebral palsy, or Movement Assessment Battery for Children, second edition percentile <5. The prediction of adverse outcome by WMI location, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) was assessed using multivariable logistic regression.ResultsSix children had adverse cognitive outcomes and 17 had adverse motor outcomes. WMI location predicted cognitive outcomes in 90% (area under receiver operating characteristic curve [AUC] 0.80) and motor outcomes in 85% (AUC 0.75). Adding IVH, BPD, and ROP to the model enhances the predictive strength for cognitive and motor outcomes (AUC 0.83 and 0.88, respectively). Rule performance was confirmed in an independent cohort of children with WMI.ConclusionsWMI on early MRI can be classified by location to predict preschool age outcomes in children born preterm. The predictive value of this WMI classification is enhanced by considering clinical factors apparent by term-equivalent age.

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Predicting long-term neurodevelopmental outcomes in very preterm neonates by umbilical cord gas parameters

American Journal of Obstetrics & Gynecology MFM ◽

10.1016/j.ajogmf.2020.100248 ◽

2020 ◽

pp. 100248

Author(s):

Sima H. Baalbaki ◽

S. Lindsay Wood ◽

Alan T. Tita ◽

Jeff M. Szychowski ◽

William W. Andrews ◽

...

Keyword(s):

Umbilical Cord ◽

Preterm Neonates ◽

Neurodevelopmental Outcomes ◽

Very Preterm

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Ultrasound detection of white matter injury in very preterm neonates: practical implications

Developmental Medicine & Child Neurology ◽

10.1111/j.1469-8749.2011.04060.x ◽

2011 ◽

Vol 53 ◽

pp. 29-34 ◽

Cited By ~ 25

Author(s):

GERDA VAN WEZEL-MEIJLER ◽

FRANCISCA T DE BRUÏNE ◽

SYLKE J STEGGERDA ◽

ANNETTE VAN DEN BERG-HUYSMANS ◽

SIJME ZEILEMAKER ◽

...

Keyword(s):

White Matter ◽

White Matter Injury ◽

Preterm Neonates ◽

Very Preterm ◽

Practical Implications

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Maternal chorioamnionitis and neurodevelopmental outcomes in preterm and very preterm neonates: A meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0208302 ◽

2018 ◽

Vol 13 (12) ◽

pp. e0208302 ◽

Cited By ~ 8

Author(s):

Dongqiong Xiao ◽

Tingting Zhu ◽

Yi Qu ◽

Xiaoyun Gou ◽

Qun Huang ◽

...

Keyword(s):

Meta Analysis ◽

Preterm Neonates ◽

Neurodevelopmental Outcomes ◽

Very Preterm

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Head circumference, total cerebral volume and neurodevelopment in preterm neonates

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-321397 ◽

2021 ◽

pp. fetalneonatal-2020-321397

Author(s):

Thiviya Selvanathan ◽

Ting Guo ◽

Eddie Kwan ◽

Vann Chau ◽

Rollin Brant ◽

...

Keyword(s):

Gestational Age ◽

Head Circumference ◽

Neonatal Intensive Care ◽

Adverse Outcomes ◽

White Matter Injury ◽

Preterm Neonates ◽

Strongly Correlated ◽

Language Outcomes ◽

Neurodevelopmental Outcomes ◽

Movement Assessment

ObjectivesTo assess the association of head circumference (HC) <10th percentile at birth and discharge from the neonatal intensive care unit (NICU) with neurodevelopment in very preterm (24–32 weeks’ gestational age) neonates, and to compare the association of HC and total cerebral volume (TCV) with neurodevelopmental outcomes.DesignIn a prospective cohort, semiautomatically segmented TCV and manually segmented white matter injury (WMI) volumes were obtained. Multivariable regressions were used to study the association of HC and TCV with neurodevelopmental outcomes, accounting for birth gestational age, WMI and postnatal illness.SettingParticipants born in 2006–2013 at British Columbia Women’s Hospital were recruited.Patients168 neonates had HC measurements at birth and discharge and MRI at term-equivalent age (TEA). 143 children were assessed at 4.5 years.Main outcome measuresMotor, cognitive and language outcomes at 4.5 years were assessed using the Movement Assessment Battery for Children Second Edition (M-ABC) and Wechsler Preschool and Primary Scale of Intelligence Third Edition Full Scale IQ (FSIQ) and Verbal IQ (VIQ).ResultsSmall birth HC was associated with lower M-ABC and FSIQ scores. In children with small birth HC, small discharge HC was associated with lower M-ABC, FSIQ and VIQ scores, while normal HC at discharge was no longer associated with adverse outcomes. HC strongly correlated with TCV at TEA. TCV did not correlate with outcomes.ConclusionsSmall birth HC is associated with poorer neurodevelopment, independent of postnatal illness and WMI. Normalisation of HC during NICU care appears to moderate this risk.

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Quantitative assessment of white matter injury in preterm neonates

Neurology ◽

10.1212/wnl.0000000000003606 ◽

2017 ◽

Vol 88 (7) ◽

pp. 614-622 ◽

Cited By ~ 60

Author(s):

Ting Guo ◽

Emma G. Duerden ◽

Elysia Adams ◽

Vann Chau ◽

Helen M. Branson ◽

...

Keyword(s):

White Matter ◽

Frontal Lobe ◽

Regional Analysis ◽

White Matter Injury ◽

Preterm Neonates ◽

Lesion Volume ◽

Neurodevelopmental Outcomes ◽

Lesion Location ◽

Frontal Lobe Lesions ◽

Motor Outcomes

Objective:To quantitatively assess white matter injury (WMI) volume and location in very preterm neonates, and to examine the association of lesion volume and location with 18-month neurodevelopmental outcomes.Methods:Volume and location of WMI was quantified on MRI in 216 neonates (median gestational age 27.9 weeks) who had motor, cognitive, and language assessments at 18 months corrected age (CA). Neonates were scanned at 32.1 postmenstrual weeks (median) and 68 (31.5%) had WMI; of 66 survivors, 58 (87.9%) had MRI and 18-month outcomes. WMI was manually segmented and transformed into a common image space, accounting for intersubject anatomical variability. Probability maps describing the likelihood of a lesion predicting adverse 18-month outcomes were developed.Results:WMI occurs in a characteristic topology, with most lesions occurring in the periventricular central region, followed by posterior and frontal regions. Irrespective of lesion location, greater WMI volumes predicted poor motor outcomes (p = 0.001). Lobar regional analysis revealed that greater WMI volumes in frontal, parietal, and temporal lobes have adverse motor outcomes (all, p < 0.05), but only frontal WMI volumes predicted adverse cognitive outcomes (p = 0.002). To account for lesion location and volume, voxel-wise odds ratio (OR) maps demonstrate that frontal lobe lesions predict adverse cognitive and language development, with maximum odds ratios (ORs) of 78.9 and 17.5, respectively, while adverse motor outcomes are predicted by widespread injury, with maximum OR of 63.8.Conclusions:The predictive value of frontal lobe WMI volume highlights the importance of lesion location when considering the neurodevelopmental significance of WMI. Frontal lobe lesions are of particular concern.

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