Ultrasound findings and neurodevelopmental outcome in preterm infants with gestational age of less than 34 weeks

Abstract Purpose Very preterm infants are at risk for cerebellar injury and impaired cerebellar growth with adverse neurodevelopmental outcome. Ultrasound through the mastoid fontanel (MF) with a curved-array or sector probe is the most established method for the sonographic examination of the cerebellum. The goal of our study was to examine the validity of transnuchal ultrasound through the foramen occipitale magnum (FOM) with a linear probe for monitoring postnatal cerebellar growth. Methods Retrospective analysis of routine ultrasound scans through FOM and MF in 105 preterm infants born between 23 and 36 weeks of gestation with a birthweight of less than 1500 g. Results Diameters of the cerebellar hemispheres obtained through the two acoustic windows mastoid fontanel and foramen occipitale magnum showed high correlations (r’s = 0.981 and 0.983, p’s < 0.001). Corrected gestational age was significantly associated with transverse cerebellar diameter (TCD) on the first scan (r = 0.908, p < 0.001) as well as postnatal cerebellar growth (r = 0.920, p < 0.001). Postnatal growth was slightly decreased resulting in cerebellar growth restriction on serial scans. Both associations exceeded the calculated ratio of TCD to head circumference (r = 0.657, p < 0.001) and TCD to biparietal diameter with gestational age (r = 0.705, p < 0.001). Conclusion Transnuchal ultrasound is feasible for examination of the preterm cerebellum and improves image quality compared to scans through the MF with higher resolution at a very short distance. Monitoring cerebellar growth during early postnatal life via transnuchal ultrasound can help to identify children at high risk for neurodevelopmental impairment.

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LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE <32 WEEKS

Journal of the Siena Academy of Sciences ◽

10.4081/jsas.2013.53 ◽

2013 ◽

Vol 5 (1) ◽

pp. 53 ◽

Cited By ~ 1

Author(s):

M.G. Gatti ◽

S. Perrone ◽

S. Badii ◽

E. Becucci ◽

G. Turrisi ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Neurodevelopmental Outcome

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1272 Survival and Neurodevelopmental Outcome of Preterm Infants with a Gestational Age of 22 to 26 Weeks in a Regional Centre

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302724.1272 ◽

2012 ◽

Vol 97 (Suppl 2) ◽

pp. A363-A363

Author(s):

P. Kutz ◽

S. Supcun-Ritzler ◽

C. Roll

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Neurodevelopmental Outcome ◽

Regional Centre

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Influence of Maternal Preeclampsia on Neurodevelopmental Outcomes of Preterm Infants

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.737 ◽

2018 ◽

Vol 24 (2) ◽

pp. 99

Author(s):

Halil Degirmencioglu ◽

Birgul Say ◽

Zeynep Ustunyurt ◽

Serife Suna Oguz

Keyword(s):

Cerebral Palsy ◽

Preterm Infants ◽

Gestational Age ◽

Infant Development ◽

Neurodevelopmental Outcome ◽

Control Group ◽

Neurodevelopmental Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

The Mean

Objective: The aim of this study was to determine the neurodevelopmental outcome of preterm infants born to mothers with preeclampsia and to compare them with preterm controls.Study design: This was a retrospective, observational study in a large, tertiary, neonatal intensive care unit. Neurodevelopmental evaluations using Bayley Scales of Infant Development II were performed in 226 two-year-old infants with birth weight ≤1500 g and gestational age ≤32 weeks who were born to mothers with preeclampsia and in 493 infants who were born after normotensive pregnancies, matched for gestational age and gender.Results: The mean gestational ages of the infants in the preeclampsia and control groups were 29.9±2.3 weeks and 28.7±4.1 weeks, respectively (p<0.001). A total of 372 infants with a mean age of 19.2±3.2 months were assessed for long-term outcome. The mean mental developmental index score was significantly higher, and the percentage of infants with cerebral palsy was significantly lower, in the preeclampsia group compared with the control group (p=0.03 and p=0.02, respectively). However, no overall significant differences in neurodevelopmental impairment rates were found between the two groups (p=0.08).Conclusion: Maternal preeclampsia seems to be a protector factor for the development of cerebral palsy in preterm infants.

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CRANIAL ULTRASOUND: EFFICIENT SCREENING TOOL FOR EARLY DETECTION OF BRAIN INJURY IN PRETERM INFANTS

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.01.2 ◽

2021 ◽

Vol 7 (1) ◽

pp. 7-11

Author(s):

Dini Rachma Erawati ◽

Yuyun Yueniwati

Keyword(s):

Brain Injury ◽

Early Detection ◽

Preterm Infants ◽

Gestational Age ◽

Screening Tool ◽

Mode Of Delivery ◽

Fisher Exact Test ◽

Cranial Ultrasound ◽

Cross Sectional ◽

Ultrasound Findings

Background: Cranial ultrasound becomes an important diagnostic tool to evaluate brain injury in infants. Brain injury is a major complication for preterm birth. The brain injury of preterm infants differs from that of a term infant. Brain injury has correlation with gestational age and mode of delivery. Objective: To analyze the correlation between cranial ultrasound findings with gestational age and mode of delivery and to reveal if cranial ultrasound can be used to detect brain injury in premature infants. Methods: An observational analytic study using cross-sectional design took place in Saiful Anwar Hospital Malang, Indonesia. 38 healthy preterm infants underwent cranial ultrasound examination within the first four day of life. Fisher Exact test was used to analyze the correlation between cranial ultrasound findings with gestational age and mode of delivery. Results: Most of the healthy preterm infants (89.5%) were ≥ 32 weeks gestational age, and 52.6% of samples had caesarean section as their mode of delivery. There were three abnormal findings in cranial ultrasound; increased periventricular echogenic (5.3%), increased parenchym echogenic (5.3%), and indistinguishable of gray-white matter differentiation (5.3%). There was no significant correlation between abnormal cranial ultrasound findings with gestational age and mode of delivery (p= 0.202; p= 0.218). Conclusion: There were abnormal cranial ultrasound findings in some healthy preterm infants despite no significant correlation between ultrasound findings with gestational age and mode of delivery. Cranial ultrasound in preterm infants could become a screening tool for early detection of brain injury.

