Neonatal cranial ultrasound abnormalities in LBW infants: Relation to cognitive outcomes at age six

Authors

Agnes H. Whitaker, Columbia University
Judy F. Feldman, Columbia University
Ronan Van Rossem, Columbia University
Irvin Sam Schonfeld, CUNY Graduate CenterFollow
Jennifer A. Pinto-Martin, University of Pennsylvania
Carolyn Torre, Columbia University
Suzannah R. Blumenthal, Columbia University
Nigel S. Paneth, Michigan State University

Document Type

Article

Publication Date

1996

Abstract

bjective: To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age.
Design: Prospective cohort study.
Sample and Methods: Six-year follow-up data were obtained on a regional birth cohort of LBW infants (< 2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors.
Results: The sample as a whole had a significantly elevated rate of mental retardation (MR; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7; CI, 1.3 to 10.8); isolated GM/IVH was more modestly related to MR (OR, 4.6; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills.
Conclusion: Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants.

Comments

This work was originally published in Pediatrics.