Preterm brain injury on term-equivalent age MRI in relation to perinatal factors and neurodevelopmental outcome at two years

ObjectivesFirst, to apply a recently extended scoring system for preterm brain injury at term-equivalent age (TEA-)MRI in a regional extremely preterm cohort; second, to identify independent perinatal factors associated with this score; and third, to assess the prognostic value of this TEA-MRI score with respect to early neurodevelopmental outcome.Study design239 extremely preterm infants (median gestational age [range] in weeks: 26.6 [24.3–27.9]), admitted to the Wilhelmina Children’s Hospital between 2006 and 2012 were included. Brain abnormalities in white matter, cortical and deep grey matter and cerebellum and brain growth were scored on T1- and T2-weighted TEA-MRI using the Kidokoro scoring system. Neurodevelopmental outcome was assessed at two years corrected age using the Bayley Scales of Infant and Toddler Development, third edition. The association between TEA-MRI and perinatal factors as well as neurodevelopmental outcome was evaluated using multivariable regression analysis.ResultsThe distribution of brain abnormalities and brain metrics in the Utrecht cohort differed from the original St. Louis cohort (p 7 days (β [95% confidence interval, CI]: 1.3 [.5; 2.0]) and parenteral nutrition >21 days (2.2 [1.2; 3.2]) were independently associated with higher global brain abnormality scores (p p = .004), fine motor (β in scaled scores [95% CI]: -.1 [-.3; -.0], p = .007) and gross motor outcome (β in scaled scores [95% CI]: -.2 [-.3; -.1], p 2 ≤.219).ConclusionPatterns of brain injury differed between cohorts. Prolonged mechanical ventilation and parenteral nutrition were identified as independent perinatal risk factors. The prognostic value of the TEA-MRI score was rather limited in this well-performing cohort.研究目的：其一，将新近拓展的极早早产儿校正胎龄磁共振成像（term-equivalent age, TEA-MRI）早产儿脑损伤评分系统应用于某区域极早早产儿队列；其二，明确与该评分独立相关的围产期危险因素；其三，评估该TEA-MRI评分对早期神经发育结局的预测价值。 研究设计：本研究纳入2006年至2012年间收治于威廉敏娜儿童医院的239例极早早产儿，其胎龄中位数（范围）为26.6周（24.3~27.9周）。采用Kidokoro评分系统，对T1、T2加权TEA-MRI图像中脑白质、皮层及深部灰质、小脑的异常情况与脑生长状况进行评分。于校正胎龄2岁时，采用第三版贝利婴幼儿发育量表（Bayley Scales of Infant and Toddler Development, third edition）评估神经发育结局。采用多变量回归分析，评估TEA-MRI评分与围产期因素及神经发育结局之间的关联。 研究结果：乌得勒支队列的脑异常分布与脑测量指标与初始圣路易斯队列存在差异。机械通气时长＞7天（β值[95%置信区间, CI]：1.3[0.5;2.0]）与肠外营养时长＞21天（2.2[1.2;3.2]）与更高的全脑异常评分独立相关；全脑异常评分与认知（β值[标准分，95%CI]：-0.1[-0.3;-0.0], p=0.004）、精细运动（β值[标准分，95%CI]：-0.1[-0.3;-0.0], p=0.007）及粗大运动结局（β值[标准分，95%CI]：-0.2[-0.3;-0.1], p<0.001）显著相关，但与语言结局无显著关联（p=0.219）。 研究结论：不同队列的脑损伤模式存在差异。长时间机械通气与肠外营养被确定为独立的围产期危险因素。在本研究纳入的预后良好队列中，TEA-MRI评分的预测价值相对有限。