Ultrasound measurements of brain structures differ between moderate-late preterm and full-term infants at term equivalent age

Breech presentation at birth has short-term but no long-term effect on neurodevelopmental outcome in moderate and late preterm infants

AIM

To investigate the effects of fetal presentation at birth on spontaneous postnatal movements, postures and neurodevelopmental outcome in moderate and late preterm (MLPT) infants.

METHODS

The study population comprised 154 infants (55 % male, 55 % singletons) of whom 33 (21 %) were born in breech presentation. During the neonatal period and at 3-4 months post-term age, categorical Prechtl general movements assessment (GMA) and detailed scoring of motor functions was performed by means of the General Movement Optimality Score (GMOS) neonatally and Motor Optimality Score-Revised (MOS-R) later. Neurodevelopment was assessed at one year using Bayley-III.

RESULTS

Infants born in breech presentation more frequently exhibited pathological GMs (p = 0.05) with increased stiffness in the lower extremities (p < 0.01) at neonatal age. Detailed motor assessments at 3-4 months post-term age (MOS-R) showed lower scores in infants born in breech compared to those with cephalic presentation at birth. Fetal presentation at the time of delivery did not impact neurodevelopmental outcomes at 12 months.

CONCLUSION

Breech presentation at birth affected GMs and movement assessments in the early postnatal period but had no persistent impact on neurodevelopmental outcomes at one year, suggesting a transient effect on lower extremity movements. Given stiffness in the extremities in neonates is an alarm sign and might relate to cramped synchronized GMs indicating an increased risk for cerebral palsy, fetal presentation at birth should be taken into consideration in neonatal neuromotor assessments.

Ultrasound evaluation of brain parenchyma in preterm infants with prenatal opioid exposure

OBJECTIVE

To evaluate whether preterm infants with prenatal opioid exposure had differences in brain size on head ultrasounds (HUS) in comparison to non-exposed infants.

STUDY DESIGN

Preterm infants ≤34 weeks with prenatal opioid exposure (n = 47) and matched non-exposed infants (n = 62) with early HUSs were examined. Fifteen brain measurements were made and linear regression models performed to evaluate differences.

RESULTS

Brain measurements were smaller in the right ventricular index [β = -0.18 mm (95% CI -0.32, -0.03]), left ventricular index [β = -0.04 mm (95% CI -0.08, -0.003)], left basal ganglia insula [β = -0.10 mm (95% CI -0.15, -0.04)], right basal ganglia insula [β = -0.08 mm (95% CI -0.14, -0.03)], corpus callosum fastigium length [β = -0.16 mm (95% CI -0.25, -0.06)], intracranial height index [β = -0.31 mm (95% CI -0.44, -0.18)], and transcerebellar measurements [β = -0.13 (95% CI -0.25, -0.02)] in the opioid-exposed group.

CONCLUSIONS

Preterm infants with prenatal opioid exposure have smaller brain sizes compared to non-exposed infants, potentially increasing their risk for neurodevelopmental abnormalities.

The Association of Dexamethasone and Hydrocortisone with Cerebellar Growth in Premature Infants

OBJECTIVES

Corticosteroids are used to prevent or treat lung disease of prematurity. While neurological side effects have been reported, detailed effects on cerebellar growth are unknown. This study aimed to compare cerebellar growth in premature infants who received dexamethasone or hydrocortisone to premature infants who did not receive postnatal corticosteroids.

STUDY DESIGN

Retrospective case-control study in infants born at a gestational age of <29 weeks and admitted to two level 3 neonatal intensive care units. Exclusion criteria were severe congenital anomalies and cerebellar or severe supratentorial lesions. Infants were treated with dexamethasone (unit 1) or hydrocortisone (unit 2) for chronic lung disease. Controls (unit 1) did not receive postnatal corticosteroids. Sequential head circumference (HC) and ultrasound measurements of transcerebellar diameter (TCD), biparietal diameter (BPD), and corpus callosum-fastigium length (CCFL) were performed until 40 weeks' postmenstrual age (PMA). Growth was assessed using linear mixed models correcting for PMA at measurement, sex, HC z-score at birth, and a propensity score indicating illness severity. Group differences before treatment were assessed using linear regression.

RESULTS

346 infants were included (68 dexamethasone, 37 hydrocortisone, 241 controls). Before starting corticosteroids, TCD, BPD, and HC measurements did not differ between patients and controls at a comparable PMA. After starting treatment, both types of corticosteroid had a negative association with TCD growth. BPD, CCFL, and HC growth were not negatively affected.

CONCLUSION

Administration of dexamethasone and hydrocortisone are both associated with impaired cerebellar growth in premature infants without evident negative associations with cerebral growth.