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Altered Cerebral Perfusion in Infants Born Preterm Compared with Infants Born Full Term - 31/01/18

Doi : 10.1016/j.jpeds.2017.09.083 
Marine Bouyssi-Kobar, MS 1, 2, Jonathan Murnick, MD, PhD 1, Marie Brossard-Racine, PhD 3, Taeun Chang, MD 4, Eman Mahdi, MD 1, Marni Jacobs, PhD 5, Catherine Limperopoulos, PhD 1, *
1 The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC 
2 Institute for Biomedical Sciences, George Washington University, Washington, DC 
3 Department of Pediatrics Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Québec, Canada 
4 Department of Neurology, Children's National Health System, Washington, DC 
5 Department of Epidemiology and Biostatistics, Children's Research Institute, Children's National Health System, Washington, DC 

*Reprint requests: Catherine Limperopoulos, PhD, Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010.Developing Brain Research LaboratoryDepartment of Diagnostic Imaging and RadiologyChildren's National Health System111 Michigan Ave NWWashingtonDC20010

Abstract

Objectives

To compare regional cerebral cortical blood flow (CBF) in infants born very preterm at term-equivalent age (TEA) and healthy newborns born full term and to examine the impact of clinical risk factors on CBF in the cohort born preterm.

Study design

This prospective, cross-sectional study included infants born very preterm (gestational age at birth <32 weeks; birth weight <1500 g) and healthy infants born full term. Using noninvasive 3T arterial spin labeling magnetic resonance imaging, we quantified regional CBF in the cerebral cortex: sensorimotor/auditory/visual cortex, superior medial/dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)/posterior cingulate cortex, insula, and lateral posterior parietal cortex, as well as in the brainstem, and deep gray matter. Analyses were performed controlling for sex, gestational age, and age at magnetic resonance imaging.

Results

We studied 202 infants: 98 born preterm and 104 born full term at TEA. Infants born preterm demonstrated greater global CBF (β = 9.03; P < .0001) and greater absolute regional CBF in all brain regions except the insula. Relative CBF in the insula, ACC and auditory cortex were decreased significantly in infants born preterm compared with their peers born at full term (P < .0001; P = .026; P = .036, respectively). In addition, the presence of parenchymal brain injury correlated with lower global and regional CBF (insula, ACC, sensorimotor, auditory, and visual cortices) whereas the need for cardiac vasopressor support correlated with lower regional CBF in the insula and visual cortex.

Conclusions

Altered regional cortical CBF in infants born very preterm at TEA may reflect early brain dysmaturation despite the absence of cerebral cortical injury. Furthermore, specific cerebral cortical areas may be vulnerable to early hemodynamic instability and parenchymal brain injury.

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Keywords : brain development, cerebral cortex, premature birth, cerebral blood flow, magnetic resonance imaging, arterial spin labeling

Abbreviations : ACC, ASL, CBF, GA, MRI, NICU, PLD, PMA, ROI, TEA


Plan


 Supported by the Canadian Institutes of Health Research (MOP-81116), the SickKids Foundation (XG 06-069), and the National Institutes of Health (R01 HL116585-01). M.B.-K. is a PhD student in the Molecular Medicine Program of the Institute for Biomedical Sciences at the George Washington University. This work is from a dissertation to be presented to the aforementioned program in partial fulfillment of the requirements for the PhD degree. The authors declare no conflicts of interest.


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Vol 193

P. 54 - février 2018 Retour au numéro
Article précédent Article précédent
  • A Randomized Trial of Conditioned or Unconditioned Gases for Stabilizing Preterm Infants at Birth
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