Dose Brain MRI before Discharge at NICU Predict Neurodevelopmental Outcomes in Very Low Birth Weight Infants?

Young Mi Yoon; Young Hwa Jung; Ji Young Kim; Hun Min Kim; Chang Won Choi; Beyong Il Kim

doi:10.14734/PN.2016.27.4.227

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Yoon, Jung, Kim, Kim, Choi, and Kim: Dose Brain MRI before Discharge at NICU Predict Neurodevelopmental Outcomes in Very Low Birth Weight Infants?

Original Article

Perinatology 2016; 27(4): 227-235.

Published online: 31 December 2016

DOI: https://doi.org/10.14734/PN.2016.27.4.227

Dose Brain MRI before Discharge at NICU Predict Neurodevelopmental Outcomes in Very Low Birth Weight Infants?

Young Mi Yoon, MD^1,², Young Hwa Jung, MD², Ji Young Kim, MD³, Hun Min Kim, MD², Chang Won Choi, MD², Beyong Il Kim, MD²

¹Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.

²Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

³Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

Correspondence to: Chang Won Choi, MD. Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea. Tel: +82-31-787-7286, Fax: +82-31-787-4054, choicw1029@gmail.com

Received 10 July 2016 Revised 18 September 2016 Accepted 20 September 2016

(open-access, http://creativecommons.org/licenses/by-nc/4.0/):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To test whether brain MRI can predict neurodevelopmental outcomes of very low birth weight (VLBW) infants in a single academic center.

Methods

This was a retrospective study of VLBW infants admitted to neonatal intensive care unit from January 2010 to December 2014. Infants who were taken brain MRI before discharge and followed-up at 12 or 24 months' corrected age (CA) were enrolled. The neurodevelopment outcomes included cerebral palsy (CP) and cognitive or motor delay on Bayley Scale of Infant Development-II.

Results

Of the 255 survivors at discharge, 182 (71.4%) had a brain MRI. Any abnormalities on brain MRI were predictive of CP (odds ratio [OR] 15.8, 95% confidence interval [CI] 1.9-128.1) and motor delay(OR 4.4, 95% CI 1.0-19.3) at 12 months' CA. Moderate to severe white matter abnormalities on brain MRI were significantly correlated with CP (OR 49.0, 95% CI 10.1-238.2) and moderate to severe motor delay (OR 8.3, 95% CI 1.2-56.7) at 12 months' CA, and CP (OR 43.8, 95% CI 6.4-299.8) at 24 months' CA. Moderate to severe white matter abnormalities on brain MRI were consistently associated with CP at 12 and 24 months' CA after adjustment for demographic and clinical variables and cranial ultrasonography findings (OR 800.5, 95% CI 6.9-92,665.7 at 12 months' CA, OR 52.0, 95% CI 1.3-2,168.2 at 24 months' CA).

Conclusion

Moderate to severe white matter abnormalities on brain MRI strongly predicted cerebral palsy at 12 months and 24 months' CA in VLBW infants.

Keywords: Infant, Premature, Magnetic resonance imaging, Neurodevelopmental outcomes

Figures and Tables

Fig. 1

Representative images of white matter abnormalities on brain MRI (axial T2-weighted and coronal T1-weighted images): A, normal white matter; B, mild abnormalities with ventricular dilatation; C, moderate abnormalities with cystic periventricular leukomalacia, hydrocephalus; D, severe abnormalities with diffuse signal abnormalities, decreased WM volume and multiple parenchymal cystic changes

Fig. 2

The study population, Brain MRI was performed in 71.4% of eligible infants before discharge at NICU, and 78%, 44.5% of infants attended follow-up clinics at 12months, 24months corrected age.

