Transcerebellar Diameter Research Articles

VP34.27: Qualitative assessment of the feasibility and acceptability of a low‐cost device for gestational age assessment in a low‐resource setting

The transcerebellar (TraCer) tool is a low-cost wireless probe linked to a commercially available tablet computer, with an artificial intelligence based software interface created to assess the fetal head circumference and transcerebellar diameter and provide a gestational age (GA). In this study we evaluate the acceptability, feasibility and the role of the TraCer tool in a low-resource setting. The study was set in two health facilities in rural and peri-urban coastal Kenya. Prior to data collection, study participants were shown a video role-play on the use of TraCer at a typical antenatal care visit. Qualitative data were collected from pregnant women and their families through six focus group discussions (n = 52) and from 18 interviews with health care workers and managers. We applied thematic analysis using an a priori framework. Women and their family members felt that the tool would fit easily into usual antenatal care and that it would be of value particularly in women uncertain of their last menstrual period (LMP). However, there was a tendency for women to perceive the tool as providing a reassurance of fetal well-being rather than GA assessment. Nurses / midwives felt the tool could be easily implemented and would boost their confidence and positive image in the community. Health care managers viewed it as implementable but did express concern regarding increased workload with limited staff. There were suggestions to reserve its use for women with uncertain or unknown LMP only. Unanimously, nurses were deemed the most appropriate cadre to use the tool. The need for appropriate training of providers was emphasised. The use of TraCer was perceived to be acceptable and feasible in coastal Kenya. This work informs the development of a simple training program and key patient communication messages to guide implementation. These are prerequisites for wider scale clinical testing.

Estimation of Gestational Age in Third Trimester of Pregnancy by Fetal Transcerebellar Diameter and its Accuracy Article type: original article

Objective: estimation of accurate gestational age correctly remains a crucial step in the antenatal care provided to all pregnant women. Our aim was to find out if transcerebellar diameter (TCD) could aid precisely in detecting accurate gestational age using ultrasound. Patients and methods: One hundred and three healthy women with singleton pregnancy were included. Pregnancies complicated with fetal anomalies, intrauterine growth restriction or death were exclud- ed. Eligible participants were examined extensively by ultrasound to confirm the gestational age using TCD, biparietal diameter (BPD) and femur length (FL). Then, data were collected and statistically analyzed comparing the three measurements. Results: TCD was accurate within in 88.3% of the cases, while FL was accurate in 65% of the cases and BPD was accurate 51.5%. Bland-Altman comparison of actual GA and GA estimated by TCD, FL and BPD showed narrow limits of agreement indicated low bias and better test with TCD, thus GA estimated by TCD was the best .There was good correlation between actual GA and GA estimated by TCD (r=0.989**, p < 0.001). Conclusion: TCD is the highest statistically significant measure- ment which could be used in the third trimester for assessing the ges- tational age compared with FL and BPD without any effect of parity, gestational age or fetal presentation on its accuracy.

Lithium exposure during pregnancy increases fetal growth.

Background:Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder, but there is a lack of knowledge about the potential adverse impact on fetal development.Aims:To investigate the impact of lithium exposure on early fetal growth.Methods:In this retrospective observational cohort study, we included all singleton pregnancies of women using lithium and referred for advanced fetal ultrasound scanning between 1994 and 2018 to the University Medical Centers in Leiden and Rotterdam, the Netherlands (n=119). The Generation R study, a population-based cohort, served as a non-exposed control population from the same geographic region (n=8184). Fetal head circumference, abdominal circumference, femur length, and transcerebellar diameter were measured by ultrasound at 18–22 weeks of gestation.Results:Lithium use during pregnancy was associated with an average increase in head circumference of 1.77 mm (95% confidence interval: 0.53, 3.01), in abdominal circumference of 5.54 mm (95% confidence interval: 3.95, 7.12) and in femur length of 0.59 mm (95% confidence interval: 0.22, 0.96) at 18–22 weeks gestation. Furthermore, lithium use during pregnancy was associated with an average increase in birth weight of 142.43 grams (95% confidence interval: 58.01, 226.89), whereas it was associated with an average decrease of 1.41 weeks in gestational duration (95% confidence interval: −1.78, −1.05).Conclusions:Lithium use during pregnancy was associated with increased fetal growth parameters at 18–22 weeks gestational age and increased birth weight. Further research is needed to evaluate both short- and long-term implications, as well as the mechanisms driving this difference in growth.

