title: Neuroimaging and neurodevelopmental outcome in extremely preterm infants.
abstract: BACKGROUND
  Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age.
  
  
  METHODS
  Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors.
  
  
  RESULTS
  Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes.
  
  
  CONCLUSIONS
  Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California; srhintz@stanford.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California;
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Barnes
authors.affiliation: Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, District of Columbia;
authors.forename: Dorothy
authors.initials: D
authors.lastname: Bulas
authors.affiliation: Department of Pediatric Imaging, Children's Hospital of Michigan, Wayne State School of Medicine, Detroit, Michigan;
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Slovis
authors.affiliation: Departments of Neonatology, and.
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
authors.affiliation: Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina;
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Wrage
authors.affiliation: Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland;
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, University of Texas Medical School-Houston, Houston, Texas;
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tyson
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California;
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
authors.affiliation: Division of Neonatology, University of Alabama-Birmingham, Birmingham, Alabama;
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio;
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island;
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California;
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors.forename: Roger G
authors.initials: RG
authors.lastname: Faix
authors.affiliation: Departments of Neonatology, and Pediatrics, University of California-San Diego, San Diego, California;
authors.forename: Wade
authors.initials: W
authors.lastname: Rich
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio;
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.affiliation: Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina;
authors.forename: Helen
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;
authors.forename: Roy J
authors.initials: RJ
authors.lastname: Heyne
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island;
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Acarregui
authors.affiliation: Pediatrics, University of California-San Diego, San Diego, California;
authors.forename: Yvonne E
authors.initials: YE
authors.lastname: Vaucher
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan;
authors.forename: Athina
authors.initials: A
authors.lastname: Pappas
authors.affiliation: Division of Neonatology, University of Alabama-Birmingham, Birmingham, Alabama;
authors.forename: Myriam
authors.initials: M
authors.lastname: Peralta-Carcelen
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio;
authors.forename: Deanne E
authors.initials: DE
authors.lastname: Wilson-Costello
authors.affiliation: Department of Pediatrics, University of Texas Medical School-Houston, Houston, Texas;
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Evans
authors.affiliation: Department of Pediatrics, Duke University, Durham, North Carolina;
authors.forename: Ricki F
authors.initials: RF
authors.lastname: Goldstein
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, Rochester, New York;
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Myers
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;
authors.forename: Brenda B
authors.initials: BB
authors.lastname: Poindexter
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts;
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McGowan
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, Georgia;
authors.forename: Ira
authors.initials: I
authors.lastname: Adams-Chapman
authors.affiliation: University of New Mexico Health Sciences Center, Albuquerque, New Mexico; and.
authors.forename: Janell
authors.initials: J
authors.lastname: Fuller
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D001921:Brain / Q000254:growth & development*; D002658:Developmental Disabilities / Q000175:diagnosis*; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D011446:Prospective Studies
keywords: MRI; neurodevelopmental; neuroimaging; preterm infant; ultrasound