Total Maturation Score Research Articles

Amplitude-integrated electroencephalography showed alterations in cerebral activity in monochorionic twins with twin-to-twin transfusion syndrome.

Monochorionic twins are at higher risk of perinatal mortality and morbidity, primarily due to pregnancy-related complications, such as twin-to-twin transfusion syndrome (TTTS). We aimed to investigate whether amplitude-integrated electroencephalography (aEEG) signals are different between monochorionic twins with and without TTTS. This was a retrospective single-centre study conducted at Innsbruck Medical University Hospital, Austria. Preterm infants born before 32 weeks of gestation between 6 November 2010 and 6 December 2022 were eligible. The aEEG was analysed for the total maturation score, its component scores and the number of sleep-wake cycles per hour. We enrolled 79 monochorionic twin infants (48% male) and 157 dichorionic (62% male) twin infants. We found no differences between these two groups of preterm infants regarding the total maturation and component scores, or the number of sleep wake cycles. Monochorionic twins with TTTS showed significantly lower total maturation scores and individual component scores compared to monochorionic twins without TTTS. Preterm infants with TTTS showed differences in neonatal aEEG signals. Whether these differences are caused by prematurity-related or TTTS-related factors, such as hemodynamic and metabolic changes due to placental anastomoses, should be investigated in future prospective studies, to gain more insight into this important topic.

Evaluation of Information Technology Governance Maturity Using COBIT 2019: A Case Study on the IT Security Industry

This study aims to evaluate the maturity of IT governance in the IT security industry using COBIT 2019. The assessment covered 13 COBIT 2019 domains, namely APO03—Managed Enterprise Architecture, APO07—Managed Human Resources, APO12—Managed Risk, APO13—Managed Security, APO14—Managed Data, BAI02—Managed Requirements Definition, BAI03—Managed Solutions Identification & Build, BAI05—Managed Organizational Change, BAI06—Managed IT Changes, BAI07—Managed IT Change Acceptance and Transitioning, BAI09—Managed Assets, BAI10—Managed Configuration, and BAI11—Managed Projects. The research methodology included observation, domain-based question formulation, RACI interviews, data collection, and question validation testing, with maturity calculation performed using appropriate formulas. Results indicate that most domains are at Level 2 (Managed), with significant contributions to maturity at Levels 3 and 4. Significant gaps were found between the current state and the desired maturity targets for many domains, such as APO03 and BAI03. The percentage contribution from Level 2 is the highest, while contributions from Levels 3 and 4 vary, with very low contributions from Level 5. The total maturity score is 2.49, with percentage contributions from Levels 2, 3, 4, and 5 being 74%, 26%, 11%, and 3%, respectively. Recommendations include improving processes to achieve Levels 3 and 4 across more domains and investing in training and development for relevant teams.

Amplitude-integrated electroencephalography showed no differences in cerebral activity between preterm singletons and twins in the first 4 weeks of life.

Genetic influences on cerebral activity have been described previously, but data are scarce in preterms. We aimed to investigate whether a genetic influence causes amplitude-integrated electroencephalography (aEEG) signals to differ between singletons and twin preterm newborns. This was a retrospective single-centre study conducted at Innsbruck Medical University Hospital, Austria. Preterm infants born before 32 weeks of gestation between 6 November 2010 and 6 December 2022 were eligible for the study. The aEEG was analysed for the total maturation score, its component scores and the number of sleep-wake cycles per hour. We enrolled 240 preterm twin infants (57.5% male) with a mean gestational age of 30 (range: 24-32) weeks and a mean birth weight of 1324 (range: 600-2116) grams. We compared 240 singleton matched preterms. No differences were found between preterm singletons and twin preterm infants regarding the total maturation and component scores, or the number of sleep-wake cycles. aEEG showed no difference between monozygotic and dizygotic twins. Compared to singletons, twin infants born preterm showed no differences in aEEG signals in the first 4 weeks of life. Future studies should include more complex non-invasive functional neuroimaging methods to gain more insight into this important topic.

