Summary: Researchers report using neuroimaging to map the brains of preterm babies soon after their born could hold clues as to possible disabilities they may develop.
Scanning a premature infant’s brain shortly after birth to map the location and volume of lesions, small areas of injury in the brain’s white matter, may help doctors better predict whether the baby will have disabilities later, according to a new study published in the January 18, 2017, online issue of Neurology.
According to the Centers for Disease Control and Prevention, one in 10 babies is born prematurely in the United States.
Lack of oxygen to the brain is the most common form of brain injury in premature infants, resulting in damage to the white matter. White matter contains nerve fibers that maintain contact between various parts of the brain. Damage to white matter can interfere with communication in the brain and the signals it sends to other parts of the body.
“In general, babies who are born before 31 weeks gestation have a higher risk of thinking, language and movement problems throughout their lives, so being able to better predict which infants will face certain developmental problems is important so they get the best early interventions possible. Just as important is to be able to reassure parents of infants who may not be at risk,” said study author Steven P. Miller, MDCM, of The Hospital for Sick Children (SickKids) in Toronto, Canada.
For the study, researchers looked at a group of premature infants who were admitted to the Neonatal ICU at British Columbia’s Women’s Hospital over seven years. They found 58 babies with white matter injury who had an MRI brain scan at an average of 32 weeks after gestation. These babies were then evaluated for motor, thinking and language skills when they were 18 months old.
Researchers found that a greater volume of small areas of injury, no matter where they were located in the brain, could predict movement problems at 18 months. They also found that a greater volume of these small areas of injury in the frontal lobe could predict thinking problems. The frontal lobe is the area of the brain that regulates problem solving, memory, language skills and voluntary movement skills.
The findings from this study highlight the importance of injury location when considering developmental outcomes. For example, premature infants with larger frontal lobe injuries had a 79 fold greater odds of developing thinking problems than infants without such injuries, as well as a 64 fold greater odds of problems with movement development.
Miller said that future studies should evaluate premature infants not just at 18 months, but at various points throughout childhood to determine the long-term consequences of early injuries in the brain.
Funding: The study was supported by the Canadian Institutes of Health Research, The Research Training Centre at The Hospital for Sick Children and SickKids Foundation, the Ontario Brain Institute and the NeuroDevNet National Centres of Excellence.
Source: Renee Tessman – AAN
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Quantitative assessment of white matter injury in preterm neonates: Association with outcomes” by Ting Guo, Emma G. Duerden, Elysia Adams, Vann Chau, Helen M. Branson, M. Mallar Chakravarty, Kenneth J. Poskitt, Anne Synnes, Ruth E. Grunau, and Steven P. Miller in Neurology. Published online January 18 2017 doi:10.1016/j.neuron.2016.12.040
Quantitative assessment of white matter injury in preterm neonates: Association with 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.
“Quantitative assessment of white matter injury in preterm neonates: Association with outcomes” by Ting Guo, Emma G. Duerden, Elysia Adams, Vann Chau, Helen M. Branson, M. Mallar Chakravarty, Kenneth J. Poskitt, Anne Synnes, Ruth E. Grunau, and Steven P. Miller in Neurology. Published online January 18 2017 doi:10.1016/j.neuron.2016.12.040