IMPACT OF MRI IN DEFINING THE CEREBRAL WHITE & GRAY MATTER ABNORMALITIES, IN PRE-TERM INFANT.
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The aim of this study is to label the nature and scope of white and gray matter MRI abnormalities in preterm infants with very low birth weight, with its relationship to the pre-natal aspects, which affixed to the occurrence and severity of these cerebral MRI abnormalities. Fifty preterm infants admitted to the neonatal intensive care unit MCU at ERFAN & KING FAHAD Hospitals, during 23 months, enlisted to undergo an MRI scan. Analysis the scans down according to scoring system of the MRI findings utilizing a combination of criteria for white matter (cysts, signal abnormality, loss of volume, ventriculomegaly, corpus callosal thinning, myelination) and gray matter (gray matter signal abnormality, delayed gyration, wide sub-arachnoids space) abnormalities, as well as the presence of moderate to severe white matter, and gray matter scores. The mean gestational age was 28.5±I.0 weeks, and mean birth weight was II 75a I0.05g. The greatest predictors for moderate-severe white matter abnormality were: Lower gestational age (P<0.01), maternal fever (Pc 0.04), proven sepsis in the infant at delivery (P=0.05), patent ductus arteriosus =0 004), grade Ill/IV intra-ventricular hemorrhage (P-0.02), and the occurrence of a pneumothorax (P —0.05), inotrope use (P<0.001). There was a significant protective effect of intrauterine growth restriction (P=0.05). Gray matter abnormality was highly related to the presence and severity of white matter abnormality. A unique pattern of cerebral aberration consisting of significant diffuse white matter atrophy, ventnculomegaly, immature gyral development, and enlarged sub-arachnoids space were found in 3 of 4 preterm infants with birth gestation <26 weeks, rising the risk for acquiring neurodevelopmental disability. This MRI study confirms a high rate of cerebral white matter alteration at term in unselected preterit, infants, which is predominantly a result of non-cystic injury in the immature infant, and claritying that the major prenatal risk factors for white matter abnormality are related to prenatal infection, particularly maternal fever and infant sepsis, and hypotension with inotrope use.