Neonatal cranial ultrasound abnormalities in low birth weight infants: relation to cognitive outcomes at six years of age.
OBJECTIVE
To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age.


METHODS
Prospective cohort study.


METHODS
Six-year follow-up data were obtained on a regional birth cohort of LBW infants (< 2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors.


RESULTS
The sample as a whole had a significantly elevated rate of mental retardation (MR; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7; CI, 1.3 to 10.8); isolated GM/IVH was more modestly related to MR (OR, 4.6; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills.


CONCLUSIONS
Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants.
Whitaker
A H
AH
Division of Child and Adolescent Psychiatry, Columbia University College of Physicians and Surgeons, New York, USA.
Feldman
J F
JF
Van Rossem
R
R
Schonfeld
I S
IS
Pinto-Martin
J A
JA
Torre
C
C
Blumenthal
S R
SR
Paneth
N S
NS
D000375:Aging / Q000523:psychology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000000981:diagnostic imaging / Q000209:etiology / Q000523:psychology; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial