White Matter Injury and General Movements in High-Risk Preterm Infants

Fellows’ Journal Club

Cerebral palsy has been predicted by analysis of spontaneous movements in the infant termed “General Movement Assessment.” The authors evaluated the utility of General Movement Assessment in predicting adverse cognitive, language, and motor outcomes in very preterm infants and attempted to identify brain imaging markers associated with both adverse outcomes and aberrant general movements in 47 preterm infants using MRI volumetric analysis and DTI. Nine infants had aberrant general movements and were more likely to have adverse neurodevelopmental outcomes, compared with infants with normal movements. In infants with aberrant movements, Tract-Based Spatial Statistics analysis identified significantly lower fractional anisotropy in widespread WM tracts. They conclude that aberrant general movements at 10–15 weeks’ postterm are associated with adverse neurodevelopmental outcomes and specific white matter microstructure abnormalities for cognitive, language, and motor delays.

Abstract

Figure 1 from paper
Differences in white matter at term-equivalent age between infants with normal and aberrant fidgety movements at 10–15 weeks. Mean FA skeleton, in green, is overlaid on the mean FA map. Superimposed are pseudocolored voxels having significantly greater anisotropy in infants with normal than in infants with aberrant fidgety movements. Color bar shows the range of P values represented by the pseudocolors. Significantly higher regions of FA can be observed in the splenium (ccs) and genu (ccg) of the corpus callosum, inferior (ilf) and superior longitudinal fasciculus (slf), fronto-occipital fasciculus (fof), anterior (alic) and posterior (plic) internal capsule, corona radiata (cr), cerebellar peduncles (cp), and fornix/stria terminalis (fx/st). Z represents the MR imaging axial section coordinates (zero is the center of the anterior commissure).

BACKGROUND AND PURPOSE

Very preterm infants (birth weight, <1500 g) are at increased risk of cognitive and motor impairment, including cerebral palsy. These adverse neurodevelopmental outcomes are associated with white matter abnormalities on MR imaging at term-equivalent age. Cerebral palsy has been predicted by analysis of spontaneous movements in the infant termed “General Movement Assessment.” The goal of this study was to determine the utility of General Movement Assessment in predicting adverse cognitive, language, and motor outcomes in very preterm infants and to identify brain imaging markers associated with both adverse outcomes and aberrant general movements.

MATERIALS AND METHODS

In this prospective study of 47 preterm infants of 24–30 weeks’ gestation, brain MR imaging was performed at term-equivalent age. Infants underwent T1- and T2-weighted imaging for volumetric analysis and DTI. General movements were assessed at 10–15 weeks’ postterm age, and neurodevelopmental outcomes were evaluated at 2 years by using the Bayley Scales of Infant and Toddler Development III.

RESULTS

Nine infants had aberrant general movements and were more likely to have adverse neurodevelopmental outcomes, compared with infants with normal movements. In infants with aberrant movements, Tract-Based Spatial Statistics analysis identified significantly lower fractional anisotropy in widespread white matter tracts, including the corpus callosum, inferior longitudinal and fronto-occipital fasciculi, internal capsule, and optic radiation. The subset of infants having both aberrant movements and abnormal neurodevelopmental outcomes in cognitive, language, and motor skills had significantly lower fractional anisotropy in specific brain regions.

CONCLUSIONS

Aberrant general movements at 10–15 weeks’ postterm are associated with adverse neurodevelopmental outcomes and specific white matter microstructure abnormalities for cognitive, language, and motor delays.

Read this article: http://bit.ly/2kBpNQU

White Matter Injury and General Movements in High-Risk Preterm Infants
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.

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