Elsevier

The Journal of Pediatrics

Volume 157, Issue 5, November 2010, Pages 726-732.e1
The Journal of Pediatrics

Original Article
Extreme Premature Birth is not Associated with Impaired Development of Brain Microstructure

https://doi.org/10.1016/j.jpeds.2010.05.026Get rights and content

Objective

To assess whether birth at <26 weeks gestation is an important predictor of brain microstructure maturation as determined by using diffusion tensor imaging.

Study design

We performed serial magnetic resonance imaging and diffusion tensor imaging in 176 infants born at <33 weeks gestation. Diffusion parameters were calculated for white and gray matter regions. Linear regression for repeated measures was used to assess the effect of extremely premature birth on brain maturation.

Results

In white matter, fractional anisotropy increased by 0.008 per week (95% CI, 0.007-0.009; P < .0001) and mean diffusivity decreased by 0.021 mm2/sec per week, (95% CI, –0.24–0.018; P < .0001). Birth at <26 weeks was associated with lower white matter fractional anisotropy (–0.01; 95% CI, –0.018–0.003; P = .008), but this effect was eliminated when co-morbid conditions were added to the model. Moderate-severe brain injury was associated with decreased mean white matter fractional anisotropy (–0.012; 95% CI, –0.02–0.004; P = .002).

Conclusion

Brain microstructure maturation as measured serially in premature infants is independent of extremely premature birth. Brain injury and co-morbid conditions may be the important determinants of microstructure maturation.

Section snippets

Methods

The study population includes infants born between 24 and 33 weeks gestation, admitted to the intensive care nurseries at University of California, San Francisco (UCSF) and the Children's & Women's Health Center of British Columbia (UBC). Exclusion criteria included evidence of congenital infections, malformations or chromosomal anomalies, and ultrasound scanning evidence of large (>2 cm) parenchymal hemorrhagic infarction. The study subjects underwent imaging twice according to study protocol,

Results

Serial diffusion tensor imaging data were available for a total of 176 infants, 97 enrolled between April 2001 and March 2008 at UCSF and 79 enrolled from April 2006 to December 2008 at UBC. During the study period, at UCSF there were an additional 54 infants enrolled who either underwent only 1 scan (36 infants) or the diffusion tensor imaging data were motion degraded (18 infants) and they were not included in this analysis. At UBC, there were an additional 27 infants enrolled who did not

Discussion

The effect of gestational age at birth on developing white and gray matter microstructure can be assessed with diffusion parameter (fractional anisotropy or mean diffusivity) changes with time, and we were unable to demonstrate an effect. Extremely premature birth, at <26 weeks, had a detrimental effect on the change in white matter fractional anisotropy. However, this effect was eliminated by neonatal morbidities that commonly accompany extreme premature birth, such as the presence of a PDA,

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    Funding and conflict of interest information is available at www.jpeds.com (Appendix ).

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