Early Brain Activity in Very Preterm Infants of Mothers with Gestational Diabetes Mellitus: A Pilot Study

Introduction: Neurological consequences of preterm infants born to mothers with gestational diabetes mellitus (GDM) are unclear. In this pilot study, we investigated the effect of GDM on brain activity in very preterm infants. Methods: Preterm infants <32 gestational weeks of mothers with GDM compared to gestational age- and sex-matched controls born between 2011 and 2018 were included. Amplitude-integrated electroencephalography (aEEG) was assessed for total maturation and individual component scores according to Burdjalov and colleagues, the dominating visual background, and the presence of sleep-wake cycles per hour in the first 72 h of life and weekly at days 7, 14, 21, and 28. Results: We included 47 infants of mothers with GDM and 94 control infants. Both the aEEG total maturation score and its individual component scores, as well as the percentage of continuous background pattern, increased equally during the first 4 weeks after birth in both groups. GDM-exposed infants showed a slightly but significantly higher number of sleep-wake cycles per hour. Conclusion: We found normal maturation of brain activity in the first 4 weeks after birth in very preterm infants born to mothers with GDM, not differing from a very preterm control group. The higher number of sleep-wake cycles per hour in GDM-exposed infants could indicate transiently enhanced maturation. Further studies on brain activity and brain development in very preterm infants of mothers with GDM are needed to validate our results.

Neurodevelopmental Outcome at 3 Years of Age in Very Low Birth Weight Infants According to Brain Development and Lesions.

During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses. The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants. VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored. Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome. We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.

Relationship between Brain Function and Microstructural Brain Maturation in Preterm Infants

Introduction: Preterm infants are at risk for impairment in brain maturation at term equivalent age (TEA). Diffusion tensor imaging (DTI) is a powerful magnetic resonance imaging (MRI) technique, quantitatively reflecting microstructural brain development of white matter regions with parameters such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Amplitude-integrated electroencephalography (aEEG) assesses electrocortical activity and brain function. Methods: Aim of this study was to investigate a possible correlation between functional and microstructural brain maturation using neonatal aEEG and DTI-MRI at TEA. The study was conducted as a retrospective single-center study in 446 infants born below 32 gestational weeks. Spearman rank’s correlation coefficients were calculated between aEEG (total maturation score) and FA/ADC value. To compare aEEG and DTI-MRI to neurodevelopmental outcome at 24 months of corrected age, we performed a multivariate linear regression analysis. Results: Analysis showed an all-time significant correlation between total maturation score and FA/ADC values of the corpus callosum at TEA with the strongest correlation at day 2, day 3, week 3, and week 4. After including perinatal variables in the model, this correlation remained highly significant at day 2 and 3. When comparing the association of aEEG and DTI-MRI to outcome, both the total maturation score at day 2, day 3, and FA/ADC of the splenium of the corpus callosum showed a significant correlation. Conclusion: This study indicates that early monitoring of functional brain maturation may predict later assessment of microstructural brain development of corpus callosum in preterm infants with a relation to neurodevelopmental outcome.

Association of aEEG and brain injury severity on MRI at term-equivalent age in preterm infants.

Measures to detect and monitor brain injury in preterm infants are amplitude-integrated electroencephalography (aEEG) and magnetic resonance imaging (MRI). To investigate the association between aEEG and MRI in a large cohort of preterm infants. Five hundred and twenty-three preterm infants were included in the study. AEEG was interpreted for the total maturation score (TMS) according to Burdjalov. Cerebral MRI was evaluated using a validated scoring system by Kidokoro. One hundred and forty-six infants (27.9%) showed some form of brain injury, with 111 infants (21.2%) showing mild injury and 35 (6.7%) showing severe injury. TMS were significantly higher in infants without injury compared to severe injury. When comparing infants with isolated intraventricular haemorrhage to infants without brain injury, TMS were significantly lower. Prediction of adverse outcome is an important aspect of neonatal care. The combination of diagnostic measures evaluating brain injury might enhance our abilities in neonatal care to provide accurate information about later outcome. Early aEEG is predictive for the severity of brain injury detected by MRI at term-equivalent age. Whether aEEG is also predictive for neurodevelopmental outcome needs to be further investigated in relation to the various patterns of preterm brain injury.

