Machine learning for understanding and predicting neurodevelopmental outcomes in premature infants: a systematic review

Machine learning techniques for predicting neurodevelopmental impairments in premature infants: a systematic review

Background and objective

Very preterm infants are highly susceptible to Neurodevelopmental Impairments (NDIs), including cognitive, motor, and language deficits. This paper presents a systematic review of the application of Machine Learning (ML) techniques to predict NDIs in premature infants.

Methods

This review presents a comparative analysis of existing studies from January 2018 to December 2023, highlighting their strengths, limitations, and future research directions.

Results

We identified 26 studies that fulfilled the inclusion criteria. In addition, we explore the potential of ML algorithms and discuss commonly used data sources, including clinical and neuroimaging data. Furthermore, the inclusion of omics data as a contemporary approach employed, in other diagnostic contexts is proposed.

Conclusions

We identified limitations and emphasized the significance of employing multimodal data models and explored various alternatives to address the limitations identified in the reviewed studies. The insights derived from this review guide researchers and clinicians toward improving early identification and intervention strategies for NDIs in this vulnerable population.

Prediction of Neurodevelopmental Outcomes in Very Preterm Infants: Comparing Machine Learning Methods to Logistic Regression

PURPOSE

Is machine learning (ML) superior to the traditionally used logistic regression (LR) in prediction of neurodevelopmental outcomes in preterm infants?

OBJECTIVES

To develop and internally validate a ML model to predict neurodevelopmental impairment (NDI) in very preterm infants (<31 weeks) at 36 months corrected age, using clinical predictors.

METHODS

A retrospective cohort of very preterm infants (230-306 weeks) born between January 2004 and December 2016 in Nova Scotia, Canada. Survivors with neurodevelopmental assessment at 36 months corrected age were included. The study sample was randomly split (80:20) into a development and testing datasets. We compared four methods: LR, elastic net (EN), random forest ensemble (RF) and gradient boosting (XGB), in relation to discrimination (AUC), calibration, and diagnostic properties.

RESULTS

Of 811 eligible infants, 663 were included (mean gestational age 28 weeks, mean birth weight 1137 g and 52% male). Of those, 195 (29%) developed NDI and 468 (71%) did not. On internal validation using the testing dataset, all four models provided good discrimination of NDI with comparable AUC. RF was superior to the other three methods with a higher AUC (0.79 vs. 0.74, 0.74, and 0.73 for XGB, EN and LR, respectively), but all models have overlapped CIs.

CONCLUSIONS

In this population-based cohort of very preterm infants, RF was superior to conventional LR in prediction of NDI at 3 years corrected age. Accurate prediction of preterm infants at risk of NDI enables early referrals for intervention programs and resources allocation toward those who are most likely to benefit.

Predicting neurodevelopmental disorders using machine learning models and electronic health records - status of the field

Machine learning (ML) is increasingly used to identify patterns that could predict neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). One key source of multilevel data for ML prediction models includes population-based registers and electronic health records. These can contain rich information on individual and familial medical histories and socio-demographics. This review summarizes studies published between 2010-2022 that used ML algorithms to develop predictive models for NDDs using population-based registers and electronic health records. A literature search identified 1191 articles, of which 32 were retained. Of these, 47% developed ASD prediction models and 25% ADHD models. Classical ML methods were used in 82% of studies and in particular tree-based prediction models performed well. The sensitivity of the models was lower than 75% for most studies, while the area under the curve (AUC) was greater than 75%. The most important predictors were patient and familial medical history and sociodemographic factors. Using private in-house datasets makes comparing and validating model generalizability across studies difficult. The ML model development and reporting guidelines were adopted only in a few recently reported studies. More work is needed to harness the power of data for detecting NDDs early.

A systematic review on machine learning approaches in cerebral palsy research

Background

This review aims to explore advances in the field of cerebral palsy (CP) focusing on machine learning (ML) models. The objectives of this study is to analyze the advances in the application of ML models in the field of CP and to compare the performance of different ML algorithms in terms of their effectiveness in CP identification, classifying CP into its subtypes, prediction of abnormalities in CP, and its management. These objectives guide the review in examining how ML techniques are applied to CP and their potential impact on improving outcomes in CP research and treatment.

