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Pediatrics. 2018 Jul;142(1). pii: e20174058. doi: 10.1542/peds.2017-4058.

Preterm Neuroimaging and School-Age Cognitive Outcomes.

Author information

1
Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California; srhintz@stanford.edu.
2
Department of Pediatrics, Women and Infants Hospital and Brown University, Providence, Rhode Island.
3
Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Research Triangle Park, North Carolina.
4
Department of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio.
5
Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Rockville, Maryland.
6
Department of Pediatrics, Duke University, Durham, North Carolina.
7
Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
8
Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
9
Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California.
10
Department of Pediatrics, University of California at San Diego, San Diego, California.
11
Department of Pediatrics, Wayne State University, Detroit, Michigan.
12
Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, District of Columbia.
13
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
14
Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana.
15
Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama.
16
Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
17
Department of Pediatrics, McGovern Medical School, University of Texas at Houston, Houston, Texas.
18
Department of Pediatrics, University of Iowa, Iowa City, Iowa.
19
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.
20
Division of Newborn Medicine, Department of Pediatrics, Tufts Medical Center, Floating Hospital for Children, Boston, Massachusetts; and.
21
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

Abstract

BACKGROUND AND OBJECTIVES:

Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value.

METHODS:

A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors.

RESULTS:

A total of 386 children had follow-up. In unadjusted analyses, severity of white matter abnormality and cerebellar lesions on MRI and adverse CUS findings were associated with outcomes. In full regression models, both adverse late CUS findings (odds ratio [OR] 27.9; 95% confidence interval [CI] 6.0-129) and significant cerebellar lesions on MRI (OR 2.71; 95% CI 1.1-6.7) remained associated with disability, but only adverse late CUS findings (OR 20.1; 95% CI 3.6-111) were associated with FSIQ <70. Predictive accuracy of stepwise models was not substantially improved with the addition of neuroimaging.

CONCLUSIONS:

Severe but rare adverse late CUS findings were most strongly associated with cognitive impairment and disability at school age, and significant cerebellar lesions on MRI were associated with disability. Near-term conventional MRI did not substantively enhance prediction of severe early school-age outcomes.

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