TO COMPARE ESTIMATION OF GESTATIONAL AGE BY FOETAL TRANSCEREBELLAR DIAMETER WITH BIPARIETAL DIAMETER`, FEMUR LENGTH, ABDOMINAL CIRCUMFERENCE, HEAD CIRCUMFERENCE AT DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY AT SMS MEDICAL COLLEGE, JAIPUR

Background: Ultrasonographic assessment of gestational age by using different foetal parameter such as BPD, FL, AC are highly reliable in first and second trimester in pregnancy. In third trimester reliability of any single parameter has limitations.&#x0D; Methods: This was a hospital based comparative cross-sectional study done in the Department of Obstetrics and Gynaecology, S.M.S. Medical College and attached hospitals, Jaipur, Rajasthan. The period of study was from June 2018 to October 2019.&#x0D; Results: The mean TCD at 15 weeks and 40 weeks was 15.00 ± 0.00mm and 53.33±1.155mm respectively. The mean BPD at 16 weeks and 40 weeks was 33.50±0.70mm and 93±1.528mm respectively. The mean HC at 15 weeks and 40 weeks was 111.00±1,41mm and 340±2.00mm respectively. The mean FL at 15 weeks and 40 weeks was 18.50±0.70mm and 77.67±1.528mm respectively. The mean AC at 15 weeks and 40 weeks was 99.00±1.41mm and 365.33±8.32mm respectively.&#x0D; Conclusion: We conclude that foetal transcerebellar diameter can thus be used as an alternative foetal parameter to assess gestational age and can be used in cases of wrong dates or when other routine parameters are not conclusive or did not accurately predict gestational age for e.g. in cases of hydrocephalus, brachycephaly, dolicocephaly, intrauterine growth restriction, achondroplasia or short limb dwarfism.&#x0D; Keywords: Gestational age, Linear regression, BPD

Assessment of Transcerebellar Diameter and Femur Length of the Foetus by Ultrasound for the Determination of Gestational Age in the Third Trimester of Pregnancy

Assessment of Transcerebellar Diameter and Femur Length of the Foetus by Ultrasound for the Determination of Gestational Age in the Third Trimester of Pregnancy

Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable?

The aim was to describe the sonographic follow-up of hindbrain herniation (HH), the banana and lemon sign after fetal myelomeningocele (fMMC) repair, and the time of disappearance of these signs after the intervention, and to investigate any predictive value for the necessity of shunting during the infant's first year of life. Additionally, the sonographic evolution of the transcerebellar diameter (TCD) before and after fetal intervention was assessed. The first 50 patients that underwent fMMC repair at Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch) were included in this study. Sonographic scans performed weekly after fMMC repair focusing on HH and banana and lemon signs were analyzed and compared between the shunted and the non-shunted group. ROC curves were generated for the time intervals of resolution of the signs in order to show their predictive accuracy for the need for shunting until 1 year of age. HH resolved in 48 fetuses (96 %) before delivery. The sonographic disappearance of HH within the first two weeks after fMMC repair was associated with a significantly lower incidence of shunt placement (OR 0.19; 95 % CI 0.4-0.9) during the first year of life (p = 0.03). All fetuses with persistent HH before delivery received a shunt. TCD growth was observed in all fetuses. The reversibility of HH within two weeks after fMMC repair is associated with an 80 % lower incidence of shunt placement during the infant's first year of life. Moreover, it allows the cerebellum to grow and to normalize its configuration.

Estimation of gestational age using trans-cerebellar diameter: a sonographic study of a cohort of healthy pregnant women of Igbo ethnic origin in a suburb of Lagos, southwest Nigeria.