Methodology

A total of 20 studies were identified on ML for CP from 2013 to 2023. Search Engines used during the review included electronic databases like PubMed for accessing biomedical and life sciences, IEEE Xplore for technical literature in computer, Google Scholar for a broad range of academic publications, Scopus and Web of Science for multidisciplinary high impact journals. Inclusion criteria included articles containing keywords such as cerebral palsy, machine learning approaches, outcome response, identification, classification, diagnosis, and treatment prediction. Studies were included if they reported the application of ML techniques for CP patients. Peer reviewed articles from 2013 to 2023 were only included for the review. We selected full-text articles, clinical trials, randomized control trial, systematic reviews, narrative reviews, and meta-analyses published in English. Exclusion criteria for the review included studies not directly related to CP. Editorials, opinion pieces, and non-peer-reviewed articles were also excluded. To ensure the validity and reliability of the findings in this review, we thoroughly examined the study designs, focusing on the appropriateness of their methodologies and sample sizes. To synthesize and present the results, data were extracted and organized into tables for easy comparison. The results were presented through a combination of text, tables, and figures, with key findings emphasized in summary tables and relevant graphs.

Results

Random forest (RF) is mainly used for classifying movements and deformities due to CP. Support vector machine (SVM), decision tree (DT), RF, and K-nearest neighbors (KNN) show 100% accuracy in exercise evaluation. RF and DT show 94% accuracy in the classification of gait patterns, multilayer perceptron (MLP) shows 84% accuracy in the classification of CP children, Bayesian causal forests (BCF) have 74% accuracy in predicting the average treatment effect on various orthopedic and neurological conditions. Neural networks are 94.17% accurate in diagnosing CP using eye images. However, the studies varied significantly in their design, sample size, and quality of data, which limits the generalizability of the findings.

Conclusion

Clinical data are primarily used in ML models in the CP field, accounting for almost 47%. With the rise in popularity of machine learning techniques, there has been a rise in interest in developing automated and data-driven approaches to explore the use of ML in CP.

Artificial Intelligence Outcome Prediction in Neonates with Encephalopathy (AI-OPiNE)

Purpose To develop a deep learning algorithm to predict 2-year neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy using MRI and basic clinical data. Materials and Methods In this study, MRI data of term neonates with encephalopathy in the High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial (ClinicalTrials.gov: NCT02811263), who were enrolled from 17 institutions between January 25, 2017, and October 9, 2019, were retrospectively analyzed. The harmonized MRI protocol included T1-weighted, T2-weighted, and diffusion tensor imaging. Deep learning classifiers were trained to predict the primary outcome of the HEAL trial (death or any neurodevelopmental impairment at 2 years) using multisequence MRI and basic clinical variables, including sex and gestational age at birth. Model performance was evaluated on test sets comprising 10% of cases from 15 institutions (in-distribution test set, n = 41) and 10% of cases from two institutions (out-of-distribution test set, n = 41). Model performance in predicting additional secondary outcomes, including death alone, was also assessed. Results For the 414 neonates (mean gestational age, 39 weeks ± 1.4 [SD]; 232 male, 182 female), in the study cohort, 198 (48%) died or had any neurodevelopmental impairment at 2 years. The deep learning model achieved an area under the receiver operating characteristic curve (AUC) of 0.74 (95% CI: 0.60, 0.86) and 63% accuracy in the in-distribution test set and an AUC of 0.77 (95% CI: 0.63, 0.90) and 78% accuracy in the out-of-distribution test set. Performance was similar or better for predicting secondary outcomes. Conclusion Deep learning analysis of neonatal brain MRI yielded high performance for predicting 2-year neurodevelopmental outcomes. Keywords: Convolutional Neural Network (CNN), Prognosis, Pediatrics, Brain, Brain Stem Clinical trial registration no. NCT02811263 Supplemental material is available for this article. © RSNA, 2024 See also commentary by Rafful and Reis Teixeira in this issue.

