Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
Neonatology. 2020;117(3):287-293. doi: 10.1159/000506836. Epub 2020 May 12.
Very preterm infants are at risk for adverse neurodevelopmental outcome. To better identify children without brain injury at risk for developmental sequelae, we assessed predictive values of supratentorial brain metrics in relation to outcome.
Very preterm infants underwent magnetic resonance imaging (MRI) at term-equivalent age. Infants with any grade of supra- or infratentorial brain injury according to Kidokoro et al. [Pediatrics 2014;134:e444-53] were excluded. Supratentorial brain metrics (biparietal width, extracerebral space, interhemispheric distance) were measured and categorised using existing cut-off values. The Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) were assessed using the Bayley Scales of Infant Development, second and third edition, at 2 years of age. Developmental delay was defined as a score <85. Positive and negative predictive values for developmental delay were calculated.
A total of 237 very preterm infants were enrolled. Of all infants, 59 (21.2%) showed developmental delay. Infants with z-scores less than -0.5 for biparietal width had significantly lower PDI (p = 0.039) and MDI (p = 0.042) than infants with normal z-scores. Enlargement of extracerebral spaces was also related to lower PDI (p = 0.047) and MDI (p = 0.036). Negative predictive value was highest when all brain metrics were within the normal range (PDI <85: 96.6%, MDI <85: 90.0%). Combining the biparietal width and the interhemispheric distance showed highest positive predictive values for developmental delay (MDI or PDI <85: 58.3%).
Supratentorial brain metrics are predictive for neurodevelopmental outcome in infants with ostensibly normal MRI. A combination of supratentorial brain metrics is most meaningful for identifying infants at risk for long-term sequelae.
极早产儿存在发生不良神经发育结局的风险。为了更好地识别没有脑损伤但存在发育后遗症风险的儿童，我们评估了与结局相关的幕上脑测量值的预测值。
极早产儿在胎龄相等时进行磁共振成像（MRI）检查。根据 Kidokoro 等人的标准[儿科 2014；134：e444-53]，排除任何程度的幕上或幕下脑损伤的婴儿。使用现有的截断值测量和分类幕上脑测量值（双额径、脑外间隙、大脑半球间距离）。在 2 岁时使用贝利婴幼儿发育量表第二版和第三版评估精神运动发育指数（PDI）和精神发育指数（MDI）。发育迟缓定义为评分<85。计算发育迟缓的阳性和阴性预测值。
共纳入 237 例极早产儿。所有婴儿中，59 例（21.2%）出现发育迟缓。双额径 z 评分小于-0.5 的婴儿的 PDI（p=0.039）和 MDI（p=0.042）明显低于正常 z 评分的婴儿。脑外间隙扩大也与较低的 PDI（p=0.047）和 MDI（p=0.036）相关。当所有脑测量值均在正常范围内时，阴性预测值最高（PDI<85：96.6%，MDI<85：90.0%）。结合双额径和大脑半球间距离显示出最高的发育迟缓阳性预测值（MDI 或 PDI<85：58.3%）。
幕上脑测量值可预测 MRI 表现正常的婴儿的神经发育结局。幕上脑测量值的组合对于识别存在长期后遗症风险的婴儿最有意义。
