Clinical Risk Factors for Punctate White Matter Lesions on Early Magnetic Resonance Imaging in Preterm Newborns

Nienke Wagenaar; Vann Chau; Floris Groenendaal; Karina J Kersbergen; Kenneth J Poskitt; Ruth E Grunau; Anne Synnes; Emma G Duerden; Linda S de Vries; Steven P Miller; Manon J N L Benders

doi:10.1016/j.jpeds.2016.11.073

Clinical Risk Factors for Punctate White Matter Lesions on Early Magnetic Resonance Imaging in Preterm Newborns

J Pediatr. 2017 Mar:182:34-40.e1. doi: 10.1016/j.jpeds.2016.11.073. Epub 2017 Jan 4.

Authors

Affiliations

¹ Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
² Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
³ Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.
⁵ Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: m.benders@umcutrecht.nl.

PMID: 28063691
DOI: 10.1016/j.jpeds.2016.11.073

Abstract

Objective: To identify clinical risk factors for punctate white matter lesions (PWML) on early magnetic resonance imaging (MRI) in 2 cohorts of newborns born extremely preterm in different neonatal centers.

Study design: A total of 250 newborns born preterm at less than 28 weeks of gestation (mean 26.4 ± 1.1 weeks) with an early MRI were identified from 2 neonatal centers, in Vancouver, Canada (cohort A, n = 100) and Utrecht, the Netherlands (cohort B, n = 150). Cohort A was imaged as part of a prospective research study and cohort B was imaged as part of routine clinical care. PWML were defined as cluster type foci of hyperintensity on T1-weighted imaging and were identified at a mean postmenstrual age of 31.1 (±1.9) weeks. Multivariable analysis was used to identify clinical factors predictive of PWML.

Results: Cluster type PWML were found in 47 newborns born extremely preterm (18.8%) and were more common in cohort A (32%) than in cohort B (10%). Newborns in cohort A generally were sicker than those in cohort B. Multivariable analyses revealed that greater birth weight (B = 0.002; P < .02), grade II-III intraventricular hemorrhage (B = 0.83; P < .02), and cohort A (B = 1.34; P < .0001) were independent predictors of PWML.

Conclusion: Several risk factors for PWML on early MRI were identified. The interaction among birth weight, intraventricular hemorrhage, and other aspects of postnatal illness as risk factors for PWML warrants further investigation in newborns born extremely preterm and may help to identify modifiable risk factors for PWML.

Keywords: magnetic resonance imaging; neonate; premature; white matter injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Female
Humans
Infant, Extremely Premature
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / pathology*
Magnetic Resonance Imaging / methods*
Male
Netherlands
Prospective Studies
Risk Factors
White Matter / pathology*

Abstract

Publication types

MeSH terms

Grants and funding