To use a sonographic method to determine the usefulness of trans-cerebellar diameter (TCD) as an independent estimator of gestational age (GA). A convenience sample of 257 healthy pregnant women of Igbo ethnic origin with singleton normal pregnancy whose GA ranged from 16 to 40weeks were examined. GA was calculated from the date of onset of the last menstrual period (LMP) and was used as the standard criterion, while the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were used to estimate GA. TCD was measured and employed to derive regression models utilized to assess GA. The mean TCD was 32.0 ± 11.6mm; TCD had a strong positive linear relationship with GA (R = 0.988; R2 = 0. 975; P = < 0.001). The GA that was estimated using regression models, which were derived using the sonographically measured TCD, was closer to the actual GA in the second and third trimesters of pregnancy than the GA estimated using other fetal parameters. In a population of healthy pregnant women of Igbo ethnic origin living in Oshodi, Lagos State, Nigeria, the sonographically measured TCD was more accurate as a single estimator of GA than BPD, HC, AC, and FL in the late stages of pregnancy. Subject to further validation, the nomograms derived using TCD proposed in the present study could be used as reliable GA estimators in the late stages of pregnancy among women who are unsure of the date of onset of their LMP.

Performance of late pregnancy biometry for gestational age dating in low-income and middle-income countries: a prospective, multicountry, population-based cohort study from the WHO Alliance for Maternal and Newborn Health Improvement (AMANHI) Study Group

SummaryBackgroundWe aimed to evaluate and improve the accuracy of the ultrasound scan in estimating gestational age in late pregnancy (ie, after 24 weeks' gestation) in low-income and middle-income countries (LMICs), where access to ultrasound in the first half of pregnancy is rare and where intrauterine growth restriction is prevalent.MethodsThis prospective, population-based, cohort study was done in three LMICs (Bangladesh, Pakistan, and Tanzania) participating in the WHO Alliance for Maternal and Newborn Health Improvement study. Women carrying a live singleton fetus dated by crown-rump length (CRL) measurements between 8+0–14+6 weeks of gestation, who were willing to return for two additional ultrasound scans, and who planned on delivering in the study area were enrolled in the study. Participants underwent ultrasonography at 24+0–29+6 weeks and at 30+0–36+6 weeks' gestation. Birthweights were measured within 72 h of birth, and the proportions of infants who had a small-for-gestational-age birthweight (ie, a birthweight <10% of the standard birthweight for the infant's gestational age and sex according to the INTERGROWTH-21st project newborn baby reference standards) and appropriate-for-gestational-age birthweights were ascertained. Estimation of gestational age by standard fetal biometry measurements in addition to transcerebellar diameter (TCD) measurements was compared with gold-standard CRL measurements by use of Bland-Altman plots to calculate the mean difference and 95% limits of agreement. Statistical modelling was done to develop new gestational age prediction formulas for third trimester ultrasonography in LMICs.FindingsBetween Feb 7, 2015, and Jan 9, 2017, 1947 women were enrolled in the study. 1387 pregnant women had an ultrasound scan at 24+0–29+6 weeks of gestation and 1403 had an ultrasound scan between 30+0–36+6 weeks of gestation. Of the 1379 unique infants whose birthweights were available, 981 (71·1%) infants were born with an appropriate-for-gestational-age birthweight and 398 (28·9%) infants were born with a small-for-gestational-age birthweight. The accuracy of late pregnancy ultrasound biometry using existing formulas to estimate gestational age in LMICs was similar to that in high-income settings. With standard dating formulas, late pregnancy ultrasound at 24+0–29+6 weeks' gestation was accurate to within approximately plus or minus 2 weeks of the gold-standard CRL measurement of gestational age, and late pregnancy ultrasound was accurate to within ±3 weeks of the CRL measurement at 30+0–36+6 weeks' gestation. In infants who were ultimately born small for gestational age, individual parameters systematically underestimated gestational age, apart from TCD, which showed minimal bias. By use of a novel parsimonious model formula that combined TCD with femur length, gestational age at the 24+0 −29+6-week ultrasound scan was estimated to within ±10·5 days of the CRL measurement and estimated to within ±15·1 days of the CRL measurement at the 30+0–36+6-week ultrasound scan. Similar results were observed in infants who were small-for-gestational-age.InterpretationIncorporation of TCD and the use of new formulas in late pregnancy ultrasound scans could improve the accuracy of gestational age estimation in both appropriate-for-gestational-age and small-for-gestational-age infants in LMICs. Given the high rates of small-for-gestational-age infants in LMICs, these results might be especially relevant. Validation of this new formula in other LMIC populations is needed to establish whether the accuracy of the late pregnancy ultrasound can be narrowed to within approximately 2 weeks.FundingBill & Melinda Gates Foundation.

