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Magnetic resonance imaging demonstrates long-term changes in brain structure in children born preterm and exposed to chorioamnionitis

      Objective

      We sought to determine if children born preterm and exposed to chorioamnionitis have differences in brain structure measured at 6-10 years of age using magnetic resonance imaging (MRI).

      Study Design

      Structural MRI was performed with 11 preterm children (8.5 ± 1.7 years) with chorioamnionitis and 16 preterm children (8.7 ± 1.4 years) without chorioamnionitis. Cortical surface reconstruction and volumetric segmentation were performed with FreeSurfer image analysis software. Subcortical structures were analyzed using multivariate analysis.

      Results

      Widespread regional differences in cortical thickness were observed. With chorioamnionitis, the frontal and temporal lobes were primarily affected by decreased cortical thickness, and the limbic, parietal, and occipital lobes were primarily affected by increased cortical thickness when compared to the comparison group. Subcortical differences were observed in the hippocampus and lateral ventricle.

      Conclusion

      Using MRI, chorioamnionitis is associated with long-term widespread regional effects on brain development in children born prematurely. Our study is limited by its small sample size.

      Key words

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      References

        • Alexander J.M.
        • Gilstrap L.C.
        • Cox S.M.
        • McIntire D.M.
        • Leveno K.J.
        Clinical chorioamnionitis and the prognosis for very low birth weight infants.
        Obstet Gynecol. 1998; 91: 725-729
        • Bashiri A.
        • Burstein E.
        • Mazor M.
        Cerebral palsy and fetal inflammatory response syndrome: a review.
        J Perinat Med. 2006; 34: 5-12
        • Dammann O.
        • Leviton A.
        Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn.
        Pediatr Res. 1997; 42: 1-8
        • Grether J.K.
        • Nelson K.B.
        Maternal infection and cerebral palsy in infants of normal birthweight.
        JAMA. 1997; 278: 207-211
        • Thomas W.
        • Speer C.P.
        Chorioamnionitis: important risk factor of innocent bystander for neonatal outcome.
        Neonatology. 2010; 99: 177-187
        • Leviton A.
        • Paneth N.
        White matter damage in preterm newborns–an epidemiologic perspective.
        Early Hum Dev. 1990; 24: 1-22
        • Wu Y.W.
        • Colford Jr, J.M.
        Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis.
        JAMA. 2000; 284: 1417-1424
        • Yoon B.H.
        • Kim C.J.
        • Romero R.
        • et al.
        Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits.
        Am J Obstet Gynecol. 1997; 177: 797-802
        • Gavilanes A.W.
        • Strackx E.
        • Kramer B.W.
        • et al.
        Chorioamnionitis induced by intraamniotic lipopolysaccharide resulted in an interval-dependent increase in central nervous system injury in the fetal sheep.
        Am J Obstet Gynecol. 2009; 200: 437
        • Inder T.E.
        • Warfield S.K.
        • Wang H.
        • Hüppi P.S.
        • Volpe J.J.
        Abnormal cerebral structure is present at term in premature infants.
        Pediatrics. 2005; 115: 286-294
        • Peterson B.S.
        • Vohr B.
        • Staib L.H.
        • et al.
        Regional brain volume abnormalities and long-term cognitive outcome in preterm infants.
        JAMA. 2000; 284: 1973-1974
        • Davis E.P.
        • Buss C.
        • Muftuler T.
        • et al.
        Children's brain development benefits from longer gestation.
        Front Psychol. 2011; 2: 1-7
        • Romero R.
        • Espinoza J.
        • Goncalves L.F.
        • et al.
        The role of inflammation and infection in preterm birth.
        Semin Reprod Med. 2007; 25: 21-39
        • Gaudet L.M.
        • Flavin M.B.
        • Islam O.
        • et al.
        Diffusion MRI brain findings in neonates exposed to chorioamnionitis: a case series.
        J Obstet Gynaecol Can. 2009; 31: 497-503
        • Chau V.
        • Poskitt K.J.
        • McFadden D.E.
        • et al.
        Effect of chorioamnionitis on brain development and injury in premature newborns.
        Ann Neurol. 2009; 66: 155-164
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin No. 101: ultrasonography in pregnancy.
        Obstet Gynecol. 2009; 113: 451-461
        • Wechsler D.
        Wechsler adult intelligence scale.
        3rd ed. Psychological Corp, San Antonio1997
