358 - Factors associated with abnormal brain MRI in very low birth weight infants

Poster Number: 358
Publication Number: 358.132

Nagapranati S. Nanduri, LAC+USC Medical Center Neonatology, Philadelphia, PA, United States; Alexis Hisey, LAC + USC Medical Center, Los Angeles, CA, United States; Christiana Marquez, LAC USC Medical Center, Yorba Linda, CA, United States; Rangasamy Ramanathan, Keck School of Medicine of USC, Los Angeles, CA, United States; Manoj Biniwale, USC Keck School of Medicine, Los Angeles, CA, United States

Background: Preterm very low birth weight infants (VLBW) are at greater risk of neurodevelopmental morbidity due to impaired brain development. Though it is clinically difficult to predict the outcome of these infants when discharged from the NICU, abnormal brain MRI findings may predict long-term consequences. Existing research shows very limited diagnostic testing done on these infants to assess neurodevelopment in the NICU. Term-equivalent MRI may indicate the need for further developmental assessments and close follow up.

Objective: This study aims to evaluate the association between various intensive care interventions and abnormal brain MRI findings in preterm VLBW infants at term gestation.

Design/Methods: Retrospective data of preterm VLBW infants ( < 1500 g) born between 2009 and 2021 at LAC + USC Medical Center was evaluated for MRI brain findings. Institutional IRB approval was obtained. An abnormal MRI was defined as abnormalities documented by pediatric neuroradiologists, including hemorrhage, periventricular leukomalacia, or ischemia. Maternal factors, resuscitation at delivery, and early neonatal factors were analyzed for significance.

Results: Out of 356 infants matching inclusion criteria, 191 (52.3%) had abnormal brain MRIs. Lower gestational age (p < 0.001) correlated strongly with abnormal MRI. Infants delivered by spontaneous vaginal delivery as well as those intubated in the delivery room and with low 5 min Apgar scores were more likely to have abnormal MRI. VLBW infants with higher ventilation and oxygen requirements within the first 24 hours of life were at higher risk for developing abnormal MRI. Infants requiring invasive ventilation support beyond 24 hours of life were also more likely to have abnormal MRI, including those requiring high frequency oscillatory ventilation and jet ventilation. Incidence of abnormal MRI in infants with hemodynamically significant patent ductus arteriosus (PDA) was also significantly higher. These infants were also more likely to have initial low hematocrit (p = 0.003) and severe intraventricular hemorrhage on first cranial ultrasound (p = 0.016). NICU duration of stay was longer for infants with abnormal MRI (p < 0.001). Over 50% of abnormal MRI findings were related to cerebellar abnormalities.Conclusion(s): VLBW infants with factors including need for intubation in the delivery room, higher ventilation and oxygen requirement in the first 24 hours of life, longer invasive ventilation, hemodynamically significant PDA, low hematocrit and abnormal initial cranial ultrasound predict abnormal brain MRI findings performed at term equivalent age.
Table 1. Findings associated with brain MRI abnormalitiesTable1_MRI.jpeg