Antecedents of Objectively Diagnosed Diffuse White Matter Abnormality in Very Preterm Infants

Pediatr Neurol. 2020 May:106:56-62. doi: 10.1016/j.pediatrneurol.2020.01.011. Epub 2020 Feb 4.

Abstract

Background: Diffuse white matter abnormality (diffuse excessive high signal intensity) is the most common finding on structural brain magnetic resonance imaging (MRI) at term-equivalent age in very preterm infants. Yet, there remains a large gap in our understanding of the etiology of diffuse white matter abnormality. Our objective was to evaluate perinatal and neonatal inflammation-associated antecedents of diffuse white matter abnormality on MRI.

Methods: We prospectively enrolled 110 very preterm infants born at ≤31 weeks gestational age and collected data on multiple perinatal/neonatal exposures, especially inflammation initiating-illnesses. We performed structural MRI at term-equivalent age and quantified the volume of diffuse white matter abnormality objectively. Multivariable regression was used to identify clinical antecedents of diffuse white matter abnormality.

Results: The mean (S.D.) birth gestational age of the final study sample of 98 very preterm infants was 28.3 (2.5) weeks. Multiple inflammation initiating-illnesses were associated with diffuse white matter abnormality in univariate analyses. In multivariable linear regression analyses controlling for gestational age, severe retinopathy of prematurity (P < 0.001) and bronchopulmonary dysplasia (P = 0.006) were independent risk factors, whereas maternal treatment with 17-hydroxyprogesterone (P < 0.001) was protective of later development of objectively quantified diffuse white matter abnormality.

Conclusions: We identified several perinatal and neonatal antecedent clinical factors associated with diffuse white matter abnormality. Although we found some support for inflammation as a common underlying mechanism, larger studies are needed to validate inflammation as a potential common pathway to the development of diffuse white matter abnormality in very preterm infants.

Keywords: Bronchopulmonary dysplasia; Diffuse white matter abnormality; Infant; Magnetic resonance imaging; Premature; Retinopathy of prematurity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchopulmonary Dysplasia / diagnostic imaging
  • Bronchopulmonary Dysplasia / pathology*
  • Female
  • Gestational Age
  • Humans
  • Infant, Extremely Premature
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / diagnostic imaging
  • Infant, Premature, Diseases / pathology*
  • Inflammation / diagnostic imaging
  • Inflammation / pathology*
  • Magnetic Resonance Imaging
  • Pregnancy
  • Pregnancy Complications* / drug therapy
  • Prospective Studies
  • Protective Factors
  • Retinopathy of Prematurity / diagnostic imaging
  • Retinopathy of Prematurity / pathology*
  • Risk Factors
  • White Matter / diagnostic imaging
  • White Matter / pathology*