Predicting 2-year neurodevelopmental outcomes in preterm infants using multimodal structural brain magnetic resonance imaging with local connectivity

The neurodevelopmental outcomes of preterm infants can be stratified based on the level of prematurity. We explored brain structural networks in extremely preterm (EP; < 28 weeks of gestation) and very-to-late (V-LP; ≥ 28 and < 37 weeks of gestation) preterm infants at term-equivalent age to predict 2-year neurodevelopmental outcomes. Using MRI and diffusion MRI on 62 EP and 131 V-LP infants, we built a multimodal feature set for volumetric and structural network analysis. We employed linear and nonlinear machine learning models to predict the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) scores, assessing predictive accuracy and feature importance. Our findings revealed that models incorporating local connectivity features demonstrated high predictive performance for BSID-III subsets in preterm infants. Specifically, for cognitive scores in preterm (variance explained, 17%) and V-LP infants (variance explained, 17%), and for motor scores in EP infants (variance explained, 15%), models with local connectivity features outperformed others. Additionally, a model using only local connectivity features effectively predicted language scores in preterm infants (variance explained, 15%). This study underscores the value of multimodal feature sets, particularly local connectivity, in predicting neurodevelopmental outcomes, highlighting the utility of machine learning in understanding microstructural changes and their implications for early intervention.

Automated neonatal nnU-Net brain MRI extractor trained on a large multi-institutional dataset

Brain extraction, or skull-stripping, is an essential data preprocessing step for machine learning approaches to brain MRI analysis. Currently, there are limited extraction algorithms for the neonatal brain. We aim to adapt an established deep learning algorithm for the automatic segmentation of neonatal brains from MRI, trained on a large multi-institutional dataset for improved generalizability across image acquisition parameters. Our model, ANUBEX (automated neonatal nnU-Net brain MRI extractor), was designed using nnU-Net and was trained on a subset of participants (N = 433) enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) study. We compared the performance of our model to five publicly available models (BET, BSE, CABINET, iBEATv2, ROBEX) across conventional and machine learning methods, tested on two public datasets (NIH and dHCP). We found that our model had a significantly higher Dice score on the aggregate of both data sets and comparable or significantly higher Dice scores on the NIH (low-resolution) and dHCP (high-resolution) datasets independently. ANUBEX performs similarly when trained on sequence-agnostic or motion-degraded MRI, but slightly worse on preterm brains. In conclusion, we created an automatic deep learning-based neonatal brain extraction algorithm that demonstrates accurate performance with both high- and low-resolution MRIs with fast computation time.

Global trends in neonatal MRI brain neuroimaging research over the last decade: a bibliometric analysis

Background

Neuroimaging plays a central role in the evaluation, treatment, and prognosis of neonates. In recent years, the exploration of the developing brain has been a major focus of research for researchers and clinicians. In this study, we conducted bibliometric and visualization analyses of the related studies in the field of neonatal magnetic resonance imaging (MRI) brain neuroimaging from the past 10 years, and summarized its research status, hotspots, and frontier development trends.

Methods

The Web of Science core collection database was used as the literature source from which to retrieve the relevant papers and reviews in the field of neonatal MRI brain neuroimaging published in the Science Citation Index-Expanded from 2013 to 2022. VOSviewer and CiteSpace were used to conduct bibliometric and visualization analyses of the annual publication volume, countries, institutions, journals, authors, co-cited literature, and the overall distribution of keywords.

Results

We retrieved 3,568 papers and reviews published from 2013 to 2022. The number of publications increased during this period. The United States (US) and the United Kingdom were the largest contributors, with the US receiving the highest H-index and number of citations. The institutions that published the most were the University of London and Harvard University. The research mainly focused on cerebral cortex, brain tissue, brain structure network, artificial intelligence algorithm, automatic image segmentation, and premature infants.

Conclusions

This study reveals the research status and hotspots of magnetic resonance imaging in the field of neonatal brain neuroimaging in the past decade, which helps researchers to better understand the research status, hotspots, and frontier development trends.