Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr. 2020 May;220:56-63. doi: 10.1016/j.jpeds.2020.01.034. Epub 2020 Mar 5.
To externally validate the independent value of objectively diagnosed diffuse white matter abnormality (DWMA; also known as diffuse excessive high signal intensity) volume to predict neurodevelopmental outcomes in very preterm infants (≤31 weeks of gestational age).
A prospective, multicenter, regional population-based cohort study in 98 very preterm infants without severe brain injury on magnetic resonance imaging (MRI). DWMA volume was diagnosed objectively on structural MRI at term-equivalent age using our published algorithm. Multivariable linear regression was used to assess the value of DWMA volume to predict cognitive and language scores on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 2 years corrected age.
Of the infants who returned for follow-up (n = 74), the mean (SD) gestational age was 28.2 (2.4) weeks, and 42 (56.8%) were boys. In bivariable analyses, DWMA volume was a significant predictor of Bayley-III cognitive and language scores. In multivariable analyses, controlling for known predictors of Bayley-III scores (ie, socioeconomic status, gestational age, sex, and global brain abnormality score), DWMA volume remained a significant predictor of cognitive (P < .001) and language (P = .04) scores at 2 years. When dichotomized, objectively diagnosed severe DWMA was a significant predictor of cognitive and language impairments, whereas visual qualitative diagnosis of DWMA was a poor predictor.
In this multicenter, prospective cohort study, we externally validated our previous findings that objectively diagnosed DWMA is an independent predictor of cognitive and language development in very preterm infants. We also demonstrated again that visually-diagnosed DWMA is not predictive of neurodevelopmental outcomes.
验证客观诊断的弥漫性脑白质异常（DWMA；也称为弥漫性过度高信号强度）体积对预测极早产儿（≤31 周龄）神经发育结局的独立价值。
这是一项前瞻性、多中心、区域性基于人群的队列研究，纳入了 98 名极早产儿，他们在磁共振成像（MRI）上没有严重脑损伤。在足月龄时，使用我们发表的算法在结构 MRI 上对 DWMA 体积进行客观诊断。多元线性回归用于评估 DWMA 体积对预测婴儿和幼儿发育量表第三版（Bayley-III）在 2 年校正年龄时的认知和语言评分的价值。
在返回进行随访的婴儿中（n=74），平均（SD）胎龄为 28.2（2.4）周，42 名（56.8%）为男性。在双变量分析中，DWMA 体积是 Bayley-III 认知和语言评分的显著预测因素。在多变量分析中，控制 Bayley-III 评分的已知预测因素（即社会经济地位、胎龄、性别和全脑异常评分）后，DWMA 体积仍然是认知（P<0.001）和语言（P=0.04）评分在 2 岁时的显著预测因素。当将其分为二分类时，客观诊断的严重 DWMA 是认知和语言障碍的显著预测因素，而 DWMA 的视觉定性诊断是较差的预测因素。
在这项多中心前瞻性队列研究中，我们对之前的发现进行了外部验证，即客观诊断的 DWMA 是极早产儿认知和语言发育的独立预测因素。我们还再次证明，视觉诊断的 DWMA 不能预测神经发育结局。
