Diffuse excessive high signal intensity in low-risk preterm infants at term-equivalent age does not predict outcome at 1 year: a prospective study.
BACKGROUND
The outcome of premature infants with only diffuse excessive high signal intensity (DEHSI) is not clear. We explored the relationship between DEHSI, white matter (WM) diffusion characteristics, perinatal characteristics, and neurobehavioral outcome at 1 year in a homogenous group of preterm infants without major brain abnormalities.


METHODS
Fifty-eight preterm infants, gestational age 29 ± 2.6 weeks, underwent an MRI at term-equivalent age (TEA). Griffiths Mental Developmental Scales, neurological assessment, and Parental Stress Index (PSI) were performed at 1 year corrected age. These measures were compared between preterm infants according to DEHSI classification (none, mild, moderate). Diffusion tensor imaging was used in major WM volumes of interest to objectively measure the degree of WM maturation.


RESULTS
No significant differences were detected in the perinatal risk characteristics, neurobehavioral outcome, and PSI at 1 year between infants with different DEHSI classifications. In infants with DEHSI, increased axial and radial diffusivities were detected in the optic radiations, centrum semiovale, and posterior limb of the internal capsule, indicating less advanced maturation of the WM. Significant correlations were detected between the time interval from birth to MRI and the WM microstructure in infants without DEHSI.


CONCLUSIONS
DEHSI in premature infants is neither a predictive measure for short-term adverse neurobehavioral outcome nor related to perinatal risk characteristics. Extrauterine exposure time had a differential effect on WM maturational trajectories in infants with DEHSI compared to those without. We suggest DEHSI may represent an alteration in WM maturational characteristics. Further follow-up studies may verify later consequences of DEHSI in premature infants.
Child Development Centre, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Centre, Weizman 6, 64239, Tel Aviv, Israel, leitnery@tlvmc.gov.il.
Yael
Y
Leitner
Maya
M
Weinstein
Vicki
V
Myers
Shimrit
S
Uliel
Karen
K
Geva
Irit
I
Berger
Ronella
R
Marom
Dafna Ben
DB
Bashat
Liat
L
Ben-Sira
Ronny
R
Geva
Varda
V
Gross-Tsur
D002657:Child Development; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000473:pathology; D056324:Diffusion Tensor Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000473:pathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D066127:White Matter / Q000254:growth & development / Q000473:pathology*