Predicting Developmental Outcomes in Preterm Infants: A Simple White Matter Injury Imaging Rule

Abstract

Objective: To develop a simple imaging rule to predict neurodevelopmental outcomes at 4.5 years in a cohort of preterm neonates with white matter injury (WMI) based on lesion location and examine whether clinical variables enhance prediction. Methods: 68 preterm neonates born 24-32 weeks’ gestation (median 27.7 7.7 7.7 weeks) were diagnosed with WMI on early brain MRI scans (median 32.3 weeks weeks weeks weeks weeks ). 3D T1-weighted images of 60 neonates with 4.5-year outcomes were reformatted and aligned to the posterior commissure-eye plane and WMI was classified by location: anterior or posterior-only to the mid-ventricle line on the reformatted axial plane. Adverse outcomes at 4.5 years were defined as Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) Full Scale IQ <85, cerebral palsy, or Movement-ABC (MABC-2) percentile <5. The prediction of adverse outcome by WMI location, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) was assessed using multivariable logistic regression. Results: Six children had adverse cognitive outcomes and seventeen had adverse motor outcomes. WMI location predicted cognitive outcomes in 90% (area under Receiver-Operating-Characteristic curve [AUC] 0.80) and motor outcomes in 85% (AUC 0.75). Adding IVH, BPD and ROP to the model enhances the predictive strength for cognitive and motor outcomes (AUC 0.83 and 0.88 respectively). Rule performance was confirmed in an independent cohort of children with WMI. Conclusions: WMI on early MRI can be classified by location to predict preschool age outcomes in children born preterm. The predictive value of this WMI classification is enhanced by considering clinical factors apparent by term-equivalent age.