Abstract
Preterm birth (gestational age < 37 weeks) with very low birth weight (VLBW, birth weight ≤ 1500 g) is associated with lifelong cognitive deficits, including in executive function, and persistent alterations in cortical and subcortical structures. However, it remains unclear whether “catch-up” growth is possible in the preterm/VLBW brain. Longitudinal structural MRI was conducted with children born preterm with VLBW (n = 41) and term-born peers participating in the Norwegian Mother and Child Cohort Study (MoBa) (n = 128) at two timepoints in early school age (mean ages 8.0 and 9.3 years). Images were analyzed with the FreeSurfer 5.3.0 longitudinal stream to assess differences in development of cortical thickness, surface area, and brain structure volumes, as well as associations with executive function development (NEPSY Statue and WMS-III Spatial Span scores) and perinatal health markers. No longitudinal group × time effects in cortical thickness, surface area, or subcortical volumes were seen, indicating similar brain growth trajectories in the groups over an approximately 16-month period in middle childhood. Higher IQ scores within the VLBW group were associated with greater surface area in left parieto-occipital and inferior temporal regions. Among VLBW preterm-born children, cortical surface area was smaller across the cortical mantle, and cortical thickness was thicker occipitally and frontally and thinner in lateral parietal and posterior temporal areas. Smaller volumes of corpus callosum, right globus pallidus, and right thalamus persisted in the VLBW group from timepoint 1 to 2. VLBW children had on average IQ 1 SD below term-born MoBa peers and significantly worse scores on WMS-III Spatial Span. Executive function scores did not show differential associations with morphometry between groups cross-sectionally or longitudinally. This study investigated divergent or “catch-up” growth in terms of cortical thickness, surface area, and volumes of subcortical gray matter structures and corpus callosum in children born preterm/VLBW and did not find group × time interactions. Greater surface area at mean age 9.3 in left parieto-occipital and inferior temporal cortex was associated with higher IQ in the VLBW group. These results suggest that preterm VLBW children may have altered cognitive networks, yet have structural growth trajectories that appear generally similar to their term-born peers in this early school age window.
Highlights
IntroductionCognitive deficits among individuals born preterm (gestational age < 37 weeks) with very low birth weight (VLBW, birth weight ≤ 1500 g) can persist for decades[1,2,3,4,5,6]. Executive functions, which are foundational for academic performance and quality of life, are often impaired in the preterm-born VLBW population, even among those with otherwise typical cognitive ability[7,8,9], starting in early childhood[10] and lasting into adulthood[11,12,13,14]
Cognitive deficits among individuals born preterm with very low birth weight (VLBW, birth weight ≤ 1500 g) can persist for decades[1,2,3,4,5,6]
Much research has pointed to altered brain growth following preterm birth/VLBW20–22 and similar brain growth rates for preterm/VLBW and term-born children and adolescents, despite different starting points[23,24,25,26]
Summary
Cognitive deficits among individuals born preterm (gestational age < 37 weeks) with very low birth weight (VLBW, birth weight ≤ 1500 g) can persist for decades[1,2,3,4,5,6]. Executive functions, which are foundational for academic performance and quality of life, are often impaired in the preterm-born VLBW population, even among those with otherwise typical cognitive ability[7,8,9], starting in early childhood[10] and lasting into adulthood[11,12,13,14]. Cross-sectional findings from an overlapping sample of this preterm/VLBW cohort and term-born participants in the Norwegian Mother and Child Cohort Study (MoBa)[35,36] identified smaller cortical surface area bilaterally in frontal, temporal, and parietal lobes; thicker cortex in frontal and occipital regions; thinner cortex in posterior parietal areas; reduced volumes of subcortical structures including corpus callosum and hippocampus in the preterm/VLBW group; and only limited group differences in white matter tracts. The aim of this study was to determine whether the cortical and subcortical deviations found at the first timepoint[35,36] persisted longitudinally, and whether VLBW children showed different growth trajectories of brain structures compared to term-born peers. We expected that preterm-born/VLBW children would continue to show altered brain structure, as well as associations between MRI findings and both cognitive scores and perinatal morbidity markers
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