Table 1

Abnormalities on Brain MRI and Neurodevelopmental Outcome at 12 and 24 Months' Corrected Age

	Normal MRI	Any abnormal MRI	P value
At 12 months’corrected age
Cerebral palsy (%)	0/84 (0.0)	10/58 (17.2)	<0.001
Any cognitive delay (%)^*	3/12 (25.0)	9/25 (36.0)	0.503
Moderate to severe cognitive delay (%)^*	0/12 (0.0)	3/25 (12.0)	0.217
Any motor delay (%)^*	5/12 (41.7)	19/25 (76.0)	0.043
Moderate to severe motor delay (%)^*	2/12 (16.7)	8/25 (32.0)	0.332
At 24 months’corrected age
Cerebral palsy (%)	0/44 (0.0)	9/37 (24.3)	0.001
Any cognitive delay (%)^†	1/6 (16.7)	8/12 (66.7)	0.052
Moderate to severe cognitive delay (%)^†	1/6 (16.7)	7/12 (58.3)	0.103
Any motor delay (%)^†	1/6 (16.7)	9/12 (75.0)	0.023
Moderate to severe motor delay (%)^†	1/6 (16.7)	8/12 (66.7)	0.052

^*37 infants were assessed with the Bayley Scales of Infant Development-II at 12 months' corrected age.

^†18 infants were assessed with the Bayley Scales of Infant Development-II at 24 months' corrected age.

Table 2

White Matter Abnormalities on Brain MRI and Neurodevelopmental Outcome at 12 and 24 Months' Corrected Age

	No white matter abnormalities	Any white matter abnormalities	P value
At 12 months’corrected age
Cerebral palsy (%)	0/105 (0.0)	10/37 (27.0)	<0.001
Any cognitive delay (%)^*	6/20 (30.0)	6/17 (35.3)	0.732
Moderate to severe cognitive delay (%)^*	0/20 (0.0)	3/17 (17.6)	0.053
Any motor delay (%)^*	10/20 (50.0)	14/17 (82.4)	0.040
Moderate to severe motor delay (%)^*	4/20 (20.0)	6/17 (35.3)	0.297
At 24 months’corrected age
Cerebral palsy (%)	0/58 (0.0)	9/23 (39.1)	<0.001
Any cognitive delay (%)^†	4/9 (44.4)	5/9 (55.6)	0.647
Moderate to severe cognitive delay (%)^†	3/9 (33.3)	5/9 (55.6)	0.357
Any motor delay (%)^†	3/9 (33.3)	7/9 (77.8)	0.065
Moderate to severe motor delay (%)^†	3/9 (33.3)	6/9 (66.7)	0.169

^*37 infants were assessed with the Bayley Scales of Infant Development-II at 12 months' corrected age.

^†18 infants were assessed with the Bayley Scales of Infant Development-II at 24 months' corrected age.

Table 3

Severity of White Matter Abnormality on Brain MRI and Neurodevelopmental Outcome at 12 and 24 Months' Corrected Age

	White matter abnormality			P value
	None	Mild	Moderate to severe	P value
At 12 months’corrected age
Cerebral palsy (%)	0/105 (0.0)	3/24 (12.5)	7/13 (53.8)	<0.001
Any cognitive delay (%)^*	6/20 (30.0)	2/11 (18.2)	4/6 (66.7)	0.118
Moderate to severe cognitive delay (%)^*	0/20 (0.0)	0/11 (0.0)	3/6 (50.0)	<0.001
Any motor delay (%)^*	10/20 (50.0)	9/11 (81.8)	5/6 (83.3)	0.121
Moderate to severe motor delay (%)^*	4/20 (20.0)	2/11 (18.2)	4/6 (66.7)	0.057
At 24 months’corrected age
Cerebral palsy (%)	0/58 (0.0)	4/16 (25.0)	5/7 (71.4)	<0.001
Any cognitive delay (%)^†	4/9 (44.4)	2/6 (33.3)	3/3 (100.0)	0.151
Moderate to severe cognitive delay (%)^†	3/9 (33.3)	2/6 (33.3)	3/3 (100.0)	0.105
Any motor delay (%)^†	3/9 (33.3)	4/6 (66.7)	3/3 (100.0)	0.105
Moderate to severe motor delay (%)^†	3/9 (33.3)	3/6 (50.0)	3/3 (100.0)	0.135

^*37 infants were assessed with the Bayley Scales of Infant Development-II at 12 months' corrected age.

^†18 infants were assessed with the Bayley Scales of Infant Development-II at 24 months' corrected age.

