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Neonatal Predictions of Neurodevelopmental Outcomes in Premature Infants

How much does MRI help clinicians predict outcomes?

In this very important study of extremely preterm infants, researchers assessed the value of using white-matter and gray-matter abnormalities on MRI to predict adverse neurodevelopmental outcome.

Infants born at very preterm gestational age are at high risk for later neurodevelopmental disabilities. Between 5% and 15% have cerebral palsy (CP), neurosensory impairment, or both. As many as half have significant cognitive, behavioral, or social abnormalities. Currently, clinicians use cranial ultrasound in the neonatal period to identify infants at increased risk for these disabilities, but it is difficult or impossible for the clinician to stratify that risk and, thus, to guide parents and identify specific care needs.

In this prospective study, 167 infants born at or before 30 weeks’ gestation were assessed with MRIs at term-equivalent age (i.e., 40 weeks’ gestation) and then with standardized neurodevelopmental examinations at age 2 years. Cranial ultrasonography was also performed at 48 hours, 5 to 7 days, and 4 to 6 weeks after birth. Eighty-two infants (49%) had gray-matter abnormalities on MRI; 120 infants (72%) had white-matter abnormalities. Independent of ultrasound findings and perinatal factors, moderate-to-severe white-matter abnormalities (found in 35 infants) predicted severe psychomotor delay and CP.

Comment: This large, well-performed study demonstrates that MRI at term equivalent improves upon current techniques in identifying infants at greatest risk for long-term neurodevelopmental problems. Many questions remain unanswered: How much do the MRI data improve prognostic accuracy? How closely does the evidence of early delays correspond with subsequent impairment? Although these results do not support routine clinical use of neonatal MRIs, the study does show the power of MRI in defining early abnormalities. These findings offer the promise that this technique ultimately will allow more precise risk stratification and will enable the clinician to provide parents with more useful answers to the question, "What will my child be like?"

— Steven A. Ringer, MD, PhD

Dr. Ringer is Chief, Division of Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston.

Published in Journal Watch Neurology November 21, 2006

Citation(s):

Woodward LJ et al. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006 Aug 17; 355:685-94.

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