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. |
