PP05.13 – 2693: Functional MRI score predicts neurodevelopmental outcome in infants with intraventricular hemorrhage

Abstract

Objective Intraventricular hemorrhage (IVH) is a significant cause of morbidity and mortality in premature infants. There is a well known correlation between IVH grade and outcome. However, only a few studies take into account the site of the lesion. The aim of the present study was to create a tool which could serve as a prognostic indicator with regard to the severity of brain damage and outcome by assessing the functional areas affected by the bleeding. Methods Infants with grade III IVH with and without parenchymal involvement who had MRI scans obtained and assessment of neurodevelopmental outcome were included into this analysis. MRIs were analyzed by the computation of a white matter (WMS), grey matter (GMS) and a combined MRI score (cS) which included the following functional areas and pathologies: WMS: Pyramidal tract, Corpus callosum, Radiatio optica and Crossroad. GMS: Gyrus precentralis and postcentralis, Hippocampus and Basal ganglia. cS was calculated by the sum of WMS and GMS. Further points were added in the presence of periventricular leukomalacia, hydrocephalus and for lesions in the Cerebellum. Neurodevelopmental outcome was evaluated at 1 and 2 years corrected age via Bayley Scales of Infant development and classified into 4 severity groups. Results Neonates with normal MDI and mild disability show significantly lower WMS, GMS and cS compared to infants with moderate/severe mental disability at 1 year corrected age. The same is true for PDI at 1 year corrected age for WMS, GMS and cS and 2 years corrected age for WMS and cS. Conclusion There is currently not much evidence with regard to the relevance of topography of injury when trying to predict outcome in preterm infants with IVH. The proposed score might serve as a prognostic tool with regard to the severity of brain damage and outcome in preterm infants with IVH. Intraventricular hemorrhage (IVH) is a significant cause of morbidity and mortality in premature infants. There is a well known correlation between IVH grade and outcome. However, only a few studies take into account the site of the lesion. The aim of the present study was to create a tool which could serve as a prognostic indicator with regard to the severity of brain damage and outcome by assessing the functional areas affected by the bleeding. Infants with grade III IVH with and without parenchymal involvement who had MRI scans obtained and assessment of neurodevelopmental outcome were included into this analysis. MRIs were analyzed by the computation of a white matter (WMS), grey matter (GMS) and a combined MRI score (cS) which included the following functional areas and pathologies: WMS: Pyramidal tract, Corpus callosum, Radiatio optica and Crossroad. GMS: Gyrus precentralis and postcentralis, Hippocampus and Basal ganglia. cS was calculated by the sum of WMS and GMS. Further points were added in the presence of periventricular leukomalacia, hydrocephalus and for lesions in the Cerebellum. Neurodevelopmental outcome was evaluated at 1 and 2 years corrected age via Bayley Scales of Infant development and classified into 4 severity groups. Neonates with normal MDI and mild disability show significantly lower WMS, GMS and cS compared to infants with moderate/severe mental disability at 1 year corrected age. The same is true for PDI at 1 year corrected age for WMS, GMS and cS and 2 years corrected age for WMS and cS. There is currently not much evidence with regard to the relevance of topography of injury when trying to predict outcome in preterm infants with IVH. The proposed score might serve as a prognostic tool with regard to the severity of brain damage and outcome in preterm infants with IVH.