Abstract
MRI of preterm infants at term commonly reveals subtle brain lesions such as diffuse white matter injury, which are linked with later cognitive impairments. The timing and mechanism of such injury remains unclear. The reduced scattering coefficient of near-infrared light (μs’) has been shown to correlate linearly with gestational age in neonates. To identify clinical variables associated with brain μs’, 60 preterm and full-term infants were studied within 7 days of birth. Dependence of μs’ obtained from the frontal head on clinical variables was assessed. In the univariate analysis, smaller μs’ was associated with antenatal glucocorticoid, emergency Caesarean section, requirement for mechanical ventilation, smaller gestational age, smaller body sizes, low 1- and 5-minute Apgar scores, higher cord blood pH and PO2, and higher blood HCO3− at the time of study. Multivariate analysis revealed that smaller gestational age, requirement for mechanical ventilation, and higher HCO3− at the time of study were correlated with smaller μs’. Brain μs’ depended on variables associated with physiological maturation and pathological conditions of the brain. Further longitudinal studies may help identify pathological events and clinical conditions responsible for subtle brain injury and subsequent cognitive impairments following preterm birth.
Highlights
MRI of preterm infants at term commonly reveals subtle brain lesions such as diffuse white matter injury, which are linked with later cognitive impairments
Our data demonstrated that the property of light scattering within the newborn brain depends on both intrinsic and extrinsic factors, such as antenatal glucocorticoid, gestational age, body size, emergency delivery, Apgar scores, requirement for mechanical ventilation, and blood gas data at birth and at the time of study
Considering that these variables are associated with physiological maturation and pathological conditions, low μs’ might reflect maturation of and damage to the brain tissue, and that serial μs’ measurements at cot-side may help identify clinical conditions and events associated with the subtle brain injury and later cognitive impairments in preterm infants
Summary
MRI of preterm infants at term commonly reveals subtle brain lesions such as diffuse white matter injury, which are linked with later cognitive impairments. White matter injury in preterm infants was associated with cognitive and motor developmental quotients at 2 years old, even when findings were corrected for overt cerebral lesions detected by cranial ultrasound[7] This suggests that subtle brain lesions visible on term MRI may be responsible for later cognitive impairments. Ijichi and colleagues reported that, in newborn infants between 30 and 42 weeks gestation, brain μs’ obtained shortly after birth was linearly correlated with the gestational age[14] It remains unclear whether (i) μs’ reflects the maturation of the brain even when extremely preterm infants of younger than 28 weeks are included, and (ii) μs’ is associated with micro-structural brain tissue changes following extrinsic clinical events, such as drug administration and hypoxic-ischaemic stress
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