Abstract
BackgroundThis study aims to determine the prognostic accuracy of term MRI in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes.MethodsWe performed a systematic review searching Central, Medline, Embase, and PsycInfo. Two independent reviewers performed study selection, data extraction, and quality assessment. We documented sensitivity and specificity for three different MRI findings (white matter abnormalities (WMA), brain abnormality (BA), and diffuse excessive high signal intensity (DEHSI)), related to developmental outcomes including cerebral palsy (CP), visual and/or hearing problems, motor, neurocognitive, and behavioral function. Using bivariate meta-analysis, we estimated pooled sensitivity and specificity and plotted summary receiver operating characteristic (sROC) curves for different cut-offs of MRI.ResultsWe included 20 papers published between 2000 and 2013. Quality of included studies varied. Pooled sensitivity and specificity values (95 % confidence interval (CI)) for prediction of CP combining the three different MRI findings (using normal/mild vs. moderate/severe cut-off) were 77 % (53 to 91 %) and 79 % (51 to 93 %), respectively. For prediction of motor function, the values were 72 % (52 to 86 %) and 62 % (29 to 87 %), respectively. Prognostic accuracy for visual and/or hearing problems, neurocognitive, and/or behavioral function was poor. sROC curves of the individual MRI findings showed that presence of WMA provided the best prognostic accuracy whereas DEHSI did not show any potential prognostic accuracy.ConclusionsThis study shows that presence of moderate/severe WMA on MRI around term equivalent age can predict CP and motor function in very preterm or low-birth-weight infants with moderate sensitivity and specificity. Its ability to predict other long-term outcomes such as neurocognitive and behavioral impairments is limited. Also, other white matter related tests as BA and DEHSI demonstrated limited prognostic value.Systematic review registrationPROSPERO CRD42013006362Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0058-7) contains supplementary material, which is available to authorized users.
Highlights
This study aims to determine the prognostic accuracy of term Magnetic resonance imaging (MRI) in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes
Our study aims to evaluate the following two questions: 1. What is the prognostic accuracy of white matter related abnormalities seen on term MRI for long-term developmental outcomes of infants born very preterm or with low birth weight? 2
The extracted data provided 54 2 × 2 tables for white matter abnormalities (WMA), brain abnormalities (BA), or diffuse excessive high signal intensity (DEHSI). These three MRI findings were used for the prediction of various developmental outcomes: cerebral palsy (CP), visual and/or hearing problems, motor, neurocognitive, and behavioral function, as well as a combination of problems in these domains defined as ‘neurodevelopmental impairment’ (NDI)
Summary
This study aims to determine the prognostic accuracy of term MRI in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes. The prognostic accuracy of white matter related MRI abnormalities for long-term developmental outcomes is debatable and its use as a standard of care is not yet recommended by the American Academy of Neurology Quality Standards [4]. The lack of knowledge about the prognostic accuracy of term MRI hampers an adequate interpretation of this test. This may invoke unwanted effects, as parents may worry unnecessarily about the possible abnormal development of their child [5, 6]. If term MRI can predict neurodevelopmental outcomes accurately, the use of this expensive diagnostic procedure as part of standard care could be justified as it may select high risk infants for prolonged and intensive supportive care
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