Abstract
Preterm-born children are at increased risk of lifelong neurodevelopmental difficulties. Group-wise analyses of magnetic resonance imaging show many differences between preterm- and term-born infants but do not reliably predict neurocognitive prognosis for individual infants. This might be due to the unrecognized heterogeneity of cerebral injury within the preterm group. This study aimed to determine whether atypical brain microstructural development following preterm birth is significantly variable between infants. Using Gaussian process regression, a technique that allows a single-individual inference, we characterized typical variation of brain microstructure using maps of fractional anisotropy and mean diffusivity in a sample of 270 term-born neonates. Then, we compared 82 preterm infants to these normative values to identify brain regions with atypical microstructure and relate observed deviations to degree of prematurity and neurocognition at 18 months. Preterm infants showed strikingly heterogeneous deviations from typical development, with little spatial overlap between infants. Greater and more extensive deviations, captured by a whole brain atypicality index, were associated with more extreme prematurity and predicted poorer cognitive and language abilities at 18 months. Brain microstructural development after preterm birth is highly variable between individual infants. This poorly understood heterogeneity likely relates to both the etiology and prognosis of brain injury.
Highlights
Preterm birth affects approximately 10% of all live births worldwide (Chawanpaiboon et al 2019) and represents a leading cause of infant mortality and morbidity (Liu et al 2015)
We investigated the association between prematurity and this atypicality index by 1) calculating the correlation with Gestational age (GA) at birth (Spearman rho, ρ) and 2) investigating whether the groupaverage atypicality index is higher in preterm compared with term infants (Mann–Whitney U; Vargha and Delaney’s A effect size estimate (Vargha and Delaney 2000); Supplementary Materials)
There were no differences in postmenstrual age (PMA) at scan, the proportion of male/female between term and preterm infants, nor did the two samples differ in head circumference (HC) at scan (Table 1)
Summary
Preterm birth affects approximately 10% of all live births worldwide (Chawanpaiboon et al 2019) and represents a leading cause of infant mortality and morbidity (Liu et al 2015). Prematurity increases the risk of atypical brain development and has been associated with a wide range of neurocognitive and behavioral deficits that often persist into adolescence. These include higher incidence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder among survivors (Johnson and Marlow 2011; Bhutta et al 2014; Agrawal et al 2018). Preterm infants show atypical maturation at term-equivalent age compared with term-born infants (van Kooij et al 2012; Ball et al 2013, 2015) that has been related to poorer neurodevelopmental outcome (Counsell et al 2008; van Kooij et al 2012; Duerden et al 2015). Prematurity has been associated with subtle diffuse microstructural alterations, where preterm infants show microstructural diffusion consistent with more “immature” white and gray matter compared with term-born infants (Counsell et al 2003; Anjari et al 2007; Ball et al 2013)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
