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Research ArticlePediatric Neuroimaging

A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth

J.A. Roelants, I.V. Koning, M.M.A. Raets, S.P. Willemsen, M.H. Lequin, R.P.M. Steegers-Theunissen, I.K.M. Reiss, M.J. Vermeulen, P. Govaert and J. Dudink
American Journal of Neuroradiology August 2016, 37 (8) 1516-1522; DOI: https://doi.org/10.3174/ajnr.A4731
J.A. Roelants
aFrom the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
dDepartments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
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I.V. Koning
dDepartments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
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M.M.A. Raets
aFrom the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
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S.P. Willemsen
dDepartments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
eBiostatistics (S.P.W.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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M.H. Lequin
fDepartment of Radiology (M.H.L.), University Medical Center Utrecht, Utrecht, the Netherlands.
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R.P.M. Steegers-Theunissen
dDepartments of Obstetrics and Gynecology (J.A.R., I.V.K., S.P.W., R.P.M.S.-T.)
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I.K.M. Reiss
aFrom the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
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M.J. Vermeulen
aFrom the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
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P. Govaert
aFrom the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
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J. Dudink
aFrom the Division of Neonatology (J.A.R., M.M.A.R., I.K.M.R., M.J.V., P.G., J.D.)
bDepartment of Radiology (J.D.)
cIntensive Care Unit (J.D.), Erasmus MC–Sophia Children's Hospital, Rotterdam, the Netherlands
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    Fig 1.

    In the upper part, we show the coronal view of the brain and the position of the sonography probe for assessment of the corresponding correct sagittal plane below. Measurements of the corpus callosum–fastigium and corpus callosum length are displayed in the sagittal sonography view (left) and schematically (right). S. Cinguli indicates sulcus cinguli.

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    Fig 2.

    Reproducibility of corpus callosum–fastigium and corpus callosum lengths by using Bland-Altman plots. The middle dashed lines depict the average measurement bias in percentage differences. The bold dashed horizontal lines represent the 95% limits of agreement for these percentage differences.

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    Fig 3.

    Growth charts of corpus callosum–fastigium (left) and corpus callosum (right) length for preterm neonates as a function of postmenstrual age (in days) and weight (in grams). On the y-axis, CCF (left) and CC (right) lengths are presented in centimeters. The gray areas indicate the parts of the weight charts that should not be used as reference curves.

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    Table 1:

    Baseline characteristicsa

    N = 140Missingb
    Maternal characteristics
        Age (yr) (mean) (SD)30 (5.6)0
        Ethnicityc0
            Dutch74 (52.9%)
            Other Western9 (6.4%)
            Non-Western57 (40.7%)
    Maternal smoking during pregnancy26 (18.6%)17
        IVF/ICSI9 (6.4%)0
        IUGR42 (30%)4
        PE/HELLP syndrome37 (26.4%)0
        Chorioamnionitis37 (26.4%)0
        PPROM32 (22.9%)0
    Neonatal characteristics
        GA at birth (wk+ days)27+2 (26+1–28+1)0
        Male sex81 (57.9%)0
        BW (g)955 (780–1125)0
        Use of antenatal steroids127 (90.7%)2
        Apgar score at fifth minute8 (7–9)0
        CRIB score3 (1–6)1
        Death17 (12.1%)0
        Days on mechanical ventilation5 (1–14)3
        Days to regain birth weight9 (7–12)14
        Sepsis67 (47.9%)0
        IVH grade I or II32 (22.9%)0
        Severe BPD15 (10.7%)33
    • Note:—IVF/ICSI indicates in vitro fertilization with or without intracytoplasmic sperm injection; IUGR, intrauterine growth retardation; PE, pre-eclampsia; PPROM, prolonged premature rupture of membranes; CRIB, clinical risk index for babies; IVH, intraventricular hemorrhage; BPD, bronchopulmonary disease.

    • ↵a Baseline data of maternal and neonatal characteristics are presented as median (interquartile range) or No. (%) unless otherwise specified.

    • ↵b Missing data were mainly due to early transfer to a secondary hospital.

    • ↵c Ethnicity was reported to provide insight in the generalizablity of the study population.

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    Table 2:

    Linear mixed modelsa

    CCF GrowthCC Growth
    UnivariableMultivariableUnivariableMultivariable
    βSEPβSEPβSEPβSEP
    GA at birth0.0290.012.022b0.0110.017.5180.0240.017.1460.0040.021.857
    BW SDS0.0530.009<.0001b0.0500.014<.001b0.0940.011<.001b0.0750.017<.001b
    Sex (female)−0.1090.030<.001b−0.0700.029.018b−0.0660.043.124−0.0030.035.938
    IUGR (no)0.0940.033.005b−0.0340.045.4510.2670.041<.001b0.0460.054.390
    PE/HELLP (yes)−0.0640.035.0680.0000.038.992−0.2000.045<.001b−0.0520.046.260
    Chorioamnionitis (yes)0.0300.035.3970.0310.035.3700.1360.047.004b0.0690.042.106
    Death (yes)−0.1030.048.033b−0.0610.046.186−0.2000.064.002b−0.1050.054.057
    Sepsis (yes)−0.0340.031.272−0.0210.029.477−0.0500.042.239−0.0430.035.218
    Days on mechanical ventilation−0.0010.002.4320.0020.002.340−0.0030.002.1600.0020.002.397
    • Note:—SDS indicates SD score; SE, standard error; IUGR, intrauterine growth retardation; PE, pre-eclampsia.

    • ↵a The effect estimates of maternal and neonatal characteristics on CCF and CC growth in both univariable and multivariable linear mixed models are shown. The effect estimates (β), standard errors, and P values are given.

    • ↵b Significant.

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    Table 3:

    Pros and cons of different methods for assessment of brain growth

    HCCUSMRI
    Patient friendly++++−
    Bedside available++++−
    Serial measurement possible++++−
    Fast measurement+++−
    Reproducible±+++
    Reflecting actual brain growth−+++
    Low costs+++−
    Dimension1D2D3D
    • Note:—++ indicates very good; +, acceptable; −, bad agreement with the corresponding item; ±, mediocre; HC, head circumference.

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American Journal of Neuroradiology: 37 (8)
American Journal of Neuroradiology
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J.A. Roelants, I.V. Koning, M.M.A. Raets, S.P. Willemsen, M.H. Lequin, R.P.M. Steegers-Theunissen, I.K.M. Reiss, M.J. Vermeulen, P. Govaert, J. Dudink
A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth
American Journal of Neuroradiology Aug 2016, 37 (8) 1516-1522; DOI: 10.3174/ajnr.A4731

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A New Ultrasound Marker for Bedside Monitoring of Preterm Brain Growth
J.A. Roelants, I.V. Koning, M.M.A. Raets, S.P. Willemsen, M.H. Lequin, R.P.M. Steegers-Theunissen, I.K.M. Reiss, M.J. Vermeulen, P. Govaert, J. Dudink
American Journal of Neuroradiology Aug 2016, 37 (8) 1516-1522; DOI: 10.3174/ajnr.A4731
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