MRI May Predict Developmental Delays in Preterm Infants

Brain magnetic resonance spectroscopy to measure brain chemical ratios in preterm infants may help determine which will have neurodevelopment problems.

Magnetic resonance spectroscopy (MRS) can identify biomarkers that predict the risk of developmental delays in preterm infants, according to an article published in the journal Radiology.

Researchers from the United Kingdom undertook a retrospective study to determine if imaging with MRI and MRS could help detect changes in the white matter in preterm infants, which could be an indicator of developmental delay.

“We are living in an era in which survival of premature birth is more common,” said lead researcher Giles S. Kendall, PhD, in a release. “However, these infants continue to be at risk for neurodevelopmental problems.” Kendall is consultant for the neonatal intensive care unit at University College London Hospitals NHS Foundation Trust and honorary senior lecturer of neonatal neuroimaging and neuroprotection at the University College London.

Forty-three infants (24 boys) who were born at less than 32 weeks gestation between January 2007 and January 2010 and were admitted to the hospital’s neonatal intensive care were included in the study. Brain MRIs had been performed on the infants when they were at a postmenstrual age of 37 to 42 weeks. The researchers were looking for changes in choline/creatine (Cho/Cr) and decreased N-acetylaspartate/choline (NAA/Cho).

“The white matter is especially fragile in the newborn and at risk for injury,” Kendall explained.

Forty of the 43 infants were also evaluated at a corrected age of one year, using the Bayley Scales of Infant and Toddler Development, 3rd edition. The follow-up was to assess fine and gross motor development, and expressive and receptive communication.

The imaging results showed that seven of the 43 infants had parenchymal lesions. “Four infants had small cysts within the periventricular white matter not seen at ultrasonography, one infant had unilateral posthemorrhagic ventricular dilatation, and two infants had linear regions of punctuate T1 shortening in the white matter,” the authors wrote.

The follow-up revealed that 15 infants (38 percent) had abnormal composite motor scores and four (10 percent) showed signs of cognitive impairment. Infants with motor scores of less than 85 (impaired) had an increased Cho/Cr ratio and a reduced NAA/Cho ratio compared to those without impairment. “Low N-acetylaspartate/choline and rising choline/creatine observed during MRS at the baby’s expected due date predicted with 70 percent certainty which babies were at high risk for motor development problems at one year,” Kendall said.

The authors concluded that this combination of ratios measured in the posterior periventricular white matter at term-equivalent age could predict the motor outcome of preterm infants (less than 32 weeks gestation) when they reached one year of age.