Table 4

Associations between Perinatal Clinical Characteristics and Radiologic Findings and Neurodevelopmental Outcome at 12 Months Corrected Age

Measure	No. of infants (%)	White matter abnormality
Measure	No. of infants (%)	Cerebral palsy	Any cognitive delay	Moderate to severe cognitive delay	Any motor delay	Moderate to severe motor delay
Clinical characteristics
Gestational age (per week)		0.8 (0.7–1.1)	1.0 (0.8–1.3)	-	1.0 (0.8–1.2)	0.9 (0.7–1.1)
Birth weight (per 100 g)		1.0 (1.0–1.0)	1.0 (1.0–1.0)	-	1.0 (1.0–1.0)	1.0 (1.0–1.0)
Male sex	60 (42.3)	0.6 (0.1–2.3)	0.3 (0.1–1.4)	-	0.8 (0.2–3.3)	0.7 (0.2–3.5)
Multiple birth	35 (24.6)	1.3 (0.3–5.5)	2.3 (0.5–9.8)	-	1.7 (0.4–7.8)	3.5 (0.8–16.2)
Moderate-severe BPD	45 (31.7)	2.3 (0.6–8.4)	1.1 (0.3–4.3)	-	1.1 (0.3–4.6)	1.7 (0.4–7.4)
Hemodynamically significant PDA	54 (38.0)	1.1 (0.3–4.1)	2.5 (0.6–10.2)	-	3.9 (0.9–18.0)	1.5 (0.3–6.3)
PDA ligation	17 (12.0)	3.6 (0.8–15.6)	1.5 (0.2–10.2)	-	3.2 (0.3–30.4)	17.3 (1.6–184.4)
Postnatal corticosteroid	38 (26.8)	1.9 (0.5–7.2)	1.3 (0.3–5.7)	-	1.7 (0.4–7.8)	1.9 (0.4–8.8)
Sepsis	12 (8.5)	5.7 (1.3–26.6)	14.3 (1.4–149.2)	-	2.4 (0.2–24.1)	5.4 (0.7–38.6)
NEC	11 (7.7)	1.4 (0.2–11.8)	2.1 (0.4–11.3)	-	1.5 (0.2–8.8)	1.1 (0.2–6.9)
Cranial ultrasonographic findings
High-grade IVH	7 (4.9)	28.7 (5.2–157.9)	1.2 (0.1–14.8)	-	1.1 (0.1–13.3)	6.5 (0.5–81.4)
PVL	9 (6.3)	4.5 (0.8–25.1)	1.7 (0.2–12.0)	-	2.4 (0.2–24.1)	2.0 (0.3–14.2)
MRI findings
Any abnormality	58 (40.8)	15.8 (1.9–128.1)	2.8 (0.5–15.8)	-	4.4 (1.0–19.3)	2.4 (0.4–13.4)
Any white matter abnormality	37 (26.1)	35.0 (4.3–288.4)	1.6 (0.4–6.8)	-	4.7 (1.0–21.4)	2.2 (0.5–9.6)
Moderate-severe white matter abnormality	13 (9.2)	49.0 (10.1–238.2)	6.9 (1.0–45.6)	-	3.2 (0.3–30.4)	8.3 (1.2–56.7)
Adjusted MRI findings^*
Any abnormality	58 (40.8)	12.1(0.9–156.3)	1.1 (0.1–11.3)	-	12.9 (1.1–151.3)	3.4 (0.2–67.5)
Any white matter abnormality	37 (26.1)	32.9 (2.0–547.8)	1.5 (0.2–2.0)	-	10.1 (0.9–119.2)	1.7 (0.1–50.9)
Moderate-severe white matter abnormality	13 (9.2)	800.5 (6.9-92,665.7)	16.5 (0.1–3,823.2)	-	3.4 (0.1–231.0)	15.3 (0.5–490.4)

Abbreviations: BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia.

^*Covariate factors included in the logistic- regression models were abnormality of cranial ultrasonographic findings (high grade IVH or PVL) and perinatal clinical characteristics including gestational age, birth weight, male sex, multiple birth, the presence of BPD, PDA, sepsis and NEC, use of postnatal corticosteroid.