Prenatal Brain Maturation is Delayed in Neonates with Congenital Diaphragmatic Hernia

To assess brain development in fetuses with congenital diaphragmatic hernia (CDH) using a fetal Total Maturation Score (fTMS). This is a retrospective cohort study using data from a single-center, clinical registry. Neonates with an antenatal diagnosis of CDH between 2014 - 2020 and prenatal brain magnetic resonance imaging (n = 48) were included. We compared our study sample with historical healthy controls (n = 48). The relationship between fTMS and gestational age, as well as the association between fTMS and key prenatal variables and placental pathologic findings, were evaluated. Compared with healthy controls, neonates with CDH had a significant delay in fTMS (p-value <0.001). Within the CDH cohort, there was no significant difference in fTMS based on CDH severity, intrathoracic liver position, right versus left CDH, sex, presence of abnormal echocardiogram findings, treatment with extracorporeal membrane oxygenation, or in-hospital mortality. Placentas of neonates with CDH had a high proportion of fetal vascular malperfusion (56%) and chronic inflammation (67%), and relatively large placentas had a protective effect on prenatal brain maturation (p-value = 0.025). Prenatal brain maturation in neonates with CDH is delayed. Placental pathology may influence fetal brain development. The etiology and clinical impact of prenatal brain immaturity in neonates with CDH warrant further investigation.

Impaired Maternal-Fetal Environment and Risk for Preoperative Focal White Matter Injury in Neonates With Complex Congenital Heart Disease.

Background Infants with congenital heart disease (CHD) are at risk for white matter injury (WMI) before neonatal heart surgery. Better knowledge of the causes of preoperative WMI may provide insights into interventions that improve neurodevelopmental outcomes in these patients. Methods and Results A prospective single-center study of preoperative WMI in neonates with CHD recorded data on primary cardiac diagnosis, maternal-fetal environment (MFE), delivery type, subject anthropometrics, and preoperative care. Total maturation score and WMI were assessed, and stepwise logistic regression modeling selected risk factors for WMI. Among subjects with severe CHD (n=183) who received a preoperative brain magnetic resonance imaging, WMI occurred in 40 (21.9%) patients. WMI prevalence (21.4%-22.1%) and mean volumes (119.7-160.4 mm3) were similar across CHD diagnoses. Stepwise logistic regression selected impaired MFE (odds ratio [OR], 2.85 [95% CI, 1.29-6.30]), male sex (OR, 2.27 [95% CI, 1.03-5.36]), and older age at surgery/magnetic resonance imaging (OR, 1.20 per day [95% CI, 1.03-1.41]) as risk factors for preoperative WMI and higher total maturation score values (OR, 0.65 per unit increase [95% CI, 0.43-0.95]) as protective. A quarter (24.6%; n=45) of subjects had ≥1 components of impaired MFE (gestational diabetes [n=12; 6.6%], gestational hypertension [n=11; 6.0%], preeclampsia [n=2; 1.1%], tobacco use [n=9; 4.9%], hypothyroidism [n=6; 3.3%], and other [n=16; 8.7%]). In a subset of 138 subjects, an exploratory analysis of additional MFE-related factors disclosed other potential risk factors for WMI. Conclusions This study is the first to identify impaired MFE as an important risk factor for preoperative WMI. Vulnerability to preoperative WMI was shared across CHD diagnoses.

Correlation between clinical features and total maturation score by magnetic resonance imaging in very low birth weight premature infants with brain injury.

Brain injury in premature infants (BIPI) seriously affects the growth and development of preterm infants. Magnetic resonance imaging (MRI) has become an important method of assessing brain development. The aim of this study was to explore the correlation between clinical features and total maturation score (TMS) by MRI in very low birth weight (VLBW) preterm infants with brain injury at term postmenstrual age (PMA). A retrospective cohort of 65 cases of BIPI with VLBW and 40 normal control cases were included, and all cases underwent MRI examination. The 2 groups were assessed in terms of TMS and sub-parameters (myelination, cortical infolding, germinal matrix, bands of migrating glial cells), and the correlation between TMS and term PMA was also analyzed. The TMS of the BIPI group was lower than that of the control group (P<0.01). The differences in myelination and cortical infolding were statistically significant (P<0.01). No significant differences in the germinal matrix and bands of migrating glial cells were found. The linear regression equation showing a positive correlation between TMS and term PMA in normal preterm infants was y=1.164x-28.888 (t=9.478, P=0.000). TMS by conventional cranial MRI can objectively reflect the brain maturity and brain damage of premature infants, and is related to the term PMA.

