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Preterm Neuroimaging and School-Age Cognitive Outcomes.

CPQCC Publication
TitlePreterm Neuroimaging and School-Age Cognitive Outcomes.
Publication TypeJournal Article
Year of Publication2018
AuthorsHintz SR, Vohr BR, Bann CM, H Taylor G, Das A, Gustafson KE, Yolton K, Watson VE, Lowe J, DeAnda MElena, M Ball B, Finer NN, Van Meurs KP, Shankaran S, Pappas A, Barnes PD, Bulas D, Newman JE, Wilson-Costello DE, Heyne RJ, Harmon HM, Peralta-Carcelen M, Adams-Chapman I, Duncan AFreeman, Fuller J, Vaucher YE, Colaizy TT, Winter S, McGowan EC, Goldstein RF, Higgins RD
Corporate AuthorsSUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
JournalPediatrics
Volume142
Issue1
Date Published2018 07
ISSN1098-4275
KeywordsBrain, Child, Child, Preschool, Cognition, Developmental Disabilities, Disability Evaluation, Echoencephalography, Follow-Up Studies, Humans, Infant, Infant, Newborn, Infant, Premature, Magnetic Resonance Imaging, Neuroimaging, Prognosis, Prospective Studies
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.

DOI10.1542/peds.2017-4058
Alternate JournalPediatrics
PubMed ID29945955
PubMed Central IDPMC6128951
Grant ListU10 HD021385 / HD / NICHD NIH HHS / United States
U10 HD053119 / HD / NICHD NIH HHS / United States
U10 HD021364 / HD / NICHD NIH HHS / United States
UG1 HD053089 / HD / NICHD NIH HHS / United States
U10 HD040461 / HD / NICHD NIH HHS / United States
U10 HD027904 / HD / NICHD NIH HHS / United States
UG1 HD034216 / HD / NICHD NIH HHS / United States
U10 HD027851 / HD / NICHD NIH HHS / United States
UG1 HD027880 / HD / NICHD NIH HHS / United States
UG1 HD053109 / HD / NICHD NIH HHS / United States
UL1 RR025008 / RR / NCRR NIH HHS / United States
U10 HD053089 / HD / NICHD NIH HHS / United States
U10 HD027856 / HD / NICHD NIH HHS / United States
U10 HD021373 / HD / NICHD NIH HHS / United States
UG1 HD087226 / HD / NICHD NIH HHS / United States
U10 HD053124 / HD / NICHD NIH HHS / United States
U10 HD027880 / HD / NICHD NIH HHS / United States
UG1 HD027853 / HD / NICHD NIH HHS / United States
U10 HD053109 / HD / NICHD NIH HHS / United States
UG1 HD087229 / HD / NICHD NIH HHS / United States
UG1 HD040689 / HD / NICHD NIH HHS / United States
U10 HD040689 / HD / NICHD NIH HHS / United States
U10 HD040492 / HD / NICHD NIH HHS / United States
UG1 HD027904 / HD / NICHD NIH HHS / United States
UL1 RR025744 / RR / NCRR NIH HHS / United States
UG1 HD040492 / HD / NICHD NIH HHS / United States
UG1 HD021364 / HD / NICHD NIH HHS / United States
U10 HD034216 / HD / NICHD NIH HHS / United States
U10 HD036790 / HD / NICHD NIH HHS / United States
UG1 HD068278 / HD / NICHD NIH HHS / United States
U24 HD095254 / HD / NICHD NIH HHS / United States