SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Exploring the multiple-hit hypothesis of preterm white matter damage using diffusion MRI.

Barnett, ML; Tusor, N; Ball, G; Chew, A; Falconer, S; Aljabar, P; Kimpton, JA; Kennea, N; Rutherford, M; David Edwards, A; et al. Barnett, ML; Tusor, N; Ball, G; Chew, A; Falconer, S; Aljabar, P; Kimpton, JA; Kennea, N; Rutherford, M; David Edwards, A; Counsell, SJ (2018) Exploring the multiple-hit hypothesis of preterm white matter damage using diffusion MRI. Neuroimage Clin, 17. pp. 596-606. ISSN 2213-1582 https://doi.org/10.1016/j.nicl.2017.11.017
SGUL Authors: Kennea, Nigel

[img]
Preview
PDF Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview

Abstract

Background: Preterm infants are at high risk of diffuse white matter injury and adverse neurodevelopmental outcome. The multiple hit hypothesis suggests that the risk of white matter injury increases with cumulative exposure to multiple perinatal risk factors. Our aim was to test this hypothesis in a large cohort of preterm infants using diffusion weighted magnetic resonance imaging (dMRI). Methods: We studied 491 infants (52% male) without focal destructive brain lesions born at < 34 weeks, who underwent structural and dMRI at a specialist Neonatal Imaging Centre. The median (range) gestational age (GA) at birth was 30+ 1 (23+ 2-33+ 5) weeks and median postmenstrual age at scan was 42+ 1 (38-45) weeks. dMRI data were analyzed using tract based spatial statistics and the relationship between dMRI measures in white matter and individual perinatal risk factors was assessed. We tested the hypothesis that increased exposure to perinatal risk factors was associated with lower fractional anisotropy (FA), and higher radial, axial and mean diffusivity (RD, AD, MD) in white matter. Neurodevelopmental performance was investigated using the Bayley Scales of Infant and Toddler Development, Third Edition (BSITD-III) in a subset of 381 infants at 20 months corrected age. We tested the hypothesis that lower FA and higher RD, AD and MD in white matter were associated with poorer neurodevelopmental performance. Results: Identified risk factors for diffuse white matter injury were lower GA at birth, fetal growth restriction, increased number of days requiring ventilation and parenteral nutrition, necrotizing enterocolitis and male sex. Clinical chorioamnionitis and patent ductus arteriosus were not associated with white matter injury. Multivariate analysis demonstrated that fetal growth restriction, increased number of days requiring ventilation and parenteral nutrition were independently associated with lower FA values. Exposure to cumulative risk factors was associated with reduced white matter FA and FA values at term equivalent age were associated with subsequent neurodevelopmental performance. Conclusion: This study suggests multiple perinatal risk factors have an independent association with diffuse white matter injury at term equivalent age and exposure to multiple perinatal risk factors exacerbates dMRI defined, clinically significant white matter injury. Our findings support the multiple hit hypothesis for preterm white matter injury.

Item Type: Article
Additional Information: © 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).
Keywords: ALIC, anterior limb of the internal capsule, BSITD-III, Bayley Scales of Infant and Toddler Development Third Edition, Brain, Development, Diffusion MRI, GA, gestational age, IMD, index of multiple deprivation, Multiple hit hypothesis, PLIC, posterior limb of the internal capsule, PMA, postmenstrual age, Prematurity, SLF, superior longitudinal fasciculus, dMRI, diffusion magnetic resonance imaging, Brain, Brain Injuries, Cohort Studies, Diffusion Magnetic Resonance Imaging, Diffusion Tensor Imaging, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Male, Risk Factors, White Matter, Brain, Humans, Brain Injuries, Diffusion Magnetic Resonance Imaging, Risk Factors, Cohort Studies, Gestational Age, Infant, Newborn, Infant, Premature, Male, Diffusion Tensor Imaging, White Matter, Brain, Development, Diffusion MRI, Prematurity, Multiple hit hypothesis
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Neuroimage Clin
ISSN: 2213-1582
Language: eng
Dates:
DateEvent
2018Published
21 November 2017Published Online
18 November 2017Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
MR/J014311/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MR/K006355/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MC_U120088465Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MR/L011530/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
RP-PG-0707-10154Department of Healthhttp://dx.doi.org/10.13039/501100000276
PubMed ID: 29234596
Web of Science ID: WOS:000426180300064
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/110404
Publisher's version: https://doi.org/10.1016/j.nicl.2017.11.017

Actions (login required)

Edit Item Edit Item