Trans-cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age

Trans-cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age

Normative ultrasound data of the fetal transverse thalamic diameter derived from 18 to 22 weeks of gestation in routine second-trimester morphology examinations.

The thalamus is important for a wide range of sensorimotor and neuropsychiatric functions. Departure from normal reference values of the thalamus may be a biomarker for differences in neurodevelopment outcomes and brain anomalies perinatally. Antenatal measurement of thalamus is not currently included in routine fetal ultrasound as differentiation of thalamic borders is difficult. The aim of this work was to present a method to standardise the thalamus measure and provide normative data of the fetal transverse thalamic diameter between 18 and 22weeks of gestational age. Transverse thalamic diameter was measured by two sonographers on 1,111 stored ultrasound images at the standard transcerebellar plane. A 'guitar' shape representative structure is presented to demarcate the thalamic diameter. The relationship of the transverse thalamic diameter with gestational age, head circumference and transcerebellar diameter using linear regression modelling was assessed, and the mean of the thalamic diameter was calculated and plotted as a reference chart. Transverse thalamic diameter increased significantly with increasing gestational age, head circumference, and transcerebellar diameter linearly, and normal range thalamic charts are presented. The guitar shape provided good reproducibility of thalamic diameter measures. Measuring thalamus size in antenatal ultrasound examinations with reference to normative charts could be used to assess midline brain structures and predict neurodevelopment disorders and potentially brain anomalies.

Toward point-of-care ultrasound estimation of fetal gestational age from the trans-cerebellar diameter using CNN-based ultrasound image analysis.

Obstetric ultrasound is a fundamental ingredient of modern prenatal care with many applications including accurate dating of a pregnancy, identifying pregnancy-related complications, and diagnosis of fetal abnormalities. However, despite its many benefits, two factors currently prevent wide-scale uptake of this technology for point-of-care clinical decision-making in low- and middle-income country (LMIC) settings. First, there is a steep learning curve for scan proficiency, and second, there has been a lack of easy-to-use, affordable, and portable ultrasound devices. We introduce a framework toward addressing these barriers, enabled by recent advances in machine learning applied to medical imaging. The framework is designed to be realizable as a point-of-care ultrasound (POCUS) solution with an affordable wireless ultrasound probe, a smartphone or tablet, and automated machine-learning-based image processing. Specifically, we propose a machine-learning-based algorithm pipeline designed to automatically estimate the gestational age of a fetus from a short fetal ultrasound scan. We present proof-of-concept evaluation of accuracy of the key image analysis algorithms for automatic head transcerebellar plane detection, automatic transcerebellar diameter measurement, and estimation of gestational age on conventional ultrasound data simulating the POCUS task and discuss next steps toward translation via a first application on clinical ultrasound video from a low-cost ultrasound probe.

843: Prenatal brain growth is altered in Congenital Diaphragmatic Hernia on ultrasound

