Is sequential cranial ultrasound reliable for detection of white matter injury in very preterm infants?

Cranial ultrasound (cUS) may not be reliable for detection of diffuse white matter (WM) injury. Our aim was to assess in very preterm infants the reliability of a classification system for WM injury on sequential cUS throughout the neonatal period, using magnetic resonance imaging (MRI) as reference standard. In 110 very preterm infants (gestational age < 32 weeks), serial cUS during admission (median 8, range 4-22) and again around term equivalent age (TEA) and a single MRI around TEA were performed. cUS during admission were assessed for presence of WM changes, and contemporaneous cUS and MRI around TEA additionally for abnormality of lateral ventricles. Sequential cUS (from birth up to TEA) and MRI were classified as normal/mildly abnormal, moderately abnormal, or severely abnormal, based on a combination of findings of the WM and lateral ventricles. Predictive values of the cUS classification were calculated. Sequential cUS were classified as normal/mildly abnormal, moderately abnormal, and severely abnormal in, respectively, 22%, 65%, and 13% of infants and MRI in, respectively, 30%, 52%, and 18%. The positive predictive value of the cUS classification for the MRI classification was high for severely abnormal WM (0.79) but lower for normal/mildly abnormal (0.67) and moderately abnormal (0.64) WM. Sequential cUS during the neonatal period detects severely abnormal WM in very preterm infants but is less reliable for mildly and moderately abnormal WM. MRI around TEA seems needed to reliably detect WM injury in very preterm infants.Epidemiology in Pediatrics and Child Healt

Improved segmentation of neonatal brain MRI scans by addressing motion artifacts with data interpolation

negatively affect segmentation. The purpose of this study was to investigate whether motion-affected slices can be replaced by interpolated slices to enhance segmentation of neonatal brain MRI scans. METHODS: From August 2017 to November 2019, moderate-late preterm infants were enrolled in a prospective cohort study entitled Brain Imaging in Moderate-late Preterm infants (BIMP-study). Around term equivalent age, MRI of the brain was performed using a 3 Tesla MRI. T2-weighed (voxel size 0.35x0.35x2mm) transverse images were automatically segmented into eight brain structures with a neonatal segmentation toolbox [1]. Upon visual inspection, scans with motion artifacts that affected segmentation (25/112; motion group) and scans without motion artifacts (27/112; control group) were selected and used for analysis. Slices with motion artifacts were re-estimated using shape-preserving cubic spline interpolation [2, 3], followed by automatic segmentation of the interpolated scan. Analysis was performed in three stages. Firstly, scans from the control group were used to test interpolation reliability: 18/54 axial slices of these scans were interpolated. Segmentation results of uninterpolated and interpolated scans were compared using the Sørensen-Dice coefficient. Secondly, uninterpolated and interpolated volumes of the motion group were compared using the Wilcoxon Signed-Ranks test. Thirdly, interpolated volumes of the motion group were compared to uninterpolated volumes of the control group using the Mann-Whitney U test. RESULTS: In the control group, Sørensen-Dice coefficients ranged between 0.87 and 0.97. In the motion group, interpolation resulted in a significant decrease of cortical (Z=-2.9, p=0.004) and deep gray matter (Z=-3.30, p<0.001), and a significant increase of white matter (Z=2.84, p=0.005) volumes. No significant differences were found between interpolated volumes of the motion group and uninterpolated volumes of the control group. CONCLUSION: Shape preserving cubic spline interpolation enables reliable segmentation of motion-affected MRI scans in moderate-late preterm infants

Ultrasound measurements of brain structures differ between moderate-late preterm and full-term infants at term equivalent age

