Neonatal neuroimaging among children born extremely preterm and motor coordination impairment at school-age

Abstract

OBJECTIVES: To examine among children born extremely preterm (EPT) initial and late cranial ultrasound (CUS) findings and near-term brain MRI findings, including white matter abnormalities (WMA) as markers for motor coordination impairment at school age.

STUDY DESIGN: This was a prospective, longitudinal study of neonatal CUS and near-term conventional MRI among infants born 24-27+6/7 weeks' estimated gestational age (EGA) to predict outcomes in a subgroup of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT). Outcome measures at 6-7 years included Movement Assessment Battery for Children (MABC-2) to determine significant motor impairment (total test score <5th %ile). Logistic regression was used to evaluate associations with near-term neuroimaging, adjusting for perinatal-neonatal factors.

RESULTS: Total test score on MABC-2 was available for 320 children. Nearly 1 in 3 children had significant motor impairment, with rates increasing with decreasing EGA (24 weeks: 41%; 25 weeks: 41%; 26 weeks: 31%; 27 weeks: 21%). Higher rates of impairment were seen with adverse late CUS findings and increasing WMA severity, but importantly, high rates were also seen among those normal late CUS (29%) and without WMA on MRI (22%). Motor impairment was independently associated with adverse late CUS in the group overall (aOR 5.0, 95% CI 1.5-16.3) and with moderate-severe WMA among those without CP (aOR 2.3, 95%CI 1.1-4.9).

CONCLUSIONS: Although motor coordination impairment was associated with abnormal neonatal neuroimaging, there was a high prevalence among all EPT infants, whether with or without neuroimaging abnormalities. These findings indicate the need for consistent long-term follow-through and intervention.