Table 5

Associations between Perinatal Clinical Characteristics and Radiologic Findings and Neurodevelopmental Outcome at 24 Months Corrected Age

Measure	No. of infants (%)	White matter abnormality
Measure	No. of infants (%)	Cerebral palsy	Any cognitive delay	Moderate to severe cognitive delay	Any motor delay	Moderate to severe motor delay
Clinical characteristics
Gestational age (per week)		0.8 (0.6–1.1)	1.1 (0.8–1.5)	1.2 (0.9–1.7)	1.1 (0.8–1.5)	1.2 (0.9–1.7)
Birth weight (per 100 g)		1.0 (1.0–1.0)	1.0 (1.0–1.0)	1.0 (1.0–1.0)	1.0 (1.0–1.0)	1.0 (1.0–1.0)
Male sex	37 (45.7)	1.1 (0.3–4.3)	1.0 (0.1–9.2)	0.3 (0.0–4.0)	0.8 (0.1–7.0)	1.0 (0.1–9.2)
Multiple birth	23 (28.4)	1.3 (0.3–5.7)	0.4 (0.1–2.7)	0.6 (0.1–4.0)	1.7 (0.3–11.1)	2.5 (0.4–16.9)
Moderate-severe BPD	30 (37.0)	2.4 (0.6–9.5)	0.2 (0.0–1.8)	0.3 (0.0–2.5)	1.1 (0.2–7.5)	0.6 (0.1–4.2)
Hemodynamically significant PDA	35 (43.2)	1.8 (0.4–7.1)	4.0 (0.6–28.4)	2.5 (0.4–16.9)	7.0 (0.9–56.9)	4.0 (0.6–28.4)
PDA ligation	12 (14.8)	3.5 (0.7–16.5)	4.0 (0.3–48.7)	3.0 (0.2–40.9)	3.0 (0.3–36.3)	4.0 (0.3–48.7)
Postnatal corticosteroid	25 (30.9)	3.3 (0.8–13.3)	0.2 (0.0–1.8)	0.3 (0.0–2.5)	0.4 (0.1–3.0)	0.2 (0.0–1.8)
Sepsis	7 (8.6)	1.4 (0.2–12.9)	2.3 (0.2–31.0)	0.6 (0.0–7.7)	1.8 (0.1–23.7)	2.3 (0.2–31.0)
NEC	8 (9.9)	1.2 (0.1–10.7)	2.3 (0.2–31.0)	1.3 (0.1–24.4)	0.8 (0.0–14.8)	1.0 (0.1–18.9)
Cranial ultrasonographic findings
High-grade IVH	6 (7.4)	11.5 (1.9–67.0)	4.0 (0.3–48.7)	5.4 (0.4–66.7)	3.0 (0.3–36.3)	1.0 (0.1–9.2)
PVL	6 (7.4)	11.5 (1.9–69.9)	1.0 (0.1–18.9)	1.3 (0.1–24.4)	0.8 (0.0–14.8)	1.0 (0.1–18.9)
MRI findings
Any abnormality	37 (45.7)	12.6 (1.5–106.0)	4.4 (0.6–34.0)	3.0 (0.4–22.7)	6.7 (0.8–55.0)	4.4 (0.6–34.0)
Any white matter abnormality	23 (28.4)	33.1 (3.8–287.2)	1.0 (0.2–6.4)	1.5 (0.2–9.8)	4.5 (0.6–34.6)	2.5 (0.4–16.9)
Moderate-severe white matter abnormality	7 (8.6)	43.8 (6.4–299.8)	4.0 (0.3–48.7)	5.4 (0.4–66.7)	3.0 (0.3–36.3)	4.0 (0.3–48.7)
Adjusted MRI findings^*
Any abnormality	37 (45.7)	7.4 (0.3–206.4)	11.2 (0.3–368.5)	17.5 (0.0–9032.6)	-	-
Any white matter abnormality	23 (28.4)	18.3 (0.8–441.3)	2.1 (0.1–34.6)	4.1 (0.0–903.4)	-	-
Moderate-severe white matter abnormality	7 (8.6)	52.0 (1.3–2,168.2)	32.0 (0.1–18,151.1)	125.1 (0.0–3,876,076.2)	-	-

Abbreviations: BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia.

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