Abnormal Cerebral Structure Is Present at Term in Premature Infants

By T. Inder, Simon Keith Warfield, Hong Wang, P. Hüppi, Joseph J. Volpe. Pediatrics, 2005

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Background. Long-term studies of the outcome of very prematurely born infants have clearly documented that the majority of such infants have significant motor, cognitive, and behavioral deficits. However, there is a limited understanding of the nature of the cerebral abnormality underlying these adverse neurologic outcomes. Aim. The overall aim of this study was to define quantitatively the alterations in cerebral tissue volumes at term equivalent in a large longitudinal cohort study of very low birth weight premature infants in comparison to term-born infants by using advanced volumetric 3-dimensional magnetic resonance imaging (MRI) techniques. We also aimed to define any relationship of such perinatal lesions as white matter (WM) injury or other potentially adverse factors to the quantitative structural alterations. Additionally, we wished to identify the relationship of the structural alterations to short-term neurodevelopmental outcome. Methods. From November 1998 to December 2000, 119 consecutive premature infants admitted to the neonatal intensive care units at Christchurch Women’s Hospital (Christchurch, New Zealand) and the Royal Women’s Hospital (Melbourne, Australia) were recruited (88% of eligible) after informed parental consent to undergo an MRI scan at term equivalent. Twenty-one term-born infants across both sites were recruited also. Postacquisition advanced 3-dimensional tissue segmentation with 3-dimensional reconstruction was undertaken to estimate volumes of cerebral tissues: gray matter (GM; cortical and deep nuclear structures), WM (myelinated and unmyelinated), and cerebrospinal fluid (CSF). Results. In comparison to the term-born infants, the premature infants at term demonstrated prominent reductions in cerebral cortical GM volume (premature infants [mean ± SD]: 178 ± 41 mL; term infants: 227 ± 26 mL) and in deep nuclear GM volume (premature infants: 10.8 ± 4.1 mL; term infants: 13.8 ± 5.2 mL) and an increase in CSF volume (premature infants: 45.6 ± 22.1 mL; term infants: 28.9 ± 16 mL). The major predictors of altered cerebral volumes were gestational age at birth and the presence of cerebral WM injury. Infants with significantly reduced cortical GM and deep nuclear GM volumes and increased CSF volume volumes exhibited moderate to severe neurodevelopmental disability at 1 year of age. Conclusions. This MRI study of prematurely born infants further defines the nature of quantitative cerebral structural abnormalities present as early as term equivalent. The abnormalities particularly involve cerebral neuronal regions including both cortex and deep nuclear structures. The pattern of cerebral alterations is related most significantly to the degree of immaturity at birth and to concomitant WM injury. The alterations are followed by abnormal short-term neurodevelopmental outcome.

Subfields: Pediatrics, Perinatology and Child Health

View Paper: https://www.semanticscholar.org/paper/055f9d73350dfb2674dde68e73b6238d79008596

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In Pediatrics, Perinatology and Child Health

Citations in the corpus

Automatic segmentation of MR images of the developing newborn brain (2005, methodology): “Keywords: Automatic brain MRI classification; Automatic brain MRI segmentation; Early brain development; Kernel density estimation; Neonatal MRI; Robust estimation”
Multi-Contrast Human Neonatal Brain Atlas: Application to Normal Neonate Development Analysis (2011, positive): “Previous studies have reported that there is a substantial correlation between several types of abnormalities and their prognosis (De Vries et al., 1999; Hayakawa et al., 1996; Inder et al., 2005; Roelants-van Rijn et al., 2001; Shah et al., 2006; Woodward et al., 2006).”
Automatic segmentation of brain MRIs of 2-year-olds into 83 regions of interest (2008, background): “, 2002), cortical grey matter (Huppi et al., 1998; Inder et al., 1999; Nosarti et al., 2002; Inder et al., 2005), cerebellum (Peterson et al.”
A dynamic 4D probabilistic atlas of the developing brain (2011, background): “, 2005), as well as decreased volumes of different brain structures, such as cortex, basal ganglia and cerebellum (Allin et al., 2004; Boardman et al., 2006; Brunssen and Harry, 2007; Inder et al., 2005; Limperopoulos et al., 2005; Nosarti et al., 2002; Stewart et al., 1999).”
The UNC/UMN Baby Connectome Project (BCP): An Overview of the Study Design and Protocol Development (2018, positive): “Augmenting the work on typically developing infants is a large corpus of neuroimaging literature on infants born premature (Brown et al., 2009; Cao et al., 2016; Huppi et al., 1991; Huppi et al., 1998; Inder et al., 2005; Kidokoro et al., 2014; van den Heuvel et al., 2014).”
Aperiodic parameters of the fMRI power spectrum associate with preterm birth and neonatal age (2026, unknown): “…maturation, preterm birth has been associated with altered brain development as younger gestational age at birth predicts smaller brain volumes 15 – 19 and higher diffusivity in the prefrontal, parietal, motor, somatosensory, and visual cortices, likely suggesting delayed maturation of these…”