Abstract
ObjectiveTo determine whether the relationship of gestational age (GA) with brain volumes and cognitive functions is linear or whether it follows a threshold model in preterm and term born children during school-age.Study designWe studied 106 children (M = 10 years 1 month, SD = 16 months; 40 females) enrolled in primary school: 57 were healthy very preterm children (10 children born 24–27 completed weeks’ gestation (extremely preterm), 14 children born 28–29 completed weeks’ gestation, 19 children born 30–31 completed weeks’ gestation (very preterm), and 14 born 32 completed weeks’ gestation (moderately preterm)) all born appropriate for GA (AGA) and 49 term-born children. Neuroimaging involved voxel-based morphometry with the statistical parametric mapping software. Cognitive functions were assessed with the WISC-IV. General Linear Models and multiple regressions were conducted controlling age, sex, and maternal education.ResultsCompared to groups of children born 30 completed weeks’ gestation and later, children born <28 completed weeks’ gestation had less gray matter volume (GMV) and white matter volume (WMV) and poorer cognitive functions including decreased full scale IQ, and processing speed. Differences in GMV partially mediated the relationship between GA and full scale IQ in preterm born children.ConclusionsIn preterm children who are born AGA and without major complications GA is associated with brain volume and cognitive functions. In particular, decreased brain volume becomes evident in the extremely preterm group (born <28 completed weeks’ gestation). In preterm children born 30 completed weeks’ gestation and later the relationship of GA with brain volume and cognitive functions may be less strong as previously thought.
Highlights
Differences in gray matter volume (GMV) partially mediated the relationship between gestational age (GA) and full scale IQ in preterm born children
In preterm children who are born appropriate for GA (AGA) and without major complications GA is associated with brain volume and cognitive functions
Very preterm birth is a risk for normal development of the brain [1,2] even in the absence of major perinatal complications such as periventricular leukomalacia (PVL), intraventricular haemorrhage (IVH), and periventricular haemorrhagic infarction (PHI) [3,4,5,6]
Summary
Very preterm birth is a risk for normal development of the brain [1,2] even in the absence of major perinatal complications such as periventricular leukomalacia (PVL), intraventricular haemorrhage (IVH), and periventricular haemorrhagic infarction (PHI) [3,4,5,6]. Compared to term-born children, very preterm children had smaller brain volume including smaller gray matter volume (GMV) and white matter volume (WMV) in childhood [6,7,8], adolescence [9,10,11,12], and young adulthood [4,13]. Compared to their peers born at term, regional volume differences in very preterm children, adolescents, and young adults were wide spread and included decreases of GMV in all lobes (frontal [9,12,13,14], temporal [4,7,9,12,14], parietal [7,9] and occipital lobes [12,13]). With regard to regional GMV one study showed that in preterm children born between 30 and 34 weeks’ gestation and with low risk for neurologic deficit or developmental difficulties, GMV in the temporal lobe was significantly reduced, which in turn was related with decreased cognitive functions [19]
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