Diminished White Matter Injury over Time in a Cohort of Premature Newborns - 12/10/14

Doi : 10.1016/j.jpeds.2014.09.009

Dawn Gano, MD ^1,^2,^⁎ , Sarah K. Andersen, BSc ³, J. Colin Partridge, MD, MPH ¹, Sonia L. Bonifacio, MD ¹, Duan Xu, PhD ⁴, David V. Glidden, PhD ⁵, Donna M. Ferriero, MD, MS ^1,⁶, A. James Barkovich, MD ⁴, Hannah C. Glass, MDCM, MAS ^1,⁶
¹ Department of Pediatrics, University of California San Francisco, San Francisco, CA
² Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
³ Department of Medicine, Queens University, Kingston, Ontario, Canada
⁴ Department of Radiology, University of California San Francisco, San Francisco, CA
⁵ Department of Biostatistics, University of California San Francisco, San Francisco, CA
⁶ Department of Neurology, University of California San Francisco, San Francisco, CA

^∗Reprint requests: Dawn Gano, MD, Clinical Fellow, UCSF Benioff Children's Hospital, 505 Parnassus Ave, M793, San Francisco, CA 94143.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 12 October 2014

Abstract

Objectives

To determine the rate of magnetic resonance imaging (MRI)-detected noncystic white matter injury (WMI) in a prospective cohort of premature newborns, and to evaluate its associations with changes in clinical predictors of WMI over the study period.

Study design

A prospective cohort of premature newborns (<33 weeks gestational age) was studied with MRI within 4 weeks of birth and near term-equivalent age. A pediatric neuroradiologist scored the severity of WMI on T₁-weighted MRI according to published criteria. WMI was classified as none/mild or moderate/severe. Subjects with severe cystic WMI, periventricular hemorrhagic infarction, or motion artifact on MRI were excluded. Changes in clinical characteristics and predictors of WMI over the study period (1998-2011) were evaluated. Predictors of moderate/severe WMI, including birth year, were evaluated using multivariate logistic regression.

Results

Among 267 newborns, 45 (17%) had moderate/severe WMI. The rate of moderate/severe WMI decreased over the study period (P = .002, χ² test for trends). On multivariate logistic regression, the odds of moderate/severe WMI decreased by 11% for each birth year of the cohort (OR, 0.89; 95% CI, 0.81-0.98; P = .02). Prolonged exposure to indomethacin also was independently associated with reduced odds of moderate/severe WMI.

Conclusion

The decreasing burden of MRI-detected moderate/severe noncystic WMI in our cohort of premature newborns is independent over time of changes in the known clinical predictors of WMI. Prolonged exposure to indomethacin is associated with reduced WMI.

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Keyword : MRI, NEC, PDA, RR, UCSF, WMI

Plan

Clinical Characteristics and WMI over Time

Clinical Predictors Associated with Moderate/Severe WMI on Early MRI

Findings on Follow-Up MRI

Prolonged Indomethacin Exposure Is Associated with Reduced WMI

Discussion

Supported by National Institutes of Health (NS35902, NS40227, NS046432, EB009756). D.G. is supported by the University of British Columbia Clinician-Investigator program. H.G. is supported by the National Institutes of Health/National Institute of Neurological Disorders and Stroke (K23NS066137) and the Newborn Brain Research Institute, University of California San Francisco. The authors declare no conflicts of interest.