Abstract
The cerebral white matter is vulnerable to injury in very preterm infants (born prior to 30 weeks gestation), resulting in a spectrum of lesions. These range from severe forms, including cystic periventricular leukomalacia and periventricular hemorrhagic infarction, to minor focal punctate lesions. Moderate to severe white matter injury in preterm infants has been shown to predict later neurodevelopmental disability, although outcomes can vary widely in infants with qualitatively comparable lesions. Resting state functional connectivity magnetic resonance imaging has been increasingly utilized in neurodevelopmental investigations and may provide complementary information regarding the impact of white matter injury on the developing brain. We performed resting state functional connectivity magnetic resonance imaging at term equivalent postmenstrual age in fourteen preterm infants with moderate to severe white matter injury secondary to periventricular hemorrhagic infarction. In these subjects, resting state networks were identifiable throughout the brain. Patterns of aberrant functional connectivity were observed and depended upon injury severity. Comparisons were performed against data obtained from prematurely-born infants with mild white matter injury and healthy, term-born infants and demonstrated group differences. These results reveal structural-functional correlates of preterm white matter injury and carry implications for future investigations of neurodevelopmental disability.
Highlights
Survival rates for prematurely-born infants have dramatically improved following advances in perinatal and neonatal care.brain injury in this population remains common.Approximately 7–23% of very low birth weight infants develop intraventricular hemorrhage (IVH), and up to 50% sustain cerebral white matter injury (WMI) [1,2,3,4]
We have previously shown that prematurity is associated with subtle rs-fcMRI changes by term equivalent postmenstrual age (PMA) in infants without overt WMI, a finding corroborated in this investigation [35]
To date, neuroimaging investigations of WMI in infants have demonstrated only modest correlation with neurodevelopmental outcomes, and the neural mechanisms leading to these impairments remain incompletely understood
Summary
7–23% of very low birth weight infants develop intraventricular hemorrhage (IVH), and up to 50% sustain cerebral white matter injury (WMI) [1,2,3,4]. WMI is often associated with more widespread cerebral lesions involving the cortical and deep gray matter [3,4,5]. This correlation between abnormalities of white and gray matter may result from concurrent primary insult or secondary deafferentiation of neurons following axonal degeneration. Regardless of mechanism, moderate-severe WMI remains a major risk factor for subsequent functional impairment in motor and cognitive domains in prematurely-born infants
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