Predicting developmental outcomes in premature infants by term equivalent MRI: systematic review and meta-analysis

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Abstract

Background

This study aims to determine the prognostic accuracy of term MRI in very preterm born (≤32 weeks) or low-birth-weight (≤1500 g) infants for long-term (>18 months) developmental outcomes.

Methods

We performed a systematic review searching Central, Medline, Embase, and PsycInfo. Two independent reviewers performed study selection, data extraction, and quality assessment. We documented sensitivity and specificity for three different MRI findings (white matter abnormalities (WMA), brain abnormality (BA), and diffuse excessive high signal intensity (DEHSI)), related to developmental outcomes including cerebral palsy (CP), visual and/or hearing problems, motor, neurocognitive, and behavioral function. Using bivariate meta-analysis, we estimated pooled sensitivity and specificity and plotted summary receiver operating characteristic (sROC) curves for different cut-offs of MRI.

Results

We included 20 papers published between 2000 and 2013. Quality of included studies varied. Pooled sensitivity and specificity values (95 % confidence interval (CI)) for prediction of CP combining the three different MRI findings (using normal/mild vs. moderate/severe cut-off) were 77 % (53 to 91 %) and 79 % (51 to 93 %), respectively. For prediction of motor function, the values were 72 % (52 to 86 %) and 62 % (29 to 87 %), respectively. Prognostic accuracy for visual and/or hearing problems, neurocognitive, and/or behavioral function was poor. sROC curves of the individual MRI findings showed that presence of WMA provided the best prognostic accuracy whereas DEHSI did not show any potential prognostic accuracy.

Conclusions

This study shows that presence of moderate/severe WMA on MRI around term equivalent age can predict CP and motor function in very preterm or low-birth-weight infants with moderate sensitivity and specificity. Its ability to predict other long-term outcomes such as neurocognitive and behavioral impairments is limited. Also, other white matter related tests as BA and DEHSI demonstrated limited prognostic value.

Systematic review registration

PROSPERO CRD42013006362

Electronic supplementary material

The online version of this article (doi:10.1186/s13643-015-0058-7) contains supplementary material, which is available to authorized users.

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Most cited references 42

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Meta-analysis: recent developments in quantitative methods for literature reviews.

R. Rosenthal, M R DiMatteo (2001)

We describe the history and current status of the meta-analytic enterprise. The advantages and historical criticisms of meta-analysis are described, as are the basic steps in a meta-analysis and the role of effect sizes as chief coins of the meta-analytic realm. Advantages of the meta-analytic procedures include seeing the "landscape" of a research domain, keeping statistical significance in perspective, minimizing wasted data, becoming intimate with the data summarized, asking focused research questions, and finding moderator variables. Much of the criticism of meta-analysis has been based on simple misunderstanding of how meta-analyses are actually carried out. Criticisms of meta-analysis that are applicable are equally applicable to traditional, nonquantitative, narrative reviews of the literature. Much of the remainder of the chapter deals with the processes of effect size estimation, the understanding of the heterogeneity of the obtained effect sizes, and the practical and scientific importance of the effect sizes obtained.

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Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.

Adnan T Bhutta, Mario A. Cleves, Patrick H Casey … (2002)

The cognitive and behavioral outcomes of school-aged children who were born preterm have been reported extensively. Many of these studies have methodological flaws that preclude an accurate estimate of the long-term outcomes of prematurity. To estimate the effect of preterm birth on cognition and behavior in school-aged children. MEDLINE search (1980 to November 2001) for English-language articles, supplemented by a manual search of personal files maintained by 2 of the authors. We included case-control studies reporting cognitive and/or behavioral data of children who were born preterm and who were evaluated after their fifth birthday if the attrition rate was less than 30%. From the 227 reviewed studies, cognitive data from 15 studies and behavioral data from 16 studies were selected. Data on population demographics, study characteristics, and cognitive and behavioral outcomes were extracted from each study, entered in a customized database, and reviewed twice to minimize error. Differences between the mean cognitive scores of cases and controls were pooled. Homogeneity across studies was formally tested using a general variance-based method and graphically using Galbraith plots. Linear meta-analysis regression models were fitted to explore the impact of birth weight and gestational age on cognitive outcomes. Study-specific relative risks (RRs) were calculated for the incidence of attention-deficit/hyperactivity disorder (ADHD) and pooled. Quality assessment of the studies was performed based on a 10-point scale. Publication bias was examined using Begg modified funnel plots and formally tested using the Egger weighted-linear regression method. Among 1556 cases and 1720 controls, controls had significantly higher cognitive scores compared with children who were born preterm (weighted mean difference, 10.9; 95% confidence interval [CI], 9.2-12.5). The mean cognitive scores of preterm-born cases and term-born controls were directly proportional to their birth weight (R(2) = 0.51; P<.001) and gestational age (R(2) = 0.49; P<.001). Age at evaluation had no significant correlation with mean difference in cognitive scores (R(2) = 0.12; P =.20). Preterm-born children showed increases in externalizing and internalizing behaviors in 81% of studies and had more than twice the RR for developing ADHD (pooled RR, 2.64; 95% CI, 1.85-3.78). No differences were noted in cognition and behaviors based on the quality of the study. Children who were born preterm are at risk for reduced cognitive test scores and their immaturity at birth is directly proportional to the mean cognitive scores at school age. Preterm-born children also show an increased incidence of ADHD and other behaviors.