Demirjian's Eight Teeth Method for Dental age Estimation in Nepalese Population.

Demirjian's method is widely used method for dental age estimation. This study was conducted with objectives of applying Demirjian's 8 teeth method to estimate age in Nepalese Population and to determine Nepal-specific formulas. We had used the Orthopantomographs of Nepalese people of age above five and below 23 years. The radiographs were compared to the 'Tooth Development Chart' and each tooth studied was assigned with any one of the 10 developmental stages using Demirijian's 8 teeth method and total maturity scores determined. Formulas were derived using regression analysis, wherein the total maturity score obtained for each individual was considered as the independent variable and the corresponding age as the dependent variable in the STATA 15.1 statistical program. There was underestimation of age in both the sexes by the original method. Regression equations were derived for males and females separately for age five to 18 years and again after adding cases up to 23 years. The estimation was better for males up to 18 years [R2=0.94, Mean Absolute Error (MAE) 0.747 years and SD 0.644] than for females up to 18 years (R2 = 0.89, MAE 0.886 years and SD 0.925). The estimation was better for up to 18 years than for up to 23 years in both sexes. Demirijian's 8 teeth method underestimated age in the study population and thus population specific equations based on the method are better for dental age estimation. The age estimation utilizing the equations from Nepalese population has given acceptable results.

Neuroimaging and neurodevelopmental outcome after early fetal growth restriction: NEUROPROJECT-FGR.

Adverse neurodevelopmental outcomes and MRI alterations are reported in infants born after fetal growth restriction (FGR). This study evaluates the additional role of FGR over prematurity in determining brain impairment. Retrospective observational study comparing 48 FGR and 36 appropriate for gestational age infants born between 26 and 32 weeks' gestation who underwent a cerebral MRI at term equivalent age. Exclusion criteria were twins, congenital anomalies, and findings of overt brain lesions. Main outcomes were total maturation score (TMS) and cerebral areas independently measured by two neuro-radiologists and Griffiths or Bayley scale III scores at median age of 2 years. TMS was not significantly different between the groups. Inner calvarium and parenchyma's areas were significantly smaller in FGR cases. There were no significant differences in the average quotient scores. A positive correlation between parenchyma area and cognitive score was found (r = 0.372, p = 0.0078) and confirmed after adjusting for sex, gestational age, and birth weight (p = 0.0014). Among FGR, the subgroup with umbilical arterial Doppler velocimetry alterations had significantly worse gross motor scores (p = 0.005). FGR plays additional role over prematurity in determining brain impairment. An early structural dimensional MRI evaluation may identify infants who are at higher risk. Fetal growth-restricted infants showed smaller cerebral parenchymal areas than preterm controls. There is a positive correlation between the parenchyma area and the cognitive score. These results highlight the already known link between structure and function and add importance to the role of a structural dimensional MRI evaluation even in the absence of overt brain lesions.

Postoperative Improvement of Brain Maturation in Infants With Congenital Heart Disease

