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Pediatrics. 2016 Nov;138(5). pii: e20161640.

Third Trimester Brain Growth in Preterm Infants Compared With In Utero Healthy Fetuses.

Author information

1
The Developing Brain Research Laboratory, Departments of Diagnostic Imaging and Radiology.
2
Institute for Biomedical Sciences, George Washington University, Washington, District of Columbia.
3
Fetal Medicine Institute, and.
4
Department of Epidemiology and Biostatistics, Children's National Health System, Washington, District of Columbia.
5
Department of Pediatrics Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada; and.
6
Department of Radiology, Children's Hospital Boston/Harvard Medical School, Boston, Massachusetts.
7
The Developing Brain Research Laboratory, Departments of Diagnostic Imaging and Radiology, climpero@childrensnational.org.

Abstract

BACKGROUND AND OBJECTIVES:

Compared with term infants, preterm infants have impaired brain development at term-equivalent age, even in the absence of structural brain injury. However, details regarding the onset and progression of impaired preterm brain development over the third trimester are unknown. Our primary objective was to compare third-trimester brain volumes and brain growth trajectories in ex utero preterm infants without structural brain injury and in healthy in utero fetuses. As a secondary objective, we examined risk factors associated with brain volumes in preterm infants over the third-trimester postconception.

METHODS:

Preterm infants born before 32 weeks of gestational age (GA) and weighing <1500 g with no evidence of structural brain injury on conventional MRI and healthy pregnant women were prospectively recruited. Anatomic T2-weighted brain images of preterm infants and healthy fetuses were parcellated into the following regions: cerebrum, cerebellum, brainstem, and intracranial cavity.

RESULTS:

We studied 205 participants (75 preterm infants and 130 healthy control fetuses) between 27 and 39 weeks' GA. Third-trimester brain volumes were reduced and brain growth trajectories were slower in the ex utero preterm group compared with the in utero healthy fetuses in the cerebrum, cerebellum, brainstem, and intracranial cavity. Clinical risk factors associated with reduced brain volumes included dexamethasone treatment, the presence of extra-axial blood on brain MRI, confirmed sepsis, and duration of oxygen support.

CONCLUSIONS:

These preterm infants exhibited impaired third-trimester global and regional brain growth in the absence of cerebral/cerebellar parenchymal injury detected by using conventional MRI.

PMID:
27940782
PMCID:
PMC5079081
DOI:
10.1542/peds.2016-1640
[Indexed for MEDLINE]
Free PMC Article

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