Associations Between Early Structural Magnetic Resonance Imaging, Hammersmith Infant Neurological Examination, and General Movements Assessment in Infants Born Very Preterm

Karen Harpster, Stephanie Merhar, Venkata Sita Priyanka Illapani, Colleen Peyton, Beth Kline-Fath, Nehal A Parikh, Karen Harpster, Stephanie Merhar, Venkata Sita Priyanka Illapani, Colleen Peyton, Beth Kline-Fath, Nehal A Parikh

Abstract

Objective: To evaluate the prevalence and associations between structural magnetic resonance imaging (sMRI) injury/abnormality at term-equivalent age and absent fidgety General Movements Assessment (GMA) and abnormal Hammersmith Infant Neurological Examination (HINE) scores among infants born very preterm at 3-4 months of corrected age.

Study design: This prospective cohort study enrolled 392 infants born ≤2 weeks of gestation from 5 neonatal intensive care units in the greater Cincinnati area between September 2016 and October 2019. Infants completed sMRI at term-equivalent age and GMA and HINE at 3-4 months of corrected age. All assessors were blinded.

Results: Of 392 infants, 375 (96%) had complete data. Of these, 44 (12%) exhibited moderate or severe brain abnormalities, 17 (4.5%) had abnormal GMA, and 77 (20.3%) had abnormal HINE. Global and regional abnormality scores on sMRI were significantly correlated with GMA (R2 range 0.05-0.17) and HINE at 3-4 months of corrected age (R2 range 0.01-0.17). These associations remained significant in multivariable analyses after adjusting for gestational age and sex. There was a significant but low correlation (R2 0.14) between GMA and HINE.

Conclusions: We observed a low prevalence of moderate or severe brain abnormalities in survivors born very preterm in this geographically defined cohort. The much greater prevalence of abnormal motor examination on the HINE compared with GMA and their low correlation suggests that these tests evaluate different constructs and, thus, should be used in combination with sMRI rather than interchangeably.

Keywords: Hammersmith infant neurological exam; MRI; cerebral palsy; general movements assessment.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Figure 1:
Figure 1:
Study flow chart
Figure 2a:
Figure 2a:
Axial demonstrate artifact at left caudothalamic groove (arrow), consistent with germinal matrix hemorrhage
Figure 2b:
Figure 2b:
Axial susceptibility weighted image demonstrating susceptibility artifact (arrows) at posterior horns of the lateral ventricles demonstrating evidence for intraventricular hemorrhage.
Figure 2c:
Figure 2c:
Coronal T2 image measuring large frontal extra-axial space
Figure 2d:
Figure 2d:
Sagittal T2 image measuring anterior to posterior and craniocaudal dimension of the cerebellar vermis and anterior to posterior dimension of the pons.

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Source: PubMed

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