To describe ultrasound brain biometry and brain perfusion in a cohort of Congenital Diaphragmatic Hernia fetuses. This is a multicenter retrospective study of fetuses with isolated left sided CDH assessed in three European fetal surgery centers: London (UK), Barcelona (Spain) and Leuven (Belgium). Included were all cases with longitudinal data (at least three measurements within a minimum period of four weeks). Outcome measurements were Middle Cerebral Artery (MCA) Doppler, Head Circumference (HC), TransCerebellar diameter (TCD), Observed-to-expected lung-to-head ratio (o/e LHR) and liver position. We included 176 cases. HC Z-score were within normal range throughout gestation but different from average towards the end of pregnancy (p< 0,0001). Average growth was increased (R2= 0.92; p< 0,0001). TCD Z-scores were normal at 20 weeks but 55% of measurements were abnormal beyond 32 weeks (p< 0.0001). The average growth curve had a different pattern compared to normal and fell below the 5th centile from 32 weeks onwards (R2= 0.80; p< 0.0001; Figure). The pulsatility index in the MCA Doppler was normal but the peak systolic velocity (PSV) was consistently 20% lower than normal (p< 0,0001). Liver herniation was correlated to lower PSV (p=0.002). Fetoscopic endoluminal tracheal occlusion (FETO) did not influence HC, TCD and MCA measurements. Fetal brain growth and perfusion is altered in isolated left sided CDH. The growth pattern of the cerebellum is different from the normal, falling below normal ranges by 32 weeks. Accordingly, lower PSV values in the MCA were found.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1032: Accuracy of three-dimensional automated ultrasound imaging of the fetal brain

To evaluate the accuracy of SonoCNS, an automated three-dimensional (3D) ultrasound (US) technique, compared with manual acquisition of five fetal intracranial measurements. A prospective observational study was performed on patients at their anatomical survey between 18’0-22’6 weeks. After informed consent, each patient received an US of the fetal head by a sonographer and a physician (MD) who each obtained manual measurements of the biparietal diameter (BPD), head circumference (HC), transcerebellar diameter (Cer), cisterna magna (CM) and posterior horn of the lateral ventricle (Vp), followed by measurements using SonoCNS. The 3D acquisition was obtained at the transthalamic plane, employing computer-aided recognition, followed by automated alignment and measurements. Both providers performed SonoCNS until all five measurements were obtained in a single sweep, or a maximum of three attempts. The accuracy of SonoCNS was compared to manual measurements using intraclass coefficients (ICC) by provider type, accounting for patient and US characteristics. 143 women were recruited for the study. Median BMI was 24.0 kg/m2 (IQR 22.5-26.8) and median suprapubic subcutaneous thickness (ST) was 1.6cm (IQR 1.3-2.0). Fifteen patients (11%) had at least one prior cesarean section, 17 (11%) had other abdominal surgery, and 78 (55%) had an anterior placenta. Successful acquisition of SonoCNS was achieved in first, second, or third attempts in 70%, 22% and 4% by sonographers and 76%, 16% and 4% by MD. SonoCNS failed in 6 (4%) and 7 (5%) of scans by the sonographers and MD, respectively. The ICC among both providers was high for BPD and HC and lower for Cer, CM and Vp. (Figure 1) Fetal lie, head position, placental location, ST and prior surgical history were not associated with the accuracy of SonoCNS. (Table 1) Automated 3D US imaging of the fetal brain reliably identify and measure BPD and HC, but were less consistent in accurately identifying the Cer, CM or Vp. Further optimization of the automated technology is necessary prior to incorporation into routine US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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English

Determination of Fetal Transcerebellar Diameter Nomogram in the Second Trimester

AbstractThe aim of the study was obtain nomogram of fetal transcerebellar diameter at 18–24 weeks of gestation with known prognosis of normal pregnancies. The study included 1236 healthy fetuses in the 18th–24th gestational week of women aged from 18 to 40 years (mean: 28.70 ± 5.26). The transcerebellar diameter, bi-parietal diameter, femur length and abdominal circumference of the fetuses were measured. Additionally, groups were divided according to maternal age and according to body mass index. The transcerebellar diameter of fetuses from 18 to 24 weeks gestation varied from 18.13 ± 2.16 to 26.42 ± 1.91 mm (mean: 22.12 ± 2.57 mm). Additionally, the mean and standard deviation of transcerebellar diameter and fetal parameters were determined according to gestational week, maternal age and maternal body mass index. Later, the correlations between transcerebellar diameter with pregnancy week, maternal age, maternal body mass index and fetal parameters were examined. Transcerebellar diameter was correlated with pregnancy week and fetal parameters (p &lt; 0.01) but was not correlated with maternal age (p &gt; 0.01). Additionally, transcerebellar diameter and fetal parameters were determined to show negative correlation with maternal body mass index (p &lt; 0.01). Comparison of transcerebellar diameter with pregnancy week determined differences between weeks (p &lt; 0.05), but no differences for age groups and body mass index groups (p &gt; 0.05). Maternal age and maternal body mass index are significant factors affecting fetal development. We believe our data related to the transcerebellar diameter obtained at the end of the study will be beneficial for assessment of fetal development and identification of fetal anomalies.

