Neuroimaging in Former Preterm Children Who Received Erythropoiesis Stimulating Agents

BACKGROUND: In premature children, erythropoiesis stimulating agents (ESAs) may improve developmental outcome. It is not clear which of several potential mechanisms are responsible for this improvement. High resolution MRI and diffusion tensor imaging characterize brain structure and white matter organization, offering possible insight into the long-term effect of ESAs on brain development. DESIGN/METHODS: MRI scans were performed at 3.5 to 4 years of age on former preterm infants treated with ESAs or placebo, and on healthy term controls. Mean cortical thickness, surface area and fractional anisotropy (FA) were compared across study groups, and correlated with general IQ measures. RESULTS: Univariate analysis found no significant effect of ESAs on cortical thickness (p = .366), surface area (p = .940) or FA (p = .150); however, there was a greater increase in FA among ESA treated girls. Group analysis found significant correlations between FA and Full Scale IQ (p = .044) and Verbal IQ (p = .036), although there was no significant relationship between Full Scale IQ and FA among just the preterm children. CONCLUSIONS: ESA treatment may have a preferential effect on white matter development in girls, although factors other than just whole brain FA are involved in mediating cognitive outcome.