Improving head growth in preterm infants - a randomised controlled trial. II: MRI and developmental outcomes in the first year.

Abstract

Background: Very preterm infants are at risk of poor growth and neurodevelopmental outcome. Illness and difficulties overcoming the challenges of feeding these infants often lead to undernutrition in the first few weeks.

Objective: To explore the relationships between early nutrition, postnatal head growth, quantitative MRI (magnetic resonance imaging) and developmental outcome in the first year among infants born before 29 weeks gestation.

Design: Infants born before 29 weeks gestation were randomised to receive hyperalimented or standard feeding regimen from birth to 34 weeks postmenstrual age (PMA). The primary outcome was occipito-frontal circumference (OFC) at 36 weeks OFC. Quantitative magnetic resonance imaging (MRI) was performed at 40 weeks PMA. Developmental assessment using Bayley Scales of Infant Development II (BSID II) was carried out at three and nine months post-term.

Results: 109 infants survived to the end of the first year PMA. 65 infants underwent MRI scan. 81 and 71 infants were seen at three and nine months post-term. Quantitative MRI findings, mental development index (MDI) and psychomotor development index (PDI) were not statistically different between the two groups. Total brain volume (TBV) at 40 weeks PMA, MDI and PDI at three months post-term correlated significantly with energy deficit at 28 days of age

Conclusions: Improving early energy deficit in very preterm infants may promote brain growth. Quantitative MRI may have a role to play in predicting developmental outcome. Postnatal growth at 36 weeks PMA and quantitative MRI finding at 40 weeks PMA appear to be closely related to mental outcomes in the first year.