Evaluation of Fetal Transcerebellar Diameter as a Sonological Parameter for the Estimation of Fetal Gestational Age in Comparison to Fetal Biometry

Evaluation of Fetal Transcerebellar Diameter as a Sonological Parameter for the Estimation of Fetal Gestational Age in Comparison to Fetal Biometry

Accuracy of Fetal Transcerebellar Diameter in the Prediction of Gestational Age in Singleton Pregnancy at the Second and the Third Trimesters

Background: Gestational age (GA) is an important parameter in obstetrics for management of pregnancy and evaluating fetal development. High incidence of perinatal mortality has been noted in patients whose accurate gestational age is not known. Objective: The aim of this study was to evaluate whether trans-cerebellar diameter (TCD) in singleton gestations can serve as a reliable predictor of gestational age (GA) in fetuses in the second and third trimester between 14-40 weeks of pregnancy in women attending the clinic for routine ultrasound examination. Patients and methods: This prospective study was carried out at the antenatal outpatient clinic at Al-Zahraa university Hospital and El-Sahel Teaching Hospital. This study was hold one thousand of pregnant women attending the outpatient clinic for routine ultrasound examination during second and third trimester between 14-40 weeks of pregnancy in a period from 1 December 2016 to March 2019. Patients and methods: This prospective study included a total of one thousand of pregnant women, attending at Antenatal Outpatient Clinic, Al-Zahraa University Hospital and El-Sahel Teaching Hospital. The accuracy of the transverse Cerebellar Diameter (TCD) in the prediction of gestational age (GA) in fetuses in the second and third trimester between 14-40 weeks of pregnancy was assessed. This study was conducted between December 2016 to March 2019 Results: According to accuracy of measured gestational age according to measured parameters in relation to actual gestational age (accuracy within 2 weeks), TCD had the highest accuracy (98.7%) than other parameters in early second trimester. Accuracy of TCD in late second trimester was 91.6% and 82% in early third trimester while in late third trimester TCD had the lowest accuracy (68.1%). Conclusion: TCD is an accurate parameter in estimation of gestational age as its values are in close relation with that of GA by LMP. TCD is a better predictor of the gestational age when compared to other parameters especially between (14-22) weeks.

Accuracy of Fetal Transcerebellar Diameter in the Prediction of Gestational Age in Singleton Pregnancy at the Second and the Third Trimesters

Background: Gestational age (GA) is an important parameter in obstetrics for management of pregnancy and evaluating fetal development. High incidence of perinatal mortality has been noted in patients whose accurate gestational age is not known. Objective: The aim of this study was to evaluate whether trans-cerebellar diameter (TCD) in singleton gestations can serve as a reliable predictor of gestational age (GA) in fetuses in the second and third trimester between 14-40 weeks of pregnancy in women attending the clinic for routine ultrasound examination. Patients and methods: This prospective study was carried out at the antenatal outpatient clinic at Al-Zahraa university Hospital and El-Sahel Teaching Hospital. This study was hold one thousand of pregnant women attending the outpatient clinic for routine ultrasound examination during second and third trimester between 14-40 weeks of pregnancy in a period from 1 December 2016 to March 2019. Patients and methods: This prospective study included a total of one thousand of pregnant women, attending at Antenatal Outpatient Clinic, Al-Zahraa University Hospital and El-Sahel Teaching Hospital. The accuracy of the transverse Cerebellar Diameter (TCD) in the prediction of gestational age (GA) in fetuses in the second and third trimester between 14-40 weeks of pregnancy was assessed. This study was conducted between December 2016 to March 2019 Results: According to accuracy of measured gestational age according to measured parameters in relation to actual gestational age (accuracy within 2 weeks), TCD had the highest accuracy (98.7%) than other parameters in early second trimester. Accuracy of TCD in late second trimester was 91.6% and 82% in early third trimester while in late third trimester TCD had the lowest accuracy (68.1%). Conclusion: TCD is an accurate parameter in estimation of gestational age as its values are in close relation with that of GA by LMP. TCD is a better predictor of the gestational age when compared to other parameters especially between (14-22) weeks.

