Effect of bronchopulmonary dysplasia and pneumonia on the neurodevelopment of preterm infants: a cerebral blood flow study.

Background: Infants with bronchopulmonary dysplasia (BPD) are prone to lung infections, such as pneumonia, due to structural and functional abnormalities. Recurrent pneumonia can exacerbate lung inflammation and worsen BPD. This study aimed to investigate the value of three-dimensional arterial spin labeling (3D-ASL) in assessing cerebral hemodynamics in preterm neonates with BPD with or without neonatal pneumonia (NP). Methods: Preterm infants with a gestational age (GA) of <32 weeks and a birth weight <1,500 g who underwent magnetic resonance imaging (MRI) examination at term-equivalent age (TEA; 37-42 weeks) were enrolled from October 2021 to May 2023 and placed into a BPD-and-NP group (BPD-NP group), a BPD-alone (BPD group), and a without-BPD-or-NP (control group). The cerebral blood flow (CBF) was measured and compared between the three groups for the following areas: the bilateral frontal, parietal, temporal, and occipital cortices and white matter; basal ganglia; thalamus; cerebellum; and hippocampus. Correlation analysis was performed between the CBF in brain regions with significant differences between groups and Children's Developmental Center of China (CDCC) scores. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of CBF. Results: A total of 50 preterm infants were enrolled in the study, including 10 infants in the BPD-NP group, 20 in the BPD group, and 20 in the control group. The duration of assisted ventilation was significantly longer in the BPD-NP and BPD groups than in the control group (P=0.003 and P=0.010, respectively). Compared to controls, infants with BPD had a significantly higher CBF in the left parietal white matter (P=0.046), left occipital white matter (P=0.041), right temporal cortex (P=0.021), and right occipital white matter (P=0.037). The BPD-NP group exhibited a lower CBF than did the BPD group in the left parietal white matter (P=0.041) and right temporal white matter (P=0.019). Within the BPD-NP group, the CBF was lower in the left occipital white matter and higher in the left cerebellum compared to the corresponding areas in the right hemisphere (P=0.006 and P=0.047, respectively). In the BPD group, CBF was lower in the left basal ganglia and higher in the left hippocampus compared to the corresponding areas in the right hemisphere (P=0.012 and P=0.037, respectively). In BPD infants, left occipital WM CBF was negatively correlated with MDI (R=-0.455, P=0.044) and PDI (R=-0.485, P=0.030) scores, and right occipital WM CBF was also negatively correlated with MDI (R=-0.638, P=0.002) and PDI (R=-0.747, P<0.001) scores. ROC curve analysis indicated significant diagnostic utility of CBF for both BPD and BPD-NP. The area under the curve (AUC) values for BPD were 0.717 in the left parietal white matter, 0.732 in the right temporal cortex, 0.704 in the left occipital white matter, and 0.720 in the right occipital white matter. For BPD-NP, the AUC values were 0.790 in the left parietal white matter and 0.788 in the right temporal white matter. Conclusions: Preterm BPD infants with or without NP exhibited different CBF patterns. Moreover, the correlation between CBF in the white matter of the occipital lobe and CDCC scores suggests that BPD may exert an effect on the neurodevelopment of preterm infants.