Neonatal Neuroimaging Among Children Born Extremely Preterm and Motor Coordination Impairment at School-Age

Abstract

Objectives: To examine, among children born extremely preterm, initial and late cranial ultrasound (CUS) findings and magnetic resonance imaging (MRI) findings of the brain at near term, including white matter abnormalities (WMA) as markers for motor coordination impairment at school age. Study design: This was a prospective, longitudinal study of neonatal CUS and conventional MRI at near term among infants born 24-276/7 weeks of estimated gestational age (EGA) to predict outcomes in a subgroup of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT). Outcome measures at 6-7 years included Movement Assessment Battery for Children (MABC-2) to determine significant motor impairment (total test score ≤5th %ile). Logistic regression was used to evaluate associations with near-term neuroimaging, adjusting for perinatal-neonatal factors. Results: Total test score on MABC-2 was available for 320 children. Nearly 1 in 3 children had significant motor impairment, with rates increasing with decreasing EGA (24 weeks: 41%; 25 weeks: 41%; 26 weeks: 31%; 27 weeks: 21%). Greater rates of impairment were seen with adverse late CUS findings and increasing WMA severity, but importantly, high rates also were seen among those with normal late CUS (29%) and without WMA on MRI (22%). Motor impairment was independently associated with adverse late CUS in the group overall (aOR 5.00, 95% CI 1.53-16.29) and with moderate-severe WMA among those without CP (aOR 2.29, 95%CI 1.08-4.87). Conclusions: Although motor coordination impairment was associated with abnormal neonatal neuroimaging, there was a high prevalence among all infants born extremely preterm, whether with or without neuroimaging abnormalities. These findings indicate the need for consistent long-term follow-through and intervention.