Reduced Cerebellar Size at Term-Equivalent Age Is Related to a 17% Lower Mental Developmental Index in Very Preterm Infants without Brain Injury

Introduction: Cerebellar injury is increasingly recognized as a relevant complication of premature birth. However, the prevalence of reduced cerebellar growth and its consequences for neurodevelopmental outcome in preterm infants without overt brain injury remain to be defined in detail. The aim of this study was to assess the transcerebellar diameter (TCD) at term-equivalent age (TEA) in very preterm infants without brain injury and to evaluate whether TCD is related to neurodevelopmental outcome in this population. Methods: Very preterm infants underwent magnetic resonance imaging at TEA. Infants with any grade of supra- or infratentorial brain injury were excluded. TCD was measured and categorized using existing cut-off values as normal TCD and mild or severe TCD reduction. Psychomotor Developmental index (PDI) and Mental Developmental index (MDI) were assessed using Bayley Scales of Infant Development II and III at a corrected age of 2 years. Results: A total of 166 infants with a mean gestational age of 29.9 ± 1.8 weeks and a mean birth weight of 1,317 ± 393 g were included. Mean TCD of girls was significantly lower compared to the mean TCD of boys (p = 0.004). TCD reduction was present in 8 infants (4.8%). Infants with a mild TCD reduction achieved lower mean MDI than infants with normal TCD (p = 0.021). Discussion: We found that reduced TCD was associated with a 17% lower mean MDI at a corrected age of 2 years. Thus, TCD at TEA may be used as an imaging marker for adverse cognitive outcome in the apparently low-risk group of preterm infants without brain injury.

Are Simple Magnetic Resonance Imaging Biomarkers Predictive of Neurodevelopmental Outcome at Two Years in Very Preterm Infants?

Background: Preterm infants are at increased risk of neurodevelopmental impairment due to the vulnerability of the immature brain. Early risk stratification is necessary for predicting outcome in the period of highest neuroplasticity. Several biomarkers in magnetic resonance imaging (MRI) at term equivalent age (TEA) have therefore been suggested. Objective: To assess the predictive value of simple brain metrics and the total abnormality score (TAS) – a modified score for brain injury and growth – in relation to neurodevelopmental outcome of very preterm infants in MRI at TEA. Methods: Single-centre cohort study including preterm infants with gestational age (GA) ≤32 weeks and birth weight ≤1,500 g. Biparietal width (BPW), interhemispheric distance, transcerebellar diameter (TCD) and TAS were assessed. To detect subtle haemorrhages, additional susceptibility-weighted imaging (SWI) was used in addition to conventional MRI to evaluate its clinical relevance. Neurodevelopment was tested by the Mental and Psychomotor Developmental Index (MDI/PDI) of the Bayley Scales of Infant Development II at a corrected age of 24 months. Results: One hundred twenty-nine children with median GA of 28.1 weeks and median birth weight of 980 g were included. BPW significantly correlated with PDI (p= 0.01, R² = 0.06) and TCD with MDI (p < 0.01, R² = 0.05) and PDI (p < 0.01, R² = 0.06) but explained variances were low. TAS was not predictive of neurodevelopmental outcome. By using SWI, additional 4 cases of low grade haemorrhages were identified compared to conventional sequences. In one case this additional information was clinically relevant (MDI/PDI below average). Conclusion: Simple brain metrics and TAS did not reliably predict neurodevelopmental outcome in a cohort with low prevalence of high grade brain injury. The additional value of SWI is yet to be determined in larger cohorts. The combination of imaging and functional biomarkers may be advisable for the prediction of neurodevelopmental outcome.