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Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Scientia Medica ◽

10.15448/1980-6108.2018.3.29354 ◽

2018 ◽

Vol 28 (3) ◽

pp. 29354

Author(s):

Sara Peixoto ◽

Joana Amaral ◽

Cristina Resende ◽

Dolores Faria ◽

Adelaide Taborda

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Intraventricular Hemorrhage ◽

Univariate Analysis ◽

Neurodevelopmental Outcome ◽

Male Gender ◽

Low Grade ◽

Antenatal Corticosteroid ◽

The Impact ◽

Cranial Ultrasonography

AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age.METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient <2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment.RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls.CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.

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Evolution of circulating thyroid hormone levels in preterm infants during the first week of life: perinatal influences and impact on neurodevelopment

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0537 ◽

2019 ◽

Vol 32 (6) ◽

pp. 597-606 ◽

Cited By ~ 2

Author(s):

An Eerdekens ◽

Gunnar Naulaers ◽

Els Ortibus ◽

Johan Verhaeghe ◽

Lies Langouche ◽

...

Keyword(s):

Thyroid Hormone ◽

Preterm Infants ◽

Gestational Age ◽

Infant Development ◽

Neurodevelopmental Outcome ◽

Thyroid Stimulating Hormone ◽

Low T3 ◽

Increased Risk ◽

Total Thyroxine ◽

The Impact

Abstract Background For several decades, transient hypothyroxinemia of prematurity (THOP) has been a topic of debate. The pathophysiology is incompletely understood and consensus on the therapeutic approach is lacking. This study aimed at gaining a better insight into the pathogenesis by studying the trends in thyroid hormone (TH) levels during the first week of life. Methods This single-center prospective observational study analyzed the plasma levels of total thyroxine (T4) and free thyroxine (fT4), total triiodothyronine (T3), thyroid-stimulating hormone (TSH) and T4-binding globulin (TBG) in cord blood and at the end of the first week of life in 120 preterm infants (gestational age [GA] <37 weeks). The change over time was calculated (delta, ∆). The impact of perinatal and subsequently postnatal variables on ∆ was studied by hierarchical multiple regression. The impact of ∆ on the neurodevelopmental outcome at the corrected ages of 9 and 24 months, measured by the Bayley Scales of Infant Development (BSID)-II, was assessed by logistic regression. Results ∆fT4 levels were negatively affected by GA and use of dopamine, whereas only GA was associated with low ∆T3 levels. Negative ∆fT4 levels were present in 75% of the extremely low-for-gestational-age infants, whereas 23.5% had a negative ∆T3 level. There was an increased risk for an abnormal mental developmental score (<85) with decreasing ∆T3 at 9 months, corrected age, but not at 24 months. Conclusions A negative evolution in circulating TH levels is principally an immaturity phenomenon, whereas dopamine can further suppress the hypothalamic-pituitary-thyroid axis. There is at least a temporary negative effect of this evolution on the infants’ neurodevelopment.

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The Impact of Hypernatremia in Preterm Infants on Neurodevelopmental Outcome at 18 Months of Corrected Age

American Journal of Perinatology ◽

10.1055/s-0040-1716845 ◽

2020 ◽

Author(s):

Heather B. Howell ◽

Matthew Lin ◽

Michele Zaccario ◽

Sadaf Kazmi ◽

Felice Sklamberg ◽

...

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Serum Sodium ◽

Neurodevelopmental Outcome ◽

Population Characteristics ◽

Peak Serum ◽

Fine Motor ◽

Study Objective ◽

The Impact

Objective The study objective was to assess the correlation between hypernatremia during the first week of life and neurodevelopmental outcomes at 18 months of corrected age in premature infants. Study Design A retrospective observational study of preterm infants born at less than 32 weeks of gestation who had a neurodevelopmental assessment with the Bayley scales of infant and toddler development III at 18 ± 6 months of corrected age. Serum sodium levels from birth through 7 days of life were collected. The study cohort was divided into two groups: infants with a peak serum sodium of >145 mmol/L (hypernatremia group) and infants with a peak serum sodium level of <145 mmol/L (no hypernatremia group). Prenatal, intrapartum, and postnatal hospital course and neurodevelopmental data at 18 ± 6 months were collected. Logistic regression analysis was used to assess the correlation between neonatal hypernatremia and neurodevelopment with adjustment for selected population characteristics. Results Eighty-eight preterm infants with complete neurodevelopmental outcome data at 18 ± 6 months of corrected gestational age were included in the study. Thirty-five neonates were in the hypernatremia group and 53 were in the no hypernatremia group. Maternal and neonatal characteristics were similar between the two groups except that the hypernatremia group had a significantly lower average birth weight and gestational age. Comparison of the mean neurodevelopmental scores between the two groups showed that patients in the hypernatremia group as compared with those in the no hypernatremia group had significantly lower neurodevelopmental scaled scores in the fine motor domain (p = 0.01). This difference remained significant (p = 0.03, odds ratio [OR] = 0.8, 95% confidence interval [CI]: 0.6–0.97) when adjusted for birth weight and gestational age. Conclusion Preterm infants born at less than 32 weeks of gestation with hypernatremia in the first week of life have lower fine motor scores at 18 months of corrected age. Key Points

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