Search

Background: The predictive value of the combination of neurological examination and brain magnetic resonance imaging (MRI) or cranial ultrasound (cUS) in preterm infants is not known., Aims: To study the prognostic value of the combination of neurological examination and brain MRI at term equivalent age (TEA) or serial neonatal cUS in very preterm infants for neurosensory outcome at 2 years of corrected age., Study Design: A prospective follow-up study., Subjects: A total of 216 very preterm infants (birth weight 1132 g [SD 331 g]) born in Turku University Hospital, from 2001 to 2006, were included., Outcome Measures: The Dubowitz neurologic examination and brain MRI were done at TEA, and serial cUS examinations were performed until TEA. The Hammersmith Infant Neurological Examination (HINE) and neurosensory impairments (NSI) were assessed at 2 years of corrected age., Results: Of all infants, 163 (76%) had one or more deviant neurological items at TEA, and 32 (15%) had the HINE total score below the 10th percentile at 2 years of corrected age. A total of 17 (8%) infants had NSI. Neurological examination at TEA improved the negative and positive predictive values of brain MRI for NSI from 99% to 100%, and from 28% to 35%, respectively, and the negative and positive predictive values of cUS from 97% to 100%, and from 61% to 79%, respectively., Conclusions: The combination of the Dubowitz neurologic examination and the brain MRI at TEA or serial neonatal cUS provides a valuable clinical tool for predicting long-term neurosensory outcome in preterm infants., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Altered brain volumes and associations between volumes and developmental outcomes have been reported in prematurely born children., Objectives: To assess which regional brain volumes are different in very low birth weight (VLBW) children without neurodevelopmental impairments ([NDI] cerebral palsy, hearing loss, blindness and significantly delayed cognitive performance) compared with VLBW children with NDI, and to evaluate the association between regional brain volumes at term-equivalent age and cognitive development and neurological performance at a corrected age of 2 years., Materials and Methods: The study group consisted of a regional cohort of 164 VLBW children, divided into one group of children without NDI (n = 148) and one group of children with NDI (n = 16). Brain (MRI) was performed at term-equivalent age, from which brain volumes were manually analysed. Cognitive development was assessed with the Bayley Scales of Infant Development II (BSID-II), and neurological performance with the Hammersmith Infant Neurological Examination at the corrected age of 2 years., Results: The volumes of total brain tissue, cerebrum, frontal lobes, basal ganglia and thalami, and cerebellum were significantly smaller, and the volume of the ventricles significantly larger, in the children with NDI than in those without NDI. Even in children without NDI, a smaller cerebellar volume was significantly correlated with poor neurological performance at 2 years of corrected age., Conclusion: Volumetric analysis at brain MRI can provide an additional parameter for early prediction of outcome in VLBW children.

Objective: To evaluate the association between maternal smoking during pregnancy and both brain volumes and head circumference in very-low-birth-weight/very-low-gestational-age infants., Study Design: The PIPARI Study is a prospective follow-up study of infants with a birth weight < or =1500 g or a gestational age <32 weeks born in 2001 to 2006 (n = 232) at Turku University Hospital. The brain was imaged by serial brain ultrasound examinations until discharge and magnetic resonance imaging at term age. The head circumference was measured at birth, term, and 2 years corrected age. These measures were correlated to maternal smoking during pregnancy as reported by the mothers., Results: The prevalence of maternal smoking was 18%. The frontal lobe (P = .01) and the cerebellar (P = .03) volumes were significantly smaller in the exposed than in the unexposed infants. The volumes of the other parts of the brain did not differ. There was no association between prenatal smoking exposure and head growth or structural brain disease., Conclusions: Prenatal smoking exposure was associated with significantly smaller frontal lobe and cerebellar volumes in the brains of preterm infants. This is consistent with reports showing an association between prenatal smoking exposure and impairments in frontal lobe and cerebellar functions such as emotion, impulse control, and attention., (Copyright 2010 Mosby, Inc. All rights reserved.)