Children with severe congenital heart disease are at risk for neurodevelopmental impairments. We examined brain maturation in infants undergoing neonatal cardiopulmonary bypass surgery or hybrid procedure for hypoplastic left heart syndrome compared to controls. This is a prospective cohort study on term-born infants with congenital heart disease with cerebral MRI pre- and postoperatively. Healthy infants served as controls. Brain maturation was measured using a semiquantitative scoring system. The progress of brain maturation from the preoperative to postoperative MRI within patients was compared. Neurodevelopment was assessed at 1 year with the Bayley Scales of Infant and Toddler Development III. A total of 92 patients with congenital heart disease and 46 controls were studied. Median total maturation score in patients was 12 (interquartile range 10.6-13.0) preoperatively and 14 (12.0-15.0) postoperatively, in controls it was 14 (13.0-15.0). Median time interval between scans was 19 days (interquartile range 14-26). After correction for postmenstrual age at MRI, the pre- and postoperative maturation score was lower in patients compared to controls (preoperative P = 0.01, postoperative P = 0.03) and increased between pre- and postoperative assessment (P ≤ 0.001). Brain maturation scores did not correlate with neurodevelopmental outcome at 1 year, when corrected for socioeconomic status and postmenstrual age at MRI. This study confirms delayed brain maturation in children with congenital heart disease, and despite neonatal cardiac bypass surgery followed by postoperative intensive care medicine brain maturation is ongoing. We encourage further investigation in outcome prediction in this population, potentially by combining more advanced MRI measures with clinical methods.

Accuracy of Chaillet and Demirjian’s 8-teeth method in dental age estimation of Central Indian population using India specific regression formulae

Demirjian’s original method for forensic dental age estimation has undergone various modifications over the years, owing to the wide discrepancies in age estimates when applied on different population samples. Specific regression formulae were derived upon testing the revised method proposed by Chaillet and Demirjian on an Indian population. The objective of this study was to apply these formulae on a Central Indian sample of 400 healthy subjects, aged between 7–25 years and assess the ability of these formulae to predict age accurately. The study sample consisted of orthopantomograms of 400 subjects, categorized into four groups: Group A (7–16-year-old males), Group B (17–25-year-old males), Group C (7–16-year-old females) and Group D (17–25-year-old females). Based on the radiographic developmental stage of each tooth in the mandibular left quadrant, their respective maturity scores were allotted and a total maturity score for all the 8 teeth was determined for each subject. This value was then substituted in the India specific regression formulae, separately for males and females, to estimate the dental age. Difference between the chronological age and estimated age was then calculated.The mean absolute error for the entire sample was 0.5 years. The mean absolute error ranged between 0.7 ± 2.05 years for males and 0.4 ± 1.86 years for female subjects, implying greater accuracy in females. Further, 78.5 % of the sample showed negligible error of less than ±1 year. In case of male subjects aged between 7–16 years, least mean absolute error of 0.34 years was obtained. Higher error rates in Group B (17–25-year-old males) and Group D (17–25-year-old females) indicated reduced tendency for accurate age prediction in subjects beyond 16 years of age. The results derived in this study, showed improved accuracy of India specific regression formulae in predicting the dental age of the population of central India.

Association of Isolated Congenital Heart Disease with Fetal Brain Maturation.

Brain MRI of newborns with congenital heart disease show signs of immaturity relative to healthy controls. Our aim was to determine whether the semiquantitative fetal total maturation score can detect abnormalities in brain maturation in fetuses with congenital heart disease in the second and third trimesters. We analyzed data from a prospective study of fetuses with and without congenital heart disease who underwent fetal MR imaging at 25-35 weeks' gestation. Two independent neuroradiologists blinded to the clinical data reviewed and scored all images using the fetal total maturation score. Interrater reliability was evaluated by the intraclass correlation coefficient using the individual reader scores, which were also used to calculate an average score for each subject. Comparisons of the average and individual reader scores between affected and control fetuses and relationships with clinical variables were evaluated using multivariable linear regression. Data from 69 subjects (48 cardiac, 21 controls) were included. High concordance was observed between readers with an intraclass correlation coefficient of 0.98 (95% CI, 0.97-0.99). The affected group had significantly lower fetal total maturation scores than the control group (β-estimate, -0.9 [95% CI, -1.5 to -0.4], P = .002), adjusting for gestational age and sex. Averaged fetal total maturation, germinal matrix, myelination, and superior temporal sulcus scores were significantly delayed in fetuses with congenital heart disease versus controls (P < .05 for each). The fetal total maturation score was not significantly associated with any cardiac, anatomic, or physiologic variables. The fetal total maturation score is sensitive to differences in brain maturation between fetuses with isolated congenital heart disease and healthy controls.

