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Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants.

Pogribna U, Yu X, Burson K, Zhou Y, Lasky RE, Narayana PA, Parikh NA - PLoS ONE (2013)

Bottom Line: Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors.White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, Texas, USA.

ABSTRACT

Objective: To identify perinatal clinical antecedents of white matter microstructural abnormalities in extremely preterm infants.

Methods: A prospective cohort of extremely preterm infants (N = 86) and healthy term controls (N = 16) underwent diffusion tensor imaging (DTI) at term equivalent age. Region of interest-based measures of white matter microstructure - fractional anisotropy and mean diffusivity - were quantified in seven vulnerable cerebral regions and group differences assessed. In the preterm cohort, multivariable linear regression analyses were conducted to identify independent clinical factors associated with microstructural abnormalities.

Results: Preterm infants had a mean (standard deviation) gestational age of 26.1 (1.7) weeks and birth weight of 824 (182) grams. Compared to term controls, the preterm cohort exhibited widespread microstructural abnormalities in 9 of 14 regional measures. Chorioamnionitis, necrotizing enterocolitis, white matter injury on cranial ultrasound, and increasing duration of mechanical ventilation were adversely correlated with regional microstructure. Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors. White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.

Conclusions: Diffusion tensor imaging is sensitive in detecting the widespread cerebral delayed maturation and/or damage increasingly observed in extremely preterm infants. In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

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Related in: MedlinePlus

Comparison of mean (SD) fractional anisotropy (A) and mean diffusivity (SD) (B) between extremely preterm infants (light blue) and healthy term infants (navy) for seven study ROIs – ALIC, anterior limb of internal capsule, PLIC, posterior limb of internal capsule, FPVZ, frontal periventricular zone, OPVZ, occipital periventricular zone, CC, corpus callosum (genu and splenium), CS, centrum semiovale, SVZ, subventricular zone; and two control ROIs – EC, external capsule, MCP, middle cerebellar peduncles.*P<0.05 and **P<0.001.
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pone-0072974-g002: Comparison of mean (SD) fractional anisotropy (A) and mean diffusivity (SD) (B) between extremely preterm infants (light blue) and healthy term infants (navy) for seven study ROIs – ALIC, anterior limb of internal capsule, PLIC, posterior limb of internal capsule, FPVZ, frontal periventricular zone, OPVZ, occipital periventricular zone, CC, corpus callosum (genu and splenium), CS, centrum semiovale, SVZ, subventricular zone; and two control ROIs – EC, external capsule, MCP, middle cerebellar peduncles.*P<0.05 and **P<0.001.

Mentions: Stata 11/12 IC (Stata Corp, College Station, TX) was used for all data analyses. Two sample t-test, Chi-square and Fisher's exact tests were used as appropriate to describe and compare demographic characteristics among the groups (Table 1). Two sample t-test and Wilcoxon Mann Whitney tests were used to compare FA and MD values between preterm and term infants (Figure 2). Intra-rater reliability for ROI placements was assessed using intra-class correlation coefficients (ICC) (17 cases randomly selected).


Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants.

Pogribna U, Yu X, Burson K, Zhou Y, Lasky RE, Narayana PA, Parikh NA - PLoS ONE (2013)

Comparison of mean (SD) fractional anisotropy (A) and mean diffusivity (SD) (B) between extremely preterm infants (light blue) and healthy term infants (navy) for seven study ROIs – ALIC, anterior limb of internal capsule, PLIC, posterior limb of internal capsule, FPVZ, frontal periventricular zone, OPVZ, occipital periventricular zone, CC, corpus callosum (genu and splenium), CS, centrum semiovale, SVZ, subventricular zone; and two control ROIs – EC, external capsule, MCP, middle cerebellar peduncles.*P<0.05 and **P<0.001.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3756943&req=5

pone-0072974-g002: Comparison of mean (SD) fractional anisotropy (A) and mean diffusivity (SD) (B) between extremely preterm infants (light blue) and healthy term infants (navy) for seven study ROIs – ALIC, anterior limb of internal capsule, PLIC, posterior limb of internal capsule, FPVZ, frontal periventricular zone, OPVZ, occipital periventricular zone, CC, corpus callosum (genu and splenium), CS, centrum semiovale, SVZ, subventricular zone; and two control ROIs – EC, external capsule, MCP, middle cerebellar peduncles.*P<0.05 and **P<0.001.
Mentions: Stata 11/12 IC (Stata Corp, College Station, TX) was used for all data analyses. Two sample t-test, Chi-square and Fisher's exact tests were used as appropriate to describe and compare demographic characteristics among the groups (Table 1). Two sample t-test and Wilcoxon Mann Whitney tests were used to compare FA and MD values between preterm and term infants (Figure 2). Intra-rater reliability for ROI placements was assessed using intra-class correlation coefficients (ICC) (17 cases randomly selected).

Bottom Line: Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors.White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, Texas, USA.

ABSTRACT

Objective: To identify perinatal clinical antecedents of white matter microstructural abnormalities in extremely preterm infants.

Methods: A prospective cohort of extremely preterm infants (N = 86) and healthy term controls (N = 16) underwent diffusion tensor imaging (DTI) at term equivalent age. Region of interest-based measures of white matter microstructure - fractional anisotropy and mean diffusivity - were quantified in seven vulnerable cerebral regions and group differences assessed. In the preterm cohort, multivariable linear regression analyses were conducted to identify independent clinical factors associated with microstructural abnormalities.

Results: Preterm infants had a mean (standard deviation) gestational age of 26.1 (1.7) weeks and birth weight of 824 (182) grams. Compared to term controls, the preterm cohort exhibited widespread microstructural abnormalities in 9 of 14 regional measures. Chorioamnionitis, necrotizing enterocolitis, white matter injury on cranial ultrasound, and increasing duration of mechanical ventilation were adversely correlated with regional microstructure. Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors. White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.

Conclusions: Diffusion tensor imaging is sensitive in detecting the widespread cerebral delayed maturation and/or damage increasingly observed in extremely preterm infants. In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.

Show MeSH
Related in: MedlinePlus