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Punctate white matter lesions predict risk for cerebral palsy: further evidence for routine brain MRI in preterm infants

Pediatric Research volume 98, pages 1993–1994 (2025)Cite this article

Punctate white matter lesions (PWML), or white matter injury, occurs in ~30% of very preterm infants (<32 weeks’ gestation). PWML are identified with brain MRI in the neonatal period, and characterized by the presence of punctate hyperintense lesions seen on T1-weighted images.1 PWML have been associated with an increased risk for neurodevelopmental impairments, including with cerebral palsy (CP).2 However, these associations have varied across studies making it challenging to accurately counsel families about expected outcomes and identify infants who may benefit most from early neurodevelopmental interventions.

In a large prospective cohort of very preterm infants, Mahabee-Gittens et al.3 investigated potential risk factors for PWML severity on term-equivalent brain MRI, and whether PMWL severity predicted a diagnosis of CP and neurodevelopmental outcomes at 2 years of age. Manually segmented PWML volumes were calculated as a marker of injury severity, and the Kidokoro score was used to assess brain maturation at term-equivalent age. Neurodevelopmental assessments were completed at 2 years corrected age with a standardized neurological examination to assess for CP and the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) to assess motor, cognitive, and language outcomes. Mahabee-Gittens et al.3 found that histologic chorioamnionitis and antenatal opioid use were associated with PWML severity, while antenatal steroids was a protective factor. Greater PWML severity was an independent predictor of CP at 2 years of age, although was not associated with BSID-III scores.

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Acknowledgements

T.S. is support by BC Children’s Hospital Research Institute.

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Authors and Affiliations

  1. Department of Pediatrics, University of British Columbia and BC Children’s Hospital Research Institute, Vancouver, BC, Canada

    Thiviya Selvanathan

  2. Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Thiviya Selvanathan

  3. Department of Neurology & Pediatrics, University of California, San Francisco, San Francisco, CA, USA

    Dawn Gano

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  1. Thiviya Selvanathan
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  2. Dawn Gano
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Correspondence to Dawn Gano.

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D.G. is an Associate Editor at Pediatric Research.

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Selvanathan, T., Gano, D. Punctate white matter lesions predict risk for cerebral palsy: further evidence for routine brain MRI in preterm infants. Pediatr Res 98, 1993–1994 (2025). https://doi.org/10.1038/s41390-025-04333-1

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