Preterm Neuroimaging and School-Age Cognitive Outcomes.

Published

Journal Article

BACKGROUND AND OBJECTIVES: Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. METHODS: A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. RESULTS: A total of 386 children had follow-up. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI and adverse CUS findings were associated with outcomes. In full regression models, both adverse late CUS findings (odds ratio [OR] 27.9; 95% confidence interval [CI] 6.0-129) and significant cerebellar lesions on MRI (OR 2.71; 95% CI 1.1-6.7) remained associated with disability, but only adverse late CUS findings (OR 20.1; 95% CI 3.6-111) were associated with FSIQ <70. Predictive accuracy of stepwise models was not substantially improved with the addition of neuroimaging. CONCLUSIONS: Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of severe early school-age outcomes.

Full Text

Duke Authors

Cited Authors

  • Hintz, SR; Vohr, BR; Bann, CM; Taylor, HG; Das, A; Gustafson, KE; Yolton, K; Watson, VE; Lowe, J; DeAnda, ME; Ball, MB; Finer, NN; Van Meurs, KP; Shankaran, S; Pappas, A; Barnes, PD; Bulas, D; Newman, JE; Wilson-Costello, DE; Heyne, RJ; Harmon, HM; Peralta-Carcelen, M; Adams-Chapman, I; Duncan, AF; Fuller, J; Vaucher, YE; Colaizy, TT; Winter, S; McGowan, EC; Goldstein, RF; Higgins, RD; SUPPORT study group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network,

Published Date

  • July 2018

Published In

Volume / Issue

  • 142 / 1

PubMed ID

  • 29945955

Pubmed Central ID

  • 29945955

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

Digital Object Identifier (DOI)

  • 10.1542/peds.2017-4058

Language

  • eng

Conference Location

  • United States