Background: Brain growth in moderate preterm (MP; gestational age (GA) 32(+0)-33(+6) weeks) and late preterm infants (LP; GA 34(+0)-36+6 weeks) may be impaired, even in the absence of brain injury.Aims: The aims of this study were to assess brain measurements of MP and LP infants, and to compare these with full-term infants (GA > 37 weeks) using linear cranial ultrasound (cUS) at term equivalent age (TEA).Study design: cUS data from two prospective cohorts were combined. Two investigators performed offline measurements on standard cUS planes. Eleven brain structures were compared between MP, LP and full-term infants using uni-and multivariable linear regression.Results were adjusted for postmenstrual age at cUS and corrected for multiple testing. Results: Brain measurements of 44 MP, 54 LP and 52 full-term infants were determined on cUS scans at TEA. Biparietal diameter and basal ganglia-insula width were smaller in MP (-9.1 mm and -1.7 mm, p < 0.001) and LP infants (-7.0 mm and -1.7 mm, p < 0.001) compared to full-term infants. Corpus callosum - fastigium length was larger in MP (+2.2 mm, p < 0.001) than in full-term infants. No significant differences were found between MP and LP infants.Conclusions: These findings suggest that brain growth in MP and LP infants differs from full-term infants. Whether these differences have clinical implications remains to be investigated.Research into fetal development and medicin

Tractography of developing white matter of the internal capsule and corpus callosum in very preterm infants

To investigate in preterm infants associations between Diffusion Tensor Imaging (DTI) parameters of the posterior limb of the internal capsule (PLIC) and corpus callosum (CC) and age, white matter (WM) injury and clinical factors. In 84 preterm infants DTI was performed between 40-62 weeks postmenstrual age on 3 T MR. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) values and fibre lengths through the PLIC and the genu and splenium were determined. WM injury was categorised as normal/mildly, moderately and severely abnormal. Associations between DTI parameters and age, WM injury and clinical factors were analysed. A positive association existed between FA and age at imaging for fibres through the PLIC (r = 0.48 p < 0.001) and splenium (r = 0.24 p < 0.01). A negative association existed between ADC and age at imaging for fibres through the PLIC (r = -0.65 p < 0.001), splenium (r = -0.35 p < 0.001) and genu (r = -0.53 p < 0.001). No association was found between DTI parameters and gestational age, degree of WM injury or categorical clinical factors. These results indicate that in our cohort of very preterm infants, at this young age, the development of the PLIC and CC is ongoing and independent of the degree of prematurity or WM injury.Neuro Imaging Researc

Atrioventriculaire geleidingstijd bij te vroeg geborenen ongeveer de helft van die bij volwassenen

Doel: Bepalen van de atrioventriculaire (AV)-geleidingstijd bij te vroeg geboren kinderen in het kader van een vergelijkend elektrocardiologisch onderzoek naar geleidingstijden versus grootte van het hart. Opzet: Descriptief. Plaats: Afdeling Neonatologie van het Academisch Ziekenhuis van de Vrije Universiteit te Amsterdam. Methode: Bij 28 baby's, geboren na een zwangerschapsduur van 26-36 weken, werd met behulp van de gebruikelijke bewakingsapparatuur en een bipolaire precordiale afleiding zo snel mogelijk na de geboorte een ECG geregistreerd. Deze ECG's werden vervolgens handmatig geanalyseerd en de relevante geleidingstijden, zoals het PQ-interval en de QRS-duur, gemeten. De gevonden waarden werden gerelateerd aan het geboortegewicht van de kinderen. (Het hartgewicht is bij benadering 0,6% van het lichaamsgewicht.) Resultaten: Het gemiddelde geboortegewicht van de kinderen bedroeg 1374 g (SD: 491), het gemiddelde PR-interval 93 ms (9), de gemiddelde QRS-duur 40 ms (4) en de gemiddelde hartfrequentie 148/min (14). Conclusie: In hartjes met een gewicht van 6-10 g bedroeg de geleidingstijd ongeveer de helft van die van het volwassen mensenhart (350-500 g; 5O keer zo zwaar). De relatieve bijdrage van de AV-knoop aan de AV-geleidingstijd is groter naarmate het hart kleiner is

Cranial ultrasonography of the immature cerebellum: Role and limitations

Developmen