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At 34 weeks, the brain weight of preterm infants is only 65% that of term infants, and the cortex volume is 53% that of term infants. Damage at this stage of development will also change the trajectory of specific processes in the development of neurons and glial cells, resulting in neurological dysfunction in survivors.The incidence of cerebral palsy in late preterm infants is three times higher than in term infants, and about 25% lag behind term infants in learning, language and other neurodevelopment. At 34-37 weeks of gestation, oligodendrocytes are still late oligodendrocyte precursors and vascular development of the white matter area is immature, making the brain more prone to white matter injury (WMI).
1.1Patients Late preterm infants who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2022.
Risk factors prompting MRI evaluation included: (1) premature rupture of fetal membrane, intrauterine distress or placental abruption before delivery; (2) asphyxia, resuscitation and rescue history, circulatory dysfunction and infection during or after delivery; and (3) early convulsions.
1.2 Assessment of brain injury MRI scans were analyzed by a radiologist and a newborn pediatrician who were unfamiliar with the clinical history. WMI diagnosis was carried out as described by reference, with some improvements.
1.3 Collection of clinical data Data, including delivery by cesarean section, gestational hypertension, diabetes mellitus, premature rupture of membranes and placental abruption, were collected for the mothers. Gestational age, weight, gender, whether small for gestational age, Apgar score, resuscitation history, circulatory disorders, early-onset sepsis, convulsions, and MRI data were collected for the newborns.
History of resuscitation and rescue refers to positive pressure ventilation, tracheal intubation, chest compression or epinephrine application during labor; circulatory disorders include at least two of the following indicators: prolonged capillary filling time, hypotension, oliguria, increased heart rate and increased liver.
1.4 Instrumentation MRI of the head was performed using an Intera Achieva 3.0T MRI system (Philips, Best, Netherlands). All infants were scanned by conventional MRI and diffusion-weighted imaging (DWI). Because of the retrospective study design, there are differences in imaging schemes, sequences and parameters measured.
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| Measure | Description | Time Frame |
|---|---|---|
| Imaging evaluation of different types of white matter injury in late preterm infants | The number of participants of white matter injury in late preterm infants, number of late preterm infants with different degrees (mild, moderate, severe) white matter injury and the imaging and pathological characteristics of early white matter injury (within 2 weeks after birth) using T1WI,T2WI,DWI,SWI. | 2009.1-2022.12 |
| Imaging differentiation of hemorrhagic and non hemorrhagic injuries | Using magnetic resonance technology, especially magnetic sensitivity, to identify and classify the cases of white matter injury in late preterm infants with or without hemorrhagic injury | 2009.1-2022.12 |
| Number of late preterm infants and distribution of gray matter injury in late preterm infants with white matter injury | Using magnetic resonance technology, To determine the number of gray matter injuries (cortex, thalamus, basal ganglia, brainstem) in late preterm infants with white matter injury | 2009.1-2022.12 |
| The number and distribution of PVL like injury in white matter injury of late preterm infants | Using magnetic resonance technology, to determine the probability of PVL-like injury in white matter injury of late preterm infants and which type and location are more prone to PVL-like outcomes | 2009.1-2022.12 |
| Measure | Description | Time Frame |
|---|---|---|
| Record of gestational age | To identify the high risk factors of brain white matter injury in late preterm infants，gestational age(weeks) of every late preterm infant will be recorded | 2009.1-2022.12 |
| Record of weight |
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Inclusion Criteria:
Exclusion Criteria:
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Late preterm infants undergoing head MRI, who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2022, were enrolled in this study.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dan Chen, master | Contact | +8618940259088 | youdrop@sina.com |
| Name | Affiliation | Role |
|---|---|---|
| Jian Mao, doctor | Shengjing Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shengjing Hospital of China Medical University | Recruiting | Shenyang | Liaoning | 110004 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16731282 | Result | Kinney HC. The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol. 2006 Apr;30(2):81-8. doi: 10.1053/j.semperi.2006.02.006. | |
| 19081113 | Result | Petrini JR, Dias T, McCormick MC, Massolo ML, Green NS, Escobar GJ. Increased risk of adverse neurological development for late preterm infants. J Pediatr. 2009 Feb;154(2):169-76. doi: 10.1016/j.jpeds.2008.08.020. Epub 2008 Dec 10. |
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Sharing the imaging results.
