title: Brain injury and altered brain growth in preterm infants: predictors and prognosis.
abstract: BACKGROUND
  To define the nature and frequency of brain injury and brain growth impairment in very preterm (VPT) infants by using MRI at term-equivalent age and to relate these findings to perinatal risk factors and 2-year neurodevelopmental outcomes.
  
  
  METHODS
  MRI scans at term-equivalent age from 3 VPT cohorts (n = 325) were reviewed. The severity of brain injury, including periventricular leukomalacia and intraventricular and cerebellar hemorrhage, was graded. Brain growth was assessed by using measures of biparietal width (BPW) and interhemispheric distance. Neurodevelopmental outcome at age 2 years was assessed across all cohorts (n = 297) by using the Bayley Scales of Infant Development, Second Edition (BSID-II) or Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), and evaluation for cerebral palsy.
  
  
  RESULTS
  Of 325 infants, 107 (33%) had some grade of brain injury and 33 (10%) had severe injury. Severe brain injury was more common in infants with lower Apgar scores, necrotizing enterocolitis, inotropic support, and patent ductus arteriosus. Severe brain injury was associated with delayed cognitive and motor development and cerebral palsy. Decreased BPW was related to lower gestational age, inotropic support, patent ductus arteriosus, necrotizing enterocolitis, prolonged parenteral nutrition, and oxygen at 36 weeks and was associated with delayed cognitive development. In contrast, increased interhemispheric distance was related to male gender, dexamethasone use, and severe brain injury. It was also associated with reduced cognitive development, independent of BPW.
  
  
  CONCLUSIONS
  At term-equivalent age, VPT infants showed both brain injury and impaired brain growth on MRI. Severe brain injury and impaired brain growth patterns were independently associated with perinatal risk factors and delayed cognitive development.
authors: Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan;
authors: Hiroyuki
authors: H
authors: Kidokoro
authors: Murdoch Children's Institute, Royal Children's Hospital, Melbourne, Australia;Departments of Pediatrics, andObstetrics and Gynecology and.
authors: Peter J
authors: PJ
authors: Anderson
authors: Murdoch Children's Institute, Royal Children's Hospital, Melbourne, Australia;Departments of Pediatrics, andObstetrics and Gynecology andResearch Office, The Royal Women's Hospital, University of Melbourne, Melbourne, Australia;
authors: Lex W
authors: LW
authors: Doyle
authors: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.
authors: Lianne J
authors: LJ
authors: Woodward
authors: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Jeffrey J
authors: JJ
authors: Neil
authors: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and tinder@partners.org.
authors: Terrie E
authors: TE
authors: Inder
mesh_terms: D001034:Apgar Score; D001921:Brain / Q000254:growth & development* / Q000473:pathology; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000473:pathology; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000473:pathology; D007969:Leukomalacia, Periventricular / Q000453:epidemiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis
keywords: MRI; brain metrics; cerebellar hemorrhage; intraventricular hemorrhage; periventricular leukomalacia