Sequential Cranial Ultrasound and Cerebellar Diffusion Weighted Imaging Contribute to the Early Prognosis of Neurodevelopmental Outcome in Preterm Infants

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks’ gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson’s r = −0.403, p = 0.046) and improved cognitive (r = −0.554, p = 0.047), motor (r = −0.487, p = 0.048), and language (r = −0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = −0.483, p = 0.014) and improved cognitive (r = −0.711, p = 0.001), motor (r = −0.675, p = 0.003), and language (r = −0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.

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Lenticulostriate Vasculopathy and Neurodevelopmental Outcomes in Preterm Infants: A Systematic Review

American Journal of Perinatology ◽

10.1055/s-0037-1598245 ◽

2017 ◽

Vol 34 (08) ◽

pp. 780-786 ◽

Cited By ~ 1

Author(s):

Abby Robinson ◽

John Flibotte ◽

Summer Kaplan ◽

Sara DeMauro

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Motor Development ◽

Neurodevelopmental Outcome ◽

Outcome Data ◽

Cranial Ultrasound ◽

Neurodevelopmental Outcomes ◽

Eligibility Criteria ◽

The Third ◽

Lenticulostriate Vasculopathy

Objective The objective of this study was to perform a systematic review of all studies that report neurodevelopmental outcomes at 12 months' corrected age or later for preterm infants (< 32 weeks) who are diagnosed with lenticulostriate vasculopathy (LSV) on cranial ultrasound. Study Design This is a systematic review. Results We identified 501 unique publications of which 3 met all prespecified eligibility criteria. Neurodevelopmental outcome data were available for 44 preterm infants with LSV. There were mixed results from the studies: the first reported impairments of mental development; the second reported impairments of motor development only; and finally, the third reported that three of three preterm infants with LSV had mild or moderate developmental delay. Conclusion The available results raise some concern for future impairments in preterm infants with LSV, but they are conflicting and inconclusive. There is insufficient evidence about the neurodevelopmental implications of LSV in preterm infants to inform counseling of parents.

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Can EEG accurately predict 2-year neurodevelopmental outcome for preterm infants?

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319825 ◽

2021 ◽

pp. fetalneonatal-2020-319825

Author(s):

Rhodri O Lloyd ◽

John M O'Toole ◽

Vicki Livingstone ◽

Peter M Filan ◽

Geraldine B Boylan

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Infant Development ◽

Strong Predictor ◽

Characteristic Curve ◽

Neurodevelopmental Outcome ◽

Neonatal Morbidity ◽

Clinical Score ◽

Cranial Ultrasound ◽

Time Points

ObjectiveEstablish if serial, multichannel video electroencephalography (EEG) in preterm infants can accurately predict 2-year neurodevelopmental outcome.Design and patientsEEGs were recorded at three time points over the neonatal course for infants <32 weeks’ gestational age (GA). Monitoring commenced soon after birth and continued over the first 3 days. EEGs were repeated at approximately 32 and 35 weeks’ postmenstrual age (PMA). EEG scores were based on an age-specific grading scheme. Clinical score of neonatal morbidity risk and cranial ultrasound imaging were completed.SettingNeonatal intensive care unit at Cork University Maternity Hospital, Ireland.Main outcome measuresBayley Scales of Infant Development III at 2 years’ corrected age.ResultsSixty-seven infants were prospectively enrolled in the study and 57 had follow-up available (median GA 28.9 weeks (IQR 26.5–30.4)). Forty had normal outcome, 17 had abnormal outcome/died. All EEG time points were individually predictive of abnormal outcome; however, the 35-week EEG performed best. The area under the receiver operating characteristic curve (AUC) for this time point was 0.91 (95% CI 0.83 to 1), p<0.001. Comparatively, the clinical course AUC was 0.68 (95% CI 0.54 to 0.80, p=0.015), while abnormal cranial ultrasound was 0.58 (95% CI 0.41 to 0.75, p=0.342).ConclusionMultichannel EEG is a strong predictor of 2-year outcome in preterm infants particularly when recorded around 35 weeks’ PMA. Infants at high risk of brain injury may benefit from early postnatal EEG recording which, if normal, is reassuring. Postnatal clinical complications can contribute to poor outcome; therefore, we state that a later EEG around 35 weeks has a role to play in prognostication.

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194 Diffusion Weighted Imaging: Correlation Between Apparent Diffusion Coefficient, Brainstem Auditory Evoked Potentials, and Neurodevelopmental Outcome

Pediatric Research ◽

10.1203/00006450-200508000-00223 ◽

2005 ◽

Vol 58 (2) ◽

pp. 387-387

Author(s):

T Kaukola ◽

M Perhomaa ◽

L Vainionpää ◽

U Tolonen ◽

J Jauhiainen ◽

...

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Evoked Potentials ◽

Diffusion Weighted Imaging ◽

Auditory Evoked Potentials ◽

Neurodevelopmental Outcome ◽

Brainstem Auditory Evoked Potentials ◽

Diffusion Weighted ◽

Apparent Diffusion

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Value of Cranial Ultrasound and Magnetic Resonance Imaging in Predicting Neurodevelopmental Outcome in Preterm Infants

PEDIATRICS ◽

10.1542/peds.90.2.196 ◽

1992 ◽

Vol 90 (2) ◽

pp. 196-199

Author(s):

Margot van de Bor ◽

Lya den Ouden ◽

Gerard L. Guit

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Preterm Infants ◽

Predictive Factor ◽

Intraventricular Hemorrhage ◽

Periventricular Leukomalacia ◽

Neurodevelopmental Outcome ◽

Cranial Ultrasound ◽

Resonance Imaging ◽

Postmenstrual Age

In this prospective study, cranial ultrasound was performed to detect periventricular-intraventricular hemorrhage and periventricular leukomalacia in 33 preterm infants of less than 32 weeks' gestation. At 44 weeks postmenstrual age magnetic resonance imaging was performed to detect the stage of myelination. Neurodevelopmental outcome was assessed at 3 years of age in 31 children (2 children died in the first year of life). Significant correlations were found between neurodevelopmental outcome and ultrasound findings (χ2 = 32.8; P < .0001) and stage of myelination (χ2 = 20.5; P < .0005). To establish the criterion with the best predictive factor, multiple regression analysis was performed with outcome as dependent variable and periventricular-intraventricular hemorrhage, periventricular leukomalacia, and stage of myelination as independent variables. It appeared that the detection of periventricular leukomalacia with ultrasound showed the best predictive factor for neurodevelopmental outcome. Routine magnetic resonance imaging at 44 weeks postmenstrual age should not be performed just for the purpose of predicting neurodevelopmental outcome more reliably.

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