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To identify the high risk factors of brain white matter injury in late preterm infants，weight(g) of every late preterm infant will be recorded
| 2009.1-2022.12 |
| Record of gender | To identify the high risk factors of brain white matter injury in late preterm infants， gender(male/female) of every late preterm infant will be recorded | 2009.1-2022.12 |
| Record of small for gestational age | To identify the high risk factors of brain white matter injury in late preterm infants，whether small for gestational age(yes/no) of every late preterm infant will be recorded | 2009.1-2022.12 |
| Record of apgar score | To identify the high risk factors of brain white matter injury in late preterm infants，Apgar score(1-10) of every late preterm infant will be recorded | 2009.1-2022.12 |
| Number of resuscitation history | To identify the high risk factors of brain white matter injury in late preterm infants，resuscitation history(yes/no) of every late preterm infant will be recorded.History of resuscitation and rescue refers to positive pressure ventilation, tracheal intubation, chest compression or epinephrine application during labor | 2009.1-2022.12 |
| Number of circulatory disorders | To identify the high risk factors of brain white matter injury in late preterm infants，circulatory disorders(yes/no) of every late preterm infant will be recorded.Circulatory disorders include at least two of the following indicators: prolonged capillary filling time, hypotension, oliguria, increased heart rate and increased liver. | 2009.1-2022.12 |
| Number of early-onset sepsis | To identify the high risk factors of brain white matter injury in late preterm infants，early-onset sepsis(yes/no) of every late preterm infant will be recorded | 2009.1-2022.12 |
| Number of convulsions | To identify the high risk factors of brain white matter injury in late preterm infants，convulsions(yes/no) of every late preterm infant will be recorded | 2009.1-2022.12 |
| Record of delivery by cesarean section | To identify the high risk factors of brain white matter injury in late preterm infants，delivery by cesarean section(yes/no) of every mother will be recorded | 2009.1-2022.12 |
| Number of gestational hypertension | To identify the high risk factors of brain white matter injury in late preterm infants，gestational hypertension(mmHg) of every mother will be recorded | 2009.1-2022.12 |
| Number of diabetes mellitus | To identify the high risk factors of brain white matter injury in late preterm infants，diabetes mellitus(yes/no) of every mother will be recorded | 2009.1-2022.12 |
| Number of premature rupture of membranes | To identify the high risk factors of brain white matter injury in late preterm infants，premature rupture of membranes(yes/no) of every mother will be recorded | 2009.1-2022.12 |
| Number of placental abruption | To identify the high risk factors of brain white matter injury in late preterm infants，placental abruption(yes/no) of every mother will be recorded | 2009.1-2022.12 |
| 15741373 | Result | Limperopoulos C, Soul JS, Gauvreau K, Huppi PS, Warfield SK, Bassan H, Robertson RL, Volpe JJ, du Plessis AJ. Late gestation cerebellar growth is rapid and impeded by premature birth. Pediatrics. 2005 Mar;115(3):688-95. doi: 10.1542/peds.2004-1169. |
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| 15128918 | Result | Ballabh P, Braun A, Nedergaard M. Anatomic analysis of blood vessels in germinal matrix, cerebral cortex, and white matter in developing infants. Pediatr Res. 2004 Jul;56(1):117-24. doi: 10.1203/01.PDR.0000130472.30874.FF. Epub 2004 May 5. |
| 21960491 | Result | Arrigoni F, Parazzini C, Righini A, Doneda C, Ramenghi LA, Lista G, Triulzi F. Deep medullary vein involvement in neonates with brain damage: an MR imaging study. AJNR Am J Neuroradiol. 2011 Dec;32(11):2030-6. doi: 10.3174/ajnr.A2687. Epub 2011 Sep 29. |
| 28076020 | Result | Taoka T, Fukusumi A, Miyasaka T, Kawai H, Nakane T, Kichikawa K, Naganawa S. Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders. Radiographics. 2017 Jan-Feb;37(1):281-297. doi: 10.1148/rg.2017160061. |
| 29731359 | Result | Vilan A, Ribeiro JM, Reis C, Sampaio L. Deep Medullary Veins and Brain Injury. J Pediatr. 2018 Sep;200:290-290.e1. doi: 10.1016/j.jpeds.2018.03.051. Epub 2018 May 3. No abstract available. |
| 19026331 | Result | du Plessis AJ. Cerebrovascular injury in premature infants: current understanding and challenges for future prevention. Clin Perinatol. 2008 Dec;35(4):609-41, v. doi: 10.1016/j.clp.2008.07.010. |
| 27257863 | Result | Martinez-Biarge M, Groenendaal F, Kersbergen KJ, Benders MJ, Foti F, Cowan FM, de Vries LS. MRI Based Preterm White Matter Injury Classification: The Importance of Sequential Imaging in Determining Severity of Injury. PLoS One. 2016 Jun 3;11(6):e0156245. doi: 10.1371/journal.pone.0156245. eCollection 2016. |
| 19699161 | Result | Ramenghi LA, Govaert P, Fumagalli M, Bassi L, Mosca F. Neonatal cerebral sinovenous thrombosis. Semin Fetal Neonatal Med. 2009 Oct;14(5):278-83. doi: 10.1016/j.siny.2009.07.010. Epub 2009 Aug 20. |
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