Abstract
ObjectiveMagnetic resonance imaging (MRI) of the brain carried out during the neonatal period shows that 55–80% of extremely preterm infants display white matter diffuse excessive high signal intensity (DEHSI). Our aim was to study differences in developmental outcome at the age of 6.5 years in children born extremely preterm with and without DEHSI.Study DesignThis was a prospective cohort study of 83 children who were born in Stockholm, Sweden, between 2004 and 2007, born at gestational age of < 27 weeks + 0 days and who underwent an MRI scan of their brain at term equivalent age. The outcome measures at 6.5 years included testing 66 children with the modified Touwen neurology examination, the Movement Assessment Battery for Children 2, the Wechsler Intelligence Scale for Children—Fourth Edition, Beery Visual-motor Integration test—Sixth Edition, and the Strengths and Difficulties Questionnaire. Group-wise comparisons were done between children with and without DEHSI using Student t-test, Mann Whitney U test, Chi square test and regression analysis.ResultsDEHSI was detected in 39 (59%) of the 66 children who were assessed at 6.5 years. The presence of DEHSI was not associated with mild neurological dysfunction, scores on M-ABC assessment, cognition, visual-motor integration, or behavior at 6.5 years.ConclusionThe presence of qualitatively defined DEHSI on neonatal MRI did not prove to be a useful predictor of long-term impairment in children born extremely preterm.
Highlights
Preterm children are born during a vulnerable stage of brain development and injuries are common, especially in the white matter [1, 2]
The presence of Diffuse excessive high signal intensity (DEHSI) was not associated with mild neurological dysfunction, scores on MABC assessment, cognition, visual-motor integration, or behavior at 6.5 years
The incidence of focal periventricular lesions has decreased, non-focal white matter abnormalities are seen in a high proportion of preterm infants using conventional structural magnetic resonance imaging (MRI) scans [1]
Summary
Preterm children (born before 28 weeks of gestation) are born during a vulnerable stage of brain development and injuries are common, especially in the white matter [1, 2]. Diffuse excessive high signal intensity (DEHSI) is defined as increased signal intensity in the periventricular and subcortical white matter on T2-weighted MRI around term equivalent age [3] and it has been reported that this is present in up to 55–80% of extremely preterm infants [4, 5]. It can either be seen in isolation or together with other white matter changes, such as reduced volume, cystic lesions, and delayed myelination, and it has been suggested that DEHSI reflects diffuse white matter injury [3, 5, 6]. Our aim was to investigate whether DEHSI was related to neurodevelopmental outcome at 6.5 years of age in children born extremely preterm
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