Evaluation parameters of graft maturation on second-look arthroscopy following anterior cruciate ligament reconstruction: a systematic review

PurposeThe purpose of this systematic review was to investigate and summarize the evaluation methods of graft maturation on second-look arthroscopy following anterior cruciate ligament (ACL) reconstruction.MethodsA literature search was performed on articles before December 2017 to identify the literature that has evaluated graft maturation on second-look arthroscopy following ACL reconstruction. Only studies using human grafts, evaluating graft maturation with two or more gross findings were included. Study design, grafts, surgical techniques, follow-up period, evaluation parameters, and categories were compiled.ResultsTwenty-eight studies were included in this study. All studies evaluated graft maturation with two or more of the following three findings: graft integrity, tension, and synovial coverage. Two to four categories were used for evaluating each parameter, but the criteria for classification were slightly different for each study. Several studies reported neo-vascularization of grafts and the total maturation score by summing up the scores assigned to each evaluation parameter. Three studies reported that there was no correlation between second-look findings and patient-reported outcomes.ConclusionsGraft integrity, tension, and synovial coverage were the most frequently evaluated for graft maturation on second-look arthroscopy. However, there is no uniform criterion for evaluation. Therefore, development of a valid, uinform criterion is required.Level of evidenceLevel IV, systematic review of level I–IV investigations.

Hemodynamic and Metabolic Assessment of Neonates With Punctate White Matter Lesions Using Phase-Contrast MRI and T2-Relaxation-Under-Spin-Tagging (TRUST) MRI.

The brain's hemodynamic and metabolism of punctate white matter lesions (PWML) is poorly understood due to a scarcity of non-invasive imaging techniques. The aim of this study was to apply new MRI techniques to quantify cerebral metabolic rate of oxygen (CMRO2), global cerebral blood flow (CBF), oxygen saturation fractions in venous blood (Yv) and oxygen extraction fraction (OEF) in neonates with PWML, for better understanding of the pathophysiology of PWML. Fifty-one newborns were recruited continuously, including 23 neonatal patients with PWML and 28 normal control neonates. Phase-contrast (PC) MRI and T2-Relaxation-Under-Spin-Tagging (TRUST) MRI were performed for the measurement of CBF and Yv. OEF and CMRO2 were calculated from the CBF and Yv values. The total maturation score (TMS) was assessed for each neonate on standard T1, 2-weighted images to evaluate cerebral maturation. The CMRO2, CBF, Yv, and OEF values were compared between groups, and their associations with age and TMS were evaluated. Significant differences between PWML group and control group were found in CMRO2 (P = 0.020), CBF (P = 0.027), Yv (P = 0.012), OEF (P = 0.018). After age/maturation is accounted for, Yv and OEF showed significant dependence on the groups (P < 0.05). Newborns with PWML had lower OEF and higher Yv. CMRO2, CBF and brain volume were correlated with age (P < 0.001) and TMS (P < 0.05). It is feasible to use non-invasive MRI methods to measure cerebral oxygen supply and consumption in neonates with PWML. Newborns with PWML have lower oxygen consumption. Yv and OEF may be helpful for the diagnosis of PWML. The positive correlation between CBF and TMS, and between CMRO2 and TMS suggested that as myelination progresses, the blood supply and oxygen metabolism in the brain increase to meet the escalating energy demand.

Semi-quantitative assessment of brain maturation by conventional magnetic resonance imaging in neonates with clinically mild hypoxic-ischemic encephalopathy.

