Ventricular dilatation in relation to outcome at 2 years of age in very preterm infants: a prospective Finnish cohort study.

AIM: The aim of this study was to analyse the relation between ventricular dilatation at term and neurodevelopmental outcome at 2 years corrected age in infants of very low birthweight (VLBW) or very low gestational age (VLGA). METHOD: A total of 225 VLBW or VLGA infants (121 males, 104 female; mean birthweight 1133 g, SD 333 g; mean gestational age 29 wks, SD 2 wks 5d) born in Turku University Hospital were included. Ventricular-brain ratio and the widths of each lateral ventricular horn were determined using ultrasonography, and the volume of the ventricles was measured by magnetic resonance imaging at term. The 2-year outcome measures included scores for the Hammersmith Infant Neurological Examination, the presence of cerebral palsy (CP), the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development (2nd edition), and the presence of severe hearing or vision impairments or any neurodevelopmental impairment (NDI). RESULTS: CP was diagnosed in 15 participants (6.7%) and severe hearing deficit in 12 participants (5.3%). No severe vision impairment was found. Mild and severe cognitive delay was found in 24 (10.7%) and 8 (3.6%) of the VLBW or VLGA infants respectively. Isolated ventricular dilatation did not increase the risk for developmental impairments. However, ventricular dilatation with additional brain pathology was significantly associated with CP, MDI score below 70, and NDI. A ventricular-brain ratio above 0.35 was a sensitive measure of developmental impairment. INTERPRETATION: Ventricular dilatation at term increases the risk of poor developmental outcome only when associated with other brain pathology. The ventricular-brain ratio is a useful clinical tool for determining the prognosis in VLBW and VLGA infants.

Brain and ventricles in very low birth weight infants at term: a comparison among head circumference, ultrasound, and magnetic resonance imaging.

OBJECTIVES: The aim of this study was to assess the relationship among the size of the lateral ventricles, head-circumference measure, and brain volumes. In addition, the association between ventricular dilatation and various brain lesions was defined. PATIENTS AND METHODS: A total of 257 preterm very low birth weight (< or =1500 g) infants who met the inclusion criteria were born in Turku University Central Hospital between 2001 and 2006. A total of 209 (84.8%) of 218 survivors participated in the study. The measurements at term included the ventricular brain ratio, the widths of the frontal and occipital horns of the lateral ventricles by ultrasound, total and regional brain volumes by MRI, and head circumference. Brain lesions were defined by ultrasound at 3 to 5, 7 to 10, and 30 days of age monthly until discharge and by MRI and ultrasound at term. RESULTS: An abnormal ventricular brain ratio (>0.35), an increasing number of dilated ventricular horns, and smaller head circumference were significantly associated with smaller total brain tissue volume. The abnormal ventricular brain ratio and the increasing number of dilated ventricular horns in ultrasound associated with larger ventricular volumes in MRI, and a smaller head circumference was associated significantly with reduced regional brain tissue volumes. Brain lesions were more common in infants with ventriculomegaly. CONCLUSIONS: The ventricular brain ratio, widths of the lateral ventricular horns, and head circumference are appropriate measures for the estimation of both total and regional brain tissue volumes. Ventriculomegaly is strongly associated with brain lesions.

Does placental inflammation relate to brain lesions and volume in preterm infants?

OBJECTIVES: To evaluate the association between histologic inflammation of placenta and brain findings in ultrasound examinations and regional brain volumes in magnetic resonance imaging in very-low-birth-weight (VLBW) or in very preterm infants. STUDY DESIGN: VLBW or very preterm infants (n = 121) were categorized into 3 groups according to the most pathologic brain finding on ultrasound examinations until term. The brain magnetic resonance imaging performed at term was analyzed for regional brain volumes. The placentas were analyzed for histologic inflammatory findings. RESULTS: Histologic chorioamnionitis on the fetal side correlated to brain lesions in univariate but not in multivariate analyses. Low gestational age was the only significant risk factor for brain lesions in multivariate analysis (P < .0001). Histologic chorioamnionitis was not associated with brain volumes in multivariate analyses. Female sex, low gestational age, and low birth weight z score correlated to smaller volumes in total brain tissue (P = .001, P = .0002, P < .0001, respectively) and cerebellum (P = .047, P = .003, P = .001, respectively). In addition, low gestational age and low-birth-weight z score correlated to a smaller combined volume of basal ganglia and thalami (P = .0002). CONCLUSIONS: Placental inflammation does not appear to correlate to brain lesions or smaller regional brain volumes in VLBW or in very preterm infants at term age.

