Investigating cerebral anomalies in preterm infants and associated risk factors with magnetic resonance imaging at term-equivalent age

TL;DR

This study uses MRI at term-equivalent age to explore how perinatal factors influence cerebral anomalies and brain volume changes in preterm infants, highlighting the impact of treatments like ventilation and nutrition.

Contribution

It provides new insights into the relationship between specific perinatal factors and cerebral anomalies using combined qualitative and quantitative MRI assessments in preterm infants.

Findings

Mechanical ventilation increases risk of cerebral anomalies

Prolonged parenteral nutrition may protect against white matter anomalies

Mechanical ventilation and small for gestational age reduce cerebral volumes

Abstract

Background: Being born very or extreme preterm is a major source of cerebral anomalies and neurodevelopmental disorders, whose occurrence depends on many perinatal factors. A better understanding of these factors could be provided by cerebral Magnetic Resonance Imaging (MRI) at term-equivalent age (TEA). Objective: To investigate, through cerebral TEA-MRIs, the relationship between the main perinatal factors, the occurrence of cerebral anomalies, and cerebral volumetry. Methods: We assembled a cohort of preterm babies born before 32 weeks of gestation who underwent a cerebral TEA-MRI. We assessed cerebral anomalies using a radiological scoring system -- the Kidokoro scoring -- and performed cerebral volumetry. We investigated the relationships between 9 clinical factors (birth characteristics, resuscitation treatments{\ldots}), Kidokoro scores, and brain volumes. Results: Among 110 preterms who underwent a cerebral MRI at TEA, only 6% suffered moderate-to-severe brain anomalies. We identified mechanical ventilation as a risk factor for cerebral anomalies (adjusted Odds-Ratio aOR = 4.6, 95% Confidence Interval CI [1.7-12.8]) and prolonged parenteral nutrition as a protective factor for white matter anomalies (aOR = 0.2, 95%CI [0.1-0.8]). Mechanical ventilation (p = 0.01) and being born small for gestational age (p < 0.001) were risk factors for the reduction of cerebral volumes. An increase in brain lesion severity was associated with decreased cerebral volumes (p = 0.016). Conclusion: Our study highlights the importance of treatment-related perinatal factors on the occurrence of cerebral anomalies in very and extreme preterms, and the interest in using both qualitative (Kidokoro scoring) and quantitative (volumetry) MRI-tools.