Background:Mild hypoxic-ischemic encephalopathy (HIE) injury is becoming the major type in neonatal brain diseases. The aim of this study was to assess brain maturation in mild HIE neonatal brains using total maturation score (TMS) based on conventional magnetic resonance imaging (MRI).Methods:Totally, 45 neonates with clinically mild HIE and 45 matched control neonates were enrolled. Gestated age, birth weight, age after birth and postmenstrual age at magnetic resonance (MR) scan were homogenous in the two groups. According to MR findings, mild HIE neonates were divided into three subgroups: Pattern I, neonates with normal MR appearance; Pattern II, preterm neonates with abnormal MR appearance; Pattern III, full-term neonates with abnormal MR appearance. TMS and its parameters, progressive myelination (M), cortical infolding (C), involution of germinal matrix tissue (G), and glial cell migration bands (B), were employed to assess brain maturation and compare difference between HIE and control groups.Results:The mean of TMS was significantly lower in mild HIE group than it in the control group (mean ± standard deviation [SD] 11.62 ± 1.53 vs. 12.36 ± 1.26, P < 0.001). In four parameters of TMS scores, the M and C scores were significantly lower in mild HIE group. Of the three patterns of mild HIE, Pattern I (10 cases) showed no significant difference of TMS compared with control neonates, while Pattern II (22 cases), III (13 cases) all had significantly decreased TMS than control neonates (mean ± SD 10.56 ± 0.93 vs. 11.48 ± 0.55, P < 0.05; 12.59 ± 1.28 vs. 13.25 ± 1.29, P < 0.05). It was M, C, and GM scores that significantly decreased in Pattern II, while for Pattern III, only C score significantly decreased.Conclusions:The TMS system, based on conventional MRI, is an effective method to detect delayed brain maturation in clinically mild HIE. The conventional MRI can reveal the different retardations in subtle structures and development processes among the different patterns of mild HIE.

Bronchopulmonary Dysplasia Is Associated with Delayed Structural Brain Maturation in Preterm Infants

Background: In recent years, cerebral magnetic resonance imaging (MRI) has been increasingly used to depict the wide spectrum of preterm brain injury. Furthermore, it has already been demonstrated by MRI at term-equivalent age (TEA) that preterm infants show delayed brain maturation as compared to term infants, and this delay has been related to neurobehavioral outcome. Objectives: The aim of the current study was to investigate the influence of prevalent neonatal risk factors for adverse outcome on structural brain maturation in very preterm infants at TEA. Methods: One hundred and thirty very preterm infants born at a mean gestational age of 29.7 weeks were included. MRI was performed at TEA and given a validated ‘total maturation score'. Brain maturation scores were compared with neonatal data. Results: In univariate analysis, bronchopulmonary dysplasia (BPD), late-onset sepsis and retinopathy of prematurity were significantly associated with delayed brain maturation. Furthermore, infants with delayed maturation had been ventilated significantly longer and more often suffered from severe arterial hypotension. In multivariate analysis, BPD remained significant as predictor of delayed brain maturation. Conclusions: This study is the first to show that delayed structural brain maturation as evaluated by MRI at TEA is preceded by BPD, which is known to be a predictor of adverse outcome in preterm infants. This finding adds further evidence to show that adverse outcome in preterm infants may have additional neural correlates that exceed common brain injury.

PO-0430 Bronchopulmonary Dysplasia Is Associated With Delayed Structural Brain Maturation In Preterm Infants

Background and aims Cerebral MRI is increasingly used to depict the wide spectrum of preterm brain injury. Furthermore MRI also illustrates postnatal brain development in preterm infants. It has been shown by MRI at term-equivalent age (TEA) that preterm infants show a delayed brain maturation as compared to term infants and this delay has been related to neurobehavioral outcome. The aim of the present study was to investigate the influence of prevalent neonatal morbidities on structural cerebral brain maturation in a cohort of preterm infants born at a GA ≤32 completed weeks. Methods 130 very preterm infants born at a mean gestational age of 29.7 ± 2.1 weeks and a mean birthweight of 1265 ± 405 grams were included. Brain MRI was performed at a mean postmenstrual age of 40.7 weeks (range 39–43). Structural brain development was evaluated by a validated “total maturation score”. Brain maturation was correlated to neonatal data. Results In univariate analysis bronchopulmonary dysplasia (BPD) and late-onset sepsis were significantly associated with delayed brain maturation. In multivariate analysis BPD remained significant for delayed maturation, with the diagnosis BPD carrying a fourfold risk for delay. Conclusions This study is the first to show that delayed structural brain maturation in preterm infants at TEA is preceded by BPD , which is a known predictor of adverse outcome. This finding adds further evidence that the neural correlates of adverse outcome go beyond mere brain “injury”.