Acoustic quality of cry in very-low-birth-weight infants at the age of 1 1/2 years.

BACKGROUND: Infant cry characteristics reflect the integrity of the central nervous system. Previous studies have shown that preterm infants and infants with neurological conditions have different cry characteristics such as fundamental frequency compared to healthy full-term infants. Cry characteristics of preterm infants after the first year of life have not been studied. AIMS: The aim of this study was to assess the quality of cry in 1 1/2-year-old very-low-birth-weight infants (VLBWI, < or =1500 g at birth). STUDY SUBJECTS AND DESIGN: Study groups included 21 VLBWI and 25 healthy full-term controls. Thirty seconds of pain cry after vaccination was recorded at well-baby clinics. The first cry utterance was acoustically analyzed using Praat software. The quality of cry was compared between the groups. In addition, the association of cry quality to patient characteristics, to developmental outcome, and to findings in brain imaging studies of the VLBWI was studied. RESULTS: The cry response was elicited in 20 of the 21 VLBWI and in 20 out of 25 full-term infants. VLBWI had higher minimum fundamental frequency and fourth formant values. Patient characteristics that were associated with cry quality were 5-min Apgar scores, the occurrence of bronchopulmonary dysplasia, Bayley Psychomotor Index scores at 12 months, and current weight and head circumference. CONCLUSIONS: Differences found between the study groups were not explained primarily by brain pathology or by patient characteristics, so it seems that prematurity has an impact on cry quality still at the age of 1 1/2 years.

Antenatal Doppler measurements and early brain injury in very low birth weight infants.

OBJECTIVE: To determine the correlation between fetoplacental blood flow and brain injury and volumes in very low birth weight (VLBW) infants. STUDY DESIGN: Antenatal blood flow from the umbilical artery (UA), middle cerebral artery (MCA), and descending aorta was determined in 70 VLBW infants. The directions of the total diastolic flow of the aortic isthmus and the end-diastolic flow of ductus venosus also were measured. Serial brain ultrasound examinations and MRI at term were performed to assess brain abnormalities. On the basis of brain imaging findings, the newborn infants were classified as normal (n = 14), intermediate brain pathology (n = 31), and major pathology (n = 25) groups. RESULTS: Abnormalities in fetoplacental blood flow were not related to anatomic brain lesions. However, an abnormal UA/MCA pulsatility index ratio was associated with reduced total brain volume (mean, 360 mL; SD, 32.5 mL) and reduced cerebral volume (344 mL; SD, 28.4 mL) compared with infants with normal UA/MCA pulsatility index ratio (mean, 405 mL; SD, 51.3 mL, P = .01, and mean, 368 mL; SD, 52.3 mL, P = .012), respectively. CONCLUSIONS: Redistribution of fetal blood flow in VLBW infants is associated with reduced brain volume at term age. Neurodevelopmental follow-up of this cohort will clarify the significance of these blood flow changes on development.

Relation of prematurity and brain injury to crying behavior in infancy.

OBJECTIVES: The objective of this study was to assess crying behavior during infancy in very preterm infants with or without brain injury. METHODS: A total of 125 very low birth weight infants survived during January 2001 to July 2004 in Turku University Hospital, Finland. They were categorized according to the most pathologic brain finding either in ultrasound or MRI. Baby Day Diary was used to assess crying behavior at term, 6 weeks, and 5 months of corrected age. The behavior of a group of term control infants (n = 49) was assessed at 5 months. RESULTS: Severe brain injuries in very low birth weight infants did not affect the duration of fussing or crying. In very low birth weight infants, brain injuries did not affect the frequency of fussing or crying bouts or the development of circadian rhythm in crying behavior. At 5 months of corrected age, fussing bouts were more frequent in very low birth weight infants compared with term control infants (6.4 per day vs 4.5 per day), and very low birth weight infants were held more (169 minutes [97] vs 130 minutes [69], respectively). CONCLUSIONS: This prospective study using a validated cry diary showed that brain injuries that are related to prematurity do not have major effects on crying behavior or development of circadian rhythm. Prematurity does not increase the duration but increases the frequency of fussing and crying at 5 months of corrected age compared with term control infants. It also seems that prematurity and brain pathology may increase caregiving activity in the form of holding.