title: Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants.
abstract: OBJECTIVE
  To identify perinatal clinical antecedents of white matter microstructural abnormalities in extremely preterm infants.
  
  
  METHODS
  A prospective cohort of extremely preterm infants (N = 86) and healthy term controls (N = 16) underwent diffusion tensor imaging (DTI) at term equivalent age. Region of interest-based measures of white matter microstructure - fractional anisotropy and mean diffusivity - were quantified in seven vulnerable cerebral regions and group differences assessed. In the preterm cohort, multivariable linear regression analyses were conducted to identify independent clinical factors associated with microstructural abnormalities.
  
  
  RESULTS
  Preterm infants had a mean (standard deviation) gestational age of 26.1 (1.7) weeks and birth weight of 824 (182) grams. Compared to term controls, the preterm cohort exhibited widespread microstructural abnormalities in 9 of 14 regional measures. Chorioamnionitis, necrotizing enterocolitis, white matter injury on cranial ultrasound, and increasing duration of mechanical ventilation were adversely correlated with regional microstructure. Conversely, antenatal steroids, female sex, longer duration of caffeine therapy, and greater duration of human milk use were independent favorable factors. White matter injury on cranial ultrasound was associated with a five weeks or greater delayed maturation of the corpus callosum; every additional 10 days of human milk use were associated with a three weeks or greater advanced maturation of the corpus callosum.
  
  
  CONCLUSIONS
  Diffusion tensor imaging is sensitive in detecting the widespread cerebral delayed maturation and/or damage increasingly observed in extremely preterm infants. In our cohort, it also aided identification of several previously known or suspected perinatal clinical antecedents of brain injury, aberrant development, and neurodevelopmental impairments.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, Houston, Texas, USA.
authors.forename: Ulana
authors.initials: U
authors.lastname: Pogribna
authors.forename: Xintian
authors.initials: X
authors.lastname: Yu
authors.forename: Katrina
authors.initials: K
authors.lastname: Burson
authors.forename: Yuxiang
authors.initials: Y
authors.lastname: Zhou
authors.forename: Robert E
authors.initials: RE
authors.lastname: Lasky
authors.forename: Ponnada A
authors.initials: PA
authors.lastname: Narayana
authors.forename: Nehal A
authors.initials: NA
authors.lastname: Parikh
mesh_terms: D001921:Brain / Q000473:pathology; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D056784:Leukoencephalopathies / Q000473:pathology*; D008297:Male; D011446:Prospective Studies