Relationship of early brain growth pattern measured by ultrasound with neurological outcome at two years of age in very low birth weight infants

The purpose of this study is to define the impact of early brain growth trajectory in very low birth weight infants (VLBWI) on neurological prognosis at 2 years, assessed using sequential ultrasound (US) scans. This is a prospective cohort study with consecutive inclusion of VLBWI ≤ 32 weeks gestational age and ≤ 1500 g at birth. Total brain volume (TBV) was assessed using sequential 3D-US from birth to discharge. Prognosis at 2 years (corrected age) was assessed using the Bayley Scales of Infant and Toddler Development Third Edition. TBV showed slower growth with postmenstrual age (PMA) in those VLBWI who had an adverse cognitive prognosis compared to those with good cognitive prognosis (mean difference in TBV between prognostic groups from 4.56 cm(3) at 28 weeks to 42.58 cm(3) at 43 weeks) as well as in those with adverse language prognosis (mean difference in TBV from 2.21 cm(3) at 28 weeks to 26.98 cm(3) at 43 weeks) although other variables showed more impact than TBV on language prognosis (gestational age at birth, brain injury at term, and socioeconomic status). No association was found between TBV and motor prognosis. Brain growth rate was also significantly higher in those VLBWI who presented good cognitive scores (18.78 + (0.33 × (PMA-33)) cm(3)/week) compared to those with adverse cognitive outcome (13.73 + (0.64 × (PMA-33)) cm(3)/week). Conclusion: Early altered brain growth is associated with poor cognitive prognosis at 2 years of age. Using sequential US monitoring, we can detect early brain growth deviation in patients who will have adverse cognitive outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00431-023-05170-2.