Abstract
The role of enlarged subarachnoid space (ESS) in preterm infants has not been described in concrete. We aimed to evaluate whether ESS should be considered a risk factor potentially associated with adverse neurodevelopmental outcomes in prematurity. Electronic medical records of 197 preterm infants (median 32.1 weeks' gestation) including cranial ultrasound (cUS) images, head circumferences, and Korean Developmental Screening Tests for Infants and Children (K-DST) results at 18–24 months corrected age were reviewed. The clinical characteristics and K-DST results were compared in infants with and without ESS (sinocortical width > 3.5 mm). A multivariable logistic regression analysis was performed to identify potential risk factors associated with positive K-DST results. At a median corrected age of 39.0 weeks, 81/197 (41.1%) infants presented ESS. A significantly greater percent of infants in the ESS group screened positive on the K-DST than in the no ESS group (27.2% vs 12.1%, p = 0.007). Within the ESS group, micro-/macrocephaly at term-equivalent age was not different with regard to the K-DST results. From the multivariable logistic regression analysis, gestational age (p = 0.016, OR = 0.855, 95% CI = 0.753–0.971) and ESS (p = 0.019, OR = 1.310, 95% CI = 1.046–1.641) were two significant risk factors associated with positive K-DST results. ESS identified on cUS at term-equivalent age in preterm infants is associated with possible developmental delays. Macrocephaly at term-equivalent age does not guarantee a benign prognosis. Future studies are required to verify ESS as a potential marker for neurodevelopmental delay in preterm infants.
Highlights
The role of enlarged subarachnoid space (ESS) in preterm infants has not been described in concrete
Infants who died during neonatal intensive care unit (NICU) stay or after hospital discharge, who did not visit for neurodevelopmental assessment at 18–24 months corrected age at our hospital, or who had major congenital anomaly or chromosomal anomaly were excluded
ESS-group infants were born at a shorter gestational age (GA) (30.1 [27.9–33.4] vs 32.9 [30.5–34.4] weeks, p < 0.001) and a lower birthweight (1360 [1029–2033] vs 1800 [1256–2195] g, p = 0.003), with a significantly lower 1-minute Apgar score
Summary
The role of enlarged subarachnoid space (ESS) in preterm infants has not been described in concrete. From the multivariable logistic regression analysis, gestational age (p = 0.016, OR = 0.855, 95% CI = 0.753–0.971) and ESS (p = 0.019, OR = 1.310, 95% CI = 1.046–1.641) were two significant risk factors associated with positive K-DST results. White matter injuries on MRI at term-equivalent age in very preterm infants are reportedly associated with grey matter abnormalities (including reduction in cerebral cortical grey matter volume) and future neurological impairment. Periventricular echogenicity greater than that of the choroid plexus, or inhomogeneous flares, which is often considered a possible US finding of non-cystic PVL9,10, has presented inconsistent association with punctate or diffuse white matter injuries or decreased brain volumes on MRI at term-equivalent age or future adverse neurological outcomes. We aimed to evaluate whether ESS should be considered a risk factor potentially associated with adverse neurodevelopmental outcomes in prematurity
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