Abstract P-526: CEREBRAL WHITE MATTER MICROSTRUCTURE CHANGES AND MEMORY IMPROVEMENT FOLLOWING WORKING-MEMORY TRAINING IN SURVIVORS OF NEONATAL CRITICAL ILLNESS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Aims & Objectives: Children treated with neonatal extracorporeal membrane oxygenation (ECMO) and/or with congenital diaphragmatic hernia (CDH) are at risk of long-term neurodevelopmental deficits. We assessed the effects of Cogmed Working-Memory Training (CWMT) in school-age survivors of neonatal ECMO and/or CDH. Methods A nationwide, single-blind randomized controlled trial assessing white matter microstructure and neuropsychological outcome before(T0) and immediately(T1) after CWMT. CWMT, an adaptive computerized training program, comprised 25 sessions of 45 minutes for five consecutive weeks at home. Participants were neonatal ECMO and/or CDH survivors (8–12 years) with an IQ≥80 and a z-score≤-1.5 on at least one (working)memory test at T0. Diffusion Tensor Imaging was used to asses white matter microstructure. Results Of 34 participants, 27 children with useable data at both T0 and T1 were randomly assigned to CWMT(n=12) or no-training(n=15)(Figure 1). Training-induced changes were found in global white matter microstructure at T1 (estimated coefficient=.007, p=.015) and the left superior longitudinal fasciculus (estimated coefficient=.009, p=.033). Changes in the superior longitudinal fasciculus were significantly associated with the improvements in verbal working-memory in the CWMT group at T1, F(1,13)=7.13, p=.026, partial eta square=.44. No other associations between training-induced changes in white matter microstructure and neuropsychological improvement were found (p>.05). Conclusions Our findings demonstrate that neurobiological plasticity exists in survivors of neonatal ECMO and/or CDH and that, despite significant brain alterations found in these children, their neurodevelopmental outcome is changeable. Given the high risk of long-term neuropsychological deficits and subsequent school problems following neonatal critical illness, these results are of great significance.