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Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants.

CPQCC Publication
TitleEarly Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants.
Publication TypeJournal Article
Year of Publication2016
AuthorsSlaughter LA, Bonfante-Mejia E, Hintz SR, Dvorchik I, Parikh NA
Date Published2016
KeywordsBrain, Case-Control Studies, Cerebral Palsy, Developmental Disabilities, Female, Humans, Infant, Infant, Extremely Low Birth Weight, Infant, Newborn, Language Development Disorders, Linear Models, Logistic Models, Magnetic Resonance Imaging, Male, Multivariate Analysis, Prognosis, Retrospective Studies, Sensitivity and Specificity, Texas

BACKGROUND: Extremely-low-birth-weight (ELBW; ≤1,000 g) infants are at high risk for neurodevelopmental impairments. Conventional brain MRI at term-equivalent age is increasingly used for prediction of outcomes. However, optimal prediction models remain to be determined, especially for cognitive outcomes.

OBJECTIVE: The aim was to evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments.

METHODS: 122 ELBW infants had a brain MRI performed at term-equivalent age. Conventional MRI findings were scored with a standardized algorithm and tested using a multivariable regression model to predict neurodevelopmental impairment, defined as one or more of the following at 18-24 months' corrected age: cerebral palsy, bilateral blindness, bilateral deafness requiring amplification, and/or cognitive/language delay. Results were compared with a commonly cited scoring system.

RESULTS: In multivariable analyses, only moderate-to-severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (OR: 12.6, 95% CI: 2.6, 62.0; p < 0.001). Moderate-to-severe gyral maturational delay also predicted cognitive delay, cognitive delay/death, and neurodevelopmental impairment/death. Diffuse cystic abnormality was a significant predictor of cerebral palsy (OR: 33.6, 95% CI: 4.9, 229.7; p < 0.001). These predictors exhibited high specificity (range: 94-99%) but low sensitivity (30-67%) for the above outcomes. White or gray matter scores, determined using a commonly cited scoring system, did not show significant association with neurodevelopmental impairment.

CONCLUSIONS: In our cohort, conventional MRI at term-equivalent age exhibited high specificity in predicting neurodevelopmental outcomes. However, sensitivity was suboptimal, suggesting additional clinical factors and biomarkers are needed to enable accurate prognostication.

Alternate JournalNeonatology
PubMed ID27050735
PubMed Central IDPMC5768198
Grant ListK23 NS048152 / NS / NINDS NIH HHS / United States