Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment.
OBJECTIVE
The aim was to survey the range of cerebral injury and abnormalities of cerebral development in infants born between 23 and 30 weeks' gestation using serial MRI scans of the brain from birth, and to correlate those findings with neurodevelopmental outcome after 18 months corrected age.


METHODS
Between January 1997 and November 2000, consecutive infants born at < 30 weeks' gestational age underwent serial MRI brain scans from birth until term-equivalent age. Infants were monitored after 18 months of age, corrected for prematurity, with the Griffiths Mental Development Scales and neurologic assessment.


RESULTS
A total of 327 MRI scans were obtained from 119 surviving infants born at 23 to 30 weeks of gestation. Four infants had major destructive brain lesions, and tissue loss was seen at term for the 2 survivors. Fifty-one infants had early hemorrhage; 50% of infants with term scans after intraventricular hemorrhage had ventricular dilation. Twenty-six infants had punctate white matter lesions on early scans; these persisted for 33% of infants assessed at term. Early scans showed cerebellar hemorrhagic lesions for 8 infants and basal ganglia abnormalities for 17. At term, 53% of infants without previous hemorrhage had ventricular dilation and 80% of infants had diffuse excessive high signal intensity within the white matter on T2-weighted scans. Complete follow-up data were available for 66% of infants. Adverse outcomes were associated with major destructive lesions, diffuse excessive high signal intensity within the white matter, cerebellar hemorrhage, and ventricular dilation after intraventricular hemorrhage but not with punctate white matter lesions, hemorrhage, or ventricular dilation without intraventricular hemorrhage.


CONCLUSIONS
Diffuse white matter abnormalities and post-hemorrhagic ventricular dilation are common at term and seem to correlate with reduced developmental quotients. Early lesions, except for cerebellar hemorrhage and major destructive lesions, do not show clear relationships with outcomes.
Dyet
Leigh E
LE
Department of Paediatrics, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom.
Kennea
Nigel
N
Counsell
Serena J
SJ
Maalouf
Elia F
EF
Ajayi-Obe
Morenike
M
Duggan
Philip J
PJ
Harrison
Michael
M
Allsop
Joanna M
JM
Hajnal
Joseph
J
Herlihy
Amy H
AH
Edwards
Bridget
B
Laroche
Sabrina
S
Cowan
Frances M
FM
Rutherford
Mary A
MA
Edwards
A David
AD
D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D001925:Brain Damage, Chronic / Q000209:etiology / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology; D002552:Cerebral Ventricles / Q000473:pathology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000209:etiology / Q000473:pathology*; D004108:Dilatation, Pathologic / Q000209:etiology / Q000473:pathology; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000473:pathology*; D007236:Infant, Small for Gestational Age; D007363:Intensive Care Units, Neonatal; D007969:Leukomalacia, Periventricular / Q000209:etiology / Q000473:pathology; D008131:London / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D012720:Severity of Illness Index