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<p>Neurological impairment is high after preterm birth. This study evaluates the impact and interplay of cMRI-detected brain injuries (BI) and clinical risk factors on neurodevelopmental outcomes and extracts the most important key factors. A retrospective analysis was conducted on risk factors (perinatal/neonatal, cMRI-detected BI) for adverse motor (MO) and cognitive (CO) outcomes (Bayley Scales of Infant Development, 24 months corrected age) in a tertiary center cohort (2009–2018) of very preterm infants (&lt; 32 weeks of gestation) using uni-/multivariable regression models. We included 342 infants (mean gestational age:28.0 ± 2.3 weeks; male:49%). Significant clinical predictors for MO/CO included GA, birthweight, APGAR score, catecholamine treatment, ventilation, retinopathy of prematurity, transfusion of red blood cells (RBCs), bronchopulmonary dysplasia, surgery, and patent ductus arteriosus interventions (all <i>p</i> &lt; 0.01/<i>p</i> &lt; 0.01), surfactant (MO: <i>p</i> = 0.037), and sepsis (<i>p</i> &lt; 0.001/<i>p</i> = 0.016). (Severe) cMRI-detected BIs (&gt; 1, all <i>p</i> &lt; 0.05) and not only severe intraventricular hemorrhage (IVH) III°/III°+PVHI and ventricular dilatation (VD) (all <i>p</i> &lt; 0.05), but also mild/moderate injuries like IVH II° (<i>p</i> &lt; 0.001/<i>p</i> &lt; 0.024), cerebellar hemorrhage (CO: <i>p</i> = 0.028), and moderate VD (MO: <i>p</i> = 0.005) significantly impacted outcomes. Independent key factors were &gt; 1 severe cMRI-detected BI (MO/CO:-11.27/-10.3 score points (sp), <i>p</i> = 0.021/0.043), APGAR score (10&#xa0;min, MO/CO:+5.3/+4.45 sp/point, <i>p</i> &lt; 0.001/<i>p</i> &lt; 0.001), surfactant administration (MO:+4.88 sp, <i>p</i> = 0.031), and transfusion of RBCs (MO/CO:-1.69/-1.96 sp/transfusion, <i>p</i> = 0.006/<i>p</i> &lt; 0.001). In conclusion, combining imaging and clinical (key) risk factors is important for risk stratification of preterm infants. Even mild BI, like IVH II°, significantly contributes to adverse outcomes, underlining the importance of cMRI.</p>

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CMRI-detected brain injuries and clinical key risk factors associated with adverse neurodevelopmental outcomes in very preterm infants

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  • 发表日期：

    2025年5月25日

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  • Karla Drommelschmidt,
  • Thomas Mayrhofer,
  • Hanna Müller,
  • Borek Foldyna,
  • Janika Raudzus,
  • Sophia L. Göricke,
  • Bernd Schweiger,
  • Selma Sirin

摘要

Neurological impairment is high after preterm birth. This study evaluates the impact and interplay of cMRI-detected brain injuries (BI) and clinical risk factors on neurodevelopmental outcomes and extracts the most important key factors. A retrospective analysis was conducted on risk factors (perinatal/neonatal, cMRI-detected BI) for adverse motor (MO) and cognitive (CO) outcomes (Bayley Scales of Infant Development, 24 months corrected age) in a tertiary center cohort (2009–2018) of very preterm infants (< 32 weeks of gestation) using uni-/multivariable regression models. We included 342 infants (mean gestational age:28.0 ± 2.3 weeks; male:49%). Significant clinical predictors for MO/CO included GA, birthweight, APGAR score, catecholamine treatment, ventilation, retinopathy of prematurity, transfusion of red blood cells (RBCs), bronchopulmonary dysplasia, surgery, and patent ductus arteriosus interventions (all p < 0.01/p < 0.01), surfactant (MO: p = 0.037), and sepsis (p < 0.001/p = 0.016). (Severe) cMRI-detected BIs (> 1, all p < 0.05) and not only severe intraventricular hemorrhage (IVH) III°/III°+PVHI and ventricular dilatation (VD) (all p < 0.05), but also mild/moderate injuries like IVH II° (p < 0.001/p < 0.024), cerebellar hemorrhage (CO: p = 0.028), and moderate VD (MO: p = 0.005) significantly impacted outcomes. Independent key factors were > 1 severe cMRI-detected BI (MO/CO:-11.27/-10.3 score points (sp), p = 0.021/0.043), APGAR score (10 min, MO/CO:+5.3/+4.45 sp/point, p < 0.001/p < 0.001), surfactant administration (MO:+4.88 sp, p = 0.031), and transfusion of RBCs (MO/CO:-1.69/-1.96 sp/transfusion, p = 0.006/p < 0.001). In conclusion, combining imaging and clinical (key) risk factors is important for risk stratification of preterm infants. Even mild BI, like IVH II°, significantly contributes to adverse outcomes, underlining the importance of cMRI.