        • Sled J.G.
        • Zijdenbos A.P.
        • Evans A.C.
        A nonparametric method for automatic correction of intensity nonuniformity in MRI data.
        IEEE Trans Med Imaging. 1998; 17: 87-97
        • Segonne F.
        • Dale A.M.
        • Busa E.
        • et al.
        A hybrid approach to the skull stripping problem in MRI.
        Neuroimage. 2004; 22: 1060-1075
        • Fischl B.
        • Salat D.H.
        • Busa E.
        • et al.
        Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain.
        Neuron. 2002; 33: 341-355
        • Fischl B.
        • Salat D.H.
        • van der Kouwe
        • et al.
        Sequence-independent segmentation of magnetic resonance images.
        Neuroimage. 2004; 23: S69-S84
        • Dale A.M.
        • Fischl B.
        • Sereno M.I.
        Cortical surface-based analysis, I: segmentation and surface reconstruction.
        Neuroimage. 1999; 9: 179-194
        • Dale A.M.
        • Sereno M.I.
        Improved localization of cortical activity by combining EEG and MEG with MRI cortical surface reconstruction: a linear approach.
        J Cogn Neurosci. 1993; 5: 162-176
        • Fischl B.
        • Dale A.M.
        Measuring the thickness of the human cerebral cortex from magnetic resonance images.
        Proc Natl Acad Sci U S A. 2000; 97: 11050-11055
        • Fischl B.
        • Sereno M.I.
        • Dale A.M.
        Cortical surface-based analysis, II: inflation, flattening, and a surface-based coordinate system.
        Neuroimage. 1999; 9: 195-207
        • Fischl B.
        • Sereno M.I.
        • Tootell R.B.
        • Dale A.M.
        High-resolution intersubject averaging and a coordinate system for the cortical surface.
        Hum Brain Mapp. 1999; 8: 272-284
        • Rosas H.D.
        • Liu A.K.
        • Hersch S.
        • et al.
        Regional and progressive thinning of the cortical ribbon in Huntington's disease.
        Neurology. 2002; 58: 695-701
        • Kuperberg G.R.
        • Broome M.R.
        • McGuire P.K.
        • et al.
        Regionally localized thinning of the cerebral cortex in schizophrenia.
        Arch Gen Psychiatry. 2003; 60: 878-888
        • Salat D.H.
        • Buckner R.L.
        • Snyder A.Z.
        • et al.
        Thinning of the cerebral cortex in aging.
        Cereb Cortex. 2004; 14: 721-730
        • Genovese C.R.
        • Lazar N.A.
        • Nichols T.
        Thresholding of statistical maps in functional neuroimaging use the false discovery rate.
        Neuroimage. 2002; 15: 870-878
        • Gomez R.
        • Romero R.
        • Ghezzi F.
        • Yoon B.H.
        • Mazor M.
        • Berry S.M.
        The fetal inflammatory response syndrome.
        Am J Obstet Gynecol. 1998; 179: 194-202
        • Gotsch F.
        • Romero R.
        • Kusanovic J.P.
        • et al.
        The fetal inflammatory response syndrome.
        Clin Obstet Gynecol. 2007; 50: 652-683
        • Duggan P.J.
        • Maalouf E.F.
        • Watts T.L.
        • et al.
        Intrauterine T-cell activation and increased proinflammatory cytokine concentrations in preterm infants with cerebral lesions.
        Lancet. 2001; 358: 1699-1700
        • Viscardi R.M.
        • Muhumuza C.K.
        • Rodriguez A.
        • et al.
        Inflammatory markers in intrauterine and fetal blood and cerebrospinal fluid compartments are associated with adverse pulmonary and neurologic outcomes in preterm infants.
        Pediatr Res. 2004; 55: 1009-1017
        • Yoon B.H.
        • Romero R.
        • Yang S.H.
        • et al.
        Interleukin-6 concentrations in umbilical cord plasma are elevated in neonates with white matter lesions associated with periventricular leukomalacia.
        Am J Obstet Gynecol. 1996; 174: 1433-1440
        • Moon J.B.
        • Kim J.C.
        • Yoon B.H.
        • et al.
        Amniotic fluid matrix metalloproteinase-8 and the development of cerebral palsy.
        J Perinat Med. 2002; 30: 301-306
        • Hagberg H.
        • Mallard C.
        Effect of inflammation on central nervous system development and vulnerability.
        Curr Opin Neurol. 2005; 18: 117-123
        • Kates W.R.
        • Burnett C.P.
        • Eliez S.
        • et al.
        Neuroanatomic variation in monozygotic twin pairs discordant for the narrow phenotype for autism.
        Am J Psychiatry. 2004; 161: 539-546
        • Koenigs M.
        • Grafman J.
        The functional neuroanatomy of depression: distinct roles for ventromedial and dorsolateral prefrontal cortex.
        Behav Brain Res. 2009; 201: 239-243