Preterm neuroimaging and school-age cognitive outcomes

Authors

Susan R. Hintz, Stanford University
Betty R. Vohr, Women and Infants Hospital of Rhode Island
Carla M. Bann, United States Environmental Protection Agency
H. Gerry Taylor, University Hospitals Rainbow Babies & Children's Hospital
Abhik Das, RTI International
Kathryn E. Gustafson, Duke University
Kimberly Yolton, Cincinnati Children's Hospital Medical Center
Victoria E. Watson, Women and Infants Hospital of Rhode Island
Jean Lowe, UNM Health Sciences Center
Maria Elena De Anda, Stanford University
M. Bethany Ball, Stanford University
Neil N. Finer, University of California, San Diego
Krisa P. Van Meurs, Stanford University
Seetha Shankaran, Wayne State University
Athina Pappas, Wayne State University
Patrick D. Barnes, Stanford University
Dorothy Bulas, Childrens National Health System
Jamie E. Newman, United States Environmental Protection Agency
Deanne E. Wilson-Costello, University Hospitals Rainbow Babies & Children's Hospital
Roy J. Heyne, UT Southwestern Medical School
Heidi M. Harmon, Indiana University-Purdue University Indianapolis
Myriam Peralta-Carcelen, The University of Alabama at Birmingham
Ira Adams-Chapman, Emory University
Andrea Freeman Duncan, University of Texas Medical School at Houston
Janell Fuller, UNM Health Sciences Center
Yvonne E. Vaucher, University of California, San Diego
Tarah T. Colaizy, University of Iowa
Sarah Winter, The University of Utah
Elisabeth C. McGowan, Women and Infants Hospital of Rhode Island
Ricki F. Goldstein, Duke University
Rosemary D. Higgins, National Institute of Child Health and Human Development (NICHD)
Alan H. Jobe, University of Cincinnati
Michael S. Caplan, Pritzker School of Medicine

Document Type

Journal Article

Publication Date

7-1-2018

Journal

Pediatrics

Volume

142

Issue

1

DOI

10.1542/peds.2017-4058

Abstract

Copyright © 2018 by the American Academy of Pediatrics. All rights reserved. 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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