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Neonatal MRI to predict neurodevelopmental outcomes in preterm infants.

Lianne J Woodward, Peter Anderson, Nicola Austin … (2006)

Very preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population. We studied 167 very preterm infants (gestational age at birth, 30 weeks or less) to assess the associations between qualitatively defined white-matter and gray-matter abnormalities on MRI at term equivalent (gestational age of 40 weeks) and the risks of severe cognitive delay, severe psychomotor delay, cerebral palsy, and neurosensory (hearing or visual) impairment at 2 years of age (corrected for prematurity). At two years of age, 17 percent of infants had severe cognitive delay, 10 percent had severe psychomotor delay, 10 percent had cerebral palsy, and 11 percent had neurosensory impairment. Moderate-to-severe cerebral white-matter abnormalities present in 21 percent of infants at term equivalent were predictive of the following adverse outcomes at two years of age: cognitive delay (odds ratio, 3.6; 95 percent confidence interval, 1.5 to 8.7), motor delay (odds ratio, 10.3; 95 percent confidence interval, 3.5 to 30.8), cerebral palsy (odds ratio, 9.6; 95 percent confidence interval, 3.2 to 28.3), and neurosensory impairment (odds ratio, 4.2; 95 percent confidence interval, 1.6 to 11.3). Gray-matter abnormalities (present in 49 percent of infants) were also associated, but less strongly, with cognitive delay, motor delay, and cerebral palsy. Moderate-to-severe white-matter abnormalities on MRI were significant predictors of severe motor delay and cerebral palsy after adjustment for other measures during the neonatal period, including findings on cranial ultrasonography. Abnormal findings on MRI at term equivalent in very preterm infants strongly predict adverse neurodevelopmental outcomes at two years of age. These findings suggest a role for MRI at term equivalent in risk stratification for these infants. Copyright 2006 Massachusetts Medical Society.

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Author and article information

Contributors

Janneke van’t Hooft: j.vanthooft@gmail.com

Johanna H. van der Lee: j.h.vanderlee@amc.uva.nl

Brent C. Opmeer: b.c.opmeer@amc.uva.nl

Cornelieke S. H. Aarnoudse-Moens: c.aarnoudse-moens@amc.uva.nl

Arnold G. E. Leenders: a.g.leenders@amc.uva.nl

Ben Willem J. Mol: b.w.mol@amc.uva.nl

Timo R. de Haan: t.r.dehaan@amc.uva.nl

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 17 May 2015

Publication date PMC-release: 17 May 2015

Publication date Collection: 2015

Volume: 4

Electronic Location Identifier: 71

Affiliations

[ ]Department of Obstetrics and Gynecology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

[ ]Pediatric Clinical Research Office, Emma Children’s Hospital, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

[ ]Clinical Research Unit, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

[ ]Pediatric Psychosocial Department, Emma Children’s Hospital, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

[ ]Medical Library, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

[ ]Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, 5000 SA Australia

[ ]Department of Neonatology (H3-147), Emma Children’s Hospital, Academical Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

Article

Publisher ID: 58

DOI: 10.1186/s13643-015-0058-7

PMC ID: 4438620

PubMed ID: 25982565

SO-VID: 09519a67-a8b2-44f2-8a91-ff58a5fe7961

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 March 2015

Date accepted : 5 May 2015

Custom metadata

ScienceOpen disciplines: Public health

Keywords: premature,preterm,development,white matter,mri

Data availability:

ScienceOpen disciplines: Public health

Keywords: premature, preterm, development, white matter, mri

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Predicting developmental outcomes in premature infants by term equivalent MRI: systematic review and meta-analysis

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Abstract

Background

Methods

Results

Conclusions

Systematic review registration

Electronic supplementary material

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Stroke MRI

Most cited references 42

Meta-analysis: recent developments in quantitative methods for literature reviews.

Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.

Neonatal MRI to predict neurodevelopmental outcomes in preterm infants.

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