Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants
Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight...
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2014-01-01
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Article |
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DOAJ |
language |
English |
format |
Article |
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DOAJ |
author |
Jessica Rose, PhD Rachel Vassar, BA Katelyn Cahill-Rowley, MS Ximena Stecher Guzman, MD Susan R. Hintz, MD David K. Stevenson, MD Naama Barnea-Goraly, MD |
spellingShingle |
Jessica Rose, PhD Rachel Vassar, BA Katelyn Cahill-Rowley, MS Ximena Stecher Guzman, MD Susan R. Hintz, MD David K. Stevenson, MD Naama Barnea-Goraly, MD Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants NeuroImage: Clinical MRI Diffusion tensor imaging White matter microstructure Brain development Risk factors Preterm infants |
author_facet |
Jessica Rose, PhD Rachel Vassar, BA Katelyn Cahill-Rowley, MS Ximena Stecher Guzman, MD Susan R. Hintz, MD David K. Stevenson, MD Naama Barnea-Goraly, MD |
author_sort |
Jessica Rose, PhD |
title |
Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants |
title_short |
Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants |
title_full |
Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants |
title_fullStr |
Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants |
title_full_unstemmed |
Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants |
title_sort |
neonatal physiological correlates of near-term brain development on mri and dti in very-low-birth-weight preterm infants |
publisher |
Elsevier |
series |
NeuroImage: Clinical |
issn |
2213-1582 |
publishDate |
2014-01-01 |
description |
Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age.
Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin.
Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = −.322, p = .009; r= −.381, p= .002), lower mean albumin (r = −.276, p= .029; r= −.385, p= .002), and lower mean bilirubin (r = −.293, p= .020; r= −.337 p= .007).
Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopmental impairment and inform neuroprotective treatment for VLBW preterm infants.
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topic |
MRI Diffusion tensor imaging White matter microstructure Brain development Risk factors Preterm infants |
url |
http://www.sciencedirect.com/science/article/pii/S2213158214000692 |
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doaj-97cd9beb1aac4e47948d158a0230aef62020-11-25T01:00:19ZengElsevierNeuroImage: Clinical2213-15822014-01-015C16917710.1016/j.nicl.2014.05.013Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infantsJessica Rose, PhD0Rachel Vassar, BA1Katelyn Cahill-Rowley, MS2Ximena Stecher Guzman, MD3Susan R. Hintz, MD4David K. Stevenson, MD5Naama Barnea-Goraly, MD6Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USADepartment of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USADepartment of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USARadiology Department, Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, ChileDivision of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USADivision of Neonatology and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USACenter for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA, USA Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age. Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin. Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = −.322, p = .009; r= −.381, p= .002), lower mean albumin (r = −.276, p= .029; r= −.385, p= .002), and lower mean bilirubin (r = −.293, p= .020; r= −.337 p= .007). Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopmental impairment and inform neuroprotective treatment for VLBW preterm infants. http://www.sciencedirect.com/science/article/pii/S2213158214000692MRIDiffusion tensor imagingWhite matter microstructureBrain developmentRisk factorsPreterm infants |